Acupuncture and moxibustion for primary insomnia: A systematic review and meta-analysis of randomized controlled trials

Introduction: Primary insomnia is defined as sleeplessness that cannot be attributed to a medical, psychiatric, or environmental cause. This systematic review of randomised controlled trials (RCTs) evaluated the efficacy and safety of acupuncture and/or moxibustion for primary insomnia compared with western or Chinese medicine. Methods: Seven databases were searched for RCTs where acupuncture and/or moxibustion was the main intervention for primary insomnia. Effectiveness rate and the Pittsburgh Sleep Quality Index (PSQI) were primary outcomes. The protocol was registered in PROSPERO (CRD42016051984). Results: Fifty-seven studies involving 4140 participants were included. The risk of bias was generally high. There were significant differences in effectiveness rate (acupuncture vs. western medicine, acupuncture plus western medicine vs. western medicine, acupuncture plus oral Chinese medicine vs. oral Chinese medicine, acupuncture plus moxibustion vs. western medicine, acupuncture plus moxibustion vs. acupuncture, and moxibustion vs. western medicine) and PSQI (acupuncture vs. western medicine, acupuncture plus western medicine vs. western medicine, and acupuncture plus moxibustion vs. western medicine). No significant difference was found in effectiveness rate (moxibustion plus oral Chinese medicine vs. oral Chinese medicine) and PSQI (acupuncture vs. sham acupuncture). Acupuncture and/or moxibustion might be associated with few adverse effects and potential long-term positive effects. Conclusions: These findings indicated that acupuncture and/or moxibustion may be effective for primary insomnia although no significant difference in effectiveness rate (moxibustion plus oral Chinese medicine vs. oral Chinese medicine) and PSQI (acupuncture vs. sham acupuncture). Current evidence is insufficient. The safety and long-term effects are still uncertain. Higher quality RCTs are warranted.