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Acupuncture Proves Effective as Method to Improve Sleep Quality for Post-Stroke Insomnia

Disease Spotlight | <b>Disease Spotlight: Insomnia</b>

In a randomized controlled trial, results demonstrated that acupuncture is to be efficacious in improving insomnia, quality of life, and affective symptoms for patients with ischemic stroke.

In a randomized controlled trial (ChiCTR-IIC-16008382), 144 ischemic stroke patients with insomnia were enrolled to assess acupuncture as a treatment for their insomnia, with results showing success towards the improvement of their sleep health.1

Those randomly assigned to the verum acupuncture group (n = 72) had significantly greater improvements in sleep quality in comparison with the sham group (n = 72) 2 weeks into treatment throughout the follow-up. Participants in the acupuncture group, compared with baseline measurements, had significantly greater reductions in the primary outcome of Insomnia Severity Index score than those in the control group at 2 weeks, 4 weeks, and at follow-up (P < .001).1

The acupuncture group also exhibited significantly greater reductions in Pittsburgh Sleep Quality Index (PSQI) scores with the mixed-effects model analysis compared to those in the control group at 4-week baseline and follow-up baseline (P < .001).

Study author Yan Cao, of Shanghai University of Traditional Chinese Medicine, and colleagues wrote, “Our study suggests that acupuncture could be a proper alternative treatment for post-stroke insomnia, especially for those people who do not accept or have insufficient response to pharmacological and psycho-behavioral therapies for insomnia.” There has been little focus on research into acupuncture for insomnia after ischemic stroke as it is the most unrecognized modifiable risk factor.

The participants in the acupuncture group had significantly higher sleep efficiency scores at the 2-week baseline, the 4-week baseline, and follow-up baseline (P <.001 for all).1 There were also no significant between-group differences in total sleep time (TST) at the 2-week baseline (P = .298) or follow-up baseline (P =.164), and there was a significant difference at the 4-week baseline (range, P = .004) between the two groups. All adverse events were mild in severity.

During the trial, the patients with ischemic stroke and insomnia who met the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria were assigned to verum or sham acupuncture treatment (n = 72 per group) for 3 sessions per week over 4 weeks. The assessment was conducted at baseline, after which there would be 1 biweekly for the 4-week treatment and at 4 weeks for a follow-up.

An improvement between the patients was also observed in the PSQI after 4 weeks of treatment throughout follow-up, as well as actigraphic variable TST, stroke-specific quality of life (SSQoL) and Hospital Anxiety and Depression Scale (HADS) scores at the end of treatment, and SSQoL and depression scores at follow-up. Between groups in the actigraphic variable sleep awakenings, there was no significant difference.

“The comparison of subjective and objective measures between the two groups showed that acupuncture was efficacious at treating post-stroke insomnia and also improved the anxiety and depression of the patients to a certain extent. In terms of safety and treatment compliance, the 4-week course of acupuncture was well tolerated and accepted by most participants,” Coa et al noted.

Of the 144 participants randomly assigned to the 2 groups, 24 participants (17%) dropped out during the treatment period, and 3 participants (2%) dropped out at follow-up. There was no difference in attrition rate between the 2 groups (Fisher exact test, P >.05) and with the sociodemographic or clinical features (P >.05), except for the sleep efficacy and sleep awakening of actigraphy, which were higher in the control group.

Cao and colleagues noted that future trials should investigate the potential of the impact of different stroke characteristics and the severity of insomnia at the baseline age. Additionally, they suggested that there should be an incorporation of more objective outcome measures such as polysomnography in the research. For accurately determining the long-term efficacy of acupuncture with post-stroke insomnia patients, an improved methodologic design is needed.

REFERENCES
1. Cao Y, Yan YJ, Xu JY, et al. Acupuncture for insomnia after ischemic stroke: an assessor-participant blinded, randomized controlled trial. Acupunct Med. 2022;40(5):443-452. doi:10.1177/09645284221077106