Acupuncture for treatment of persistent disturbed sleep: A randomized clinical trial in veterans with mild traumatic brain injury and post-traumatic stress disorder

Abstract

Persistent sleep disturbance is one of the most highly prevalent symptoms after mild traumatic brain injury (mTBI) and is often refractory to conventional therapies. In the presence of co-existing post-traumatic stress disorder (PTSD), it is especially hard to treat. This randomized clinical trial (RCT) is to evaluate real acupuncture, as compared to sham, in improving persistent sleep disturbance in veterans with mTBI and PTSD. This RCT was conducted at a US Department of Veterans Affairs Medical Center and included sixty veterans aged 24–55 (mean 40) with history of mTBI of at least 3-months and refractory sleep disturbance. They were randomized into 2 groups and stratified by PTSD status. Each received up to 10 treatment sessions. The primary outcome measure was change in baseline-adjusted global Pittsburgh Sleep Quality Index (PSQI) score following intervention. Secondary outcomes were wrist-actigraphy assessed objective sleep measurements. Comorbid PTSD was analyzed as a covariate. Mean [SD] pre-intervention global PSQI score was 14.3 [3.2]. Those receiving real acupuncture had a global PSQI score improvement of 4.4 points (relative to 2.4 points in sham, P = 0.04), and actigraphically measured sleep efficiency (absolute) improvement of 2.7% (relative to a decrement of 5.3% in sham, P = 0.0016). Effective blinding for active treatment was maintained throughout the study. PTSD participants presented with more significant sleep difficulties at baseline; acupuncture was effective for those both with and without PTSD. Real acupuncture, compared to a sham needling procedure, resulted in a significant improvement in subjective and objective sleep measures for veterans with mTBI and disturbed sleep, even in the presence of PTSD. These results indicate that an alternative medicine treatment modality like acupuncture provides meaningful relief for a particularly recalcitrant problem affecting large segments of the veteran population.