Efficacy and safety of Chinese herbal acupoint application for post-stroke sleep disorders: a systematic review and meta-analysis.

OBJECTIVE: To evaluate the efficacy and safety of Chinese herbal acupoint application for post-stroke sleep disorders, particularly insomnia and poor sleep quality, and to provide evidence for sleep management during post-stroke rehabilitation. METHODS: This systematic review and meta-analysis followed the PRISMA 2020 reporting guideline and was registered in PROSPERO (CRD420261358357). China National Knowledge Infrastructure, Wanfang Data, VIP Database, Chinese Biomedical Literature Database (SinoMed), PubMed, the Cochrane Library, Embase, and Web of Science were searched from inception to April 1, 2026. Randomized controlled trials comparing acupoint application plus a comparator intervention with the same comparator intervention alone were included. Two reviewers independently screened studies and extracted data. Risk of bias was assessed using the original Cochrane Risk of Bias tool (RoB 1), certainty of evidence was evaluated using GRADE, and meta-analyses were performed in RevMan 5.4.1. RESULTS: Seven randomized controlled trials involving 608 participants were included. Compared with the matched comparator intervention alone, adjunctive acupoint application was associated with a higher trial-defined clinical response rate [odds ratio (OR) = 3.50, 95% confidence interval (CI) 2.05-5.97; p < 0.00001] and lower Pittsburgh Sleep Quality Index scores [mean difference (MD) = -2.69, 95% CI - 3.84 to -1.55; p < 0.00001], Hamilton Anxiety Rating Scale scores (MD = -9.38, 95% CI - 10.09 to -8.68; p < 0.00001), and Hamilton Depression Rating Scale scores (MD = -7.58, 95% CI - 9.08 to -6.08; p < 0.00001). Only two studies reported adverse events, and no study reported post-treatment follow-up. The certainty of evidence was low for trial-defined clinical response and very low for the other outcomes. CONCLUSION: Low- to very-low-certainty evidence suggests that adjunctive Chinese herbal acupoint application may improve subjective sleep quality and emotional symptoms after stroke. However, the true effects may differ substantially from the pooled estimates. Current evidence is insufficient to establish safety or sustained benefit; larger, multicenter, rigorously designed trials are required. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/, CRD420261358357.