Background. Rehabilitation may be an effective additional treatment method in patients with obstructive sleep apnea (OSA). Physical exercise, weight reduction, pulmonary rehabilitation, and myofunctional therapy (MT) represent beneficial components of rehabilitation recommended as a possible adjunct to standard OSA treatment. Methods and Results. A 54-year-old man with morbid obesity, long-lasting snoring, breathing pauses, frequent waking, as well as persistent drowsiness and fatigue during the day underwent polysomnography (PSG) to investigate suspected OSA. Severe OSA was confirmed by PSG and a 12-week comprehensive, home-based telerehabilitation program (tele-RHB program) along with continuous positive airway pressure (CPAP) therapy was implemented. The tele-RHB program included regular teleconsultations, aerobic-endurance training, MT, inspiratory and expiratory muscle training, as well as recommendations on proper nutrition, a healthy lifestyle, and behavioral changes. Following the treatment, the patient's quality of life (QoL), exercise capacity, lung function, and OSA severity significantly improved. The patient achieved an overall 19.9 kg reduction in weight, of which 16.2 kg was body fat, and his apnea-hypopnea index decreased by 42.6 episodes/hour. Conclusion. Our case report suggests that the comprehensive home-based tele-RHB program adjunct to CPAP therapy may be a novel approach for improving OSA severity, a patient's QoL, exercise capacity, lung function and body composition. It is important to note that such a program should be optional, however it may be needed to achieve the highest possible overall improvement in a patient's life. Further clinical investigations are needed to determine the therapeutic efficacy and clinical potential of this tele-RHB program.
BACKGROUND Obstructive sleep apnea (OSA) is characterized by recurrent intermittent partial or complete obstruction of the upper respiratory tract during sleep, which negatively affects the quality of the patient's daily life (QoL). Middle-aged and older men who smoke and suffer from obesity are most at risk. Even though the use of continuous positive airway pressure (CPAP) during sleep remains the standard treatment, various rehabilitation methods also appear to be effective. OBJECTIVE This study aims to evaluate if comprehensive home-based remotely supervised rehabilitation program (tele-RHB program) in combination with standard therapy improves severity, objectives parameters and subjective perception in male participants with OSA. METHODS This randomized controlled trial aims to recruit 50 male participants between the ages of 30-60 years with newly diagnosed OSA. Participants will be randomized 1:1 either to a 12-week tele-RHB program along with CPAP therapy or to CPAP therapy alone. After the completion of the intervention, the participants will be invited to complete a One year follow-up. The primary outcomes will be the apnea-hypopnea index, Epworth Sleepiness Scale score, 36-Item Short Form Health Survey score, percentage of body fat, six minute walk test distance covered, and maximal inspiratory and expiratory mouth pressure values. Secondary outcomes will include values of other selected polysomnographic parameters, anthropometric measurements of neck, waist, hip circumference and body mass index values, forced vital capacity, and forced expiratory volume in 1 second, WHOQOL - BREF score and lipid profile values. RESULTS Study recruitment began on October 25, 2021, and estimated study completion is expected on December 2024. Analyses will be performed to examine whether the combination of tele-RHB program and CPAP therapy will be more effective in reduction of OSA severity, improvement of QoL, body composition, and circumferences, exercise tolerance, lipid profile, and respiratory muscle and lung function compared to CPAP therapy alone. CONCLUSIONS The study will evaluate the effect of comprehensive tele-RHB program on selected parameters mentioned above in male participants. The results of this intervention could help the further development of novel additional therapeutic home-based option for OSA. CLINICALTRIAL ClinicalTrials.gov NCT04759456; https://clinicaltrials.gov/ct2/show/NCT04759456
Background Obstructive sleep apnea (OSA) is characterized by recurrent, intermittent partial or complete obstruction of the upper respiratory tract during sleep, which negatively affects the patient's daily quality of life (QoL). Middle-aged and older men who smoke and have obesity are most at risk. Even though the use of continuous positive airway pressure (CPAP) during sleep remains the gold standard treatment, various rehabilitation methods, such as exercise, respiratory therapy, myofunctional therapy, and nutritional lifestyle interventions, also appear to be effective. Moreover, it is increasingly recommended to use alternative or additional therapy options in combination with CPAP therapy. Objective This study aims to evaluate if a comprehensive home-based, remotely supervised rehabilitation program (tele-RHB), in combination with standard therapy, can improve OSA severity by decreasing the apnea-hypopnea index (AHI); improve objective parameters of polysomnographic, spirometric, anthropometric, and body composition examinations; improve lipid profile, maximal mouth pressure, and functional capacity tests; and enhance the subjective perception of QoL, as well as daytime sleepiness in male participants with moderate to severe OSA. Our hypothesis is that a combination of the tele-RHB program and CPAP therapy will be more effective by improving OSA severity and the abovementioned parameters. Methods This randomized controlled trial aims to recruit 50 male participants between the ages of 30 and 60 years with newly diagnosed moderate to severe OSA. Participants will be randomized 1:1, either to a 12-week tele-RHB program along with CPAP therapy or to CPAP therapy alone. After the completion of the intervention, the participants will be invited to complete a 1-year follow-up. The primary outcomes will be the polysomnographic value of AHI, Epworth Sleepiness Scale score, 36-Item Short Form Health Survey (SF-36) score, percentage of body fat, 6-minute walk test distance covered, as well as maximal inspiratory and expiratory mouth pressure values. Secondary outcomes will include polysomnographic values of oxygen desaturation index, supine AHI, total sleep time, average heart rate, mean oxygen saturation, and the percentage of time with oxygen saturation below 90%; anthropometric measurements of neck, waist, and hip circumference; BMI values; forced vital capacity; forced expiratory volume in 1 second; World Health Organization’s tool to measure QoL (WHOQOL-BREF) score; and lipid profile values. Results Study recruitment began on October 25, 2021, and the estimated study completion date is December 2024. Analyses will be performed to examine whether the combination of the tele-RHB program and CPAP therapy will be more effective in the reduction of OSA severity and improvement of QoL, body composition and circumferences, exercise tolerance, lipid profile, as well as respiratory muscle and lung function, compared to CPAP therapy alone. Conclusions The study will evaluate the effect of a comprehensive tele-RHB program on selected parameters mentioned above in male participants. The results of this intervention could help the further development of novel additional therapeutic home-based options for OSA. Trial Registration ClinicalTrials.gov NCT04759456; https://clinicaltrials.gov/ct2/show/NCT04759456 International Registered Report Identifier (IRRID) DERR1-10.2196/47460
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