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Lin J, Kong Y, Chen H, Zhu M, Lv Q, Xu B, Zhu F. Effects of acupuncture on obstructive sleep apnea-hypopnea syndrome: A meta-analysis. Res Nurs Health 2023; 46:220-235. [PMID: 36808731 DOI: 10.1002/nur.22302] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 01/04/2023] [Accepted: 01/26/2023] [Indexed: 02/21/2023]
Abstract
Our study aimed to systematically evaluate the effect of acupuncture in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). Literature search of four Chinese databases and six English databases for studies published from the inception of each database to March 1, 2022 and identify relevant studies published in Chinese or English. Related randomized controlled trials of acupuncture for the treatment of OSAHS were included to analyze the efficacy of acupuncture. Two researchers independently reviewed all of the retrieved studies to screen for eligible studies and extract the required relevant data. Included studies were subjected to a methodological quality assessment using the Cochrane Manual 5.1.0, and to a meta-analysis using Cochrane Review Manager version 5.4. A total of 19 studies with 1365 participants were examined. Compared with the control group, the apnea-hypopnea index, lowest oxygen saturation, Epworth Sleepiness Scale, interleukin-6, tumor necrosis factor α, and nuclear factor κ-B indicators all exhibited statistically significant changes. Thus, acupuncture was effective in alleviating the state of hypoxia and sleepiness and reduced the inflammatory response and disease severity among reported patients with OSAHS. Therefore, acupuncture could be widely used in the clinical treatment of OSAHS patients as a complementary strategy and warrants further study.
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Affiliation(s)
- Jiamin Lin
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Yue Kong
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
- 900TH Hospital of Joint Logistic Support Force, Fuzhou, China
| | - Hailan Chen
- The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Meilin Zhu
- 900TH Hospital of Joint Logistic Support Force, Fuzhou, China
| | - Qian Lv
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Baoling Xu
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Fangfang Zhu
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
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The Clinical Effects of the Phlegm-Resolving Method in the Treatment of Obstructive Sleep Apnea-Hypopnea Syndrome: A Meta-Analysis of Randomized Controlled Trials. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:7426552. [PMID: 35958923 PMCID: PMC9357714 DOI: 10.1155/2022/7426552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 07/02/2022] [Accepted: 07/08/2022] [Indexed: 11/20/2022]
Abstract
Objective This study evaluated the clinical efficacy and safety of the phlegm-resolving method in traditional Chinese medicine (TCM) for the treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods We searched the PubMed, Embase, Cochrane Library, Wanfang, CNKI, and VIP databases according to specific search strategies. The data were analyzed using RevMan 5.3 software. Results Thirteen randomized controlled trials (RCTs) comprising 882 patients with OSAHS were selected. Compared to continuous positive airway pressure (CPAP), the phlegm-resolving method of TCM combined with CPAP significantly more effectively improved the apnea/hypopnea index (AHI), Epworth Sleepiness Scale (ESS), and lowest oxygen saturation (LSaO2). While the treatment effect was better for a treatment duration of >6 weeks compared to that at ≤6 weeks, the difference was not statistically significant. Compared to health guidance alone, the combination of the phlegm-resolving method in TCM with health guidance showed significantly better efficacy in improving AHI, ESS, and LSaO2. In terms of reducing ESS and increasing LSaO2, the effect was better for treatment courses >6 weeks. When the AHI was reduced, a duration of ≤6 weeks showed more advantages; however, the difference was not significant. Only one study reported mild nausea in one participant in the treatment group at the initial stage of treatment; the remaining studies did not mention any side effects. Conclusion Both the resolving phlegm method of TCM combined with CPAP and the resolving phlegm method of TCM combined with health guidance were more effective in improving AHI, LSaO2, and ESS compared to the control group.
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The efficacy of acupuncture for patients with mild to moderate obstructive sleep apnea syndrome: A protocol for a randomized controlled clinical trial. WORLD JOURNAL OF ACUPUNCTURE-MOXIBUSTION 2022. [DOI: 10.1016/j.wjam.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Ko J, Baik J, Lee S, Lee S. Intraoral acupuncture treatment for obstructive sleep apnoea with snoring: a case series. Acupunct Med 2021; 39:529-532. [PMID: 33583194 DOI: 10.1177/0964528420987852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To investigate the effects of acupuncture of the intraoral, head and neck regions in patients with obstructive sleep apnoea (OSA). METHODS Four patients diagnosed with OSA were treated with local acupuncture, including intraoral needling, to stimulate the upper airway dilator muscle. Clinical improvements were evaluated with the apnoea-hypopnoea index (AHI), obstructive apnoea-hypopnoea index (oAHI), snoring, and oxygen desaturation index (ODI) using a portable sleep monitoring device. RESULTS After 10 treatment sessions, all patients showed improvement in the AHI and oAHI, and most of the patients showed decreased ODI and snoring. CONCLUSIONS These results suggest that acupuncture of the intraoral and head regions may be effective at improving the symptoms of OSA. Acupuncture treatment for OSA should be further investigated.
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Affiliation(s)
- Jungeun Ko
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Jungeui Baik
- Chungin Korean Medical Clinic, Seoul, Republic of Korea
| | - Suji Lee
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Sanghoon Lee
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea
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Acupuncture for Obstructive Sleep Apnea (OSA) in Adults: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2020; 2020:6972327. [PMID: 32258139 PMCID: PMC7079261 DOI: 10.1155/2020/6972327] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 12/26/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Our aim was to assess the efficacy and safety of acupuncture for OSA patients with various severities of the disorder. METHODS Eight databases including PubMed, Cochrane Library, EMBASE, Web of Science, China National Knowledge Infrastructure (CNKI), Chongqing VIP (CQVIP), Wanfang Data, and Chinese Biomedical Literature Database (CBM) were comprehensively searched till July 2019. Randomized controlled trials (RCTs) testing acupuncture in the treatment of OSA were eligible for inclusion. Studies were selected for inclusion, and data were extracted by two authors independently. The Cochrane Collaboration's Risk of Bias Assessment Tool and RevMan software (version 5.3) were used to evaluate the quality of studies and conduct statistical analysis. RESULTS Nine RCTs with 584 participants were included. The trials covered acupuncture and electropuncture. Acupuncture caused clinically significant reductions in AHI (MD: -6.18; 95% CI: -9.58 to -2.78; Z = 3.56, P = 0.0004) as well as in ESS (MD: -2.84; 95% CI: -4.80 to -0.16, Z = 2.09, P = 0.04). AHI was reduced more in the subgroup analysis of moderate OSA patients (MD: -9.44; 95% CI: -12.44 to -6.45; Z = 6.18, P < 0.00001) and severe OSA patients (MD: -10.09; 95% CI: -12.47 to -7.71; Z = 8.31, P < 0.00001). ESS was also reduced more in the subgroup analysis of moderate OSA patients (MD: -2.40; 95% CI: -3.63 to -1.17; Z = 3.83, P = 0.0001) and severe OSA patients (MD: -4.64; 95% CI: -5.35 to -3.92; Z = 12.72, P < 0.00001). Besides, acupuncture had a beneficial effect on LSaO2 (MD: 5.29; 95% CI: 2.61 to 7.97; Z = 3.86, P = 0.0001). The outcome of AHI and LSaO2 yielded consistent results after sensitivity analysis, but the direction of the outcome of ESS was reversed. And the quality of evidence was mainly low to very low. CONCLUSIONS Acupuncture therapy is effective for OSA patients in reducing AHI and ESS and in improving the LSaO2 of various severities, especially in moderate and severe OSA patients. High-quality trials are urgently needed.
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Silva MVFP, Lustosa TC, Arai VJ, Couto Patriota TLG, Lira MPF, Lins-Filho OL, Chalegre ST, B B A S K, Secundo IV, Pedrosa RP. Effects of acupuncture on obstructive sleep apnea severity, blood pressure control and quality of life in patients with hypertension: A randomized controlled trial. J Sleep Res 2019; 29:e12954. [PMID: 31868987 DOI: 10.1111/jsr.12954] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 08/21/2019] [Accepted: 11/06/2019] [Indexed: 11/28/2022]
Abstract
Obstructive sleep apnea (OSA) is a common condition among patients with hypertension and treatment with continuous positive airway pressure (CPAP) can decrease blood pressure (BP). However, CPAP is not well tolerated by a significant proportion of patients. The authors investigated the effects of acupuncture on OSA severity and BP control in patients with hypertension. Hypertensive patients with mild to moderate OSA (apnea-hypopnea index, 5-30 events/hr) were randomly assigned to receive acupuncture or sham-acupuncture treatment. Patients were assessed at baseline and after 10 acupuncture sessions using polysomnography, 24-hr ambulatory BP monitoring and a quality of life questionnaire. Forty-four patients (34% men; mean age, 57.0 ± 5.4 years; body mass index, 29.6 ± 3.2 kg/m2 ; apnea-hypopnea index, 16.3 ± 6.7 events/hr) completed the study. There were no differences in pre-post-intervention apnea-hypopnea index, daytime or nocturnal BP, or quality of life between the acupuncture and sham-acupuncture groups (p > .05). Acupuncture therapy in hypertensive patients with OSA did not reduce OSA severity, daytime or nocturnal BP, or quality of life.
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Affiliation(s)
- Marcus Vinícius F P Silva
- Sleep and Heart Laboratory, Pronto Socorro Cardiologico de Pernambuco (PROCAPE) da Universidade de Pernambuco, Recife, Brazil
| | - Thais C Lustosa
- Sleep and Heart Laboratory, Pronto Socorro Cardiologico de Pernambuco (PROCAPE) da Universidade de Pernambuco, Recife, Brazil
| | - Victor J Arai
- Sleep and Heart Laboratory, Pronto Socorro Cardiologico de Pernambuco (PROCAPE) da Universidade de Pernambuco, Recife, Brazil
| | - Tarcya L G Couto Patriota
- Sleep and Heart Laboratory, Pronto Socorro Cardiologico de Pernambuco (PROCAPE) da Universidade de Pernambuco, Recife, Brazil
| | - Maria P F Lira
- Sleep and Heart Laboratory, Pronto Socorro Cardiologico de Pernambuco (PROCAPE) da Universidade de Pernambuco, Recife, Brazil
| | - Ozeas L Lins-Filho
- Sleep and Heart Laboratory, Pronto Socorro Cardiologico de Pernambuco (PROCAPE) da Universidade de Pernambuco, Recife, Brazil
| | - Sintya T Chalegre
- Sleep and Heart Laboratory, Pronto Socorro Cardiologico de Pernambuco (PROCAPE) da Universidade de Pernambuco, Recife, Brazil
| | - Kamilla B B A S
- Sleep and Heart Laboratory, Pronto Socorro Cardiologico de Pernambuco (PROCAPE) da Universidade de Pernambuco, Recife, Brazil
| | - Isaac V Secundo
- Sleep and Heart Laboratory, Pronto Socorro Cardiologico de Pernambuco (PROCAPE) da Universidade de Pernambuco, Recife, Brazil
| | - Rodrigo P Pedrosa
- Sleep and Heart Laboratory, Pronto Socorro Cardiologico de Pernambuco (PROCAPE) da Universidade de Pernambuco, Recife, Brazil
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Lavigne G, Herrero Babiloni A, Beetz G, Dal Fabbro C, Sutherland K, Huynh N, Cistulli P. Critical Issues in Dental and Medical Management of Obstructive Sleep Apnea. J Dent Res 2019; 99:26-35. [DOI: 10.1177/0022034519885644] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
This critical review focuses on obstructive sleep apnea (OSA) and its management from a dental medicine perspective. OSA is characterized by ≥10-s cessation of breathing (apnea) or reduction in airflow (hypopnea) ≥5 times per hour with a drop in oxygen and/or rise in carbon dioxide. It can be associated with sleepiness and fatigue, impaired mood and cognition, cardiometabolic complications, and risk for transportation and work accidents. Although sleep apnea is diagnosed by a sleep physician, its management is interdisciplinary. The dentist’s role includes 1) screening patients for OSA risk factors (e.g., retrognathia, high arched palate, enlarged tonsils or tongue, enlarged tori, high Mallampati score, poor sleep, supine sleep position, obesity, hypertension, morning headache or orofacial pain, bruxism); 2) referring to an appropriate health professional as indicated; and 3) providing oral appliance therapy followed by regular dental and sleep medical follow-up. In addition to the device features and provider expertise, anatomic, behavioral, demographic, and neurophysiologic characteristics can influence oral appliance effectiveness in managing OSA. Therefore, OSA treatment should be tailored to each patient individually. This review highlights some of the putative action mechanisms related to oral appliance effectiveness and proposes future research directions.
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Affiliation(s)
- G.J. Lavigne
- Faculté de médicine dentaire, Université de Montréal, Montréal, Canada
- Research Center, CIUSSS du Nord-de-l’Île-de-Montréal, Montréal, Canada
- Division of Experimental Medicine, McGill University, Montréal, Canada
| | - A. Herrero Babiloni
- Faculté de médicine dentaire, Université de Montréal, Montréal, Canada
- Research Center, CIUSSS du Nord-de-l’Île-de-Montréal, Montréal, Canada
- Division of Experimental Medicine, McGill University, Montréal, Canada
| | - G. Beetz
- Research Center, CIUSSS du Nord-de-l’Île-de-Montréal, Montréal, Canada
| | | | - K. Sutherland
- Charles Perkins Centre and Sydney Medical School, University of Sydney, and Royal North Shore Hospital, Sydney, Australia
| | - N. Huynh
- Faculté de médicine dentaire, Université de Montréal, Montréal, Canada
| | - P.A. Cistulli
- Charles Perkins Centre and Sydney Medical School, University of Sydney, and Royal North Shore Hospital, Sydney, Australia
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Birch S, Lee MS, Alraek T, Kim TH. Overview of Treatment Guidelines and Clinical Practical Guidelines That Recommend the Use of Acupuncture: A Bibliometric Analysis. J Altern Complement Med 2018; 24:752-769. [PMID: 29912569 DOI: 10.1089/acm.2018.0092] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION As positive evidence emerges for the use of an intervention to treat a health problem, the intervention gradually becomes incorporated into treatment guidelines (TGs) or clinical practice guidelines (CPGs) that are related to that health problem. To assess whether this general hypothesis can apply to acupuncture, 96 health problems were identified for which positive conclusions in systematic reviews and meta-analyses regarding the effectiveness of acupuncture have been made and then searched for TGs or CPGs that have recommended the use of acupuncture. METHODS Through August 31, 2017, searches were performed in relevant medical databases and Google using "treatment guideline," "clinical practice guideline," and the names of the 96 medical conditions as search terms. A "snow-balling" search approach was adopted. All positive recommendations were added into the registry. RESULTS A total of 1311 publications were found that recommended using acupuncture published between 1991 and 2017. The number per year reached 50 in 2005 and 100 in 2009. In addition, 2189 positive recommendations were found for the use of acupuncture. Of these, 1486 were related to 107 pain indications and 703 were related to 97 nonpain indications. These recommendations were made by a wide range of groups, such as government health institutions, national guideline, and medical specialty groups. The recommendations came from around the world but were especially abundant in North America, Europe, and Australasia. DISCUSSION AND CONCLUSION Considerably more recommendations were found for the use of acupuncture than are known within the acupuncture or medical communities. A trend by year was also found; a rise in the number of positive statements about acupuncture was typically followed by a rise in the number of recommendations of acupuncture. Thus, the recommendations followed the emergent evidence for acupuncture. Better implementation plans need to be developed for the CPG/TG recommendations about acupuncture to be more effective/efficient.
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Affiliation(s)
- Stephen Birch
- 1 Department of Health Sciences, Kristiania University College , Oslo, Norway
| | - Myeong Soo Lee
- 2 Clinical Medicine Division, Korea Institute of Oriental Medicine , Daejeon, Republic of South Korea
| | - Terje Alraek
- 1 Department of Health Sciences, Kristiania University College , Oslo, Norway .,3 Department of Community Medicine, Faculty of Medicine, National Research Centre in Complementary and Alternative Medicine, UiT The Arctic University of Norway , Tromso, Norway
| | - Tae-Hun Kim
- 4 Korean Medicine Clinical Trial Center, Korean Medicine Hospital, Kyung Hee University , Seoul, Republic of Korea
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