Resistance Training of Inspiratory Muscles After Coronary Artery Disease May Improve Obstructive Sleep Apnea in Outpatient Cardiac Rehabilitation: RICAOS Study

Pierre Labeix,Frederic Roche,Jean-Claude Barthelemy,Arnauld Garcin,David Hupin,Mathieu Berger,Amandine Zellag

doi:10.3389/fphys.2022.846532

Abstract

BackgroundObstructive sleep apnea (OSA) affects 5% of the adult population and its prevalence is up to 13 times higher in coronary artery disease (CAD) patients. However, OSA in this population is less symptomatic, leading to lower adherence to positive airway pressure (CPAP). While oropharyngeal exercise showed a significant decrease in apnea-hypopnea index (AHI) in patients with moderate OSA, there have been no studies testing the impact of specific inspiratory muscle training (IMT) for these patients. The aim of our study was to assess the effectiveness of IMT on AHI reduction in CAD patients with moderate OSA.MethodsWe included patients with CAD involved in a cardiac rehabilitation program and presenting an AHI between 15 and 30. Patients were randomized in a 1:1 allocation to a control group (CTL – classic training) or an IMT group (classic training + IMT). IMT consisted in 60 deep inspirations a day, 6 days a week, into a resistive load device set at 70% of the maximum inspiratory pressure (MIP). After 6 weeks, we compared AHI, neck circumference, Epworth Sleepiness Scale, Pittsburgh Sleep Quality index, and quality of life with the 12-item Short Form Survey before and after rehabilitation.ResultsWe studied 45 patient (60 ± 9 y, BMI = 27 ± 6 kg.m−2). The IMT group (n = 22) significantly improved MIP ( p < 0.05) and had a significant decrease in AHI by 25% (−6.5 ± 9.5, p = 0.02). In the CTL group (n = 23), AHI decreased only by 3.5% (−0.7 ± 13.1; p = 0.29). Between groups, we found a significant improvement in MIP ( p = 0.003) and neck circumference ( p = 0.01) in favor of the IMT group. However, we did not find any significant improvement of AHI in the IMT group compared to CTL ( p = 0.09).ConclusionA specific IMT during cardiac rehabilitation contributes to reduce significantly AHI in CAD patients with moderate OSA. Magnitude of the decrease in OSA severity could be enhanced according to implementation of specific IMT in this population.

Highlights

Prevalence of moderate to severe obstructive sleep apnea (OSA; apnea plus hypopnea index >15 events.h−1) is thought to affect up to 23% of women and 49% of men (Heinzer et al, 2015)
The objective of our study was to assess the effects of strengthening inspiratory muscles on apnea-hypopnea index (AHI) in coronary patients with moderate OSA engaged at the same time in a postinfarction cardiac rehabilitation program (CR) using a randomized controlled design
636 patients were admitted to our cardiac rehabilitation center and 191 patients (40%) were assessed for suspected OSA

Summary

Introduction

Prevalence of moderate to severe obstructive sleep apnea (OSA; apnea plus hypopnea index >15 events.h−1) is thought to affect up to 23% of women and 49% of men (Heinzer et al, 2015). The absence of clinical repercussions may induce a higher withdrawal rate of standard continuous positive airway pressure (CPAP) treatment For those who have accepted CPAP, long-term adherence remains an important issue (Anandam et al, 2013; McEvoy et al, 2016; Rotenberg et al, 2016; Libman et al, 2017; Askland et al, 2020). Alternative treatments, such as mandibular advancement or surgery, can be proposed for moderate OSA or for patients with limited daytime symptoms but with limited tolerance by some patients over time (Fleury et al, 2010; Giralt-Hernando et al, 2019).

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