Efficacy of Electroacupuncture on Treating Depression-Related Insomnia: A Randomized Controlled Trial

Abstract

Objective

To evaluate the efficacy of electroacupuncture (EA) on treating insomnia in patients with depression.

Patients and Methods

In a patient-assessor-blind, randomized and sham controlled trial, 90 depression patients with insomnia were assigned into three different groups, receiving EA in the treatment group, superficial acupuncture at sham points in the control group A, or Streitberger non-insertion sham acupuncture in the control group B. Treatment was applied 3 times weekly for 8 consecutive weeks. The primary outcome was measured using the Pittsburgh Sleep Quality Index (PSQI). Secondary outcomes were sleep parameters including sleep efficiency (SE), total sleep time (TST) and numbers of sleep awakenings (SA) recorded in the actigraphy, as well as applying the Hamilton Rating Scale for Depression (HAMD-17), Self-Rating Depression Scale (SDS) and Hamilton Rating Scale for Anxiety (HAMA). Assessments were performed at the baseline (week 0), week 4, week 8, and week 12. Linear mixed-effects models were used for analyses and all statistical tests were two-sided.

Results

Patients in the EA group had more significant improvement in PSQI scores than those in the control groups over time (respectively p<0.001 and p=0.04 for treatment and time interaction). At 8-week posttreatment, the EA group reported a reduction of −6.64 points in PSQI scores compared with −2.23 points in the control group A (95% CI= −5.74 to −2.39) and −2.94 points in the control group B (95% CI= −5.73 to −2.47). Compared with the two control groups, significant between-group differences were seen in SE (both p<0.01) and TST (both p<0.01) at week 8; similar results can be found in HAMD-17, SDS, and HAMA scores as well. However, there were no between-group differences in SA (respectively p=0.24 and p=0.08) after 8-weeks of treatment.

Conclusion

Electroacupuncture may improve the sleep quality of patients with depression.

Trial Registration

Chinese Clinical Trial Registry (ChiCTR); URL: http://www.chictr.org.cn/showproj.aspx?proj=12327; Trial ID: ChiCTR-IIR-16008058.

Keywords:

• insomnia
• depression
• electroacupuncture
• randomized controlled trial

Abbreviations

MDD, major depressive disorder; EA, electroacupuncture; TCM, Traditional Chinese Medicine; PSQI, Pittsburgh Sleep Quality Index; SDS, Self-Rating Depression Scale; HAMD, Hamilton Rating Scale for Depression; HAMA, Hamilton Rating Scale for Anxiety; SE, sleep efficiency; TST, total sleep time; SA, sleep awakening; AE, adverse event; ADM, antidepressant medication; CRF, case report form; RCT, randomized controlled trial; ITT, intention-to-treat; ANOVA, analysis of variance; CBT-I; cognitive behavior therapy for insomnia; MID, minimal important difference; MCID, minimal clinically important difference.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author (Shifen Xu) upon reasonable request. Also, the individual deidentified participant data is available after contacting the corresponding author via email ([email protected]). The data will be available immediately following publication without an end date.

Acknowledgments

The study was partly supported by grants from the National Natural Science Foundation of China (No 81973943), Shanghai Hospital Development Center (No SHDC12016124), and Shanghai Municipal Health Commission (2019LJ06), and sponsored by Shanghai Sailing Program (No 20YF1446200). We would like to thank Dr Philippa Hazlewood from the International Education College, Shanghai University of Traditional Chinese Medicine, for her editorial support.

Disclosure

The authors report no conflicts of interest in this work.