Exercise training reduces sympathetic nerve activity and improves executive performance in individuals with obstructive sleep apnea

Thiago Tanaka Goya, Rosyvaldo Ferreira-Silva, Elisangela Macedo Gara, Renan Segalla Guerra, Eline Rozária Ferreira Barbosa, Edgar Toschi-Dias, Paulo Jannuzzi Cunha, Carlos Eduardo Negrão, Geraldo Lorenzi-Filho, Linda Massako Ueno-Pardi, Thiago Tanaka Goya, Rosyvaldo Ferreira-Silva, Elisangela Macedo Gara, Renan Segalla Guerra, Eline Rozária Ferreira Barbosa, Edgar Toschi-Dias, Paulo Jannuzzi Cunha, Carlos Eduardo Negrão, Geraldo Lorenzi-Filho, Linda Massako Ueno-Pardi

Abstract

Objective: To investigate the effects of exercise training (ET) on muscle sympathetic nerve activity (MSNA) and executive performance during Stroop Color Word Test (SCWT) also referred to as mental stress test.

Methods: Forty-four individuals with obstructive sleep apnea (OSA) and no significant co-morbidities were randomized into 2 groups; 15 individuals completed the control period, and 18 individuals completed the ET. Mini-mental state of examination and intelligence quotient were also assessed. MSNA assessed by microneurography, heart rate by electrocardiography, blood pressure (automated oscillometric device) were measured at baseline and during 3 min of the SCWT. Peak oxygen uptake (VO2 peak) was evaluated using cardiopulmonary exercise testing. Executive performance was assessed by the total correct responses during 3 min of the SCWT. ET consisted of 3 weekly sessions of aerobic exercise, resistance exercises, and flexibility (72 sessions, achieved in 40±3.9 weeks).

Results: Baseline parameters were similar between groups. Heart rate, blood pressure, and MSNA responses during SCWT were similar between groups (p>0.05). The comparisons between groups showed that the changes in VO2 (4.7±0.8 vs -1.2±0.4) and apnea-hypopnea index (-7.4±3.1 vs 5.5±3.3) in the exercise-trained group were significantly greater than those observed in the control group respectively (p<0.05) after intervention. ET reduced MSNA responses (p<0.05) and significantly increased the number of correct answers (12.4%) during SCWT. The number of correct answers was unchanged in the control group (p>0.05).

Conclusions: ET improves sympathetic response and executive performance during SCWT, suggesting a prominent positive impact of ET on prefrontal functioning in individuals with OSA. ClinicalTrials.gov: NCT002289625.

Trial registration: ClinicalTrials.gov NCT02289625.

Conflict of interest statement

No potential conflict of interest was reported.

Figures

Figure 1. Profile of a randomized clinical…
Figure 1. Profile of a randomized clinical trial showing the progress of individuals throughout the trial. AHI = apnea-hypopnea index; OSA = obstructive sleep apnea; MSNA = muscle sympathetic nerve activity.
Figure 2A. Muscle sympathetic nerve activity bursts…
Figure 2A. Muscle sympathetic nerve activity bursts frequency. * = Pre versus post at rest and during 3 min of SCWT in exercise-trained group, p<0.05; † = versus rest, p<0.05 (within group in pre and post intervention/control); †† = versus first and second min of the SCWT p<0.05 (within group in pre and post control). Values are mean ± SD. SCWT = Stroop color word test; MSNA = muscle sympathetic nerve activity.
Figure 2B. Muscle sympathetic nerve activity bursts…
Figure 2B. Muscle sympathetic nerve activity bursts frequency responses. † = versus rest, p<0.05 (within group in pre and post intervention/control); †† = versus first and second min of the SCWT p<0.05 (within group in pre and post control). Values are mean ± SD. SCWT = Stroop color word test; MSNA = muscle sympathetic nerve activity.
Figure 3. Sympathetic neurograms (30 sec) at…
Figure 3. Sympathetic neurograms (30 sec) at rest and during 3 min of Stroop Color Word Test (SCWT).
Figure 4. Individual values of executive performance…
Figure 4. Individual values of executive performance indicated by the total number of correct answers during the SCWT. Short horizontal lines and bars are mean±SD. In the control group, the total number of correct answers from pre to post was similar (p>0.05). In contrast, the total number of correct answers significantly increased in the exercise-trained group. There were group x time interaction effects (p<0.001). SCWT = Stroop Color Word Test; ns = not significant.
Figure 5A. Heart rate at rest and…
Figure 5A. Heart rate at rest and during the SCWT. † = versus rest, p<0.05 (within group in pre and post intervention/control); # = versus second and third min of the SCWT p<0.05 (within group in within group in pre and post intervention/control). Values are mean ± SD. SCWT = Stroop Color Word Test
Figure 5B. Heart rate responses during the…
Figure 5B. Heart rate responses during the SCWT. † = versus rest, p<0.05 (within group in pre and post intervention/control); # = versus second and third min of the SCWT p<0.05 (within group in within group in pre and post intervention/control). Values are mean ± SD. SCWT = Stroop Color Word Test.
Figure 5C. Ankle mean arterial BP at…
Figure 5C. Ankle mean arterial BP at rest and during the SCWT.
Figure 5D. Ankle mean arterial BP responses…
Figure 5D. Ankle mean arterial BP responses during the SCWT. † = versus rest, p<0.05 (within group in pre and post intervention/control); # = versus first min of the SCWT p<0.05 (within group in pre and post intervention/control). Values are mean ± SD. BP = blood pressure; SCWT = Stroop Color Word Test.

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