Invasive or noninvasive? A systematic review and network meta-analysis of acupuncture and acupressure to treat sleep disturbance in cancer patients

Background: Both acupuncture and acupressure have been suggested beneficial for reducing sleep disturbance in cancer patients. While acupuncture is invasive involving needle insertion, acupressure is noninvasive. Their comparative effectiveness is unclear, hindering clinical recommendations. Aims: This study aimed to explore the comparative effectiveness of acupuncture and acupressure on sleep in cancer patients. Methods: This is a systematic review and Bayesian network meta-analysis. Eight key English and Chinese databases were searched. Twenty-four randomized controlled trials involving 2002 cancer patients comparing the effects of six treatments (manual acupuncture, electroacupuncture, acupressure, sham, enhanced usual care, and no treatment) on sleep were found. Results: Compared with enhanced supportive care, acupressure demonstrated the largest effect size for reducing self-reported sleep disturbance (standardized mean difference [SMD] = −2.67, 95% CrI: −3.46 to −1.90; GRADE = moderate), followed by acupuncture (SMD = −1.87, 95% CrI: −2.94 to −0.81, GRADE = moderate) and electroacupuncture (SMD = −1.60, 95% CrI: −3 to −0.21; GRADE = low). The surface under the cumulative ranking curve indicates that acupressure is most likely to rank highest. Linking Evidence to Action: Based on available evidence, acupressure can be recommended as the optimal treatment for reducing sleep disturbance in cancer patients. More rigorous trials are warranted to confirm whether different forms of acupuncture or acupressure have different effects on sleep in cancer patients. Particularly, studies examining acupuncture interventions alone instead of in combination with other therapies are needed.