Inspiratory Muscle Training in the Severity of Obstructive Sleep Apnea, Sleep Quality and Excessive Daytime Sleepiness: A Placebo-Controlled, Randomized Trial

José Carlos Nogueira Nóbrega-Júnior, Armèle Dornelas de Andrade, Erika Alves Marinho de Andrade, Maria do Amparo Andrade, Alice Santana Valadares Ribeiro, Rodrigo Pinto Pedrosa, Ana Paula de Lima Ferreira, Anna Myrna Jaguaribe de Lima, José Carlos Nogueira Nóbrega-Júnior, Armèle Dornelas de Andrade, Erika Alves Marinho de Andrade, Maria do Amparo Andrade, Alice Santana Valadares Ribeiro, Rodrigo Pinto Pedrosa, Ana Paula de Lima Ferreira, Anna Myrna Jaguaribe de Lima

Abstract

Purpose: Exercise programs have been considered as an adjuvant treatment in obstructive sleep apnea (OSA). However, few studies have focused on the effects of the inspiratory muscle training (IMT) in reducing the severity and the symptoms of OSA.

Patients and methods: A randomized controlled trial was conducted and approved by the local Ethics Committee. All subjects signed the informed consent form and were randomized into 2 groups: a) IMT group (n = 8), 8 weeks of IMT with 75% of maximal inspiratory pressure (MIP) and b) placebo group (n = 8): subjects performed IMT without load.

Results: IMT group showed reduction in the apnea-hypopnea index (AHI) (p = 0.01), in the Berlin questionnaire score (p = 0.001) and an increase in inspiratory muscle strength (p = 0.018). IMT group demonstrated a reduction in the AHI (31.7 ± 15.9 events/h vs 29.9 ± 15.8 events/h; p <0.001), in the Berlin questionnaire scores (2.6 ± 0.5 vs 1.2 ± 0.5; p = 0.016), Pittsburgh Sleep Quality Index (PSQI) score (7.2 ± 3.6 vs 3.7 ± 1.3; p = 0.008), in the Epworth Sleepiness Scale (ESS) (12.5 ± 4.0 vs 7.7 ± 3.0; p = 0.008) and increase in MIP (83.6 ± 26.5 cmH2O and 127.9 ± 32.5 cmH2O; p = 0.010).

Conclusion: The IMT promotes discrete changes in the AHI and improves sleep quality and excessive daytime sleepiness in OSA. Moreover, IMT is a cheap, useful and simple home-based training program and can be considered as an adjunct therapy for OSA patients.

Keywords: adjuvant therapy; exercise training; obstructive sleep apnea symptoms; respiratory exercises.

Conflict of interest statement

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; or expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

© 2020 Nóbrega-Júnior et al.

Figures

Figure 1
Figure 1
Flow diagram of patient recruitment and progress through the randomized controlled trial.
Figure 2
Figure 2
Changes in the apnea-hypopnea index (AHI), Pittsburgh Sleep Quality Index (PSQI), Berlin questionnaire, Excessive Daytime Sleepiness (EDS) and maximum inspiratory pressure (MIP) after IMT and placebo groups intervention.
Figure 3
Figure 3
Changes in the apnea–hypopnea index (AHI), Pittsburgh Sleep Quality Index (PSQI), Berlin questionnaire, Excessive Daytime Sleepiness (EDS) and Maximum Inspiratory Pressure (MIP) pre-post IMT and placebo groups.

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