Acupuncture and related therapies for insomnia symptoms in hypertensive patients: protocol for a network meta-analysis of randomized controlled trials

Introduction: Insomnia and hypertension frequently co-occur and may exacerbate cardiovascular risk. While acupuncture and related therapies (ARTs) are widely used for sleep symptoms, their comparative effectiveness across modalities remains unclear. This protocol outlines a Bayesian network meta-analysis (NMA) to compare the effectiveness of ARTs for insomnia in adults with hypertension and inform clinical decision-making. Methods and analysis: This protocol follows preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) and is registered in PROSPERO. We will search PubMed, Embase, Cochrane Library (CENTRAL), Web of Science, and four Chinese databases (CNKI, Wanfang, VIP, and SinoMed) from inception to January 2026, and we will also screen WHO ICTRP, ClinicalTrials.gov, and ChiCTR without language restrictions. Eligible studies are randomized controlled trials enrolling adults with hypertension and insomnia, comparing an ART with sham, usual care, sleep hygiene, pharmacotherapy, or another ART. The primary outcome is change in global insomnia severity at post-treatment or at the first follow-up; secondary outcomes include sleep parameters, blood pressure, quality of life, mood, and adverse events. Pairwise meta-analyses will be performed using RevMan. A Bayesian random-effects NMA will be implemented in R (v4.4.1), with network plots and league tables generated in Stata (v15.1). The assumptions of transitivity and coherence will be assessed using design-by-treatment and node-splitting approaches; model fit will be evaluated using the deviance information criterion (DIC). Risk of bias will be assessed using RoB 2, and the certainty of evidence will be rated using GRADE adapted for NMA, with prespecified subgroup and sensitivity analyses. Registration number: PROSPERO; identifier CRD420251173289.