Pulmonary rehabilitation and oropharyngeal exercises as an adjunct therapy in obstructive sleep apnea: a randomized controlled trial.

Objective: It is well recognized that the most effective treatment for obstructive sleep apnea (OSA) is continuous positive airway pressure (CPAP). Different treatment possibilities comprise surgery, mandibular advancement, pulmonary rehabilitation, and oropharyngeal and facial exercises (PR program). However, these treatments showed inconsistent results. The purpose of the study was to compare the short-term effects of CPAP and the combination of PR program with CPAP on OSA severity, ventilatory functions, and changes in body characteristics in a newly diagnosed patient.
Methods: This study was a single-center, two-arm, parallel, randomized, controlled, open-label trial. Forty patients with OSA (20 men, 20 women, aged 54.2 ± 6.8 years) with moderate to severe obstructive sleep apnea were randomized to CPAP and CPAP + PR. The PR group underwent six weeks of 60-min twice-weekly individual PR programs. The primary outcome measure was apnea/hypopnea index, oxygen desaturation index, and Epworth Sleepiness Scale. The secondary outcome measures were a percentage of total sleep time with oxygen saturation below 90%, body mass index (BMI), vital capacity and forced expiratory volume in 1 s (% of predicted), neck, waist, and hip circumferences.
Results: Five patients with OSA did not complete the program. The comparison between baseline and final assessment was made in 15 patients in the CPAP + PR group and 20 patients in the control group with CPAP only. Although OSA severity was controlled with CPAP treatment in both groups, a significant reduction of neck, waist, and hip circumferences, BMI, and improvement of pulmonary function were confirmed only in the CPAP + PR group after treatment.
Conclusion: Treatment with CPAP combined with the PR program improved OSA patients to a greater extent than only CPAP.
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