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5MinuteConsult Journal Club

Breathe Easier with Inspiratory & Expiratory Resistance Training


Sleep Breath (2021).

Study Summary

This systematic review evaluated using a simple inspiratory and expiratory trainer to determine impact on sleep parameters in patients with obstructive sleep apnea. Expiratory resistance exercises showed a decrease in the apnea-hypopnea index (AHI) when compared to baseline (MD = - 8.4; 95% CI = - 12.4 to - 4.4; I2 = 19%). Inspiratory resistance exercises demonstrated a decrease in Epworth Sleepiness Scale (ESS) (MD = - 4.4; 95% CI = - 8.2 to - 0.6; I2 = 0%) as well as a significant decrease in the Pittsburgh Sleep Quality Index (PSQI). Most studies had users do the exercises once a day and found improved outcomes within 5-12 weeks.


Use of a simple, inexpensive handheld device improved sleep parameters in those with obstructive sleep apnea.


This is a simple intervention that has clinically meaningful results. CPAP can drop AHI scores by up to 95%, and improve ESS by about 40%, but dropout use with CPAP is great, as is cost, need for cleaning, and careful follow up. The inspiratory and expiratory trainers used in these studies are available without a prescription for $30-50, and from online retailers, can be tried for a month and returned for free if not happy. There is data on how they improve asthma, and maybe even COPD outcomes. More to come on these devices. Encourage patients to give them a try.

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Contributed by Frank J. Domino, April 6, 2022