Skip to main content

Advertisement

SpringerLink
Log in

Effects of inspiratory muscle training on the severity of obstructive sleep apnea in individuals after stroke: a protocol for a randomized controlled trial

  • Sleep Breathing Physiology and Disorders • Original Article
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

Background

Obstructive sleep apnea (OSA) is the most common form of sleep-disordered breathing in cerebrovascular diseases, requiring a multidisciplinary approach. There are few studies evaluating the effects of inspiratory muscle training (IMT) in individuals with OSA and the findings regarding the possible effect on apnea hypopnea index (AHI) reduction are controversial.

Objective

This protocol for a randomized clinical trial will assess the effects of IMT on the severity of obstructive sleep apnea, sleep quality, and daytime sleepiness in individuals after stroke participating in a rehabilitation program.

Methods

This study will be a randomized controlled trial with blinded assessors. Forty individuals after stroke will randomized to two groups. For 5 weeks, both groups will participate in the rehabilitation program activities, including aerobic exercise, resistance training, and educational class when they will receive guidance on the behavioral management of OSA. The experimental group will also perform high-intensity IMT 5 times a week, for 5 weeks, consisting initially of five sets of five repetitions achieving 75% of the maximal inspiratory pressure, increasing one set each week, totaling nine sets at the end of training. The primary outcome will be the severity of OSA measured as AHI at 5 weeks. Secondary outcomes will include sleep quality measured by the Pittsburgh Sleep Quality Index (PSQI) and daytime sleepiness measured by Epworth Sleepiness Scale (ESS). Outcomes will be collected by a researcher blinded to group allocation at baseline (week 0), after intervention (week 5), and 1 month beyond intervention (week 9).

Trial registration

Clinical Trials Register: NCT05135494.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

The datasets generated during and/or analyzed during the current study are not publicly available due to why dates are not public but are available from the corresponding author on reasonable request.

References

  1. Johnson KG, Johnson DC (2010) Frequency of sleep apnea in stroke and TIA patients: a meta-analysis. J Clin sleep Med JCSM Off Publ Am Acad Sleep Med 6:131–137

    Google Scholar 

  2. Seiler A, Camilo M, Korostovtseva L et al (2019) Prevalence of sleep-disordered breathing after stroke and TIA. Neurology 92:e648–e654. https://doi.org/10.1212/WNL.0000000000006904

    Article  PubMed  Google Scholar 

  3. Bassetti CLA, Randerath W, Vignatelli L et al (2020) EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke. Eur J Neurol 27:1117–1136. https://doi.org/10.1111/ene.14201

    Article  CAS  PubMed  Google Scholar 

  4. Dong JY, Zhang YH, Qin LQ (2013) Obstructive sleep apnea and cardiovascular risk: meta-analysis of prospective cohort studies. Atherosclerosis 229:489–495

    Article  CAS  PubMed  Google Scholar 

  5. Aaronson JA, Van Bennekom CAM, Hofman WF et al (2015) Obstructive sleep apnea is related to impaired cognitive and functional status after stroke. Sleep 38:1431-1437B. https://doi.org/10.5665/sleep.4984

    Article  PubMed  PubMed Central  Google Scholar 

  6. Kernan WN, Ovbiagele B, Black HR et al (2014) Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association. Stroke 45:2160–2236. https://doi.org/10.1161/STR.0000000000000024

    Article  PubMed  Google Scholar 

  7. Sateia MJ (2014) International classification of sleep disorders-third edition: highlights and modifications. Chest 146(5):1387–1394

    Article  PubMed  Google Scholar 

  8. Eckert DJ (2018) Phenotypic approaches to obstructive sleep apnoea –new pathways for targeted therapy. Sleep Med Rev 37:45–59. https://doi.org/10.1016/j.smrv.2016.12.003

    Article  PubMed  Google Scholar 

  9. Chien MY, Wu YT, Lee PL et al (2010) Inspiratory muscle dysfunction in patients with severe obstructive sleep apnoea. Eur Respir J 35:373–380. https://doi.org/10.1183/09031936.00190208

    Article  PubMed  Google Scholar 

  10. Colelli DR, Kamra M, Rajendram P et al (2020) Predictors of CPAP adherence following stroke and transient ischemic attack. Sleep Med 66:243–249. https://doi.org/10.1016/j.sleep.2018.10.009

    Article  PubMed  Google Scholar 

  11. Patil SP, Ayappa IA, Caples SM et al (2019) Treatment of adult obstructive sleep apnea with positive airway pressure: an American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med 15:335–343. https://doi.org/10.5664/jcsm.7640

    Article  PubMed  PubMed Central  Google Scholar 

  12. Menezes KKKP, Nascimento LR, Ada L et al (2016) Respiratory muscle training increases respiratory muscle strength and reduces respiratory complications after stroke: a systematic review. J Physiother 62:138–144. https://doi.org/10.1016/j.jphys.2016.05.014

    Article  PubMed  Google Scholar 

  13. How SC, McConnell AK, Taylor BJ, Romer LM (2007) Acute and chronic responses of the upper airway to inspiratory loading in healthy awake humans: an MRI study. Respir Physiol Neurobiol 157:270–280. https://doi.org/10.1016/j.resp.2007.01.008

    Article  PubMed  Google Scholar 

  14. Chen T-A, Mao S-T, Lin H-C et al (2022) 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. Sleep Breath. https://doi.org/10.1007/s11325-022-02773-1

    Article  PubMed  PubMed Central  Google Scholar 

  15. Azeredo LM de, Souza LC de, Guimarães BLS, Puga FP, Behrens NSCS, Lugon JR (2022) Inspiratory muscle training as adjuvant therapy in obstructive sleep apnea: a randomized controlled trial. Braz J Med Biol Res 55:e12331. https://doi.org/10.1590/1414-431X2022e12331

  16. Dar JA, Mujaddadi A, Moiz JA (2022) Effects of inspiratory muscle training in patients with obstructive sleep apnoea syndrome: a systematic review and meta-analysis. Sleep Sci (Sao Paulo, Brazil) 15:480–489. https://doi.org/10.5935/1984-0063.20220081

    Article  Google Scholar 

  17. Nóbrega-Júnior JCN, Dornelas de Andrade A, de Andrade EAM 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.S269360

    Article  PubMed  PubMed Central  Google Scholar 

  18. Lin HC, Chiang LL, Ong JH et al (2020) The effects of threshold inspiratory muscle training in patients with obstructive sleep apnea: a randomized experimental study. Sleep Breath 24:201–209. https://doi.org/10.1007/s11325-019-01862-y

    Article  PubMed  Google Scholar 

  19. Sateia MJ (2014) International Classification of Sleep Disorders-Third Edition. Chest 146:1387–1394. https://doi.org/10.1378/chest.14-0970

    Article  PubMed  Google Scholar 

  20. ATS (2002) ATS/ERS Statement on respiratory muscle testing. Am J Respir Crit Care Med 166:518–624. https://doi.org/10.1164/rccm.166.4.518

    Article  Google Scholar 

  21. Britto RR, Rezende NR, Marinho KC et al (2011) Inspiratory muscular training in chronic stroke survivors: a randomized controlled trial. Arch Phys Med Rehabil 92:184–190. https://doi.org/10.1016/j.apmr.2010.09.029

    Article  PubMed  Google Scholar 

  22. Buysse DJ, Reynolds CF, Monk TH et al (1989) The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res 28:193–213. https://doi.org/10.1016/0165-1781(89)90047-4

    Article  CAS  PubMed  Google Scholar 

  23. Bertolazi AN, Fagondes SC, Hoff LS et al (2009) Validação da escala de sonolência de Epworth em português para uso no Brasil. J Bras Pneumol 35:877–883

    Article  PubMed  Google Scholar 

  24. Kuo Y-C, Song T-T, Bernard JR, Liao Y-H (2017) Short-term expiratory muscle strength training attenuates sleep apnea and improves sleep quality in patients with obstructive sleep apnea. Respir Physiol Neurobiol 243:86–91. https://doi.org/10.1016/j.resp.2017.05.007

    Article  PubMed  Google Scholar 

  25. POWERbreathe International Limited (2020) POWERbreathe Medic Plus. In: POWERbreathe. https://www.powerbreathe.com/powerbreathe-medic-plus

  26. Ferreira STBP, do Socorro Brasileiro-Santos M, Teixeira JB, et al (2022) Clinical safety and hemodynamic, cardiac autonomic and inflammatory responses to a single session of inspiratory muscle training in obstructive sleep apnea. Sleep Breath 26:99–108. https://doi.org/10.1007/s11325-021-02364-6

    Article  PubMed  Google Scholar 

  27. Parreiras de Menezes KK, Nascimento LR, Ada L et al (2019) High-intensity respiratory muscle training improves strength and dyspnea poststroke: a double-blind randomized trial. Arch Phys Med Rehabil 100:205–212. https://doi.org/10.1016/j.apmr.2018.09.115

    Article  PubMed  Google Scholar 

  28. Zhang XX, Zheng Y, Dang Y et al (2020) Can inspiratory muscle training benefit patients after stroke? A systematic review and meta-analysis of randomized controlled trials. Clin Rehabil 34:866–876. https://doi.org/10.1177/0269215520926227

    Article  PubMed  Google Scholar 

  29. Pozuelo-Carrascosa DP, Carmona-Torres JM, Laredo-Aguilera JA et al (2020) Effectiveness of respiratory muscle training for pulmonary function and walking ability in patients with stroke: a systematic review with meta-analysis. Int J Environ Res Public Health 17:1–22. https://doi.org/10.3390/ijerph17155356

    Article  Google Scholar 

  30. Sapienza CM, Wheeler K (2006) Respiratory muscle strength training: functional outcomes versus plasticity. Semin Speech Lang 27:236–244. https://doi.org/10.1055/s-2006-955114

    Article  PubMed  Google Scholar 

  31. Vaz L de O, Almeida J de C, Froes KS dos SO, et al (2021) Effects of inspiratory muscle training on walking capacity of individuals after stroke: a double-blind randomized trial. Clin Rehabil 35:1247–1256. https://doi.org/10.1177/0269215521999591

Download references

Author information

Authors and Affiliations

  1. The SARAH Network of Rehabilitation Hospitals, Av Tancredo Neves 2782, Salvador, Bahia, 41820900, Brazil

    Lorena de Oliveira Vaz, Ana Paula Galvão, Daniela Lino Macedo Nunes, Juliana Carvalho de Almeida & Juliana de Fátima Garcia Diniz

  2. Post-Graduation Program in Health Sciences, Federal University of Bahia, Salvador, Bahia, Brazil

    Lorena de Oliveira Vaz & Jamary Oliveira-Filho

Authors
  1. Lorena de Oliveira Vaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ana Paula Galvão
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Daniela Lino Macedo Nunes
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Juliana Carvalho de Almeida
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Juliana de Fátima Garcia Diniz
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jamary Oliveira-Filho
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lorena de Oliveira Vaz.

Ethics declarations

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Competing interests

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

de Oliveira Vaz, L., Galvão, A.P., Nunes, D.L.M. et al. Effects of inspiratory muscle training on the severity of obstructive sleep apnea in individuals after stroke: a protocol for a randomized controlled trial. Sleep Breath 27, 2257–2263 (2023). https://doi.org/10.1007/s11325-023-02825-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-023-02825-0

Keywords

Search

Navigation