Acupuncture for Sleep Fragmentation in Older Adults: A Single-Arm Pilot Study

Change equals the Week 6 mean minus the baseline mean. Wake after sleep onset (WASO) is the total minutes scored awake between sleep onset and final awakening for each valid night. Sleep is measured with Actiwatch 2 (Philips Respironics) worn on the nondominant wrist, recorded in 60-second epochs, and scored with Philips Actiware version 6.0.9 using sleep diaries. Each timepoint is the mean across all valid nights in the 7-day assessment window. A timepoint is valid if it includes at least 5 valid nights, including at least 1 weekend night; otherwise it is treated as missing. Unit: minutes.

Change equals the Week 6 mean minus the baseline mean. Sleep efficiency is the percentage of time in bed scored as sleep for each valid night. Sleep is measured with Actiwatch 2 (Philips Respironics) worn on the nondominant wrist, recorded in 60-second epochs, and scored with Philips Actiware version 6.0.9 using sleep diaries. Each timepoint is the mean across all valid nights in the 7-day assessment window. A timepoint is valid if it includes at least 5 valid nights, including at least 1 weekend night; otherwise it is treated as missing. Unit: percentage points.

The Pittsburgh Sleep Quality Index total score ranges from 0 to 21; higher scores indicate poorer sleep quality. Change at Week 6 and at the optional approximately 3-month post-treatment follow-up equals the respective follow-up score minus baseline.

Change equals the Week 6 mean minus the baseline mean. Actiware-derived awakenings are counted for each valid night. Sleep is measured with Actiwatch 2 (Philips Respironics) worn on the nondominant wrist, recorded in 60-second epochs, and scored with Philips Actiware version 6.0.9 using sleep diaries. Each timepoint is the mean across all valid nights in the 7-day assessment window. A timepoint is valid if it includes at least 5 valid nights, including at least 1 weekend night; otherwise it is treated as missing. Unit: awakenings per night.

Change equals the Week 6 mean minus the baseline mean. For each valid night, the Actiware 6.0.9 sleep fragmentation index is the sum of (1) the percentage of epochs classified as mobile during the sleep interval and (2) the percentage of all immobile bouts lasting no more than 1 minute. Higher values indicate greater sleep fragmentation. Actiwatch 2 is worn on the nondominant wrist and recorded in 60-second epochs. Each timepoint is the mean across valid nights in the 7-day window. A timepoint requires at least 5 valid nights, including at least 1 weekend night; otherwise it is missing. Unit: percentage points.

The Insomnia Severity Index total score ranges from 0 to 28; higher scores indicate greater insomnia severity. Change at Weeks 2, 4, and 6 and at the optional approximately 3-month post-treatment follow-up equals the respective follow-up score minus baseline.

The Epworth Sleepiness Scale total score ranges from 0 to 24; higher scores indicate greater daytime sleepiness. Change at Week 6 and at the optional approximately 3-month post-treatment follow-up equals the respective follow-up score minus baseline.

Change equals the Week 6 value minus the baseline value for the diffusion tensor imaging along the perivascular space (DTI-ALPS) index. Unit: unitless (dimensionless index).

Change equals the Week 6 value minus baseline for time-averaged mean velocity measured by pulsed-wave Doppler ultrasonography with the participant supine and the head in a neutral position. The left and right internal jugular veins are measured and analyzed separately; values are not combined by a simple bilateral average. Repeated measurements for each side are averaged. Unit: centimeters per second (cm/s).

Change equals the Week 6 value minus baseline for cross-sectional area measured by transverse B-mode ultrasonography with the participant supine and the head in a neutral position. The left and right internal jugular veins are measured and analyzed separately; values are not combined by a simple bilateral average. Repeated measurements for each side are averaged. Minimal transducer pressure is used to avoid vein compression. Unit: square centimeters (cm²).

Change equals the Week 6 score minus baseline. The composite is the sum of word-list learning across 3 trials (0-30), delayed recall (0-10), and recognition discriminability (0-10), for a total range of 0-50; higher scores indicate better memory performance. Recognition discriminability is calculated as correct "Yes" responses plus correct "No" responses minus 10; values below 0 are scored as 0. Remote memory is not included in this composite.

Number of enrolled participants who complete at least 10 of the 12 planned acupuncture sessions divided by the total number enrolled, multiplied by 100. This threshold corresponds to at least 80% treatment adherence. Unit: percentage of participants.

Number of enrolled participants who complete the Week 6 assessment of the primary outcome, 7-day mean wake after sleep onset, divided by the total number enrolled, multiplied by 100. Unit: percentage of participants.

Number of enrolled participants with valid actigraphy timepoints at both baseline and Week 6 divided by the total number enrolled, multiplied by 100. Each timepoint requires at least 5 valid nights, including at least 1 weekend night. Unit: percentage of participants.