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Breathe Better E-Newsletter>
Acupuncture For OSA Sufferers: Sham or Science?
July 22, 2008
As a licensed acupuncturist, it's empowering to see your
profession cast in an approving light, especially when it's
reviewed by a well respected medical journal. However,
since I have witnessed the effectiveness of acupuncture for
a myriad of disorders, I am always curious as to why its
efficacy is not positively portrayed in more clinical
trials. Having reviewed this study for Dr. Park, I now know
why.
STUDY OVERVIEW
The purpose of this study was to investigate the efficacy
of acupuncture in the treatment of moderate obstructive
sleep apnea syndrome (OSAS). It was a randomized,
placebo-controlled, single-blinded study, with blinded
evaluation of 36 patients presenting with an apnea/hypopnea
index (AHI) of 15-30/h (for an explanation of AHI go to:
http://www.medicinenet.com/sleep_apnea/article.htm). The
patients were divided into 3 groups: an experimental group
of 12 people receiving acupuncture once a week for 10
weeks, a sham group of 12 patients who received “fake”
acupuncture once a week for 10 weeks, and a control group
of 12 patients who received no treatment. The results
showed that out of the 26 patients who completed the study,
there were significant changes for those in the
experimental group that received acupuncture. Not only did
the number of respiratory events (or number of
obstructions) decrease in the acupuncture group, but there
were also marked improvements in the outcome measures as
displayed by the SF-36 and Epworth questionnaires. The
investigating team concluded that acupuncture is more
effective than sham acupuncture in relieving the
respiratory events of patients presenting with moderate
OSAS.
SHAM VERSUS REAL LIFE RESULTS
My first question regarding this study has to do with the
conclusion made by the investigating team. While the
research showed that acupuncture is more effective than
sham acupuncture in relieving respiratory events in
moderate OSAS, there was no mention of a comparison of the
experimental group (those receiving acupuncture) to the
control group (those not receiving acupuncture).
Granted, real acupuncture versus “sham” acupuncture may
prove that there is such as thing as a “good” treatment
versus a “bad” treatment. Especially as the research team
here utilizes the sham group in the same way that a
pharmaceutical company would compare those who were taking
"placebos" to those who were taking the "controlled
substance" in question. However, some TCM (Traditional
Chinese Medicine) practitioners may disagree with the
study's conclusion citing faults in its design.
EASTERN VERSUS WESTERN STUDY DESIGN
The study noted that there were some improvements in the
sham group over those in the control group. This implies
that even though no real acupuncture points were used on
specific meridians, there was some sensation or response
that provoked an outcome for the patient. This can lead to
conflicting ideas as to whether the sham acupuncture is in
fact a real treatment or if it is truly placebo acupuncture
as it is meant to be. For this reason, a future study with
only 2 study arms, an experimental group and a control
group, omitting a sham group altogether in favor of simply
comparing the results of acupuncture to no acupuncture may
be better from a TCM perspective.
Furthermore, if it is true that a clinical trial must show
a certain reliability and reproducibility in order for it
to be deemed valid, this same criteria makes it difficult
to assay the full impact of acupuncture and other forms of
TCM for the treatment of illnesses confined within a
Westernized paradigm of disease and health.
DIFFERENT PARADIGMS, DIFFERENT PERSPECTIVES
When I was in graduate school, I was part of a research
team that put together a proposal for studying the effects
of acupuncture in post-stroke rehabilitation. Our analysis
of previous studies addressing the use of acupuncture
revealed several fundamental difficulties in the assessment
of an ancient Eastern medical paradigm within the framework
of modern Western medical research protocols. These
difficulties occurred primarily when attempting to apply
scientific demands of reliability and validity to the TCM
treatment approach based on individual presentation and
pattern diagnosis.
TCM sees each person as an individual with a unique set of
patterns and presentations regardless of the disease
diagnosis. That being said, 5 people presenting with OSAS
to a TCM practitioner may be diagnosed with 5 different TCM
disease patterns and therefore treated with different
acupuncture point prescriptions. While some of the points
may be the same, as noted in this pilot study being
reviewed, there may be other points specific to each
individual that addresses the root of his/her sleep apnea
syndrome. Treating the root of the disorder or what is
considered the underlying cause is a fundamental treatment
principle in TCM. Not only can such a treatment reduce the
severity of the symptoms, but it may also reduce the
occurrence or recurrence of such disorders altogether.
Therefore, it would be interesting to note the long-term
effects of using the same point protocol on different
patients and whether or not further evaluation at a later
date would show more variance in results. Unfortunately,
there is no mention in the original article of the
different TCM disease patterns used to come up with their
acupuncture point prescription or if that was even taken
into consideration.
In essence, the basic differences in approach may make a
true study of TCM impossible within a Western medical
framework. Thus, trying to adhere to strict TCM protocols
usually results in studies being conducted with
discrepancies in design, intervention and control
procedures--all things that in a more statistical
evaluation like the study mentioned would compromise the
scientific relevance and validity of their results.
Perhaps the future of clinical trials investigating the
efficacy of acupuncture lies within a setting that allows
for both a TCM approach of customized treatment along with
a Western standardization that will be statistically
measurable, reproducible, and scientifically valid. While
the efficacy of acupuncture has been seen for thousands of
years, it seems the progress of acupuncture research is
slow indeed, and the gap between TCM and Western medicine
may be the sticking point when trying to conduct a valid
clinical study using acupuncture.
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Amy R. Hausman, L.Ac, Dipl. OM. (NCCAOM) is board-certified
in Chinese Medicine. As the founder of Co-Creative Healing
Arts and
Acupuncture, Amy brings her experience as a licensed
acupuncturist and psycho-spiritual counselor to those
suffering from anxiety/depression, sleep
disorders,reproductive issues, pain management, addictions,
chronic sinusitis, migraines, and other acute and chronic
illnesses.
Focusing on the body as a whole rather than only the part
that is
sick is a key to healing all types of disorders. It is this
subtle yet powerful approach that Amy integrates using her
background in both Chinese medicine and Integrative Energy
Medicine in order to help initiate the person’s own healing
process.
For a limited time, mention this article and receive $50
off your first consultation and treatment. You can contact
her directly at: 917-334-8907.
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*Treatment of Moderate Obstructive Sleep Apnea Syndrome
with Acupuncture: A randomized, placebo-controlled pilot
trial
Anaflavia O. Freire, Gisele C.M. Sugai, Fernanda Silveira
Chrispin, Sonia Maria Togeiro, Ysao Yamamura, Luiz Eugenio
Mello, Sergio Tufik: Sleep Medicine, 2006, xx(xxxx), 1-8, ©
Elsevier
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