Effects of Acupuncture on Sleep Quality, Psychological Status, and Neuroendocrine Biomarkers in Patients With Chronic Insomnia: A Systematic Review and Meta-Analysis

Abstract

Chronic insomnia impairs daytime functioning and increases the risk of cardiovascular and psychiatric disorders. Although cognitive behavioral therapy and pharmacotherapy are conventional treatments, their use may be limited by implementation barriers and adverse effects. This study systematically evaluated the efficacy of acupuncture compared with sham acupuncture for chronic insomnia. Nine English- and Chinese-language databases and clinical trial registries were searched from inception to July 1, 2026, for randomized controlled trials (RCTs). Eligible studies included patients aged 18–65 years with a formal diagnosis of chronic insomnia. The primary outcome was sleep quality; secondary outcomes included objective sleep parameters, psychological status, and neuroendocrine biomarkers. Random-effects models were used, and evidence certainty was assessed using the Grading of Recommendations Assessment, Development and Evaluation framework. Fourteen RCTs involving 957 patients were included. Acupuncture significantly improved sleep quality compared with sham acupuncture (standardized mean difference = −0.97, 95% confidence interval [−1.24, −0.69]). Manual acupuncture reduced sleep latency and increased total sleep time, whereas electroacupuncture showed no clear advantage over sham acupuncture for these outcomes. Acupuncture also reduced cortisol and increased serum gamma-aminobutyric acid (GABA) levels but did not significantly improve melatonin levels, anxiety, or depressive symptoms. Acupuncture may improve sleep quality and objective sleep parameters in patients with chronic insomnia. These effects may involve regulation of the hypothalamic–pituitary–adrenal axis and GABAergic system. Due to the methodological limitations of the included studies, the overall quality of evidence is moderate. Larger, rigorously reported trials are needed to strengthen the evidence.