Efficacy of acupuncture-related treatment for sleep disturbances in children with neurodevelopmental disorders: a systematic review and meta-analysis

This study represents an important scientific contribution to the understanding of alternative treatments for sleep disturbances in children with neurodevelopmental disorders. Sleep disturbances are extremely common in this population, affecting up to 80% of children with conditions such as autism, attention deficit hyperactivity disorder, cerebral palsy, and intellectual disability. These sleep problems not only impair nighttime rest but also intensify daytime fatigue, hinder emotional regulation, and contribute to symptoms of anxiety, depression, and aggression. This situation creates a detrimental cycle in which sleep disturbances and emotional dysregulation feed each other, and they are now recognized as correlated symptoms of neurodevelopmental disorders rather than merely independent comorbidities.

Pharmacological treatment for sleep disturbances in children with neurodevelopmental disorders remains limited, leading non-pharmacological interventions to be recommended as first-line treatment. In this context, acupuncture emerges as a promising option, as it is believed to improve sleep through regulation of the autonomic nervous system balance and neurotransmitter levels, with a favorable safety profile, few side effects, and no risk of tolerance or dependence.

This research aimed to systematically evaluate the efficacy of acupuncture-related treatments for sleep disturbances in children with neurodevelopmental disorders. The researchers conducted a comprehensive search of 16 databases in May 2025, identifying randomized controlled trials that assessed acupuncture-related treatments in this population. The primary outcome was the total score of the Children's Sleep Habits Questionnaire (CSHQ), a widely used instrument for evaluating sleep disturbances in children. Secondary outcomes included subscale scores of this questionnaire, overall efficacy rate, and polysomnographic parameters.

Statistical analysis was performed using rigorous methods, including subgroup analyses based on the acupuncture modality used.

The study included seventeen trials involving 1,091 children with neurodevelopmental disorders and sleep disturbances. The results demonstrated that acupuncture treatment combined with conventional treatment significantly reduced total sleep questionnaire scores compared with conventional treatment alone. The most notable improvements were observed in sleep-related anxiety and night awakenings. Improvements were also observed in the overall efficacy rate and in polysomnographic parameters such as nighttime sleep time and awakening, with few adverse events reported.

Among the subscales of the original questionnaire, five showed statistically significant improvements: sleep anxiety, night awakenings, daytime sleepiness, sleep duration, and sleep-disordered breathing. Daytime sleepiness was the most significantly reduced aspect after treatment, followed by night awakenings and sleep duration.

The clinical implications of these findings are substantial for patients and healthcare professionals. First, when combined with conventional non-pharmacological treatments, acupuncture-related treatments demonstrated potential to improve both the quality and quantity of sleep, indicated by reduction of night awakenings and increase in sleep efficiency and total sleep time. Second, these treatments may help relieve psychological factors that interfere with sleep, making bedtime more manageable, particularly through significant reduction of sleep-related anxiety. Third, by reducing daytime sleepiness, acupuncture-related treatments may improve daytime functioning and, consequently, increase overall daily activity levels.

The most frequently used acupuncture points included Baihui, Shenting, Anmian, and Shenmen — points traditionally associated with treatment of neuropsychiatric and sleep disorders.

The study presents some important limitations that should be considered when interpreting the results. The substantial heterogeneity resulting from differences in acupuncture modalities and non-pharmacological treatments across studies requires careful interpretation of the results. None of the included studies described blinding procedures, and only one study used sham acupuncture, failing to fully eliminate the risk of expectation and placebo effects associated with invasive procedures. In addition, the uncertainty about protocol registration in all but one study raises concerns about selective reporting bias and limited methodological transparency.

Most studies were conducted in China, where acupuncture is culturally accepted, which may influence the results through cultural and geographical bias and limit global applicability.

Despite these limitations, the findings suggest that acupuncture-related treatments may have beneficial effects on sleep disturbances in children with neurodevelopmental disorders, with few adverse events reported. These treatments may serve as potential adjuvant therapies to existing conventional treatments. The proposed mechanism of action involves restoring autonomic balance through reduction of sympathetic hyperactivity and promotion of parasympathetic activity, thereby relieving sleep-related anxiety. Acupuncture may reduce cerebral arousal and regulate sleep by increasing levels of serotonin, melatonin, and gamma-aminobutyric acid, contributing to neural stabilization without risk of tolerance or dependence.

This review represents the first meta-analysis evaluating acupuncture-related treatments as adjuvant therapies for sleep disturbances in children with neurodevelopmental disorders, providing moderate-quality evidence for their efficacy when combined with conventional treatments.