The role of physical exercise in obstructive sleep apnea

Flávio Maciel Dias de Andrade, Rodrigo Pinto Pedrosa, Flávio Maciel Dias de Andrade, Rodrigo Pinto Pedrosa

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. RESUMO A apneia obstrutiva do sono (AOS) é uma condição clínica comum, possuindo prevalência variável e subestimada. Principal condição associada à hipertensão arterial sistêmica secundária, associa-se ainda à fibrilação atrial, acidente vascular encefálico e doença arterial coronariana, aumentando a morbidade e mortalidade cardiovascular. O tratamento da AOS com pressão positiva contínua em vias aéreas não é tolerado por todos os pacientes e, muitas vezes, não é indicado para formas leves. Daí, métodos alternativos de tratamento da AOS e de suas consequências cardiovasculares são necessários. A prática usual de exercícios físicos promove benefícios adicionais à redução do peso em pacientes com AOS; contudo, os mecanismos ainda são incertos. Entre as adaptações fisiológicas proporcionadas pelo exercício físico nessa população destacam-se o aumento do tônus da musculatura dilatadora das vias aéreas superiores e do tempo do estágio do sono de ondas lentas e a redução do acúmulo cervical de líquido, da resposta inflamatória sistêmica e do peso corpóreo. Os principais benefícios de programas de exercício físico para essa população incluem a redução da gravidade da AOS e da sonolência diurna e o aumento da eficiência do sono e consumo máximo de oxigênio. Poucos estudos avaliaram o papel do exercício físico realizado de forma isolada no tratamento da AOS, além de existirem muitas diferenças relacionadas aos protocolos de exercício utilizados. Entretanto, o emprego de exercícios aeróbios isolados ou combinados aos exercícios resistidos é um ponto comum entre os estudos. Nessa revisão, os principais estudos e mecanismos envolvidos no tratamento da AOS por meio da realização de exercícios físicos são apresentados. Além dos benefícios clínicos sistêmicos proporcionados pelo exercício físico, pacientes com AOS submetidos a um programa regular de exercícios predominantemente aeróbicos, apresentam redução da gravidade da doença e da sonolência diurna, aumento da eficiência do sono e do pico de consumo de oxigênio, independentemente da perda de peso.

Figures

Chart 1. Risk factors for obstructive sleep…
Chart 1. Risk factors for obstructive sleep apnea. -
Figure 1. Pathophysiology of the effects of…
Figure 1. Pathophysiology of the effects of obstructive sleep apnea on the cardiovascular system. Adapted from Bradley & Floras, 2009. BP: blood pressure; and LV: left ventricular.
Figure 2. Interrelationship between chronic diseases resulting…
Figure 2. Interrelationship between chronic diseases resulting in hypervolemia and worsening of obstructive sleep apnea.
Chart 2. Characteristics of the exercise programs.
Chart 2. Characteristics of the exercise programs.

References

    1. Spicuzza L, Caruso D, Di Maria G. Obstructive sleep apnoea syndrome and its management. Ther Adv Chronic Dis. 2015;6(5):273–285.
    1. Naughton MT. Sleep disorders in patients with congestive heart failure. Curr Opin Pulm Med. 2003;9(6):453–458.
    1. Lorenzi-Filho G, Genta PR, Pedrosa RP, Drager LF, Martinez D. Cardiovascular consequences of obstructive sleep apnea syndrome [Article in Portuguese] J Bras. Pneumol. 2010;36(2):38–42.
    1. Punjabi NM. The epidemiology of adult obstructive sleep apnea. Proc Am Thorac Soc. 2008;5(2):136–143.
    1. Tufik S, Santos-Silva R, Taddei JA, Bittencourt LR. Obstructive sleep apnea syndrome in the Sao Paulo Epidemiologic Sleep Study. Sleep Med. 2010;11(5):441–446.
    1. Pedrosa RP, Drager LF, Gonzaga CC, Sousa MG, de Paula LK, Amaro AC. Obstructive sleep apnea The most common secondary cause of hypertension associated with resistant hypertension. Hypertension. 2011;58(5):811–817.
    1. Iftikhar IH, Kline CE, Youngstedt SD. Effects of exercise training on sleep apnea a meta-analysis. Lung. 2014;192(1):175–184.
    1. Pham LV, Schwartz AR. The pathogenesis of obstructive sleep apnea. J Thorac Dis. 2015;7(8):1358–1372.
    1. Jordan AS, McSharry DG, Malhotra A. Adult obstructive sleep apnoea. Lancet. 2014;383(9918):736–747.
    1. Bradley TD, Floras JS. Obstructive sleep apnoea and its cardiovascular consequences. Lancet. 2009;373(9657):82–93.
    1. Somers VK, White DP, Amin R, Abraham WT, Costa F, Culebras A. 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. J Am Coll Cardiol. 2008;52(8):686–717.
    1. Stansbury RC, Strollo PJ. Clinical manifestations of sleep apnea. J Thorac Dis. 2015;7(9):E298–E310.
    1. Lévy P, Ryan S, Oldenburg O, Parati G. Sleep apnoea and the heart. Eur Respir Rev. 2013;22(129):333–352.
    1. Pedrosa RP, Barros IM, Drager LF, Bittencourt MS, Medeiros AK, Carvalho LL. OSA is common and independently associated with hypertension and increased arterial stiffness in consecutive perimenopausal women. Chest. 2014;146(1):66–72.
    1. Pedrosa RP, Drager LF, de Paula LK, Amaro AC, Bortolotto LA, Lorenzi-Filho G. Effects of OSA treatment on BP in patients with resistant hypertension a randomized trial. Chest. 2013;144(5):1487–1494.
    1. Sullivan CE, Issa FG, Berthon-Jones M, Eves L. Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet. 1981;1(8225):862–865.
    1. Morgenthaler TI, Kapen S, Lee-Chiong T, Alessi C, Boehlecke B, Brown T. Practice parameters for the medical therapy of obstructive sleep apnea. Sleep. 2006;29(8):1031–1035.
    1. Sundaram S, Bridgman SA, Lim J, Lasserson TJ. Surgery for obstructive sleep apnoea. Cochrane Database Syst Rev. 2005;(4):CD001004–CD001004.
    1. Smith PL, Gold AR, Meyers DA, Haponik EF, Bleecker ER. Weight loss in mildly to moderately obese patients with obstructive sleep apnea. Ann Intern Med. 1985;103(6):850–855.
    1. Schwartz AR, Gold AR, Schubert N, Stryzak A, Wise RA, Permutt S. Effect of weight loss on upper airway collapsibility in obstructive sleep apnea. Pt 1Am Rev Respir Dis. 1991;144(3):494–498.
    1. Peppard PE, Young T, Palta M, Dempsey J, Skatrud J. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA. 2000;284(23):3015–3021.
    1. Kushida CA, Morgenthaler TI, Littner MR, Alessi CA, Bailey D, Coleman J., Jr Practice parameters for the treatment of snoring and Obstructive Sleep Apnea with oral appliances an update for 2005. Sleep. 2006;29(2):240–243.
    1. Kushida CA, Littner MR, Hirshkowitz M, Morgenthaler TI, Alessi CA, Bailey D. Practice parameters for the use of continuous and bilevel positive airway pressure devices to treat adult patients with sleep-related breathing disorders. Sleep. 2006;29(3):375–380.
    1. Bennett LS. Adult obstructive sleep apnoea syndrome. J R Coll Physicians Lond. 1999;33(5):439–444.
    1. Yamamoto U, Mohri M, Shimada K, Origuchi H, Miyata K, Ito K. Six-month aerobic exercise training ameliorates central sleep apnea in patients with chronic heart failure. J Card Fail. 2007;13(10):825–829.
    1. Ueno LM, Drager LF, Rodrigues AC, Rondon MU, Braga AM, Mathias W., Jr Effects of exercise training in patients with chronic heart failure and sleep apnea. Sleep. 2009;32(5):637–647.
    1. Quan SF, O'Connor GT, Quan JS, Redline S, Resnick HE, Shahar E. Association of physical activity with sleep-disordered breathing. Sleep Breath. 2007;11(3):149–157.
    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(1):49–56.
    1. Awad KM, Malhotra A, Barnet JH, Quan SF, Peppard PE. Exercise is associated with a reduced incidence of sleep-disordered breathing. Am J Med. 2012;125(5):485–490.
    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(4):173–176.
    1. Fregosi RF, Ludlow CL. Activation of upper airway muscles during breathing and swallowing. J Appl Physiol (1985) 2014;116(3):291–301.
    1. Vincent HK, Shanely RA, Stewart DJ, Demirel HA, Hamilton KL, Ray AD. Adaptation of upper airway muscles to chronic endurance exercise. Am J Respir Crit Care Med. 2002;166(3):287–293.
    1. Haxhiu MA, van Lunteren E, Mitra J, Cherniack NS, Strohl KP. Comparison of the responses of the diaphragm and upper airway muscles to central stimulation of the sciatic nerve. Respir Physiol. 1984;58(1):65–76.
    1. Hussain SN, Ward ME, Gatensby AG, Roussos C, Deschamps A. Respiratory muscle activation by limb muscle afferent stimulation in anesthetized dogs. Respir Physiol. 1991;84(2):185–198.
    1. Shiota S, Ryan CM, Chiu KL, Ruttanaumpawan P, Haight J, Arzt M. Alterations in upper airway cross-sectional area in response to lower body positive pressure in healthy subjects. Thorax. 2007;62(10):868–872.
    1. Redolfi S, Arnulf I, Pottier M, Lajou J, Koskas I, Bradley TD. Attenuation of obstructive sleep apnea by compression stockings in subjects with venous insufficiency. Am J Respir Crit Care Med. 2011;184(9):1062–1066.
    1. Redolfi S, Arnulf I, Pottier M, Bradley TD, Similowski T. Effects of venous compression of the legs on overnight rostral fluid shift and obstructive sleep apnea. Respir Physiol Neurobiol. 2011;175(3):390–393.
    1. White LH, Bradley TD. Role of nocturnal rostral fluid shift in the pathogenesis of obstructive and central sleep apnoea. J Physiol. 2013;591(5):1179–1193.
    1. Mirrakhimov AE. Physical exercise related improvement in obstructive sleep apnea Look for the rostral fluid shift. Med Hypotheses. 2013;80(2):125–128.
    1. Redolfi S, Yumino D, Ruttanaumpawan P, Yau B, Su MC, Lam J. Relationship between overnight rostral fluid shift and Obstructive Sleep Apnea in nonobese men. Am J Respir Crit Care Med. 2009;179(3):241–246.
    1. White LH, Lyons OD, Yadollahi A, Ryan CM, Bradley TD. Effect of below-the-knee compression stockings on severity of obstructive sleep apnea. Sleep Med. 2015;16(2):258–264.
    1. Mendelson M, Lyons OD, Yadollahi A, Inami T, Oh P, Bradley TD. Effects of exercise training on sleep apnoea in patients with coronary artery disease a randomised trial. Eur Respir J. 2016;48(1):142–150.
    1. Beltrami FG, Nguyen X, Pichereau C, Maury E, Fleury B, Fagondes S. Sleep in the intensive care unit. J Bras Pneumol. 2015;41(6):539–546.
    1. Ratnavadivel R, Chau N, Stadler D, Yeo A, McEvoy RD, Catcheside PG. Marked reduction in obstructive sleep apnea severity in slow wave sleep. J Clin Sleep Med. 2009;5(6):519–524.
    1. McSharry DG, Saboisky JP, Deyoung P, Matteis P, Jordan AS, Trinder J. A mechanism for upper airway stability during slow wave sleep. Sleep. 2013;36(4):555–563.
    1. Heinzelmann F, Bagley RW. Response to physical activity programs and their effects on health behavior. Public Health Rep. 1970;85(10):905–911.
    1. Martins PJ, Mello MT, Tufik S. Exercício e Sono. Rev Bras Med Esporte. 2001;7(1):28–36.
    1. Youngstedt SD, O'Connor PJ, Crabbe JB, Dishman RK. The influence of acute exercise on sleep following high caffeine intake. Physiol Behav. 2000;68(4):563–570.
    1. Youngstedt SD, O'Connor PJ, Dishman RK. The effects of acute exercise on sleep a quantitative synthesis. Sleep. 1997;20(3):203–214.
    1. Kredlow MA, Capozzoli MC, Hearon BA, Calkins AW, Otto MW. The effects of physical activity on sleep a meta-analytic review. J Behav Med. 2015;38(3):427–449.
    1. Newman AB, Foster G, Givelber R, Nieto FJ, Redline S, Young T. Progression and regression of sleep-disordered breathing with changes in weight the Sleep Heart Health Study. Arch Intern Med. 2005;165(20):2408–2413.
    1. Dobrosielski DA, Patil S, Schwartz AR, Bandeen-Roche K, Stewart KJ. Effects of exercise and weight loss in older adults with obstructive sleep apnea. Med Sci Sports Exerc. 2015;47(1):20–26.
    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(5):409–415.
    1. Alves Eda S, Ackel-D'Elia C, Luz GP, Cunha TC, Carneiro G, Tufik S. Does physical exercise reduce excessive daytime sleepiness by improving inflammatory profiles in obstructive sleep apnea patients. Sleep Breath. 2013;17(2):505–510.
    1. Cavagnolli DA, Esteves AM, Ackel-D'Elia C, Maeda MY, de Faria AP, Tufik S. Aerobic exercise does not change C-reactive protein levels in non-obese patients with obstructive sleep apnoea. Eur J Sport Sci. 2014;14(1):S142–S147.
    1. Norman JF, Von Essen SG, Fuchs RH, McElligott M. Exercise training effect on obstructive sleep apnea syndrome. Sleep Res Online. 2000;3(3):121–129.
    1. Kline CE, Crowley EP, Ewing GB, Burch JB, Blair SN, Durstine JL. The effect of exercise training on obstructive sleep apnea and sleep quality a randomized controlled trial. Sleep. 2011;34(12):1631–1640.
    1. Servantes DM, Pelcerman A, Salvetti XM, Salles AF, de Albuquerque PF, de Salles FC. Effects of home-based exercise training for patients with chronic heart failure and sleep apnoea a randomized comparison of two different programmes. Clin Rehabil. 2012;26(1):45–57.
    1. Aiello KD, Caughey WG, Nelluri B, Sharma A, Mookadam F, Mookadam M. Effect of exercise training on sleep apnea A systematic review and meta-analysis. Respir Med. 2016;116:85–92.
    1. Ackel-D'Elia C, da Silva AC, Silva RS, Truksinas E, Sousa BS, Tufik S. Effects of exercise training associated with continuous positive airway pressure treatment in patients with obstructive sleep apnea syndrome. Sleep Breath. 2012;16(3):723–735.
    1. Schütz TC, Cunha TC, Moura-Guimaraes T, Luz GP, Ackel-D'Elia C, Alves Eda S. Comparison of the effects of continuous positive airway pressure, oral appliance and exercise training in obstructive sleep apnea syndrome. Clinics (Sao Paulo) 2013;68(8):1168–1174.

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