Exercises For Sleep Apnea

exercises for sleep apnea 1
impression exercises for sleep apnea 1

Exercises For Sleep Apnea

June 14, 2011 (Minneapolis) — Three new studies show that people who are more physically active sleep longer and more deeply than those who are sedentary. For adults with sleep apnea, a condition that stresses the heart and repeatedly interrupts sleep when breathing briefly slows or stops, an exercise program that combined brisk walking and weight training cut the severity of their disorder by 25% — as much as some kinds of surgery. “The most compelling point of the research was that this 25% reduction was achieved without any reduction in body weight,” says study researcher Christopher Kline, PhD, a postdoctoral scholar in the department of psychiatry at the University of Pittsburgh School of Sleep Medicine. Being overweight is a well-known risk factor for sleep apnea, and previous studies have shown that losing weight may improve the condition. “For a 25% reduction due to weight loss, you actually need to lose about 10% of your body weight,” Kline says. For his study participants, who weighed, on average, more than 220 pounds, “They’d have to lose 22 pounds for them to achieve the same benefit that we achieved just through exercise.” A separate analysis on the same study volunteers found that exercise also improved daytime sleepiness, decreased fatigue, and sharpened thinking compared to a program of light stretching. “I think studies like this one are very important, because we need as many options for treating sleep apnea as we can get,” says Virend Somers, MD, PhD, a cardiologist and sleep apnea specialist at the Mayo Clinic in Rochester, Minn., who was not involved in the research. Studies have shown that sleep apnea increases blood pressure. Sleep apnea has also been linked to higher risks for a host of cardiovascular problems, including strokes, heart attacks, heart failure, and fluttering heartbeats called arrhythmias. “I think it’s a very good strategy because along with treating the sleep apnea, exercise, we know, has a breadth of cardiovascular benefits in terms of mitigating established risk factors. This is particularly important in this population,” Somers says. Still, Somers notes, this is one of the earliest studies to test this approach. And although the risk to patients who want to copy this exercise program is low, he says more studies are needed to see how durable the improvements may be and whether patients could see even more benefit if they combined exercise with weight loss. Somers and the study researchers say that because apnea can have such serious health consequences, it would be a mistake for people to think, based on this study, that exercise alone could substitute for medical therapies like continuous positive airway pressure, or CPAP, machines, which completely eliminate apnea. But it’s a step in the right direction, he says.
exercises for sleep apnea 1

Exercises For Sleep Apnea

DiscussionOur findings indicate that exercise training has a statistically significant effect on AHI that seems to be independent of changes in BMI. An important finding of our meta-analysis is that the reduction in OSA severity was achieved without a significant reduction in body weight. This suggests a possible role of exercise in the treatment of sleep apnea. Using a pre- to postintervention model and pooling the mean differences in AHI across the studies, we found that exercise training resulted in a mean AHI reduction of 6.27 events/h. Limiting the results to studies that used exercise as the sole intervention and using change scores to calculate the difference in AHI between the cohorts that received exercise as an intervention and the controls, we found a similar reduction in AHI. Our meta-analysis shows that BMI did not change with exercise, but there was a significant improvement in sleep efficiency and daytime sleepiness.The AHI reduction seen in our meta-analysis seems modest compared with similar meta-analyses that evaluated the effects of dietary weight loss, surgery, oral appliances, and CPAP on OSA severity. Anandam et al. , in a meta-analysis of studies on dietary weight loss intervention showed a reduction in AHI by 23.1 events/h (95 % CI 8.9–37.3, p = 0.001) corresponding to a 44 % reduction compared with baseline. In another meta-analysis, oral appliances were found to reduce AHI by 12.07 events/h (95 % CI −9.7 to −14.3, p < 0.01), suggesting an improvement of 60.25 % postintervention . Finally, Greenburg et al. showed that bariatric surgery reduced AHI by 38.2 events/h (95 % CI 31.9–44.4), possibly suggesting a 71.11 % improvement compared to baseline.An important finding of our meta-analysis is that the reduction in OSA severity was achieved without a significant reduction in body weight. This is an important distinction, as epidemiologic research estimates that a reduction in body weight of approximately 10 % would be necessary to achieve the 25–30 % reduction in OSA severity that we documented with exercise . Furthermore, complete amelioration of OSA is not necessary to obtain significant health benefits; even modest differences in OSA severity have been associated with significantly reduced risk of adverse health outcomes (e.g., hypertension) . Finally, whereas CPAP and oral appliances are dependent upon nightly use to obtain the effects, evidence indicates that exercise training elicits chronic reduction in the severity of OSA .Besides changes in OSA severity, the improvements in secondary outcomes following exercise training are noteworthy. The improvement in cardiorespiratory fitness has unique health and longevity benefits . Moreover, the improvement in sleep efficiency with exercise is similar to what is typically achieved with CPAP . Likewise, the effects on daytime sleepiness (as measured by the Epworth Sleepiness Scale) with exercise training is similar to that seen with CPAP . Therefore, although based upon a small number of studies, these preliminary findings suggest that the effects of exercise in adults with OSA extend past AHI reduction.Although converging evidence suggests beneficial effects of exercise training on the severity of sleep apnea, the current body of evidence remains inconclusive on the exact mechanisms of these effects. Different theories have been proposed. An earlier study in canines found increased tone in the genioglossus muscle when the gastrocnemius muscle and sciatic nerve were stimulated . Later, two studies in humans raised some interest in the possible role of strength of respiratory muscles in relation to exercise . However, contrary to this hypothesis, Sengul et al. found no change in the strength of respiratory muscles in OSA patients who received breathing and aerobic exercise training.Some authors have also suggested that exercise can lead to decreased leg fluid accumulation and, hence, prevent the nocturnal rostral fluid shift that may be implicated in upper airway collapse . This mechanism would more likely be associated with a potential acute effect of exercise rather than a training effect, which could nevertheless be important if repeated frequently. However, a recent study by Jafari and Mohsenin casts some doubt on this study, as they found no progressive worsening in OSA despite a demonstrable fluid shift overnight.Slow wave sleep (SWS) has been found to be associated with decreased severity of sleep apnea . In the study by McSharry et al. this effect was thought to be related to the increased genioglossus single motor unit activity during SWS, making the airway more stable and resistant to collapse. It also is known that exercise training is associated with increased SWS . Is it possible that the effects of exercise on reducing sleep apnea severity could be related to the protective effects of SWS that it induces?. Proving such a relationship in a well designed study would indeed be more insightful. However, it is possible that no single mechanism is responsible and perhaps there is a complex interplay of factors associated with exercise training that leads to improvement in the severity of sleep apnea.Our meta-analysis has numerous strengths. First, our analysis had enough power to detect an effect of exercise intervention in the included studies. Given a total of 87 participants that received exercise intervention, we estimate that our meta-analysis had a power of 100 % to detect a change in AHI of 12.8 assuming a standard deviation of nine. Second, there was no evidence of publication bias by funnel plots. Third, our sensitivity analyses showed no significant change in the overall statistical significance of the results. Fourth, the analysis for the change in AHI based on the pre- and postintervention effects of exercise showed no significant heterogeneity. Finally, our study showed that significant effects from exercise training occurred despite the fact that studies differed in the mode, frequency, intensity, compliance, and levels of supervision of the exercise interventions.However, there also are limitations to our study. Most of the studies had a small sample size and the length of intervention in most studies ranged from 12 to 24 weeks. Therefore, this meta-analysis does not address the long-term efficacy of exercise training on OSA severity. With so few studies thus far, it was not possible to evaluate which exercise characteristics were associated with more favorable OSA outcomes. It also is a limitation of our study that the data on secondary outcomes had moderate to high heterogeneity.In conclusion, our meta-analysis demonstrates that exercise training leads to a significant reduction in AHI, improvement in sleep efficiency, and daytime sleepiness, independent of the effects on BMI. Although the effect size in AHI reduction seems smaller compared with CPAP and oral appliances, exercise training may be an ideal adjunct therapy, especially considering its effects on sleep efficiency and daytime sleepiness. Given the preliminary nature of our findings, RCTs involving a larger number of participants and longer duration of intervention are needed to determine whether the beneficial effects of exercise training in patients with sleep apnea can be sustained over a longer period of time.

Exercises For Sleep Apnea

Exercises For Sleep Apnea
Exercises For Sleep Apnea
Exercises For Sleep Apnea
Exercises For Sleep Apnea
Exercises For Sleep Apnea

Be the first to comment

Leave a Reply

Your email address will not be published.


*