Therapeutic effect of hyperbaric oxygen combined with estazolam on insomnia: A meta-analysis

To investigate the therapeutic efficacy of hyperbaric oxygen combined with estazolam in the treatment of insomnia. A systematic search was performed across the PubMed, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang, and VIP databases to collect literature on the treatment of insomnia with hyperbaric oxygen combined with estazolam published up to July 2025. The extracted content of literature included general information, treatment regimens, outcome indicators, etc. Additionally, the methodological quality of the included studies was assessed. RevMan 5.4 and R 4.4 were used to analyze the heterogeneity and evaluate publication bias. A total of 11 trials with 915 cases were included, including 455 cases from the experimental group and 460 cases from the control group. The Meta-analysis results revealed that the total effective rate of the experimental group was significantly higher than that of the control group ( RR =1.22, 95 % CI =1.11–1.34, Z = 4.27, P < 0.001). After treatment, Pittsburgh Sleep Quality Index (PSQI) score of the experimental group was significantly lower than that of the control group ( SMD =-1.61, 95 % CI =-2.40∼-0.82, Z = -3.99, P < 0.001). After treatment, sleep latency of the experimental group was significantly shorter than that of the control group ( SMD =-0.99, 95 % CI =-1.39∼-0.59, Z = -4.88, P < 0.001). After treatment, total sleep duration of the experimental group was significantly longer than that of the control group ( SMD =1.25, 95 % CI =0.08–2.41, Z = 2.10, P = 0.03). There was no significant difference in the incidence of adverse reactions between the two groups ( RR =0.54, 95 % CI =0.20–1.50, Z = -1.18, P = 0.24). Begg’s test and funnel plot indicated no publication bias ( P > 0.05). The combined application of hyperbaric oxygen and estazolam represents an effective treatment for insomnia, significantly improving sleep quality, reducing sleep latency, and presenting no serious adverse reactions.