Efficacy of auriculotherapies for primary insomnia: A systematic review and network meta-analysis

BACKGROUND: Auriculotherapy has been used extensively for insomnia in traditional Chinese medicine due to its high effectiveness and few adverse effects. However, there are several auriculotherapy approaches, and it's still uncertain which is best for treating primary insomnia (PI). The purpose of this study is to determine the best auriculotherapy strategy for treating PI. METHODS: A comprehensive search was conducted across 8 databases to identify randomized controlled trials investigating the use of auriculotherapy for the treatment of PI. The search period spanned from database inception through July 28, 2025. The observation group received either single or combined auriculotherapy, while the control group was given another type of auriculotherapy, oral eszopiclone, sham stimulation, or usual care. The primary outcome was the Pittsburgh Sleep Quality Index, and the secondary outcome was safety assessments. Methodological quality was assessed with the Cochrane Risk of Bias Tool (version 5.1.0). Data analysis was done using Stata 16.0 and Review Manager 5.4. RESULTS: A total of 25 studies were included, covering 11 distinct auriculotherapies, and 2106 patients with PI diagnoses were included. The results of the traditional comparison showed that both auricular acupressure and transcutaneous auricular vagus nerve stimulation were more effective than the control group at lowering Pittsburgh Sleep Quality Index scores. According to the findings of the network meta-analysis, 11 auriculotherapies were more effective than sham stimulation or usual care at treating PI. According to the surface under the cumulative ranking curve values, the following are the top 5 interventions, in order of probability: Auricular bloodletting + auricular acupressure (85.8%), auricular massage + auricular scraping + auricular acupressure (85.5%), auricular scraping + auricular acupressure (84.8%), auricular needle-embedding + auricular acupressure (71.2%), and auricular acupuncture + auricular acupressure (67.5%). CONCLUSION: The most effective auriculotherapy regimens for PI are auricular bloodletting + auricular acupressure and auricular massage + auricular scraping + auricular acupressure. However, because of the small number of studies included in the current meta-analysis, these results need to be confirmed. Future studies should focus on high-quality, suitably powered randomized controlled trials that compare these auriculotherapy modalities head-to-head.