Immediate effect of acupuncture on the sleep pattern of patients with obstructive sleep apnoea.

BACKGROUND: Most patients with obstructive sleep apnoea (OSA) do not tolerate treatment with nasal continuous positive airway pressure, the 'gold standard' treatment for this condition. It was shown in a pilot study that acupuncture was more effective than placebo treatment (sham acupuncture) in producing significant changes in the respiratory events assessed by polysomnography (PSG). OBJECTIVES: To investigate the immediate effect of manual acupuncture (MA) and electroacupuncture (EA) on the sleep pattern of patients presenting with moderate OSA. METHODS: 40 patients with an Apnoea-Hypopnoea Index (AHI) of 15-30/h were randomly allocated to MA treatment (n=10), EA 10 Hz treatment (n=10), EA 2 Hz treatment (n=10) and a no-treatment control group (n=10). The patients received MA or EA (2 or 10 Hz) just before the PSG study at 20:00. RESULTS: The AHI (p=0.005; p=0.005), the Apnoea Index (p=0.038; p=0.009) and the respiratory events (p=0.039; p=0.014) decreased significantly in the MA and EA 10 Hz groups, respectively (AHI (21.9, 11.2), Apnoea Index (5.15, 0.7), respiratory events (120.5, 61.0) in the MA group before and after. AHI (20.6, 9.9), Apnoea Index (8.2, 0.3), respiratory events (117.0, 56.0) in the EA 10 Hz group before and after). The micro-arousals decreased only in the MA group (146.0 vs 88.5, p=0.0002). There were no significant changes in the EA 2 Hz group or in the control group. CONCLUSION: A single session of either MA or EA 10 Hz had an acute effect in reducing the AHI as well as the number of nocturnal respiratory events of patients presenting with moderate OSA.

Treatment of moderate obstructive sleep apnea syndrome with acupuncture: a randomised, placebo-controlled pilot trial.

BACKGROUND AND PURPOSE: To investigate the efficacy of acupuncture in the treatment of moderate obstructive sleep apnea syndrome (OSAS), assessed by polysomnography (PSG) and questionnaires of functional quality of life (SF-36) and excessive daytime sleepiness (Epworth). PATIENTS AND METHODS: We performed a randomised, placebo-controlled, single-blinded study, with blinded evaluation on 36 patients presenting an apnea/hypopnea index (AHI) of 15-30/h, assessed by PSG. The study took place at the Public Hospital of the Universidade Federal de São Paulo, Brazil, in the Division of Sleep Disorders of the Department of Psychobiology, between January, 2002 and August, 2004. Patients were randomly assigned to three groups: the acupuncture group (n=12); the sham group, submitted to needle insertion in non-acupoints (n=12); and the control group, receiving no treatment (n=12). Patients received acupuncture or sham acupuncture once a week for 10 weeks. RESULTS: Twenty-six patients completed the study. The AHI (P=0.005), the apnea index (AI) (P=0.008) and the number of respiratory events (P=0.005) decreased significantly in the acupuncture group but not in the sham group. On the other hand, the control group displayed significant deterioration in some of the polysomnographic parameters, with a significant increase in the number of respiratory events (P=0.025). Acupuncture treatment significantly improved (before vs. after treatment) several dimensions of the SF-36 and Epworth questionnaires. There was no significant association between changes in the body mass index (BMI) and AHI. CONCLUSIONS: Acupuncture is more effective than sham acupuncture in ameliorating the respiratory events of patients presenting with moderate OSAS.

Effect of moxibustion at acupoints Ren-12 (Zhongwan), St-25 (Tianshu), and St-36 (Zuzanli) in the prevention of gastric lesions induced by indomethacin in Wistar rats.

This study was aimed at assessing the physical characteristics underlying the action of moxibustion at acupoints Ren-12 (Zhongwan), St-25 (Tianshu), and St-36 (Zuzanli) in preventing acute injuries of the gastric mucous membrane induced by indomethacin in Wistar rats. Induction of gastric lesions, by means of intragastric administration of indomethacin (100 mg/kg), in adult male Wistar rats was followed by treatment with moxibustion using Artemisia vulgaris dried leaves at 60 or 45 degrees C, heating with Artemisia vulgaris charcoal at 50 degrees C, heating with a regular tobacco cigar at 50 degrees C, and heating with a regular water pad at 50 degrees C, The effects of the different heating protocols over the gastric lesions were then compared. In addition, another group of animals was pretreated with capsaicin (100 mg/kg, s.c.), in order to lesion C fibers and, 15 days later, subjected to indomethacin administration and moxibustion treatment. Moxibustion was significantly more efficient at 60 degrees C than at 45 degrees C in preventing gastric lesions triggered by indomethacin. Moxibustion applied in acupoints provided a significant reduction of the lesion area, which was two times less than that of animals stimulated in a nonacupoint (sham group). Comparing the therapeutic effects provided by different forms of heating over the gastric lesions, the burning of dry leaves of Artemisia vulgaris was significantly more efficient in preventing gastric lesions than moxibustion made with Artemisia charcoal or tobacco (cigar) or by heating the animal with a water pad. Desensitization of the afferent sensory C fibers by capsaicin significantly diminished the ability of moxibustion to block the lesions in the gastric mucous membrane. Moxibustion can efficiently prevent indomethacin-induced gastric lesions in rats and this effect is dependent on the temperature, the material used for moxibustion, the use of acupuncture points, and the integrity of C fibers.

Serotonin involvement in the electroacupuncture- and moxibustion-induced gastric emptying in rats.

OBJECTIVE: Electroacupuncture (EA) as well as moxibustion stimulation has been reported to produce an excitatory effect on the gastrointestinal motility of the rat. Serotonergic neurons of the mioenteric and submucous plexus are major participants in the gastrointestinal physiology. Here, we compared the outcomes of the stimulation of a specific set of acupoints with either acupuncture or moxibustion on the gastrointestinal motility and the role of serotonin (5-HT) in this effect. METHODS: To analyze the role of 5-HT on the gastrointestinal motility of the rat, we studied the flow of 25 glass beads administered to the stomach, after treatment of the animals with a serotonin inhibitor (para-chlorophenylalanine [pCPA]). Acupuncture stimulation was performed on acupoints St-36 (Zusanli) and Sp-6 (Sanyinjiao), with electrical stimulation, or on acupoints Ren-10 (Xiawan), Ren-12 (Zhongwan) and St-25 (Tianshu), with moxibustion. Animals subjected to sham stimulation were used as controls in addition to naive, unstimulated animals. RESULTS: Stimulation of the hind limb (St-36 and Sp-6) and abdominal (Ren-10, Ren-12, St-25) acupoints resulted in effective gastric emptying, as compared with sham-stimulated animals. Pretreatment of animals with pCPA abolished either the response provided by acupuncture stimulation in animal groups subjected to hind limb acupoints or the response provided by moxibustion stimulation in abdominal acupoints. CONCLUSION: Our data suggest that moxibustion in the abdominal points and EA in the hind limb require an intact serotonergic pathway. In addition, we suggest that this involvement of serotonin is a general feature of the mediated effects of acupuncture on gastric emptying of the rat.