title: Resistive inspiratory muscle training in sleep-disordered breathing of traumatic tetraplegia.
abstract: 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.
authors.affiliation: Department of Physical Medicine & Rehabilitation, College of Medicine, National Taiwan University Hospital, 7 Chung-Shan S. Road, Taipei, Taiwan, ROC.
authors.forename: Tyng-Guey
authors.initials: TG
authors.lastname: Wang
authors.forename: Yen-Ho
authors.initials: YH
authors.lastname: Wang
authors.forename: Fu-Tan
authors.initials: FT
authors.lastname: Tang
authors.forename: Kwan-Hwa
authors.initials: KH
authors.lastname: Lin
authors.forename: I-Nan
authors.initials: IN
authors.lastname: Lien
mesh_terms: 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
chemical_list: D010100:Oxygen