Abstract
Objectives Acupuncture has increasingly been used for insomnia relief after stroke. We aimed to evaluate the methodological quality and summarize the evidence regarding the effectiveness of acupuncture for poststroke insomnia (PSI) from systematic reviews/meta-analyses (SRs/MAs). Methods Eight databases were searched from inception through August 23, 2020. SRs/MAs on acupuncture treatment for PSI were included. Methodological quality assessment was performed using Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2), and evidence quality assessment was performed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Results Six SRs/MAs on acupuncture treatment for PSI were included. The AMSTAR-2 showed that the methodological quality of all included SRs/MAs was rated as critically low. According to the evaluation results of GRADE, 38.9% (7/18) of outcomes were rated as very low-quality evidence, 22.2% (4/18) were low-quality evidence, and 8.9% (7/18) were moderate-quality evidence. Descriptive analysis results showed that acupuncture was an effective treatment modality for PSI. Conclusions All included reviews indicated that acupuncture was more effective than the control group for the treatment of PSI, but the credibility of the results is limited owing to the generally low methodological and evidence quality of the included SRs/MAs. More high-quality evidence is needed to determine whether acupuncture is more effective than other treatments.
Highlights
Worldwide, stroke is the second leading cause of death and the third-largest source of disability [1]
Inclusion and Exclusion Criteria. e inclusion criteria were as follows: (a) study design: systematic reviews/meta-analyses (SRs/MAs) based on randomized controlled trials (RCTs); (b) participants: the participants had poststroke insomnia (PSI) diagnosed according to any authoritative diagnostic criteria, no restrictions on sex, age, race, onset time, or the source of cases; (c) intervention: acupuncture therapy versus conventional medication (CM) or acupuncture therapy combined with CM versus CM alone; and (d) outcomes: effective rate, sleep parameters, sleep efficiency, scales, or index for sleep quality evaluation, adverse effects
In one review [17] that used the Pittsburgh Sleep Quality Index (PSQI) score to compare the effects of acupuncture plus auricular acupressure with those of CM, the results indicated that the combined treatment was superior to CM alone in terms of improvement in daytime dysfunction, but there was no statistical difference between different treatments in terms of improvement in sleep onset latency and sleep time
Summary
Stroke is the second leading cause of death and the third-largest source of disability [1]. Insomnia is one of the most common poststroke complications, affecting approximately 40% to 60% of stroke patients [2]. A large number of chronic poststroke insomnia (PSI) patients are produced, insomnia continues to be the most unrecognized modifiable risk factor for stroke [3]. Untreated PSI causes cognitive dysfunction, altered mood, and fatigue and may impede stroke rehabilitation, lengthen hospital stay, influence stroke outcomes, and increase the possibility of stroke recurrence [4]. E primary pharmacological treatments for PSI are benzodiazepines, nonbenzodiazepine sedatives, and melatonin agonists. Effective pharmacological treatments are available, their significant side effects have limited their clinical applications and longterm use [5]. Erefore, faced with the limitations of currently available PSI treatments, many people are interested in complementary and alternative medicine Cognitive behavioral therapy often results in an acute reduction in sleep time during the first few weeks of treatment, which means that sleep quality improvement with cognitive behavioral therapy requires long-term implementation [6]. erefore, faced with the limitations of currently available PSI treatments, many people are interested in complementary and alternative medicine
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