Are acupuncture and related therapies effective in reducing sleep disturbances among perimenopausal and postmenopausal women?
Date of publication of the systematic review: March 2016
Design
Systematic review of 31 randomized controlled trials (RCTs).
Participants
2433 women who experienced medically induced or natural menopause-related symptoms (mean age range: 44.1 to 63.0 years).
Intervention
Acupuncture therapies included manual needle acupuncture, electro acupuncture, auricular acupuncture, point stimulation, and transcutaneous electrical acupoint stimulation. The frequency and duration of each acupuncture session were not reported by the reviewer.
Comparator
Comparison: Acupuncture and related therapies versus Chinese herbs or sham acupuncture.
Major Outcomes
Outcome 1: Menopause-related sleep disturbances as measured by Pittsburgh Sleep Quality Index at the end of treatment;
Outcome 2: Secretion of serum estradiol (pg/mL) as measured at the end of treatment;
Outcome 3: Reduction in the secretion of serum follicle-stimulating hormone level (milli-international units/mL) as measured at the end of treatment;
Outcome 4: Reduction in the secretion of serum luteinizing hormone level (milli-international units/mL) as measured at the end of treatment.
Settings
The reviewers did not state whether the included trials were conducted in inpatient or outpatient settings. 26 trials were conducted in China, and the reviewers did not state where the remaining trials were conducted.
Comparison    Acupuncture and related therapies versus Chinese herbs or sham acupuncture
Main Results
Compared to Chinese herbs or sham acupuncture, acupuncture and related therapies were associated with a significant reduction in sleep disturbances (pooled weighted mean difference (pooled WMD): -3.26, 95%CI: -4.5 to -2.0). Acupuncture and related therapies showed a significant increase in the secretion of serum estradiol (pooled WMD: 7.56pg/mL, 95% CI: 4.03 to 11.08). Besides, there were significant reductions in the secretion of serum follicle- stimulating hormone (pooled WMD: -6.75 milli-international units/mL, 95% CI: -12.16 to -1.34) and luteinizing hormone (pooled WMD: -2.71 milli-international units/mL, 95%CI: -4.22 to -1.20).
Comparison: Acupuncture and related therapies versus Chinese herbs or sham acupuncture among perimenopausal and postmenopausal women
Outcomes (unit) No. of studies (Total no. of participants) Mean value / No. of participants Heterogeneity test (I2) Pooled WMD (95% CI) Overall quality of evidence*
Intervention Comparator
1 (NA) 31/ not reported Not reported Not reported 76.33% -3.26 (-4.5 to -2.0) Low
2 (pg/mL) 8/ not reported 42.38/ not reported 34.25/ not reported 93.35% 7.56 (4.03 to 11.08) Moderate
3 (milli-international units/mL) 7/ not reported 50.87/ not reported 51.03/ not reported 75.56% -6.75 (-12.16 to -1.34) Moderate
4 (milli-international units/mL) 7/ not reported 48.03/ not reported 34.92/ not reported 0% -2.71 (-4.22 to -1.20) High
Keys: WMD = weighted mean difference; CI = confidence interval.
Comparison    Acupuncture and related therapies versus Chinese herbs or sham acupuncture
Main Results
Compared to Chinese herbs or sham acupuncture, acupuncture and related therapies were associated with a significant reduction in sleep disturbances (pooled weighted mean difference (pooled WMD): -3.26, 95%CI: -4.5 to -2.0). Acupuncture and related therapies showed a significant increase in the secretion of serum estradiol (pooled WMD: 7.56pg/mL, 95% CI: 4.03 to 11.08). Besides, there were significant reductions in the secretion of serum follicle- stimulating hormone (pooled WMD: -6.75 milli-international units/mL, 95% CI: -12.16 to -1.34) and luteinizing hormone (pooled WMD: -2.71 milli-international units/mL, 95%CI: -4.22 to -1.20).
Comparison: Acupuncture and related therapies versus Chinese herbs or sham acupuncture among perimenopausal and postmenopausal women
Outcomes (unit) 1 (NA) 2 (pg/mL) 3 (milli-international units/mL) 4 (milli-international units/mL)
No. of studies (Total no. of participants) 31/ not reported 8/ not reported 7/ not reported 7/ not reported
Mean value / No. of participants Intervention Not reported 42.38/ not reported 50.87/ not reported 48.03/ not reported
Comparator Not reported 34.25/ not reported 51.03/ not reported 34.92/ not reported
Pooled WMD (95% CI) -3.26 (-4.5 to -2.0) 7.56 (4.03 to 11.08) -6.75 (-12.16 to -1.34) -2.71 (-4.22 to -1.20)
Overall quality of evidence* Low Moderate Moderate High
Keys: WMD = weighted mean difference; CI = confidence interval.
Conclusion
Benefits
Compared to Chinese herbs or sham acupuncture, acupuncture and related therapies reduced sleep disturbances among perimenopausal and postmenopausal women. The overall quality of evidence is low. Further research is likely to have an important impact on our confidence in this estimate of effect. It showed a significant increase in the secretion of serum estradiol. Besides, they provided significant reduction in the secretion of serum follicle- stimulating hormone and luteinizing hormone. However, trustworthiness of the result is limited due to significant heterogeneity and the case of surrogate outcome. For outcomes 2 and 3, the overall quality of evidence is moderate. Further research is fairly likely to have an important impact on our confidence in this estimate of effect. For outcome 4, the overall quality of evidence is high. Further research is unlikely to have an important impact on our confidence in this estimate of effect.
Harms
Adverse events were not mentioned by the authors of this review.
Link to Original Article
https://www.ncbi.nlm.nih.gov/pubmed/26855097
The synopsis is based on the following article:
Chiu HY, Hsieh YJ, Tsai PS. Acupuncture to Reduce Sleep Disturbances in Perimenopausal and Postmenopausal Women: A Systematic Review and Meta-analysis. Obstet Gynecol. 2016 Mar;127(3):507-15.


* Interpretation of quality assessment results:
• Very low: Further research is most likely to have an important impact on our confidence in this estimate of effect.
• Low: Further research is likely to have an important impact on our confidence in this estimate of effect.
• Moderate: Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
• High: Further research is unlikely to have an important impact on our confidence in this estimate of effect.
• Very high: Further research is most unlikely to have an important impact on our confidence in this estimate of effect.

Details of assessment method can be found at Chung VC, Wu XY, Ziea ET, Ng BF, Wong SY, Wu JC. Assessing internal validity of clinical evidence on effectiveness of CHinese and integrative medicine: Proposed framework for a CHinese and Integrative Medicine Evidence RAting System (CHIMERAS). European Journal of Integrative Medicine. 2015 Aug 31;7(4):332-41.