Respiratory Muscle Training Combined With Aerobic Exercise in Obstructive Sleep Apnea Syndrome
Condition: Obstructive Sleep Apnea Syndrome
MeSH terms: Apnea; Sleep Apnea Syndromes; Sleep Apnea, Obstructive; Syndrome
Study type: Interventional

Summary: 
      In this study, which was planned to evaluate the effects of inspiratory and expiratory
      respiratory muscle training in addition to aerobic exercise in individuals with OSAS; 40
      cases over the age of 40 who were diagnosed with severe (AHI: 30 and over) Obstructive Sleep
      Apnea Syndrome by polysomnography in the Sleep Laboratory of the Department of Chest Diseases
      of the Istanbul University Istanbul Medical Faculty Hospital will be included. The cases will
      be divided into two groups with the randomization system and the education of both groups
      will continue for a total of 8 weeks. In the literature, it is stated that there is a need
      for studies on the benefits and results of the use of respiratory muscle training as an
      adjunct therapy to CPAP or oral devices. No studies were found that evaluated the effects of
      inspiratory and expiratory respiratory muscle training in addition to aerobic exercise in
      patients with OSAS. For this reason, OSAS patients using regular CPAP were planned as two
      groups in the treatment part of this study. Control Group: For gradual aerobic exercise
      training, bicycle ergometer training in the hospital environment and brisk walking at home
      once a week (3 days a week, 20-40 minutes a day) will be given under supervision two days a
      week.

      Training Group: In addition to the aerobic exercise, the training group will be given
      respiratory muscle training once a day, 5 days a week, as a home program. Intraoral pressure
      measurements will be repeated once a week to calculate the new threshold load. Respiratory
      muscle training: Respiratory muscle training in 50% of MIP and 30% of MEP, as ICE + IME (5
      days a week, 15 minutes per day, 15 minutes of IMI). Evaluations will be repeated before and
      after treatment. The original value of this study is that the effects of Respiratory Muscle
      Training Combined with Aerobic Exercise in addition to CPAP treatment will be investigated in
      individuals with OSAS.
    

Detailed description: 
      Combined Exercises Grup: In addition to the aerobic exercise, the training group will be
      given respiratory muscle training once a day, 5 days a week, as a home program. Intraoral
      pressure measurements will be repeated once a week to calculate the new threshold load.
      Respiratory muscle training: Respiratory muscle training in 50% of MIP and 30% of MEP, as ICE
      + IME (5 days a week, 15 minutes per day, 15 minutes of IMI). Evaluations will be repeated
      before and after treatment. The original value of this study is that the effects of
      Respiratory Muscle Training Combined with Aerobic Exercise in addition to CPAP treatment will
      be investigated in individuals with OSAS.

      Aerobic Exercises Grup: For gradual aerobic exercise training, bicycle ergometer training in
      the hospital environment and brisk walking at home once a week (3 days a week, 20-40 minutes
      a day) will be given under supervision two days a week Obstructive Sleep Apnea Syndrome
      (OSAS) is a syndrome with a highly complex pathophysiology characterized by repetitive
      complete or partial upper airway occlusions during sleep. As a result of collapse in the
      pharyngeal airways during sleep, air flow to the lungs decreases partially (hypopnea) or
      completely (apnea), hypoxia and hypercapnia develop, and the congestion ends with the end of
      sleep. The repetition of these situations that develop during sleep stimulates the
      sympathetic nervous system and causes changes in blood pressure.Excessive daytime sleepiness
      and neurocognitive disorders can be observed as a result of sleep disruptions and hypoxia
      that develop with multiple stimuli .It has been reported that there is a continuous increase
      in the prevalence of OSAS. The incidence of OSAS in the general adult population varies
      between 9-38%, with a higher incidence in males. Due to obesity, its prevalence is increasing
      at an alarming rate, especially in middle and high-income countries . OSAS causes potentially
      serious health consequences such as impaired quality of life, emotional impairment,
      neurocognitive impairment, permanent brain damage, cardiovascular morbidity, and sudden death
      during sleep. OSAS has a very complex pathophysiology and the roles of influencing factors
      are also variable among individuals. In the physiopathology of upper airway obstruction,
      factors such as anatomical and mechanical factors, impaired contractile function of upper
      airway muscles, respiratory control instability come to the fore . One of the mechanisms that
      cause altered neuromechanical responses in OSAS is the deterioration of the contractile
      function of the upper airway muscles. In these patients, the upper respiratory tract muscles
      work under hypoxic conditions and as a result, a modification in the muscle fiber structure
      develops. In this modification, muscle fibers change from type I fibers that are resistant to
      fatigue to type II muscle fibers that increase strength but are not resistant to fatigue. As
      a result, the contractility of the muscle is preserved, but the fatigue increases. With this
      modification in the muscle fiber, inflammation may occur in the muscle working under
      increased load, with muscle damage that impairs the contractility of the muscle. Muscle
      dysfunction may develop as a result of these events .

      During sleep, there is a decrease in lung volume and upper airway dilator muscle tone.
      Therefore, upper and lower airway muscle function is relatively reduced during sleep and may
      increase airway obstruction. It is thought that increasing upper airway dilator muscle
      activity and increasing lung volume are effective in maintaining airway patency. Coordinated
      contraction of the upper airway dilator muscles (eg genioglossus) and inspiratory pump
      muscles (eg diaphragm) is required for breathing to continue with an open airway. Inspiratory
      muscle weakness increases susceptibility to hypoventilation during sleep .

      Treatment methods of OSAS include conservative (Continuous Positive Airway Pressure (CPAP)
      device and intraoral device applications) and surgical interventions. CPAP therapy, which is
      the most effective method available in OSAS, has been shown to improve sleepiness,
      hypertension and many cardiovascular indices seen in patients . CPAP is considered the first
      choice in the treatment of especially moderate or severe OSAS cases, but it is costly and
      patient compliance is an important condition that affects treatment success.

      It is known that respiratory muscle training increases respiratory muscle strength in people
      with COPD and neuromuscular diseases . It has been reported that inspiratory muscle training
      in OSAS patients improves OSAS severity, daytime sleepiness and sleep quality, decreases the
      severity and frequency of snoring, improves respiratory muscle strength, and can reduce the
      cost of CPAP treatment by increasing its use in rehabilitation programs. However, it has been
      shown that training applied to the upper respiratory tract with the didgeridoo instrument in
      people with snoring and OSAS reduces daytime sleepiness, apnea-hypopnea index, and upper
      airway collapse. Strengthening both inspiratory and expiratory muscles seems reasonable given
      that weakness of the upper airway and inspiratory muscles in these patients affects
      sleep-related outcome measures. In addition, it is stated in the literature that there is a
      need for studies on the benefits and results of the use of respiratory muscle training as an
      adjunct to CPAP or oral devices .

      It is known that most of the patients with OSAS also have low exercise capacity. OSAS
      severity is associated with worsening exercise tolerance. In the treatment of OSAS patients,
      exercise training in addition to CPAP therapy has received increasing attention in recent
      years . It has been shown that regular exercise training applied in patients with OSAS
      reduces AHI, body weight and body mass index, improves aerobic capacity and quality of life .
      In a recent meta-analysis, aerobic exercise training has been reported to effectively improve
      quality of life, daytime sleepiness, and sleep quality . No studies were found that evaluated
      the effects of inspiratory and expiratory respiratory muscle training in addition to aerobic
      exercise in patients with OSAS. The aim of this study is to evaluate the effects of
      inspiratory and expiratory respiratory muscle training in addition to aerobic exercise in
      patients with OSAS.
    

Intervention name(s): Gradual Aerobic exercise training AND Respiratory muscle training; Gradual Aerobic exercise training
Intervention type(s): Other; Other
Intervention description(s): Combined Exercise Group; Aerobic exercise Group
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Sleep Apnea , Respiratory Muscle Training, Aerobic Exercise