Abstract
BACKGROUND: Primary insomnia (PI) is a chronic sleep disorder with a complex pathogenesis, and various treatment options are available. In recent years, multiple acupoint stimulation therapies have gained increasing attention as non-pharmacological interventions. This systematic review and network meta-analysis aimed to assess the comparative efficacy of different acupoint stimulation therapies for PI. METHODS: We searched eight Chinese and English databases and six trial registries from inception to September 22, 2024. Outcomes included total effective rate (TER), Pittsburgh Sleep Quality Index (PSQI) with its six subcomponents, and the change in PSQI scores (ΔPSQI) from baseline to post-treatment. A random-effects model was used for the network meta-analysis. Risk of bias and certainty of evidence were assessed using the ROB2 tool and CINeMA framework. The PROSPERO registration number is CRD42025640547. RESULTS: A total of 95 RCTs involving 7,628 patients were included, comparing 14 acupoint stimulation therapies and involving 108 major acupoints. Body acupuncture combined with electroacupuncture ranked highest in improving the TER (SUCRA: 0.874), while moxibustion combined with tuina was most effective in reducing the total PSQI score (0.966). Moxibustion alone demonstrated the greatest improvement in the PSQI score difference (0.933). Electroacupuncture combined with auricular acupressure showed superior effectiveness in improving all six PSQI subcomponents. The most frequently used acupuncture points were Shenmen (HT 7, 62.1%), Baihui (GV 20, 56.3%), and Anmian (EX-HN 22, 45.8%), while the most commonly used ear points included Shenmen (TF(4), 17.4%), Xin (CO(15), 14.2%), and Pizhixia (AT(4), 11.1%). Cluster analysis identified eight prevalent patterns of point compatibility. CONCLUSIONS: The tolerability and long-term efficacy of different acupoint stimulation therapies for primary insomnia remain unclear. These findings support individualized treatment and acupoint compatibility, laying the groundwork for optimizing intervention protocols and exploring neuroimmune mechanisms. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD42025640547, identifier CRD42025640547.