Effects of acupuncture on the brain in primary insomnia: a coordinate-based meta-analysis of fMRI studies

Altered connection properties of the left dorsolateral superior frontal gyrus in de novo drug-naïve insomnia disorder

Background

Insomnia disorder (ID) is increasingly prevalent, posing significant risks to patients' physical and mental health. However, its neuropathological mechanisms remain unclear. Despite extensive research on ID using resting-state functional magnetic resonance imaging, a unified framework for describing its brain function alterations remains absent. Moreover, most prior studies have not fully accounted for the potential impact of medication on outcomes regarding enrollment criteria.

Methods

We recruited 22 ID and 22 healthy controls (HC), matched for age and gender. Patients with ID were never prescribed medications for sleep disorders before enrollment. We detected differences in voxel-wise degree centrality (DC) between the two groups and analyzed the correlation between altered DC values and insomnia severity. Additionally, we conducted receiver operating characteristic analysis to evaluate the diagnostic effectiveness of the altered DC values for ID.

Results

In ID patients, the weighted DC values of the left dorsolateral superior frontal gyrus (SFG) and the left supramarginal gyrus (SMG) were significantly lower than those of HC, with a notable negative correlation between the weighted DC values of the left dorsolateral SFG and PSQI scores. Receiver operating characteristic analysis showed that the weighted DC of the left dorsolateral SFG effectively differentiates between ID and HC, exhibiting high sensitivity and specificity.

Conclusion

This study offers new insights into brain dysfunction and the pathophysiology of ID through voxel-based DC measurements. The results indicate that altered DC properties of the left dorsolateral SFG might serve as a diagnostic marker for ID and a potential therapeutic target for brain function modulation.

Research status and trends of functional magnetic resonance imaging technology in the field of acupuncture: a bibliometric analysis over the past two decades

Objective

Although fMRI has been widely used in the field of acupuncture. However, the literature analysis in this field still has significant differences. This study summarizes the current status of functional magnetic resonance imaging (fMRI) in the field of acupuncture and moxibustion and predicts its future trends through Web of Science bibliometric analysis.

Methods

This study uses "fMRI" and "acupuncture" as keywords to search for literature related to functional magnetic resonance imaging (fMRI) in acupuncture research in the Web of Science Core Collection database from January 1, 2004, to April 30, 2024. Visualization analyses were conducted using Citespace (version 6.3 R1) and VOSviewer (version 1.6.20). Citespace was employed to analyze annual publications, countries, institutions, keywords, and co-cited references. VOSviewer was used to analyze authors and co-cited authors, as well as journals and co-cited journals.

Results

From 2004 to 2024, a total of 967 publications were retrieved, of which 557 were included after screening. Despite annual fluctuations, the overall trend shows an increase. China and the Chinese Academy of Sciences are the countries and institutions with the highest number of publications, with Tian, J being the author with the most publications, and Kong, J having the highest Co-citation frequency. The article by Dhond, RP, published in 2008, has the highest Co-citation frequency among the co-cited literature. Evidence-based Complementary and Alternative Medicine is the journal with the most publications, while Neuroimage is the co-cited journal with the highest citation frequency. Keyword co-occurrence and burst reveal the main research hotspots, including the diversity of intervention methods, cortical activation, mechanisms related to pain-associated diseases, and brain-related diseases. Keyword burst detection reflects emerging trends, including meta-analysis and systematic reviews, the relationship between ischemic stroke and women, and the connection between mild cognitive impairment and prevention.

Conclusion

This study employs bibliometric methods to explore the current status, research hotspots, and frontier issues regarding the application of functional magnetic resonance imaging (fMRI) technology in the field of acupuncture, providing new perspectives and directions for acupuncture fMRI research.

Brain function assessment of acupuncture for chronic insomnia disorder with mild cognitive dysfunction based on fNIRS: protocol for a randomized controlled trial

Background

Chronic Insomnia Disorder (CID) is highly prevalent among older adults and impairs cognitive function. Insomnia accelerates the progression of mild cognitive impairment (MCI) and increases the risk of developing dementia. Acupuncture has been demonstrated in improving sleep quality and cognitive function. This study aims to explore the functional brain characteristics of CID with MCI patients and to assess the effects of acupuncture therapy using functional near-infrared spectroscopy (fNIRS).

Methods and design

This study is a single-center randomized controlled trial. Participants will be randomly assigned to the manual acupuncture group or the placebo acupuncture group for an 8-week intervention period. fNIRS data will be collected during resting test and working memory test at baseline and at end of the intervention. The primary outcome is the change of the Montreal Cognitive Assessment (MoCA) score, secondary outcomes include the change of Mini-Mental State Examination (MMSE), Insomnia Severity Index (ISI), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7), and Apathy Evaluation Scale-Informant (AES-I).

Discussion

The results of the study will provide insights into the effects of acupuncture on sleep quality and cognitive performance in CID with MCI patients. By utilizing fNIRS technology, we will elucidate the neural functional characteristic underlying the therapeutic benefits of acupuncture.

Clinical trial registration

https://ClinicalTrials.gov, identifier ChiCTR2300076182.

Exploring the pathogenesis of insomnia and acupuncture intervention strategies based on the microbiota-gut-brain axis

Insomnia is a common sleep disorder observed in clinical settings, with a globally rising prevalence rate. It not only impairs sleep quality and daytime functioning but also contributes to a range of physiological and psychological conditions, often co-occurring with somatic and mental disorders. Currently, the pathophysiology of this condition is not fully understood. Treatment primarily involves symptomatic management with benzodiazepine receptor agonists, melatonin and its receptor agonists, sedative antidepressants, atypical antipsychotics, and orexin receptor antagonists. However, due to the adverse side effects of these drugs, including dependency, addiction, and tolerance, there is an urgent need for safer, more effective, and environmentally friendly treatment methods. In recent years, research on the microbiota-gut-brain axis has received significant attention and is expected to be key in uncovering the pathogenesis of insomnia. Acupuncture stimulates acupoints, activating the body's intrinsic regulatory abilities and exerting multi-pathway, multi-target regulatory effects. A substantial body of evidence-based research indicates that acupuncture is effective in treating insomnia. However, the unclear mechanisms of its action have limited its further clinical application in insomnia treatment. Therefore, this study aims to elucidate the pathogenesis of insomnia from the perspective of the microbiota-gut-brain axis by examining metabolic, neuro-endocrine, autonomic nervous, and immune pathways. Additionally, this study discusses the comprehensive application of acupuncture in treating insomnia, aiming to provide new strategies for its treatment.

Acupuncture modulates emotional network resting-state functional connectivity in patients with insomnia disorder: a randomized controlled trial and fMRI study

BACKGROUND

Insomnia disorder (ID) is one of the most common sleep problems, usually accompanied by anxiety and depression symptoms. Functional magnetic resonance imaging (fMRI) study suggests that both poor sleep quality and negative emotion are linked to the dysregulation of brain network related to emotion processing in ID patients. Acupuncture therapy has been proven effective in improving sleep quality and mood of ID patients, but the involved neurobiological mechanism remains unclear. We aimed to investigate the modulation effect of acupuncture on resting-state functional connectivity (rsFC) of the emotional network (EN) in patients experiencing insomnia.

METHODS

A total of 30 healthy controls (HCs) and 60 ID patients were enrolled in this study. Sixty ID patients were randomly assigned to real and sham acupuncture groups and attended resting-state fMRI scans before and after 4 weeks of acupuncture treatment. HCs completed an MRI/fMRI scan at baseline. The rsFC values within EN were calculated, and Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), Pittsburgh Sleep Quality Index (PSQI), Hyperarousal Scale (HAS), and actigraphy data were collected for clinical efficacy evaluation.

RESULTS

Resting-state FC analysis showed abnormalities in rsFC centered on the thalamus and dorsolateral prefrontal cortex within EN of ID patients compared to HCs. After real acupuncture treatment, rsFC of the anterior cingulate cortex, hippocampus, and amygdala were increased compared with the sham acupuncture group (p < 0.05, FDR corrected). In real acupuncture group, the rsFC value was decreased between left amygdala and left thalamus after 4 weeks of treatment compared with baseline. A trend of correlation was found that the increased rsFC value between the right amygdala and left hippocampus was positively correlated with the decreased HAMA scores across all ID patients, and the decreased left amygdala rsFC value with the left thalamus was negatively correlated with the increased sleep efficiency in the real acupuncture group.

CONCLUSION

Our findings showed that real acupuncture could produce a positive effect on modulating rsFC within network related to emotion processing in ID patients, which may illustrate the central mechanism underlying acupuncture for insomnia in improving sleep quality and emotion regulation.

TRIAL REGISTRATION

http://www.chictr.org.cn ., ChiCTR1800015282, 20/03/2018.

Acupuncture for primary insomnia: Effectiveness, safety, mechanisms and recommendations for clinical practice

Primary insomnia (PI) is an increasing concern in modern society. Cognitive-behavioral therapy for insomnia is the first-line recommendation, yet limited availability and cost impede its widespread use. While hypnotics are frequently used, balancing their benefits against the risk of adverse events poses challenges. This review summarizes the clinical and preclinical evidence of acupuncture as a treatment for PI, discussing its potential mechanisms and role in reliving insomnia. Clinical trials show that acupuncture improves subjective sleep quality, fatigue, cognitive impairments, and emotional symptoms with minimal adverse events. It also positively impacts objective sleep processes, including prolonging total sleep time, improving sleep efficiency, reducing sleep onset latency and wake after sleep onset, and enhancing sleep architecture/structure, including increasing N3% and REM%, and decreasing N1%. However, methodological shortcomings in some trials diminish the overall quality of evidence. Animal studies suggest that acupuncture restores circadian rhythms in sleep-deprived rodents and improves their performance in behavioral tests, possibly mediated by various clinical variables and pathways. These may involve neurotransmitters, brain-derived neurotrophic factors, inflammatory cytokines, the hypothalamic-pituitary-adrenal axis, gut microbiota, and other cellular events. While the existing findings support acupuncture as a promising therapeutic strategy for PI, additional high-quality trials are required to validate its benefits.