Introduction

The “oxygen bar” phenomenon is touted as the health-conscious alternative to shisha/hooka (or any other illegal substances that one might choose to inhale for fun). An “oxygen bar” is a free-standing booth that you can rent and sit/stand in to inhale over 90% pure oxygen and aromatherapy via disposable nasal cannula. Regular room air only has 21% oxygen.

According to very clever marketing, the “oxygen bar” experience is guaranteed to have people talking about your corporate event or party and have you stand out from the crowd.

The new obsession with oxygen does not end there. There is also a growing interest in hyperbaric oxygen therapy as a health-promoting treatment for a wide range of conditions, including migraines, ME, sports injuries, and strokes.

Is there any research to back up any of the latest fashion in oxygen?

What Is Oxygen Therapy?

Oxygen is a vital element. It does not exactly date back as far as the Big Bang but has certainly been around for a long time. Swedish scientist Karl Scheele and British chemist Joseph Priestly discovered oxygen independently in the 1770s. Joseph Priestly foresaw the oxygen bars of the future and is quoted as saying:

“The feeling of it to my lungs was not sensibly different from that of common air; but I fancied that my breast felt peculiarly light and easy for some time afterwards. Who can tell but that, in time, this pure air may become a fashionable article in luxury. Hitherto only two mice and myself have had the privilege of breathing it.” (1)

Oxygen was first used clinically as a treatment for phosgene poisoning in wartime and is now used for a wide range of indications in medical practice.

Just to be clear, there is a huge difference between “recreational oxygen” and “therapeutic oxygen.” “Recreational oxygen” would never offer high enough doses of oxygen for therapeutic purposes. As physicians, we classify oxygen as a drug and prescribe oxygen in the same way that we prescribe drugs.

There are two main forms of administration of therapeutic oxygen: normobaric and hyperbaric oxygen.

Firstly, normobaric oxygen therapy (NBOT) is oxygen administered at one atmosphere of pressure. This is the type of oxygen commonly used in hospitals and clinics for pneumonia, chronic obstructive pulmonary disease, etc. and peri-operatively. The physician decides what percentage of oxygen to use and titrates the dose to the clinical response.

Secondly, hyperbaric oxygen therapy (HBOT) refers to the administration of 100% oxygen at environmental pressures greater than one atmosphere. This increases the amount of dissolved oxygen in the plasma, which in turn increases the delivery of oxygen to the tissues.

According to the Undersea and Hyperbaric Medical Society, the list of approved indications for HBOT includes decompression sickness, carbon monoxide poisoning, non-healing wounds, air/gas embolism, gas gangrene, crush injury, severe anemia, arterial insufficiency, intracranial abscess, necrotizing fasciitis, compromised skin grafts, radiation injury, and sudden sensorineural hearing loss (2).

Is There Any Research?

There are over 70,000 published articles on oxygen, including 6,186 clinical trials.

To put this into context, there are 12,000 studies and less than 300 clinical trials on helium gas.

Does Oxygen Therapy Help Treat Chronic Obstructive Pulmonary Disease (COPD)?

Oxygen therapy is widely used in the acute and chronic management of people with chronic obstructive pulmonary disease (3). It is used acutely in the hospital setting during acute infectious exacerbation of COPD, e.g. influenza, streptococci, etc. Some people with COPD have extensive lung damage and require chronic oxygen support. This can be done with home oxygen therapy using mobile oxygen cylinders.

Bottom Line

Oxygen therapy is established as the standard of care in the acute and chronic management of COPD.

Does It Help Treat Cancer?

A German team undertook a comprehensive literature review to evaluate the effect of HBOT on cancer (4). This is a slightly complex issue which needs some clarification.

Essentially, hypoxia is a hallmark of cancer cells.

On the one hand, there is hope that HBOT could inhibit tumor growth.

On the other hand, given the fact that oxygen plays a key role in cell growth, there are concerns that HBOT could act as a cancer promoter or lead to cancer recurrence.

The meta-analysis concluded that different cancers respond differently to HBOT.

In summary:

There are no human clinical trials on HBOT in breast cancer or leukemia.

HBOT is not recommended as a stand-alone treatment in colorectal cancer but could play a role as adjuvant therapy in gliomas and prostate cancer and shows no benefit in prostate or cervical cancer, which are classified as non-responders.

Bottom Line

There is no simple single answer to the question of whether oxygen therapy helps cancer. Available evidence suggests that different cancers respond differently to oxygen therapy, and much more research is needed.

Does It Help People Quit Smoking?

There are no studies looking at the role of oxygen therapy in smoking cessation. Logically, people who smoke and need oxygen might consider quitting smoking to preserve their lung function. (Experience tells us that this is not always the case.)

Equally, oxygen is flammable, and one could assume that people who use oxygen would stop smoking. (Again, experience tells us that this is not the case. It is not unusual to see people smoking while attached to an oxygen cylinder. If in doubt, stand outside any hospital for a few minutes.)

Bottom Line

There is no connection between oxygen therapy and smoking cessation.

Does It Help Cure Herpes?

There is one study looking at the effects of oxygen therapy on herpes infection (5). The study looks at herpes zoster, which is the virus that causes shingles, and not herpes simplex, which is the virus that causes cold sores.

A total of 68 patients with herpes zoster (shingles) were randomly allocated to HBOT or a control group. All patients received standard antiviral therapy. The patients in the HBOT arm of the study had a non-statistically significant improvement in symptoms, including blister resolution, scar formation time, and subsequent development of post-herpetic neuralgia and depression.

Bottom Line

HBOT results in a non-statistically significant benefit in herpes zoster (shingles) infection. It does not cure herpes zoster infection. Nothing cures herpes zoster infection, as the virus remains dormant in the body. There is no information on HBOT for herpes simplex (cold sore) infection.

Does It Treat Headaches?

A Cochrane review evaluated the effect of NBOT and HBOT for the treatment and prevention of migraines and cluster headaches (6).

The review identified 11 trials, which included 209 study participants. Overall, the quality of the evidence was poor according to the Cochrane reviewers.

There was no evidence that HBOT could prevent migraine headaches or reduce migraine-associated gastrointestinal upset.

A meta-analysis of available poor-quality data from studies suggested that HBOT was effective at terminating acute migraine and that NBOT was effective in terminating cluster headaches.

The Cochrane reviewers concluded that more research needs to be done in this area.

Bottom Line

At this time, there is some data to suggest that HBOT is effective at terminating migraine headaches and that NBOT is effective at terminating cluster headaches.

Does It Treat Pain?

There is a Turkish double-blind, placebo-controlled trial looking at the effect of HBOT on complex regional pain syndrome (reflex sympathetic dystrophy) (7).

A total of 71 patients were randomized to 15 sessions in a hyperbaric chamber with either HBOT or normal air.

The study showed that there was a significant decrease in pain and an improvement in the range of movement in the group who received HBOT as compared to the placebo group.

A comprehensive review of oxygen for chronic pain was published last year and concluded that “Early clinical research indicates HBOT may be useful in modulating human pain; however, further studies are required to determine whether HBOT is a safe and efficacious treatment modality for chronic pain conditions.” (8)

Bottom Line

A single study showed that HBOT is beneficial for complex regional pain syndrome. Further studies are needed to assess the effect of HBOT on different forms and severity of pain.

Does It Improve Sleep or Help Insomnia?

There is nothing in the literature to suggest that oxygen therapy helps with insomnia. However, there are complex and clinically relevant interactions between the sleep cycle and oxygenation.

Perhaps the best-known of sleep-disordered breathing syndromes is the obstructive sleep apnea syndrome (OSA). This occurs when people go through cycles of not breathing while asleep. There are two key ways of treating obstructive sleep apnea – continuous positive airway pressure and oxygen therapy (3).

A comprehensive review of the utility of supplemental oxygen during sleep was published by pulmonary physicians at the Brigham Women’s Hospital (9).

The article explains that there is considerable overlap between sleep disorders and pulmonary disease. Sleep deprivation can impair respiratory function. Additionally, many patients have both obstructive sleep apnea and respiratory disease.

Bottom Line

There is a complex interconnection between sleep cycles and oxygenation. There is no science to support the claim that oxygen improves sleep or insomnia.

Is Oxygen Therapy Safe & Are There Interactions?

Oxygen is flammable and should be kept away from naked flames.

Another key risk of any oxygen therapy is hypoventilation. Patients with advanced chronic obstructive pulmonary disease get their drive to breathe from chemoreceptors on the carotid (10). Excess oxygen therapy reduces this respiratory drive and can result in retention of carbon dioxide (hypercarbia) and, ultimately, death.

Excess doses of normobaric oxygen (hyperoxia) can also result in pulmonary fibrosis.

Side effects of HBOT include middle ear barotrauma, myopia (visual disturbance), claustrophobia, and inspiratory pain (11).

HBOT is expensive and costs on average $350 per 30-minute session.

Conclusion

There is nothing to support the use of recreational oxygen therapy apart from the recommendations of Joseph Priestley, his two mice, and the oxygen bar industry.

However, NBOT is well-established as the standard of care in the management of a wide range of medical conditions.

There is far less information on HBOT than NBOT. The Undersea and Hyperbaric Medical Society explains that it is ethically exceptionally difficult to conduct research on HBOT (12). People who need HBOT for licensed indications are usually critically unwell and, as such, are unable to provide informed consent.

Additionally, the number of people with conditions such as necrotizing fasciitis is small (thankfully), making it difficult to get a critical mass of people to make statistical analysis meaningful.

As Joseph Priestley said, “In completing one discovery we never fail to get an imperfect knowledge of others of which we could have no idea before, so that we cannot solve one doubt without creating several new ones.”

It has been some 250 years after oxygen was “discovered” and it seems we have a very imperfect knowledge of its clinical utility and have effectively created a lot of “doubts” to figure out.