Investigation of respiratory muscle function, pulmonary function, and exercise capacity in women and men with obstructive sleep apnea syndrome

Year 2023, Volume: 10 Issue: 3, 177 - 185, 29.12.2023

Şahveren Çakartaş Deniz İnal İnce Bahar Kaymakamzade Melda Sağlam Finn Rasmussen

https://doi.org/10.15437/jetr.1211009

Abstract

Purpose: This study aimed to evaluate electromyography respiratory muscle function, respiratory muscle strength, pulmonary function and exercise capacity in women and men with Obstructive Sleep Apnea Syndrome (OSAS).
Method: Nineteen patients (mean age=54.68±13.15 years, 10 M, 9 F) were included in the study. Apnea/hypopnea index (AHI) and the lowest oxygen saturation (SpO2) values were recorded from the polysomnography (PSG) evaluation. Forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) values were recorded from pulmonary function test. Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were measured. Respiratory muscle function was evaluated using diaphragmatic superficial electromyography (EMGdi) and sternocleidomastoid electromyography (EMGscm) measurements. Six-minute walk test (6MWT) and Pittsburgh Sleep Quality Index (PSQI) was performed.
Results: Male OSAS patients’ FEV1, FVC, MEP, EMGdi, EMGscm values, and 6MWT distance were significantly higher than those of female OSAS patients (p<0.05). In males, AHI and the lowest SpO2 during sleep were correlated (r=-0.659, p=0.038). In females with OSAS, AHI was significantly related to the lowest SpO2 (r=-0.678) and MIP (r=0.904, p<0.05). MIP and 6DYT distance were significantly correlated in females (r=-0.762, p=0.017).
Conclusion: Lung function, respiratory muscle strength, diaphragmatic function, and exercise capacity are more adversely affected in female OSAS patients than in males. The diaphragmatic function could be evaluated in OSAS and could contribute to the direction of the treatment program.

Keywords

Obstructive sleep apnea syndrome, Electromyography, Exercise capacity, Respiratory function tests

Obstrüktif uyku apne sendromu olan kadın ve erkeklerde respiratuar kas fonksiyonu, solunum fonksiyonları ve egzersiz kapasitesinin incelenmesi

Abstract

Amaç: Bu çalışmada Obstrüktif Uyku Apne Sendromu (OUAS) tanısı almış kadın ve erkek hastalarda elektromiyografik respiratuar kas fonksiyonu, solunum kas kuvveti, solunum fonksiyonları ve egzersiz kapasitenin karşılaştırılması amaçlandı.
Yöntem: Çalışmaya 19 OUAS olgusu (yaş ortalaması=54,68±13,15 yıl, 10 E, 9 K) dahil edildi. Polisomnografi (PSG) değerlendirmesinden apne/hipopne indeksi (AHİ) ve en düşük oksijen satürasyonu (SpO2) değerleri kaydedildi. Solunum fonksiyon testinde birinci saniyedeki zorlu ekspirasyon volümü (FEV1) ve zorlu vital kapasite (FVC) değerleri kaydedildi. Maksimal inspiratuar basınç (MIP) ve maksimal ekspiratuar basınç (MEP) ölçüldü. Respiratuar kas fonksiyonu, diyafragma yüzeyel elektromiyografi (EMGdi) ve sternoclediomasteoid elektromiyografi (EMGscm) ölçümleri ile değerlendirildi. Altı dakika yürüme testi (6DYT) ve Pittsburgh Uyku Kalitesi İndeksi (PUKİ) uygulandı.
Bulgular: Erkek OUAS hastalarının FEV1, FVC, %MIP, MEP, EMGdi, EMGscm ve 6DYT mesafesi değerleri kadın olgulardan daha yüksekti (p<0,05). Erkeklerde AHİ ve uyku sırasındaki en düşük SpO2 değeri ilişkiydi (r=-0,659, p=0,038). Kadın OUAS olgularında AHİ, en düşük SpO2 değeri (r=-0,678) ve MIP değeri (r=0,904) ile anlamlı ilişki gösterdi (p<0,05). Kadınlarda MIP ve 6DYT mesafesi arasında anlamlı bir korelasyon vardı (r=-0,762, p=0,017).
Sonuç: Kadın OUAS olgularında solunum fonksiyonları solunum kas kuvveti ve diyafragmatik fonksiyon ve egzersiz kapasitesi erkek olgulara göre daha fazla etkilenmektedir. OUAS’ta diyafragmatik fonksiyon değerlendirilerek tedavi programının yönlendirilmesine katkı sağlayabilir.

Keywords

Obstrüktif uyku apne sendromu, Elektromiyografi, Egzersiz kapasitesi, Solunum fonksiyon testleri

References

• Devita M, Zangrossi A, Marvisi M, et al. Global cognitive profile and different components of reaction times in obstructive sleep apnea syndrome: effects of continuous positive airway pressure over time. Int J Psychophysiol. 2018;123:121-126.
• Faber J, Faber C, Faber AP. Obstructive sleep apnea in adults. Dental Press J Orthod. 2019;24:99-109.
• Osman AM, Carter SG, Carberry JC, et al. Obstructive sleep apnea: current perspectives. Nat Sci Sleep. 2018;10:21-34.
• Vitacca M, Paneroni M, Braghiroli A, et al. Exercise capacity and comorbidities in patients with obstructive sleep apnea. J Clin Sleep Med. 2020;16:531-538.
• Gottlieb DJ, Punjabi NM. Diagnosis and management of obstructive sleep apnea: a review JAMA. 2020;323:1389-1400.
• Wimms A, Woehrle H, Ketheeswaran S, et al. Obstructive sleep apnea in women: specific issues and interventions. Biomed Res Int. 2016;2016:1764837.
• Jordan AS, Catcheside PG, O'Donoghue FJ, et al. Long-term facilitation of ventilation is not present during wakefulness in healthy men or women. J Appl Physiol (1985). 2002;93:2129-2136.
• Mitchell RA, Schaeffer MR, Ramsook AH, et al. Sex differences in respiratory muscle activation patterns during high-intensity exercise in healthy humans. Respir Physiol Neurobiol. 2018;247:57-60.
• Ivanhoe JR, Cibirka RM, Lefebvre CA, et al. Dental considerations in upper airway sleep disorders: a review of the literature. J Prosthet Dent. 1999;82:685-698.
• Stavrou VT, Vavougios GD, Astara K, et al. The 6-minute walk test and anthropometric characteristics as assessment tools in patients with obstructive sleep apnea syndrome. a preliminary report during the pandemic. J Pers Med. 2021;11:563.
• Quanjer PH, Stanojevic S, Cole TJ, et al. Multi-ethnic reference values for spirometry for the 3-95-yr age range: the global lung function 2012 equations. Eur Respir J. 2012;40:1324-1343.
• Black L, Hyatt RE. Maximal respiratory pressures: normal values and relationship to age and sex. Am Rev Respir Dis. 1969;99:696-702.
• Segizbaeva MO, Donina ZA, Timofeev NN, et al. EMG analysis of human inspiratory muscle resistance to fatigue during exercise. Adv Exp Med Biol. 2013;788:197-205.
• Mathiowetz V, Kashman N, Volland G, et al. Grip and pinch strength: normative data for adults. Arch Phys Med Rehabil. 1985;66:69-74.
• Zielinska D, Bellwon J, Rynkiewicz A, et al. Prognostic value of the six-minute walk test in heart failure patients undergoing cardiac surgery: a literature review. Rehabil Res Pract2013;2013:965494.
• Enright PL, Sherrill DL. Reference equations for the six-minute walk in healthy adults. Am J Respir Crit Care Med. 1998;158:1384-1387.
• Agargun MY, Kara H, Anlar O. The validity and reliability of the Pittsburgh Sleep Quality Index. Turk Psikiyatr Dergisi. 1996:7:107-111.
• Tabachnick BG, Fidell LS. Using multivariate statistics. 6th ed. Boston: Pearson, 2013.
• Schober P, Boer C, Schwarte LA. Correlation coefficients: appropriate use and interpretation. Anesth Analg. 2018;126:1763-1768.
• Jordan AS, Wellman A, Edwards JK, et al. Respiratory control stability and upper airway collapsibility in men and women with obstructive sleep apnea. J Appl Physiol (1985). 2005;99(5):2020-7.
• Cintra F, Poyares D, Rizzi CF, et al. Cardiorespiratory response to exercise in men and women with obstructive sleep apnea. Sleep Med. 2009;10:368-73.
• Pal A, Ogren JA, Aguila AP, et al. Functional organization of the insula in men and women with obstructive sleep apnea during Valsalva. Sleep. 2021;44(1):zsaa124.
• Morris JL, Mazzotti DR, Gottlieb DJ, et al. Sex differences within symptom subtypes of mild obstructive sleep apnea. Sleep Med. 2021;84:253-258.
• Harik-Khan RI, Wise RA, Fozard JL. Determinants of maximal inspiratory pressure. The Baltimore Longitudinal Study of Aging. Am J Respir Crit Care Med.1998;158(5 Pt 1):1459-64.
• Pessoa IMBS, Parreira VF, Fregonezi GAF, et al. Reference values for maximal inspiratory pressure: a systematic review. Can Respir J. 2014;21:43-50.
• Chien MY, Wu YT, Lee PL, et al. Inspiratory muscle dysfunction in patients with severe obstructive sleep apnoea. Eur Respir J. 2010;35:373-380.
• Vranish JR, Bailey EF. Inspiratory muscle training improves sleep and mitigates cardiovascular dysfunction in obstructive sleep apnea. Sleep. 2016;39:1179-1185.
• Mezzanotte WS, Tangel DJ, White DP. Waking genioglossal electromyogram in sleep apnea patients versus normal controls (a neuromuscular compensatory mechanism). J Clin Invest. 1992;89:1571-1579.
• Bordoni B, Escher AR, Toccafondi A, et al. Obstructive sleep apnea and role of the diaphragm. Cureus. 2022;14(9):e29004.
• O'Halloran KD, Lewis P, McDonald F. Sex, stress and sleep apnoea: decreased susceptibility to upper airway muscle dysfunction following intermittent hypoxia in females. Respir Physiol Neurobiol. 2017;245:76-82.
• Sauleda J, Garcia-palmer FJ, Tarraga S, et al. Skeletal muscle changes in patients with obstructive sleep apnoea syndrome. Respir Med. 2003;97:804-810.
• Porto JM, Nakaishi APM, Cangussu-Oliveira LM, et al. Relationship between grip strength and global muscle strength in community-dwelling older people. Arch Gerontol Geriatr. 2019,82:273-278.
• Lin CC, Hsieh WY, Chou CS, et al. Cardiopulmonary exercise testing in obstructive sleep apnea syndrome. Respir Physiol Neurobiol. 2006;150:27-34.
• Naghan PA, Aloosh O, Torang HA, et al. Can 6-minute walk test predict severity of obstructive sleep apnea syndrome? Sleep Sci Pract. 2017;1:17.
• Pływaczewski R, Stokłosa A, Bieleń P, et al. Six-minute walk test in obstructive sleep apnoea. Pneumonol Alergol Pol. 2008;76:75-82.
• Bohannon RW, Crouch R. Minimal clinically important difference for change in 6-minute walk test distance of adults with pathology: a systematic review. Eval Clin Pract. 2017;23:377-381.
• Stavrou VT, Astara K, Karetsi E, et al. Respiratory muscle strength as an indicator of the severity of the apnea-hypopnea index: stepping towards the distinction between sleep apnea and breath holding. Cureus. 2021;13(3): e14015.
• Molnar V, Molnar A, Lakner Z, et al. Examination of the diaphragm in obstructive sleep apnea using ultrasound imaging. Sleep Breath. 2022;26:1333-1339.