Joint Research Projects
Study In Thailand
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Introduction
Obstructive sleep apnea (OSA) a sleep-breathing disorder that affects 7-24% of the adult population. It is defined by repeated apnea/hypopnea during sleep and causes fragmented sleep and decreased oxygen saturation in patients with OSA. Current first-line treatment for OSA is continuous positive airway pressure (CPAP). However, the adherence to CPAP is less then optimal because of the cost and interference to sleep. There are other treatments included mandibular advancement device (MAD), upper airway surgery, physical therapy, and lifestyle counseling. In the alternate treatments, physical therapy is one of the most cost-effective option. Our previous studies have shown physical therapy intervention can mitigate the number of apnea/hypopnea events during sleep and improve oxygen saturation rate in patients with OSA. However, hospital-based physical therapy needed to be supplemented by home exercise to produce adequate treatment effect. To mitigate the inherent limitations in adherence and performance accuracy of home exercise, we aim to develop a smartphone application for home-based physical therapy to improve the adherence and performance accuracy of home exercise and thus improving the treatment effect of home-based physical therapy.
Methods
The physical therapy program used for this program is based on a program developed by Dr. Ching-Hsia Hung’s group. The program includes two parts, a part of upper airway and respiratory muscle strengthening exercises and a part of general endurance training. The detailed description of the program is summarized in Figure 1 and Figure 2. The smartphone application we developed included videos and figures to provide step-by-step tutorials for each exercise. In addition, there will be pop-up notifications on the screen or alarm at preset times to remind patients the time to practice. We intend to recruit 30 newly diagnosed OSA patients to use our smartphone application to assist the performance of home exercise for 8 weeks. For the evaluation of treatment effect, polysomnography (PSG) will be applied to all subjects to compare the changes of sleep parameters after 8 weeks treatment. The patient adherence will be measured by self-report diary and time of using recorded by the application.
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1. Upper airway muscle strengthening: 20 minutes
(1) Retropalatal exercise: Phase I: Isotonic elevation of the soft palate and uvula with intermittently pronouncing the vowel. Phase II: Yawning and simultaneously elevating the soft palate and uvala on voluntary basis, sustain for 5 s. Repeat the procedure 10 times per set, perform two sets for each exercise session.
(2) Retroglossal exercise: Phase I: Placing the tip of the tongue against the front of the palate and sliding the tongue backward; sticking the tongue in and out while the mouth opens. Phase II: Sticking the tongue out forwardly and deviate laterally, and finally curling upward and downward; slowly rotating the tongue as a circle between the teeth and the mouth and as far as possible. Phase III: Forcing the back of the tongue against the floor of the mouth while keeping the tip of the tongue in contact with the inferior incisive teeth, and sustaining for 8 s; sticking the tongue out as previously and against the tongue depressor as resisted loading. Repeat the procedure 10 times per set, perform two sets for each exercise session.
(3) Deglutition exercise: Swallowing saliva while gently holding the tongue between front teeth; then, additional loading imposed while holding the tongue in neck extension position and controlling swallowing saliva while keeping water in mouth. Repeat the procedure 10 times per set, perform two sets for each exercise session.
(4) Temporo-Mandibular Joint exercise: It involves muscle balance control between supra-hyoid and infra-hyoid muscles. Jaw movement was introduced with resisted loading, especially while opening/closing the mouth and protruding/retruding the jaw. Repeat the procedure 10 times per set, perform two sets for each exercise session.
(5) Facial exercise: Buccinators: Recruitment of the buccinator muscle against the finger that was introduced in the oral cavity, pressing the buccinator muscle outward for 10 s. Orbicularis oris: Pucker the lips as if about to kiss and hold for 10 s. Buccinators and orbicularis oris: Recruitment of the buccinators and orbicularis oris when puffing out one’s cheeks as fully as possible with keeping lips closed for 15 s. Repeat all exercises 10 times per set, perform two sets for each exercise session. |
Figure 1. Description of upper airway and respiratory muscle exercise
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3-1 Stretching exercise
(1) biceps stretch (2) chest stretch (3) neck/back stretch (4) trunk/hip flexors stretch (5) hamstring/calf stretch One exercise session contained one set of 8 repetitions, the participant would hold for 10 seconds at the end-range of each exercise. |
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3-2 Resistance exercise
(1) sit-ups (2) modified push-ups One exercise session contained 2 sets of 8 repetitions |
Figure 2. Description of general endurance training
Results
Our research group have developed a smartphone application for patient use. The instructions, step-by-step tutorials and notifications have successfully localized for Vietnamese speakers. Please refer to the attached video for demonstration.
Figure 3. Screenshots of the home-based physical therapy exercise smartphone application
Discussion
Our preliminary result showed the instruction and tutorial of the home-based physical therapy program can be successfully integrated to a smartphone device and localize for Vietnamese users (the instructions were originally produced in Chinese and English). Further trials in patients with OSA is already underway in order to evaluate the effect of the application to improve patient adherence and performance accuracy of the home-based physical therapy program.
