Effects of exercise on sleep symptoms in patients with severe obstructive sleep apnea

Abstract

Objective: To investigate the extent to which exercise is associated with symptoms in patients with severe obstructive sleep apnea (OSA). Methods: We included subjects with an apnea-hypopnea index (AHI) > 30 events/h who completed validated sleep and exercise questionnaires. We compared symptom frequency/scores between exercisers and nonexercisers, adjusting for the usual confounders. Results: The sample included 907 nonexercisers and 488 exercisers (mean age, 49 ± 14 years; mean AHI, 53 ± 20 events/h; 81% men). Nonexercisers and exercisers differed significantly in terms of obesity (72% vs. 54%), the mean proportion of sleep in non-rapid eye movement stage 3 sleep (9 ± 8% vs. 11 ± 6%), and tiredness (78% vs. 68%). Nonexercisers had a higher symptom frequency/scores and poorer sleep quality. Adjustment for exercise weakened the associations between individual symptoms and the AHI, indicating that exercise has a mitigating effect. In binary logistic models, exercise was associated with approximately 30% lower adjusted questionnaire1 score > 2, tiredness; poor-quality sleep, unrefreshing sleep, and negative mood on awakening. Although the odds of an Epworth Sleepiness Scale score > 10 were lower in exercisers, that association did not withstand adjustment for confounders. Conclusions: Exercise is associated with lower frequency/intensity of symptoms in patients with severe OSA. Because up to one third of patients with severe OSA might exercise regularly and therefore be mildly symptomatic, it is important not to rule out a diagnosis of OSA in such patients.

Exercise and obstructive sleep apnoea: a 24-week follow-up study

“…Possible explanatory effects of exercise on sleep discussed in the literature include improved fitness levels, changes in body composition, and changes in night-time heart rate variability and metabolism 29. In addition, patients with OSA who exercise are less likely to complain about poor sleep quality than non-exercisers 30. The correlation between sleepiness and OSA severity is found to be poor,30 as demonstrated in a study on exercise and diet that found significant weight loss and improvement in daytime sleepiness without changes in AHI 31.…”

“…In addition, patients with OSA who exercise are less likely to complain about poor sleep quality than non-exercisers 30. The correlation between sleepiness and OSA severity is found to be poor,30 as demonstrated in a study on exercise and diet that found significant weight loss and improvement in daytime sleepiness without changes in AHI 31. As discussed in extant literature,7 night-time neck fluid accumulation may increase AHI; this could be reduced with physical activity, which leads to less retention of leg fluid that can shift to the neck during sleep 32 33…”

The Brazilian Journal of Pulmonology and its progress in the major international databases

“…The articles with the highest number of citations, which influenced our indicators, were primarily those on tuberculosis, lung cancer, and sleep disorders, some of which were produced exclusively by researchers in Brazil, whereas others involved international collaboration. 5 - 7 Another relevant aspect is that, according to the JCR database, 43% of the articles published in 2017 and 2018 were cited in 2019. In addition, in accordance with the objectives proposed at the beginning of the current editorship, efforts have been made to increase the numbers of guidelines and recommendations for the major respiratory diseases, as well as the number of editorials by international authors and the number of articles with a greater impact on clinical practice, which will certainly contribute to a greater visibility of the Journal, nationally and internationally.…”