OBJECTIVE To examine the effectiveness of acupressure on sleep quality in cancer patients and to identify the population-level and intervention-level characteristics associated with the intervention outcome of sleep quality. METHODS Systematic review and meta-analysis. METHODS PubMed, EMBASE, APA PsycInfo, Web of Science, CINAHL, Cochrane Library, China National Knowledge Infrastructure and WanFang were searched for eligible randomised controlled trials from inception to April 2024. METHODS Methodological quality was assessed using the Cochrane Risk of Bias Tool for Randomised Trials 2.0. A random-effects model was used for the meta-analysis. Subgroup analyses and the meta-regression aimed to investigate potential heterogeneity and identify characteristics that may be associated with more favourable acupressure outcomes. RESULTS In total, 22 randomised controlled trials involving 2113 participants were included in this meta-analysis. Compared with various control groups, acupressure exhibited a significant beneficial effect on sleep quality in cancer patients at post-intervention (SMD = -1.38, 95% CI [-1.81, -0.95], p < 0.001) and at 4-week follow-up (SMD = -0.33, 95% CI [-0.56, -0.10], p = 0.004). Acupressure also showed statistically significant improvements in sleep efficiency (SMD = 0.77, 95% CI [0.27, 1.26], p = 0.002) and total sleep time (SMD = 0.68, 95% CI [0.15, 1.22], p = 0.010) at post-intervention. None of the characteristics significantly affected the overall effect size on sleep quality. CONCLUSIONS Acupressure appears to be a promising intervention for enhancing sleep quality among cancer patients. Future studies should elucidate the long-term effects of acupressure on sleep quality, identify effective acupressure characteristics and determine which types of cancer patients benefit from this intervention. CONCLUSIONS This study provides a comprehensive summary of evidence supporting the use of acupressure to enhance sleep quality in cancer patients and demonstrates its effectiveness in clinical nursing practice. PRISMA 2020 statement. No Patient or Public Contribution.