The effect of playing a wind instrument or singing on risk of sleep apnea: a systematic review and meta-analysis

Abstract

Study Objectives: To systematically survey the scientific literature concerning the effect of playing a wind instrument or singing on sleep, snoring, and/or obstructive sleep apnea. Methods: The PubMed, EMBASE, and Cochrane databases were searched up to December 2019. Observational studies and (Randomized) Controlled Clinical Trials that assessed sleep, snoring, or obstructive sleep apnea as clinical outcome or via a questionnaire were included. For the individual studies, the potential risk of bias was scored. Data between oral musicians and control participants were extracted. Descriptive analysis and meta-analysis were performed. Results: Six eligible studies (5 cross-sectional, 1 randomized controlled trial) were retrieved, with an estimated potential bias ranking from low to high. The sample sizes ranged from 25 to 1,105 participants. Descriptive analysis indicated that players of a double-reed instrument have a lower risk of obstructive sleep apnea and that singers snore less compared with control participants. Playing a didgeridoo showed a positive effect on apnea-hypopnea index, daytime sleepiness, and partner's rating for sleep disturbance. The descriptive analysis could not be substantiated in the meta-analysis. The magnitude of the effect was zero to small, and the generalizability was limited because of long (professional) rehearsal time or small sample size. Conclusions: Playing a wind instrument and singing may have a small but positive effect on sleep disorders. Considering the practicality and investment of (rehearsal) time, didgeridoo and singing are the most promising interventions to reduce obstructive sleep apnea and snoring, respectively. However, the results of this review are based on few studies and the synthesis of the evidence is graded to have low certainty.

Role of playing wind instruments and singing in snoring and obstructive sleep apnea

“…Overall, van der Weijden et al's study 12 supports favorable effects of playing certain wind instruments and singing in alleviating symptoms and risk of snoring and OSA. However, future research in the role of myofunctional therapy as a therapeutic adjunct will require large, population-based, randomized controlled studies with standardized exercises that are observed over a sufficient lead time to measure any positive effects on symptoms and severity of snoring and OSA.…”

“…In this issue of Journal of Clinical Sleep Medicine, the paper by van der Weijden et al 12 reports a systematic review and metaanalysis of present scientific literature illustrating the role of playing musical wind instruments or singing in alleviating the risk of OSA, snoring, and related symptoms of sleep disturbance and daytime sleepiness. The authors included observational and/or randomized controlled studies where active participants either played a wind instrument or sang, and outcomes evaluating sleep such as snoring, risk of OSA, physician diagnosis of OSA, apnea-hypopnea index, and daytime sleepiness were compared with the control group (nonplayers, nonsingers, or healthy volunteers).…”

Treatments for obstructive sleep apnea: CPAP and beyond

“…Myofunctional therapy consists of interventions such as electrical stimulation of the tongue, 60,61 speech therapy, 62,63 circular breathing, singing, or wind-instrument playing, 64,65 which strengthen the facial, tongue, oropharyngeal, or skeletal structures and enhance the neuromuscular compensatory mechanisms that counteract the anatomic mechanical loads contributing to airway narrowing. 66,67 A European task force did not recommend myofunctional therapy as a standard treatment of obstructive sleep apnea, based on limited and low-quality evidence.…”

Assessment of respiratory effort with EMG extracted from ECG recordings during prolonged breath holds: Insights into obstructive apnea and extreme physiology

“…Future study using simple ECG derived EMG signals may help inform the unique components of volitional apnea that might be beneficial to harness as a therapeutic or training tool in OSA and epilepsy. Importantly, breath training of other types, such as singing (Courtney, 2020;van der Weijden et al, 2020) and restrictive breathing (Kido et al, 2013) has been proposed to help patients with OSA.…”