Objective: Sleep deprivation can lead to cognitive impairment, and acupuncture has been shown to symptoms associated with insufficient sleep; however, effects on cognitive impairment and the underlying mechanisms remain unclear. Following a "clinical observation–basic validation" approach, this study aimed to investigate the impact of acupuncture on cognitive function in both sleep-deprived patients and rats.

Methods: A total of 22 middle-aged and elderly patients with chronic insomnia were enrolled and randomly assigned to either an acupuncture group (receiving bilateral needling at Shenmen, Sanyinjiao, and Taichong acupoints) or a placebo group. Sleep quality and cognitive function were assessed before and after treatment using the Athens Insomnia Scale-5 (AIS-5) and Verbal Fluency Test (VFT). In the animal experiment, 24 rats were randomly divided into four groups: a blank control group, a sleep deprivation (SD) group, a SD＋acupoint electroacupuncture (SDA) group, and an SD＋sham acupuncture (SDS) group. Emotional state and learning and memory performance were recorded in all rats. Serum levels of hypothalamic-pituitary-adrenal (HPA) axis hormones, including adrenocorticotrophic hormone (ACTH), corticotropin releasing hormone (CRH), and corticosteroid (CORT)], as well as oxidative stress enzymes [superoxide dismutase (SOD) and malonaldehyde (MDA)], and proinflammatory cytokines [interleukin (IL)-6, IL-1β, and tumor necrosis factor-α (TNF-α)] were measured. The morphology and density of neurons and glial cells in the cornu ammonis1 (CA1) of the hippocampus were also examined.

Results: In the 22 middle-aged and elderly patients with chronic insomnia, acupuncture treatment significantly reduced both the total AIS-5 score and individual subscale scores compared to baseline (all P < 0.05), and VFT scores showed meaningful improvement (P = 0.022). The effects of acupuncture on SD rats were observed across five main dimensions. (1) Behavioral outcomes: compared with the SD group, both the SDA and SDS groups exhibited prolonged sleep duration (P < 0.001 and P = 0.001, respectively); the SDA group showed an increased number of entries into the central area of the open field(P = 0.027), and both the SDA and SDS groups demonstrated a significant greater number of platform crossings in the Morris water maze(P = 0.002 and P = 0.012, respectively). (2) HPA axis hormone levels: compared with the SD group, the SDA group showed elevated CRH levels and reduced CORT levels, while ACTH levels remained unchanged (P = 0.014, 0.020, and 0.436, respectively); the SDS group exhibited increased ACTH levels, with no significant difference in CRH or CORT (P = 0.017, 0.371, and 0.944, respectively). (3) Oxidative stress response: compared with the SD group, SOD levels were significantly lower in the SDA group (P = 0.018). (4) Inflammatory response: compared with the SD group, the SDA group showed markedly reduced levels of TNF-α,IL-1β and IL-6 (P = 0.017, 0.006, and 0.007, respectively). (5) Histopathological findings: compared to the SD group, the SDA group demonstrated greater preservation of neurons and a reduction in glial cells in the hippocampal CA1 region.

Conclusion: Acupuncture can ameliorates cognitive impairment induced by acute SD, potentially through pathways involving HPA axis-mediated oxidative stress and inflammatory responses.