Abstract
Objectives
Patients with obstructive sleep apnea (OSA) (an obstructed airway and intermittent hypoxia) negatively affect their respiratory muscles. We evaluated the effects of a 12-week threshold inspiratory muscle training (TIMT) program on OSA severity, daytime sleepiness, and pulmonary function in newly diagnosed OSA.
Methods
Sixteen patients with moderate-to-severe OSA were randomly assigned to a TIMT group and 6 to a control group. The home-based TIMT program was 30–45 min/day, 5 days/week, for 12 weeks using a TIMT training device. Their apnea-hypopnea index (AHI), Epworth sleepiness scale (ESS), and forced vital capacity (FVC) scores were evaluated pre- and post-treatment. Polysomnographic (PSG) analysis showed that 9 TIMT-group patients had positively responded (TIMT-responder group: post-treatment AHI < pre-treatment) and that 7 had not (TIMT non-responder group: post-treatment AHI > pre-treatment).
Results
Post-treatment AHI and ESS scores were significantly (both P < 0.05) lower 6% and 20.2%, respectively. A baseline AHI ≤ 29.0/h predicted TIMT-responder group patients (sensitivity 77.8%; specificity 85.7%). FVC was also significantly (P < 0.05) higher 7.2%. Baseline AHI and FEV6.0 were significant predictors of successful TIMT-responder group intervention. OSA severity and daytime sleepiness were also significantly attenuated.
Conclusions
Home-based TIMT training is simple, efficacious, and cost-effective.
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Abbreviations
- AE:
-
Aerobic exercise
- AHI:
-
Apnea-hypopnea index
- AHI-NREM:
-
Apnea-hypopnea index during non-rapid eye movement (NREM) sleep
- AHI-REM:
-
Apnea-hypopnea index during rapid eye movement (REM) sleep
- ATS:
-
American Thoracic Society
- BMI:
-
Body mass index
- EEG:
-
Electroencephalography
- ESS:
-
Epworth sleepiness scale
- FEV1.0 :
-
Forced expiratory volume in 1 s
- FEV6.0 :
-
Forced expiratory volume in 6 s
- FVC:
-
Forced vital capacity
- IMT:
-
Inspiratory muscle training
- NREM:
-
Non-rapid eye movement
- OSA:
-
Obstructive sleep apnea
- PFT:
-
Pulmonary function test
- PSG:
-
Polysomnography
- PSQI:
-
Pittsburgh sleep quality index
- PT:
-
Physical therapist
- REM:
-
Rapid eye movement
- RM:
-
Repetition maximum
- ROC:
-
Receiver operating characteristic
- RPE:
-
Rating of perceived exertion
- TIMT:
-
Threshold inspiratory muscle training program
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Acknowledgments
We thank Professor Yu-Wen Chen, Grace Chen, and the sleep medicine center staff members at National Cheng Kung University Hospital and Tainan Hospital who participated in the study.
Funding
This study was funded by Shu-Zen Junior College of Medicine and Management, under contract SZPT10403008, and by the Gary & Amy Foundation, and by National Cheng-Kung University Hospital (grant number NCKUH-10802018).
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All procedures performed in studies involving human participants were approved by the Institutional Review Board of National Cheng Kung University (IRB No. A-ER-103-168).
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Lin, HC., Chiang, LL., Ong, JH. et al. The effects of threshold inspiratory muscle training in patients with obstructive sleep apnea: a randomized experimental study. Sleep Breath 24, 201–209 (2020). https://doi.org/10.1007/s11325-019-01862-y
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DOI: https://doi.org/10.1007/s11325-019-01862-y