Abstract
Background Although the effectiveness of auricular plaster therapy (APT) on primary insomnia has been systematically reviewed, no systematic review of studies has focused on the effect on comorbid insomnia. Objective To evaluate the efficacy and safety of APT for comorbid insomnia. Methods Fifteen databases were searched from inception to July 2018. Randomized controlled trials (RCTs) of APT as an exclusive intervention for comorbid insomnia against Western medications, sham APT or no treatment were identified. ResultsFourteen studies involving 928 participants were identified. The pooled outcomes revealed that APT was superior to control conditions for the global score on PSQI (SMD = -1.13, and 95% CI = -1.48—-0.78) and the effective rate (RR = 1.24, 95% CI = 1.13—1.36, NNT = 5, and 95% CI =4—7). Furthermore, the results of subgroup analyses were similar to the pooled results. Additionally, the pooled results were verified to be stable by sensitivity analyses. Regarding safety, no significant difference was identified between APT and Western medications. Conclusions APT appears to be an effective and safe treatment for comorbid insomnia. However, the benefits of APT for comorbid insomnia could not be ascertained due to the paucity of the quantity and quality of the included studies. Large-scale studies using proper methodology are needed to yield a firm conclusion.
Highlights
Insomnia is one of the most major public health problems, which is characterized by difficulty initiating or maintaining sleep, and early morning waking with significant impairment in daytime functioning [1]
Subgroup analyses demonstrated that auricular plaster therapy (APT) had better effective rate compared with the Western medications (RR = 1.18, 95% confidence interval (CI) = 1.09—1.28, P < 0.0001, number needed to treat (NNT) = 6, and 95% CI = 4—10), sham APT, or no treatment (RR = 1.67, 95% CI = 1.11—2.52, P = 0.01, NNT = 3, and 95% CI = 2—5) (Figure 7), the P-value was not significant in meta-regression (P = 0.073)
Eleven studies compared Semen Vaccariae (SV) with control conditions and two studies compared magnetic pellets (MP) with control groups. These results suggested that APT was statistically favoured over controls (SV: Risk ratio (RR) = 1.23, 95% CI = 1.11—1.37, P = 0.0001, NNT = 5, and 95% CI = 4—8; MP: RR = 1.30, 95% CI = 1.07—1.59, P = 0.009, NNT = 4, and 95% CI = 2—12) (Figure 8), the P-value was not significant in metaregression (P = 0.555)
Summary
Insomnia is one of the most major public health problems, which is characterized by difficulty initiating or maintaining sleep, and early morning waking with significant impairment in daytime functioning [1]. Secondary insomnia is the term used when insomnia is associated with another disorder [2, 3]. Comorbid insomnia is subdivided into insomnia associated with another medical or psychiatric disorder [5]. The effectiveness of auricular plaster therapy (APT) on primary insomnia has been systematically reviewed, no systematic review of studies has focused on the effect on comorbid insomnia. To evaluate the efficacy and safety of APT for comorbid insomnia. Randomized controlled trials (RCTs) of APT as an exclusive intervention for comorbid insomnia against Western medications, sham APT or no treatment were identified. No significant difference was identified between APT and Western medications. The benefits of APT for comorbid insomnia could not be ascertained due to the paucity of the quantity and quality of the included studies. Large-scale studies using proper methodology are needed to yield a firm conclusion
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