1011 Telehealth Breath Training for Alleviation of Sleep Disturbed Breathing: a Pilot Study

Abstract

Introduction: Sleep Disturbed Breathing (SDB) results from anatomical and neuro-physiological triggers. Several studies indicate breath training can mitigate symptoms. Specifically mild hypoxic sequences with slow hypopnic breathing exercises over several weeks may invoke neuroplastic changes stabilizing breathing control. We pilot tested a telehealth solution to train patients remotely. Results support further research. Method(s): 7 adults, RDI 5-20, BMI < 35, no compounding co-morbidities were recruited. Pre- and post-training polysomnographic data, Sleep Apnea Quality of Life (SAQLI) and Epworth Sleepiness Scale (ESS) Indices were recorded. Training included written and recorded instruction. Subjects performed prompted breathing sequences, combining six mildly hypoxic breath-holds with relaxed controlled breathing, 20 minutes daily over 6 weeks. Wireless finger-tip PPG/SpO2 sensors monitored sessions. Data were analyzed for heart and breathing rates, HRV, SpO2, vagal tone and breath holding times (BHT). Result(s): Post training, mean SAQLI increased by +4% (SD 15%); ESS declined by -60% (SD -90%); integrated snoring metrics fell by 32% (SD 35%), 55% (SD 35%) and 75% (SD 29%) at levels >30dB, >40db and >50db respectively; BHT's increased by 69% (SD 76%) asymptotic to a steady value. AHI/RDI data were inconclusive. Conclusion(s): Daily training using mild self-imposed hypoxia with intervening hypopneic intervals via telehealth showed significant reductions in snoring especially at high intensities indicating improved upper airway responsiveness. Symptom questionnaires reported positive outcomes. AHI/RDI data were inconclusive. Telehealth enabled individual breath training might help with SDB either as an adjunctive or stand-alone treatment and reduce neurophysiological triggers exacerbating SDB in some phenotypes. We suggest further research with a larger population to explore potential benefits including AHI/RDI reduction as an adjunct lowcost non-invasive therapy for SDB and OSA. Subjects should be screened for phenotypic neurophysiological traits known to contribute to SDB including high loop gain, poor upper airway responsiveness and low arousal threshold pre- and post-training to determine if efficacy is greater in particular phenotypes.