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Acupuncture therapy is effective for moderate and severe obstructive sleep apnea


Obstructive sleep apnea (OSA) is characterized by episodes of a complete (apnea) or partial collapse (hypopnea) of the upper airway with an associated decrease in oxygen saturation or arousal from sleep. This disturbance results in fragmented, nonrestorative sleep.


Obstructive sleep apnea is a common sleep disorder causing excessive daytime sleepiness, increasing risk for motor vehicle accidents, and impairing quality of life, and it is closely associated with cardiovascular events, diabetes, and other diseases. Approximately 936 million adults worldwide have mild to severe OSA and 425 million have moderate to severe OSA; the prevalence exceeds 50% in some countries, and China is the most affected. OSA is associated with high economic and social burdens—the cost for diagnosis and treatment in the United States was up to $12.4 billion in 2015. Because of the high prevalence, hazard, and economic burden, the prevention and treatment of OSA is of great importance. Currently, therapies for OSA have been designed and proposed to reduce the frequency of sleep-disordered breathing events, including continuous positive airway pressure (CPAP), surgical procedures, weight loss and lifestyle interventions, and pharmacotherapy. One traditional and novel intervention is the application of acupuncture.


One systemic review was performed with a comprehensive search up to July 2019 with no language restriction, including 8 databases (PubMed, Cochrane Library, EMBASE, Web of Science, China National Knowledge Infrastructure (CNKI), Chongqing VIP (CQVIP), Wanfang Data, and Chinese Biomedical Literature Database (CBM)). Medical subject heading terms (MeSH) and free terms were combined in the process of searching. Moreover, the reference lists of all related articles were examined for relevant citations to ensure the comprehensiveness of the search.


That systemic review finally included nine randomized controlled trials (RCTs) , published from 2007 to 2018 ( 11 years), with 584 participants. The trials covered acupuncture and electropuncture. Acupuncture caused clinically significant reductions in apnea-hypopnea index (AHI), Epworth Sleepiness Score (ESS), and lowest oxygen saturation (LSaO2). The clinical outcome is better in the subgroup of moderate OSA patients and severe OSA.

There were some possible adverse effects of acupuncture, for instance, infection, hematoma, fainting during acupuncture, and bending of needle. In this review, three studies provided information about adverse effects, but no adverse effects were reported about acupuncture.


Advantages of Acupuncture Treatment


We recommend acupuncture as an adjuvant therapy for OSA because it has some of the following advantages. Acupuncture has an acute effect in reducing AHI as well as the number of nocturnal respiratory events of OSA patients, which can play a therapeutic effect on OSA patients more rapidly. At present, the most effective therapy to reduce OSA is positive airway pressure (PAP), and CPAP provides a constant level of positive pressure across inspiration and expiration. However, it requires tremendous effort on the patient's part to position the mask properly and maintain the machine and supplies. And direct side effects have been reported with the use of PAP, including headache, chest discomfort, and sense of suffocation or difficulty exhaling. These side effects can result in sleep disruption and poor sleep quality, thereby reducing patient adherence to CPAP. Thus, a complementary therapy such as acupuncture may be warranted when treatment intolerance due to side effects occurs. Besides, compared with acupuncture, CPAP has the greater cost-effectiveness, while acupuncture has advantage in cost. Furthermore, all studies included mentioned the arrival of qi when acupuncture was performed and the retention of the needle. The most commonly used acupoints were Zhaohai (KI6), Sanyinjiao (SP6), Sishencong (EX-HN1), Shenmen (HT7), Zusanli (ST36), and lianquan (CV23). Point selection and arrival of qi were essential in the acupuncture treatment for OSA. Acupuncture plays an effective role only if the operating procedure was observed.


Reference:

Acupuncture for Obstructive Sleep Apnea (OSA) in Adults: A Systematic Review and Meta-Analysis. Biomed Res Int. 2020; 2020: 6972327.doi: 10.1155/2020/6972327

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