Resistive inspiratory muscle training in sleep-disordered breathing of traumatic tetraplegia.
OBJECTIVE
To assess the effect of resistive inspiratory muscle training (RIMT) on the static pulmonary function and sleep-induced breathing disorder of individuals with chronic cervical cord injury.


METHODS
Before-after training.


METHODS
Home-setting training program.


METHODS
Fourteen complete traumatic tetraplegic patients (12 men, 2 women; mean age, 41.1 +/- 14y; range, 19-56y) injured for more than 6 months.


METHODS
Subjects participated in a 6-week RIMT program for 15 minutes twice daily at a training intensity of 60% of maximum inspiratory pressure (MIP). The participants were reevaluated at the end of 6-week training.


METHODS
Lung volume, peak expiratory flow (PEF), MIP, and maximum expiratory pressure (MEP) were measured by using a spirometry and inspiratory force meter, respectively. Capnography was used to monitor nocturnal pulse oxyhemoglobin saturation (SpO(2)) and end-tidal carbon dioxide tension level (ETCO(2)) of the patients.


RESULTS
The maximum voluntary ventilation (MVV) and MIP of individuals with chronic cervical cord injury substantially improved after RIMT. MIP increased from -68.7 +/- 27.4cmH(2)O to -77.3 +/- 24.0cmH(2)O and MVV rose from 62.7 +/- 33.2L to 73.4 +/- 31.3L (P <.05). Despite increasing from 3.5 +/- 1.8L/s to 4.0 +/- 1.7L/s, PEF was statistically insignificant. For the individuals with improved MIP, the duration of ETCO(2) greater than 48mmHg reduced from 2.2% +/- 3.3% to 1.0% +/- 2.0% of total sleep time (P =.05) and that of SpO(2) less than 90% significantly declined from 1.8% +/- 2.8% to 1.3% +/- 2.4% of total sleep time (P <.05).


CONCLUSIONS
These findings suggest that RIMT can enhance the respiratory muscle strength and endurance of chronic tetraplegia and further ameliorate the sleep-induced breathing disorder. Therefore, RIMT is suggested as a home program for patients with sleep-disordered breathing.
Wang
Tyng-Guey
TG
Department of Physical Medicine & Rehabilitation, College of Medicine, National Taiwan University Hospital, 7 Chung-Shan S. Road, Taipei, Taiwan, ROC.
Wang
Yen-Ho
YH
Tang
Fu-Tan
FT
Lin
Kwan-Hwa
KH
Lien
I-Nan
IN
D000328:Adult; D001945:Breathing Exercises; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008176:Lung Volume Measurements; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D011782:Quadriplegia / Q000503:physiopathology / Q000534:rehabilitation*; D012132:Respiratory Muscles / Q000503:physiopathology; D012133:Respiratory Paralysis / Q000503:physiopathology / Q000534:rehabilitation*; D012891:Sleep Apnea Syndromes / Q000503:physiopathology / Q000534:rehabilitation*; D013119:Spinal Cord Injuries / Q000503:physiopathology / Q000534:rehabilitation*; D014939:Work of Breathing / Q000502:physiology
D010100:Oxygen