Jiaying Lian,1 Yanhong Jiang,2 Lingli Kong,3 Mingqi Zhou4 

1Department of Neurology, Quzhou Hospital of Traditional Chinese Medicine, Quzhou, People’s Republic of China; 2Second Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, People’s Republic of China; 3Intensive Care Medicine Department, Quzhou Hospital of Traditional Chinese Medicine, Quzhou, People’s Republic of China; 4Acupuncture and Moxibustion Massage Department, Quzhou Hospital of Traditional Chinese Medicine, Quzhou, People’s Republic of China

Correspondence: Mingqi Zhou, Email 819119801@qq.com

Background: Post-stroke sleep disorders (PSSD) are among the most prevalent complications of stroke, significantly impeding neurological recovery and increasing the risk of recurrence. While Western medicine primarily relies on pharmacological treatments, these often come with side effects and inconsistent outcomes. Recent evidence supports the effectiveness of various acupuncture therapies for PSSD, but the optimal treatment strategy remains unclear.
Objective: To compare the efficacy of different acupuncture therapies for PSSD using a network meta-analysis.
Methods: We conducted systematic searches in multiple databases, including CNKI (since 1994), VIP (since 1989), CBM (since 1978), WanFang (since 1998), the Chinese Clinical Trial Registry (since 2005), PubMed (since 1966), EMBASE (since 1974), The Cochrane Library (since 1993), Web of Science (since 1900), and ClinicalTrials (since 2000). Randomized controlled trials (RCTs) on acupuncture therapies for PSSD were included up to May 31, 2024. Studies were screened based on predefined inclusion and exclusion criteria, and their quality was assessed using the Cochrane Handbook for Systematic Reviews of Interventions. Data were analyzed using RevMan 5.3 and Stata 14.
Results: A total of 53 RCTs involving 3973 patients were included. The network meta-analysis evaluated 12 interventions. Auricular acupressure combined with Western medicine ranked highest for improving PSQI scores (surface under the cumulative ranking curve [SUCRA]: 96.2%), followed by acupuncture (68.5%) and moxibustion combined with Western medicine (63.6%). For increasing serum 5-HT levels, moxibustion combined with Western medicine ranked highest (SUCRA: 89.3%), followed by acupuncture combined with Western medicine (79.1%). Acupuncture combined with Western medicine was most effective in reducing serum NE levels (SUCRA: 97%).
Conclusion: Acupuncture therapies are effective for PSSD and it is more effective when used in combination with western medicine. These effects may be mediated by modulating neurotransmitter levels. However, further large-scale, multi-center RCTs are needed to confirm these findings. This study followed PRISMA guidelines and was registered with PROSPERO (CRD42023470398).

Keywords: acupuncture and moxibustion therapy, stroke, sleep disorders, network meta-analysis, PSQI, 5-HT, NE