咽頭喉頭運動によるいびきの軽減

論文No697

Effects of Oropharyngeal Exercises on Snoring: A Randomized Trial 
                                                                                        

Vanessa Ieto, PhD; Fabiane Kayamori, SLP; Maria I. Montes, MD; Raquel P. Hirata, MS; Marcelo G. Gregório, MD, PhD; Adriano M. Alencar, PhD; Luciano F. Drager, MD, PhD; Pedro R. Genta, MD, PhD; Geraldo Lorenzi-Filho, MD, PhD                    

Chest. 2015;148(3):683-691. doi:10.1378/chest.14-2953

ブラジルからの報告．

＜背景＞
いびきは良く見られる兆候であり，閉塞性睡眠時無呼吸（ＯＳＡ）の疑いがある．
しかし，いびきはポリソムノグラフ検査では客観的に測定できず，いびきに関する標準的な治療はない．
この研究では，咽頭喉頭運動がいびきに効果があるかを，
軽度の自覚症状のあるいびきが主訴の患者およびいびきと軽症ー中等度のＯＳＡの診断のある患者において調べた．

＜方法＞
患者はランダムに２群に分けられ，３か月治療した．
鼻拡張ストリップと呼吸運動（コントロール），毎日咽頭喉頭運動する群（治療群）である．
スタート時と３か月後に睡眠質問票(Epworth Sleepiness Scale)とポリソムノグラフ検査，いびきの客観的測定をうけた．

＜結果＞
３９名（平均４６歳，ＢＭＩ２８．２，ＡＨＩ　１５．３，ＥＳＳ　９．２，ピッツバーグ睡眠質指数６．４）で研究した．
コントロール（２０名）と治療群（１９名）で背景に差はなかった．
それぞれ１名ずつ脱落した．
Intensin-to-treat解析が行われた．
コントロール群では有意な差はでなかった．
治療群ではいびき指数が減少した（９９．５vs ４８．２／時）．全いびき指数も減少した（６０．４vs ３１．０）．

＜感想＞
単純ないびきにおいては，咽頭喉頭の運動をすることでいびきの軽減（約半分）が期待できそうです．

BACKGROUND:  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.

METHODS:  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.

RESULTS:  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.

CONCLUSIONS:  Oropharyngeal exercises are effective in reducing objectively measured snoring and are a possible treatment of a large population suffering from snoring.