Oropharyngeal Muscle Exercise Therapy Improves Signs and Symptoms of Post-stroke Moderate Obstructive Sleep Apnea Syndrome

Abstract

The primary aim of the current study was to assess the effects of oropharingeal muscle exercises in obstruction severity on stroke patients with OSAS. The secondary aims were to evaluate the effects of the exercises on rehabilitation of neurological function, sleeping, and morphology change of upper airway. An open-label, single-blind, parallel-group, randomized, controlled trial was designed. Fifty post-stroke patients with moderate OSAS were randomly assigned into 2 groups (25 in each group). For the therapy group, oropharyngeal muscle exercise was performed during the daytime for 20 min, twice a day, for 6 weeks. The control group was subjected to sham therapy of deep breathing. Primary outcomes were the obstruction severity by polysomnography. Secondary outcomes included recovery of motor and neurocognitive function, personal activities of daily living assessment (ADL), sleep quality and sleepiness scale. It also included upper airway magnetic resonance imaging (MRI) measurements. Assessments were made at baseline and after 6-week exercise. Finally, 49 patients completed the study. The apnea–hypopnea index, snore index, arousal index, and minimum oxygen saturation improved after exercise (P < 0.05). Oropharyngeal muscle exercises improved subjective measurements of sleep quality (P = 0.017), daily sleepiness (P = 0.005), and performance (both P < 0.05) except for neurocognition (P = 0.741). The changes in obstruction improvement, sleep characteristics and performance scale were also associated with training time, as detected by Pearson's correlation analysis. The anatomic structural remodeling of the pharyngeal airway was measured using MRI, including the lager retropalatal distance (P = 0.018) and shorter length of soft palate (P = 0.044) compared with the baseline. Hence, oropharyngeal muscle exercise is a promising alternative treatment strategy for stroke patients with moderate OSAS.Clinical Trial Registration: http://www.chictr.org.cn. Unique identifier: ChiCTR-IPR-16009970

EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke

“…A further two class II quality studies on the impact of CPAP on measures of vascular risk were published after the systematic search finished and were included [122,123]. Seven primary studies of class II to IV quality using other interventions were included: one RCT using positional therapy [124] and six proof‐of‐concept studies or retrospective analyses using adaptive servo‐ventilation, expiratory positive airway pressure, oxygen, transnasal insufflation, oropharyngeal muscle exercise or mirtazapine [125–130]. …”

“…• Seven primary studies of class II to IV quality using other interventions were included: one RCT using positional therapy [124] and six proof-of-concept studies or retrospective analyses using adaptive servo-ventilation, expiratory positive airway pressure, oxygen, transnasal insufflation, oropharyngeal muscle exercise or mirtazapine [125][126][127][128][129][130]. Overview of the evidence.…”

“…There is very little or no evidence on the effect of specific SDB treatment alternatives, such as oropharyngeal muscle exercise [130], positional therapy [124] or mandibular advancement devices, or other positive airway pressure modes [127][128][129], oxygen [125] or pharmacotherapy [126], on stroke outcomes, cardiovascular events or mortality (Table S17). Statements.…”

EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke

“…Seven primary studies of class II to IV quality using other interventions were included: one RCT using positional therapy [124], six proof-of concept studies or retrospective analyses using adaptive servo-ventilation, expiratory positive airway pressure, oxygen, transnasal insufflation, oropharyngeal muscle exercise or mirtazapine [125][126][127][128][129][130].…”

“…There is very little or no evidence on the effect of specific SDB treatment alternatives, such as oropharyngeal muscle exercise [130], positional therapy [124] or mandibular advancement devices, or other positive airway pressure modes [127][128][129], oxygen [125] or pharmacotherapy [126], on stroke outcomes, cardiovascular events or mortality (table e17).…”