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      Oropharyngeal Muscle Exercise Therapy Improves Signs and Symptoms of Post-stroke Moderate Obstructive Sleep Apnea Syndrome

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          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

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          Quantification of sleepiness: a new approach.

          E Hoddes, V Zarcone, H A Smythe … (1973)
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            Obstructive sleep apnoea syndrome.

            Patrick Levy, Malcolm Kohler, Walter McNicholas … (2015)
            Obstructive sleep apnoea syndrome (OSAS) is a common clinical condition in which the throat narrows or collapses repeatedly during sleep, causing obstructive sleep apnoea events. The syndrome is particularly prevalent in middle-aged and older adults. The mechanism by which the upper airway collapses is not fully understood but is multifactorial and includes obesity, craniofacial changes, alteration in upper airway muscle function, pharyngeal neuropathy and fluid shift towards the neck. The direct consequences of the collapse are intermittent hypoxia and hypercapnia, recurrent arousals and increase in respiratory efforts, leading to secondary sympathetic activation, oxidative stress and systemic inflammation. Excessive daytime sleepiness is a burden for the majority of patients. OSAS is also associated with cardiovascular co-morbidities, including hypertension, arrhythmias, stroke, coronary heart disease, atherosclerosis and overall increased cardiovascular mortality, as well as metabolic dysfunction. Whether treating sleep apnoea can fully reverse its chronic consequences remains to be established in adequately designed studies. Continuous positive airway pressure (CPAP) is the primary treatment modality in patients with severe OSAS, whereas oral appliances are also widely used in mild to moderate forms. Finally, combining different treatment modalities such as CPAP and weight control is beneficial, but need to be evaluated in randomized controlled trials. For an illustrated summary of this Primer, visit: http://go.nature.com/Lwc6te.
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              Obesity and obstructive sleep apnea: pathogenic mechanisms and therapeutic approaches.

              Allison R. Schwartz, M. Laffan, Vsevolod Polotsky … (2008)
              Obstructive sleep apnea is a common disorder whose prevalence is linked to an epidemic of obesity in Western society. Sleep apnea is due to recurrent episodes of upper airway obstruction during sleep that are caused by elevations in upper airway collapsibility during sleep. Collapsibility can be increased by underlying anatomic alterations and/or disturbances in upper airway neuromuscular control, both of which play key roles in the pathogenesis of obstructive sleep apnea. Obesity and particularly central adiposity are potent risk factors for sleep apnea. They can increase pharyngeal collapsibility through mechanical effects on pharyngeal soft tissues and lung volume, and through central nervous system-acting signaling proteins (adipokines) that may affect airway neuromuscular control. Specific molecular signaling pathways encode differences in the distribution and metabolic activity of adipose tissue. These differences can produce alterations in the mechanical and neural control of upper airway collapsibility, which determine sleep apnea susceptibility. Although weight loss reduces upper airway collapsibility during sleep, it is not known whether its effects are mediated primarily by improvement in upper airway mechanical properties or neuromuscular control. A variety of behavioral, pharmacologic, and surgical approaches to weight loss may be of benefit to patients with sleep apnea, through distinct effects on the mass and activity of regional adipose stores. Examining responses to specific weight loss strategies will provide critical insight into mechanisms linking obesity and sleep apnea, and will help to elucidate the humoral and molecular predictors of weight loss responses.
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                Author and article information

                Contributors
                Journal
                Journal ID (nlm-ta): Front Neurol
                Journal ID (iso-abbrev): Front Neurol
                Journal ID (publisher-id): Front. Neurol.
                Title: Frontiers in Neurology
                Publisher: Frontiers Media S.A.
                ISSN (Electronic): 1664-2295
                Publication date (Electronic): 29 October 2018
                Publication date Collection: 2018
                Volume: 9
                Electronic Location Identifier: 912
                Affiliations
                [1] 1Department of Rehabilitation, Affiliated Zhongshan Hospital of Dalian University , Dalian, China
                [2] 2Department of Anatomy, Medical College of Dalian University , Dalian, China
                [3] 3Department of Imaging, Affiliated Zhongshan Hospital of Dalian University , Dalian, China
                [4] 4Department of Rehabilitation, People's Hospital of Longhua District of Shenzhen , Shenzhen, China
                Author notes

                Edited by: Nicola Smania, Università degli Studi di Verona, Italy

                Reviewed by: Marialuisa Gandolfi, Università degli Studi di Verona, Italy; Filippo Brighina, Università degli Studi di Palermo, Italy; Allison Hyngstrom, Marquette University, United States

                *Correspondence: Dongmei Ye shuiyan_1980@ 123456163.com

                This article was submitted to Stroke, a section of the journal Frontiers in Neurology

                †These authors have contributed equally to this work

                Article
                DOI: 10.3389/fneur.2018.00912
                PMC ID: 6215830
                SO-VID: 79536e64-a1aa-4682-b514-7fbf141a667e
                Copyright © Copyright © 2018 Ye, Chen, Song, Shen, Liu, Zhang, Zhang, Li, Yu and Wang.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                Date received : 17 July 2018
                Date accepted : 09 October 2018
                Page count
                Figures: 2, Tables: 8, Equations: 0, References: 41, Pages: 10, Words: 6653
                Categories
                Subject: Neurology
                Subject: Clinical Trial

                ScienceOpen disciplines: Neurology
                Keywords: mri,obstructive sleep apnea syndrome,oropharyngeal muscles exercise,polysomnography,stroke
                Data availability:
                ScienceOpen disciplines: Neurology
                Keywords: mri, obstructive sleep apnea syndrome, oropharyngeal muscles exercise, polysomnography, stroke

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