An ancient practice may offer modern relief for sleep disturbances experienced by patients with multiple myeloma undergoing hematopoietic stem cell transplant (HSCT), according to research published by El Iskandarani et al in Acupuncture in Medicine. Based on a randomized, prospective study of 63 adults undergoing inpatient or outpatient autologous HSCT who also received acupuncture treatment, improvements in certain aspects of sleeping, including sleep efficiency and wakefulness after sleep onset, were noted.
“We found that true acupuncture may improve certain aspects of sleep quality in [patients with] multiple myeloma receiving autologous HSCT,” noted lead study author Sarah El Iskandarani, MD, of the Integrative Medicine Service at Memorial Sloan Kettering Cancer Center (MSK), New York. “Specifically, acupuncture was found to improve sleep efficiency significantly when compared to sham acupuncture in our study, particularly in inpatients. There were also tendencies toward higher wakefulness after sleep onset in the acupuncture vs sham group and reduced sleep-onset latency time for inpatients vs outpatients,” Dr. El Iskandarani added.
According to the study authors, sleep disturbance is a common and debilitating symptom experienced by patients undergoing HSCT, often persisting for more than 6 months after treatment. Current management approaches mainly involve pharmacologic interventions, which may lead to unwelcome side effects, Dr. El Iskandarani noted.
The randomized, sham-controlled trial took place over 32 months, with 63 adults enrolled (later reduced to 60 evaluable patients). Patients were randomly assigned to receive either true or sham acupuncture (administered by licensed acupuncturists) starting the day after receipt of chemotherapy. Both groups were administered their respective treatments daily for 5 consecutive days. The acupuncturists alone were privy to the treatment details, ensuring that blinding was effectively upheld. A multivariate regression analysis was used to compare sleep outcomes between the two groups.
Secondary Analysis Shows Improved Sleep Quality
In the secondary analysis, with sleep quality as a secondary outcome measure, the study revealed a significant improvement in sleep efficiency among those receiving true acupuncture vs sham acupuncture. Of note, this improvement was more pronounced among inpatient recipients, offering a potential solution for those facing multiple sleep-disruptive factors inherent to in-hospital treatment. Differences did not achieve statistical significance for other sleep-related variables, the study authors noted.
“One of the strengths of our study is the fact that our population of patients is known for experiencing a high symptom burden,” Dr. El Iskandarani noted. “Most previous studies investigating the effect of acupuncture on insomnia have included patients [without cancer], and only a few have included insomnia patients with comorbidities such as stroke, end-stage renal disease, perimenopause, or psychiatric diseases. Comparatively, few studies have investigated the effect of acupuncture on sleep quality in patients [with cancer],” she added.
Although acupuncture was associated with improved sleep quality, the researchers could not be certain whether the effects were directly or indirectly related to the intervention, given that acupuncture can reduce HSCT symptoms such as pain, nausea, and vomiting. Researchers also highlighted the positive safety profile of the intervention, with acupuncture being associated with few attributable adverse events. This suggests that acupuncture potentially adds another tool to the symptom management kit for patients undergoing HSCT, without the associated concern of additional adverse events.
As the results pertain to a secondary outcome, however, authors advised caution with respect to interpretation and noted that further verification will be necessary in a larger trial setting. “Future research could focus on the delineation of specific aspects of sleep quality and patient-reported outcomes associated with acupuncture,” Dr. El Iskandarani noted. “Moreover, it would be interesting to explore whether acupuncture's efficacy lies directly in sleep quality improvement or indirectly by way of reducing contributing symptoms.”
Disclosure: The original study was funded by a grant from the Gateway for Cancer Research and the MSK Integrative Medicine and Translational Research Grant. The researchers received support from the National Institutes of Health/National Cancer Institute and Patient-Centered Outcomes Research Institute. For full disclosures of the study authors, visit journals.sagepub.com.
