Effect of transcutaneous electrical acupoint stimulation on sleep quality: A systematic review and meta-analysis

Poor sleep quality may have a negative effect on health. Clinical studies have assessed the ability of transcutaneous electrical acupoint stimulation (TEAS) to improve sleep quality. This review aims to explore the efficacy and safety of TEAS to improve sleep quality, as well as the most promising application scenarios for TEAS. Eight databases were searched from their inception to 25 March 2023 to identify randomized controlled trials (RCTs) of the effects of TEAS on sleep quality compared to sham stimulation or pharmacotherapy. In the meta-analysis, Pittsburgh sleep quality index (PSQI) global score was the main outcome. The methodological quality of each included article was assessed using the Cochrane Risk of Bias tool. Publication bias was assessed by funnel plots. A total of 16 studies involving 1555 participants met the inclusion criteria. Twelve RCTs had low or moderate risk of bias and four RCTs had high risk of bias. Overall, the findings indicated that TEAS was effective in improving sleep quality (mean difference (MD) -2.22; 95% confidence interval (CI) [-3.29, -1.15]; p<0.0001) with high heterogeneity (I2=92%; p<0.00001). Among different cause of insomnia, TEAS was found to be effective in patients with postoperative insomnia (MD -0.95; 95% CI [-1.62, -0.27]; p=0.006; I2=66%). Subgroup analyses showed that TEAS was more effective in middle-aged patients (MD -1.60; 95% CI [-2.14, -1.06]; p<0.00001; I2=0%), and Neiguan (PC6) and Hegu (LI4) were effective acupoints during perioperative period (MD -1.45; 95% CI [-1.95, -0.95]; p<0.00001; I2=6%). Four studies reported adverse effects, none of which were serious. TEAS could effectively improve postoperative insomnia. For postoperative insomnia, the effect of TEAS was more significant in middle-aged patients, and simultaneous stimulation of PC6 and LI4 was effective. However, due to the small number of included studies and variation in patient types, additional high-quality, large-scale, multicenter, RCTs of the effect of TEAS on sleep quality are needed. CRD42023440453. Military Special Program to Cultivate and Improve TCM Service Capability [2021ZY002]; Shanghai “Science and Technology Innovation Action Plan” Yangfan Project [23YF1459200].