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Electroacupuncture for Insomnia Significantly Improves Quality of Sleep in Patients With Depression

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

In a randomized clinical trial, the application of electroacupuncture treatment for insomnia in patients with depression significantly improved the quality of sleep in comparison with sham acupuncture or the control group.

A 32-week randomized clinical trial (NCT03122080) in Shanghai, China, showed in its findings that electroacupuncture treatment for insomnia in patients with depression significantly improved the quality of sleep in comparison with the sham acupuncture or the control group over 8 weeks, and was sustained until the final week of the intervention.1

Notably, the efficacy of using electroacupuncture as a treatment for insomnia was also sustained at the 24-week postintervention follow-up that was conducted. The difference in sleep quality using the Pittsburgh Sleep Quality Index (PSQI) score during week 8 of the intervention was –3.6 (95% CI, –4.4 to –2.8; P <.001) between the electroacupuncture and sham acupuncture groups.1 In addition, the difference in sleep quality was –5.1 (95% CI, –6.0 to –4.2; P <.001) between the electroacupuncture and control groups. Electroacupuncture as a therapy for depression and sleep disorders in clinical practice is widely known, but the treatment efficacy for comorbid insomnia and depression has been unclear to date.

Xuan Yin, MD, of Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, and colleagues wrote that their “findings constitute subjective and objective evidence of the efficacy and safety of electroacupuncture with standard care in treating comorbid depression and insomnia compared with sham acupuncture with standard care or standard care alone.” Also, the findings displayed that the patients in the electroacupuncture group had a greater reduction of severity of insomnia, depressive mood, and anxiety symptoms towards the end of the intervention.

The trial recruited 270 patients, 71.9% of whom were women (n = 194) and 28.1% were men (n = 76). The mean for age with the participants was 50.3 years (SD, 14.2).1 The intention-to-treat analysis included 91.5% of participants (n = 247) who completed all outcome measurements at week 32, with only 8.5% of patients (n = 23) dropping out of the trial.

The PSQI, from baseline to week 8, within the electroacupuncture group had a mean difference of –6.2 (95% CI, –6.9 to –5.6). There was significant improvement with the 17-item Hamilton Depression Rating Scale (–10.7; 95% CI, –11.8 to –9.7, P < .001), the Insomnia Severity Index (–7.6; 95% CI, –8.5 to –6.7, P < .001), and the Self-rating Anxiety Scale (–2.9; 95% CI, –4.1 to –1.7, P < .001) scores. The total sleep time recorded was increased to 29.1 min (95% CI, 21.5-36.7, P < .001) in the electroacupuncture group during the 8-week intervention period in the actigraphy. Overall, there were no between-group differences in the frequency of sleep awakenings along with no serious adverse events reported.

“To our knowledge, there have been no similar large-scale, multicenter, randomized clinical trials studying the effects of EA on treating comorbid depression and insomnia. This strictly designed, rigorously conducted trial provides important clinical evidence about the role and value of EA as an alternative therapy for treating insomnia and depressive moods,” Yin et al noted.

The trial was conducted from September 1, 2016, to July 30, 2019, which took place in 3 tertiary hospitals in Shanghai, China. The patients then were randomly assigned to receive either electroacupuncture treatment and standard care, sham acupuncture treatment and standard care, or standard care only as the control. The eligibility for the trial had the criteria of patients in the range of 18 to 70 years in age, with insomnia, and having met the benchmark for depression, classified in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.

The patients in the 3 groups were provided with standard care which was guided by psychiatrists. Those who were in the electroacupuncture and sham acupuncture groups received real or sham acupuncture treatment with 3 sessions in the span of a week for 8 weeks. The sessions totaled to 24, which the patients completed over the intervention time. The change in PSQI from baseline to week 8 was set as the primary outcome. Then, the secondary outcomes for the trial were the PSQI at 12, 20, and 32 weeks of follow-up; Insomnia Severity Index; sleep parameters recorded in actigraphy; Self-Rating Anxiety Scale score; and the 17-item Hamilton Depression Rating Scale score.

Past research has shown that acupuncture has little effect on treating depression combined with insomnia.2,3 After 8 weeks of electroacupuncture treatment, this clinical trial revealed it to be an alternative therapy that is safe and effective for treating insomnia in patients with depression. Yin and colleagues noted that future studies, "should focus on a longer treatment period with precise objective outcome assessment.”

For more information about clinical depression, check out our sister publication, PsychiatricTimes.

REFERENCES
1. Yin X, Li W, Liang T, et al. Effect of Electroacupuncture on Insomnia in Patients With Depression: A Randomized Clinical Trial. JAMA Netw Open. 2022;5(7):e2220563. Published 2022 Jul 1. doi:10.1001/jamanetworkopen.2022.20563
2. Chung KF, Yeung WF, Yu YM, et al. Acupuncture for residual insomnia associated with major depressive disorder: a placebo- and sham-controlled, subject- and assessor-blind, randomized trial. J Clin Psychiatry. 2015;76(6):e752-e760. doi:10.4088/JCP.14m09124
3. Zhao FY, Fu QQ, Kennedy GA, et al. Can acupuncture improve objective sleep indices in patients with primary insomnia? A systematic review and meta-analysis. Sleep Med. 2021;80:244-259. doi:10.1016/j.sleep.2021.01.053