Short-term expiratory muscle strength training attenuates sleep apnea and improves sleep quality in patients with obstructive sleep apnea

Kuo, Yu Chi; Song, Ting; Bernard, Jeffrey R.; Liao, Yi Hung

doi:10.1016/j.resp.2017.05.007

Cited by 25 publications

(54 citation statements)

References 31 publications

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“…Paired meta-analyses were conducted for continuous outcomes. Trial authors were contacted to retrieve missing data on AHI, 14,16 and standard error of the mean percentage clarification. 24 Mean and standard deviation (SD) were calculated from median and 25% quartile (q1) and 75% quartile (q3) as follows: mean = (q1 + median + q3) / 3; SD = (q3 − q1) / 1.35.…”

Section: Statistical Analysesmentioning

confidence: 99%

“…In this systematic review, the term respiratory muscle therapy will be used to incorporate both upper and lower airway muscle therapy, ranging from myofunctional/oropharyngeal exercises encompassing speech therapy and tongue exercises (upper airway muscles) 14 to breathing exercises and wind musical instrument playing, 15 which seems to have some efficacy on expiratory muscle training (lower airway muscles). 16 One limitation of this systematic review is the fact that respiratory muscle therapy encompasses a variety of interventions. Although all these therapies exercise the airway muscles, it is unclear at this point how each of these therapies works or which one is the best option to treat OSA.…”

Section: Introductionmentioning

confidence: 99%

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

Hsu

Emperumal

Grbach

et al. 2020

Journal of Clinical Sleep Medicine

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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.

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Section: Statistical Analysesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Hsu

Emperumal

Grbach

et al. 2020

Journal of Clinical Sleep Medicine

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“…Alguns estudos randomizados [7][8][9] realizaram protocolos de treinamento da musculatura respiratória em pacientes com SAOS de diferentes graus, durante um período entre 5 e 12 semanas. Foi observado que o fortalecimento dessa musculatura contribuiu para a melhora da qualidade do sono e redução do número de apneias noturnas.…”

Section: Introductionunclassified

Avaliação da capacidade funcional, força muscular respiratória e pico de fluxo expiratório em pacientes com apneia obstrutiva do sono

Conceição¹,

Rodrigues²,

Nunes

et al. 2021

Fisioter Bras

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Introdução: A síndrome da apneia obstrutiva do sono (SAOS) é caracterizada pela obstrução das vias aéreas superiores durante o sono, o que causa efeitos sistêmicos durante a vigília. Objetivo: O objetivo deste estudo é avaliar a capacidade funcional, a força da musculatura respiratória e o pico de fluxo expiratório (PFE) de pacientes com SAOS. Métodos: Trata-se de um estudo transversal realizado na cidade de Patos de Minas/MG no ano de 2019, no qual foram incluídos 14 indivíduos que possuíam SAOS moderada e grave. Primeiramente os pacientes responderam a um questionário sociodemográfico elaborado pelos autores. Em seguida, foi realizada a manovacuometria, a mensuração do PFE e o teste de caminhada de seis minutos (TC6M). Resultados: A maioria dos pacientes eram homens (71,4%), obesos (78,6%) e hipertensos (57,1%). Como resultados dos testes obtivemos - PImáx obtida vs predita = 86,4 vs 102,8 (p = 0,004), PEmáx obtida vs predita = 98,5 vs 113,5 (p = 0,05), PFE obtido vs predito = 381,3 vs 495,8 (p < 0,001) e TC6M obtido vs predito = 485,3m vs 536,6m (p = 0,03). Conclusão: Nessa amostra de indivíduos com SAOS grave e moderada houve redução da força muscular respiratória, do PFE, e da capacidade funcional.Palavras-chave: síndromes da apneia do sono, músculos respiratórios, tolerância ao exercício.

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“…Likewise, expiratory exercises have been successful at improving sleep quality and markers related to obstructive sleep apnea (Kuo, Song, Bernard & Liao, 2017;Herkenrath et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

Effect of respiratory therapy on patients with sleep bruxism and associated respiratory events: Study protocol for a randomized controlled clinical trial

Cavalcante-Leão

Stechman-Neto

Ravazzi

et al. 2021

RSD

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Aim: The aim of this study will be to perform respiratory physiotherapy on patients with sleep bruxism and associated respiratory events (apnea and hypopnea). Methodology: The study will be a randomized, controlled, double-blind, clinical trial with a sample of individuals with sleep bruxism and associated respiratory events. Respiratory (inspiratory and/or expiratory) physiotherapy will be performed using the THRESHOLD IMT and PEP and the results will be compared to a placebo group. Discussion: Regarding respiratory events, there is a broad variety of possible treatments for sleep apnea depending on the physiopathology, severity and patient preference, with CPAP considered the gold standard. However, data on CPAP are inconsistent, with adherence to therapy reported to be between 45 and 89%. Thus, other forms of treatment are proposed, including respiratory training. Understanding obstructive sleep apnea syndrome as the loss of the dilation strength of the pharynx and the inability to maintain the path open for air, respiratory muscle training could assist in increasing dilation strength, enabling the passage of air during sleep. Taking into consideration that sleep bruxism may be associated with events of apnea and hypopnea, the intervention to treat obstructive respiratory events related to sleep may have a positive impact on events related to sleep bruxism (rhythmic activity of the masticatory muscles). To determine this, we will measure the apnea/hypopnea index (AHI) and number of contractions of the masseter muscle (characteristic of the activity of bruxism) before and after the intervention using polysomnography. Trial registration: The trial was registered with the REBEC platform: RBR-9F6JKM (ensaiosclinicos.gov.br).

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Short-term expiratory muscle strength training attenuates sleep apnea and improves sleep quality in patients with obstructive sleep apnea

Cited by 25 publications

References 31 publications

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

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

Avaliação da capacidade funcional, força muscular respiratória e pico de fluxo expiratório em pacientes com apneia obstrutiva do sono

Effect of respiratory therapy on patients with sleep bruxism and associated respiratory events: Study protocol for a randomized controlled clinical trial

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