Prevalência da apneia obstrutiva do sono na asma e efeitos do treinamento muscular inspiratório

Abstract

OSA and asthma are two respiratory clinical conditions that are very prevalent worldwide, overlapping with similar comorbidities and underlying pathophysiology, potentiating both conditions. Objective: to assess the global prevalence of obstructive sleep apnea (OSA) in asthmatics and the effects of inspiratory muscle training (IMT) in reducing the apnea-hypopnea index (AHI), improving spirometry, optimizing respiratory muscle strength, quality of life and sleep of patients with OSA. Methods: two systematic reviews with meta-analysis were performed. Six databases were searched: EMBASE, PUBMED/MEDLINE, Cochrane Library, Physiotherapy Evidence Database, Periódicos CAPES and SciELO, from the earliest available date to September 2022. Cohort studies and cross-sectional studies were selected to analyze the prevalence of OSA in asthmatics. Randomized controlled trials (RCTs) were used to assess the effects of IMT in patients with OSA. The quality of prevalence studies was assessed using the Critical Appraisal Tool for Studies with prevalence data from the Joanna Briggs Institute and the quality of RCTs using the PEDro Scale. Mean differences, standard mean differences and confidence intervals were calculated. Results: regarding data on the prevalence of OSA in asthmatics, of the 223 articles initially found, 7 studies that included 639 asthmatic patients of different severities were evaluated for eligibility. Two hundred and thirty-nine asthmatic patients had OSA, representing 37.4% of the studied sample. Article 2: In the 14 RCTs, it was observed that IMT improved maximal inspiratory pressure MD (32 cmH2O, 95% CI: 16.1 to 48.0); forced vital capacity (FVC) DM (8.8%, predicted 95% CI: 1.4 to 16.3), reduced the Apnea-Hypopnea Index (AHI) by -2.7 events/h (95% CI: -4.3, -1.1), as well as there was a reduction in the Daytime Epworth Sleepiness Scale scores of -4.8 (95% CI: -9.9, -0.33), in systolic blood pressure of -9.7 mmHg (95% CI: -14.3, -5.0), diastolic blood pressure in -5.6 mmHg (95% CI: -8.8, -2.4) and Pittsburgh Sleep Quality Index in -2.7 (95% CI: -3.5, -1.9). No serious adverse events were reported. Overall conclusion: according to the selected studies, one can observe that the worldwide prevalence of OSA in patients with asthma is high. In addition, it is worth noting that patients with the severe form of the disease have shown to have a higher prevalence of OSA compared to patients with mild to moderate asthma. It was also observed that IMT is effective in increasing inspiratory muscle strength, reducing AHI, improving quality of sleep, optimizing FVC and lowering blood pressure. Furthermore, adding IMT to conventional exercise may be effective in improving inspiratory muscle strength and mental domains of quality of life compared to conventional exercise alone in patients with OSA. However, further studies are needed to determine optimal dosages and duration of effect.