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Patients with mild to moderate OSA may benefit from exercise
May 07, 2009Practicing certain tongue and pharyngeal exercises may reduce symptoms of mild to moderate obstructive sleep apnea (OSA), according to new research being published in the second issue for May of the American Journal of Respiratory and Critical Care Medicine.
Although CPAP is the gold standard treatment for severe OSA, the vast majority of subjects from epidemiological studies have mild or moderate OSA. The compliance to CPAP among mild to moderate OSA is variable, and there are only a few forms of alternative treatments for this large number of subjects and patients.
"It was commonly thought among doctors that strengthening and toning oropharyngeal muscles would have no benefit to the patient during sleep, but a recent study showed that didgeridoo playing helped decrease snoring and OSA," said Geraldo Lorenzi-Filho, M.D., Ph.D. "This was a change of paradigm, and indicated that not everything you do during the day is lost during sleep."
Dr. Lorenzi-Filho and colleagues investigated the effects of exercises on the symptoms of OSA in the first randomized, controlled study to do so. They recruited a group of 31 recently-diagnosed patients, who were evaluated for OSA severity using polysomnography. Snoring frequency and intensity, daytime sleepiness and sleep quality were assessed using self-reports and validated questionnaires. The subjects were the randomized to two groups-the exercise group and the control group. Each of the 16 individuals in the exercise group underwent a daily and weekly regimen of tongue and pharyngeal exercises. The 15 individuals in the control group underwent a sham treatment regimen involving deep breathing and nasal lavage with a saline solution.
After three months, there were no significant changes to OSA symptoms in the control group. However, the treatment group showed significant improvements in lowest oxygen saturation levels in blood, subjective sleepiness, snoring symptoms and quality of sleep scores.
Additionally, while there were no changes in abdominal circumference in either group, neck circumference decreased significantly in the treatment group with no concomitant changes in body mass index.
"These data suggest that the exercises were able to promote remodeling of the upper airways," Said Dr. Lorenzi-Filho.
Overall, the treatment groups showed a 40 percent decrease in OSA severity. Ten of the 16 patients in the treatment group who had originally been classified as having moderate OSA based on their apnea-hypopnea index (AHI) score were reclassified as having either mild (eight) or no OSA (two). "This was nearly two thirds of the treatment group, whereas none of the control group were reclassified with a milder disease," said Dr. Lorenzi-Filho. "This indicates to us that these exercises have significant potential to improve symptoms in sufferers of OSA."
"The muscles of the upper airways are extremely complex and the mechanisms leading to OSA are far from being well understood," said Dr. Lorenzi-Filho. "A strong muscle may be working on the wrong direction and not necessarily helping to open the airways. The overall set of exercises we tested target the correct physiology of the upper airway and should promote remodeling of the upper airways."
This was the first rigorous study of the subject, and the evidence supports that certain exercises do, in fact, aid in remodeling the upper airways in such a way as to reduce OSA symptoms.
"[T]here seems to be reasonable logic to targeting tongue strength as a potential mechanism for remodeling the upper airway," wrote Catriona Steele, Ph.D. in an accompanying editorial that appears in the same issue of the journal.
Dr. Lorenzi-Filho acknowledges that work is just beginning in this exciting area of research: "How exactly these exercises work? Do we need all of them or just a few? Do different patients need different set of exercises? What are the exact mechanisms leading to upper airway obstruction?," he asked. "The answer is we don't know, but these are some of the possible future areas of research."
American Thoracic Society
Dr. Lorenzi-Filho and colleagues investigated the effects of exercises on the symptoms of OSA in the first randomized, controlled study to do so. They recruited a group of 31 recently-diagnosed patients, who were evaluated for OSA severity using polysomnography. Snoring frequency and intensity, daytime sleepiness and sleep quality were assessed using self-reports and validated questionnaires. The subjects were the randomized to two groups-the exercise group and the control group. Each of the 16 individuals in the exercise group underwent a daily and weekly regimen of tongue and pharyngeal exercises. The 15 individuals in the control group underwent a sham treatment regimen involving deep breathing and nasal lavage with a saline solution.
After three months, there were no significant changes to OSA symptoms in the control group. However, the treatment group showed significant improvements in lowest oxygen saturation levels in blood, subjective sleepiness, snoring symptoms and quality of sleep scores.
Additionally, while there were no changes in abdominal circumference in either group, neck circumference decreased significantly in the treatment group with no concomitant changes in body mass index.
"These data suggest that the exercises were able to promote remodeling of the upper airways," Said Dr. Lorenzi-Filho.
Overall, the treatment groups showed a 40 percent decrease in OSA severity. Ten of the 16 patients in the treatment group who had originally been classified as having moderate OSA based on their apnea-hypopnea index (AHI) score were reclassified as having either mild (eight) or no OSA (two). "This was nearly two thirds of the treatment group, whereas none of the control group were reclassified with a milder disease," said Dr. Lorenzi-Filho. "This indicates to us that these exercises have significant potential to improve symptoms in sufferers of OSA."
"The muscles of the upper airways are extremely complex and the mechanisms leading to OSA are far from being well understood," said Dr. Lorenzi-Filho. "A strong muscle may be working on the wrong direction and not necessarily helping to open the airways. The overall set of exercises we tested target the correct physiology of the upper airway and should promote remodeling of the upper airways."
This was the first rigorous study of the subject, and the evidence supports that certain exercises do, in fact, aid in remodeling the upper airways in such a way as to reduce OSA symptoms.
"[T]here seems to be reasonable logic to targeting tongue strength as a potential mechanism for remodeling the upper airway," wrote Catriona Steele, Ph.D. in an accompanying editorial that appears in the same issue of the journal.
Dr. Lorenzi-Filho acknowledges that work is just beginning in this exciting area of research: "How exactly these exercises work? Do we need all of them or just a few? Do different patients need different set of exercises? What are the exact mechanisms leading to upper airway obstruction?," he asked. "The answer is we don't know, but these are some of the possible future areas of research."
American Thoracic Society
Obstructive Sleep Apnea Current Events and Obstructive Sleep Apnea News RSSImproved diet and exercise alone unlikely to cure obstructive sleep apnea in obese patients
A study in the Oct. 15 issue of the Journal of Clinical Sleep Medicine found that while a strict diet and exercise program may benefit obese patients with mild to moderate obstructive sleep apnea (OSA), it is unlikely to eliminate the condition.
Minimally invasive procedure effective for treating snoring
Radiofrequency ablation, a procedure that uses heat to shrink the tissue of the soft palate, is an effective and minimally invasive procedure that can be used to treat patients who snore.
Many patients with sleep apnea also suffer from GI tract conditions
Patients who suffer from obstructive sleep apnea (OSA) also tend to have additional gastrointestinal (GI) tract conditions, such as gastric reflux and hiatal hernia, which form at the opening in your diaphragm where your food pipe (esophagus) joins your stomach.
Stress, fatigue plague patients with allergic rhinitis and obstructive sleep apnea
Patients who suffer from both allergic rhinitis and obstructive sleep apnea (OSA) may experience escalated symptoms of stress and fatigue.
Severe sleep apnea tied to increased risk of death
Moderate to severe obstructive sleep apnea is associated with an increased risk of death from any cause in middle-aged adults, especially men, according to new results from a landmark study supported by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH).
Obstructive sleep apnea is prevalent in adults with Down syndrome
A study in the Aug. 15 issue of the Journal of Clinical Sleep Medicine shows that adults with Down syndrome also frequently suffer from obstructive sleep apnea (OSA).
Study finds increased 'sibling risk' of obstructive sleep apnea in children
A study in the Aug. 1 issue of the journal SLEEP indicates that children have an increased risk of developing obstructive sleep apnea (OSA) if they have at least one sibling who has been diagnosed with the sleep disorder.
Benefits from upper airway surgery for sleep apnea found to equal CPAP
Adults who struggle with CPAP treatment for obstructive sleep apnea (OSA) should be considered candidates for reconstructive surgery on the upper airway, because it holds the same quality-of-life (QOL) benefits but with more permanence.
Biomarker of breathing control abnormality associated with hypertension and stroke
A study in the July 1 issue of the journal SLEEP identified a distinct ECG-derived spectrographic phenotype, designated as narrow-band elevated low frequency coupling (e-LFCNB), that is associated with prevalent hypertension, stroke, greater severity of sleep disordered breathing and sleep fragmentation in patients suffering from obstructive sleep apnea (OSA).
CPAP treatment linked to lower mortality in stroke patients with OSA
Stroke patients with obstructive sleep apnea (OSA) who undergo treatment with continuous positive airway pressure (CPAP) following their stroke may substantially reduce their risk of death.
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