Effects of respiratory muscle therapy on obstructive sleep apnea: a systematic review and meta-analysis

Abstract

Study Objectives: The purpose of this study is to conduct a systematic review and meta-analysis evaluating the effects of respiratory muscle therapy (ie, oropharyngeal exercises, speech therapy, breathing exercises, wind musical instruments) compared with control therapy or no treatment in improving apneahypopnea index ([AHI] primary outcome), sleepiness, and other polysomnographic outcomes for patients diagnosed with obstructive sleep apnea (OSA). Methods: Only randomized controlled trials with a placebo therapy or no treatment searched using PubMed, EMBASE, Cochrane, and Web of Science up to November 2018 were included, and assessment of risk of bias was completed using the Cochrane Handbook. Results: Nine studies with 394 adults and children diagnosed with mild to severe OSA were included, all assessed at high risk of bias. Eight of the 9 studies measured AHI and showed a weighted average overall AHI improvement of 39.5% versus baselines after respiratory muscle therapy. Based on our meta-analyses in adult studies, respiratory muscle therapy yielded an improvement in AHI of −7.6 events/h (95% confidence interval [CI] = −11.7 to −3.5; P ≤.001), apnea index of −4.2 events/h (95% CI = −7.7 to −0.8; P ≤ .016), Epworth Sleepiness Scale of −2.5 of 24 (95% CI= −5.1 to −0.1; P ≤ .066), Pittsburgh Sleep Quality Index of −1.3 of 21 (95% CI= −2.4 to −0.2; P ≤ .026), snoring frequency (P = .044) in intervention groups compared with controls. Conclusions: This systematic review highlights respiratory muscle therapy as an adjunct management for OSA but further studies are needed due to limitations including the nature and small number of studies, heterogeneity of the interventions, and high risk of bias with low quality of evidence.

Treatment of Obstructive Sleep Apnea in Children: Handling the Unknown with Precision

“…To date, the studies have included only a very limited number of patients along with relatively short follow-up periods. A recent meta-analysis confirms the high level of heterogeneity of the interventions (multiple approaches and different exercises for the same objective) and, more importantly, the presence of a high risk of bias due to the low quality of the evidence [116]. Although oropharyngeal exercises have few complications and are relatively easy to teach to patients, child co-operation and adherence are essential for any potential benefit related to this type of interventions.…”

The Role of Myofunctional Therapy in Treating Sleep-Disordered Breathing: A State-of-the-Art Review

“…The search strategy identified 23 studies that met the inclusion criteria [ 5 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ]. The mean sample size (excluding systematic reviews and meta-analyses) was 38.28.…”

“…The mean age pondered by the sample size and excluding systematic reviews and meta-analyses was 51.19 years. The search strategy retrieved three meta-analyses [ 5 , 10 , 15 ], one systematic review [ 23 ], nine randomized clinical trials [ 8 , 11 , 12 , 13 , 19 , 21 , 24 , 25 , 26 ], seven quasi-experimental studies [ 9 , 16 , 17 , 18 , 20 , 22 , 29 ], one cohort study [ 14 ], one case series [ 27 ], and no case–control studies.…”

“…Polysomnographic (PSG) variables were included in 18 studies [ 5 , 9 , 10 , 11 , 12 , 13 , 15 , 16 , 17 , 19 , 21 , 22 , 23 , 24 , 25 , 28 , 29 ], including two meta-analyses [ 5 , 10 ] and two systematic reviews [ 23 , 28 ]. We note that the meta-analysis of Hsu et al [ 10 ] and the review by Valbuza et al [ 23 ] reported studies using MFT and respiratory exercises, as well as protocols that included singing exercises and playing wind instruments, which were not considered to be MFT in the meta-analysis of Camacho et al [ 5 ] or in our review.…”

“…Hsu et al included five single-blinded randomized controlled trials (RCTs) and four non-blinded RCTs in their meta-analysis. In their analyses of the studies of adults, the average decrease in the AHI was −36.0% ± 25.6% in the intervention groups and −0.3% ± 15.3% in the control groups [ 10 ].…”