Ann Am Thorac Soc. 2026 Feb 21:aaoag041. doi: 10.1093/annalsats/aaoag041. Online ahead of print.
ABSTRACT
RATIONALE: Inspiratory muscle training (IMT) is a relatively new intervention for obstructive sleep apnea (OSA) with the aim of improving respiratory muscle strength and mitigating OSA-related symptoms. However, its effects on key clinical endpoints remains unclear.
OBJECTIVES: To evaluate the effects of IMT on OSA severity, sleep quality, respiratory function, and cardiovascular outcomes.
METHODS: We systematically searched PubMed, EMBASE, CENTRAL, and Web of Science for randomized control trials (RCTs) assessing IMT in adults with OSA. Studies assessed IMT versus control/placebo with outcomes, including the apnea-hypopnea index (AHI), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), maximal inspiratory pressure (MIP), lowest oxygen saturation (LSaO2), blood pressure (BP), and body mass index (BMI).
RESULTS: Ten RCTs (166 IMT vs. 157 control participants) found significant improvements in OSA with IMT across multiple domains. The intergroup difference in mean BMI reduction (mean difference [MD], -1.48; 95% credible interval [CI], -2.39 to -0.57), mean PSQI gain (-3.15; -3.69 to -2.62), mean LSaO2 gain (2.86; 1.01 to 4.71), mean ESS reduction (-3.18; -4.50 to -1.87), mean MIP gain (25.54; 11.09 to 40.00), the percentage of predicted values for forced vital capacity (FVC) (FVC%) predicted gain (17.20; 9.53 to 24.87), and mean systolic blood pressure (SBP) reduction (-6.63; -13.26 to -0.00) indicated the benefit of IMT over the control therapy. However, there was no significant improvement in AHI (1.00; -2.57 to 4.56). Heterogeneity primarily stemmed from differences in intervention protocols and baseline disease severity among the patients.
CONCLUSIONS: IMT resulted in clinically meaningful symptomatic benefits across OSA phenotypes by enhancing respiratory strength, sleep quality, and cardiovascular health. However, the lack of significant improvement in AHI suggests that IMT may not impact primary pathophysiological markers of OSA. Thus, IMT may be an adjunctive intervention, rather than a primary therapy, for reducing event frequency in OSA.
PMID:41721779 | DOI:10.1093/annalsats/aaoag041