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Sleep and Breathing

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28.12.2022 | Ent • Original Article

Effects of inspiratory muscle training on blood pressure- and sleep-related outcomes in patients with obstructive sleep apnea: a meta-analysis of randomized controlled trials

verfasst von: Tzu-Ang Chen, Sheng-Ting Mao, Huei-Chen Lin, Wen-Te Liu, Ka-Wai Tam, Cheng-Yu Tsai, Yi-Chun Kuan

Erschienen in: Sleep and Breathing | Ausgabe 5/2023

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Abstract

Purpose

Obstructive sleep apnea (OSA) is frequently accompanied by hypertension, resulting in cardiovascular comorbidities. Continuous positive airway pressure is a standard therapy for OSA but has poor adherence. Inspiratory muscle training (IMT) may reduce airway collapsibility and sympathetic output, which may decrease OSA severity and blood pressure. In this meta-analysis of randomized controlled trials (RCTs), we evaluated the efficacy of IMT in patients with OSA.

Methods

We searched PubMed, EMBASE, Cochrane Library, Web of Science, and ClinicalTrials.gov databases for relevant RCTs published before November 2022.

Results

Seven RCTs with a total of 160 patients with OSA were included. Compared with the control group, the IMT group exhibited significantly lower systolic and diastolic blood pressure (mean difference [MD]: − 10.77 and − 4.58 mmHg, respectively), plasma catecholamine levels (MD: − 128.64 pg/mL), Pittsburgh Sleep Quality Index (MD: − 3.06), and Epworth Sleepiness Scale score (MD: − 4.37). No significant between-group differences were observed in the apnea–hypopnea index, forced vital capacity (FVC), ratio of forced expiratory volume in 1 s to FVC, or adverse effects. The data indicate comprehensive evidence regarding the efficacy of IMT for OSA. However, the level of certainty (LOC) remains low.

Conclusion

IMT improved blood pressure- and sleep-related outcomes without causing adverse effects and may thus be a reasonable option for lowering blood pressure in patients with OSA. However, additional studies with larger sample sizes and rigorous study designs are warranted to increase the LOC.

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Ramos-Barrera GE, DeLucia CM, Bailey EF (2020) Inspiratory muscle strength training lowers blood pressure and sympathetic activity in older adults with OSA: a randomized controlled pilot trial. J Appl Physiol 1985 129:449–458. https://doi.org/10.1152/japplphysiol.00024.2020CrossRefPubMedPubMedCentral

Ahmad M, Makati D, Akbar S (2017) Review of and updates on hypertension in obstructive sleep apnea. Int J Hypertens 2017:1848375. https://doi.org/10.1155/2017/1848375CrossRefPubMedPubMedCentral

Hou H et al (2018) Association of obstructive sleep apnea with hypertension: a systematic review and meta-analysis. J Glob Health 8:010405. https://doi.org/10.7189/jogh.08.010405CrossRefPubMedPubMedCentral

Virani SS et al (2021) Heart Disease and Stroke Statistics-2021 update: a report from the American Heart Association. Circulation 143:e254–e743. https://doi.org/10.1161/cir.0000000000000950CrossRefPubMed

Martynowicz H et al (2021) Renalase and hypertension-demographic and clinical correlates in obstructive sleep apnea. Sleep Breath 25:669–675. https://doi.org/10.1007/s11325-020-02157-3CrossRefPubMed

Fava C et al (2014) Effect of CPAP on blood pressure in patients with OSA/hypopnea a systematic review and meta-analysis. Chest 145:762–771. https://doi.org/10.1378/chest.13-1115CrossRefPubMed

Bratton DJ et al (2015) CPAP vs Mandibular advancement devices and blood pressure in patients with obstructive sleep apnea: a systematic review and meta-analysis. JAMA 314:2280–2293. https://doi.org/10.1001/jama.2015.16303CrossRefPubMed

McEvoy RD et al (2016) CPAP for prevention of cardiovascular events in obstructive sleep apnea. N Engl J Med 375:919–931. https://doi.org/10.1056/NEJMoa1606599CrossRefPubMed

Whelton PK et al (2018) 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 71:e13–e115. https://doi.org/10.1161/HYP.0000000000000065CrossRefPubMed

10.

Kline CE et al (2011) The effect of exercise training on obstructive sleep apnea and sleep quality: a randomized controlled trial. Sleep 34:1631–1640. https://doi.org/10.5665/sleep.1422CrossRefPubMedPubMedCentral

11.

Ferreira S et al (2021) Clinical safety and hemodynamic, cardiac autonomic and inflammatory responses to a single session of inspiratory muscle training in obstructive sleep apnea. Sleep Breath 26(1):99–108. https://doi.org/10.1007/s11325-021-02364-6CrossRefPubMed

12.

Ferreira JB et al (2013) Inspiratory muscle training reduces blood pressure and sympathetic activity in hypertensive patients: a randomized controlled trial. Int J Cardiol 166:61–67. https://doi.org/10.1016/j.ijcard.2011.09.069CrossRefPubMed

13.

Cheng S et al (2014) Healthy humans with a narrow upper airway maintain patency during quiet breathing by dilating the airway during inspiration. J Physiol 592:4763–4774. https://doi.org/10.1113/jphysiol.2014.279240CrossRefPubMedPubMedCentral

14.

Erturk N et al (2020) The effectiveness of oropharyngeal exercises compared to inspiratory muscle training in obstructive sleep apnea: a randomized controlled trial. Heart Lung 49(6):940–948. https://doi.org/10.1016/j.hrtlng.2020.07.014CrossRefPubMed

15.

Lin HC et al (2019) The effects of threshold inspiratory muscle training in patients with obstructive sleep apnea: a randomized experimental study. Sleep Breath 24(1):201–209. https://doi.org/10.1007/s11325-019-01862-yCrossRefPubMed

16.

Souza AKF et al (2018) Effectiveness of inspiratory muscle training on sleep and functional capacity to exercise in obstructive sleep apnea: a randomized controlled trial. Sleep Breath 22:631–639. https://doi.org/10.1007/s11325-017-1591-5CrossRefPubMed

17.

Vranish JR, Bailey EF (2016) Inspiratory muscle training improves sleep and mitigates cardiovascular dysfunction in obstructive sleep apnea. Sleep 39:1179–1185. https://doi.org/10.5665/sleep.5826CrossRefPubMedPubMedCentral

18.

Nóbrega-Júnior JCN et al (2020) Inspiratory muscle training in the severity of obstructive sleep apnea, sleep quality and excessive daytime sleepiness: a placebo-controlled, randomized trial. Nat Sci Sleep 12:1105–1113. https://doi.org/10.2147/NSS.S269360CrossRefPubMedPubMedCentral

19.

Hsu B et al (2020) Effects of respiratory muscle therapy on obstructive sleep apnea: a systematic review and meta-analysis. J Clin Sleep Med 16:785–801. https://doi.org/10.5664/jcsm.8318CrossRefPubMedPubMedCentral

20.

Torres-Castro R et al (2022) Respiratory muscle training in patients with obstructive sleep apnoea: a systematic review and meta-analysis. Clocks Sleep 4:219–229. https://doi.org/10.3390/clockssleep4020020CrossRefPubMedPubMedCentral

21.

Page MJ et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372:n71. https://doi.org/10.1136/bmj.n71CrossRefPubMedPubMedCentral

22.

Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5:13. https://doi.org/10.1186/1471-2288-5-13CrossRefPubMedPubMedCentral

23.

DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188. https://doi.org/10.1016/0197-2456(86)90046-2CrossRefPubMed

24.

Verges S (2019) Respiratory muscle training. In: Cogo A, Bonini M, Onorati P (eds) exercise and sports pulmonology: pathophysiological adaptations and rehabilitation. Springer International Publishing, Cham, pp 143–151CrossRef

25.

de Abreu RM et al (2017) Effects of inspiratory muscle training on cardiovascular autonomic control: a systematic review. Auton Neurosci 208:29–35. https://doi.org/10.1016/j.autneu.2017.09.002CrossRefPubMed

26.

Hill K et al (2010) Inspiratory muscle training for patients with chronic obstructive pulmonary disease: a practical guide for clinicians. Arch Phys Med Rehabil 91:1466–1470. https://doi.org/10.1016/j.apmr.2010.06.010CrossRefPubMed

27.

Guyatt G et al (2011) GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol 64:383–394. https://doi.org/10.1016/j.jclinepi.2010.04.026CrossRefPubMed

28.

Green M et al (2021) Meta-analysis of changes in the levels of catecholamines and blood pressure with continuous positive airway pressure therapy in obstructive sleep apnea. J Clin Hypertens (Greenwich) 23:12–20. https://doi.org/10.1111/jch.14061CrossRefPubMed

29.

Iftikhar IH et al (2013) Effect of oral appliances on blood pressure in obstructive sleep apnea: a systematic review and meta-analysis. J Clin Sleep Med : JCSM : Off Publ Am Acad Sleep Med 9:165–174. https://doi.org/10.5664/jcsm.2420CrossRef

30.

Tan SN, Yang HC, Lim SC (2021) Anatomy and pathophysiology of upper airway obstructive sleep apnoea: review of the current literature. Sleep Med Res 12:1–8. https://doi.org/10.17241/smr.2020.00829CrossRef

31.

Mello PR et al (2012) Inspiratory muscle training reduces sympathetic nervous activity and improves inspiratory muscle weakness and quality of life in patients with chronic heart failure: a clinical trial. J Cardiopulm Rehabil Prev 32:255–261. https://doi.org/10.1097/HCR.0b013e31825828daCrossRefPubMed

32.

Cortelli P et al (2012) Baroreflex modulation during sleep and in obstructive sleep apnea syndrome. Auton Neurosci 169:7–11. https://doi.org/10.1016/j.autneu.2012.02.005CrossRefPubMed

Titel: Effects of inspiratory muscle training on blood pressure- and sleep-related outcomes in patients with obstructive sleep apnea: a meta-analysis of randomized controlled trials
verfasst von: Tzu-Ang Chen
Sheng-Ting Mao
Huei-Chen Lin
Wen-Te Liu
Ka-Wai Tam
Cheng-Yu Tsai
Yi-Chun Kuan
Publikationsdatum: 28.12.2022
Verlag: Springer International Publishing
Erschienen in: Sleep and Breathing / Ausgabe 5/2023
Print ISSN: 1520-9512
Elektronische ISSN: 1522-1709
DOI: https://doi.org/10.1007/s11325-022-02773-1

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