Effects Of Acupuncture And Moxibustion On Post-stroke Insomnia: Meta-analysis And Overview Of Systematic Reviews

Objective: At present,the published evidence on the effectiveness and safety of acupuncture and moxibustion in treating insomnia patients after stroke is inconsistent.The purpose of this paper is to reevaluate the evidence from systematic evaluation and meta analysis,summarize and analyze the relevant evidence on the efficacy and safety of acupuncture and moxibustion in treating insomnia after stroke,and provide more objective,scientific,and more concentrated high-quality evidence for clinical use.Methods: Systematic review of randomised controlled trials(RCTs)of acupuncture therapy and moxibustion used to treat insomnia after stroke was searched from seven databases,including Chinese databases including China Knowledge Network(CNKI),Wan Fang Data,China Vipers(VIP),CBM,and English databases including Pub Med,EMBASE,Web of Science,and English databases including and not limited to acupuncture,moxibustion,and ear acupuncture;the search period was from database creation to March 8,2023.Methodological quality for inclusion in the systematic evaluation was assessed using the AMSTAR 2 tool;reporting quality for inclusion in the systematic evaluation was assessed using the PRISMA inventory;and evidence quality for inclusion in the systematic evaluation was assessed using the GRADE tool.The results of the two evaluations were tested for intra-group correlation coefficient(ICC)to evaluate the consistency and credibility of the results.A meta-analysis of outcome indicators was performed using stata16.0 software,where dichotomous variables were evaluated using the odds ratio(OR)and95% confidence interval(CI),and multiple indicators were used to jointly evaluate the effectiveness and safety of acupuncture for post-stroke insomnia.Results: Eleven systematic evaluations were included and 10 were evaluated using the AMSTAR 2 tool,which showed that two(2/10,20%)were of "low" methodological quality and the remaining SRs(8/10,80%)were of "very low" quality The results of the assessment showed that six SRs(6/10,60%)were of ’high quality’,three SRs(3/10,30%)were of’moderate quality’ and one SR(1/10,30%)was of ’high quality’.The GRADE tool was used to assess the quality of evidence for 11 SRs,which evaluated a total of 40 outcome indicators,of which there was no high level of evidence,2(2/40,5%)were of medium level,and 15(15/40,37.5%)were of low level.and the remaining evidence was of very low quality(23/40,57.5%),with overall evidence of low quality.The results based on meta-analysis and systematic evaluation re-evaluation showed that acupuncture-related therapies were significantly effective and safe in treating post-stroke insomnia.Conclusion: Acupuncture was effective in the treatment of post-stroke insomnia patients with few adverse effects and a good safety profile,but the overall quality of SRs was not high.There may be an impact on the reliability of the conclusions.Higher quality randomised controlled trials are still needed to validate the clinical efficacy of acupuncture for post-stroke insomnia.