Ieto Vanessa, Kayamori Fabiane, Montes Maria I, Hirata Raquel P, Gregório Marcelo G, Alencar Adriano M, Drager Luciano F, Genta Pedro R, Lorenzi-Filho Geraldo
Sleep Laboratory, University of São Paulo Medical School, São Paulo, Brazil.
Neurology Department, University of Antioquia, Medellín, Colombia.
Chest. 2015 Sep;148(3):683-691. doi: 10.1378/chest.14-2953.
Snoring is extremely common in the general population and may indicate OSA. However, snoring is not objectively measured during polysomnography, and no standard treatment is available for primary snoring or when snoring is associated with mild forms of OSA. This study determined the effects of oropharyngeal exercises on snoring in minimally symptomatic patients with a primary complaint of snoring and diagnosis of primary snoring or mild to moderate OSA.
Patients were randomized for 3 months of treatment with nasal dilator strips plus respiratory exercises (control) or daily oropharyngeal exercises (therapy). Patients were evaluated at study entry and end by sleep questionnaires (Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index) and full polysomnography with objective measurements of snoring.
We studied 39 patients (age, 46 ± 13 years; BMI, 28.2 ± 3.1 kg/m2; apnea-hypopnea index (AHI), 15.3 ± 9.3 events/h; Epworth Sleepiness Scale, 9.2 ± 4.9; Pittsburgh Sleep Quality Index, 6.4 ± 3.3). Control (n = 20) and therapy (n = 19) groups were similar at study entry. One patient from each group dropped out. Intention-to-treat analysis was used. No significant changes occurred in the control group. In contrast, patients randomized to therapy experienced a significant decrease in the snore index (snores > 36 dB/h), 99.5 (49.6-221.3) vs 48.2 (25.5-219.2); P = .017 and total snore index (total power of snore/h), 60.4 (21.8-220.6) vs 31.0 (10.1-146.5); P = .033.
Oropharyngeal exercises are effective in reducing objectively measured snoring and are a possible treatment of a large population suffering from snoring.
ClinicalTrials.gov; No.: NCT01636856; URL: www.clinicaltrials.gov.
打鼾在普通人群中极为常见，可能提示阻塞性睡眠呼吸暂停（OSA）。然而，在多导睡眠监测期间并未对打鼾进行客观测量，并且对于原发性打鼾或打鼾伴有轻度OSA的情况，尚无标准治疗方法。本研究确定了口咽锻炼对以打鼾为主诉且诊断为原发性打鼾或轻度至中度OSA的症状轻微患者打鼾的影响。
患者被随机分为两组，分别接受为期3个月的鼻扩张条加呼吸锻炼治疗（对照组）或每日口咽锻炼治疗（治疗组）。在研究开始和结束时，通过睡眠问卷（爱泼华嗜睡量表、匹兹堡睡眠质量指数）以及对打鼾进行客观测量的全夜多导睡眠监测对患者进行评估。
我们研究了39例患者（年龄46±13岁；体重指数28.2±3.1kg/m²；呼吸暂停低通气指数（AHI）15.3±9.3次/小时；爱泼华嗜睡量表9.2±4.9；匹兹堡睡眠质量指数6.4±3.3）。对照组（n = 20）和治疗组（n = 19）在研究开始时情况相似。每组各有1例患者退出。采用意向性分析。对照组无显著变化。相比之下，随机分配到治疗组的患者打鼾指数（鼾声>36dB/小时）显著降低，从99.5（49.6 - 221.3）降至48.2（25.5 - 219.2）；P = 0.017，总打鼾指数（每小时打鼾总功率）从60.4（21.8 - 220.6）降至31.0（10.1 - 146.5）；P = 0.033。
口咽锻炼可有效减少客观测量的打鼾，是治疗大量打鼾患者的一种可能方法。
ClinicalTrials.gov；编号：NCT01636856；网址：www.clinicaltrials.gov。
