Chinese herbal medicine and acupuncture for insomnia in stroke patients: A systematic review and meta-analysis of randomised controlled trials
Insomnia is highly prevalent in stroke patients; however, there is no ideal intervention. This systematic review examined the effect and safety of Chinese herbal medicine (CHM) and acupuncture on sleep in adults with stroke. Six databases were searched from inception to June 2023 to identify randomi...
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| Veröffentlicht in: | Sleep medicine 2024-08, Vol.120, p.65-84 |
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| creator | Su, Qing Wang, Liyan Yu, Hongshen Li, Huishan Zou, Danmei Ni, Xiaojia |
| description | Insomnia is highly prevalent in stroke patients; however, there is no ideal intervention. This systematic review examined the effect and safety of Chinese herbal medicine (CHM) and acupuncture on sleep in adults with stroke.
Six databases were searched from inception to June 2023 to identify randomised controlled trials (RCTs). The primary outcome was Pittsburgh Sleep Quality Index (PSQI) scores. Risk of bias and evidence quality was assessed. A pairwise random-effect meta-analysis was performed.
A total of 54 RCTs published in 55 articles were finally included in the systematic review, including 35 of CHM and 19 of acupuncture therapies. Compared with placebo/sham procedure, CHM and acupuncture were more effective in improving PSQI scores. The evidence of moderate quality suggested that CHM outperformed benzodiazepine drugs (BZDs) while it presented an effect similar to that of non-BZDs in improving sleep quality. CHM and acupuncture also provided additional benefits to the patients treated with pharmacological agents alone. However, the evidence specific to individual CHM prescriptions lay in various factors and methodological quality, and the evidence on the comparative effectiveness between acupuncture and other therapies was conflicting or limited.
Overall, CHM and acupuncture used alone or in combination with pharmacotherapy can safely improve sleep in stroke patients with insomnia. In the future, RCTs on outstanding CHM prescriptions and the comparative effectiveness research between acupuncture and other therapies are needed.
PROSPERO No. CRD42020194029 and No. CRD42020194030.
•Chinese herbal medicine and acupuncture potentially improve sleep quality and quantity in stroke patients.•Chinese herbal medicine and acupuncture are well-tolerant, without serious adverse events.•High-quality clinical trials on outstanding Chinese herbal prescriptions specific to post-stroke insomnia are needed.•Rigorous comparative effectiveness research between acupuncture and other therapies is also needed. |
| doi_str_mv | 10.1016/j.sleep.2024.05.006 |
| format | Article |
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Six databases were searched from inception to June 2023 to identify randomised controlled trials (RCTs). The primary outcome was Pittsburgh Sleep Quality Index (PSQI) scores. Risk of bias and evidence quality was assessed. A pairwise random-effect meta-analysis was performed.
A total of 54 RCTs published in 55 articles were finally included in the systematic review, including 35 of CHM and 19 of acupuncture therapies. Compared with placebo/sham procedure, CHM and acupuncture were more effective in improving PSQI scores. The evidence of moderate quality suggested that CHM outperformed benzodiazepine drugs (BZDs) while it presented an effect similar to that of non-BZDs in improving sleep quality. CHM and acupuncture also provided additional benefits to the patients treated with pharmacological agents alone. However, the evidence specific to individual CHM prescriptions lay in various factors and methodological quality, and the evidence on the comparative effectiveness between acupuncture and other therapies was conflicting or limited.
Overall, CHM and acupuncture used alone or in combination with pharmacotherapy can safely improve sleep in stroke patients with insomnia. In the future, RCTs on outstanding CHM prescriptions and the comparative effectiveness research between acupuncture and other therapies are needed.
PROSPERO No. CRD42020194029 and No. CRD42020194030.
•Chinese herbal medicine and acupuncture potentially improve sleep quality and quantity in stroke patients.•Chinese herbal medicine and acupuncture are well-tolerant, without serious adverse events.•High-quality clinical trials on outstanding Chinese herbal prescriptions specific to post-stroke insomnia are needed.•Rigorous comparative effectiveness research between acupuncture and other therapies is also needed.</description><identifier>ISSN: 1389-9457</identifier><identifier>ISSN: 1878-5506</identifier><identifier>EISSN: 1878-5506</identifier><identifier>DOI: 10.1016/j.sleep.2024.05.006</identifier><identifier>PMID: 38905930</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>Acupuncture ; Acupuncture Therapy - methods ; Chinese herbal medicine ; Drugs, Chinese Herbal - therapeutic use ; Humans ; Insomnia ; Meta-analysis ; Randomized Controlled Trials as Topic ; Sleep Initiation and Maintenance Disorders - drug therapy ; Sleep Initiation and Maintenance Disorders - therapy ; Stroke ; Stroke - complications ; Systematic review</subject><ispartof>Sleep medicine, 2024-08, Vol.120, p.65-84</ispartof><rights>2024 The Authors</rights><rights>Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c284t-d0d9cdc624473ab1d22bc6a509241a8b75acfac9cc574548d800dbcf7ac617273</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.sleep.2024.05.006$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3536,27903,27904,45974</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38905930$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Su, Qing</creatorcontrib><creatorcontrib>Wang, Liyan</creatorcontrib><creatorcontrib>Yu, Hongshen</creatorcontrib><creatorcontrib>Li, Huishan</creatorcontrib><creatorcontrib>Zou, Danmei</creatorcontrib><creatorcontrib>Ni, Xiaojia</creatorcontrib><title>Chinese herbal medicine and acupuncture for insomnia in stroke patients: A systematic review and meta-analysis of randomised controlled trials</title><title>Sleep medicine</title><addtitle>Sleep Med</addtitle><description>Insomnia is highly prevalent in stroke patients; however, there is no ideal intervention. This systematic review examined the effect and safety of Chinese herbal medicine (CHM) and acupuncture on sleep in adults with stroke.
Six databases were searched from inception to June 2023 to identify randomised controlled trials (RCTs). The primary outcome was Pittsburgh Sleep Quality Index (PSQI) scores. Risk of bias and evidence quality was assessed. A pairwise random-effect meta-analysis was performed.
A total of 54 RCTs published in 55 articles were finally included in the systematic review, including 35 of CHM and 19 of acupuncture therapies. Compared with placebo/sham procedure, CHM and acupuncture were more effective in improving PSQI scores. The evidence of moderate quality suggested that CHM outperformed benzodiazepine drugs (BZDs) while it presented an effect similar to that of non-BZDs in improving sleep quality. CHM and acupuncture also provided additional benefits to the patients treated with pharmacological agents alone. However, the evidence specific to individual CHM prescriptions lay in various factors and methodological quality, and the evidence on the comparative effectiveness between acupuncture and other therapies was conflicting or limited.
Overall, CHM and acupuncture used alone or in combination with pharmacotherapy can safely improve sleep in stroke patients with insomnia. In the future, RCTs on outstanding CHM prescriptions and the comparative effectiveness research between acupuncture and other therapies are needed.
PROSPERO No. CRD42020194029 and No. CRD42020194030.
•Chinese herbal medicine and acupuncture potentially improve sleep quality and quantity in stroke patients.•Chinese herbal medicine and acupuncture are well-tolerant, without serious adverse events.•High-quality clinical trials on outstanding Chinese herbal prescriptions specific to post-stroke insomnia are needed.•Rigorous comparative effectiveness research between acupuncture and other therapies is also needed.</description><subject>Acupuncture</subject><subject>Acupuncture Therapy - methods</subject><subject>Chinese herbal medicine</subject><subject>Drugs, Chinese Herbal - therapeutic use</subject><subject>Humans</subject><subject>Insomnia</subject><subject>Meta-analysis</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Sleep Initiation and Maintenance Disorders - drug therapy</subject><subject>Sleep Initiation and Maintenance Disorders - therapy</subject><subject>Stroke</subject><subject>Stroke - complications</subject><subject>Systematic review</subject><issn>1389-9457</issn><issn>1878-5506</issn><issn>1878-5506</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9UU1v1TAQjBCIlsIvQEI-cklYJ3bsIHGonviSKnGBs-WsN6ofSRxsB_T-BL8Zt69w5LSj0eysPVNVLzk0HHj_5tikmWhrWmhFA7IB6B9Vl1wrXUsJ_eOCOz3Ug5DqonqW0hGAK67F0-qi8CCHDi6r34dbv1IidktxtDNbyHksDLOrYxb3bV8x75HYFCLzawrL6m0BLOUYvhPbbPa05vSWXbN0SpmWQiCL9NPTr3uThbKt7WrnU_KJhYnFwobFJ3IMw1ps5rnAHL2d0_PqyVQGvXiYV9W3D--_Hj7VN18-fj5c39TYapFrB25Ah30rhOrsyF3bjthbCUMruNWjkhYniwOiVEIK7TSAG3FSFnuuWtVdVa_PvlsMP3ZK2ZQHIc2zXSnsyXSgOGgFghdpd5ZiDClFmswW_WLjyXAwd0WYo7kvwtwVYUCaUkTZevVwYB9Lpv92_iZfBO_OAirfLGFFk7AkiSX_SJiNC_6_B_4ApxqeXA</recordid><startdate>202408</startdate><enddate>202408</enddate><creator>Su, Qing</creator><creator>Wang, Liyan</creator><creator>Yu, Hongshen</creator><creator>Li, Huishan</creator><creator>Zou, Danmei</creator><creator>Ni, Xiaojia</creator><general>Elsevier B.V</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202408</creationdate><title>Chinese herbal medicine and acupuncture for insomnia in stroke patients: A systematic review and meta-analysis of randomised controlled trials</title><author>Su, Qing ; Wang, Liyan ; Yu, Hongshen ; Li, Huishan ; Zou, Danmei ; Ni, Xiaojia</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c284t-d0d9cdc624473ab1d22bc6a509241a8b75acfac9cc574548d800dbcf7ac617273</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Acupuncture</topic><topic>Acupuncture Therapy - methods</topic><topic>Chinese herbal medicine</topic><topic>Drugs, Chinese Herbal - therapeutic use</topic><topic>Humans</topic><topic>Insomnia</topic><topic>Meta-analysis</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Sleep Initiation and Maintenance Disorders - drug therapy</topic><topic>Sleep Initiation and Maintenance Disorders - therapy</topic><topic>Stroke</topic><topic>Stroke - complications</topic><topic>Systematic review</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Su, Qing</creatorcontrib><creatorcontrib>Wang, Liyan</creatorcontrib><creatorcontrib>Yu, Hongshen</creatorcontrib><creatorcontrib>Li, Huishan</creatorcontrib><creatorcontrib>Zou, Danmei</creatorcontrib><creatorcontrib>Ni, Xiaojia</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Sleep medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Su, Qing</au><au>Wang, Liyan</au><au>Yu, Hongshen</au><au>Li, Huishan</au><au>Zou, Danmei</au><au>Ni, Xiaojia</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Chinese herbal medicine and acupuncture for insomnia in stroke patients: A systematic review and meta-analysis of randomised controlled trials</atitle><jtitle>Sleep medicine</jtitle><addtitle>Sleep Med</addtitle><date>2024-08</date><risdate>2024</risdate><volume>120</volume><spage>65</spage><epage>84</epage><pages>65-84</pages><issn>1389-9457</issn><issn>1878-5506</issn><eissn>1878-5506</eissn><abstract>Insomnia is highly prevalent in stroke patients; however, there is no ideal intervention. This systematic review examined the effect and safety of Chinese herbal medicine (CHM) and acupuncture on sleep in adults with stroke.
Six databases were searched from inception to June 2023 to identify randomised controlled trials (RCTs). The primary outcome was Pittsburgh Sleep Quality Index (PSQI) scores. Risk of bias and evidence quality was assessed. A pairwise random-effect meta-analysis was performed.
A total of 54 RCTs published in 55 articles were finally included in the systematic review, including 35 of CHM and 19 of acupuncture therapies. Compared with placebo/sham procedure, CHM and acupuncture were more effective in improving PSQI scores. The evidence of moderate quality suggested that CHM outperformed benzodiazepine drugs (BZDs) while it presented an effect similar to that of non-BZDs in improving sleep quality. CHM and acupuncture also provided additional benefits to the patients treated with pharmacological agents alone. However, the evidence specific to individual CHM prescriptions lay in various factors and methodological quality, and the evidence on the comparative effectiveness between acupuncture and other therapies was conflicting or limited.
Overall, CHM and acupuncture used alone or in combination with pharmacotherapy can safely improve sleep in stroke patients with insomnia. In the future, RCTs on outstanding CHM prescriptions and the comparative effectiveness research between acupuncture and other therapies are needed.
PROSPERO No. CRD42020194029 and No. CRD42020194030.
•Chinese herbal medicine and acupuncture potentially improve sleep quality and quantity in stroke patients.•Chinese herbal medicine and acupuncture are well-tolerant, without serious adverse events.•High-quality clinical trials on outstanding Chinese herbal prescriptions specific to post-stroke insomnia are needed.•Rigorous comparative effectiveness research between acupuncture and other therapies is also needed.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>38905930</pmid><doi>10.1016/j.sleep.2024.05.006</doi><tpages>20</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Acupuncture Acupuncture Therapy - methods Chinese herbal medicine Drugs, Chinese Herbal - therapeutic use Humans Insomnia Meta-analysis Randomized Controlled Trials as Topic Sleep Initiation and Maintenance Disorders - drug therapy Sleep Initiation and Maintenance Disorders - therapy Stroke Stroke - complications Systematic review |
| title | Chinese herbal medicine and acupuncture for insomnia in stroke patients: A systematic review and meta-analysis of randomised controlled trials |
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