Pulmonary rehabilitation: A novel adjunct in management of obstructive sleep apnea

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Submitted: March 9, 2022
Accepted: June 10, 2022
Published: June 20, 2022
Abstract Views: 1284
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Pulmonary rehabilitation (PR) is being used in the routine management of patients of obstructive sleep apnea (OSA) at some centers. However, the studies documenting benefits of PR in OSA lack standardization in terms of outcome measures. A study was hence planned to determine the efficacy of PR on exercise capacity, health related quality of life (HRQOL), day time sleepiness and sleep-quality of life (QOL) in patients of OSA. As a part of comprehensive therapy, patients diagnosed with OSA are managed with continuous positive airway pressure (CPAP), 8 weeks thrice weekly outpatient hospital-based PR and medical treatment at the Pulmonary Medicine Department, Government Medical College and Hospital, Chandigarh. However, some patients refuse for PR because of time constraints and travel issues. Patients with newly diagnosed OSA without co-existing respiratory disease, who agreed for the CPAP, PR and medical management were enrolled in group A. The patients who refused for PR but were ready for CPAP and medical management were enrolled in Group B; 30 patients were taken in each group. Exercise capacity, HRQOL, day time sleepiness and sleep-QOL were determined at baseline and at 8-weeks follow-up by 6-minute walk distance (6MWD), St. George's Respiratory Questionnaire (SGRQ), Epworth Sleepiness Scale (ESS) and Functional Outcomes of Sleep Questionnaire (FOSQ) and compared amongst the two groups. Four patients from group A were excluded as they did not complete PR; 26 patients from group A and 30 patients from group B were finally analyzed. At baseline, both groups were matched with respect to age, gender, apnea-hypopnea index (AHI), body mass index (BMI), FEV1%predicted, 6MWD, SGRQ, ESS and FOSQ. At follow up at 8 weeks, BMI, 6MWD, SGRQ, ESS and FOSQ improved significantly from baseline in group A (p<0.001). FEV1%predicted also improved but non significantly. In group B, FEV1%predicted, BMI, 6MWD, SGRQ, ESS and FOSQ score did not improve significantly from baseline. Mean improvement from baseline in BMI, 6MWD, SGRQ, ESS and FOSQ was significantly more in group A than group B (p<0.001, p<0.001, p=0.041, p<0.001 and p<0.001, respectively). PR, being beneficial, should be incorporated in standard management of OSA.



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Pham LV, Schwartz AR. The pathogenesis of obstructive sleep apnea. J Thorac Dis 2015;7:1358.
Watson NF. Health care savings: the economic value of diagnostic and therapeutic care for obstructive sleep apnea. J Clin Sleep Med 2016;12:1075-7. DOI: https://doi.org/10.5664/jcsm.6034
Calik MW. Treatments for obstructive sleep apnea. J Clin Outcomes Manag 2016;23:181–92.
Virk JS, Kotecha B. When continuous positive airway pressure (CPAP) fails. J Thorac Dis 2016;8:1112. DOI: https://doi.org/10.21037/jtd.2016.09.67
Spruit M, Singh S, Garvey C, et al. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med 2013;188:e13-64.
Neumannova K, Hobzova M, Sova M, et al. Pulmonary rehabilitation and oropharyngeal exercises as an adjunct therapy in obstructive sleep apnea: a randomized controlled trial. Sleep Med 2018;52:92–7. DOI: https://doi.org/10.1016/j.sleep.2018.03.022
Kline CE, Crowley EP, Ewing GB, et al. The effect of exercise training on obstructive sleep apnea and sleep quality: a randomized controlled trial. Sleep 2011;34:1631-40. DOI: https://doi.org/10.5665/sleep.1422
Sateia MJ. International classification of sleep disorders. Chest 2014;146:1387-94. DOI: https://doi.org/10.1378/chest.14-0970
Berry RB, Brooks R, Gamaldo C, et al. AASM scoring manual updates for 2017 (version 2.4). J Clin Sleep Med 2017;13:665-6. DOI: https://doi.org/10.5664/jcsm.6576
Holland AE, Spruit MA, Troosters T, et al. An official European Respiratory Society/American Thoracic Society technical standard: field walking tests in chronic respiratory disease. Eur Respir J 2014;44:1428-46. DOI: https://doi.org/10.1183/09031936.00150314
Jones PW, Quirk FH, Baveystock CM. The St George's Respiratory Questionnaire. Respir Med 1991;85:25-31 DOI: https://doi.org/10.1016/S0954-6111(06)80166-6
Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 1991;14:540-5. DOI: https://doi.org/10.1093/sleep/14.6.540
Billings ME, Rosen CL, Auckley D, et al. Psychometric Performance and Responsiveness of the functional outcomes of sleep questionnaire and sleep apnea quality of life instrument in a randomized trial: The HomePAP study. Sleep 2014;37:2017-24. DOI: https://doi.org/10.5665/sleep.4262
Jones PW, Beeh KM, Chapman KR, et al. Minimal clinically important differences in pharmacological trials. Am J Respir Crit Care Med 2014;189:250-5. DOI: https://doi.org/10.1164/rccm.201310-1863PP
Ackel-D’Elia C, da Silva AC, Silva RS, et al. Effects of exercise training associated with continuous positive airway pressure treatment in patients with obstructive sleep apnea syndrome. Sleep Breath 2012;16:723-35. DOI: https://doi.org/10.1007/s11325-011-0567-0
Guimarães KC, Drager LF, Genta PR, et al. Effects of oropharyngeal exercises on patients with moderate obstructive sleep apnea syndrome. Am J Respir Crit Care Med 2009;179:962-6. DOI: https://doi.org/10.1164/rccm.200806-981OC
Karagullu H, Altindag O, Uyar M, et al. Efficacy of pulmonary rehabilitation program with cycle ergometer in obstructive sleep apnea syndrome. J Osteoporos Phys Act 2015;3:133. DOI: https://doi.org/10.4172/2329-9509.1000133
Swift DL, Johannsen NM, Lavie CJ, et al. The role of exercise and physical activity in weight loss and maintenance. Prog Cardiovasc Dis. 2014;56:441–7. DOI: https://doi.org/10.1016/j.pcad.2013.09.012
Stavres J, Zeigler MP, Pasternostro Bayles M. Six weeks of moderate functional resistance training increases basal metabolic rate in sedentary adult women. Int J Exerc Sci 2018;11:32-41.
Kang SJ, Kim EH, Ko KJ. Effects of aerobic exercise on the resting heart rate, physical fitness, and arterial stiffness of female patients with metabolic syndrome. J Phys Ther Sci 2016;28:1764-8. DOI: https://doi.org/10.1589/jpts.28.1764
Elkhateeb NB, Elhadidi AA, Masood HH, et al. Pulmonary rehabilitation in chronic obstructive pulmonary disease. Egypt J Chest Dis Tuberc 2015;64:359-69. DOI: https://doi.org/10.1016/j.ejcdt.2015.03.001
Lan CC, Chu WH, Yang MC, et al. Benefits of pulmonary rehabilitation in patients with COPD and normal exercise capacity. Respir Care 2013;58:1482-8. DOI: https://doi.org/10.4187/respcare.02051

How to Cite

Agarwal, Prakhar, Kranti Garg, Varinder Saini, and Isha Singh. 2022. “Pulmonary Rehabilitation: A Novel Adjunct in Management of Obstructive Sleep Apnea”. Monaldi Archives for Chest Disease 93 (1). https://doi.org/10.4081/monaldi.2022.2260.