May 12, 2009

Sleep Apnea Sufferers May Benefit From Exercises

A new study indicates that training exercises for the tongue and soft palate may help to mitigate the symptoms associated with moderate obstructive sleep apnea (OSA).

For patients suffering from OSA, muscles in the throat periodically collapse during sleep and block oxygen flow to the lungs.  Loud bursts of snoring are associated with these periods of "apnea" as the sleeper struggles to get breath.  The sleeper is usually awakened repeatedly either by the feeling of suffocation or by the sound of his own snoring.  The results are very poor sleep quality and general fatigue during the daytime hours.

A recent report published in the American Journal of Respiratory and Critical Care Medicine experimented with the effects using a didgeridoo to train the upper airway muscles.  The research study had found that training with the instrument "significantly ameliorated OSA syndrome severity and associated symptoms," according to chief investigator Dr. Geraldo Lorenzi-Filho at the University of Sao Paulo Medical School in Brazil.

A didgeridoo, also known as a drone pipe, is a long wooden wind instrument that was first invented by Australian Aborigines.  The instrument has gained popularity amongst a number of modern musicians in recent years for it unique, deep reverberating sound.

Using the previous study as a springboard for their own, Dr. Lorenzi-Filho and his associates devised a set of isometric and isotonic exercises derived from exercises used in speech therapy involving suction, swallowing, chewing, breathing and speaking.  In a small clinical trial, 31 patients with OSA were randomly divided into two groups, one that was assigned to a 3-month regimen of the mouth and throat exercises and the other to a placebo "deep breathing" therapy.

By the end of the 3-month period, the researchers had observed a dramatic drop in the number apnea episodes per hour of sleep, falling from 22.4 to 13.7 in the group who had performed the exercises.  Several other standardized sleep indices, such as the Pittsburgh Sleep Quality test and the Epworth Sleepiness Scale, also showed significant improvement in the quality of sleep and a reduction in snoring volume.

The group also found an average reduction of more than one centimeter in the neck circumference of the patients who had participated in the exercises, suggesting, as Dr. Lorenzi-Filho explained, "that the exercise induced upper airway remodeling."

No significant changes either in sleep quality or neck girth were observed in the patients from the control group.

"Our results suggest that this set of oropharyngeal exercises is a promising alternative to the treatment of moderate OSA," concluded the report.

In a critical commentary that followed the study, Dr. Catriona M. Steel of the University of Toronto suggested that it is improbable that most of the exercise performed could have an effect in remodeling musculature.

She did, however, agree that exercises simulating balloon inflation "“ like didgeridoo training "“ help to build the strength of underlying muscles.

Dr. Catriona suggests that future research in the field should focus on elucidating the effects of nasopharyngeal and tongue pressure resistance exercises in alleviating the effects of apnea episodes.

The American Academy of Sleep Medicine estimates that some 18 million Americans suffer from OSA which, in addition to persistent drowsiness, can also lead to increased risk of high blood pressure and higher rates of strokes, cardiac arrhythmias and heart attacks, according the organization's website.


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