SYSTEMATIC REVIEW article
Front. Neurol.
Sec. Sleep Disorders
Comparative effectiveness and safety of acupuncture treatments for primary insomnia: a systematic review and network meta-analysis of randomized trial
Ting Fang 1
Xinrui Cao 1
Lin Liu 1
Shiyou Lu 2,3
1. School of Acupuncture and Massage, Shandong University of Traditional Chinese Medicine, Jinan, China
2. Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
3. Shandong Key Laboratory of Traditional Chinese Medicine Efficacy and Mechanism, Jinan, China
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Abstract
Background: This study employed a Bayesian network meta-analysis (NMA) to systematically evaluate the efficacy and safety of various acupuncture therapies compared to conventional medication, sham acupuncture, and other interventions for primary insomnia. Methods: PubMed, Embase, Cochrane Library, Web of Science, CNKI, VIP Chinese Scientific Journals, Wanfang, and China Biology Medicine were searched from inception to July 16, 2025. Literature quality was assessed using the Cochrane Risk of Bias Tool v 2.0 (RoB 2.0). Statistical analyses were performed using Stata 18 and R 4.5.1. Results: In total, 80 studies involving 7,791 patients were included. Among these, 60.0% were rated as low RoB, 26.3% as unclear RoB, and 13.8% as high RoB. Statistical analysis showed that, compared with conventional medication, abdominal acupuncture (Weighted Mean Difference (MD) -3.73; 95% Credible Interval (95% CrI) [-6.88, -0.55]), acupuncture (MD -1.96; 95% CrI [-2.64, -1.27]), and catgut embedding (MD -3.08; 95% CrI [-5.18, -0.93]) significantly reduced the short-term Pittsburgh sleep quality index (PSQI) scores. Compared with acupuncture, warm acupuncture (MD -2.55; 95% CrI [-4.88, -0.21]) significantly reduced the long-term PSQI scores. Compared with sham acupuncture, abdominal acupuncture (Standardized Mean Difference (SMD) -3.06; 95% CrI [-6.08, -0.09]) and acupuncture (SMD -2; 95% CrI [-3.05, -0.98]) significantly reduced anxiety scores; meanwhile, acupuncture (SMD -1.52; 95% CrI [-2.79, -0.26]) significantly reduced depression scores. Compared with conventional medication, acupuncture (Relative Risk (RR) 1.19; 95% CrI [1.12, 1.27]) and catgut embedding (RR 1.25; 95% CrI [1.05, 1.52]) significantly improved clinical efficacy rates. However, no significant differences were observed in the relative effectiveness among different acupuncture therapies. The cumulative sample size included in the safety analysis was 1,772, from which 99 adverse events were reported (5.59%). No significant differences were detected across interventions; based on the surface under the cumulative ranking curve (SUCRA), wrist-ankle needle may show higher potential safety. Conclusion: Currently, no single intervention has emerged as optimal across all outcomes. Abdominal acupuncture, catgut embedding, electroacupuncture, and wrist-ankle needle ranked relatively high for certain outcomes based on SUCRA and showed potential advantages. However, given the potential publication bias, variations in acupuncture protocols, and insufficient long-term follow-up data, further validation is required.
Summary
Keywords
Acupuncture Therapy, insomnia, NMA, Primary insomnia, Systematic review
Received
20 November 2025
Accepted
13 February 2026
Copyright
© 2026 Fang, Cao, Liu and Lu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Shiyou Lu
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