Physical Activity Following Positive Airway Pressure Treatment in Adults With and Without Obesity and With Moderate-Severe Obstructive Sleep Apnea

Abstract

Study objectives: To examine the level of physical activity (PA) before and following positive airway pressure (PAP) treatment in adults who have obstructive sleep apnea (OSA) with obesity versus without obesity.

Methods: Simultaneous waist accelerometer and wrist actigraphy recordings were obtained in 129 adults with obesity and 69 adults without obesity and who had OSA prior to and following 4 months of PAP therapy and in 52 patients in a control group. Primary PA measurements were average steps per day on waist accelerometry and average counts per minute (CPM) per day on wrist actigraphy.

Results: At baseline, participants with obesity and OSA exhibited fewer steps per day on waist accelerometer and fewer CPM per day on wrist actigraphy compared to participants without obesity and with OSA (despite similar apnea-hypopnea index between groups). Following PAP treatment, participants with OSA had modestly increased CPM per day on wrist actigraphy (17.69 [95% confidence interval (CI), 5.67-29.71], P = .005) and increased light PA time (0.26 [95% CI, 0.07-0.44] hours, P = .008) on waist accelerometer. Participants without obesity and with OSA had greater improvements in PA measures on average compared to participants with obesity and OSA, although the differences were not statistically significant. Weight increased following PAP treatment in the participants with obesity and OSA (1.71 [95% CI, 0.41-3.02] kg, P = .010) but was unchanged in the group without obesity (0.93 [95% CI, -0.89 to 2.76] kg, P = .311).

Conclusions: Compared to study participants without obesity and with OSA, participants with obesity and OSA had reduced PA at baseline. PA increased significantly in participants without obesity, with OSA, and who were adherent to PAP treatment. Results indicate that treatment of OSA is unlikely to be associated with a change in PA in adults with obesity and OSA and help explain the absence of weight loss following PAP treatment in adults with OSA.

Clinical trial registration: Registry: ClinicalTrials.gov, title: The Effects of Treating Obese and Lean Patients With Sleep Apnea (PISA), identifier: NCT01578031, URL: https://ichgcp.net/clinical-trials-registry/NCT01578031.

Keywords: obesity; obstructive sleep apnea; physical activity; positive airway pressure; waist accelerometer; wrist actigraphy.

© 2018 American Academy of Sleep Medicine.

Figures

Figure 1. Flow diagram illustrating the analysis populations.

AHI = apnea- hypopnea index, BMI = body mass index, OSA = obstructive sleep apnea, PAP = positive airway pressure.

Figure 2. Primary PA measures comparison between obese and non-obese groups at baseline.

Whiskers represent 95% confidence intervals. P values are for between-group difference. CPM = counts per minute, OSA = obstructive sleep apnea, PA = physical activity.

Figure 3. Changes from baseline in primary PA measures in all participants, and in those with OSA with and without obesity following PAP therapy.

Upper panel shows changes in steps per day on waist accelerometer. Lower panel shows changes in CPM per day on wrist actigraphy. Whiskers represent 95% confidence intervals. P values inside brackets are for the change from baseline in each group. P values without brackets are for between-group difference. CPM = counts per minute, OSA = obstructive sleep apnea, PA = physical activity, PAP = positive airway pressure.