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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

Effects of acupuncture therapy on insomnia

SR Sok, JA Erlen, and KB Kim.

Review published: 2003.

CRD summary

This review assessed the effects of acupuncture therapy on insomnia. The authors concluded that acupuncture may be an effective intervention for insomnia. A number of methodological problems, both in the included studies and in the review, mean that this conclusion may not be reliable.

Authors' objectives

To assess the trends across acupuncture studies for insomnia, to examine dependent variables, and to evaluate the effects of acupuncture therapy on insomnia in older people. Only the latter objective is discussed in this abstract.

Searching

MEDLINE, AMED, all EBM reviews (i.e. Cochrane Database of Systematic Reviews, ACP Journal Club, DARE and the Cochrane Controlled Trials Register), MANTIS, CINAHL, AIDSLINE, PsycINFO, International Pharmaceutical Abstracts, BIOETHICSLINE, Cancerlit, HealthSTAR and SPORTDiscus were searched from January 1975 to December 2002. The keywords were 'insomnia', 'acupuncture' and 'experimental design'. Only papers published in the English language were eligible.

Study selection

Study designs of evaluations included in the review

No specific study designs were given, other than that the studies had to be experimental in nature. The majority appeared to be uncontrolled before-and-after studies.

Specific interventions included in the review

Other than stating 'acupuncture therapy', no other inclusion criteria for the interventions were given. Across the included studies a variety of meridian points were used and treatment frequencies and duration varied. The majority of the studies involved single treatments, whilst those that offered a course of treatments involved 3 to 12 treatments.

Participants included in the review

The participants were those suffering from insomnia (no a priori definition was provided). Definitions of insomnia varied across the studies. The participants' ages ranged from 16 to 91 years, with most studies including people over the age of 50 with a predominance of females. The duration of insomnia ranged from 3 days to 34 years, with most of the participants having insomnia for more than 5 years. The studies took place in China or the USA, but ethnicity was not specifically stated in most studies.

Outcomes assessed in the review

No specific outcomes were noted other than the relief of insomnia. All studies used self-report questionnaires; one study also included physiological measurement. The outcomes were in terms of perceived levels of treatment effectiveness or length of time asleep.

How were decisions on the relevance of primary studies made?

The authors did not state how the papers were selected for the review, or how many reviewers performed the selection.

Assessment of study quality

The authors did not state that they assessed validity.

Data extraction

The principal investigator abstracted and verified the data. The outcomes were extracted as described by individual study authors, including an effectiveness rate where documented.

Methods of synthesis

How were the studies combined?

The studies were combined in a narrative.

How were differences between studies investigated?

Differences between the studies, in terms of participant characteristics and treatment regimens, were described in the paper.

Results of the review

Eleven studies (n=990) were included in the review.

All studies reported statistically significant positive results of acupuncture for the relief of insomnia. The effectiveness rates ranged from 82.36 to 100%, based on 8 studies.

Authors' conclusions

Acupuncture may be an effective intervention for the alleviation of insomnia.

CRD commentary

The review question was clear, but the inclusion criteria for the participants and outcomes were not fully specified and those for study design were broad. The lack of explicitly defined inclusion criteria and the lack of reported duplication of methods used to select studies mean that there is the potential for bias in the study selection process. Although a range of databases was searched, the restriction to studies published in English might have led to the exclusion of relevant studies and raises the possibility of both language and publication bias. No attempts were made to reduce reviewer bias and errors in the extraction of data. It was unclear from the report which studies had a control group, and no quality assessment was performed to distinguish the more rigorous studies. This means that the results from these studies and any synthesis may not be reliable. As the authors noted, the very positive outcomes in the included studies should be viewed in the context of being based on self-report, which is less reliable than physiological measures. Given the methodological issues highlighted in the included studies and in the review, any conclusions on the role of acupuncture for insomnia may not be reliable.

Implications of the review for practice and research

Practice: The authors advised that health care professionals should be well-informed about available treatment options including complementary therapies

Research: The authors recommended a randomised controlled trial to determine the effectiveness of acupuncture in comparison with other therapies for insomnia. They stated that there is a need for research into the use of auricular acupuncture therapy for older people and women with insomnia.

Funding

Postdoctoral Fellowship Program of the Korea Science and Engineering Foundation.

Bibliographic details

Sok S R, Erlen J A, Kim K B. Effects of acupuncture therapy on insomnia. Journal of Advanced Nursing 2003; 44(4): 375-384. [PubMed: 14651709]

Indexing Status

Subject indexing assigned by NLM

MeSH

Acupuncture Therapy /methods; Female; Humans; Male; Medicine, Chinese Traditional /methods; Sleep Initiation and Maintenance Disorders /therapy; Treatment Outcome

AccessionNumber

12004003216

Database entry date

31/05/2006

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

PMID: 14651709

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