Objective  To evaluate the efficacy of non-drug intervention in improving insomnia symptoms after stroke by a network Meta-analysis.

Methods  PubMed, The Cochrane Library, Embase, Web of Science, CNKI, WanFang Data, VIP and CBM were searched for the randomized controlled trials (RCTs) about the improvement of post-stroke insomnia symptoms by non-drug intervention from the inception of the databases to May 2024. Two researchers screened the literature, extracted data, and evaluated the risk of bias of the included studies. Stata 15.0 software was used to perform a network Meta-analysis.

Results  A total 42 RCTs, including 2 945 patients, involving nine non-pharmaceutical interventions (auricular application pressure, hyperbaric oxygen therapy, repetitive transcranial magnetic stimulation, point application, Chinese medicine foot bath, acupuncture, acusector, five-tone therapy, moxibustion).

Results of the network Meta-analysis showed that, in the aspects of PSQI scores, the effects of Chinese medicine foot bath [MD=-3.70, 95%CI(- 6.04, -1.36)], acusector [MD=-3.50, 95%CI(-5.36, -1.64)], repetitive transcranial magnetic stimulation [MD=-3.33, 95%CI(-4.70, -1.95)], acupuncture [MD=-2.95, 95%CI(-3.72, -2.19)] and auricular application pressure [MD=-2.93, 95%CI(-4.38, -1.47)] were better than that of western medicine for sedation and sleep (P<0.05). The effect of Chinese medicine foot bath was the best. In terms of total effective rate, acusector [OR=6.32, 95%CI(2.97, 13.47)], acupuncture [OR=4.41, 95%CI(3.01, 6.48)] and auricular application pressure [OR=3.63, 95%CI(1.91, 6.87)] were superior to western medicine for sedation and sleep (P<0.05). Acusector had the best effect.

Conclusion  The existing evidence showed that Chinese medicine foot bath could improve the PSQI score of sleep quality after stroke, and acusector had certain advantages in improving the total effective rate of insomnia symptoms after stroke, but more high-quality and large sample randomized controlled studies are needed to further verify this conclusion.

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