Auricular Acupressure for Insomnia in Patients with Decompensated Hepatitis B-Related Liver Cirrhosis: A Clinical Observation

Abstract

Objective

This study aims to evaluate the efficacy and safety of auricular acupressure for insomnia in patients with decompensated hepatitis B-related liver cirrhosis (DHBV-LC).

Methods

This prospective randomized controlled trial enrolled 60 patients with DHBV-LC and comorbid insomnia between May 2023 and June 2024. The participants were randomly divided into two groups: a control group (n = 30) receiving standard therapy and an intervention group (n = 30) receiving standard therapy combined with auricular acupressure for a course of 4 weeks. The observed indicators included the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), traditional Chinese medicine (TCM) syndrome scores, clinical response rates, and adverse events. Independent-sample t-tests and chi-square (χ²) tests were used for statistical analysis.

Results

Both groups showed significant reductions in PSQI, ISI, and TCM syndrome scores compared with baseline (P < 0.05). The intervention group showed greater reductions in PSQI (3.51 ± 0.69 vs 2.62 ± 0.68; P < 0.001), ISI (5.17 ± 1.05 vs 3.43 ± 1.27; P < 0.001), and TCM syndrome (11.23 ± 1.17 vs 13.60 ± 1.19; P < 0.001) scores. Clinical response rates were higher in the intervention group (86.7% vs 65.5%; P < 0.05). No significant difference in adverse events was observed (P > 0.05).

Conclusion

Auricular acupressure can significantly improve sleep quality in patients with insomnia secondary to DHBV-LC with good safety and tolerability, making it a promising therapeutic approach worthy of wider clinical application.

Keywords

sleep initiation and maintenance disorders liver cirrhosis chronic hepatitis B acupressure

Get full access to this article

View all access options for this article.

References

Butt

M. F.

Albusoda

Farmer

A. D.

Aziz

(2020). The anatomical basis for transcutaneous auricular vagus nerve stimulation. Journal of Anatomy, 236(4), 588–611. https://doi.org/10.1111/joa.13122

Chinese Society of Neurology, Chinese Medical Association; Chinese Society of Sleep Disorders, Chinese Society of Neurology, Chinese Medical Association. (2018). Chinese Guideline for diagnosis and treatment of insomnia (2017). Chinese Journal of Neurology, 51(5), 324–335. https://doi.org/10.3760/cma.j.issn.1006-7876.2018.05.002

Córdoba

Cabrera

Lataif

Penev

Zee

Blei

A. T.

(1998). High prevalence of sleep disturbance in cirrhosis. Hepatology, 27(2), 339–345. https://doi.org/10.1002/hep.510270204

Edinger

J. D.

Arnedt

J. T.

Bertisch

S. M.

Carney

C. E.

Harrington

J. J.

Lichstein

K. L.

Sateia

M. J.

Troxel

W. M.

Zhou

E. S.

Kazmi

Heald

J. L.

Martin

J. L.

(2021). Behavioral and psychological treatments for chronic insomnia disorder in adults: An American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine, 17(2), 255–262. https://doi.org/10.5664/jcsm.8986

Fakih

Perbawati

, Monalisa. (2022). Relevance of WHO traditional medicine strategy (2014–2023) with traditional health care policy in the perspective of national law and international law. Asian Journal of Legal Studies, 1(1), 25–34. https://doi.org/10.53402/ajls.v1i1.117

Gallego-Durán

Hadjihambi

Ampuero

Rose

C. F.

Jalan

Romero-Gómez

(2024). Ammonia-induced stress response in liver disease progression and hepatic encephalopathy. Nature Reviews Gastroenterology & Hepatology, 21(11), 774–791. https://doi.org/10.1038/s41575-024-00970-9

Hertenstein

Trinca

Wunderlin

Schneider

C. L.

Züst

M. A.

Fehér

K. D.

Straten

A. V.

Berger

Baglioni

Johann

Spiegelhalder

Riemann

Feige

Nissen

(2022). Cognitive behavioral therapy for insomnia in patients with mental disorders and comorbid insomnia: A systematic review and meta-analysis. Sleep Medicine Reviews, 62, 101597. https://doi.org/10.1016/j.smrv.2022.101597

Huang

X. R.

Wang

S. J.

F. L.

(2025). Auricular acupressure for insomnia in women with breast cancer: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore), 104(7), e41498. https://doi.org/10.1097/MD.0000000000041498

Hui

Wang

Feng

Mao

Fan

Lin

Cui

Chen

Sun

Wang

Sun

(2021). Relationship between sleep-wake disturbance and risk of malnutrition in hospitalized patients with cirrhosis. Front Nutr, 8, 719176. https://doi.org/10.3389/fnut.2021.719176

10.

Juanola

A. T.

de Wit

Gananandan

Roux

Zaccherini

Jiménez

Tonon

Solé

Villaseca

Uschner

F. E.

Graupera

Pose

Moreta

M. J.

Campion

Beuers

Mookerjee

R. P.

Francoz

Durand

Vargas

Piano

Alonso

Trebicka

Laleman

Asrani

S. K.

Soriano

Alessandria

Serra-Burriel

Morales-Ruiz

Torres

Allegretti

A. S.

Krag

Caraceni

Watson

Abraldes

J. G.

Solà

Kamath

P. S.

Hernaez

Ginès

; LiverHope Investigators. (2023). Novel prognostic biomarkers in decompensated cirrhosis: A systematic review and meta-analysis. Gut, 73(1), 156–165. https://doi.org/10.1136/gutjnl-2023-329923

11.

Lan

(2013). A system review on treating insomnia with auricular acupressure. [D]. Chengdu University of Traditional Chinese Medicine. 2013.

12.

S. L.

Yang

L. X.

Zhao

Wang

M. M.

Guo

(2019). Clinical observation on insomnia with heart-spleen deficiency type treated with ear acupoint pressing combined with acupoint massage based on midnight-noon ebb-flow. Journal of Shanxi University of Chinese Medicine, 20(06), 438–441. https://doi.org/10.19763/j.cnki.2096-7403.2019.06.16

13.

Liu

X. C.

Tang

M. Q.

Wang

A. Z.

H. X.

Zhao

G. F.

Gao

C. N.

W. S.

(1996). Reliability and validity of the Pittsburgh Sleep Quality Index. Chinese Journal of Psychiatry, 29(2), 103–107.

14.

López-Franco

Morin

J. P.

Cortés-Sol

Molina-Jiménez

Del Moral

D. I.

Flores-Muñoz

Roldán-Roldán

Juárez-Portilla

Zepeda

R. C.

(2021). Cognitive impairment after resolution of hepatic encephalopathy: A systematic review and meta-analysis. Frontiers in Neuroscience, 15, 579263. https://doi.org/10.3389/fnins.2021.579263

15.

Lou

T. W.

Yang

R. X.

Fan

J. G.

(2024). The global burden of fatty liver disease: The major impact of China. Hepatobiliary Surgery and Nutrition, 13(1), 119–123. https://doi.org/10.21037/hbsn-23-556

16.

National Health Commission of the People’s Republic of China. (1993). Guiding principles for clinical study of new Chinese medicines (volume 1). China Medical Science Press, 186–188. 1993.

17.

Ran

Zhou

Kang

, et al. (2022). Advances in the mechanism and clinical research of acupuncture in the treatment of insomnia[C]//BIBE 2022. The 6th International Conference on Biological Information and Biomedical Engineering, VDE, 2022, 1–6.

18.

Sharma

M. K.

Kainth

Kumar

Bhardwaj

Agarwal

H. K.

Maiwall

Jamwal

K. D.

Shasthry

S. M.

Jindal

Choudhary

Anand

Dhamija

R. M.

Kumar

Sharma

B. C.

Sarin

S. K.

(2019). Effects of zolpidem on sleep parameters in patients with cirrhosis and sleep disturbances: A randomized, placebo-controlled trial. Clinical and Molecular Hepatology, 25(2), 199–209. https://doi.org/10.3350/cmh.2018.0084

19.

Tan

J. Y.

Molassiotis

Wang

Suen

L. K.

(2014). Adverse events of auricular therapy: A systematic review. Evidence-Based Complementary and Alternative Medicine, 2014, 506758. https://doi.org/10.1155/2014/506758

20.

Tsai

P. S.

Wang

S. Y.

Wang

M. Y.

C. T.

Yang

T. T.

Huang

C. J.

Fang

S. C.

(2005). Psychometric evaluation of the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI) in primary insomnia and control subjects. Quality of Life Research, 14(8), 1943–1952. https://doi.org/10.1007/s11136-005-4346-x

21.

Wang

Y. K.

L. J.

Z. W.

Wang

F. C.

Wang

Z. H.

Mang

Z. X.

(2020). Effectiveness and cerebral responses of multi-points acupuncture for primary insomnia: A preliminary randomized clinical trial and fMRI study. BMC Complementary Medicine and Therapies, 20(1), 254. https://doi.org/10.1186/s12906-020-02969-6

22.

World Health Organization. (2008). WHO standard acupuncture point locations in the Western Pacific Region. WHO Western Pacific Region. 2008.

23.

Q. M.

You

(2014). Hepatitis B-related liver cirrhosis: Research updates in China. Chinese Journal of Viral Diseases, 4(01), 7–10. https://doi.org/10.16505/j.2095-0136.2014.01.017

24.

Xing

X. M.

Ning

Y. Y.

(2013). Nursing experience of auricular seed-embedding therapy in the treatment of patients with preoperative insomnia. Journal of Clinical Medicine in Practice, 17(6), 87–88. https://doi.org/10.7619/jcmp.201306030

25.

X. Y.

Ding

H. G.

W. G.

J. H.

Han

Jia

J. D.

Wei

Duan

Z. P.

Linghu

E. Q.

Zhuang

(2019). Chinese Guidelines on the management of liver cirrhosis. Chinese Journal of Clinical Hepatology, 35(11), 2408–2425. https://doi.org/10.3969/j.issn.1001-5256.2019.11.006

26.

D. S.

(2010). Insomnia Severity Index: Psychometric properties with Chinese community-dwelling older people. Journal of Advanced Nursing, 66(10), 2350–2359. https://doi.org/10.1111/j.1365-2648.2010.05394.x

27.

Zeng

Zheng

Zhan

Fang

Zhao

Xiao

Zheng

Yang

(2024). Traditional Chinese herbal formulas modulate gut microbiome and improve insomnia in patients with distinct syndrome types: Insights from an interventional clinical study. Frontiers in Cellular and Infection Microbiology, 14, 1395267. https://doi.org/10.3389/fcimb.2024.1395267