Objective: To evaluate the value of exercising the pharyngeal musculature to treat obstructive sleep apnoea and hypopnoea syndrome (OSAHS).
Methods: From January 2010 to April 2012, 75 patients diagnosed with OSAHS by full night polysomnography (PSG), presenting with symptoms including feeling tired, sleepy and fatigued during daytime, frequent snoring, witnessed apnoeas, or being referred by other physicians when treated for high blood pressure. Excluded were patients with tonsillar hypertrophy greater than grade II, adenoidal hypertrophy, maxillofacial deformities, laryngopharyngeal and neck tumors, clinical and biochemical evidence of hypothyroidism, neuromuscular disorders and other sleep-related diseases. Of the eligible patients 54 agreed to be treated by a regime of exercising pharyngeal musculature, the exercise group. 21 of eligible patients refused any of the course of 12 months, which constituted the control group. Both groups were matched for age, height, and weight. Investigations included a syndrome scale which was made up of modified STOP BANG questionnaire designed for assessment of the symptoms and signs of OSAHS. Additional investigations included PSG for recording the Apnoea Hypopnoea Index (AHI) and the lowest saturation of blood oxygen (LSaO2) and Body Mass Index (BMI). All patients also had 320-detector computerized tomography (320-detector CT) of the upper airway for calculating the resilience, (used as a measure which reflects the softness of soft tissue) of the pharyngeal wall of the posterior palatal area (from the level of the palate to the
lower end of the soft palate) and the posterior lingual area (from the lower end of the soft palate to the upper edge of the epiglottis). These investigations and readings were recorded before treatment, at 6-month and at 12-month. The Wilcoxon Signed Rank test was used to compare the scores of the Modified STOP BANG questionnaire. The Paired-Samples t test was used to compare the variables of AHI, LSaO2 and BMI of patients in the treatment group: before treatment and post treatment at 6–month and 12-month. Independent-Samples t test was used for comparison of the resilience of posterior palate area and the posterior lingual area in two groups before treatment and at 12-month by Statistical Package for Social Science (SPSS) V17.0, and a p value less than 0.05 was considered to be statistically significant.
Results: 6 months and 12 months after commencing exercises, the scores from an in house Modified STOP BANG questionnaire, AHI and LSaO22 were measured in the exercise group. Before treatment, in the exercise group the mean of the Modified STOP BANG questionnaire score was 17.08 (5-24), and was 14.47(2-23) at 6-months and 14.35(2-23) at 12-months; the AHI was 22.84 (5.8-64) before treatment and 15.36 (2.1-62) and 13.79 per hour (1.8-58.5 per hour) at 6-month and 12-month respectively; the LSaO22 was 74.05±13.86% at the start of the treatment and 81.18±6.89% and 81.93±13.69% at 6-month and at 12-month respectively, There was a statistically significant difference of AHI and LSaO2 between before treatment and post treatment at 6-month and 12-month. Although the BMI varied from 26.4±10.6 before treatment to 25.7±12.3 and 27.5±15.8 at 6-month and 12-month respectively, it was noteworthy that this was not a significant difference (p>0.05). At 12-month, the resilience of antero-posterior pharyngeal wall and the total pharyngeal wall area of posterior palate in the exercise group was lower than that before treatment (p<0.05). In the control group the difference was not significant (p>0.05).
Conclusion: Exercising the pharyngeal musculature is a non-invasive, non-surgical and effective method that should be considered in the management of patients suffering OSAHS. In particular patients who are elderly, those with mild to moderate OSAHS patients who are either unfit for surgery or unable to comply with Continuous Positive Airway Pressure (CPAP) or Mandibular Advancement Devices (MAD) therapy.