Respiratory Rehabilitation in Obstructive Sleep Apneas
Condition: Sleep Disorder; Sleep Apnea Syndromes
MeSH terms: Apnea; Sleep Apnea Syndromes; Sleep Apnea, Obstructive; Sleep Wake Disorders; Syndrome
Study type: Interventional

Summary: 
      The Obstructive Sleep Apnea is characterized by obstruction of the upper airway during sleep
      (for at least 10 sec), with repeated breathing pauses, accompanied by oxygen desaturation in
      the blood and by sleep interruption with repeated arousals.

      The investigators hypothesized that good sleep hygiene, the execution of respiratory
      rehabilitation exercises, with specific myofascial exercises on the muscles that are
      compromised in the Obstructive Sleep Apnea, can improve the patient's clinical outcome and
      quality of life.

      The objective of this study is to evaluate the effect of respiratory rehabilitation with
      myo-functional exercises in mild obstructive sleep.
    

Detailed description: 
      Patients: Eligible patients aged between 40 and 80 years old, with BMI < 30 and with a recent
      diagnosis of mild Obstructive Sleep Apnea evaluated with home night cardio-respiratory
      monitoring.

      The investigators will exclude patients with one or more of the following conditions:
      subjects who regularly use hypnoinductive drugs, with craniofacial malformations, who have
      suffered recent facial trauma, suffering from hypothyroidism, suffering from neuromuscular
      diseases, with recent strokes, severe obstructive nasal disease, systemic infectious diseases
      and neoplastic diseases.

      Home night cardio-respiratory monitoring: all patients will be evaluated according to
      international guidelines (AAMS American Academy Sleep Medicine) with an instrument equipped
      with sensors for detection oral/nasal flow, snoring, chest/abdomen movements, pulse oximetry
      and heart rate.

      Questionnaire: The investigators will employ questionnaires validated in Italy: Snoring
      frequency (derived from the Berlin questionnaire); subjective daytime sleepiness (Epworth
      questionnaire); quality of sleep (Pittsburgh sleep quality questionnaire).

      Patients will be randomized into two groups randomly with a 1: 1 ratio: group 1 (treated
      group) or group 2 (control group) for a total of 20 patients per group (according to the
      sample size calculation reported in the protocol).

      The treatment group will be subjected to an integrated rehabilitation protocol, composed of
      Respiratory rehabilitation exercises with diaphragmatic breathing, thoracic mobilization
      exercises and manual pompage techniques, followed by manual trigger point therapy techniques,
      (that were identified by palpation following the guidelines provided by Travell and Simons
      trigger point manual), the accessory inspiratory muscles like pectoralis minor muscle,
      scapula elevator muscle, Sternocleidomastoid muscle. The integrated rehabilitation protocol
      will be 45 minutes, 3 weekly sessions for 4 weeks, for a total of 12 consecutive sessions.
      Also, at every patient will be taught oropharyngeal exercises to perform at home twice a day
      (the duration of 15 minutes each session) involving in particular exercises for soft palate,
      tongue, facial and genio-glosso muscle.

      Both in the treated group and the control group will be given a booklet with the rules for
      proper sleep hygiene because sleep is influenced by our lifestyle and various environmental
      factors can affect the quality of night sleep.
    

Intervention name(s): Myofunctional exercises; The rules of sleep hygiene
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Myofunctional exercises: Respiratory rehabilitation exercises with diaphragmatic breathing, thoracic mobilization exercises and manual pompage techniques, followed by manual trigger point therapy techniques, that were identified by palpation following the guidelines provided by Travell and Simons trigger point manual, the accessory inspiratory muscles like pectoralis minor muscle, scapula elevator muscle, Sternocleidomastoid muscle.
Home oropharyngeal exercises: at every patient will be taught oropharyngeal exercises to perform at home twice a day (the duration of 15 minutes each session) involving in particular exercises for soft palate, tongue, facial and genio-glosso muscle.
The rules of sleep hygiene: a list of behaviours that physiologically promote a good night's sleep.; The rules of sleep hygiene: a list of behaviours that physiologically promote a good night's sleep.
Other intervention name(s): home oropharyngeal exercises; the rules of sleep hygiene
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Rehabilitation; sleep obstructive apnea; oropharyngeal exercises; myofunctional exercises