Frontiers in Neurology

Objective Insomnia causes daytime impairment and reduced quality of life. We evaluated the comparative efficacy and safety of Traditional Chinese Medicine (TCM) treatment strategies for insomnia. Methods Nine databases (PubMed, Embase, Web of Science, Cochrane CENTRAL, ClinicalTrials.gov , CNKI, Wanfang, VIP, SinoMed) were searched through January 2026 for randomized controlled trials (RCTs). Primary outcomes were ISI and PSQI scores; secondary outcomes included clinical efficacy and adverse events (AEs). Data were synthesized using frequentist network meta-analysis. Results Twelve RCTs involving 1,260 participants were included, evaluating five strategy nodes: TCM alone, TCM plus Western medicine (WM), WM alone, placebo, and CBT-I. For ISI, TCM plus WM ranked highest (SUCRA 89.7%) and significantly improved scores versus placebo (OR 2.84, 95% CI 1.42–5.68) and WM (OR 1.96, 95% CI 1.08–3.56). For PSQI, TCM plus WM showed the highest probability of improvement (SUCRA 71.9%) with greater reduction versus placebo (MD −2.31, 95% CI −3.65 to −0.97). For clinical efficacy, SUCRA values were 86.6% for TCM plus WM, 77.2% for TCM, 20.9% for WM, and 15.3% for placebo. For AEs (higher SUCRA indicating better safety), SUCRA values were 94.8% for WM, 43.9% for TCM plus WM, 31.1% for placebo, and 30.2% for TCM. Sensitivity analysis excluding secondary insomnia confirmed robust findings. Conclusion Integrated TCM-WM and TCM therapies demonstrate clinical efficacy and acceptable safety for insomnia management. Systematic review registration The review protocol was prospectively registered in the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY) (Registration number: INPLASY202680041; DOI: 10.37766/inplasy2026.8.0041 ).

هدف: بی‌خوابی موجب اختلال در عملکرد روزانه و کاهش کیفیت زندگی می‌شود. ما اثربخشی و ایمنی نسبی راهبردهای درمانی طب سنتی چینی (TCM) را برای بی‌خوابی ارزیابی کردیم. روش‌ها: نه پایگاه داده (PubMed، Embase، Web of Science، Cochrane CENTRAL، ClinicalTrials.gov، CNKI، Wanfang، VIP، SinoMed) تا ژانویه ۲۰۲۶ برای کارآزمایی‌های تصادفی‌سازی‌شده کنترل‌شده (RCT) جست‌وجو شدند. پیامدهای اولیه، نمرات ISI و PSQI بودند؛ پیامدهای ثانویه شامل اثربخشی بالینی و عوارض جانبی (AEs) بود. داده‌ها با استفاده از فراتحلیل شبکه‌ای فریکوئنسیستی ترکیب شدند. نتایج: دوازده RCT با مشارکت ۱۲۶۰ نفر وارد مطالعه شدند که پنج گره راهبردی را ارزیابی کردند: TCM به‌تنهایی، TCM به‌علاوه داروی غربی (WM)، WM به‌تنهایی، دارونما و درمان شناختی-رفتاری برای بی‌خوابی (CBT-I). برای ISI، TCM به‌علاوه WM بالاترین رتبه را داشت (SUCRA ۸۹.۷٪) و به طور معناداری نسبت به دارونما (OR ۲.۸۴، ۹۵٪ CI ۱.۴۲–۵.۶۸) و WM (OR ۱.۹۶، ۹۵٪ CI ۱.۰۸–۳.۵۶) نمرات را بهبود داد. برای PSQI، TCM به‌علاوه WM بالاترین احتمال بهبود را نشان داد (SUCRA ۷۱.۹٪) با کاهش بیشتر نسبت به دارونما (MD ‎−۲.۳۱، ۹۵٪ CI ‎−۳.۶۵ تا ‎−۰.۹۷). برای اثربخشی بالینی، مقادیر SUCRA به ترتیب ۸۶.۶٪ برای TCM به‌علاوه WM، ۷۷.۲٪ برای TCM، ۲۰.۹٪ برای WM و ۱۵.۳٪ برای دارونما بود. برای عوارض جانبی (SUCRA بالاتر نشان‌دهنده ایمنی بیشتر)، مقادیر SUCRA به ترتیب ۹۴.۸٪ برای WM، ۴۳.۹٪ برای TCM به‌علاوه WM، ۳۱.۱٪ برای دارونما و ۳۰.۲٪ برای TCM بود. تحلیل حساسیت با حذف بی‌خوابی ثانویه، یافته‌های قوی را تأیید کرد. نتیجه‌گیری: درمان‌های ترکیبی TCM-WM و TCM اثربخشی بالینی و ایمنی قابل قبولی برای مدیریت بی‌خوابی نشان می‌دهند. ثبت مرور نظام‌مند: پروتکل این مرور به طور پیش‌نگر در پلتفرم بین‌المللی ثبت پروتکل‌های مرور نظام‌مند و فراتحلیل (INPLASY) ثبت شده است (شماره ثبت: INPLASY202680041؛ DOI: 10.37766/inplasy2026.8.0041).

Background Stroke is a leading cause of disability worldwide and is frequently accompanied by psychological and functional impairments. Acceptance and Commitment Therapy (ACT), a third-wave behavioral intervention focusing on psychological flexibility, has been increasingly applied in stroke rehabilitation. Although previous reviews have suggested beneficial effects of ACT in stroke patients, whether these benefits persist in the short term after the intervention ends, and the certainty of the evidence, remain unclear. Methods A systematic review and meta-analysis was conducted according to PRISMA guidelines and registered in PROSPERO (CRD420261325108). Randomized controlled trials evaluating ACT in stroke patients were included. Pooled effects were calculated using random-effects models, with separate analyses for post-intervention and follow-up outcomes. Sources of heterogeneity were explored using subgroup analyses and meta-regression. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and certainty of evidence was evaluated using the GRADE framework. Results Twenty-two RCTs involving 1,975 participants were included. ACT may be associated with reductions in depressive symptoms (post-intervention: SMD = −1.32, 95% CI: −1.80 to −0.84; follow-up: SMD = −0.76, 95% CI: −1.07 to −0.45) and anxiety symptoms (post-intervention: SMD = −1.36, 95% CI: −1.90 to −0.82; follow-up: SMD = −0.51, 95% CI: −1.42 to 0.40, not significant); depressive symptoms remained statistically significant at follow-up. Heterogeneity was considerable for both outcomes at post-intervention ( I 2 = 93.68% for depression and 93.60% for anxiety), so the pooled estimates represent average effects across studies. ACT may also be associated with improvements in psychological flexibility, quality of life, and sleep quality; however, these outcomes were based on a limited number of studies and showed considerable heterogeneity ( I 2 = 74.68 to 92.26%), so they should be interpreted cautiously. However, no statistically significant effects were observed for activities of daily living, neurological function, or hope. ACT did not appear to increase dropout rates in the available studies ( K = 16; RR = 0.99, 95% CI: 0.58–1.69). Meta-regression analyses indicated that intervention duration may not be a significant moderator of treatment effects. The certainty of evidence ranged from very low to moderate, mainly due to risk of bias and inconsistency. Conclusion Acceptance and Commitment Therapy may be a useful adjunctive intervention for improving psychological outcomes in people with stroke. However, evidence for functional recovery remains insufficient. Future high-quality RCTs with standardized protocols, larger samples, and longer follow-up are needed to confirm the long-term effectiveness of ACT. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/ , identifer CRD420261325108.

Sleep and circadian disturbances in Alzheimer’s disease (AD) affect patients and caregivers, but clinical action depends on the syndrome, measurement, and outcome under consideration. This narrative review links sleep assessment to indication-based care while distinguishing symptomatic benefit, physiological target engagement, and disease modification. A purposive literature search was supplemented by targeted checks of PubMed-indexed and original publisher records through 4 October 2026. Selected studies are described by population, AD ascertainment, comparator, and measured endpoint rather than assigned formal evidence-certainty grades. Actigraphy characterizes behavioral rest–activity patterns; melatonin timing and temperature rhythms address endogenous circadian physiology under controlled conditions. Polysomnography and quantitative electroencephalography characterize respiratory events, sleep architecture, and oscillatory activity. These measurements inform different questions and do not independently assign AD etiology or cognitive-functional stage. Clinical priorities include confirmed obstructive sleep apnea, cognition-adapted insomnia care, irregular sleep timing, medication-related effects, parasomnias, limb symptoms, and excessive daytime sleepiness. Interpretation incorporates hypoxemia, treatment exposure, comorbidity, caregiver support, and competing diagnoses. Randomized sleep benefits remain distinct from observational cognitive associations or exploratory imaging and cerebrospinal fluid changes. Human and animal studies of arousal circuits, protein dynamics, inflammation, and fluid transport provide mechanistic context, with conflicting results interpreted according to the actual experimental endpoint. The review provides a clinically organized account of selected evidence, not a comprehensive treatment ranking. Sleep care and cognitive-etiologic assessment should proceed in parallel, with follow-up matched to patient function, safety, and the specific treatment goal.