Current perspectives and trends in acupuncture for sleep disorders: a bibliometric analysis

Sleep disorders represent a major global health challenge, affecting more than one third of the world's population and generating annual medical costs of more than $100 billion for insomnia alone. These disorders go far beyond simple difficulty falling asleep and can cause anything from immediate problems such as memory deficits and weakened immunity to serious long-term consequences including anxiety, depression, heart disease, and even cancer. Given the limitations of conventional treatments, which often involve medications with significant adverse effects or psychological therapies that are difficult to access, acupuncture has emerged as a promising therapeutic alternative, based on the principles of traditional Chinese medicine for balancing the flow of vital energy through stimulation of specific points on the body.

This innovative study performed a comprehensive bibliometric analysis to map the scientific landscape of acupuncture research for sleep disorders over the past two decades. The researchers systematically examined 432 scientific publications indexed in the Web of Science Core Collection between 2004 and 2023, using advanced statistical tools to identify publication patterns, international collaborations, leading institutions, and research trends. The methodology included citation analysis, keyword mapping, citation-burst identification, and the construction of visual collaboration networks, providing a unique panoramic view of the field. This approach allowed not only quantification of scientific output but also identification of major research centers, influential authors, and future directions of the field.

The results show notable growth in research on acupuncture for sleep disorders, especially over the past five years, with a mean annual growth rate of 11.77%. China emerged as the most productive country, contributing 61.6% of publications, followed by the United States and South Korea. However, the analysis showed that, despite the high volume of Chinese publications, the mean citation rate per article was considerably lower than that of the next-ranked countries, suggesting uneven quality of scientific output. Leading institutions include the University of Hong Kong, Shanghai University of Traditional Chinese Medicine, and Memorial Sloan Kettering Cancer Center.

The journal MEDICINE was identified as the most active in publishing studies, while the prestigious journal SLEEP established itself as the most influential. Among authors, Ka-Fai Chung from the University of Hong Kong stood out as the most productive researcher, with 18 articles published on the subject since 2007.

For patients and clinicians, these findings have important and encouraging clinical implications. The research demonstrates that electroacupuncture has emerged as the predominant technique for treating sleep disorders, gradually replacing methods such as acupressure. The most cited studies provided preliminary evidence that acupuncture can be effective not only for primary insomnia but also for secondary conditions associated with cancer, depression, and restless legs syndrome. Particularly relevant is the finding that acupuncture can increase nighttime melatonin secretion and reduce both insomnia and anxiety.

For cancer patients, for example, the research suggests acupuncture may be as effective as cognitive behavioral therapy for improving sleep, with the added advantage of helping with pain control. Proposed mechanisms include the regulation of neurotrophic factors, modulation of the gut microbiota, adjustment of the hypothalamic-pituitary-adrenal axis, and protection against insomnia-related neuronal damage.

Despite the promising results, the study also identified important limitations that must be considered by patients and clinicians. The uneven quality of published studies, especially those originating in some countries, indicates that more rigorous research is still needed. The lack of standardized protocols for clinical studies and the absence of harmonized metrics for assessing efficacy represent significant challenges to establishing definitive clinical guidelines. Furthermore, although multiple meta-analyses have been conducted, current evidence is still considered insufficient to definitively recommend or rule out acupuncture for all types of sleep disorders.

The authors also acknowledge that data were collected exclusively from a single database, which may have missed some relevant publications, and that institutional changes over time may have affected some analyses.

In conclusion, this bibliometric study offers the first comprehensive view of the research landscape on acupuncture for sleep disorders, revealing a growing field with significant therapeutic potential. The results suggest that acupuncture, particularly electroacupuncture, represents a promising treatment option for various sleep disorders, with growing evidence of efficacy and safety. Looking ahead, the investigators identified the critical need to develop standardized study protocols and establish uniform metrics for evaluating treatment efficacy. This direction is essential to translate the accumulated knowledge into practical clinical guidelines that can benefit patients worldwide, offering a safe and effective alternative to conventional treatments for sleep disorders.