Beyond nighttime symptoms: acupuncture for daytime dysfunction improvement in insomnia—a meta-analysis

Insomnia features include persistent difficulties in sleep initiation and sleep maintenance, leading to significant daytime dysfunction and diminished quality of life. While acupuncture is increasingly utilized in the management of insomnia, its specific efficacy in alleviating daytime dysfunction remains inadequately substantiated. This systematic review aims to address this evidence gap. A total of 5,037 articles from 6 electronic databases were searched and screened. Data analysis was performed using Review Manager 5.4 software and Stata 13. The Cochrane tool for assessing the risk of bias in randomized trials (RoB2) and GRADE were used to evaluate the quality of the RCTs and the evidence. Eighteen randomized controlled trials (RCTs) encompassing a total of 1,767 patients were analyzed. Data of the Montreal Cognitive Assessment (MoCA), Auditory Verbal Memory Test (AVMT), and Fatigue Scale-14 (FS-14) scores were extracted and aggregated, along with the scores of the Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI). Moderate-quality evidence showed that acupuncture therapies could not only significantly reduce insomnia severity but also enhance memory ability and relieve cognitive impairment. Low-quality evidence presented that acupuncture could improve sleep quality and reduce fatigue in patients with chronic primary insomnia. Although heterogeneity was observed across several synthesized outcomes, the results were robust. Systematic review registration: The research protocol was registered in PROSPERO (ID: CRD42023442722).