1
|
Silva de Sousa A, Pereira da Rocha A, Brandão Tavares DR, Frazão Okazaki JÉ, de Andrade Santana MV, Fernandes Moça Trevisani V, Pereira Nunes Pinto AC. Respiratory muscle training for obstructive sleep apnea: Systematic review and meta-analysis. J Sleep Res 2024; 33:e13941. [PMID: 37258418 DOI: 10.1111/jsr.13941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/22/2023] [Accepted: 05/02/2023] [Indexed: 06/02/2023]
Abstract
Obstructive sleep apnea is the most common sleep disorder. This review aims to evaluate the effectiveness and safety of respiratory muscle training in the treatment of patients with obstructive sleep apnea. The study protocol was registered in Prospero Platform (CRD42018096980). We performed searches in the main databases: Medical Literature Analysis and Retrieval System Online (MEDLINE) via Pubmed; Excerpta Medica dataBASE (Embase) via Elsevier; Cochrane Central Register of Controlled Trials (CENTRAL) via Cochrane Library; Latin American and Caribbean Literature on Health Sciences (LILACS) through the Portal of the Virtual Health Library and Physiotherapy Evidence Database (PEDro) for all randomised-controlled trials published before July 2022. The randomised-controlled trials were assessed for risk of bias and certainty of evidence. Thirteen randomised-controlled trials were included. All studies had an overall high risk of bias. Inspiratory muscle training probably improves systolic blood pressure and sleepiness when compared with sham. However, inspiratory muscle training probably does not improve diastolic blood pressure and maximum expiratory pressure, and may not be superior to sham for apnea-hypopnea index, forced expiratory volume in 1 s, forced vital capacity, sleep quality and quality of life. In addition, it is uncertain whether there is any effect of inspiratory muscle training on maximum inspiratory pressure and physical capacity. Inspiratory muscle training may also improve maximum inspiratory pressure and maximum expiratory pressure compared with oropharyngeal exercises. However, it may not be superior for apnea-hypopnea index, sleep quality, sleepiness, quality of life and functional capacity. When associated with physical exercise, inspiratory muscle training may not be superior to physical exercise alone for maximum inspiratory pressure, maximum expiratory pressure, systolic and diastolic blood pressure, and functional capacity. At the same time, when associated with cardiac rehabilitation exercises, inspiratory muscle training may reduce apnea-hypopnea index, improve inspiratory muscle strength, sleepiness and sleep quality compared with cardiac rehabilitation alone. However, it may not be superior for improving quality of life. Regarding expiratory muscle training, it may improve expiratory muscle strength and sleep quality, but not sleepiness when compared with sham. The evidence on the effects of expiratory muscle training in apnea-hypopnea index is very uncertain.
Collapse
Affiliation(s)
- André Silva de Sousa
- Programa de Pós- Graduação em Saúde Baseada em Evidências, Universidad Federal de São Paulo, São Paulo, Brazil
| | - Aline Pereira da Rocha
- Programa de Pós- Graduação em Saúde Baseada em Evidências, Universidad Federal de São Paulo, São Paulo, Brazil
| | | | - Jane Érika Frazão Okazaki
- Programa de Pós- Graduação em Saúde Baseada em Evidências, Universidad Federal de São Paulo, São Paulo, Brazil
| | | | - Virgínia Fernandes Moça Trevisani
- Programa de Pós- Graduação em Saúde Baseada em Evidências, Universidad Federal de São Paulo, São Paulo, Brazil
- Universidade de Santo Amaro, São Paulo, Brazil
| | - Ana Carolina Pereira Nunes Pinto
- Programa de Pós- Graduação em Saúde Baseada em Evidências, Universidad Federal de São Paulo, São Paulo, Brazil
- Universidade Federal do Amapá, Macapá, Brazil
- Iberoamerican Cochrane Centre - Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| |
Collapse
|
2
|
Mingming Z, Wenhong C, Xiaoying M, Yang J, Liu HH, Lingli S, Hongwu M, Zhirong J. Abnormal prefrontal functional network in adult obstructive sleep apnea: A resting-state fNIRS study. J Sleep Res 2024; 33:e14033. [PMID: 37723923 DOI: 10.1111/jsr.14033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 08/13/2023] [Accepted: 08/16/2023] [Indexed: 09/20/2023]
Abstract
To assess prefrontal brain network abnormality in adults with obstructive sleep apnea (OSA), resting-state functional near infrared spectroscopy (rs-fNIRS) was used to evaluate 52 subjects, including 27 with OSA and 25 healthy controls (HC). The study found that patients with OSA had a decreased connection edge number, particularly in the connection between the right medial frontal cortex (MFG-R) and other right-hemisphere regions. Graph-based analysis also revealed that patients with OSA had a lower global efficiency, local efficiency, and clustering coefficient than the HC group. Additionally, the study found a significant positive correlation between the Montreal Cognitive Assessment (MoCA) score and both the connection edge number and the graph-based indicators in patients with OSA. These preliminary results suggest that prefrontal rs-fNIRS could be a useful tool for objectively and quantitatively assessing cognitive function impairment in patients with OSA.
Collapse
Affiliation(s)
- Zhao Mingming
- Department of Sleep Medicine, People's Hospital of Guangxi Zhuang Autonomous Region, Nan Ning, China
| | - Chen Wenhong
- Department of Sleep Medicine, People's Hospital of Guangxi Zhuang Autonomous Region, Nan Ning, China
| | - Mo Xiaoying
- Department of Sleep Medicine, People's Hospital of Guangxi Zhuang Autonomous Region, Nan Ning, China
| | - Jianrong Yang
- Department of Sleep Medicine, People's Hospital of Guangxi Zhuang Autonomous Region, Nan Ning, China
| | - Howe Hao Liu
- Physical Therapy Department, Allen College, Waterloo, Lowa, USA
| | - Shi Lingli
- Department of Sleep Medicine, People's Hospital of Guangxi Zhuang Autonomous Region, Nan Ning, China
| | - Ma Hongwu
- Department of Sleep Medicine, People's Hospital of Guangxi Zhuang Autonomous Region, Nan Ning, China
| | - Jiang Zhirong
- Department of Sleep Medicine, People's Hospital of Guangxi Zhuang Autonomous Region, Nan Ning, China
| |
Collapse
|
3
|
Smith PJ, Sherwood A, Avorgbedor F, Ingle KK, Kraus WE, Hinderliter AE, Blumenthal JA. Sleep Quality, Metabolic Function, Physical Activity, and Neurocognition Among Individuals with Resistant Hypertension. J Alzheimers Dis 2023:JAD230029. [PMID: 37212110 DOI: 10.3233/jad-230029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Resistant hypertension (RH) is a major risk factor for stroke, cognitive decline, and dementia. Sleep quality is increasingly suggested to play an important role linking RH to cognitive outcomes, although the mechanisms linking sleep quality to poor cognitive function have yet to be fully delineated. OBJECTIVE To delineate biobehavioral mechanisms linking sleep quality, metabolic function, and cognitive function among 140 overweight/obese adults with RH in the TRIUMPH clinical trial. METHODS Sleep quality was indexed using actigraphy measures of sleep quality and sleep fragmentation, as well as self-reported sleep quality from the Pittsburgh Sleep Quality Index (PSQI). Cognitive function was assessed using a 45-minute battery assessing executive function, processing speed, and memory. Participants were randomized to a cardiac rehabilitation-based lifestyle program (C-LIFE) or a standardized education and physician advice condition (SEPA) for 4 months. RESULTS Better sleep quality at baseline was associated with better executive function (B = 0.18 p = 0.027), as well as greater fitness (B = 0.27, p = 0.007) and lower HBA1c (B = -0.25, p = 0.010). Cross-sectional analyses revealed that the sleep quality executive function association was mediated by HBA1c (B = 0.71 [0.05, 2.05]). C-LIFE improved sleep quality (-1.1 [-1.5, -0.6] versus+-0.1 [-0.8, 0.7]) and actigraphy steps (+922 [529, 1316] versus+56 [-548, 661]), with actigraphy mediating improvements in executive function (B = 0.40 [0.02, 1.07]). CONCLUSION Better metabolic function and improved physical activity patterns levels play important roles linking sleep quality and executive function in RH.
Collapse
Affiliation(s)
- Patrick J Smith
- Department of Psychiatry, University of North Carolina at Chapel Hill, NC, USA
| | - Andrew Sherwood
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Forgive Avorgbedor
- Department of Nursing, University of North Carolina at Greensboro, NC, USA
| | - Krista K Ingle
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - William E Kraus
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Alan E Hinderliter
- Department of Medicine, University of North Carolina at Chapel Hill, NC, USA
| | - James A Blumenthal
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| |
Collapse
|
4
|
Yu H, Gao Y, Tong T, Liang C, Zhang H, Yan X, Wang L, Zhang H, Dai H, Tong H. Self-management behavior, associated factors and its relationship with social support and health literacy in patients with obstructive sleep apnea–hypopnea syndrome. BMC Pulm Med 2022; 22:352. [PMID: 36115966 PMCID: PMC9482733 DOI: 10.1186/s12890-022-02153-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 09/13/2022] [Indexed: 11/23/2022] Open
Abstract
Background The proportion of patients with obstructive sleep apnea–hypopnea syndrome (OSAHS) is increasing year by year in China, which has become a major public health problem. Self-management of OSAHS and multiple support from caregivers are key to low hospital admissions and high quality of life for patients with OSAHS. Social support and health literacy are the main promoters of self-management behavior. However, their contributions have not been adequately studied. The purpose of this study is to investigate the level of self-management among patients with OSAHS and its relationship with general demographics, social support, and health literacy. Methods A total of 280 patients with OSAHS treated in two Classiii Grade A hospitals in Jinzhou City, Liaoning Province from October 2020 to July 2021 were selected as the study subjects. Patients were investigated by General Characteristics Questionnaire, Social Support Rating Scale (SSRS), Health Literacy Scale for Chronic Patients (HLSCP), and OSAHS Self-management Behavior Questionnaire, and the influencing factors of self-management of patients with OSAHS were analyzed. Results The average score of OSAHS self-management was 74.49(SD = 8.06), SSRS and HLSCP scores were positively correlated with total scores of self-management behavior. Furthermore, we found that disease duration, SSRS, and HLSCP scores were the main predictors of self-management behavior (R2 = 0.390, P < 0.001). Conclusion This study found that OSAHS patients with a longer duration of disease and higher SSRS or HLSCP scores also had higher levels of self-management. The factors discussed in this study may be helpful in developing individualized interventions in self-management for patients with OSAHS.
Collapse
|
5
|
Xie W, Shu Y, Liu X, Li K, Li P, Kong L, Yu P, Huang L, Long T, Zeng L, Li H, Peng D. Abnormal Spontaneous Brain Activity and Cognitive Impairment in Obstructive Sleep Apnea. Nat Sci Sleep 2022; 14:1575-1587. [PMID: 36090000 PMCID: PMC9462436 DOI: 10.2147/nss.s376638] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 08/28/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE This study aimed to explore the alterations in spontaneous brain activity in obstructive sleep apnea (OSA) using percent amplitude of fluctuation (PerAF) and investigate the relationship between abnormal spontaneous brain activity and cognitive impairment in OSA. PATIENTS AND METHODS Overall, 52 patients with moderate to severe OSA and 61 healthy controls (HCs) were eventually enrolled in this study. All participants underwent resting-state functional magnetic resonance (rs-fMRI) and T1-weighted imaging. The PerAF was calculated and compared between patients with OSA and HCs, with voxel level P < 0.001 and cluster level P < 0.05 corrected with Gaussian Random Field was be considered statistically different. A partial correlation analysis was used to assess the relationship between altered PerAF and clinical assessments in patients with OSA. RESULTS Compared to HCs, patients with OSA had significantly lower PerAF values in the right rectal gyrus and left superior frontal gyrus, but higher PerAF values in the right cerebellum posterior lobe and left middle frontal gyrus. The PerAF values of some specific regions in patients with OSA correlated with sleep efficiency and Montreal Cognitive Assessment scores. Additionally, support vector machine analysis showed that PerAF values in all differential brain regions could differentiate patients with OSA from HCs with good accuracy. CONCLUSION Specific brain areas in OSA patients may exhibit aberrant neuronal activity, and these anomalies may be linked to decreased cognitive performance. This discovery offers fresh perspectives on these patients' neurocognition.
Collapse
Affiliation(s)
- Wei Xie
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Yongqiang Shu
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Xiang Liu
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Kunyao Li
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Panmei Li
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Linghong Kong
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Pengfei Yu
- Big Data Research Center, The Second Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Ling Huang
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Ting Long
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Li Zeng
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Haijun Li
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China.,PET Center, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Dechang Peng
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China.,PET Center, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| |
Collapse
|
6
|
Sharma AK, Yerrabelli D, Sagili H, Sahoo JP, Gaur GS, Kumar A. Relationship between advanced glycated end products and maternal cognition in gestational diabetes: a case control study. J Matern Fetal Neonatal Med 2021; 35:7806-7811. [PMID: 34154496 DOI: 10.1080/14767058.2021.1937111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Gestational diabetes (GDM) is a form of glucose intolerance which manifests during pregnancy. There is lack of literature regarding the study of cognitive functions in GDM. Recent evidences suggests an increase in accumulation of serum Advanced glycated end products (AGE'S) during GDM. Accumulation of AGE's in brain can induce changes in permeability of blood brain barrier and creates oxidative stress and inflammation that can alter cognitive functions. In this study we hypothesize that diagnosis of GDM in pregnancy is related to lower cognitive scores which is correlated to increased serum AGE's level. METHOD This was a cross sectional case control study which recruited 60 participants in total consisting of two groups with 30 participants in each - diagnosed cases of GDM and healthy pregnant controls. Subjects were recruited from OPD of Obstetrics & Gynecology department in a tertiary care hospital in South India at gestational age of 32-36 weeks. On the first appointment, biochemical parameters of Fasting plasma glucose (FPG) & HbA1C was measured in both groups. Serum was obtained for testing levels of N Carboxy methyl lysine (N-CML) (a form of AGE). On second appointment, pen and paper neurocognitive tests including Montreal cognitive tests (MOCA) and Trail making test (TMT A & B) was presented. Event related potentials (ERP's) are time locked EEG wave signals produced in response to a sensory, motor or cognitive event. P300 is an "endogenous" ERP produced by cognitive processing in response to a stimuli presented to subject. P300 wave Latency and amplitude was recorded in both the groups as an objective marker of cognitive processing. Above mentioned biochemical and neurocognitive parameters were compared between both the groups and correlation analysis between serum AGE levels and neurocognitive parameters was performed using SPSS software. RESULTS Biochemical parameters of HbAIC & N-CML(A form of AGE) levels were increased in GDM group (HbA1C 6.01±0.30 and N CML 236.25 ± 68.9) vs Control group (HbA1C 4.11 ± 0.68 and NCML 198.42 ± 44.2). Scores in MOCA were significantly lower in GDM (28 (27-29)) group as compared to controls (24 (23-25)). GDM subjects took significantly greater time to perform TMT A (24.59 ± 2.60 s) test than controls (29.7 ± 1.72 s). Significant changes were not found in P300 Latency & amplitude in GDM group. Decreased MOCA scores and increased duration of TMT A attempt were correlated with increased serum AGE concentration in GDM group. CONCLUSIONS Our study indicates the vulnerability of women suffering from GDM to cognitive impairment during pregnancy. Lower scores in cognitive tests were correlated to AGE accumulation in GDM women.
Collapse
Affiliation(s)
- Akriti Kapila Sharma
- Department of Physiology, All India Institute of Medical Sciences, Rishikesh, India
| | - Dhanalakshmi Yerrabelli
- Department of Physiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Haritha Sagili
- Department of Obstetrics & Gyanecology, Jawaharlal Institute of Post graduate Medical Education and Research (JIPMER), Puducherry, India
| | - Jay Prakash Sahoo
- Department of Endocrinology, Jawaharlal Institute of Post graduate Medical Education and Research (JIPMER), Puducherry, India
| | - Girwar Singh Gaur
- Department of Physiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Arun Kumar
- Department of Physiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| |
Collapse
|