Association between sleep disorders, obesity, and exercise: a review

Trent A Hargens, Anthony S Kaleth, Elizabeth S Edwards, Katrina L Butner, Trent A Hargens, Anthony S Kaleth, Elizabeth S Edwards, Katrina L Butner

Abstract

Decreased sleep duration and quality is associated with an increase in body weight and adiposity. Insomnia, obstructive sleep apnea, and restless legs syndrome are three of the most prevalent types of sleep disorder that lead to an increased risk for numerous chronic health conditions. Various studies have examined the impact of these sleep disorders on obesity, and are an important link in understanding the relationship between sleep disorders and chronic disease. Physical activity and exercise are important prognostic tools in obesity and chronic disease, and numerous studies have explored the relationship between obesity, sleep disorders, and exercise. As such, this review will examine the relationship between sleep disorders and obesity. In addition, how sleep disorders may impact the exercise response and how exercise may impact patient outcomes with regard to sleep disorders will also be reviewed.

Keywords: insomnia; obesity; obstructive sleep apnea; sleep disorders.

References

    1. International Classification of Sleep Disorders. Diagnostic and Coding Manual. 2nd ed. Westchester, IL: American Academy of Sleep Medicine; 2005.
    1. Roth T, Roehrs T, Pies R. Insomnia: pathophysiology and implications for treatment. Sleep Med Rev. 2007;11:71–79.
    1. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328:1230–1235.
    1. Young T, Evans L, Finn L, Palta M. Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep. 1997;20:705–706.
    1. Innes KE, Selfe TK, Agarwal P. Prevalence of restless legs syndrome in North American and Western European populations: a systematic review. Sleep Med. 2011;12:623–634.
    1. Lopez-Garcia E, Faubel R, Leon-Munoz L, Zuluaga MC, Banegas JR, Rodriguez-Artalejo F. Sleep duration, general and abdominal obesity, and weight change among the older adult population of Spain. Am J Clin Nutr. 2008;87:310–316.
    1. Patel SR, Blackwell T, Redline S, et al. The association between sleep duration and obesity in older adults. Int J Obes (Lond) 2008;32:1825–1834.
    1. Caples SM, Gami AS, Somers VK. Obstructive sleep apnea. Ann Intern Med. 2005;142:187–197.
    1. Carotenuto M, Santoro N, Grandone A, et al. The insulin gene variable number of tandemrepeats (INS VNTR) genotype and sleep disordered breathing in childhood obesity. J Endocrinol Invest. 2009;32:752–755.
    1. Carotenuto M, Bruni O, Santoro N, Del Giudice EM, Perrone L, Pascotto A. Waist circumference predicts the occurrence of sleep-disordered breathing in obese children and adolescents: a questionnaire-based study. Sleep Med. 2006;7:357–361.
    1. Punjabi NM, Shahar E, Redline S, Gottlieb DJ, Givelber R, Resnick HE. Sleep-disordered breathing, glucose intolerance, and insulin resistance: the Sleep Heart Health Study. Am J Epidemiol. 2004;160:521–530.
    1. Somers VK, White DP, Amin R, et al. Sleep apnea and cardiovascular disease: an American Heart Association/American College Of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council On Cardiovascular Nursing. In collaboration with the National Heart, Lung, and Blood Institute National Center on Sleep Disorders Research (National Institutes of Health) Circulation. 2008;118:1080–1111.
    1. Edinger JD, Bonnet MH, Bootzin RR, et al. Derivation of research diagnostic criteria for insomnia: report of an American Academy of Sleep Medicine Work Group. Sleep. 2004;27:1567–1596.
    1. Riemann D, Kloepfer C, Berger M. Functional and structural brain alterations in insomnia: implications for pathophysiology. Eur J Neurosci. 2009;29:1754–1760.
    1. Roth T. Insomnia: definition, prevalence, etiology, and consequences. J Clin Sleep Med. 2007;3:S7–S10.
    1. Vgontzas AN, Bixler EO, Lin H-M, et al. Chronic insomnia is associated with nyctohemeral activation of the hypothalamic-pituitary-adrenal axis: clinical implications. J Clin Endocrinol Metab. 2001;86:3787–3794.
    1. Nofzinger EA, Nissen C, Germain A, et al. Regional cerebral metabolic correlates of WASO during NREM sleep in insomnia. J Clin Sleep Med. 2006;2:316–322.
    1. Nofzinger EA, Buysse DJ, Germain A, Price JC, Miewald JM, Kupfer DJ. Functional neuroimaging evidence for hyperarousal in insomnia. Am J Psychiatry. 2004;161:2126–2128.
    1. Pearson NJ, Johnson LL, Nahin RL. Insomnia, trouble sleeping, and complementary and alternative medicine: Analysis of the 2002 national health interview survey data. Arch Intern Med. 2006;166:1775–1782.
    1. Singareddy R, Vgontzas AN, Fernandez-Mendoza J, et al. Risk factors for incident chronic insomnia: a general population prospective study. Sleep Med. 2012;13:346–353.
    1. Vgontzas AN, Lin HM, Papaliaga M, et al. Short sleep duration and obesity: the role of emotional stress and sleep disturbances. Int J Obes (Lond) 2008;32:801–809.
    1. Taheri S, Lin L, Austin D, Young T, Mignot E. Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index. PLoS Med. 2004;1:e62.
    1. Dallman MF, Pecoraro N, Akana SF, et al. Chronic stress and obesity: a new view of “comfort food”. Proc Natl Acad Sci U S A. 2003;100:11696–11701.
    1. King AC, Oman RF, Brassington GS, Bliwise DL, Haskell WL. Moderate-intensity exercise and self-rated quality of sleep in older adults. A randomized controlled trial. JAMA. 1997;277:32–37.
    1. Kline CE, Sui X, Hall MH, et al. Dose-response effects of exercise training on the subjective sleep quality of postmenopausal women: exploratory analyses of a randomised controlled trial. BMJ Open. 2012;2:e001044.
    1. Brand S, Gerber M, Beck J, Hatzinger M, Puhse U, Holsboer-Trachsler E. High exercise levels are related to favorable sleep patterns and psychological functioning in adolescents: a comparison of athletes and controls. J Adolesc Health. 2010;46:133–141.
    1. Grandner MA, Patel NP, Perlis ML, et al. Obesity, diabetes, and exercise associated with sleep-related complaints in the American population. Z Gesundh Wiss. 2011;19:463–474.
    1. Chasens ER, Yang K. Insomnia and physical activity in adults with prediabetes. Clin Nurs Res. 2012;21:294–308.
    1. Paparrigopoulos T, Tzavara C, Theleritis C, Psarros C, Soldatos C, Tountas Y. Insomnia and its correlates in a representative sample of the Greek population. BMC Public Health. 2010;10:531.
    1. Foley D, Ancoli-Israel S, Britz P, Walsh J. Sleep disturbances and chronic disease in older adults: results of the 2003 National Sleep Foundation Sleep in America Survey. J Psychosom Res. 2004;56:497–502.
    1. Morgan K. Daytime activity and risk factors for late-life insomnia. J Sleep Res. 2003;12:231–238.
    1. Strand LB, Laugsand LE, Wisloff U, Nes BM, Vatten L, Janszky I. Insomnia symptoms and cardiorespiratory fitness in healthy individuals: the Nord-Trondelag Health Study (HUNT) Sleep. 2013;36:99C–108C.
    1. Passos GS, Poyares D, Santana MG, Garbuio SA, Tufik S, Mello MT. Effect of acute physical exercise on patients with chronic primary insomnia. J Clin Sleep Med. 2010;6:270–275.
    1. Reid KJ, Baron KG, Lu B, Naylor E, Wolfe L, Zee PC. Aerobic exercise improves self-reported sleep and quality of life in older adults with insomnia. Sleep Med. 2010;11:934–940.
    1. Singh NA, Clements KM, Fiatarone MA. A randomized controlled trial of the effect of exercise on sleep. Sleep. 1997;20(2):95–101.
    1. King AC, Pruitt LA, Woo S, et al. Effects of moderate-intensity exercise on polysomnographic and subjective sleep quality in older adults with mild to moderate sleep complaints. J Gerontol A Biol Sci Med Sci. 2008;63(9):997–1004.
    1. Malhotra A, White DP. Obstructive sleep apnoea. Lancet. 2002;360:237–245.
    1. Kato M, Adachi T, Koshino Y, Somers VK. Obstructive sleep apnea and cardiovascular disease. Circ J. 2009;73:1363–1370.
    1. Peppard PE, Young T, Palta M, Dempsey J, Skatrud J. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA. 2000;284:3015–3021.
    1. Tishler PV, Larkin EK, Schluchter MD, Redline S. Incidence of sleep-disordered breathing in an urban adult population: the relative importance of risk factors in the development of sleep-disordered breathing. JAMA. 2003;289:2230–2237.
    1. Young T, Shahar E, Nieto FJ, et al. Predictors of sleep-disordered breathing in community-dwelling adults: the Sleep Heart Health Study. Arch Intern Med. 2002;162:893–900.
    1. Tuomilehto H, Seppa J, Uusitupa M. Obesity and obstructive sleep apnea – Clinical significance of weight loss. Sleep Med Rev. 2012
    1. Johansson K, Neovius M, Lagerros YT, et al. Effect of a very low energy diet on moderate and severe obstructive sleep apnoea in obese men: a randomised controlled trial. BMJ. 2009;339:b4609.
    1. Foster GD, Borradaile KE, Sanders MH, et al. A randomized study on the effect of weight loss on obstructive sleep apnea among obese patients with type 2 diabetes: the Sleep AHEAD study. Arch Intern Med. 2009;169:1619–1626.
    1. Ong CW, O’Driscoll DM, Truby H, Naughton MT, Hamilton GS. The reciprocal interaction between obesity and obstructive sleep apnoea. Sleep Med Rev. Epub July 17, 2012.
    1. Calvin AD, Albuquerque FN, Lopez-Jimenez F, Somers VK. Obstructive sleep apnea, inflammation, and the metabolic syndrome. Metab Syndr Relat Disord. 2009;7:271–278.
    1. Enriori PJ, Evans AE, Sinnayah P, Cowley MA. Leptin resistance and obesity. Obesity. 2006;14( Suppl 5):254S–258S.
    1. Grunstein RR, Stenlof K, Hedner J, Sjostrom L. Impact of obstructive sleep apnea and sleepiness on metabolic and cardiovascular risk factors in the Swedish Obese Subjects (SOS) Study. Int J Obes Relat Metab Disord. 1995;19(6):410–418.
    1. Beebe DW, Miller N, Kirk S, Daniels SR, Amin R. The association between obstructive sleep apnea and dietary choices among obese individuals during middle to late childhood. Sleep Med. 2011;12(8):797–799.
    1. Spiegel K, Tasali E, Penev P, Van Cauter E. Brief communication: Sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels, and increased hunger and appetite. Ann Intern Med. 2004;141:846–850.
    1. Wijnen H, Boothroyd C, Young MW, Claridge-Chang A. Molecular genetics of timing in intrinsic circadian rhythm sleep disorders. Ann Med. 2002;34:386–393.
    1. Quan SF, Griswold ME, Iber C, et al. Short-term variability of respiration and sleep during unattended nonlaboratory polysomnography–the Sleep Heart Health Study. [corrected] Sleep. 2002;25:843–849.
    1. Pedrazzoli M, Ling L, Young TB, Finn L, Tufik S, Mignot E. Effect of the prion 129 polymorphism on nocturnal sleep and insomnia complaints: a population-based study. J Sleep Res. 2002;11:357–358.
    1. Malhotra A, Ayas NT, Epstein LJ. The art and science of continuous positive airway pressure therapy in obstructive sleep apnea. Curr Opin Pulm Med. 2000;6:490–495.
    1. Hla KM, Skatrud JB, Finn L, Palta M, Young T. The effect of correction of sleep-disordered breathing on BP in untreated hypertension. Chest. 2002;122:1125–1132.
    1. Atamer A, Delaney M, Young LR. An expert system for fault management assistance on a space sleep experiment. Arch Ital Biol. 2002;140:303–313.
    1. Hackney JE, Weaver TE, Pack AI. Health literacy and sleep disorders: a review. Sleep Med Rev. 2008;12:143–151.
    1. Vgontzas AN, Tan TL, Bixler EO, Martin LF, Shubert D, Kales A. Sleep apnea and sleep disruption in obese patients. Arch Intern Med. 1994;154:1705–1711.
    1. Brown MA, Goodwin JL, Silva GE, et al. The impact of sleep-disordered breathing on body mass index (BMI): the Sleep Heart Health Study (SHHS) Southwest J Pulm Crit Care. 2011;3:159–168.
    1. Pillar G, Shehadeh N. Abdominal fat and sleep apnea: the chicken or the egg? Diabetes Care. 2008;31( Suppl 2):S303–S309.
    1. Shah N, Roux F, Mohsenin V. Improving health-related quality of life in patients with obstructive sleep apnea: what are the available options? Treat Respir Med. 2006;5:235–244.
    1. Redenius R, Murphy C, O’Neill E, Al-Hamwi M, Zallek SN. Does CPAP lead to change in BMI? J Clin Sleep Med. 2008;4:205–209.
    1. West SD, Kohler M, Nicoll DJ, Stradling JR. The effect of continuous positive airway pressure treatment on physical activity in patients with obstructive sleep apnoea: a randomised controlled trial. Sleep Med. 2009;10:1056–1058.
    1. Vanhecke TE, Franklin BA, Zalesin KC, et al. Cardiorespiratory fitness and obstructive sleep apnea syndrome in morbidly obese patients. Chest. 2008;134:539–545.
    1. Kaleth AS, Chittenden TW, Hawkins BJ, et al. Unique cardiopulmonary exercise test responses in overweight middle-aged adults with obstructive sleep apnea. Sleep Med. 2007;8:160–168.
    1. Grote L, Hedner J, Peter JH. The heart rate response to exercise is blunted in patients with sleep-related breathing disorder. Cardiology. 2004;102:93–99.
    1. Aguillard RN, Riedel BW, Lichstein KL, Grieve FG, Johnson CT, Noe SL. Daytime functioning in obstructive sleep apnea patients: exercise tolerance, subjective fatigue, and sleepiness. App Psychophysiol Biofeedback. 1998;23:207–217.
    1. Tryfon S, Stanopoulos I, Dascalopoulou E, Argyropoulou P, Bouros D, Mavrofridis E. Sleep apnea syndrome and diastolic blood pressure elevation during exercise. Respiration. 2004;71:499–504.
    1. Kline CE, Crowley EP, Ewing GB, et al. Blunted heart rate recovery is improved following exercise training in overweight adults with obstructive sleep apnea. Int J Cardiol. Epub May 7, 2012.
    1. Maeder MT, Munzer T, Rickli H, et al. Association between heart rate recovery and severity of obstructive sleep apnea syndrome. Sleep Med. 2008;9:753–761.
    1. Hargens TA, Guill SG, Zedalis D, Gregg JM, Nickols-Richardson SM, Herbert WG. Attenuated heart rate recovery following exercise testing in overweight young men with untreated obstructive sleep apnea. Sleep. 2008;31:104–110.
    1. Nanas S, Sakellariou D, Kapsimalakou S, et al. Heart rate recovery and oxygen kinetics after exercise in obstructive sleep apnea syndrome. Clin Cardiol. 2010;33:46–51.
    1. Ucok K, Aycicek A, Sezer M, et al. Aerobic and anaerobic exercise capacities in obstructive sleep apnea and associations with subcutaneous fat distributions. Lung. 2009;187:29–36.
    1. Lin CC, Hsieh WY, Chou CS, Liaw SF. Cardiopulmonary exercise testing in obstructive sleep apnea syndrome. Respir Physiol Neurobiol. 2006;150:27–34.
    1. Guillermo LQ, Gal TJ, Mair EA. Does obstructive sleep apnea affect aerobic fitness? Ann Otol Rhinol Laryngol. 2006;115:715–720.
    1. Vanuxem D, Badier M, Guillot C, Delpierre S, Jahjah F, Vanuxem P. Impairment of muscle energy metabolism in patients with sleep apnoea syndrome. Respir Med. 1997;91:551–557.
    1. Alonso-Fernandez A, Garcia-Rio F, Arias MA, et al. Obstructive sleep apnoea-hypoapnoea syndrome reversibly depresses cardiac response to exercise. Eur Heart J. 2006;27:207–215.
    1. Ozturk LM, Metin G, Cuhadaroglu C, Utkusavas A, Tutluoglu B. Cardiopulmonary responses to exercise in moderate-to-severe obstructive sleep apnea. Tuberk Toraks. 2005;53:10–19.
    1. Bonanni E, Pasquali L, Manca ML, et al. Lactate production and catecholamine profile during aerobic exercise in normotensive OSAS patients. Sleep Med. 2004;5:137–145.
    1. Tremel F, Pepin JL, Veale D, et al. High prevalence and persistence of sleep apnoea in patients referred for acute left ventricular failure and medically treated over 2 months. Eur Heart J. 1999;20:1201–1209.
    1. Donnelly JE, Blair SN, Jakicic JM, et al. American College of Sports Medicine Position Stand. Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults. Medicine and Science in Sports and Exercise. 2009;41(2):459–471.
    1. Epstein LJ, Kristo D, Strollo PJ, Jr, et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009;5:263–276.
    1. Sengul YS, Ozalevli S, Oztura I, Itil O, Baklan B. The effect of exercise on obstructive sleep apnea: a randomized and controlled trial. Sleep Breath. 2011;15:49–56.
    1. Ueno LM, Drager LF, Rodrigues AC, et al. Effects of exercise training in patients with chronic heart failure and sleep apnea. Sleep. 2009;32:637–647.
    1. Barnes M, Goldsworthy UR, Cary BA, Hill CJ. A diet and exercise program to improve clinical outcomes in patients with obstructive sleep apnea – a feasibility study. J Clin Sleep Med. 2009;5:409–415.
    1. Norman JF, Von Essen SG, Fuchs RH, McElligott M. Exercise training effect on obstructive sleep apnea syndrome. Sleep Res. 2000;3:121–129.
    1. Giebelhaus V, Strohl KP, Lormes W, Lehmann M, Netzer N. Physical exercise as an adjunct therapy in sleep apnea-an open trial. Sleep Breath. 2000;4:173–176.
    1. Kline CE, Crowley EP, Ewing GB, et al. The effect of exercise training on obstructive sleep apnea and sleep quality: a randomized controlled trial. Sleep. 2011;34:1631–1640.
    1. Netzer N, Lormes W, Giebelhaus V, et al. Physical training of patients with sleep apnea. Pneumologie. 1997;51(Suppl 3):779–782. German.
    1. Ackel-D’Elia C, da Silva AC, Silva RS, et al. Effects of exercise training associated with continuous positive airway pressure treatment in patients with obstructive sleep apnea syndrome. Sleep Breath. 2012;16:723–735.
    1. Hong S, Dimsdale JE. Physical activity and perception of energy and fatigue in obstructive sleep apnea. Med Sci Sports Exerc. 2003;35:1088–1092.
    1. Peppard PE, Young T. Exercise and sleep-disordered breathing: an association independent of body habitus. Sleep. 2004;27:480–484.
    1. Quan SF, O’Connor GT, Quan JS, et al. Association of physical activity with sleep-disordered breathing. Sleep Breath. 2007;11:149–157.
    1. Connor JR, Boyer PJ, Menzies SL, et al. Neuropathological examination suggests impaired brain iron acquisition in restless legs syndrome. Neurology. 2003;61:304–309.
    1. Reese JP, Stiasny-Kolster K, Oertel WH, Dodel RC. Health-related quality of life and economic burden in patients with restless legs syndrome. Expert Rev Pharmacoecon Outcomes Res. 2007;7:503–521.
    1. Krueger BR. Restless legs syndrome and periodic movements of sleep. Mayo Clin Proc. 1990;65:999–1006.
    1. Stiasny K, Wetter TC, Trenkwalder C, Oertel WH. Restless legs syndrome and its treatment by dopamine agonists. Parkinsonism Relat Disord. 2000;7:21–25.
    1. Winkelmann J, Prager M, Lieb R, et al. “Anxietas tibiarum”. Depression and anxiety disorders in patients with restless legs syndrome. J Neurol. 2005;252:67–71.
    1. Krieger J, Schroeder C. Iron, brain and restless legs syndrome. Sleep Med Rev. 2001;5:277–286.
    1. Ekbom K, Ulfberg J. Restless legs syndrome. J Intern Med. 2009;266:419–431.
    1. Allen R. Dopamine and iron in the pathophysiology of restless legs syndrome (RLS) Sleep Med. 2004;5:385–391.
    1. Trenkwalder C, Hogl B, Winkelmann J. Recent advances in the diagnosis, genetics and treatment of restless legs syndrome. J Neurol. 2009;256:539–553.
    1. Trenkwalder C, Paulus W. Restless legs syndrome: pathophysiology, clinical presentation and management. Nat Rev Neurol. 2010;6:337–346.
    1. Allen RP, Barker PB, Wehrl F, Song HK, Earley CJ. MRI measurement of brain iron in patients with restless legs syndrome. Neurology. 2001;56:263–265.
    1. Trotti LM, Bhadriraju S, Rye DB. An update on the pathophysiology and genetics of restless legs syndrome. Curr Neurol Neurosci Rep. 2008;8:281–287.
    1. Mallon L, Broman JE, Hetta J. Restless legs symptoms with sleepiness in relation to mortality: 20-year follow-up study of a middle-aged Swedish population. Psychiatry Clin Neurosci. 2008;62:457–463.
    1. Elwood P, Hack M, Pickering J, Hughes J, Gallacher J. Sleep disturbance, stroke, and heart disease events: evidence from the Caerphilly cohort. J Epidemiol Community Health. 2006;60:69–73.
    1. Gao X, Schwarzschild MA, Wang H, Ascherio A. Obesity and restless legs syndrome in men and women. Neurology. 2009;72:1255–1261.
    1. Ohayon MM, Roth T. Prevalence of restless legs syndrome and periodic limb movement disorder in the general population. J Psychosom Res. 2002;53:547–554.
    1. Alattar M, Harrington JJ, Mitchell CM, Sloane P. Sleep problems in primary care: a North Carolina Family Practice Research Network (NC-FP-RN) study. J Am Board Fam Med. 2007;20:365–374.
    1. Moller C, Wetter TC, Koster J, Stiasny-Kolster K. Differential diagnosis of unpleasant sensations in the legs: prevalence of restless legs syndrome in a primary care population. Sleep Med. 2010;11:161–166.
    1. Mustafa M, Erokwu N, Ebose I, Strohl K. Sleep problems and the risk for sleep disorders in an outpatient veteran population. Sleep Breath. 2005;9:57–63.
    1. Schlesinger I, Erikh I, Avizohar O, Sprecher E, Yarnitsky D. Cardiovascular risk factors in restless legs syndrome. Mov Disord. 2009;24:1587–1592.
    1. Phillips B, Young T, Finn L, Asher K, Hening WA, Purvis C. Epidemiology of restless legs symptoms in adults. Arch Intern Med. 2000;160:2137–2141.
    1. Daniele TM, de Bruin VM, AC EF, de Oliveira DS, Pompeu CM, de Bruin PF. The relationship between physical activity, restless legs syndrome, and health-related quality of life in type 2 diabetes. Endocrine. Epub December 1, 2012.
    1. Esteves AM, Mello MT, Benedito-Silva AA, Tufik S. Impact of aerobic physical exerise on Restless Legs Syndrome. Sleep Sci. 2011;4:45–48.
    1. Aukerman MM, Aukerman D, Bayard M, Tudiver F, Thorp L, Bailey B. Exercise and restless legs syndrome: a randomized controlled trial. J Am Board Fam Med. 2006;19:487–493.

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