Inspiratory Muscle Training Improves Sleep and Mitigates Cardiovascular Dysfunction in Obstructive Sleep Apnea

Abstract

Study objectives: New and effective strategies are needed to manage the autonomic and cardiovascular sequelae of obstructive sleep apnea (OSA). We assessed the effect of daily inspiratory muscle strength training (IMT) on sleep and cardiovascular function in adults unable to use continuous positive airway pressure (CPAP) therapy.

Methods: This is a placebo-controlled, single-blind study conducted in twenty four adults with mild, moderate, and severe OSA. Subjects were randomly assigned to placebo or inspiratory muscle strength training. Subjects in each group performed 5 min of training each day for 6 w. All subjects underwent overnight polysomnography at intake and again at study close.

Results: We evaluated the effects of placebo training or IMT on sleep, blood pressure, and plasma catecholamines. Relative to placebo-trained subjects with OSA, subjects with OSA who performed IMT manifested reductions in systolic and diastolic blood pressures (-12.3 ± 1.6 SBP and -5.0 ± 1.3 DBP mmHg; P < 0.01); plasma norepinephrine levels (536.3 ± 56.6 versus 380.6 ± 41.2 pg/mL; P = 0.01); and registered fewer nighttime arousals and reported improved sleep (Pittsburgh Sleep Quality Index scores: 9.1 ± 0.9 versus 5.1 ± 0.7; P = 0.001). These favorable outcomes were achieved without affecting apneahypopnea index.

Conclusions: The results are consistent with our previously published findings in normotensive adults but further indicate that IMT can modulate blood pressure and plasma catecholamines in subjects with ongoing nighttime apnea and hypoxemia. Accordingly, we suggest IMT offers a low cost, nonpharmacologic means of improving sleep and blood pressure in patients who are intolerant of CPAP.

Keywords: hypertension; obstructive sleep apnea; respiratory training.

© 2016 Associated Professional Sleep Societies, LLC.

Figures

Figure 1

Mean (± standard error of the mean) Pittsburgh Sleep Quality Index (PSQI) scores pretraining versus posttraining (n = 12 per group). PSQI scores range from 0–21, with scores ≤ 5 considered indicative of healthy sleep. IMT, inspiratory muscle strength training. *P # P < 0.01, relative to placebo group.

Figure 2

(A) Average (± standard error of the mean) systolic and diastolic blood pressure (n = 12 per group). Note a significant decline in systolic blood pressure for the training group that begins in week 3. (*P < 0.01, relative to week 1). (B) Mean arterial blood pressure at the end of each training week for male and female subjects in IMT and placebo training groups. IMT, inspiratory muscle strength training