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Analysis of Patterns in Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS)

abstracted & translated by
Bob Flaws, Lic. Ac., FNAAOM (USA), FRCHM (UK)

Keywords: Chinese medicine, pattern discrimination, obstructive sleep apnea hypopnea syndrome (OSAHS)

Sleep apnea refers to the cessation of breathing during sleep. It is commonly associated with both being overweight and snoring. Rather than being a benign sleep disorder, sleep apnea is statistically associated with the development of hypertension and heart disease. On pages 25-26 of issue #7, 2004 of Xin Zhong Yi (New Chinese Medicine), Su Jun and Li Lei published a study which attempts to identify the Chinese medical disease mechanisms associated with this condition. The title of Su and Li’s article is "An Analysis of the Symptoms & Patterns of Obstructive Sleep Apnea Hypopnea Syndrome." A summary of that article is presented below.

Cohort description:

Altogether, there were 183 individual’s enrolled in this study which was conducted in Guangdong province from November 1999 to November 2003. There were 122 persons with a confirmed diagnosis of OSAHS and 61 patients who did not have OSAHS. Among the 122 OSAHS sufferers, there were 97 males and 25 females with an average age of 56.9 years. These patients had been diagnosed with OSAHS for from 2-30 years, with an average disease duration of 11.6 years. This cohort of OSAHS patients was then further divided into two groups. The first group had had OSAHS for less than 10 years. This group consisted of 62 patients with 52 males and 10 females and an average age of 50.7 years. The second group had had OSAHS for more than 10 years and consisted of 60 patients, with 45 males and 15 females and an average age of 63.0 years. In the comparison group without OSAHS, there were 48 males and 13 females with an average age of 60.4 years.

Study methodology:

First, the patients with OSAHS were compared to the normal persons without OSAHS in terms of the signs and symptoms of phlegm. Each of several symptoms or signs was assigned a number from 1-3 to gauge severity. Then the number of persons exhibiting that sign or symptom in each group and the total number of points from each group were tallied and compared. The results are shown in the table below.

Group No. Fat Teeth-marks Chest oppression Sleepiness Thick, slimy fur

		No.	Points	No.	Points	No.	Points	No.	Points	No.	Points
OSAHS	122	120	327	117	239	95	169	73	135	110	197
Normal	61	22	47	24	46	19	25	6	10	40	65

This table shows that the patients with OSAHS had more signs and symptoms of of phlegm dampness and more severe phlegm dampness than did the normal patients without OSAHS with which they were compared. This suggests that phlegm dampness plays a major role in the disease mechanisms of OSAHS.

Then the two group of OSAHS sufferers were compared in terms of the signs and symptoms of blood stasis and qi vacuity. The following two tables show the number of patients and total number of points for these signs and symptoms.

Blood stasis

Group No. Headache, cynaotic Purple tongue, Tort. sublingual Choppy, fine pulse

Lips Static macules Veins

		No.	Points	No.	Points	No.	Points	No.	Points
Group 1	62	21	37	14	20	25	57	13	22
Group 2	60	45	70	40	77	55	100	38	45

This table shows that the patients with OSAHS for less than 10 years are less likely to display blood stasis signs and symptoms as well as less severe signs and symptoms.

Qi vacuity

Group No. Short breath Fatigue, Constant Weak, forceless

Lack of strength Sleepiness Pulse

		No.	Points	No.	Points	No.	Points	No.	Points
Group 1	62	36	70	37	80	20	31	37	95
Group 2	60	45	117	45	93	40	97	49	104

This table shows that patients with OSAHS for less than 10 years are less likely to display qi vacuity signs and symptoms as well as less severe signs and symptoms of qi vacuity as those who ave suffered from this condition for more than 10 years. However, the difference between these two groups in terms of qi vacuity is not as pronounced as it was in terms of blood stasis.

According to the Chinese authors, in the early stage of this condition (i.e., the first 10 years), the main pattern is phlegm dampness blockage and obstruction. Therefore, the clear yang is not upborne and turbid yin is not downborne. If this condition then endures for a long time, eventually there is blood stasis and qi vacuity as well. In those with blood stasis, red blood cell agglutination and blood viscosity are typically elevated. Thus it is Drs. Su and Li’s advice that patients in the early stage of OSAHS should be treated based on the principles of dispelling phlegm, transforming stasis, fortifying the spleen, and supplementing the qi. To this, I would add coursing the liver and rectifying the qi. This is because of the inter-relationship between the liver and spleen and the qi and blood/qi and body fluids. In individual patients, it may also be necessary to clear depressive, phlegm, or damp heat and to nourish the blood.