. 2021 Nov 11;17:3325–3343. doi: 10.2147/NDT.S337504

Table 3.

Critical Appraisal for Evidence Quality of SRs/MAs Based on GRADE System

Authors, Year	Interventions	Outcomes	Numbers of Studies (Numbers of Participants)	MD/SMD/RR, 95% CI	I²% (p)	Limitations	Inconsistency	Imprecision	Publication Bias	Quality of Evidence
He et al 2021²⁵	Acupuncture vs hypnotics (or + oryzanol)/HRT	PSQI	13 (1115)	−0.63 [−0.75, −0.51]	96 (<0.001)	−1^①	−1^②	0	−1^⑤	Very low
He et al 2021²⁵	Acupuncture vs hypnotics (or + oryzanol)/HRT	Effectiveness rate	20 (1737)	1.85 [1.57, 2.18]	17 (<0.001)	−1^①	0	0	−1^⑤	Low
Li et al 2020²⁶	Acupuncture vs placebo-acupuncture	PSQI	3 (185)	−3.98 [−6.35, −1.61]	92 (0.001)	−1^①	−1^②	−1^③	0	Very low
	Acupuncture vs placebo-acupuncture	ISI	2 (149)	−6.05 [−9.44, −2.65]	84 (<0.001)	−1^①	−1^②	−1^③	0	Very low
	Acupuncture + hypnotics/CHM vs hypnotics/CHM	Serum FSH level	4 (312)	−11.26 [−12.71, −9.82]	31 (<0.001)	−1^①	0	−1^③	0	Low
	Acupuncture + hypnotics/CHM vs hypnotics/CHM	Serum E2 level	4 (312)	8.48 [−7.58, 24.54]	97 (0.30)	−1^①	−1^②	−1^③	0	Very low
	Acupuncture (or + hypnotics/CHM) vs waitlist control/hypnotics/CHM	PSQI	7 (509)	−3.66 [−4.50, −2.22]	89 (<0.001)	−1^①	−1^②	0	0	Low
Ma et al 2020²⁷	Acupuncture + CHM vs CHM	Effectiveness rate	4 (300)	1.19 [1.08, 1.31]	0 (<0.001)	−1^①	0	0	0	Moderate
Wang 2021²⁸	Acupuncture + CHM vs hypnotics (or oryzanol)	Effectiveness rate	12 (939)	1.10 [1.05, 1.15]	38 (<0.001)	−1^①	0	0	0	Moderate
Zhang et al 2016²⁹	Acupuncture vs hypnotics	PSQI	2 (162)	−4.43 [−5.20, −3.66]	0 (<0.001)	−1^①	0	−1^③	−1^④	Very low
Zhang et al 2016²⁹	Acupuncture vs hypnotics (or + oryzanol)	Effectiveness rate	4 (292)	4.09 [2.02, 8.28]	0 (<0.001)	−1^①	0	−1^③	−1^④	Very low
Zhang et al 2012³⁰	Acupuncture vs hypnotics/CHM	PSQI	2 (120)	−0.62 [−2.75, 1.51]	81 (0.57)	−1^①	−1^②	−1^③	−1^⑤	Very low
	Acupuncture vs hypnotics/CHM	Serum E2 level	2 (180)	33.69 [29.87, 37.50]	0 (<0.001)	−1^①	0	−1^③	−1^⑤	Very low
	Acupuncture vs hypnotics/CHM (or + oryzanol)	Effectiveness rate	11 (858)	5.99 [2.32, 15.49]	76 (<0.001)	−1^①	−1^②	0	−1^⑤	Very low
Zhao et al 2021¹¹	Acupuncture vs hypnotics	PSQI	10 (1059)	−2.38 [−3.38, −1.37]	93 (<0.001)	−1^①	−1^②	0	0	Low
		KI	4 (274)	−5.95 [−10.68, −1.21]	96 (0.01)	−1^①	−1^②	−1^③	0	Very low
		Serum FSH level	3 (366)	−0.53 [−1.45, 0.39]	94 (0.26)	−1^①	−1^②	−1^③	0	Very low
		Serum E2 level	3 (366)	0.63 [−0.51, 1.77]	96 (0.28)	−1^①	−1^②	−1^③	0	Very low
		Effectiveness rate	10 (1047)	1.10 [1.05, 1.16]	20 (<0.001)	−1^①	0	0	0	Moderate
	Acupuncture + hypnotics vs hypnotics	PSQI	3 (208)	−3.13 [−5.43, −0.83]	84 (0.008)	−1^①	−1^②	−1^③	0	Very low
Zhou et al 2020³¹	Acupuncture vs hypnotics (or + oryzanol)	Effectiveness rate	11 (1102)	2.85 [2.02, 4.04]	37 (<0.001)	−1^①	0	0	−1^④	Low
Zhou et al 2020³¹	Acupuncture vs hypnotics (or + oryzanol)	PSQI	8 (720)	−3.80 [−5.46,-2.14]	97 (<0.001)	−1^①	−1^②	0	−1^④	Very low
Jiang et al 2020³²	Acupuncture vs hypnotics (or + oryzanol)	PSQI	8 (737)	−3.46 [−4.95, −1.96]	97 (<0.001)	−1^①	−1^②	0	−1^④	Very low
		Effectiveness rate	10 (879)	4.14 [2.66, 6.46]	0 (<0.001)	−1^①	0	0	−1^④	Low
		Serum E2 level	3 (374)	1.70 [−7.52, 10.92]	93 (0.72)	−1^①	−1^②	−1^③	−1^④	Very low

Notes: GRADE [^①The design of the trial has a large bias in randomization, allocation concealment, blinding or other factors; ^②the confidence interval overlaps less, the heterogeneity test p is very small, the I² is larger, and the heterogeneity could not be completely explained by conducting subgroup analysis, sensitivity analysis, or meta-regression; ^③the confidence interval is not narrow enough;^④funnel graph asymmetry;^⑤fewer studies are included due to incomplete retrieval and there may be a greater risk of publication bias].

Abbreviations: Effectiveness rate, total clinical effectiveness rate; PSQI, Pittsburgh Sleep Quality Index; ISI, Insomnia Severity Index; KI, Kupperman Index; FSH, follicle-stimulating hormone; E2, Estradiol; CHM, Chinese herbal medicine.