Abstract
The primary aim of the current study was to assess the effects of oropharingeal muscle exercises in obstruction severity on stroke patients with OSAS. The secondary aims were to evaluate the effects of the exercises on rehabilitation of neurological function, sleeping, and morphology change of upper airway. An open-label, single-blind, parallel-group, randomized, controlled trial was designed. Fifty post-stroke patients with moderate OSAS were randomly assigned into 2 groups (25 in each group). For the therapy group, oropharyngeal muscle exercise was performed during the daytime for 20 min, twice a day, for 6 weeks. The control group was subjected to sham therapy of deep breathing. Primary outcomes were the obstruction severity by polysomnography. Secondary outcomes included recovery of motor and neurocognitive function, personal activities of daily living assessment (ADL), sleep quality and sleepiness scale. It also included upper airway magnetic resonance imaging (MRI) measurements. Assessments were made at baseline and after 6-week exercise. Finally, 49 patients completed the study. The apnea–hypopnea index, snore index, arousal index, and minimum oxygen saturation improved after exercise (P < 0.05). Oropharyngeal muscle exercises improved subjective measurements of sleep quality (P = 0.017), daily sleepiness (P = 0.005), and performance (both P < 0.05) except for neurocognition (P = 0.741). The changes in obstruction improvement, sleep characteristics and performance scale were also associated with training time, as detected by Pearson's correlation analysis. The anatomic structural remodeling of the pharyngeal airway was measured using MRI, including the lager retropalatal distance (P = 0.018) and shorter length of soft palate (P = 0.044) compared with the baseline. Hence, oropharyngeal muscle exercise is a promising alternative treatment strategy for stroke patients with moderate OSAS.Clinical Trial Registration: http://www.chictr.org.cn. Unique identifier: ChiCTR-IPR-16009970
Highlights
Based on previous studies, 57% of stroke patients suffer from obstructive sleep apnea syndrome (OSAS) in rehabilitation units [1, 2]
apnea–hypopnea index (AHI), apnea-hypopnea index; SaO2, oxygen saturation; AI, arousal index per sleep hour; SI, snore index; SSS, Stanford Sleepiness Scale; Pittsburgh Sleep Quality Index (PSQI), Pittsburg sleep quality index scale; Mini-Mental State Examination (MMSE), Mini-mental State Examination; Fugl–Meyer assessment (FMA), Fugl-Meyer Assessment, *Values are presented as mean or median
The present study examined the effects of oropharyngeal exercise in stroke patients with moderate OSAS using objective polysomnography measurements and quantification of subjective symptoms, including snoring, daytime sleepiness, and sleep quality
Summary
57% of stroke patients suffer from obstructive sleep apnea syndrome (OSAS) in rehabilitation units [1, 2]. The set of oropharyngeal exercises used in the present study was developed in 16 years and has previously been shown to be effective in patients with stroke-free OSAS in uncontrolled and controlled studies [14,15,16]. The primary aim of the study was to assess the effects of oropharingeal muscle exercises in obstruction severity. The secondary aims were to evaluate the effects of the exercises on recovery of neurological function, sleeping, and anatomic changing of upper airway. It was hypothesized that oropharyngeal muscle exercise could be beneficial for patients’ recovery in the airway obstruction and in the motor, neurocognitive, and ADL performance after stroke
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