Inspiratory muscle training as adjuvant therapy in obstructive sleep apnea: a randomized controlled trial

Abstract

The aim of this randomized controlled trial was to analyze the effects of an inspiratory muscle training (IMT) program on apnea and hypopnea index (AHI), inspiratory muscle strength, sleep quality, and daytime sleepiness in individuals with obstructive sleep apnea (OSA), whether or not they used continuous positive airway pressure (CPAP (+/-) therapy. The intervention group underwent IMT with a progressive resistive load of 40-70% of the maximum inspiratory pressure (PImax) for 30 breaths once a day for 12 weeks. The control group was submitted to a similar protocol, but with at a minimum load of 10 cmH 2 O. Changes in the AHI were the primary outcome. PImax was measured with a digital vacuometer, daytime somnolence was measured by the Epworth sleepiness scale (ESS), and the quality of sleep by the Pittsburgh Sleep Quality Index (PSQI). CPAP use was treated as a confounder and controlled by stratification resulting in 4 subgroups: IMT-/CPAP-, IMT-/CPAP+, IMT+/CPAP-, and IMT +/CPAP+. Sixty-five individuals were included in the final analysis. Significant variations were found in the 4 parameters measured throughout the study after the intervention in both CPAP-and CPAP+ participants: PImax was increased and AHI was reduced, whereas improvements were seen in both ESS and PSQI. The twelve-week IMT program increased inspiratory muscle strength, substantially reduced AHI, and had a positive impact on sleep quality and daytime sleepiness, whether or not participants were using CPAP. Our findings reinforce the role of an IMT program as an adjunct resource in OSA treatment.

Effect of inspiratory muscle training on hypoxemia in obese patients undergoing painless gastroscopy: protocol for a single-center, double-blind, randomized controlled trial

“…Last, we will explore its impact on blood pressure, sleep quality, and pro-inflammatory cytokines in obese individuals undergoing painless gastroscopy. Both procedural sedation and obesity can have negative effects on sleep and the cardiopulmonary system ( 17 , 40 ), and pro-inflammatory cytokines play a role in sleep regulation and are associated with various diseases ( 41 ). Several studies have indicated that IMT can be used as an auxiliary means to reduce the tendency of upper airway collapse during sleep and improve sleep quality ( 17 ).…”

“…IMT involves resistance-loaded muscle training using a small breathing device and is widely utilized in pulmonary rehabilitation settings ( 18 ). Its purpose is to enhance the performance of both primary and accessory respiratory muscles, improve physiological reserve, preserve the patency of smaller airways, increase maximal voluntary ventilation, and facilitate lung expansion ( 4 , 15 , 17 , 19 , 20 ). Several pieces of evidence have indicated that preoperative IMT can increase maximum inspiratory pressure (Pi(max)), decrease postoperative pulmonary complications, improve exercise endurance, and shorten hospital stays ( 21–23 ).…”

Safety and efficacy of remimazolam tosilate combined with low-dose fentanyl for procedural sedation in obese patients undergoing gastroscopy: study protocol for a single-centre, double-blind, randomised controlled trial

“…Hypoxaemia is associated with several adverse events related to the heart and brain 7. Increased body mass index (BMI), greater than 30 kg×m –2 , is frequently linked to obstructive or restrictive lung diseases, which can result in cardiopulmonary adverse events during procedural sedation 8–10. Sedatives can increase the probability of respiratory depression and further exacerbate hypoxaemia during procedural sedation due to airway obstruction, particularly in obese patients.…”