Application of Standardised Yoga Protocols as the Basis of Physiotherapy Recommendation in Treatment of Sleep Apneas: Moving Beyond Pranayamas

  • Vivek KumarEmail author
  • Vibhor Malhotra
  • Satish Kumar
Original Article


Yoga is an ancient Indian practice of mental and physical exercises (syn: asanas), postures (syn: mudras), movements and breathing techniques which sustain healthy living of the body and the mind. It incorporates various exercises of breathing, oropharyngeal structures and facial expressions, the physiology and effect of which are comparable to international physiotherapy recommendations in treatment of obstructive sleep apnea (OSA) i.e. to preserve upper airway patency by maintaining airway dilator muscle tone. Preliminary results show that yoga can be an effective and constructive alternative to physiotherapy for sleep apnea and snoring patients. To compare the physiotherapy recommendations in snoring patients with various yoga exercises postures. To determine the efficacy of yoga in treatment of sleep apnea. To formulate a standardized yoga protocol for universal usage in sleep apnea. We studied the available literature on physiotherapy recommendations for OSA and yoga asanas involving the nasal, oropharynx and facial structures and perceived a noteworthy similarity in physiological basis of both. A set of these yogasanas were put together and patients presenting with snoring and diagnosed with mild to moderate sleep apnea were presented and encouraged to perform the standardized set of yoga exercises for a period of 3 months. A total of 23 patients were recommended yoga protocols as initial form of treatment in snoring and mild to moderate sleep apnea. Clinical and statistically significant improvement gauzed by recommended score chart was discerned in majority of subjects. The results were comparable to the efficacy of existing physiotherapy regimen published in international literature. The benefits of yoga in sleep disorders go beyond the scope of measured outcomes. Standardizing the protocols for yoga in treatment for snoring and sleep apnea is the need of the hour. Further studies on efficacy of yoga need to be performed to understand its full realm of potential.


Snoring Obstructive sleep apnea (OSA) Yoga Yogasana Physiotherapy Oropharyngeal muscle 


Compliance with Ethical Standards

Conflict of interest


Ethical Approval

Departmental ethical clearance taken.

Informed Consent


Animal Subjects

No animal subjects were used.


  1. 1.
    American Academy of Sleep Medicine (AASM) Task Force (1999) Sleep-related breathing disorders in adults. Recommendation for syndrome definition and measurement techniques in clinical research. Sleep 22:667–668CrossRefGoogle Scholar
  2. 2.
    Marin JM, Carrizo SJ, Vicente E, Agusti AG (2005) Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnea with or without treatment with continuous positive airway pressure: an observational study. Lancet 365:1046–1053CrossRefPubMedGoogle Scholar
  3. 3.
    Pham LV, Schwartz AR (2015) The pathogenesis of obstructive sleep apnea. J Thorac Dis 7(8):1358–1372PubMedPubMedCentralGoogle Scholar
  4. 4.
    Jordan AS, McSharry DG, Malhotra A (2014) Adult obstructive sleep apnoea. Lancet 383(9918):736–747CrossRefPubMedGoogle Scholar
  5. 5.
    Bradley TD, Floras JS (2009) Obstructive sleep apnoea and its cardiovascular consequences. Lancet 373(9657):82–93CrossRefPubMedGoogle Scholar
  6. 6.
    Malhotra A, White DP (2002) Obstructive sleep apnoea. Lancet 360:237–245CrossRefPubMedGoogle Scholar
  7. 7.
    Vincent HK, Shanely RA, Stewart DJ, Demirel HA, Hamilton KL, Ray AD et al (2002) Adaptation of upper airway muscles to chronic endurance exercise. Am J Respir Crit Care Med 166(3):287–293CrossRefPubMedGoogle Scholar
  8. 8.
    Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohi KP (1999) Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med 131:485–491CrossRefPubMedGoogle Scholar
  9. 9.
    Johns MW (1991) A new method for measuring daytime sleepiness. The Epworth Sleepiness Scale. Sleep 14:540–559CrossRefPubMedGoogle Scholar
  10. 10.
    Buysse DJ, Reynolds CF III, Monk TH, Berman SR, Kupfer DJ (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 28:193–213CrossRefPubMedGoogle Scholar
  11. 11.
    Burwell CS, Robin ED, Whaley RD, Bickelmann AG (1956) Extreme obesity associated with alveolar hypoventilation: a pickwickian syndrome. Am J Med 21:811–818CrossRefPubMedGoogle Scholar
  12. 12.
    Pedrosa RP, Barros IM, Drager LF, Bittencourt MS, Medeiros AK, Carvalho LL et al (2014) OSA is common and independently associated with hypertension and increased arterial stiffness in consecutive perimenopausal women. Chest 146(1):66–72CrossRefPubMedGoogle Scholar
  13. 13.
    Young T et al (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328:1230–1235CrossRefPubMedGoogle Scholar
  14. 14.
    Naughton MT (2003) Sleep disorders in patients with congestive heart failure. Curr Opin Pulm Med. 9(6):453–458CrossRefPubMedGoogle Scholar
  15. 15.
    Peppard PE, Young T, Palta M, Dempsey J, Skatrud J (2000) Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA 284(23):3015–3021CrossRefPubMedGoogle Scholar
  16. 16.
    Weitzenblum E, Racineux JL (2004) Syndrome d’apnées obstructives du sommeil, 2nd edn. Masson, ParisGoogle Scholar
  17. 17.
    Guimarães KC, Drager LF, Genta PR, Marcondes BF, Lorenzi-Filho G (2009) Effects of oropharyngeal exercises on patients with moderate obstructive sleep apnea syndrome. Am J Respir Crit Care Med 179(10):962–966CrossRefPubMedGoogle Scholar
  18. 18.
    Guillemineault C, Tilkian A, Dement WC (1976) The sleep apnea syndromes. Annu Rev Med 27:465–484CrossRefGoogle Scholar
  19. 19.
    Peppard PE, Young T, Palta M, Skatrud J (2000) Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 342:1378–1834CrossRefPubMedGoogle Scholar

Copyright information

© Association of Otolaryngologists of India 2018

Authors and Affiliations

  1. 1.Patna Medical CollegePatnaIndia
  2. 2.Department of ENTPatna Medical CollegePatnaIndia
  3. 3.PatnaIndia

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