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Improving Sleep with OMT: A Randomized Controlled Trial using Cervical Techniques to Improve Sleep for OMSI
Le, D. [7]
Fagen, D. [1]
Christensen, S. [1]
Jensen, C. [2]
Alacron, A. [1]
Slife, R. [1]
Thakur, C. [1]
Teo, R. [1]
Spradley, G. [1]
Jackson, S [3]
Zamanian, P. [1]
Finley, D. [1]
Tran, N. [2]
Tran, A. [3]
Redeman, K. [1]
Marble, A. [1]
Keane, J. [4]
Mangiaracina, M. [1]

Journal: Journal of Osteopathic Medicine Date: 2024/12, 124(12):Pages: A33-A35. doi: Subito , type of study: randomized controlled trial

Full text    (https://www.degruyter.com/document/doi/10.1515/jom-2024-2000/html)

Keywords:

cervical spine [303]
OMT [3797]
osteopathic manipulative treatment [3818]
randomized controlled trial [903]
sleep [68]

Abstract:

Context: Recent research findings indicate that a significant portion, specifically 55.64%, of medical students report experiencing suboptimal sleep quality, averaging 6.5 hours of sleep, with 30% obtaining less than 7 hours [1]. The impact of sleep on learning and academic performance is well-documented [2]. Stress, a prevalent factor in medical school, can lead to heightened sympathetic activity, contributing to sleep disorders such as excessive daytime sleepiness and insomnia [3]. It is hypothesized that medical students may be in a hyper-sympathetic state, resulting in autonomic dysfunction throughout their educational journey. Studies have shown that vagus nerve stimulation (VNS) can help regulate the autonomic system by balancing sympathetic and parasympathetic activity [4]. While cervical non-invasive VNS has proven effective in managing sleep-related issues [5], the use of Osteopathic Manipulative Treatment (OMT) for autonomic dysfunction in this context remains unexplored. However, previous research has demonstrated an increase in parasympathetic activity through OMT, leading to a reduction in heart rate [6]. Objective: Therefore, this randomized clinical trial aims to investigates the potential advantages of OMT, incorporating cervical soft tissue therapy and OccipitoAtlantal (OA) decompression, in modulating the autonomic system over a six week period to improve sleep quality among OMS-I students at A.T. Still University (ATSU) in Arizona, measuring the sleep quality through the Pittsburgh Sleep Quality Index (PSQI) [7]. Methods: A cohort of 41 participants was recruited from ATSU during the fall quarter of 2023 to engage in a 6-week study involving OMT sessions conducted thrice weekly on Mondays, Wednesdays, and Fridays. The Principal Investigator ensured the removal of personal identifiers, and subjects were allocated randomly through a number generator. Subsequently, they were randomly divided into two distinct groups: a control group comprising 20 individuals and a treatment group consisting of 21 participants. The treatment team administered interventions, while the data team was responsible for data collection. Both teams were only privy to the subjects’ identities through their assigned numerical labels. Throughout the course of the study, one member from the treatment group and three from the control group withdrew from participation. The inclusion criteria stipulated the enrollment of exclusively medical students from the class of 2027 at ATSU in Arizona to maintain uniformity in stress levels attributed to examinations and academic tasks. Eligibility for participation was extended to individuals of any gender, ethnicity, or national origin. Subjects who did not meet these predefined criteria were excluded from the study. The exclusion criteria encompassed individuals with documented sleep disorders, neurological conditions, ongoing medical treatments affecting sleep patterns, contraindications for OMT, or those unable to utilize designated data collection applications. Additionally, individuals unable to attend all sessions over the six-week period were also excluded from participation. The treatment subjects underwent a 5-minute cervical soft tissue procedure, followed by 2-3 minutes of OA decompression, plus 2-3 minutes of rest, totaling a 10-minute session. These treatments were administered by second-year osteopathic medical students who were trained and supervised by OMT faculty at ATSU. The control subjects maintained a supine position for an equivalent duration. Implementing a sham trial for the control group was deemed unfeasible due to documented evidence indicating that touch interventions have demonstrated efficacy in alleviating stress among adult individuals [8]. Both cohorts completed the weekly PSQI assessment via a Google Form. The responses were converted into scaled scores ranging from 0 to 3, where higher scores denoted increased sleep disturbances and lower scores indicated fewer disruptions. The anonymized data was subsequently transferred to a dedicated Google sheet for analysis by distinct team members. Additional data points gathered included height, weight, gender, last menstrual period, bed size, and presence of pets. The statistical analysis encompassed paired sample t-tests utilizing the PSQI scores, following a within-subjects design to track changes within each participant over the weeks. The primary focus of the study was to examine the variation in PSQI scores pre and post treatment between the treatment and control groups. A 95% confidence interval was established around the mean difference, with a significance level set at α=0.05. Results: The comprehensive PSQI scores of both the treatment and control groups exhibited a substantial decrease from the baseline at week 0 to the assessment at week 6, as illustrated in Figure 1. While the treatment group showed a more pronounced reduction in PSQI score compared to the control group, statistical analysis using Mann-Whitney U tests did not yield statistically significant results (p = 0.234). While the overall comparison does not yield statistical significance, it is noteworthy that was a trend towards significance and may potentially achieve significance with an expanded sample size and/ or duration. Upon stratifying participants based on their Body Mass Index (BMI), as depicted in Figures 2 and 3, individuals with a BMI 25 did not exhibit a statistically significant effect when compared to the control groups (p = 0.857) when compared to the control group, as detailed in Table 1. Conclusion: The data suggests promising outcomes in enhancing sleep quality. The less favorable trend observed in individuals with a BMI > 25 may be attributed to the presence of Obstructive Sleep Apnea (OSA), with overweight or obese individuals being at a heightened risk [9]. OSA is estimated to affect 1 in 20 adults, leading to behavioral and cardiovascular complications [10]. Overcoming the effects of OSA may necessitate a longer duration of treatment. Nevertheless, it is possible that the current intervention may not be sufficient to fully address OSA, and additional measures such as weight management with OMT could be considered to achieve statistical significance. Further research supported by funding could leverage smart devices for monitoring sleep patterns and academic stress may offer valuable insights into the mechanisms underlying autonomic dysfunction induced by the stress of medical education. Prior studies have demonstrated that academic stress can elevate sympathetic activity, as evidenced by alterations in heart rate variability and salivary alpha-amylase levels [11]. Parameters such as heart rate variability, electrodermal activity, and potentially respiratory rate could serve as indicators of stress and anxiety levels over time [12], aiding in the optimization of treatment duration, frequency, and intensity. Nonetheless, the current study provides evidence that a standardized OMT regimen administered over 6-week period yields improvements in sleep quality for students with a BMI < 25.

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