Efficacy and safety of different acupuncture therapies in treating sleep apnea syndrome: a systematic review and network meta-analysis.

Objective: To evaluate and rank the efficacy and safety of different acupuncture (AP) therapies in treating sleep apnea syndrome (SAS).

Methods: We searched PubMed, Web of Science, Cochrane Library, Embase, Wanfang Data, CNKI, CBM, and VIP for randomized controlled trials (RCTs) studying AP for SAS until April 25, 2024. Effectiveness required a >25% decrease in apnea-hypopnea index (AHI) and a >1/3 reduction in symptom scores after treatment. Secondary outcomes included AHI, lowest oxygen saturation (LSaO₂), longest apnea time (LAT), Epworth Sleepiness Scale (ESS) score, and adverse events (AEs). We performed standard pairwise meta-analyses and network meta-analyses (NMA) using Stata15.1 and RStudio4.2.3, assessed evidence quality (GRADE), and ranked treatments using SUCRA values.

Results: Network meta-analysis of 43 randomized trials (3402 SAS patients) revealed distinct efficacy profiles: Electroacupuncture (EA) was the best intervention for reducing apnea-hypopnea index (AHI) (SUCRA=86.0%), while acupoint catgut embedding (ACE) ranked highest for both shortening longest apnea time (LAT) (SUCRA=98.7%) and improving lowest oxygen saturation (LSaO₂) (SUCRA = 89.7%). For reducing daytime sleepiness (ESS), manual acupuncture combined with Chinese herbal decoction (MA+OCHD) was most effective (SUCRA = 87.6%). In terms of overall clinical effectiveness rate, manual acupuncture plus Western medicine (MA+WM) performed best (SUCRA = 79.8%). Safety analysis showed Chinese herbal decoction (OCHD) alone was associated with the fewest adverse events (SUCRA = 93.4%).

Conclusion: AP therapies are effective and safe for SAS. EA or ACE best improves breathing parameters, MA+OCHD best reduces sleepiness, and MA+WM yields the highest overall effectiveness. These findings guide SAS treatment selection.