Effect of traditional Chinese medicine on sleep and blood pressure in patients with comorbid hypertension-insomnia: a systematic review and meta-analysis

Figures

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  Figure 1. PRISMA flowchart for the review 2020.

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  Figure 2. Risk of bias assessment of individual studies using the ROB2 tool. Green circle with plus symbol indicates low risk of bias; blue circle with question mark indicates some concerns due to insufficient or unclear information; no high-risk judgments were identified. D1, bias arising from the randomization process; D2, bias due to deviations from intended interventions; D3, bias due to missing outcome data; D4, bias in measurement of the outcome; D5, bias in selection of the reported result. Overall judgment reflects the highest risk level across domains for each study.

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  Figure 3. Risk of bias assessment overall studies with ROB2 tool. Green bars represent the proportion of studies judged as low risk of bias; blue bars represent the proportion of studies with some concerns due to insufficient or unclear information; no studies were rated as high risk of bias. Bias domains are defined as follows: bias arising from the randomization process; bias due to deviations from intended interventions; bias due to missing outcome data; bias in measurement of the outcome; bias in selection of the reported result. Overall risk of bias reflects the highest level of concern identified across domains for each study.

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  Figure 4. (a) Forest plot of pooled standardized mean differences in sleep quality (PSQI scores) comparing syndrome-differentiated TCM with control interventions in RCTs. (b) Funnel plot assessing publication bias for sleep quality outcomes (SMD) in included randomized controlled trials.

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  Figure 5. (a) Forest plot of pooled standardized mean differences in systolic and diastolic blood pressure comparing syndrome-differentiated TCM with control interventions in RCTs. (b) Funnel plot for assessment of publication bias in blood pressure outcomes (SMD) in the included randomized controlled trials.

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  Figure 6. Heatmap of effect sizes for TCM interventions on sleep and blood pressure outcomes. Color intensity in the heatmap corresponds to the reported effect size magnitude for each outcome. The coding is as follows: Dark Red = 3 (Strongest Effect), Light Pink = 2 (Moderate Effect), Medium Blue = 2.5, Light Blue = 0.4 (Weak Effect), Light Green/White = 0 (No Apparent Effect). Numerical values within cells represent the specific effect size estimate for the respective TCM intervention and outcome measure.