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Lai YJ, Su PL, Li CY, Lin CY, Hung CH, Lin CY. Oropharyngeal Rehabilitation for Patients With Moderate to Severe Obstructive Sleep Apnea After Transoral Robotic Surgery. Otolaryngol Head Neck Surg 2022; 167:971-978. [PMID: 35349361 DOI: 10.1177/01945998221088752] [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: 01/07/2023]
Abstract
OBJECTIVE To determine whether combined transoral robotic surgery and postoperative oropharyngeal rehabilitation are effective for reducing the severity of obstructive sleep apnea. STUDY DESIGN A quasi-experimental study enrolled participants without blinding between May 2019 and April 2021. SETTING Single-center study at National Cheng Kung University Hospital. METHODS Patients with moderate to severe obstructive sleep apnea who were otherwise healthy were recruited from the ear, nose, and throat department at National Cheng Kung University Hospital. The group undergoing transoral robotic surgery with oropharyngeal rehabilitation (n = 18) received a 12-week intervention consisting of home-based rehabilitation exercises following surgery; the transoral robotic surgery group (n = 17) received surgery only; and the control group (n = 15) received conservative treatment, such as continuous positive airway pressure therapy or other oral appliance therapy. Polysomnography data and tongue muscle performance were measured before and after the interventions. RESULTS The group that underwent transoral robotic surgery with oropharyngeal rehabilitation exhibited significantly improved tongue protrusion strength as compared with the transoral robotic surgery-only group, as well as significantly improved apnea-hypopnea index in the supine position vs the control group. CONCLUSION In this study, we demonstrated the synergistic effects of transoral robotic surgery and postoperative oropharyngeal rehabilitation for adult patients with obstructive sleep apnea. Objective records should be used to monitor home-based rehabilitation exercises and examine the lasting synergistic effects.
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Affiliation(s)
- Yi-Ju Lai
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Physical Therapy, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan
| | - Po-Lan Su
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Sleep Medicine Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan.,Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Chung-Ying Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ching-Hsia Hung
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Cheng-Yu Lin
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Environmental and Occupational Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Inspiratory Muscle Training in Obstructive Sleep Apnea Associating Diabetic Peripheral Neuropathy: A Randomized Control Study. BIOMED RESEARCH INTERNATIONAL 2020; 2020:5036585. [PMID: 32626744 PMCID: PMC7306097 DOI: 10.1155/2020/5036585] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/15/2020] [Accepted: 06/01/2020] [Indexed: 02/07/2023]
Abstract
Objective This work is aimed at assessing the effects of inspiratory muscle training on lung functions, inspiratory muscle strength, and aerobic capacity in diabetic peripheral neuropathy (DPN) patients with obstructive sleep apnea (OSA). Methods A randomized control study was performed on 55 patients diagnosed with DPN and OSA. They were assigned to the training group (IMT, n = 28) and placebo training group (P-IMT, n = 27). Inspiratory muscle strength, lung functions, and aerobic capacity were evaluated before and after 12 weeks postintervention. An electronic inspiratory muscle trainer was conducted, 30 min a session, three times a week for 12 consecutive weeks. Results From seventy-four patients, 55 have completed the study program. A significant improvement was observed in inspiratory muscle strength (p < 0.05) in the IMT group while no changes were observed in the P-IMT group (p > 0.05). No changes were observed in the lung function in the two groups (p > 0.05). Also, VO2max and VCO2max changed significantly after training in the IMT group (p < 0.05) while no changes were observed in the P-IMT group (p > 0.05). Other cardiopulmonary exercise tests did not show any significant change in both groups (p > 0.05). Conclusions Based on the outcomes of the study, it was found that inspiratory muscle training improves inspiratory muscle strength and aerobic capacity without a notable effect on lung functions for diabetic patients suffering from DPN and OSA.
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Kwan BCH, McBain RA, Luu BL, Butler JE, Bilston LE, Gandevia SC. Influence of respiratory mechanics and drive on genioglossus movement under ultrasound imaging. PLoS One 2018; 13:e0195884. [PMID: 29659626 PMCID: PMC5901985 DOI: 10.1371/journal.pone.0195884] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 03/30/2018] [Indexed: 11/18/2022] Open
Abstract
METHODS Twenty healthy subjects (10 males, age 28±5 years [mean ± SD]) lay supine, awake, with the head in a neutral position. Ventilation was monitored with inductance bands. Real-time B-mode ultrasound movies were analysed. We measured genioglossus motion (i) during spontaneous breathing, voluntary targeted breathing (normal tidal volume Vt), and voluntary hyperpnoea (at 1.5Vt and 2 Vt); (ii) during inspiratory flow resistive loading; (iii) with changes in end-expiratory lung volume (EELV). RESULTS Average peak inspiratory displacement of the infero-posterior region of genioglossus was 0.89±0.56 mm; 1.02±0.88 mm; 1.27±0.70 mm respectively for voluntary Vt, and during voluntary hyperpnoea at 1.5Vt and 2Vt. A change in genioglossus motion was observed with increased Vt. During increasing inspiratory resistive loading, the genioglossus displaced less anteriorly (p = 0.005) but more inferiorly (p = 0.027). When lung volume was altered, no significant changes in genioglossus movement were observed (p = 0.115). CONCLUSION In healthy subjects, we observed non-uniform heterogeneous inspiratory motion within the inferoposterior part of genioglossus during spontaneous quiet breathing with mean peak displacement between 0.5-2 mm, with more displacement in the posterior region than the anterior. This regional heterogeneity disappeared during voluntary targeted breathing. This may be due to different neural drive to genioglossus during voluntary breathing. During inspiratory resistive loading, the observed genioglossus motion may serve to maintain upper airway patency by balancing intraluminal negative pressure with positive pressure generated by upper airway dilatory muscles. In contrast, changes in EELV were not accompanied by major changes in genioglossus motion.
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Affiliation(s)
- Benjamin C. H. Kwan
- Neuroscience Research Australia (NeuRA), Barker St, Sydney, NSW, Australia
- Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- * E-mail:
| | - Rachel A. McBain
- Neuroscience Research Australia (NeuRA), Barker St, Sydney, NSW, Australia
| | - Billy L. Luu
- Neuroscience Research Australia (NeuRA), Barker St, Sydney, NSW, Australia
| | - Jane E. Butler
- Neuroscience Research Australia (NeuRA), Barker St, Sydney, NSW, Australia
| | - Lynne E. Bilston
- Neuroscience Research Australia (NeuRA), Barker St, Sydney, NSW, Australia
- Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Simon C. Gandevia
- Neuroscience Research Australia (NeuRA), Barker St, Sydney, NSW, Australia
- Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
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Rehling T, Banghøj AM, Kristiansen MH, Tarnow L, Molsted S. Reduced Inspiratory Muscle Strength in Patients with Type 2 Diabetes Mellitus and Obstructive Sleep Apnoea. J Diabetes Res 2017; 2017:4121794. [PMID: 29147664 PMCID: PMC5632871 DOI: 10.1155/2017/4121794] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 08/05/2017] [Accepted: 08/30/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) is related to type 2 diabetes (T2DM), and it may be associated with reduced inspiratory muscle strength (IMS). The aim of this study was to investigate the IMS in patients with T2DM, with or without OSA. METHODS Patients with T2DM with OSA (n = 33) and without OSA (n = 28) were included. The maximum IMS was tested using the POWERbreathe KH2 device. Reference IMS values were data calculated using an algorithm based on general populations and adjusted for age and gender. RESULTS There was no difference in IMS between the OSA group (median (range) 77 (35-124) cmH2O) and the non-OSA group (84 (33-122) cmH2O) (p = 0.97). The IMS values were reduced in the OSA group compared with the reference values (92.9 (62.3-100.0) cmH2O) (p = 0.030), whereas the non-OSA group did not have reduced IMS. When the IMS values of all T2DM patients were compared with reference values, the IMS values were 79 (33-124) cmH2O and 93.8 (62.3-102.4) cmH2O, respectively (p = 0.017). CONCLUSION No difference in IMS between patients with T2DM with or without OSA was found. However, patients with T2DM and OSA had reduced IMS compared with age- and gender-matched references whereas the non-OSA group did not have reduced IMS.
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Affiliation(s)
- Thomas Rehling
- University College (UCC) Department of Physiotherapy, Hillerød, Denmark
- Department of Clinical Research, Nordsjællands Hospital, Hillerød, Denmark
| | - Anne Margareta Banghøj
- Department of Cardiology, Nephrology & Endocrinology, Nordsjællands Hospital, Hillerød, Denmark
| | | | - Lise Tarnow
- Department of Clinical Research, Nordsjællands Hospital, Hillerød, Denmark
- Health, Aarhus University, Aarhus, Denmark
| | - Stig Molsted
- Department of Cardiology, Nephrology & Endocrinology, Nordsjællands Hospital, Hillerød, Denmark
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The relationship between the duration of obstructive respiratory events and outcomes of multilevel upper airway surgery in patients with obstructive sleep apnea. Eur Arch Otorhinolaryngol 2015; 273:2651-7. [DOI: 10.1007/s00405-015-3781-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Accepted: 09/08/2015] [Indexed: 10/23/2022]
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Kanezaki M, Ogawa T, Izumi T. Tongue Protrusion Strength in Arousal State Is Predictive of the Airway Patency in Obstructive Sleep Apnea. TOHOKU J EXP MED 2015; 236:241-5. [DOI: 10.1620/tjem.236.241] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Masashi Kanezaki
- Department of Physical Therapy, Faculty of Health Care Sciences, Himeji Dokkyo University
| | | | - Tadafumi Izumi
- Graduate School of Rehabilitation Sciences, Health Sciences University of Hokkaido
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Koo BB, Mansour A. Correlates of Obstructive Apnea Duration. Lung 2013; 192:185-90. [DOI: 10.1007/s00408-013-9510-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 09/10/2013] [Indexed: 11/28/2022]
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Shortt CM, Fredsted A, Bradford A, O'Halloran KD. Diaphragm muscle remodeling in a rat model of chronic intermittent hypoxia. J Histochem Cytochem 2013; 61:487-99. [PMID: 23640977 DOI: 10.1369/0022155413490947] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Respiratory muscle remodeling occurs in human sleep apnea--a common respiratory disorder characterized by chronic intermittent hypoxia (CIH) due to recurrent apnea during sleep. We sought to determine if CIH causes remodeling in rat sternohyoid (upper airway dilator) and diaphragm muscles. Adult male Wistar rats were exposed to CIH (n=8), consisting of 90 sec of hypoxia (5% at the nadir; SaO₂ ~80%)/90 sec of normoxia, 8 hr per day, for 7 consecutive days. Sham animals (n=8) were exposed to alternating air/air cycles in parallel. The effect of CIH on myosin heavy-chain (MHC) isoform (1, 2a, 2x, 2b) distribution, sarcoplasmic reticulum calcium ATPase (SERCA) isoform distribution, succinate dehydrogenase activity, glycerol phosphate dehydrogenase activity, and Na⁺/K⁺ ATPase pump content was determined. Sternohyoid muscle structure was unaffected by CIH treatment. CIH did not alter oxidative/glycolytic capacity or the Na⁺/K⁺-ATPase pump content of the diaphragm. CIH significantly increased the areal density of MHC 2b fibers in the rat diaphragm, and this was associated with a shift in SERCA proteins from SERCA2 to SERCA1. We conclude that CIH causes a slow-to-fast fiber transition in the rat diaphragm after just 7 days of treatment. Respiratory muscle functional remodeling may drive aberrant functional plasticity such as decreased muscle endurance, which is a feature of human sleep apnea.
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Affiliation(s)
- Christine M Shortt
- UCD School of Medicine and Medical Science, University College Dublin, Dublin, Ireland.
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Saboisky JP, Butler JE, Gandevia SC, Eckert DJ. Functional role of neural injury in obstructive sleep apnea. Front Neurol 2012; 3:95. [PMID: 22715333 PMCID: PMC3375463 DOI: 10.3389/fneur.2012.00095] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Accepted: 05/28/2012] [Indexed: 12/31/2022] Open
Abstract
The causes of obstructive sleep apnea (OSA) are multifactorial. Neural injury affecting the upper airway muscles due to repetitive exposure to intermittent hypoxia and/or mechanical strain resulting from snoring and recurrent upper airway closure have been proposed to contribute to OSA disease progression. Multiple studies have demonstrated altered sensory and motor function in patients with OSA using a variety of neurophysiological and histological approaches. However, the extent to which the alterations contribute to impairments in upper airway muscle function, and thus OSA disease progression, remains uncertain. This brief review, primarily focused on data in humans, summarizes: (1) the evidence for upper airway sensorimotor injury in OSA and (2) current understanding of how these changes affect upper airway function and their potential to change OSA progression. Some unresolved questions including possible treatment targets are noted.
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Gea J, Casadevall C, Pascual S, Orozco-Levi M, Barreiro E. Respiratory diseases and muscle dysfunction. Expert Rev Respir Med 2012; 6:75-90. [PMID: 22283581 DOI: 10.1586/ers.11.81] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Many respiratory diseases lead to impaired function of skeletal muscles, influencing quality of life and patient survival. Dysfunction of both respiratory and limb muscles in chronic obstructive pulmonary disease has been studied in depth, and seems to be caused by the complex interaction of general (inflammation, impaired gas exchange, malnutrition, comorbidity, drugs) and local factors (changes in respiratory mechanics and muscle activity, and molecular events). Some of these factors are also present in cystic fibrosis and asthma. In obstructive sleep apnea syndrome, repeated exposure to hypoxia and the absence of reparative rest are believed to be the main causes of muscle dysfunction. Deconditioning appears to be crucial for the functional impairment observed in scoliosis. Finally, cachexia seems to be the main mechanism of muscle dysfunction in advanced lung cancer. A multidimensional therapeutic approach is recommended, including pulmonary rehabilitation, an adequate level of physical activity, ventilatory support and nutritional interventions.
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Affiliation(s)
- Joaquim Gea
- Servei de Pneumologia, Hospital del Mar-IMIM, Departament de Ciències Experimentals i de la Salut (CEXS), Universitat Pompeu Fabra, CIBER de Enfermedades Respiratorias ISC III, Barcelona, Catalunya, Spain.
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Jácome Gonçalves M, do Lago STS, de Paiva Godoy E, de Freitas Fregonezi GA, Sousa Bruno S. Influence of Neck Circumference on Respiratory Endurance and Muscle Strength in the Morbidly Obese. Obes Surg 2010; 21:1250-6. [DOI: 10.1007/s11695-010-0077-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2009] [Accepted: 01/06/2010] [Indexed: 11/28/2022]
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Steele CM. On the plausibility of upper airway remodeling as an outcome of orofacial exercise. Am J Respir Crit Care Med 2009; 179:858-9. [PMID: 19423718 DOI: 10.1164/rccm.200901-0016ed] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Karamessinis L, Galster P, Schultz B, Elliott J, Mason TA, Brooks LJ, Gallagher PR, Marcus CL. Relationship between REM density, duty cycle, and obstructive sleep apnea in children. Sleep 2007; 30:837-43. [PMID: 17682653 PMCID: PMC1978365 DOI: 10.1093/sleep/30.7.837] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
STUDY OBJECTIVES The pattern and distribution of rapid eye movement (REM) sleep changes during development, yet there have been few studies of REM density in children. Although children with obstructive apnea syndrome (OSAS) obstruct primarily during REM sleep, the relationship between REM density and obstructive apnea has not been established for this population. We hypothesized that (i) REM density and REM cycle duration increases over the course of the night in children, (ii) the duty cycle (inspiratory time divided by respiratory cycle time) increases over the course of the night in children with suspected OSAS, and (iii) the increase in REM density over the course of the night is associated with increased severity of obstructive apnea. DESIGN REM density and respiratory parameters were measured during polysomnography. SETTING Sleep laboratory PATIENTS 76 children with suspected OSAS. INTERVENTIONS NA MEASUREMENTS AND RESULTS: REM density and the duration of REM cycles increased over the course of the night until the fifth REM cycle, and then stabilized. The duty cycle increased across the first 6 REM cycles. However, the apnea hypopnea index (AHI) did not increase across REM cycles, and was not affected by the changes in REM density or duty cycle. We speculate that the increase in the duty cycle is a compensatory response to increased upper airway loads during sleep, and that this may lead to ventilatory or upper airway muscle fatigue.
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Affiliation(s)
| | - Patricia Galster
- The Sleep Center and
- the Division of Biostatistics and Epidemiology, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA
| | | | | | | | | | - Paul R. Gallagher
- the Division of Biostatistics and Epidemiology, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA
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Current World Literature. Curr Opin Anaesthesiol 2007; 20:284-6. [PMID: 17479036 DOI: 10.1097/aco.0b013e3281e3380b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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How SC, McConnell AK, Taylor BJ, Romer LM. Acute and chronic responses of the upper airway to inspiratory loading in healthy awake humans: an MRI study. Respir Physiol Neurobiol 2007; 157:270-80. [PMID: 17341450 DOI: 10.1016/j.resp.2007.01.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2006] [Revised: 01/12/2007] [Accepted: 01/15/2007] [Indexed: 11/25/2022]
Abstract
We assessed upper airway responses to acute and chronic inspiratory loading. In Experiment I, 11 healthy subjects underwent T(2)-weighted magnetic resonance imaging (MRI) of upper airway dilator muscles (genioglossus and geniohyoid) before and up to 10 min after a single bout of pressure threshold inspiratory muscle training (IMT) at 60% maximal inspiratory mouth pressure (MIP). T(2) values for genioglossus and geniohyoid were increased versus control (p<0.001), suggesting that these airway dilator muscles are activated in response to acute IMT. In Experiment II, nine subjects underwent 2D-Flash sequence MRI of the upper airway during quiet breathing and while performing single inspirations against resistive loads (10%, 30% and 50% MIP); this procedure was repeated after 6 weeks of IMT. Lateral narrowing of the upper airway occurred at all loads, whilst anteroposterior narrowing occurred at the level of the laryngopharynx at loads > or =30% MIP. Changes in upper airway morphology and narrowing after IMT were undetectable using MRI.
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Affiliation(s)
- Stephen C How
- Centre for Sports Medicine and Human Performance, School of Sport and Education, Brunel University, Uxbridge, Middlesex UB8 3PH, UK
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