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CC BY-NC-ND 4.0 · Sleep Sci 2022; 15(04): 480-489
DOI: 10.5935/1984-0063.20220081
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Effects of inspiratory muscle training in patients with obstructive sleep apnoea syndrome: a systematic review and meta-analysis

Javid Ahmad Dar
1   Jamia Millia Islamia, Centre for Physiotherapy and Rehabilitation Sciences - New Delhi - India
,
Aqsa Mujaddadi
1   Jamia Millia Islamia, Centre for Physiotherapy and Rehabilitation Sciences - New Delhi - India
,
Jamal Ali Moiz
1   Jamia Millia Islamia, Centre for Physiotherapy and Rehabilitation Sciences - New Delhi - India
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Obstructive sleep apnoea (OSA) is a common disorder marked by repetitive occurrence of breathing cessation during sleep due to partial or complete upper airway obstruction. An obstructive airway and the successive asphyxia chronically overload the inspiratory muscles resulting in an increased inspiratory effort. The present systematic review aimed to examine the effects of inspiratory muscle training (IMT) on inspiratory muscle strength [maximal inspiratory pressure (PImax)], severity of disease [apnea hypopnoea index (AHI)], sleep quality [Pittsburgh sleep quality index (PSQI)], day time sleepiness [Epworth sleepiness scale (ESS)], lung function [forced expiratory volume in 1 second (FEV1)] and exercise capacity [cardiopulmonary exercise testing, (CPET), 6 minute walk test, (6MWT)] in mild to severe OSA. Among 953 articles retrieved from various databases (PubMed, SCOPUS, Web of Science and Cochrane), 7 articles were found to be eligible for the present review. Randomized controlled trials reporting the effect of IMT in OSA were selected. The quality assessment was conducted using Cochrane risk-of-bias tool for randomized trials. All seven studies were meta-analyzed. The result depicted significant change in PImax, ES 1.73 (95%CI 0.54 to 2.92,p=0.004), PSQI -1.29 (95%CI -1.94 to -0.65,p<0.0001), ESS -1.08 (95% CI -1.79 to - 0.37,p=0.003) and FEV1 0.74 (95%CI 0.20 to 1.28,p=0.007). IMT may be considered as an effective treatment strategy in mild to severe OSA resulting in improved inspiratory muscle strength, sleep quality, daytime sleepiness, and lung function. However, there is still dearth evidence on repercussion of IMT on lung function and exercise capacity and warrants high quality evidence to reach definitive conclusions.

Inspiratory Muscle Trainer - Inspiratory Muscle Training - Obstructive Sleep Apnoea - Obstructive Sleep Apnoea Syndrome


Publikationsverlauf

Eingereicht: 09. Juli 2021

Angenommen: 25. Februar 2022

Artikel online veröffentlicht:
01. Dezember 2023

© 2023. Brazilian Sleep Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • REFERENCES

  • 1 Senaratna CV, Perret JL, Lodge CJ, Lowe AJ, Campbell BE, Matheson MC, et al. Prevalence of obstructive sleep apnea in the general population: a systematic review. Sleep Med Rev. 2017 Aug;34:70-81. DOI: https:// doi.org/10.1016/j.smrv.2016.07.002
  • 2 White DP. Pathogenesis of obstructive and central sleep apnea. Am J Respir Crit Care Med. 2005 Aug;172(11):1363-70. DOI: https://doi. org/10.1164/rccm.200412-1631SO
  • 3 Chien MY, Wu YT, Lee PL, Chang YJ, Yang PC. Inspiratory muscle dysfunction in patients with severe obstructive sleep apnoea. Eur Respir J. 2010;35(2):373-80. DOI: https://doi.org/10.1183/09031936.00190208
  • 4 Bradley TD, Floras JS. Obstructive sleep apnoea and its cardiovascular consequences. Lancet. 2009 Jan;373(9657):82-93. DOI: https://doi. org/10.1016/S0140-6736(08)61622-0
  • 5 Iftikhar IH, Bittencourt L, Youngstedt SD, Ayas N, Cistulli P, Schwab R, et al. Comparative efficacy of CPAP, MADs, exercise-training, and dietary weight loss for sleep apnea: a network meta-analysis. Sleep Med. 2017 Feb;30:7-14. DOI: https://doi.org/10.1016/j.sleep.2016.06.001
  • 6 Van Zeller M, Severo M, Santos AC, Drummond M. 5-years APAP adherence in OSA patients - do first impressions matter? Respir Med. 2013 Dec;107(12):2046-52. DOI: https://doi.org/10.1016/j.rmed.2013.10.011
  • 7 Felício CM, Dias FVS, Trawitzki LVV. Obstructive sleep apnea: focus on myofunctional therapy. Nat Sci Sleep. 2018 Feb;10:271-86. DOI: https:// doi.org/10.2147/NSS.S141132
  • 8 Aiello KD, Caughey WG, Nelluri B, Sharma A, Mookadam F, Mookadam M. Effect of exercise training on sleep apnea: a systematic review and meta-analysis. Respir Med. 2016 Jul;116:85-92. DOI: https://doi. org/10.1016/j.rmed.2016.05.015
  • 9 Illi SK, Held U, Frank I, Spengler CM. Effect of respiratory muscle training on exercise performance in healthy individuals. Sport Med. 2012 Dec;42(8):707-24. DOI: https://doi.org/10.1007/bf03262290
  • 10 Vranish JR, Bailey EF. Inspiratory muscle training improves sleep and mitigates cardiovascular dysfunction in obstructive sleep apnea. Sleep. 2016 Jun;39(6):1179-85. DOI: https://doi.org/10.5665/sleep.5826
  • 11 Andhare NM, Vidyapeeth TM, Yeole U, Vidyapeeth TM. Comparison of inspiratory muscle training and conventional breathing exercises in obstructive sleep apnoea: a randomized control trial. UGC Care J. 2020 Apr;19(5):1-8.
  • 12 Erturk N, Calik-Kutukcu E, Arikan H, Savci S, Inal-Ince D, Caliskan H, et al. The effectiveness of oropharyngeal exercises compared to inspiratory muscle training in obstructive sleep apnea: a randomized controlled trial. Hear Lung. 2020 Nov;49(6):940-8. DOI: https://doi.org/10.1016/j. hrtlng.2020.07.014
  • 13 Lin HC, Chiang LL, Ong JH, Tsai King, Hung CH, Lin CY. The effects of threshold inspiratory muscle training in patients with obstructive sleep apnea: a randomized experimental study. Sleep Breath. 2020 May;24(1):201-9. DOI: https://doi.org/10.1007/s11325-019-01862-y
  • 14 Nóbrega-Júnior JCN, Andrade AD, Andrade EAM, Ribeiro ASV, Pedrosa RP, Ferreira APL, et al. Inspiratory muscle training in the severity of obstructive sleep apnea, sleep quality and excessive daytime sleepiness: a placebo-controlled, randomized trial. Nat Sci Sleep. 2020 Sep;12:1105-13. DOI: https://doi.org/10.2147/NSS.S269360
  • 15 Moawd SA, Azab AR, Alrawaili SM, Abdelbasset WK. Inspiratory muscle training in obstructive sleep apnea associating diabetic peripheral neuropathy: a randomized control study. Biomed Res Int. 2020;2020:5036585. DOI: https://doi.org/10.1155/2020/5036585
  • 16 Souza AKF, Andrade AD, Medeiros AIC, Aguiar MIR, Rocha TDS, Pedrosa RP, et al. Effectiveness of inspiratory muscle training on sleep and functional capacity to exercise in obstructive sleep apnea: a randomized controlled trial. Sleep Breath. 2018;22(3):631-9. DOI: https://doi.org/10.1007/s11325-017-1591-5
  • 17 Kamioka H. Preferred reporting items for systematic review and metaanalysis protocols (PRISMA-P) 2015 statement. Jpn Pharmacol Ther. 2019;47(8):1177-85.
  • 18 Pepin JL, Leger P, Veale D, Langevin B, Robert D, Levy P. Side effects of nasal continuous positive airway pressure in sleep apnea syndrome: study of 193 patients in two French sleep centers. Chest. 1995 Feb;107(2):375-81. DOI: https://doi.org/10.1378/chest.107.2.375
  • 19 Cochrane Collaboration. The RoB 2.0 tool (individually randomized, parallel group trials). Cochrane Methods Bias. 2016;2016:1-21.
  • 20 Murphy M, Travers M, Gibson W. The RoB 2.0 tool. Cochrane Methods Bias. 2018;7(1):58.
  • 21 Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al. Cochrane handbook for systematic reviews of interventions. Hoboken: Wiley; 2019. DOI: https://doi.org/10.1002/9781119536604
  • 22 Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. Chinese J Evidence-Based Med. 2009;9(1):8-11.
  • 23 Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, et al. GRADE guidelines: 1. Introduction - GRADE evidence profiles and summary of findings tables. J Clin Epidemiol. 2011 Apr;64(4):383-94. DOI: https:// doi.org/10.1016/j.jclinepi.2010.04.026
  • 24 Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, et al. Rules for scoring respiratory events in sleep: Update of the 2007 AASM manual for the scoring of sleep and associated events. J Clin Sleep Med. 2012 Oct;8(5):597-619. DOI: https://doi.org/10.5664/jcsm.2172
  • 25 Gibson GJ, Whitelaw W, Siafakas N. ATS/ERS Statement on respiratory muscle testing. Am J Respir Crit Care Med. 2002;166(4):518-624. DOI: https://doi.org/10.1164/rccm.166.4.518
  • 26 Task P. Practice parameters for the indications for polysomnography and related procedures. Polysomnography Task Force, American Sleep Disorders Association Standards of Practice Committee. Sleep. 1997;20(6):406-22.
  • 27 Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ, Buysse DJ, et al. The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28:193-213.
  • 28 Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991 Nov;14(6):540-5. DOI: https://doi.org/10.1093/ sleep/14.6.540
  • 29 Albouaini K, Egred M, Alahmar A, Wright DJ. Cardiopulmonary exercise testing and its application. Postgrad Med J. 2007;83(985):675-82. DOI: https://doi.org/10.1136/hrt.2007.121558
  • 30 Giles TL, Lasserson TJ, Smith BJ, White J, Wright J, Cates CJ. Continuous positive airways pressure for obstructive sleep apnoea in adults: a Cochrane Collaboration Review. Cochrane Database Syst Rev. 1996;(1):CD001106.
  • 31 McDaid C, Griffin S, Weatherly H, Durée K, Van Der Burgt M, Van Hout S, et al. Continuous positive airway pressure devices for the treatment of obstructive sleep apnoea-hypopnoea syndrome: a systematic review and economic analysis. Health Technol Assess. 2009;13(4):1-162. DOI: https://doi.org/10.3310/hta13040
  • 32 Gloeckl R, Marinov B, Pitta F. Practical recommendations for exercise training in patients with COPD. Eur Respir Rev. 2013;22(128):178-86. DOI: https://doi.org/10.1183/09059180.00000513
  • 33 Ries AL, Bauldoff GS, Carlin BW, Casaburi R, Emery CF, Mahler AC, et al. Pulmonary rehabilitation: joint ACCP/AACVPR Evidence-Based Clinical Practice Guidelines. Chest. 2007;131(5 Suppl):4S-42S. DOI: https://doi.org/10.1378/chest.06-2418
  • 34 Corrêa APS, Ribeiro JP, Balzan FMH, Mundstock L, Ferlin EL, Moraes RS. Inspiratory muscle training in type 2 diabetes with inspiratory muscle weakness. Med Sci Sports Exerc. 2011 Jul;43(7):1135-41. DOI: https:// doi.org/10.1249/MSS.0b013e31820a7c12
  • 35 Geddes EL, O’Brien K, Reid WD, Brooks D, Crowe J. Inspiratory muscle training in adults with chronic obstructive pulmonary disease: an update of a systematic review. Respir Med. 2008 Dec;102(12):1715-29. DOI: https://doi.org/10.1016/j.rmed.2008.07.005
  • 36 Mohamed AS, Sharshar RS, Elkolaly RM, Serageldin SM. Upper airway muscle exercises outcome in patients with obstructive sleep apnea syndrome. Egypt J Chest Dis Tuberc. 2017 Jan;66(1):121-5. DOI: https://doi.org/10.1016/j.ejcdt.2016.08.014
  • 37 Enright S, Chatham K, Ionescu AA, Unnithan VB, Shale DJ. Inspiratory muscle training improves lung function and exercise capacity in adults with cystic fibrosis. Chest. 2004 Aug;126(2):405-11. DOI: https://doi. org/10.1378/chest.126.2.405
  • 38 Herkenrath SD, Treml M, Priegnitz C, Galetke W, Randerath WJ. Effects of respiratory muscle training (RMT) in patients with mild to moderate obstructive sleep apnea (OSA). Sleep Breath. 2018;22(2):323-8. DOI: https://doi.org/10.1007/s11325-017-1582-6
  • 39 Ferretti G. Maximal oxygen consumption in healthy humans: theories and facts. Eur J Appl Physiol. 2014 Jul;114(10):2007-36. DOI: https:// doi.org/10.1007/s00421-014-2911-0
  • 40 Edwards AM, Cooke CB. Oxygen uptake kinetics and maximal aerobic power are unaffected by inspiratory muscle training in healthy subjects where time to exhaustion is extended. Eur J Appl Physiol. 2004 Aug;93(1-2):139-44. DOI: https://doi.org/10.1007/s00421-004-1188-0
  • 41 Edwards AM. Respiratory muscle training extends exercise tolerance without concomitant change to peak oxygen uptake: physiological, performance and perceptual responses derived from the same incremental exercise test. Respirology. 2013 Apr;18(6):1022-7. DOI: https://doi. org/10.1111/resp.12100