Acupuncture for insomnia among individuals with substance use disorder: A systematic review and meta-analysis

Background and aims:

Insomnia is a common comorbidity and a recognized risk factor among individuals with substance use disorder (SUD). It is imperative to consider nonpharmacological adjunct therapies for bidirectional effects when treating insomnia in individuals with SUD. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of acupuncture for treating insomnia in individuals with SUD.

Methods:

Electronic databases were searched from inception to December 2024 to identify relevant randomized controlled trials (RCTs) comparing needle acupuncture with sham acupuncture, conventional care, non-acupuncture active treatment, or waitlist controls in patients with insomnia and SUD. The primary outcome was sleep quality, which was measured using the Pittsburgh Sleep Quality Index (PSQI) (lower scores indicate better sleep quality). Pooled effects were estimated using random effects models. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Trial sequential analysis (TSA) was used to assess the risk of false-positive and-negative results.

Results:

Eighteen RCTs with 1750 participants met the inclusion criteria. All the RCTs were conducted in China. Sixteen RCTs had a moderate-to-high risk of bias. The pooled results showed that manual acupuncture (MA) yielded a better total PSQI score than sham acupuncture (mean difference (MD), -2.15 [95% confidence interval (CI), -2.93 to -1.38], P < 0.00001; minimal clinically important difference (MCID): -1.25), with low-certainty evidence. The TSA results indicated that the sample size reached the required information volume and that no additional trials were needed for confirmation. Subgroup analyses revealed that acupuncture interventions had a greater effect among individuals with opioid use disorder (OUD) (MD, -1.93 [95% CI, -2.61 to -1.25], P < 0.00001) than on those with alcohol use disorder (MD, -1.49 [95% CI, -2.12 to -0.87], P < 0.00001) or new drug use disorder (MD, -3.94 [95% CI, -7.99 to 0.12], P = 0.06). However, the evidence regarding the efficacy of other forms of acupuncture and the comparative effectiveness between various forms of acupuncture was limited.

Conclusions:

Review of eighteen RCTs provides low certainty evidence that MA may be more effective than sham acupuncture for improving sleep quality in individuals with SUD, with the effect potentially stronger among those with OUD. Given that most of the included studies exhibited a moderate to high risk of bias, the strength of the conclusions should be interpreted with caution. Therefore, additional research on the use of acupuncture to alleviate insomnia and reduce SUD withdrawal symptoms is warranted.

Graphical Abstract: https://links.lww.com/AHM/A234