Clinical safety and hemodynamic, cardiac autonomic and inflammatory responses to a single session of inspiratory muscle training in obstructive sleep apnea

Abstract

Purpose To determine clinical safety and cardiovascular, cardiac autonomic and inflammatory responses to a single session of inspiratory muscle training (IMT) in obstructive sleep apnea (OSA) subjects. Methods In a randomized controlled trial individuals of both sexes, aged between 30 and 70 years old with diagnosis of moderate to severe OSA were enrolled. Volunteers with OSA (n = 40) performed an IMT session with three sets of 30 repetitions with a 1-min interval between them. The IMT group (n = 20) used a load of 70% of the maximum inspiratory pressure (MIP), and the placebo group (n = 20) performed the IMT without load. Measurements of systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), heart rate variability (HRV), and inflammatory markers were performed pre, post-immediate and 1 h after the IMT session. Results No differences were shown in SBP, DBP, HRV, or inflammatory markers at any of the intervals analyzed. However, HR in the IMT group was lower 1 h after the IMT session compared to the pre-session values (p = 0002). HR was higher in the placebo group when comparing pre × post-immediate (p < 0.001). HR decreased after the first hour in relation to the pre (p < 0.001) and post-immediate (p < 0.001) values. Conclusion IMT sessions promote discreet hemodynamic, cardiac autonomic and inflammatory responses. Therefore, IMT is considered clinically safe and can be performed at home, guided but unsupervised, with lower cost and greater adherence to exercise program for subjects with OSA.

Respiratory muscle training for obstructive sleep apnea: Systematic review and meta‐analysis

“…The smallest studies included 16 adult participants (Nóbrega‐Júnior et al, 2020; Souza et al, 2018) and the largest study included 55 participants (Moawd et al, 2020). Five RCTs evaluated individuals who were not using CPAP (Erturk et al, 2020; Ferreira et al, 2022; Kuo et al, 2017; Souza et al, 2018; Vranish & Bailey, 2016), two assessed participants using equipment or other assistive devices (Ramos‐Barrera et al, 2020; Vivodtzev et al, 2018), and the others did not report. The studies included participants with varying levels of disease severity.…”

“…The studies included participants with varying levels of disease severity. The intervention duration of the included studies ranged from very short term (up to 1 month; Ferreira et al, 2022) to short term (up to 12 weeks; Azeredo et al, 2019; Erturk et al, 2020; Fischer et al, 2019; Kuo et al, 2017; Labeix et al, 2022; Lin, Chang, et al, 2020; Moawd et al, 2020; Nóbrega‐Júnior et al, 2020; Ramos‐Barrera et al, 2020; Souza et al, 2018; Vivodtzev et al, 2018; Vranish & Bailey, 2016). No study reported an intervention time longer than 12 weeks (medium and long term).…”

“…Interventions were evaluated at different follow‐up times. One study evaluated the acute effect of the intervention (after 1 hr; Ferreira et al, 2022) and the other 12 studies evaluated short‐term effects (< 3 months). No studies evaluated the medium‐ (> 3 months and < 1 year) and long‐term effects (> 1 year).…”

A hypotensive protocol of inspiratory muscle strength training: Systematic review and meta‐analysis with trial sequential analysis

“…The 13 studies included five trials (Table 1 ) focusing on healthy adults, 8 , 17 , 18 , 19 , 20 five trials focusing on patients with hypertension (simple systolic hypertension, 21 , 22 , 23 Grade I and II hypertension 24 and essential hypertension 16 ) and two tests on patients with OSA 25 , 26 from five countries including the USA, China, Brazil, Thailand, and Turkey. A total of 386 participants were enrolled in the study.…”

“…Of the 12 articles included in this paper (Table 2 ), nine studies 8 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 25 , 26 used threshold devices and three studies 21 , 23 , 24 used flow resistance loads with MIP ranging from 15% to 75% of MIP and water column fluctuations in the range of 18−20 mm H 2 O. There are two studies 18 , 20 in which several groups of different resistances were compared.…”