The Role of Acupuncture in Treating Perimenopausal Insomnia: An Overview and Quality Assessment of Systematic Reviews and Meta-Analyses

Abstract

Fei-Yi Zhao,1– 3,* Wen-Jing Zhang,3,* Gerard A Kennedy,1,4,5 Russell Conduit,1 Zhen Zheng,1 Qiang-Qiang Fu6 1School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, 3083, Australia; 2Department of Nursing, School of International Medical Technology, Shanghai Sanda University, Shanghai, 201209, People’s Republic of China; 3Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200071, People’s Republic of China; 4School of Science, Psychology and Sport, Federation University, Mount Helen, Victoria, Australia; 5Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, 3084, Australia; 6Department of General Practice, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, 200090, People’s Republic of China*These authors contributed equally to this workCorrespondence: Zhen ZhengSchool of Health and Biomedical Sciences, RMIT University, PO Box 71, Bundoora, Victoria, 3083, AustraliaTel [phone]Fax [phone]Email [email protected] FuDepartment of General Practice, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, 200090, People’s Republic of ChinaTel [phone]Fax [phone]Email [email protected]: To summarize and critically assess the reliability of the methodological quality and outcome measures from systematic reviews (SRs)/meta-analyses (MAs) and provide an overall verdict about the therapeutic value of acupuncture for perimenopausal insomnia (PMI).Methods: We conducted a comprehensive literature search for SRs/MAs of seven major databases (English and Chinese). For each included review, the methodological quality was appraised according to the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2), the evidence quality was classified on the basis of the Grading of Recommendations, Assessment, Development and Evaluation (GRADE), and reporting quality was evaluated complying with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 (PRISMA-2009). Veritas plots were used to quantify the quality of included SRs/MAs.Results: Nine SRs/MAs were deemed eligible for the present overview. Considering the assessment of results from the AMSTAR-2 checklist, the methodological quality of one SR/MA was considered low, and the remaining eight were critically low. Major methodological deficiencies were concentrated on item 2 (the lack of protocol and/or registration information), item 7 (the lack of a list of excluded studies), and item 10 (the lack of reports on funding sources for individual studies included in the SRs/MAs). For the GRADE system, of the 25 outcomes, only three (12%) were rated as moderate-quality, while the remaining 22 were rated between low- and very low-quality. The PRISMA-2009 statement indicated three major reporting quality limitations in most SRs/MAs, namely: 1) only search terms without specific retrieval strategy; 2) incomplete descriptions for study characteristics, particularly the specific dosage and frequency of interventions in treatment/control groups; and 3) inadequate investigation and explanation of the source of high heterogeneity among original randomized control trials included. According to Veritas plots, quality rank scores of included SRs/MAs ranged from 3.3 to 8.3, with an average score of 6.4 ± 1.7.Conclusion: Acupuncture appears to be beneficial for PMI management, but the quality of evidence is weakened by the unsatisfactory quality of both SRs/MAs and original trials included.Keywords: acupuncture, perimenopausal insomnia, systematic review, meta-analysis, methodological quality, quality of evidence

Keywords

• acupuncture
• perimenopausal insomnia
• systematic review
• meta-analysis
• methodological quality
• quality of evidence