Efficacy of traditional Chinese medicine external therapy on sleep quality in patients with cancer: A systematic review and network meta-analysis

Objective: This network meta-analysis aims to assess and compare the effectiveness of various external therapies from traditional Chinese medicine (TCM) in enhancing sleep quality among patients with cancer.Methods: We systematically searched nine electronic databases, encompassing five English and four Chinese da-tabases, for randomized controlled trials (RCTs) from their inception up to August 10, 2023. The random effects model was utilized for effect size analysis, and the standardized mean difference (SMD) along with its corre-sponding 95% confidence interval (CI) were computed. Network meta-analysis and comparative effects ranking were executed utilizing STATA 14.0.Results: We included thirty-four RCTs involving seven distinct external TCM therapies. Among these, Chinese med-icine pillow (SMD =-3.27; 95% CI:-6.03 to-0.51), auricular acupressure (SMD =-2.33; 95% CI:-3.36 to-1.29), moxibustion (SMD =-2.28; 95% CI:-3.63 to-0.94), acupressure (SMD =-1.67; 95% CI:-2.64 to-0.70), and acupuncture (SMD =-1.43; 95% CI:-2.65 to-0.21) demonstrated significant effects in improving sleep quality when compared to usual care or waitlist. The cumulative ranking curve values revealed that the Chinese medicine pillow exhibited the highest potential for effectively enhancing sleep quality in patients with cancer, followed by auricular acupressure, moxibustion, acupressure, acupuncture, Tuina, and electroacupuncture. Conclusions: Our study highlights the Chinese medicine pillow as an optimal external TCM therapy for amelio-rating sleep quality in cancer patients, but more RCTs are needed to validate this conclusion. These findings serve as valuable support for future clinical trials and research endeavors. Systematic review registration: CRD42022381370.