PHYSIOTHERAPY AND OBSTRUCTIVE SLEEP APNEA: A SYNTHESIS OF PHYSIOTHERAPY INTERVENTIONS TO SUPPORT THE DEVELOPMENT OF A NOVEL PROGRAM

J.T.A.T. Lam^1,2, G. Lavigne^3,4, D.H. Gagnon^1,2

Background: Moderate-to-severe obstructive sleep apnea (OSA) causes breathing to repeatedly stop and start during sleep and affects up to 14% of the adult population. OSA mainly results from oropharyngeal muscle weaknesses, especially of the tongue. The use of a continuous positive airway pressure (CPAP) during sleep is the principal prescribed technology to alleviate OSA impacts. However, as an inherent musculoskeletal condition, it is surprising that no OSA-specific physiotherapy program has yet been developed and tested in the context of inter-professional collaborations.

Purpose: To retrieve and classify OSA-specific interventions that are part of the physiotherapy scope of practice to inform the development of a future OSA-specific physiotherapy program.

Methods: A systematized search of the scientific literature was conducted following the preferred reporting items from systematic reviews and meta-analyses (PRISMA). Search terms were structured around terms defining the targeted population (e.g.,sleep apnea, etc.) and relevant interventions (e.g.,physical therapy, modalities, etc.) and were used to search Medline, Embase and CINAHL databases starting in 2000. Research manuscripts, literature reviews, and conference abstracts that investigated individuals diagnosed with OSA as well as at least one modalities/interventions aiming to alleviate OSA or related-symptoms and falling within the physiotherapy scope of practice (e.g.,therapeutic exercises, manual therapy, physical modalities and electrotherapy, education, etc.) were selected and analyzed by the two independent reviewers before extracting interventions. The interventions were classified into 8 categories that were classified as being rehabilitative (n=7) or compensatory (n=1).

Results: Out of the 1151 articles retrieved, a total of 78 articles met the inclusion criteria and qualified for full analysis and data extraction. Similar interventions within the scope of physiotherapy practice were classified into eight categories: aerobic exercise, oropharyngeal exercises, breathing exercises, electrical simulation, education, rostral fluid change, needling, manipulations and positional therapy (only compensatory intervention type). The largest category of interventions included 31 articles about aerobic exercise (i.e.,walking, running, etc.) to improve the cardiorespiratory system. In comparison, only 10 articles studied oropharyngeal exercises, specific exercise located in the face (i.e.,jaw, tongue, etc.) and only 11 articles focused on breathing (i.e. expiration/inspiration muscle). The second largest category is electrical stimulation which included 13 articles (i.e.,electrical muscle stimulation). Other categories were much less studied: sleep hygiene(5 articles), positional therapy(4), rostral fluid change(1), needling(1) and manipulations(1).

Conclusion(s): A broad spectrum of interventions falling within the scope of physiotherapy practice was retrieved but limited evidence concerning their effects was available. This interventions overview determined that aerobic exercise and electrical stimulation are the two main categories of interventions that should be included in a physical therapy intervention to improve OSA symptoms. These findings could direct future clinical research and develop the scope of physiotherapy interventions for sleep disordered breathing.

Implications: This synthesis of the OSA-specific interventions aligning with the physiotherapy scope of practice will support the development of a consensus on the content of an OSA-specific physiotherapy program to be implemented and evaluated in the context of inter-professional collaboration in sleep clinics in Quebec, Canada. Opinions of international experts in this field will be gathered and reconciled using a Delphi consultation process.

Funding, acknowledgements: Center for Interdisciplinary Research in Rehabilitation, Réseau de recherche en santé respiratoire du Québec, Ordre de la physiothérapie du Québec

Keywords: Obstructive Sleep Apnea, Physiotherapy, Interprofessional Collaboration

Topic: Cardiorespiratory

Did this work require ethics approval? No

Institution: Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR)

Committee: Research Ethics Board (REB)

Reason: Review of the litterature