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Wishney M, Darendeliler MA, Dalci O. Myofunctional therapy and prefabricated functional appliances: an overview of the history and evidence. Aust Dent J 2019; 64:135-144. [DOI: 10.1111/adj.12690] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2019] [Indexed: 11/30/2022]
Affiliation(s)
- M Wishney
- Discipline of Orthodontics Faculty of Dentistry University of Sydney Sydney New South Wales Australia
- Dental Hospital Sydney Local Health District Surry Hills New South Wales Australia
| | - MA Darendeliler
- Discipline of Orthodontics Faculty of Dentistry University of Sydney Sydney New South Wales Australia
- Dental Hospital Sydney Local Health District Surry Hills New South Wales Australia
| | - O Dalci
- Discipline of Orthodontics Faculty of Dentistry University of Sydney Sydney New South Wales Australia
- Dental Hospital Sydney Local Health District Surry Hills New South Wales Australia
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Brupbacher G, Gerger H, Wechsler M, Zander-Schellenberg T, Straus D, Porschke H, Gerber M, von Känel R, Schmidt-Trucksäss A. The effects of aerobic, resistance, and meditative movement exercise on sleep in individuals with depression: protocol for a systematic review and network meta-analysis. Syst Rev 2019; 8:105. [PMID: 31027509 PMCID: PMC6486698 DOI: 10.1186/s13643-019-1018-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 04/05/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The main objective of this review is to assess the effects of aerobic, resistance, and meditative movement exercise on sleep quality in patients with unipolar depression. A secondary goal is to ascertain the effects on sleep duration, sleepiness, daytime functioning, use of hypnotics, and adverse events. METHODS A systematic computerized search will be performed in the following online databases: PubMed, EMBASE (on Ovid), Cochrane Library, PsycINFO (on Ovid), SPORTDiscus (on EBSCOhost), CINHAL (on EBSCOhost), Clinicaltrials.gov , WHO International Clinical Trials Registry, OpenGrey, and ProQuest Dissertations and Theses. Bibliographies of all included studies as well as any other relevant reviews identified via the search will be screened. Randomized trials using aerobic, resistance, or meditative movement exercise interventions which target sleep as a primary or secondary outcome will be included. The primary outcome will be differences in sleep quality at post-intervention. Secondary outcomes will be adverse events, differences in sleep duration, daytime sleepiness and functioning, and the use of hypnotics at post-intervention. Two authors will independently screen the identified records. Disagreement will be resolved by consensus or if no consensus can be reached by adjudication of a designated third reviewer. Data extraction will be done independently by two authors using a standardized and piloted data extraction sheet. Bias in individual studies will be assessed using the revised Cochrane risk of bias tool. The certainty of evidence across all outcomes will be evaluated using the CINeMA (Confidence in Network Meta-Analysis) framework. A frequentist network meta-analysis will be conducted. The systematic review and network meta-analysis will be presented according to the PRISMA for Network Meta-Analyses (PRISMA-NMA) guideline. DISCUSSION This systematic review and network meta-analysis will provide a synthesis of the currently available evidence concerning the effects of aerobic, resistance, and meditative movement exercises on sleep in patients with unipolar depression. Thereby, we hope to accelerate the consolidation of evidence and inform decision-makers on potential benefits and harms. SYSTEMATIC REVIEW REGISTRATION The protocol has been registered at the International Prospective Register of Systematic Reviews (PROSPERO; registration number: CRD42019115705).
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Affiliation(s)
- Gavin Brupbacher
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052, Basel, Switzerland.
- Oberwaid AG, Rorschacher Strasse 311, 9016, St. Gallen, Switzerland.
| | - Heike Gerger
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Missionsstrasse 62a, 4055, Basel, Switzerland
| | - Monika Wechsler
- University Medical Library Basel, Spiegelgasse 5, 4051, Basel, Switzerland
| | - Thea Zander-Schellenberg
- Division of Clinical Psychology and Epidemiology, Faculty of Psychology, University of Basel, Missionsstrasse 62a, 4055, Basel, Switzerland
| | - Doris Straus
- Oberwaid AG, Rorschacher Strasse 311, 9016, St. Gallen, Switzerland
| | | | - Markus Gerber
- Division of Sport and Psychosocial Health, Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052, Basel, Switzerland
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zürich, University of Zurich, Culmannstrasse 8, 8091, Zurich, Switzerland
| | - Arno Schmidt-Trucksäss
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052, Basel, Switzerland
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Leo CG, Mincarone P, Bodini A, Sedile R, Guarino R, Tumolo MR, Malorgio R, Quitadamo M, Sabato E, Viegi G, Insalaco G, Sabina S. Obstructive sleep apnoea: Improving healthcare services by combining process modelling and population analysis. Int J Med Inform 2019; 127:43-51. [PMID: 31128831 DOI: 10.1016/j.ijmedinf.2019.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 04/01/2019] [Accepted: 04/09/2019] [Indexed: 01/06/2023]
Abstract
CONTEXT Disease management broke through in the early 1990s to counterbalance hyper-specialization with a more comprehensive approach. Its role became immediately relevant in chronic conditions and, consequently, in Obstructive Sleep Apnoea (OSA). This is a common chronic condition for which is important to organise services at the local level, taking into account organisational factors and the characteristics of the assisted population. OBJECTIVES The aim of this work is to propose and apply, coherently with a disease management approach, a combination of healthcare process modelling and population analysis as a way to identify critical issues and explore shared solutions. METHODS A multidisciplinary working group was created with scholars who are skilled in process analysis, statistics and medicine. Through semi-structured interviews and on-site meetings, healthcare processes were represented with a standard graphical language: Unified Modeling Language™. Population analysis was based on statistical analysis performed on a 5-year retrospective cohort assisted by a Community Pulmonary Service. RESULTS A shared graphic presentation of the current healthcare process and the results of the statistical analyses constituted the knowledge base to identify critical issues and recommend corresponding solutions, which include: a) refine the local patient database with additional details on comorbidities and risk factors; b) support a greater involvement of "gate-keepers" in the screening phase; c) provide practical tools for the definition of strategies to increment the adherence to therapy; d) include recommendations for physical exercise and interdisciplinary cooperation; and e) define process indicators for measuring the quality of the screening and therapeutic phases. CONCLUSION The concomitant analyses of formalised processes and critical risk factors represent a useful approach for systematically identifying areas of improvement in healthcare processes and allow us to discuss solutions. Moreover, the specific adoption of UML® for graphical modelling and representation of patient care processes allows us to formalise them by adopting a standard language that can be taken as the basis for implementing web services to support the execution of the modelled processes.
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Affiliation(s)
- Carlo Giacomo Leo
- National Research Council, Institute of Clinical Physiology, Branch of Lecce, c/o Ecotekne via Monteroni, 73100 Lecce, Italy.
| | - Pierpaolo Mincarone
- National Research Council Institute, for Research on Population and Social Policies, Research Unit of Brindisi, c/o ex Osp. Di Summa, Piazza Di Summa, 72100 Brindisi, Italy.
| | - Antonella Bodini
- National Research Council, Institute for Applied Mathematics and Information Technologies "Enrico Magenes", Branch of Milan, Via Bassini 15, 20133 Milan, Italy.
| | - Raffaella Sedile
- National Research Council, Institute of Clinical Physiology, Branch of Lecce, c/o Ecotekne via Monteroni, 73100 Lecce, Italy.
| | - Roberto Guarino
- National Research Council, Institute of Clinical Physiology, Branch of Lecce, c/o Ecotekne via Monteroni, 73100 Lecce, Italy.
| | - Maria Rosaria Tumolo
- National Research Council Institute, for Research on Population and Social Policies, Research Unit of Brindisi, c/o ex Osp. Di Summa, Piazza Di Summa, 72100 Brindisi, Italy.
| | - Roberto Malorgio
- Local Health Unit of Brindisi, Community Pulmonary Service, Via Dalmazia 3, 72100, Italy.
| | - Matteo Quitadamo
- Local Health Unit of Brindisi, Community Pulmonary Service, Via Dalmazia 3, 72100, Italy.
| | - Eugenio Sabato
- National Research Council Institute, for Research on Population and Social Policies, Research Unit of Brindisi, c/o ex Osp. Di Summa, Piazza Di Summa, 72100 Brindisi, Italy; Local Health Unit of Brindisi, "Perrino" Hospital, Pulmonary Department, S.S. 7 per Mesagne Brindisi, Italy.
| | - Giovanni Viegi
- National Research Council, Institute of Biomedicine and Molecular Immunology "Alberto Monroy", via U. La Malfa, 153, 90146 Palermo, Italy.
| | - Giuseppe Insalaco
- National Research Council, Institute of Biomedicine and Molecular Immunology "Alberto Monroy", via U. La Malfa, 153, 90146 Palermo, Italy.
| | - Saverio Sabina
- National Research Council, Institute of Clinical Physiology, Branch of Lecce, c/o Ecotekne via Monteroni, 73100 Lecce, Italy.
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Crump C, Sundquist J, Winkleby MA, Sundquist K. Cardiorespiratory fitness and long-term risk of sleep apnea: A national cohort study. J Sleep Res 2019; 28:e12851. [PMID: 30957362 DOI: 10.1111/jsr.12851] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 02/25/2019] [Accepted: 02/26/2019] [Indexed: 01/20/2023]
Abstract
Sleep apnea is increasing in prevalence, and is an important cause of cardiometabolic diseases and mortality worldwide. Its only established modifiable risk factor is obesity; however, up to half of all sleep apnea cases may occur in non-obese persons, and hence there is a pressing need to identify other modifiable risk factors to facilitate more effective prevention. We sought to examine, for the first time, cardiorespiratory fitness in relation to the risk of sleep apnea, independent of obesity. A national cohort study was conducted to examine cardiorespiratory fitness in all 1,547,478 Swedish military conscripts during 1969-1997 (97%-98% of all 18-year-old men) in relation to risk of sleep apnea through 2012 (maximum age 62 years). Cardiorespiratory fitness was measured as maximal aerobic workload in Watts, and sleep apnea was identified from nationwide outpatient and inpatient diagnoses. A total of 44,612 (2.9%) men were diagnosed with sleep apnea in 43.7 million person-years of follow-up. Adjusting for age, height, weight, socioeconomic factors and family history of sleep apnea, low cardiorespiratory fitness at age 18 years was associated with a significantly increased risk of sleep apnea in adulthood (lowest versus highest cardiorespiratory fitness tertile: incidence rate ratio, 1.44; 95% confidence interval, 1.40-1.49; p < 0.001; continuous cardiorespiratory fitness per 100 Watts: incidence rate ratio, 0.71; 95% confidence interval, 0.70-0.73; p < 0.001). An increased risk was observed even among men with normal body mass index (lowest versus highest cardiorespiratory fitness tertile: incidence rate ratio, 1.30; 95% confidence interval, 1.26-1.35; p < 0.001). These findings identify low cardiorespiratory fitness early in life as a new modifiable risk factor for development of sleep apnea in adulthood.
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Affiliation(s)
- Casey Crump
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jan Sundquist
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Marilyn A Winkleby
- Stanford Prevention Research Center, Stanford University, Stanford, CA, USA
| | - Kristina Sundquist
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Center for Primary Health Care Research, Lund University, Malmö, Sweden
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Gubelmann C, Heinzer R, Haba-Rubio J, Vollenweider P, Marques-Vidal P. Physical activity is associated with higher sleep efficiency in the general population: the CoLaus study. Sleep 2019; 41:4956778. [PMID: 29617980 DOI: 10.1093/sleep/zsy070] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Indexed: 11/15/2022] Open
Abstract
Study Objectives To evaluate the association of objective physical activity (PA) and sedentary behavior (SB) with sleep duration and quality. Methods Cross-sectional study including 2649 adults (53.5% women, 45-86 years) from the general population. Proportions of time spent in PA and SB were measured using 14 day accelerometry. Low PA and high SB statuses were defined as the lowest and highest tertile of each behavior. "Inactive," "Weekend warrior," and "Regularly active" weekly patterns were also defined. Sleep parameters were derived from the accelerometer and validated questionnaires. Results High PA, relative to low PA, was associated with higher sleep efficiency (76.6 vs. 73.8%, p < 0.01) and lower likelihood of evening chronotype [relative-risk ratio (RR) and 95% CI: 0.71 (0.52; 0.97)]. Similar associations were found for low SB relative to high SB. "Weekend warriors" relative to "Inactives," had higher sleep efficiency [76.4 vs. 73.9%, p < 0.01] and lower likelihood of evening chronotype [RR: 0.63 (0.43; 0.93)]. "Regularly actives," relative to "Inactives," had higher sleep efficiency [76.7 vs. 73.9%, p < 0.01] and tended to have less frequently an evening chronotype [RR: 0.75 (0.54; 1.04), p = 0.09]. No associations were found for PA and SB with sleep duration, daytime sleepiness, insomnia, and risk of sleep apnea (after adjustment for body mass index). Conclusions High PA and low SB individuals, even if they do not sleep longer, have higher sleep efficiency and have less frequently an evening chronotype.
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Affiliation(s)
- Cédric Gubelmann
- Department of Medicine, Internal Medicine, Lausanne University Hospital, Switzerland
| | - Raphael Heinzer
- Centre for Investigation and Research in Sleep, Lausanne University Hospital, Switzerland
| | - José Haba-Rubio
- Centre for Investigation and Research in Sleep, Lausanne University Hospital, Switzerland
| | - Peter Vollenweider
- Department of Medicine, Internal Medicine, Lausanne University Hospital, Switzerland
| | - Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital, Switzerland
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Van Offenwert E, Vrijsen B, Belge C, Troosters T, Buyse B, Testelmans D. Physical activity and exercise in obstructive sleep apnea. Acta Clin Belg 2019; 74:92-101. [PMID: 29726745 DOI: 10.1080/17843286.2018.1467587] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES In the last decade significant research has focused on the relationship between physical activity (PA), exercise and obstructive sleep apnea (OSA). The purpose of this study is to provide an overview and interpretation of different studies regarding this subject. METHODS PubMed, Embase and Cochrane Library databases were searched for English articles published before August 21, 2017. Search terms were 'Sleep Apnea, Obstructive' and 'Exercise'. RESULTS Low levels of PA are associated with higher odds of OSA. A negative correlation between PA level and OSA severity is shown, even after adjusting for baseline differences. OSA also impairs the aerobic exercise capacity significantly. OSA patients have a poor hemodynamic response to exercise, which is related to OSA severity. Findings on the influence of continuous positive airway pressure (CPAP) on PA in OSA are inconsistent in terms of statistical significance. A regular and predominantly aerobic exercise training significantly reduces OSA severity, even without a significant decrease in body weight. CONCLUSION The available evidence suggests that further research is necessary to explore the relationships between PA, exercise and OSA and to examine the efficacy of exercise as alternative or additional treatment for OSA.
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Affiliation(s)
| | - Bart Vrijsen
- Department of Pulmonology, University Hospitals Leuven, Leuven, Belgium
| | - Catharina Belge
- Department of Pulmonology, University Hospitals Leuven, Leuven, Belgium
| | - Thierry Troosters
- Department of Rehabilitation Sciences, Pulmonary Rehabilitation and Respiratory Division, University Hospitals Leuven, Leuven, Belgium
| | - Bertien Buyse
- Department of Pulmonology, University Hospitals Leuven, Leuven, Belgium
| | - Dries Testelmans
- Department of Pulmonology, University Hospitals Leuven, Leuven, Belgium
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57
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Torres-Castro R, Vilaró J, Martí JD, Garmendia O, Gimeno-Santos E, Romano-Andrioni B, Embid C, Montserrat JM. Effects of a Combined Community Exercise Program in Obstructive Sleep Apnea Syndrome: A Randomized Clinical Trial. J Clin Med 2019; 8:jcm8030361. [PMID: 30875753 PMCID: PMC6463021 DOI: 10.3390/jcm8030361] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/09/2019] [Accepted: 03/10/2019] [Indexed: 12/27/2022] Open
Abstract
Physical activity is associated with a decreased prevalence of obstructive sleep apnea and improved sleep efficiency. Studies on the effects of a comprehensive exercise program in a community setting remain limited. Our objective was to investigate the effects of a combined physical and oropharyngeal exercise program on the apnea-hypopnea index in patients with moderate to severe obstructive sleep apnea. This was a randomized clinical trial where the intervention group followed an eight-week urban-walking program, oropharyngeal exercises, and diet and sleep recommendations. The control group followed diet and sleep recommendations. A total of 33 patients were enrolled and randomized and, finally, 27 patients were included in the study (IG, 14; CG, 13) Obstructive sleep apnea patients were analyzed with a median age of 67 (52–74) and median apnea-hypopnea index of 32 events/h (25–41). The apnea-hypopnea index did not differ between groups pre- and post-intervention. However, in intervention patients younger than 60 (n = 6) a reduction of the apnea-hypopnea index from 29.5 (21.8–48.3) to 15.5 (11–34) events/h (p = 0.028) was observed. While a comprehensive multimodal program does not modify the apnea-hypopnea index, it could reduce body weight and increase the walking distance of patients with moderate to severe obstructive sleep apnea. Patients younger than 60 may also present a decreased apnea-hypopnea index after intervention.
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Affiliation(s)
- Rodrigo Torres-Castro
- Servicio de Neumología, Unidad del Sueño, Hospital Clínic de Barcelona, 08036 Barcelona, Spain.
- Departamento de Kinesiología, Facultad de Medicina, Universidad de Chile, 8380453 Santiago, Chile.
| | - Jordi Vilaró
- Facultad de Ciencias de la Salud Blanquerna. Global Research on Wellbeing (GRoW)), Universitat Ramon Llull, 08025 Barcelona, Spain.
| | - Joan-Daniel Martí
- Unidad de Cuidados Intensivos en Cirugía Cardiovascular, Instituto Clínico Cardiovascular, Hospital Clínic de Barcelona, 08036 Barcelona, Spain.
| | - Onintza Garmendia
- Servicio de Neumología, Unidad del Sueño, Hospital Clínic de Barcelona, 08036 Barcelona, Spain.
| | - Elena Gimeno-Santos
- Respiratory Institute, Hospital Clínic de Barcelona, 08036 Barcelona, Spain.
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain.
| | - Bárbara Romano-Andrioni
- Servicio de Endocrinología y Nutrición, Hospital Clínic de Barcelona, 08036 Barcelona, Spain.
| | - Cristina Embid
- Servicio de Neumología, Unidad del Sueño, Hospital Clínic de Barcelona, 08036 Barcelona, Spain.
| | - Josep M Montserrat
- Servicio de Neumología, Unidad del Sueño, Hospital Clínic de Barcelona, 08036 Barcelona, Spain.
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58
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Kim JW, Lim HJ. Lifestyle Modification in Patients with Obstructive Sleep Apnea. SLEEP MEDICINE RESEARCH 2018. [DOI: 10.17241/smr.2018.00255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Targeting volume overload and overnight rostral fluid shift: A new perspective to treat sleep apnea. Sleep Med Rev 2018; 42:160-170. [DOI: 10.1016/j.smrv.2018.07.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 07/25/2018] [Accepted: 07/31/2018] [Indexed: 01/15/2023]
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Effects of 12 weeks of regular aerobic exercises on autonomic nervous system in obstructive sleep apnea syndrome patients. Sleep Breath 2018; 22:1189-1195. [DOI: 10.1007/s11325-018-1736-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 09/12/2018] [Accepted: 10/03/2018] [Indexed: 12/16/2022]
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Bollens B, Reychler G. Efficacy of exercise as a treatment for Obstructive Sleep Apnea Syndrome: A systematic review. Complement Ther Med 2018; 41:208-214. [PMID: 30477841 DOI: 10.1016/j.ctim.2018.10.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 09/30/2018] [Accepted: 10/01/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Obstructive Sleep Apnea Syndrome (OSAS) is a prevalent condition associated with numerous adverse health consequences. Exercise therapy was described as a valuable OSAS treatment alternative to continuous positive airway pressure. OBJECTIVE The objective of the present systematic review was to assess the efficacy of exercise in reducing OSAS severity and associated comorbidities. SETTING We queried MEDLINE and SCOPUS and ScienceDirect databases with the following keywords: "sleep apnea" and "sleep disordered breathing" for the population and "physical activity", "fitness" and "exercise" for the intervention. RESULTS Eight studies including a total number of 354 patients showed that OSAS severity was significantly reduced after intervention. This reduction was associated with significant improvement in cardio-vascular fitness, sleep quality and quality of life. Conversely, this effect was not directly related to body weight reduction. CONCLUSION This systematic review suggests that physical activity should be recommended as a treatment for OSAS patients. However, further research is necessary to demonstrate this long-term efficiency with a higher level of confidence and to better understand the underlying physiological mechanisms.
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Affiliation(s)
- Benjamin Bollens
- Cliniques universitaires Saint-Luc, Physical and Rehabilitation Medicine Department, Avenue Hippocrate, 10, 1200 Brussels, Belgium.
| | - Grégory Reychler
- Cliniques universitaires Saint-Luc, Physical and Rehabilitation Medicine Department, Avenue Hippocrate, 10, 1200 Brussels, Belgium; Cliniques universitaires Saint-Luc, Pneumology Department, Avenue Hippocrate, 10, 1200 Brussels, Belgium
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Gruet M. Fatigue in Chronic Respiratory Diseases: Theoretical Framework and Implications For Real-Life Performance and Rehabilitation. Front Physiol 2018; 9:1285. [PMID: 30283347 PMCID: PMC6156387 DOI: 10.3389/fphys.2018.01285] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 08/27/2018] [Indexed: 12/13/2022] Open
Abstract
Fatigue is a primary disabling symptom in chronic respiratory diseases (CRD) with major clinical implications. However, fatigue is not yet sufficiently explored and is still poorly understood in CRD, making this symptom underdiagnosed and undertreated in these populations. Fatigue is a dynamic phenomenon, particularly in such evolving diseases punctuated by acute events which can, alone or in combination, modulate the degree of fatigue experienced by the patients. This review supports a comprehensive inter-disciplinary approach of CRD-related fatigue and emphasizes the need to consider both its performance and perceived components. Most studies in CRD evaluated perceived fatigue as a trait characteristic using multidimensional scales, providing precious information about its prevalence and clinical impact. However, these scales are not adapted to understand the complex dynamics of fatigue in real-life settings and should be augmented with ecological assessment of fatigue. The state level of fatigue must also be considered during physical tasks as severe fatigue can emerge rapidly during exercise. CRD patients exhibit alterations in both peripheral and central nervous systems and these abnormalities can be exacerbated during exercise. Laboratory tests are necessary to provide mechanistic insights into how and why fatigue develops during exercise in CRD. A better knowledge of the neurophysiological mechanisms underlying perceived and performance fatigability and their influence on real-life performance will enable the development of new individualized countermeasures. This review aims first to shed light on the terminology of fatigue and then critically considers the contemporary models of fatigue and their relevance in the particular context of CRD. This article then briefly reports the prevalence and clinical consequences of fatigue in CRD and discusses the strengths and weaknesses of various fatigue scales. This review also provides several arguments to select the ideal test of performance fatigability in CRD and to translate the mechanistic laboratory findings into the clinical practice and real-world performance. Finally, this article discusses the dose-response relationship to training and the feasibility and validity of using the fatigue produced during exercise training sessions in CRD to optimize exercise training efficiency. Methodological concerns, examples of applications in selected diseases and avenues for future research are also provided.
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Mônico-Neto M, Moreira Antunes HK, dos Santos RVT, D'Almeida V, Alves Lino de Souza A, Azeredo Bittencourt LR, Tufik S. Physical activity as a moderator for obstructive sleep apnoea and cardiometabolic risk in the EPISONO study. Eur Respir J 2018; 52:13993003.01972-2017. [DOI: 10.1183/13993003.01972-2017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 07/28/2018] [Indexed: 11/05/2022]
Abstract
Obstructive sleep apnoea (OSA) is positively associated with cardiometabolic diseases; however, high levels of physical activity could decrease the incidence of OSA and associated comorbidities.In this study we aimed to examine the incidence of OSA in relation to physical activity, and its role as a protective factor in individuals with OSA on the incidence of cardiometabolic diseases, in an 8–9-year follow-up study. We analysed data of 658 volunteers from the São Paulo Epidemiologic Sleep Study (EPISONO), a cohort study of individuals aged 20–80 years, collected through polysomnography, the International Physical Activity Questionnaire and an assessment of cardiometabolic profile.Active subjects had a lower risk of developing OSA compared with nonactive subjects (relative risk 0.877, 95% CI 0.296–0.855) and there was a reduced risk of developing type 2 diabetes mellitus in active/apnoeic subjects (relative risk 0.493, 95% CI 0.252–0.961) compared with nonactive subjects. Metabolic equivalent was negatively associated to cardiometabolic markers, such as C-reactive protein (exp(B)=0.720; p=0.001), interleukin-6 (exp(B)=0.991; p=0.03), insulin (exp(B)=0.982; p=0.03), triglycerides (exp(B)=0.997; p<0.001), homeostasis model assessment for insulin resistance (exp(B)≤0.946; p<0.024), quantitative insulin sensitivity check index (exp(B)=992.4; p<0.001) and mean arterial pressure (exp(B)=0.987; p=0.001).Physical activity was a protective factor against type 2 diabetes mellitus in apnoeic individuals; moreover, being active reduced the risk of developing OSA and was associated with a better cardiometabolic profile.
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Vancampfort D, Stubbs B, Smith L, Hallgren M, Firth J, Herring MP, Probst M, Koyanagi A. Physical activity and sleep problems in 38 low- and middle-income countries. Sleep Med 2018; 48:140-147. [DOI: 10.1016/j.sleep.2018.04.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 03/26/2018] [Accepted: 04/11/2018] [Indexed: 10/16/2022]
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Gao YN, Wu YC, Lin SY, Chang JZC, Tu YK. Short-term efficacy of minimally invasive treatments for adult obstructive sleep apnea: A systematic review and network meta-analysis of randomized controlled trials. J Formos Med Assoc 2018. [PMID: 29523457 DOI: 10.1016/j.jfma.2018.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Many treatments have been proposed for adult obstructive sleep apnea (OSA), but no comprehensive comparison of all interventions has been performed. We aimed to compare and rank the effectiveness of all minimally invasive treatments for adult OSA in a systematic review and network meta-analysis. Literature was searched within Ovid MedLine, EMBASE Classic+Embase, Cochrane library, and Cochrane Database of Systematic Reviews from inception to Aug 9th, 2016 for randomized controlled trials comparing minimally invasive treatments for adult OSA. The outcomes were the changes in apnea-hypopnea index (AHI) and Epworth sleepiness scale (ESS). Frequentist approach to network meta-analysis was used and treatment hierarchy was summarized according to the surfaces under the cumulative ranking curves. Eighty-nine randomized controlled trials comprising 6346 adult OSA participants and comparing 18 different interventions were included. In comparison with no treatment, positive airway pressure (PAP) was most effective in reducing AHI (23.28 [weighted mean difference]; 95% confidence interval: 19.20-27.35). PAP was ranked first followed by mandibular advancement device (MAD) in reducing AHI. Exercise was ranked first followed by cervico-mandibular support collar in reducing ESS. Considering the effectiveness in reducing both AHI and ESS, PAP was ranked the best, followed by MAD and positional therapy, while lifestyle modification alone was the least effective intervention. Interventions that are highly effective in reducing objective laboratory-derived AHI do not demonstrate equivalent effectiveness in improving patients' subjective sleepiness. Future improvement of the interventions is necessary to simultaneously improve both objective and subjective outcomes.
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Affiliation(s)
- You-Ning Gao
- School of Dentistry, College of Medicine, National Taiwan University, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Yun-Chun Wu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Shih-Ying Lin
- School of Dentistry, College of Medicine, National Taiwan University, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Jenny Zwei-Chieng Chang
- School of Dentistry, College of Medicine, National Taiwan University, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan.
| | - Yu-Kang Tu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
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66
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Mendelson M, Bailly S, Marillier M, Flore P, Borel JC, Vivodtzev I, Doutreleau S, Verges S, Tamisier R, Pépin JL. Obstructive Sleep Apnea Syndrome, Objectively Measured Physical Activity and Exercise Training Interventions: A Systematic Review and Meta-Analysis. Front Neurol 2018. [PMID: 29520251 PMCID: PMC5827163 DOI: 10.3389/fneur.2018.00073] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
A systematic review of English and French articles using Pubmed/Medline and Embase included studies assessing objective physical activity levels of obstructive sleep apnea (OSA) patients and exploring the effects of exercise training on OSA severity, body mass index (BMI), sleepiness, and cardiorespiratory fitness [peak oxygen consumption (VO2peak)]. Two independent reviewers analyzed the studies, extracted the data, and assessed the quality of evidence. For objective physical activity levels, eight studies were included. The mean number of steps per day across studies was 5,388 (95% CI: 3,831–6,945; p < 0.001), which was by far lower than the recommended threshold of 10,000 steps per day. For exercise training, six randomized trials were included. There was a significant decrease in apnea–hypopnea-index following exercise training (mean decrease of 8.9 events/h; 95% CI: −13.4 to −4.3; p < 0.01), which was accompanied by a reduction in subjective sleepiness, an increase in VO2peak and no change in BMI. OSA patients present low levels of physical activity and exercise training is associated with improved outcomes. Future interventions (including exercise training) focusing on increasing physical activity levels may have important clinical impacts on both OSA severity and the burden of associated co-morbidities. Objective measurement of physical activity in routine OSA management and well-designed clinical trials are recommended. Registration # CRD42017057319 (Prospero).
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Affiliation(s)
- Monique Mendelson
- 1HP2 Laboratory, University Grenoble Alpes, Grenoble, France.,U1042, INSERM, Grenoble, France
| | - Sébastien Bailly
- 1HP2 Laboratory, University Grenoble Alpes, Grenoble, France.,U1042, INSERM, Grenoble, France
| | - Mathieu Marillier
- 1HP2 Laboratory, University Grenoble Alpes, Grenoble, France.,U1042, INSERM, Grenoble, France
| | - Patrice Flore
- 1HP2 Laboratory, University Grenoble Alpes, Grenoble, France.,U1042, INSERM, Grenoble, France
| | - Jean Christian Borel
- 1HP2 Laboratory, University Grenoble Alpes, Grenoble, France.,U1042, INSERM, Grenoble, France.,AGIR à Dom. Association, Meylan, France
| | - Isabelle Vivodtzev
- 1HP2 Laboratory, University Grenoble Alpes, Grenoble, France.,U1042, INSERM, Grenoble, France
| | - Stéphane Doutreleau
- 1HP2 Laboratory, University Grenoble Alpes, Grenoble, France.,U1042, INSERM, Grenoble, France.,Grenoble Alps University Hospital, Grenoble, France
| | - Samuel Verges
- 1HP2 Laboratory, University Grenoble Alpes, Grenoble, France.,U1042, INSERM, Grenoble, France
| | - Renaud Tamisier
- 1HP2 Laboratory, University Grenoble Alpes, Grenoble, France.,U1042, INSERM, Grenoble, France.,Grenoble Alps University Hospital, Grenoble, France
| | - Jean-Louis Pépin
- 1HP2 Laboratory, University Grenoble Alpes, Grenoble, France.,U1042, INSERM, Grenoble, France.,Grenoble Alps University Hospital, Grenoble, France
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67
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Vivodtzev I, Tamisier R, Croteau M, Borel JC, Grangier A, Wuyam B, Lévy P, Minville C, Sériès F, Maltais F, Pépin JL. Ventilatory support or respiratory muscle training as adjuncts to exercise in obese CPAP-treated patients with obstructive sleep apnoea: a randomised controlled trial. Thorax 2018; 73:thoraxjnl-2017-211152. [PMID: 29463621 DOI: 10.1136/thoraxjnl-2017-211152] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 01/08/2018] [Accepted: 01/29/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) and obesity are interdependent chronic diseases sharing reduced exercise tolerance and high cardiovascular risk. INTERVENTION A 3-month intervention with innovative training modalities would further improve functional capacity and cardiovascular health than usual cycle exercise training in already continuous positive airway pressure (CPAP)-treated obese patients with OSA. METHODS Fifty three patients (35 MEASUREMENTS AND MAIN RESULTS All training modalities increased 6 min walking distance without differences between groups (P=0.97). ERGO+NIV and ERGO+RMT led to significantly higher improvement in VO2peak compared with ERGO (3.1 (95% CI 1.6 to 4.6) vs 2.3 (0.8 to 3.7) vs 0.5(-1.0 to 1.9) mL/min/kg, respectively, P=0.04) and ERGO+NIV significantly reduced self-measured blood pressure compared with ERGO+RMT and ERGO (systolic: -9.5 (95% CI -14.1 to -4.9) vs -13 (-5.8 to 3.1) vs -0.7 (-5.1 to 3.8) mm Hg, respectively, P=0.01). Waist and neck circumferences were reduced after ERGO+NIV compared with ERGO+RMT and ERGO (P=0.01). CONCLUSIONS Combining RMT or NIV with cycling exercise training failed to provide further improvement in functional capacity as compared with cycling exercise training alone. However, the combination of NIV and exercise training demonstrated superiority for improving cardiometabolic risk factors in obese CPAP-treated patients with OAS. TRIAL REGISTRATION NUMBER Results, NCT01155271.
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Affiliation(s)
- Isabelle Vivodtzev
- HP2 Laboratory, Centre Hospitalier Universitaire Grenoble Alpes, INSERM U1042, Grenoble Alps University, Grenoble, France
- Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Cambridge, Massachusetts, USA
| | - Renaud Tamisier
- HP2 Laboratory, Centre Hospitalier Universitaire Grenoble Alpes, INSERM U1042, Grenoble Alps University, Grenoble, France
| | - Marilie Croteau
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec, QC, Canada
| | - Jean-Christian Borel
- HP2 Laboratory, Centre Hospitalier Universitaire Grenoble Alpes, INSERM U1042, Grenoble Alps University, Grenoble, France
| | - Angélique Grangier
- HP2 Laboratory, Centre Hospitalier Universitaire Grenoble Alpes, INSERM U1042, Grenoble Alps University, Grenoble, France
| | - Bernard Wuyam
- HP2 Laboratory, Centre Hospitalier Universitaire Grenoble Alpes, INSERM U1042, Grenoble Alps University, Grenoble, France
| | - Patrick Lévy
- HP2 Laboratory, Centre Hospitalier Universitaire Grenoble Alpes, INSERM U1042, Grenoble Alps University, Grenoble, France
| | - Caroline Minville
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec, QC, Canada
| | - Frédéric Sériès
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec, QC, Canada
| | - François Maltais
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec, QC, Canada
| | - Jean-Louis Pépin
- HP2 Laboratory, Centre Hospitalier Universitaire Grenoble Alpes, INSERM U1042, Grenoble Alps University, Grenoble, France
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68
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Gautier-Veyret E, Pépin JL, Stanke-Labesque F. Which place of pharmacological approaches beyond continuous positive airway pressure to treat vascular disease related to obstructive sleep apnea? Pharmacol Ther 2017; 186:45-59. [PMID: 29277633 DOI: 10.1016/j.pharmthera.2017.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Obstructive sleep apnea (OSA) is characterized by recurrent episodes of partial or complete upper airway obstruction, occurring during sleep, leading to chronic intermittent hypoxia (IH), which harms the cardiovascular system. OSA is associated with both functional and structural vascular alterations that contribute to an increased prevalence of fatal and non-fatal cardiovascular events. OSA is a heterogeneous disease with respect to the severity of hypoxia, the presence of daytime symptoms, obesity, and cardiovascular comorbidities. Various clusters of OSA phenotypes have been described leading to more highly personalized treatment. The aim of this review is to describe the various therapeutic strategies including continuous positive airway pressure (CPAP), oral appliances, surgery, weight loss, and especially pharmacological interventions that have been evaluated to reduce vascular alterations in both OSA patients and preclinical animal models. Conventional therapies, predominantly CPAP, have a limited impact on vascular alterations in the presence of co-morbidities. A better knowledge of pharmacological therapies targeting IH-induced vascular alterations will facilitate the use of combined therapies and is crucial for designing clinical trials in well-defined OSA phenotypes.
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Affiliation(s)
- Elodie Gautier-Veyret
- Univ. Grenoble Alpes, HP2, F-38041 Grenoble, France; INSERM U1042, 38041 Grenoble, France; Centre hospitalier Universitaire Grenoble Alpes, 38043 Grenoble, France.
| | - Jean-Louis Pépin
- Univ. Grenoble Alpes, HP2, F-38041 Grenoble, France; INSERM U1042, 38041 Grenoble, France; Centre hospitalier Universitaire Grenoble Alpes, 38043 Grenoble, France
| | - Françoise Stanke-Labesque
- Univ. Grenoble Alpes, HP2, F-38041 Grenoble, France; INSERM U1042, 38041 Grenoble, France; Centre hospitalier Universitaire Grenoble Alpes, 38043 Grenoble, France
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69
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Igelström H, Åsenlöf P, Emtner M, Lindberg E. Improvement in obstructive sleep apnea after a tailored behavioural sleep medicine intervention targeting healthy eating and physical activity: a randomised controlled trial. Sleep Breath 2017; 22:653-661. [PMID: 29222619 PMCID: PMC6133123 DOI: 10.1007/s11325-017-1597-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 10/30/2017] [Accepted: 11/15/2017] [Indexed: 12/19/2022]
Abstract
Purpose The aim of the present single-centre randomised controlled trial was to assess the effect of a behavioural sleep medicine (BSM) intervention on obstructive sleep apnea (OSA) severity in patients who have been referred for new treatment with continuous positive airway pressure (CPAP). Methods After baseline assessment including ventilatory and anthropometric parameters, and physical activity monitoring, 86 patients who were overweight (BMI ≥ 25) and had moderate-severe OSA with apnea-hypopnea index (AHI) ≥ 15 were randomised into a control group (CG; CPAP and advice about weight loss) or an experimental group (ExpG; CPAP and BSM intervention targeting physical activity and eating behaviour). The BSM intervention comprised 10 individual sessions with a dietician and a physiotherapist and included behaviour change techniques such as goal setting and self-monitoring. After 6 months, a new recording of ventilatory parameters was performed without CPAP. Results In ExpG, 40% (n = 14) had improved from severe to moderate or mild OSA or from moderate to mild OSA compared to 16.7% in CG (n = 6, p = 0.02). Further, a lower AHI and amount body fat at baseline were correlated with improvement in severity class. Being in ExpG implied a mean improvement in AHI by 9.7 and an odds ratio of 4.5 for improving in severity classification. Conclusions The results highlight the clinical importance of lifestyle modifications in conjunction with CPAP treatment in patients with OSA.
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Affiliation(s)
- Helena Igelström
- Department of Neuroscience; Physiotherapy, Uppsala University, Box 593, BMC, SE-75124, Uppsala, Sweden. .,Department of Medical Sciences; Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
| | - Pernilla Åsenlöf
- Department of Neuroscience; Physiotherapy, Uppsala University, Box 593, BMC, SE-75124, Uppsala, Sweden
| | - Margareta Emtner
- Department of Neuroscience; Physiotherapy, Uppsala University, Box 593, BMC, SE-75124, Uppsala, Sweden.,Department of Medical Sciences; Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Eva Lindberg
- Department of Medical Sciences; Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
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70
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Andrade FMDD, Pedrosa RP. The role of physical exercise in obstructive sleep apnea. J Bras Pneumol 2017; 42:457-464. [PMID: 28117479 PMCID: PMC5344097 DOI: 10.1590/s1806-37562016000000156] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 10/31/2016] [Indexed: 12/20/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a common clinical condition, with a variable and underestimated prevalence. OSA is the main condition associated with secondary systemic arterial hypertension, as well as with atrial fibrillation, stroke, and coronary artery disease, greatly increasing cardiovascular morbidity and mortality. Treatment with continuous positive airway pressure is not tolerated by all OSA patients and is often not suitable in cases of mild OSA. Hence, alternative methods to treat OSA and its cardiovascular consequences are needed. In OSA patients, regular physical exercise has beneficial effects other than weight loss, although the mechanisms of those effects remain unclear. In this population, physiological adaptations due to physical exercise include increases in upper airway dilator muscle tone and in slow-wave sleep time; and decreases in fluid accumulation in the neck, systemic inflammatory response, and body weight. The major benefits of exercise programs for OSA patients include reducing the severity of the condition and daytime sleepiness, as well as increasing sleep efficiency and maximum oxygen consumption. There are few studies that evaluated the role of physical exercise alone for OSA treatment, and their protocols are quite diverse. However, aerobic exercise, alone or combined with resistance training, is a common point among the studies. In this review, the major studies and mechanisms involved in OSA treatment by means of physical exercise are presented. In addition to systemic clinical benefits provided by physical exercise, OSA patients involved in a regular, predominantly aerobic, exercise program have shown a reduction in disease severity and in daytime sleepiness, as well as an increase in sleep efficiency and in peak oxygen consumption, regardless of weight loss.
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Affiliation(s)
- Flávio Maciel Dias de Andrade
- Laboratório do Sono e Coração, Pronto-Socorro Cardiológico de Pernambuco - PROCAPE - Universidade de Pernambuco, Recife (PE) Brasil.,Hospital Metropolitano Sul Dom Helder Câmara, Instituto de Medicina Integral Professor Fernando Figueira - IMIP Hospitalar - Recife (PE) Brasil
| | - Rodrigo Pinto Pedrosa
- Laboratório do Sono e Coração, Pronto-Socorro Cardiológico de Pernambuco - PROCAPE - Universidade de Pernambuco, Recife (PE) Brasil.,Hospital Metropolitano Sul Dom Helder Câmara, Instituto de Medicina Integral Professor Fernando Figueira - IMIP Hospitalar - Recife (PE) Brasil
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71
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Parsons C, Allen S, Parish J, Mookadam F, Mookadam M. The efficacy of continuous positive airway pressure therapy in reducing cardiovascular events in obstructive sleep apnea: a systematic review. Future Cardiol 2017. [DOI: 10.2217/fca-2017-0004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Prospective studies show an association between obstructive sleep apnea and cardiovascular disease. Continuous positive airway pressure (CPAP) is the treatment of choice and effectively reduces subjective sleepiness and apneic and hypopneic events. However, randomized trials have not shown a reduction in cardiovascular outcomes with CPAP therapy. We review the past 10 years of randomized trial evidence regarding the therapeutic efficacy of CPAP on cardiovascular outcomes and mortality in adults with obstructive sleep apnea. The majority of studies found no significant improvement in cardiovascular outcomes with CPAP, although many noted nonsignificant benefits. Adjusted analysis in several trials showed significant cardiovascular benefit in those patients with higher CPAP compliance. Existing trials may lack sufficient follow-up and CPAP compliance, among other limitations.
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Affiliation(s)
- Christine Parsons
- Department of Internal Medicine, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259, USA
| | - Sorcha Allen
- Department of Internal Medicine, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259, USA
| | - James Parish
- Department of Sleep Disorders & Pulmonology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259, USA
| | - Farouk Mookadam
- Division of Cardiovascular Diseases, Mayo Clinic, 13400 EShea Blvd, Scottsdale, AZ 85259, USA
| | - Martina Mookadam
- Department of Family Medicine, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259, USA
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72
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Abstract
Sleep-related breathing disorders include obstructive sleep apnea (OSA), central sleep apnea, sleep-related hypoventilation, and sleep-related hypoxemia. Excessive daytime sleepiness (EDS) is frequently reported by patients with OSA but is not invariably present. The efficacy of positive airway pressure therapy in improving EDS is well established for OSA, but effectiveness is limited by suboptimal adherence. Non-OSA causes of sleepiness should be identified and treated before initiating pharmacotherapy for persistent sleepiness despite adequately treated OSA. Further research on the identification of factors that promote EDS in the setting of OSA is needed to aid in the development of better treatment options.
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Affiliation(s)
- Ken He
- Division of General Internal Medicine, University of Washington, Seattle, WA 98195, USA; Hospital and Sleep Medicine Sections, VA Puget Sound Health Care System, S-111-Pulm, 1660 South Columbian Way, Seattle, WA 98108, USA
| | - Vishesh K Kapur
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA 98104, USA
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Interrelationship between Sleep and Exercise: A Systematic Review. Adv Prev Med 2017; 2017:1364387. [PMID: 28458924 PMCID: PMC5385214 DOI: 10.1155/2017/1364387] [Citation(s) in RCA: 131] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 03/13/2017] [Indexed: 01/08/2023] Open
Abstract
Although a substantial body of literature has explored the relationship between sleep and exercise, comprehensive reviews and definitive conclusions about the impact of exercise interventions on sleep are lacking. Electronic databases were searched for articles published between January 2013 and March 2017. Studies were included if they possessed either objective or subjective measures of sleep and an exercise intervention that followed the guidelines recommended by the American College of Sports Medicine. Thirty-four studies met these inclusion criteria. Twenty-nine studies concluded that exercise improved sleep quality or duration; however, four found no difference and one reported a negative impact of exercise on sleep. Study results varied most significantly due to participants' age, health status, and the mode and intensity of exercise intervention. Mixed findings were reported for children, adolescents, and young adults. Interventions conducted with middle-aged and elderly adults reported more robust results. In these cases, exercise promoted increased sleep efficiency and duration regardless of the mode and intensity of activity, especially in populations suffering from disease. Our review suggests that sleep and exercise exert substantial positive effects on one another; however, to reach a true consensus, the mechanisms behind these observations must first be elucidated.
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