Respiratory muscle training for obstructive sleep apnea: Systematic review and meta-analysis

Area of Science:

• Pulmonology and Respiratory Medicine
• Sleep Medicine
• Rehabilitation Science

Background:

• Obstructive sleep apnea (OSA) is a prevalent sleep disorder with significant health implications.
• Respiratory muscle training (RMT) is explored as a non-invasive treatment modality for OSA.
• Evaluating the efficacy and safety of RMT in OSA patients is crucial for clinical practice.

Purpose of the Study:

• To systematically review the effectiveness and safety of respiratory muscle training (RMT) for obstructive sleep apnea (OSA).
• To assess the impact of inspiratory and expiratory muscle training on various clinical outcomes in OSA patients.
• To evaluate the evidence quality and risk of bias in randomized controlled trials (RCTs) of RMT for OSA.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials (RCTs).
• Searches conducted across major databases (MEDLINE, Embase, CENTRAL, LILACS, PEDro) up to July 2022.
• Included 13 RCTs, assessing risk of bias and certainty of evidence for all included studies.

Main Results:

• Inspiratory muscle training (IMT) likely improves systolic blood pressure and sleepiness compared to sham interventions.
• IMT shows uncertain effects on maximum inspiratory pressure and physical capacity; evidence for other outcomes is limited or uncertain.
• Expiratory muscle training (EMT) may improve expiratory muscle strength and sleep quality, but its effect on OSA severity is uncertain.

Conclusions:

• Current evidence suggests IMT may offer modest benefits for specific OSA symptoms and cardiovascular parameters, but high risk of bias necessitates caution.
• Combined RMT with exercise or cardiac rehabilitation shows potential synergistic effects, warranting further investigation.
• More high-quality RCTs are needed to definitively establish the role of RMT in managing obstructive sleep apnea.