The effect of acupuncture on upper airway function and physiology in obstructive sleep apnoea

© 2017 Dr Therese ThorntonObstructive sleep apnoea (OSA) involves repetitive obstruction of the upper airway during sleep. Continuous positive airway pressure (CPAP) is the most common treatment, however, many patients cannot tolerate CPAP and adherence rates are low. Recent research has suggested that acupuncture can reduce the severity of OSA. The past research, while promising did not conform to normal Chinese medicine (CM) practice as the researchers failed to diagnose CM syndromes in their patient sample nor design their treatment based on CM syndrome analysis. It was also not possible to rule out potential confounding effects of the sham treatment, as the method employed was not guaranteed to be biologically inert. The aim of the present study was to address these limitations and determine whether acupuncture is an effective alternative treatment for OSA, and to identify underlying physiological changes as a result of acupuncture treatment. Initially, 39 patients admitted for investigative PSG to diagnose OSA underwent standard CM diagnostic procedures to identify common CM syndromes in the OSA population. Four CM phenotypes of OSA were identified and the most common phenotype (occurring in >44% of the sampled population) was then incorporated into the inclusion criteria for the clinical trial of acupuncture treatment. The acupuncture treatment employed was also designed to target the CM phenotype pathology. Further, the sham method employed in the present study, was also guaranteed to be biologically inert. Twenty OSA patients were randomly assigned to receive either 12 weeks of active needle acupuncture (n=10 (3 F); mean age=56.3 years) or sham laser acupuncture (n=10 (3 F); mean age=45.3 years) treatments. Prior to and following the treatment period subjects underwent detailed polysomnography, including measurement of epiglottic pressure, calibrated airflow and genioglossus muscle activity. In addition, subjective health and wellbeing, sleepiness and mood were assessed. AHI, waking nasopharyngeal resistance, ventilation, arousal threshold and genioglossus muscle activity were analysed while blinded to treatment type and study time. One participant was excluded due to an insufficient amount of sleep for analysis. There was no significant effect of treatment type on pre- and post-treatment measurement of NREM AHI (mean pre-treatment: active= 38.10, sham=26.44; mean post-treatment: active=38.83; sham=37.06 events/hour) or NREM AI (mean pre-treatment: active=57.71, sham=49.03; mean post-treatment: active=58.98, sham=58.60 events/hour). There were no significant differences within the active or sham groups, nor between groups across time for the subjective questionnaires. All upper airway physiology measurements made during NREM sleep were also unchanged following both sham and active acupuncture treatment. The data indicates that there are no differences between active- versus sham-acupuncture on subjective health and wellbeing, sleepiness, or mood, nor their AHI or upper airway function and physiology in a clinical OSA population. Once theoretical and methodological limitations of past research were controlled for our data suggest that acupuncture is not an effective treatment for OSA