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Objective: Chemoreflex hypersensitity was caused by obstructive sleep apnea (OSA) in patients with metabolic syndrome (MetS). This study tested the hypothesis that hypocaloric diet and exercise training (D1ET) would improve peripheral and central chemoreflex sensitivity in patients with MetS and OSA. Methods: Patients were assigned to: (1) D1ET (n 5 16) and (2) no intervention control (C, n 5 8). Minute ventilation (VE, pre-calibrated pneumotachograph) and muscle sympathetic nerve activity (MSNA, microneurography) were evaluated during peripheral chemoreflex sensitivity by inhalation of 10% O 2 and 90% N 2 with CO 2 titrated and central chemoreflex by 7% CO 2 and 93% O 2 for 3 min at study entry and after 4 months. Results: Peak VO 2 was increased by D1ET; body weight, waist circumference, glucose levels, systolic/diastolic blood pressure, and apnea-hypopnea index (AHI) (34 6 5.1 vs. 18 6 3.2 events/h, P 5 0.04) were reduced by D1ET. MSNA was reduced by D1ET at rest and in response to hypoxia (8.6 6 1.2 vs. 5.4 6 0.6 bursts/min, P 5 0.02), and VE in response to hypercapnia (14.8 6 3.9 vs. 9.1 6 1.2 l/min, P 5 0.02). No changes were found in the C group. A positive correlation was found between AHI and MSNA absolute changes (R 5 0.51, P 5 0.01) and body weight and AHI absolute changes (R 5 0.69, P < 0.001). Conclusions: Sympathetic peripheral and ventilatory central chemoreflex sensitivity was improved by D1ET in MetS1OSA patients, which may be associated with improvement in sleep pattern.

We identified 10 risk factors significantly associated with the need for ANR in newborns ≥34 weeks. We developed a validated risk score that allows the identification of newborns at higher risk of need for ANR. Using this tool, the presence of specialised personnel in the delivery room may be designated more appropriately.

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