Impact of respiratory muscle training on sleep disordered breathing in people with tetraplegia: a sub-analysis of a randomised controlled trial
6 affiliations
- 1The Kolling Institute and the School of Medical Scfiences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW Australia
- 2University of New South Wales, Sydney, NSW Australia
- 3Prince of Wales Hospital, Randwick, NSW Australia
- 4Royal North Shore Hospital, St Leonards, NSW Australia
- 5The George Institute for Global Health, Newtown, NSW Australia
- 6FHMRI Sleep Health, Flinders University, Adelaide, SA Australia
Abstract
Study design: Sub-analysis of a randomised controlled trial.
Objectives: Respiratory muscle training (RMT) in people with tetraplegia yields marked improvements in inspiratory muscle strength. The present study investigated whether RMT also modifies sleep disordered breathing (SDB) and daytime sleepiness.
Setting: Independent research institute in Sydney, Australia.
Methods: Sixty-two adults with tetraplegia underwent six weeks of supervised RMT. The active-RMT group trained the respiratory muscles through progressive threshold loading to a mean intensity of 50% maximal inspiratory pressure whereas the sham-RMT group experienced the same training protocol, but their device had no progressive threshold load. Primary measures of SDB were obtained using level II ambulatory polysomnograms and daytime sleepiness was assessed using the Epworth Sleepiness Scale (ESS) at baseline and after 6-weeks RMT.
Results: Forty-eight participants completed two home-based polysomnograms. Maximal inspiratory pressure (primary outcome) increased more after active intervention than sham, between-group difference 11.8cmH2O (95%CI, 5.2–18.4, p = 0.001). There were no between group differences for any SDB parameter; mean apnoea-hypopnea index (± SD) (active 46 ± 21 vs. 45 ± 22 events/h; sham 44 ± 25 vs. 40 ± 25 events/h; p = 0.553) nor ESS (active 9.5 ± 5.7 vs. 9.2 ± 6.7; sham 10.8 ± 6.2 vs. 10.1 ± 5.8; p = 0.952).
Conclusions: Despite significant increases in inspiratory muscle strength, 6 weeks of supervised respiratory muscle training at a mean intensity of 50% maximal inspiratory pressure does not reduce SDB or daytime sleepiness in people with tetraplegia and severe SDB.
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BibTeX
@article{boswellruys2026impact,
title = {{Impact of respiratory muscle training on sleep disordered breathing in people with tetraplegia: a sub-analysis of a randomised controlled trial}},
author = {Claire L. Boswell-Ruys and R. H. Chaminda Lewis and Rachel A. McBain and Nirupama S. Wijesuriya and Danny J. Eckert and Bonsan Bonne Lee and Simon C. Gandevia and Jane E. Butler},
journal = {Spinal Cord},
year = {2026},
month = aug,
doi = {10.1038/s41393-026-01252-8},
url = {https://doi.org/10.1038/s41393-026-01252-8},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Impact of respiratory muscle training on sleep disordered breathing in people with tetraplegia: a sub-analysis of a randomised controlled trial
AU - Claire L. Boswell-Ruys
AU - R. H. Chaminda Lewis
AU - Rachel A. McBain
AU - Nirupama S. Wijesuriya
AU - Danny J. Eckert
AU - Bonsan Bonne Lee
AU - Simon C. Gandevia
AU - Jane E. Butler
PY - 2026
DA - 2026/08/13
JO - Spinal Cord
DO - 10.1038/s41393-026-01252-8
UR - https://doi.org/10.1038/s41393-026-01252-8
AB - Study design: Sub-analysis of a randomised controlled trial. Objectives: Respiratory muscle training (RMT) in people with tetraplegia yields marked improvements in inspiratory muscle strength. The present study investigated whether RMT also modifies sleep disordered breathing (SDB) and daytime sleepiness. Setting: Independent research institute in Sydney, Australia. Methods: Sixty-two adults with tetraplegia underwent six weeks of supervised RMT. The active-RMT group trained the respiratory muscles through progressive threshold loading to a mean intensity of 50% maximal inspiratory pressure whereas the sham-RMT group experienced the same training protocol, but their device had no progressive threshold load. Primary measures of SDB were obtained using level II ambulatory polysomnograms and daytime sleepiness was assessed using the Epworth Sleepiness Scale (ESS) at baseline and after 6-weeks RMT. Results: Forty-eight participants completed two home-based polysomnograms. Maximal inspiratory pressure (primary outcome) increased more after active intervention than sham, between-group difference 11.8cmH2O (95%CI, 5.2–18.4, p = 0.001). There were no between group differences for any SDB parameter; mean apnoea-hypopnea index (± SD) (active 46 ± 21 vs. 45 ± 22 events/h; sham 44 ± 25 vs. 40 ± 25 events/h; p = 0.553) nor ESS (active 9.5 ± 5.7 vs. 9.2 ± 6.7; sham 10.8 ± 6.2 vs. 10.1 ± 5.8; p = 0.952). Conclusions: Despite significant increases in inspiratory muscle strength, 6 weeks of supervised respiratory muscle training at a mean intensity of 50% maximal inspiratory pressure does not reduce SDB or daytime sleepiness in people with tetraplegia and severe SDB.
SN - 1362-4393
SN - 1476-5624
ER -