阻塞性睡眠呼吸暂停的康复与治疗性运动：超越呼吸暂停低通气指数的视角。

文献信息

中文摘要

引言： 阻塞性睡眠呼吸暂停（OSA）是一种多系统疾病，其临床影响超出夜间呼吸事件。尽管呼吸暂停低通气指数（AHI）被广泛用于对疾病严重程度进行分类，但该参数不能充分反映OSA患者所经历的功能、症状和生活质量负担。在此背景下，康复干预已成为该疾病综合管理中相关的治疗策略。
目的： 综合关于康复在OSA患者中作用的现有科学证据，强调其超越AHI的临床影响及其对以患者为中心结局的贡献。
方法： 在PubMed、Embase/Scopus和Google Scholar中进行了结构化文献检索的叙述性综述。纳入评估成人OSA人群康复干预的随机对照试验、系统综述和荟萃分析。检索涵盖运动训练、口咽肌功能治疗、吸气肌训练和多学科生活方式项目，使用全面的多术语检索语法。
结果： 证据表明，康复干预可导致日间嗜睡、睡眠质量、功能能力、认知表现和生活质量的持续改善，即使AHI的变化不大或可变。多学科项目显示出最稳健的效果，包括在选定亚组中AHI降低超过50%（INTERAPNEA试验）。最近的一项伞状综述证实，在所有评估的非药物干预中，结构化体育活动在生活质量方面取得了最大改善。
结论： 康复是OSA综合管理的重要组成部分，提供超越AHI的临床有意义益处，并强化以患者功能和生活质量为中心的治疗方法。

英文摘要

INTRODUCTION: Obstructive sleep apnea (OSA) is a multisystem disease whose clinical impact extends beyond nocturnal respiratory events. Although the apnea hypopnea index (AHI) is widely used to classify disease severity, this parameter does not adequately reflect the functional, symptomatic, and quality-of-life burden experienced by individuals with OSA. In this context, rehabilitative interventions have emerged as relevant therapeutic strategies within the comprehensive management of the disease.
OBJECTIVE: To synthesize the available scientific evidence on the role of rehabilitation in individuals with OSA, highlighting its clinical impact beyond the AHI and its contribution to patient-centered outcomes.
METHODS: A narrative review with structured bibliographic search was conducted in PubMed, Embase/Scopus, and Google Scholar. Randomized controlled trials, systematic reviews, and meta-analyses evaluating rehabilitative interventions in adult populations with OSA were included. The search covered exercise training, oropharyngeal myofunctional therapy, inspiratory muscle training, and interdisciplinary lifestyle programs using a comprehensive, multi-term search syntax.
RESULTS: The evidence indicates that rehabilitative interventions lead to consistent improvements in daytime sleepiness, sleep quality, functional capacity, cognitive performance, and quality of life, even when changes in the AHI are modest or variable. Interdisciplinary programs demonstrated the most robust effects, including reductions in AHI exceeding 50% in selected subgroups (INTERAPNEA trial). A recent umbrella review confirmed that structured physical activity achieved the greatest improvements in quality of life among all non-pharmacological interventions evaluated.
CONCLUSION: Rehabilitation represents an essential component of the comprehensive management of OSA, providing clinically meaningful benefits beyond the AHI and reinforcing a therapeutic approach centered on patient functionality and quality of life.