The effect of playing a wind instrument or singing on risk of sleep apnea: a systematic review and meta-analysis

J Clin Sleep Med. 2020 Sep 15;16(9):1591-1601. doi: 10.5664/jcsm.8628.


Study objectives: To systematically survey the scientific literature concerning the effect of playing a wind instrument or singing on sleep, snoring, and/or obstructive sleep apnea.

Methods: The PubMed, EMBASE, and Cochrane databases were searched up to December 2019. Observational studies and (Randomized) Controlled Clinical Trials that assessed sleep, snoring, or obstructive sleep apnea as clinical outcome or via a questionnaire were included. For the individual studies, the potential risk of bias was scored. Data between oral musicians and control participants were extracted. Descriptive analysis and meta-analysis were performed.

Results: Six eligible studies (5 cross-sectional, 1 randomized controlled trial) were retrieved, with an estimated potential bias ranking from low to high. The sample sizes ranged from 25 to 1,105 participants. Descriptive analysis indicated that players of a double-reed instrument have a lower risk of obstructive sleep apnea and that singers snore less compared with control participants. Playing a didgeridoo showed a positive effect on apnea-hypopnea index, daytime sleepiness, and partner's rating for sleep disturbance. The descriptive analysis could not be substantiated in the meta-analysis. The magnitude of the effect was zero to small, and the generalizability was limited because of long (professional) rehearsal time or small sample size.

Conclusions: Playing a wind instrument and singing may have a small but positive effect on sleep disorders. Considering the practicality and investment of (rehearsal) time, didgeridoo and singing are the most promising interventions to reduce obstructive sleep apnea and snoring, respectively. However, the results of this review are based on few studies and the synthesis of the evidence is graded to have low certainty.

Keywords: OSA; singing; sleep; sleep apnea; snoring; wind instrument.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Cross-Sectional Studies
  • Humans
  • Singing*
  • Sleep Apnea Syndromes*
  • Sleep Apnea, Obstructive* / therapy
  • Snoring