1341 - Efficacy of Acupuncture Therapy Compared to Sham for Sleep Rehabilitation in Combatant Post Traumatic Stress Disorder Patients: A Systematic Review and Meta-Analysis

Sleep disturbance is a prevalent and disabling symptom in posttraumatic stress disorder (PTSD). Acupuncture is increasingly utilized as adjunctive therapy for this condition, yet its efficacy for sleep outcomes and variation in internal methodology in this population remains incompletely characterized. While clinical trials demonstrate acupuncture as a successful adjuvant for PTSD, its focus on sleep benefits has been overshadowed and improving sleep can trigger widespread benefits. This makes determining the global efficacy and best variation of acupuncture as a treatment modality a task worth pursuing.

Design:

A criteria following a PICO organization with prespecified exclusion and inclusion criteria were defined and articles were conglomerated from multiple databases. Eligible studies included prospective observational studies, randomized controlled, clinical, and military trials, that compare the benefit to sham (false acupuncture; negative control). Furthermore, articles were selected for those with standardized sleep related outcomes, such as the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and actigraphy; alternative assessments were also discussed. Differing treatment modalities within acupuncture were compared for efficacy in sleep related outcomes. 

Results:

Auricular acupuncture (AA) and non-auricular acupuncture (NA) both demonstrated a statistically significant difference compared to sham when evaluating PQSI scores (p = 0.003 and 0.04, respectively). Differences in AA technique and positioning yielded variances in statistical significance (p = 0.0165 to 0.023) compared to sham when evaluating ISI. Examining actigraphy data, a p value of 0.0016 is noted with NA; no significant difference was noted with AA treatment, but positive trends were noted at 1-2 months. 

Conclusions:

Conclusion: Acupuncture is associated with clinically meaningful improvements in sleep quality and insomnia symptoms in patients with PTSD. The magnitude of benefit is moderate, and effects are observed in both subjective and objective sleep parameters. These findings support further investigation of acupuncture as an adjunctive treatment for sleep disturbance in psychiatric populations.