Acupuncture Treatment Of Sleep Apnea Hypopnea Syndrome Cognitive Damage, Clinical Observations,

1 ObjectiveTo observe the clinical efficacy of 22 sleep apnea hypopnea syndrome pati ents treating by select the points from the local area, needling Lianquan(R N23), Renying(ST9) and taking electro-acupuncture stimulation. We confirmed that acupuncture Lianquan (RN23), Renying(ST9) can reduce the apnea index o f sleep apnea hypopnea syndrome patients, increased their minimum oxygen sa turation during sleep, improved difficulty in concentrating, memory loss an d other cognitive impairment, and irregular snoring, asphyxia or apnea duri ng sleep, daytime sleepiness, fatigue, sleep does not recover from fatigue and other symptoms. Explore the mechanism of action of acupuncture therapy on sleep apnea hypopnea syndrome patients with cognitive impairment.2 Methods27 cases of sleep apnea hypopnea syndrome patients treated in acupuncture clinics of Guang An Men Hospital of China Academy of Chinese Medical Scien ces who met the diagnostic criteria of "Obstructive sleep apnea hypopnea sy ndrome diagnosis and treatment guidelines (draft)" working out by Chinese M edical Association Respiratory Diseases Association Sleep Respiratory Disor ders Group, were selected as sample. They were age of 50.32±12.32 years old, their average body mass index was 26.80±3.77kg/m2. Case inclusion c riteria:1) those who meet the diagnostic criteria for SAHS; 2) age older t han 18 years, less than 75 years; 3) signed informed consent, voluntary pa rticipants. Exclusion criteria:1) long-term alcoholics; 2) patients with s evere nasal obstruction; 3) antiadoncus degree≥Ⅱ; 4) patients who had pr evious surgical treatment of local area; 5) severe difficulty swallowing, o r confusion, or aphasia, or dementia persons; 6) sleep apnea syndrome cause s by other diseases; 7) patients with severe heart, lung, liver, kidney and other system complications. Exclusion criteria:1) patients for various re asons do not adhere to the PSG polysomnography monitoring; 2) patients for various reasons unable to adhere to acupuncture therapy. Sleep monitoring r esults before treatment, P300 test results were taken for the self-control. Took Lianquan (RN23) (Slightly upward, upper laryngeal protuberance, the mi dpoint of the upper edge of hyoid body), slowly obliquely 0.5-0.8 inch dire ction to the base of the tongue with a 30-size,1.5-inch needle, stop needl ing when felt numbness and bulge on throat. Took Renying(ST9) (lateral lary ngeal protuberance, anterior sternocleidomastoid, carotid arterial pulse ar ea), slowly perpendicularly 0.3-0.8 inch to avoid the artery with a 30-size, 1.5-inch needle, stop needling when felt numbness and bulge. Picked the ne edles on the two points with Great Wall KWD-808 pulse electrotherapy device on the handle, selected a continuous wave type, frequency of 2Hz, the curr ent strength of the patient tolerance for the degree, kept the needle for 3 0 minutes. Took the treatment 3 times a week, took sleep monitoring, P300 t est again after 6 weeks of treatment. ESS sleepiness scale and Montreal Cog nitive Assessment evaluation were made before and after treatment.3 Results5 patients did not complete the observation,4 patients failed to adhere to complete acupuncture therapy; 1 case completed acupuncture therapy faile d to retest sleep test.22 patients completed the observation had 18 males a nd 4 females, and there was no adverse reaction. Those 22 patients with sle ep apnea hypopnea syndrome before treatment, had 10 severe OSAS cases,6 mo derate cases,6 mild cases. After the treatment of acupuncture and electro-acupuncture there were 5 severe cases,7 moderate cases,9 mild cases,1 ca se of index AHI<5. Clinical grading significantly lowered down. After trea tment of acupuncture and electro-acupuncture, the apnea index decreased sig nificantly (P<0.05), the value of minimum oxygen saturation during sleep i ncreased significantly (P<0.05), the evaluation scores of ESS sleepiness s cale decreased significantly (P<0.01), the Montreal Cognitive Assessment ev aluation scores increased significantly (P<0.01). Patients'Cz latency sho rtened (P<0.05), Pz latency shortened (P<0.05), P300 reaction time shorte ned (P<0.05). Through the above data showed acupuncture add EA on Lianquan (RN23), Renying(ST9) can decrease patients'apnea index and improve the min imum oxygen saturation during sleep, improve cognitive impairment.4 DiscussionThrough the study of 27 included sleep apnea hypopnea syndrome patients, we found apnea hypopnea index> 40 times/hour or more that(severe apnea) accounted for 37.0%, hypopnea index of 20-40 times/hour (moderate apnea) is accounted for 22.2%, the patients were mainly moderate to severe sleep a pnea hypopnea syndrome. Patients'blood oxygen saturation degree below 80% w ith severe hypoxemiaof took 44.4%, blood oxygen saturation degree between 8 0-84% took 14.8% of patients with moderate hypoxemia. ESS sleepiness scale scores>15degrees took 33.3%, between 10 to 15 degrees took 11.1%, Montreal Cognitive Assessment evaluation scores<26 took 40.7%. The data showed sleep apnea hypopnea syndrome patients may mostly associated with cognitive impa irment. Among the 22 cases sleep apnea syndrome patients completed observat ion with severe obstructive sleep apnea syndrome accounted for 45.5%, moder ate for 27.3%; severe hypoxemia accounted took for 54.5%, moderate hypoxemi a accounted for 18.2%. After took the treatment of acupuncture on Lianquan (RN23), Renying(ST9) 6 weeks later, we found patients'AHI apnea hypopnea i ndex decreased significantly, blood oxygen saturation degree at night signi ficantly increased, especially blood oxygen saturation degree at night was more significant rised, the proportion of severe obstructive sleep apnea sy ndrome cases was 22.7%, moderate was 31.8%; the proportion severe hypoxia w as 22.7%, moderate was 31.8%, the left were mild or normal, ESS Sleepiness Scale score>15 took 4.5%, scores between 10 to 15 accounted for 9.1%, Mo ntreal Cognitive Assessment Evaluation less than 26 degrees accounted for 9. 1%. Patients'snoring, asphyxia or apnea during sleep, daytime sleepiness, fatigue, sleep does not recover from fatigue and other syndromes were impro ved. Needle on the deep part of Lianquan(RN23) and make low-frequency elect rical stimulation continually, can regulate the hypoglossal nerve and muscl e under Lianquan (RN23) point, and thus increased the contractility of throa t muscles, airway lumen can maintain a certain tenacity, genioglossus-based upper airway muscles moved forward so that effective expanse the the airwa y behind the tongue, thereby maintaining the upper airway open, so that inc rease blood oxygen saturation at night, and greatly improve hypoxemia, thus improve some patients'subjective clinical symptoms.