Ten RCTs were included in this review (n=846). Overall methodological quality was described as poor, only three RCTs described their randomisation method and this was judged appropriate in two trials. No trials reported on allocation concealment, three mentioned blinding their participants, and only three reported drop-out and withdrawal rates. According to the auricular acupuncture quality assessor, 8/10 trials scored 80% or more on the visual analogue scale that measured confidence in the appropriate application of acupuncture. The assessor would have treated the patient groups in a similar or same manner as eight trials.
Auricular acupuncture versus placebo auricular acupuncture (three trials): Meta-analysis of two trials that compared magnetic pellet auricular acupuncture with placebo showed a significant effect in favour of the active treatment for sleep efficiency with no significant heterogeneity (WMD 7.5, 95% CI 2.2 to 12.9, p=0.006). The same two trials reported mixed results in terms of nocturnal sleeping time: one found a positive effect over placebo and the second found no effect. The third RCT compared needle auricular acupuncture with placebo and found no significant differences between groups for any of the reported sleep parameters.
Auricular acupuncture versus conventional drugs (four trials): Three RCTs compared Semen Vaccariae (SV) radish seeds with conventional drugs. All reported statistically significant benefits for the auricular acupuncture group over the controls, however, due to statistical heterogeneity pooling was not considered appropriate (no further details reported). One RCT compared magnetic pellet auricular acupuncture with diazepam and reported significantly greater benefits for symptoms and emotions relating to sleep for the auricular acupuncture group.
Auricular acupuncture versus no treatment or routine care (three trials): Two RCTs compared auricular acupuncture with thumb-tack type needles versus no treatment and reported significant effects in favour of auricular acupuncture for sleep score and satisfaction scores. Pooling was not possible due to the limited data reported in these studies. The third RCT compared Semen Vaccariae auricular acupuncture with usual care and found beneficial effects in favour of the auricular acupuncture intervention.