Abstract
The genioglossus is a major upper airway dilator muscle. Our goal was to assess the efficacy of upper airway muscle training on Obstructive Sleep Apnea (OSA) as an adjunct treatment. Sixty-eight participants with OSA (AHI > 10/h) were recruited from our clinic. They fall into the following categories: (a) Treated with Automatic Positive Airway Pressure (APAP), (n = 21), (b) Previously failed APAP therapy (Untreated), (n = 25), (c) Treated with Mandibular Advancement Splint (MAS), (n = 22). All subjects were given a custom-made tongue strengthening device. We conducted a prospective, randomized, controlled study examining the effect of upper airway muscle training. In each subgroup, subjects were randomized to muscle training (volitional protrusion against resistance) or sham group (negligible resistance), with a 1:1 ratio over 3 months of treatment. In the baseline and the final visit, subjects completed home sleep apnea testing, Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), SF-36 (36-Item Short Form Survey), and Psychomotor Vigilance Test (PVT). Intervention (muscle training) did not affect the AHI (Apnea-Hypopnea Index), (p-values > 0.05). Based on PSQI, ESS, SF-36 scores, and PVT parameters, the changes between the intervention and sham groups were not significant, and the changes were not associated with the type of treatment (p-value > 0.05). The effectiveness of upper airway muscle training exercise as an adjunct treatment requires further study.
Highlights
Obstructive sleep apnea (OSA) is defined by repetitive episodes of pharyngeal collapse during sleep [1,2]
The genioglossus muscle has a crucial role in the pathogenesis of OSA and is a major upper airway dilator
Our results indicate that this particular training device was not effective for OSA treatment, and these results may inform future device designs as well as future studies regarding pharyngeal muscle training
Summary
Obstructive sleep apnea (OSA) is defined by repetitive episodes of pharyngeal collapse during sleep [1,2]. OSA leads to excessive daytime sleepiness because of sleep fragmentation and other factors. Continuous positive airway pressure (CPAP) therapy reduces daytime sleepiness and the risk of cardiovascular morbidity and mortality, and it is known as the most effective intervention for sleep disordered breathing in severely affected patients [3,4]. The genioglossus muscle has a crucial role in the pathogenesis of OSA and is a major upper airway dilator. Studies evaluating genioglossus (GG) muscle activity at sleep onset suggest that patients with OSA have a marked reduction in activity in comparison with healthy individuals [7,8]. Mandibular advancement splints (MAS) pull the patient’s mandible in a forward and downward position to increase the airway patency in OSA patients [6,9]
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