<p>Inspiratory Muscle Training in the Severity of Obstructive Sleep Apnea, Sleep Quality and Excessive Daytime Sleepiness: A Placebo-Controlled, Randomized Trial</p>

Abstract

Purpose: Exercise programs have been considered as an adjuvant treatment in obstructive sleep apnea (OSA). However, few studies have focused on the effects of the inspiratory muscle training (IMT) in reducing the severity and the symptoms of OSA. Patients and Methods: A randomized controlled trial was conducted and approved by the local Ethics Committee. All subjects signed the informed consent form and were randomized into 2 groups: a) IMT group (n = 8), 8 weeks of IMT with 75% of maximal inspiratory pressure (MIP) and b) placebo group (n = 8): subjects performed IMT without load. Results: IMT group showed reduction in the apnea-hypopnea index (AHI) (p = 0.01), in the Berlin questionnaire score (p = 0.001) and an increase in inspiratory muscle strength (p = 0.018). IMT group demonstrated a reduction in the AHI (31.7 ± 15.9 events/h vs 29.9 ± 15.8 events/h; p <0.001), in the Berlin questionnaire scores (2.6 ± 0.5 vs 1.2 ± 0.5; p = 0.016), Pittsburgh Sleep Quality Index (PSQI) score (7.2 ± 3.6 vs 3.7 ± 1.3; p = 0.008), in the Epworth Sleepiness Scale (ESS) (12.5 ± 4.0 vs 7.7 ± 3.0; p = 0.008) and increase in MIP (83.6 ± 26.5 cmH 2 O and 127.9 ± 32.5 cmH 2 O; p = 0.010). Conclusion: The IMT promotes discrete changes in the AHI and improves sleep quality and excessive daytime sleepiness in OSA. Moreover, IMT is a cheap, useful and simple homebased training program and can be considered as an adjunct therapy for OSA patients.

Respiratory Muscle Training in Patients with Obstructive Sleep Apnoea: A Systematic Review and Meta-Analysis

“…Of these, 12 were excluded for conference abstract, two for wrong intervention, one for wrong population, and one for wrong publication type. Ultimately, eight studies met the criteria for eligibility and were included in the review [ 16 , 17 , 21 , 22 , 23 , 24 , 25 , 26 ]. The flow chart of the study selection process is shown in Figure 1 .…”

“…Two studies were conducted in the USA [ 17 , 26 ], two in Taiwan [ 23 , 25 ], two in Brazil [ 16 , 21 ], one in Egypt [ 22 ], and one in Turkey [ 24 ]. All studies were published after 2016.…”

“…The characteristics of the included studies are shown in Table 1 . Seven studies included IMT [ 16 , 17 , 21 , 22 , 23 , 24 , 26 ], and one applied expiratory muscle training (EMT) [ 25 ].…”

“…In total, 210 patients with OSA were analysed (115 in the intervention group and 95 in the control group). Sample sizes varied between 16 [ 16 , 21 ] and 55 [ 22 ] participants. The studies included 63 (30%) females and 147 (70%) males with mean ages varying between 44.3 ± 2.9 [ 25 ] and 69.7 ± 3.4 [ 17 ] years.…”

“…Although the involvement of the respiratory muscles in OSA is evident, the effect of RMT to improve clinical outcomes is not clear [ 16 , 17 ]. Therefore, we aimed to determine the effects of RMT in AHI and subjective symptoms in patients with OSA.…”