SynthesisFrontiers in neurology2025
Efficacy and safety of non-pharmacological therapies for primary insomnia: a network meta-analysis.
Synthesis in Frontiers in neurology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
1 citing paper in PubMed, 1 synthesis or guideline pooled it.
Corrections and comments
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Authors and funding
13 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Primary insomnia (PI) is a prevalent sleep disorder that significantly impacts quality of life. While pharmacological treatments are common, concerns about side effects and dependency have led to increased interest in non-pharmacological alternatives. This study systematically evaluates the efficacy and safety of various non-pharmacological therapies for adult PI through a network meta-analysis, providing evidence-based guidance for clinicians. Methods: We analyzed 53 randomized controlled trials (RCTs) involving 4,181 adults with PI. The included studies assessed 11 non-pharmacological interventions, such as acupuncture, acupressure, cupping therapy, and cognitive behavioral therapy (CBT), alongside control groups (e.g., placebo, waitlist, and pharmacological comparators). Primary outcomes included the Pittsburgh Sleep Quality Index (PSQI), total sleep time (TST), sleep efficiency (SE), and sleep latency (SL). Data synthesis was performed using STATA 17 software with a random-effects model, and evidence quality was appraised using the GRADE framework. Results: Pooled analyses revealed that all seven non-pharmacological therapies significantly improved PI outcomes compared to controls. Acupuncture reduced PSQI scores by -2.71 points (95% confidence interval (CI): -4.94 to -0.49) versus waitlist, while acupuncture showed a - 1.81 point reduction (95% CI: -2.93 to -0.68). For SE, acupressure and CBT increased SE by 1.48% (95% CI: 0.56-2.39) and 1.34% (95% CI: 0.70-1.98), respectively, compared to SH. Notably, CBT and acupressure shortened SL by approximately 10 min (e.g., CBT: -10.15 min, 95% CI: -11.79 to -8.52 vs. benzodiazepines), while acupressure extended TST by 2.07 h (95% CI: 0.46-3.68). SUCRA rankings identified CBT as the most effective for reducing SL (85.8% probability) and improving SE (89.2%), whereas acupuncture excelled in increasing TST (84.8%). Adverse events were infrequent and mild, primarily limited to transient localized reactions in acupuncture studies. Conclusion: This study demonstrates that non-pharmacological therapies are effective and safe in managing PI, with CBT, acupuncture, and acupressure emerging as optimal choices for specific sleep parameters. These findings advocate non-pharmacological interventions into clinical practice and offer clinicians valuable insights for selecting appropriate treatment modalities for PI management. However, study limitations like heterogeneity and small sample sizes highlight the need for larger, well-designed RCTs. Future studies should use standardized measures for more specific insomnia assessment.
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