Electroacupuncture Combined with Cognitive Behavioral Therapy for Insomnia Alleviates Insomnia-Anxiety Comorbidity in Gynecological Cancer Patients Undergoing Chemotherapy: A Randomized Controlled Trial

Insomnia and anxiety affect many gynecological cancer patients on chemotherapy, and non-pharmacological options are limited. This randomized trial examined whether adding electroacupuncture (EA) to cognitive behavioral therapy for insomnia (CBT-I) improves both conditions. Seventy-six patients received EA + CBT-I or sham EA + CBT-I for 4 weeks. Outcomes included sleep quality (PSQI), insomnia severity (AIS), anxiety (HAMA), objective sleep parameters, and overall response rate. At Week 4, the EA group showed a greater reduction in PSQI global score (mean difference in change from baseline: -3.11, 95% CI: -4.11 to -2.11, p < 0.001). More patients in the EA group achieved AIS ≤ 6 (71.1% vs. 42.1%, p = 0.010) and HAMA ≤ 14 (92.1% vs. 65.8%, p = 0.005). Deep sleep (p = 0.001), REM sleep (p = 0.045), and sleep score (p = 0.008) also increased more with EA group. The overall response rate was higher with EA (92.1% vs. 71.1%, p = 0.016). No serious adverse events occurred. These findings suggest that adding EA to CBT-I improves sleep and anxiety in this population, with a favorable safety profile.