{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T17:57:37Z","timestamp":1778003857866,"version":"3.51.4"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2023,12,30]],"date-time":"2023-12-30T00:00:00Z","timestamp":1703894400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,12,30]],"date-time":"2023-12-30T00:00:00Z","timestamp":1703894400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Manipal Academy of Higher Education, Bangalore"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sleep Breath"],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Purpose<\/jats:title>\n                <jats:p>The aim of this study is to investigate the effect of comprehensive rehabilitation on apnea hypopnea index (AHI)\u00a0in patients with obstructive sleep apnea\u00a0(OSA).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Patients diagnosed with OSA and meeting the eligibility criteria will be randomly allocated in the groups. The experimental group will receive comprehensive rehabilitation, and the control group will receive myofunctional therapy. CPAP will be continued by all the participants. Both the groups will receive the interventions for 12\u00a0weeks. The primary outcome measures are AHI and Epworth Sleepiness Scale (ESS), and secondary outcomes are Pittsburg Sleep Quality Index (PSQI), Oxygen Desaturation Index (ODI), Snoring Index (SI), Manual Assessment of Respiratory Motion (MARM), Breath Hold Test (BHT), and Self Evaluation of Breathing Questionnaire (SEBQ). The outcomes will be assessed at baseline and at the end of 12\u00a0weeks. A follow-up will be taken at the end of 24\u00a0weeks.\u00a0Power analysis suggests that enrollment of\u00a0118 patients will required. Repeated measures ANOVA will be used to analyze the effect of the intervention.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>By performing this research, we may develop insights on a novel comprehensive approach for treatment of patients with OSA.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Trial registration<\/jats:title>\n                <jats:p>CTRI\/2023\/10\/058486.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s11325-023-02982-2","type":"journal-article","created":{"date-parts":[[2023,12,30]],"date-time":"2023-12-30T02:01:47Z","timestamp":1703901707000},"page":"1099-1104","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Effect of comprehensive rehabilitation on apnea hypopnea index in patients with obstructive sleep apnea: a protocol for randomized controlled trial"],"prefix":"10.1007","volume":"28","author":[{"given":"Mrudula","family":"Pawar","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6753-1154","authenticated-orcid":false,"given":"Prem","family":"Venkatesan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Satyanarayana","family":"Mysore","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guruprasad","family":"Bhat","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2023,12,30]]},"reference":[{"issue":"2","key":"2982_CR1","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1007\/s00408-021-00426-w","volume":"199","author":"JJ Lee","year":"2021","unstructured":"Lee JJ, Sundar KM (2021) Evaluation and management of adults with obstructive sleep apnea syndrome. Lung 199(2):87\u2013101. https:\/\/doi.org\/10.1007\/s00408-021-00426-w","journal-title":"Lung"},{"issue":"19","key":"2982_CR2","doi-asserted-by":"publisher","first-page":"10277","DOI":"10.3390\/ijerph181910277","volume":"18","author":"M Santilli","year":"2021","unstructured":"Santilli M, Manciocchi E, D\u2019addazio G, Di Maria E, D\u2019attilio M, Femminella B et al (2021) Prevalence of obstructive sleep apnea syndrome: a single-center retrospective study. Int J Environ Res Public Health 18(19):10277","journal-title":"Int J Environ Res Public Health"},{"issue":"15","key":"2982_CR3","doi-asserted-by":"publisher","first-page":"1442","DOI":"10.1056\/NEJMcp1816152","volume":"380","author":"CG Solomon","year":"2019","unstructured":"Solomon CG, Veasey SC, Rosen IM (2019) Obstructive sleep apnea in adults. N Engl J Med 380(15):1442\u20131449","journal-title":"N Engl J Med"},{"issue":"3","key":"2982_CR4","doi-asserted-by":"publisher","first-page":"576","DOI":"10.1183\/09031936.97.10030576","volume":"10","author":"KE Bloch","year":"1997","unstructured":"Bloch KE, Li Y, Sackner MA, Russi EW (1997) Breathing pattern during sleep disruptive snoring. Eur Respir J 10(3):576\u2013586","journal-title":"Eur Respir J"},{"issue":"6","key":"2982_CR5","doi-asserted-by":"publisher","first-page":"1222","DOI":"10.1183\/09031936.00058406","volume":"28","author":"I Koutsourelakis","year":"2006","unstructured":"Koutsourelakis I, Vagiakis E, Roussos CZS (2006) Obstructive sleep apnoea and oral breathing in patients free of nasal obstruction. Eur Respir J 28(6):1222\u20131228","journal-title":"Eur Respir J"},{"issue":"3","key":"2982_CR6","doi-asserted-by":"publisher","first-page":"479","DOI":"10.5664\/jcsm.6506","volume":"13","author":"VK Kapur","year":"2017","unstructured":"Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K et al (2017) Clinical practice guideline OSA american academy. J Clin Sleep Med 13(3):479\u2013504","journal-title":"J Clin Sleep Med"},{"issue":"8","key":"2982_CR7","doi-asserted-by":"publisher","first-page":"1036","DOI":"10.1093\/sleep\/29.8.1036","volume":"29","author":"SC Veasey","year":"2006","unstructured":"Veasey SC, Guilleminault C, Strohl KP, Sanders MH, Ballard RD, Magalang UJ (2006) Medical therapy for obstructive sleep apnea: a review by the Medical Therapy for Obstructive Sleep Apnea Task Force of the Standards of Practice Committee of the American Academy of Sleep Medicine. Sleep 29(8):1036\u20131044","journal-title":"Sleep"},{"key":"2982_CR8","doi-asserted-by":"publisher","first-page":"101473","DOI":"10.1016\/j.smrv.2021.101473","volume":"57","author":"SG Sch\u00fctz","year":"2021","unstructured":"Sch\u00fctz SG, Dunn A, Braley TJ, Pitt B, Shelgikar AV (2021) New frontiers in pharmacologic obstructive sleep apnea treatment: a narrative review. Sleep Med Rev 57:101473","journal-title":"Sleep Med Rev"},{"issue":"1","key":"2982_CR9","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1002\/kjm2.12130","volume":"36","author":"HP Chang","year":"2020","unstructured":"Chang HP, Chen YF, Du JK (2020) Obstructive sleep apnea treatment in adults. Kaohsiung J Med Sci 36(1):7\u201312","journal-title":"Kaohsiung J Med Sci"},{"issue":"4","key":"2982_CR10","doi-asserted-by":"publisher","first-page":"971","DOI":"10.1007\/s11739-022-02983-1","volume":"17","author":"F Gambino","year":"2022","unstructured":"Gambino F, Zammuto MM, Virz\u00ec A, Conti G, Bonsignore MR (2022) Treatment options in obstructive sleep apnea. Intern Emerg Med 17(4):971\u2013978","journal-title":"Intern Emerg Med"},{"issue":"5","key":"2982_CR11","doi-asserted-by":"publisher","first-page":"669","DOI":"10.5665\/sleep.4652","volume":"38","author":"M Camacho","year":"2015","unstructured":"Camacho M, Certal V, Abdullatif J, Zaghi S, Ruoff CM, Capasso R et al (2015) Myofunctional therapy to treat obstructive sleep apnea: a systematic review and meta-analysis. Sleep 38(5):669\u2013675","journal-title":"Sleep"},{"key":"2982_CR12","doi-asserted-by":"publisher","unstructured":"Rueda JR, Mugueta-Aguinaga I, Vilar\u00f3 J, Rueda-Etxebarria M (2020) Myofunctional therapy (oropharyngeal exercises) for obstructive sleep apnoea. Cochrane Database Syst Rev 2020(11). https:\/\/doi.org\/10.1002\/14651858.cd013449.pub2","DOI":"10.1002\/14651858.cd013449.pub2"},{"issue":"1","key":"2982_CR13","doi-asserted-by":"publisher","first-page":"1","DOI":"10.52010\/ijom.2022.48.1.2","volume":"48","author":"R Courtney","year":"2022","unstructured":"Courtney R, Engel R, Grace S, Potts A, Riordan B, Ireland K et al (2022) Functional nasal breathing rehabilitation: effectiveness and feasibility of an online integrative breathing therapy protocol. Int J Orofac Myol 48(1):1\u201315","journal-title":"Int J Orofac Myol"},{"key":"2982_CR14","doi-asserted-by":"publisher","unstructured":"Schulz KF, Altman DG, Moher D\u00a0(2010) CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. Trials 11(1). https:\/\/doi.org\/10.1186\/1745-6215-11-32","DOI":"10.1186\/1745-6215-11-32"},{"issue":"3","key":"2982_CR15","doi-asserted-by":"publisher","first-page":"200","DOI":"10.7326\/0003-4819-158-3-201302050-00583","volume":"158","author":"A Chan","year":"2016","unstructured":"Chan A, Tetzlaff JM, Altman DG (2016) 2013 statement\u202f: defining standard protocol items for clinical trials. Ann Intern Med 158(3):200\u2013207","journal-title":"Ann Intern Med"},{"issue":"3","key":"2982_CR16","first-page":"263","volume":"5","author":"LJ Epstein","year":"2009","unstructured":"Epstein LJ, Kristo D, Strollo PJJ, Friedman N, Malhotra A, Patil SP et al (2009) Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin sleep Med JCSM Off Publ Am Acad Sleep Med 5(3):263\u2013276","journal-title":"J Clin sleep Med JCSM Off Publ Am Acad Sleep Med"},{"issue":"10","key":"2982_CR17","doi-asserted-by":"publisher","first-page":"962","DOI":"10.1164\/rccm.200806-981OC","volume":"179","author":"KC Guimar\u00e3es","year":"2009","unstructured":"Guimar\u00e3es KC, Drager LF, Genta PR, Marcondes BF, Lorenzi-Filho G et al (2009) Effects of oropharyngeal exercises on patients with moderate obstructive sleep apnea syndrome. Am J Respir Crit Care Med 179(10):962\u20136","journal-title":"Am J Respir Crit Care Med"},{"key":"2982_CR18","doi-asserted-by":"publisher","unstructured":"Ser\u00e7e S, Ovayolu \u00d6, Bayram N, Ovayolu N, Kul S (2022) The effect of breathing exercise on daytime sleepiness and fatigue among patients with obstructive sleep apnea syndrome. J Breath Res 16(4):046006. https:\/\/doi.org\/10.1088\/1752-7163\/ac894d","DOI":"10.1088\/1752-7163\/ac894d"},{"issue":"1","key":"2982_CR19","doi-asserted-by":"publisher","first-page":"320","DOI":"10.1186\/s12890-023-02612-3","volume":"23","author":"M Qiao","year":"2023","unstructured":"Qiao M, Xie Y, Wolff A, Kwon J (2023) Long term adherence to continuous positive airway pressure in mild obstructive sleep apnea. BMC Pulm Med 23(1):320","journal-title":"BMC Pulm Med"},{"issue":"12","key":"2982_CR20","doi-asserted-by":"publisher","first-page":"2075","DOI":"10.5664\/jcsm.7540","volume":"14","author":"IM Rosen","year":"2018","unstructured":"Rosen IM, Kirsch DB, Carden KA, Malhotra RK, Ramar K, Aurora RN et al (2018) Clinical use of a home sleep apnea test: an updated American Academy of Sleep Medicine position statement. J Clin Sleep Med 14(12):2075\u20132077","journal-title":"J Clin Sleep Med"},{"issue":"1","key":"2982_CR21","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1007\/s11325-021-02372-6","volume":"26","author":"E Zancanella","year":"2022","unstructured":"Zancanella E, do Prado LF, de Carvalho LB, Machado J\u00fanior AJ, Crespo AN, do Prado GF (2022) Home sleep apnea testing: an accuracy study. Sleep Breath 26(1):117\u201323","journal-title":"Sleep Breath"},{"key":"2982_CR22","doi-asserted-by":"crossref","unstructured":"Collop NA, Tracy SL, Kapur V, Mehra R, Kuhlmann D, Fleishman SA, Ojile JM (2011) Obstructive sleep apnea devices for out-of-center (OOC) testing: technology evaluation. J Clin Sleep Med: JCSM: Off Publ Am Acad Sleep Med 7(5):531\u2013548","DOI":"10.5664\/JCSM.1328"},{"key":"2982_CR23","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1016\/j.sleep.2018.06.007","volume":"51","author":"JN Miller","year":"2018","unstructured":"Miller JN, Kupzyk KA, Zimmerman L, Pozehl B, Schulz P, Romberger D et al (2018) Comparisons of measures used to screen for obstructive sleep apnea in patients referred to a sleep clinic. Sleep Med 51:15\u201321. https:\/\/doi.org\/10.1016\/j.sleep.2018.06.007","journal-title":"Sleep Med"},{"issue":"4","key":"2982_CR24","doi-asserted-by":"publisher","first-page":"376","DOI":"10.1093\/sleep\/15.4.376","volume":"15","author":"MW Johns","year":"1992","unstructured":"Johns MW (1992) Reliability and factor analysis of the Epworth Sleepiness Scale. Sleep 15(4):376\u2013381","journal-title":"Sleep"},{"key":"2982_CR25","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1016\/0165-1781(89)90047-4","volume":"28","author":"DJ Buysse","year":"1989","unstructured":"Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 28:193\u2013213","journal-title":"Psychiatry Res"},{"issue":"2","key":"2982_CR26","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1007\/s10484-008-9052-3","volume":"33","author":"R Courtney","year":"2008","unstructured":"Courtney R, Van Dixhoorn J, Cohen M (2008) Evaluation of breathing pattern: comparison of a manual assessment of respiratory motion (MARM) and respiratory induction plethysmography. Appl Psychophysiol Biofeedback 33(2):91\u2013100","journal-title":"Appl Psychophysiol Biofeedback"},{"issue":"17","key":"2982_CR27","doi-asserted-by":"publisher","first-page":"4043","DOI":"10.1113\/JP276206","volume":"596","author":"L Messineo","year":"2018","unstructured":"Messineo L, Taranto-Montemurro L, Azarbarzin A, Oliveira Marques MD, Calianese N, White DP et al (2018) Breath-holding as a means to estimate the loop gain contribution to obstructive sleep apnoea. J Physiol 596(17):4043\u20134056","journal-title":"J Physiol"},{"issue":"2","key":"2982_CR28","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1089\/acm.2007.7204","volume":"14","author":"R Courtney","year":"2008","unstructured":"Courtney R, Cohen M (2008) Investigating the claims of Konstantin Buteyko, M.D., Ph.D.: The relationship of breath holding time to end tidal CO2 and other proposed measures of dysfunctional breathing. J Altern Complement Med 14(2):115\u201323","journal-title":"J Altern Complement Med"},{"issue":"1","key":"2982_CR29","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1007\/s10484-015-9316-7","volume":"41","author":"AJ Mitchell","year":"2016","unstructured":"Mitchell AJ, Bacon CJ, Moran RW (2016) Reliability and determinants of self-evaluation of breathing questionnaire (SEBQ) score: a symptoms-based measure of dysfunctional breathing. Appl Psychophysiol Biofeedback 41(1):111\u2013120","journal-title":"Appl Psychophysiol Biofeedback"}],"container-title":["Sleep and Breathing"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11325-023-02982-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11325-023-02982-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11325-023-02982-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,6,24]],"date-time":"2024-06-24T09:19:24Z","timestamp":1719220764000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11325-023-02982-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,30]]},"references-count":29,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2024,6]]}},"alternative-id":["2982"],"URL":"https:\/\/doi.org\/10.1007\/s11325-023-02982-2","relation":{},"ISSN":["1520-9512","1522-1709"],"issn-type":[{"value":"1520-9512","type":"print"},{"value":"1522-1709","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,30]]},"assertion":[{"value":"18 October 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 December 2023","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 December 2023","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 December 2023","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This research will involve human participants.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Research involving human participants and\/or animals"}},{"value":"All procedures performed in studies involving human participants will be in accordance with the ethical standards of the Manipal Hospital, Bangalore, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Informed consent will be taken from the participants.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"The authors declare no competing interests.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}