Inspiratory Muscle Training for Obstructive Sleep Apnea: Protocol Development and Feasibility of Home Practice by Sedentary Adults

A hypotensive protocol of inspiratory muscle strength training: Systematic review and meta-analysis with trial sequential analysis

The aim of this study was to evaluate the hypotensive effect and optimal protocol of inspiratory muscle resistance training (IMST). Randomized controlled trials using IMST to lower blood pressure (BP) were retrieved from 12 databases as of July 2022. A meta-analysis of BP and heart rate variability (HRV) was performed and a trial sequence analysis was performed using trial sequential analysis (TSA) software. Twelve articles (n = 386 participants) from five countries were included, with a mean quality score of 5.83. IMST achieved significant results in reducing systolic, diastolic, and mean arterial pressure (-7.93 [-12.08, -3.78]; -3.80 [-6.08, -1.53]; -4.90 [-13.76, 3.96]). Furthermore, TSA has shown that the findings for systolic and diastolic BP are conclusive. Finally, considerable variation remained between studies when analyzing HRV. The overall hypotensive effect of IMST was demonstrated by the TSA and was well tolerated in different populations. Of these, two interventions, high resistance or low resistance combined with slow breathing, showed the best efficacy under an 8-week exercise intervention. In addition, the process of lowering BP by modulating sympathetic vagal activity has not been further confirmed in this study. Future long-term interventions, especially those over 3 months, are needed to observe the prolonged antihypertensive effects and modulatory mechanisms; controlling for variables such as respiratory rate and executing more rigorous studies to further explore antihypertensive options.

Effect of continuous nursing combined with respiratory exercise nursing on pulmonary function of postoperative patients with lung cancer

BACKGROUND

Lung cancer is a malignant tumor with high morbidity and mortality among cancers. Surgery is currently one of the primary methods of treating lung cancer. Although it can slow down the progression of the disease by removing the lesion, this invasive surgery inevitably damages the integrity of the patient’s chest. Moreover, the patient’s pulmonary function may have a low compensatory capacity after surgery, causing various respiratory diseases such as atelectasis, respiratory function decline, and even serious cardiovascular disease. All of these have great negative impacts on the surgical effect and the prognosis of patients. With the continuous exploration and development of nursing, continuous nursing and respiratory exercise nursing have been gradually applied in the nursing of patients after lung cancer surgery, and have achieved good nursing results.

AIM

To investigate the effect of continuous nursing combined with respiratory exercise nursing on the pulmonary function of postoperative patients with lung cancer.

METHODS

A total of 80 patients with lung cancer who underwent surgery in our hospital from January 2021 to December 2021 were selected as the study subjects. All subjects were randomly divided into the control group (n = 40 cases) and the experimental group (n = 40 cases). Patients with lung cancer in the control group were given conventional nursing after surgery, while the experimental group was given continuous nursing combined with respiratory exercise nursing based on conventional nursing. The recovery of pulmonary function and respiratory symptoms was observed before and after 3 mo of intervention in both groups. The pulmonary function parameters, blood gas analysis, MD Anderson Symptom Inventory-lung cancer module (MDASI-LC) scores, incidence of pulmonary complications, and Morisky compliance scores were compared between the two groups before and after 3 mo of intervention.

RESULTS

There was no significant difference in pulmonary function and blood gas analysis between the two groups before intervention (P > 0.05). 3 mo after the intervention, the pulmonary function parameters in the experimental group (SpO₂, VC, MVV, FEV1, FEV1% pred, and FEV1/FVC) were higher than those in the control group, and the differences were statistically significant (P < 0.05). There was no significant difference in blood gas analysis between the two groups before intervention (P > 0.05). PaO₂ in the experimental group was significantly higher than that in the control group, and PaCO₂ was significantly lower than that in the control group 3 mo after the intervention. The difference had statistical significance (P < 0.05). 3 mo after the intervention, the MDASI score of respiratory symptoms in the experimental group was significantly lower than that in the control group (P < 0.05), and the incidence of pulmonary complications was lower than that in the control group (P < 0.05). In addition, the treatment compliance and nursing satisfaction of patients in the experimental group were higher than those in the control group, and the differences were statistically significant (P < 0.05).

CONCLUSION

Continuous nursing combined with respiratory exercise nursing can significantly accelerate the recovery of respiratory function in postoperative lung cancer patients, reduce the incidence of postoperative complications of lung cancer as well as improve the treatment compliance of patients.

Environmental Benefits of Sleep Apnoea Detection in the Home Environment

Sleep Apnoea (SA) is a common chronic illness that affects nearly 1 billion people around the world, and the number of patients is rising. SA causes a wide range of psychological and physiological ailments that have detrimental effects on a patient’s wellbeing. The high prevalence and negative health effects make SA a public health problem. Whilst the current gold standard diagnostic procedure, polysomnography (PSG), is reliable, it is resource-expensive and can have a negative impact on sleep quality, as well as the environment. With this study, we focus on the environmental impact that arises from resource utilisation during SA detection, and we propose remote monitoring (RM) as a potential solution that can improve the resource efficiency and reduce travel. By reusing infrastructure technology, such as mobile communication, cloud computing, and artificial intelligence (AI), RM establishes SA detection and diagnosis support services in the home environment. However, there are considerable barriers to a widespread adoption of this technology. To gain a better understanding of the available technology and its associated strength, as well as weaknesses, we reviewed scientific papers that used various strategies for RM-based SA detection. Our review focused on 113 studies that were conducted between 2018 and 2022 and that were listed in Google Scholar. We found that just over 50% of the proposed RM systems incorporated real time signal processing and around 20% of the studies did not report on this important aspect. From an environmental perspective, this is a significant shortcoming, because 30% of the studies were based on measurement devices that must travel whenever the internal buffer is full. The environmental impact of that travel might constitute an additional need for changing from offline to online SA detection in the home environment.

Effects of the Combination of Continuous Nursing Care and Breathing Exercises on Respiratory Function, Self-Efficacy, and Sleep Disorders in Patients with Lung Cancer Discharged from Hospital

The purpose of this study was to explore the effect of respiratory function and self-efficacy of patients with lung cancer after surgery by the combination of continuing nursing care and breathing exercises and to assess its clinical value in improving the quality of patients' sleep. 120 cases of lung cancer patients were divided into the control group (n = 60 cases) and the experimental group (n = 60 cases) randomly. The control group used conventional care methods for postoperative lung cancer patients, while the experimental group used continuous care combined with a respiratory exercise care model on the basis of conventional care, comparing the differences in the recovery of lung function, self-efficacy, sleep quality, incidence of sleep disorders, and other indicators between the two groups. The average indicator of recovery condition in patients of experimental groups FEV1 (L), FEV1% pred (%), and FEV1/FVC (%) was higher than patients in control groups with lower symptom scores and complication rates (P < 0.05). The self-efficacy score of patients in the experimental group was higher than that in the control group (P < 0.05) during sixty days of follow-up. The sleeping time of the experimental group was significantly shorter than that of the control group (P < 0.05) and the sleep time was longer than that of the control group (P < 0.05), but the incidence of sleep disorders and drug use rate were lower than that of the control group (P < 0.05) before discharge. Continuous nursing care combined with respiratory exercises can significantly accelerate the recovery of lung function and respiratory function reconstruction in patients with lung cancer after surgery, improve the self-efficacy score of patients, improve the sleep quality of patients, and be conducive to postoperative rehabilitation of patients.

Respiratory Muscle Training in Patients with Obstructive Sleep Apnoea: A Systematic Review and Meta-Analysis

Background: Effective treatments for obstructive sleep apnoea (OSA) include positive pressure, weight loss, oral appliances, surgery, and exercise. Although the involvement of the respiratory muscles in OSA is evident, the effect of training them to improve clinical outcomes is not clear. We aimed to determine the effects of respiratory muscle training in patients with OSA. Methods: A systematic review was conducted in seven databases. Studies that applied respiratory muscle training in OSA patients were reviewed. Two independent reviewers analysed the studies, extracted the data and assessed the quality of evidence. Results: Of the 405 reports returned by the initial search, eight articles reporting on 210 patients were included in the data synthesis. Seven included inspiratory muscle training (IMT), and one included expiratory muscle training (EMT). Regarding IMT, we found significant improvement in Epworth sleepiness scale in −4.45 points (95%CI −7.64 to −1.27 points, p = 0.006), in Pittsburgh sleep quality index of −2.79 points (95%CI −4.19 to −1.39 points, p < 0.0001), and maximum inspiratory pressure of −29.56 cmH2O (95%CI −53.14 to −5.98 cmH2O, p = 0.01). However, the apnoea/hypopnea index and physical capacity did not show changes. We did not perform a meta-analysis of EMT due to insufficient studies. Conclusion: IMT improves sleepiness, sleep quality and inspiratory strength in patients with OSA.