Cardiorespiratory fitness and long‐term risk of sleep apnea: A national cohort study

Abstract

Summary Sleep apnea is increasing in prevalence, and is an important cause of cardiometabolic diseases and mortality worldwide. Its only established modifiable risk factor is obesity; however, up to half of all sleep apnea cases may occur in non‐obese persons, and hence there is a pressing need to identify other modifiable risk factors to facilitate more effective prevention. We sought to examine, for the first time, cardiorespiratory fitness in relation to the risk of sleep apnea, independent of obesity. A national cohort study was conducted to examine cardiorespiratory fitness in all 1,547,478 Swedish military conscripts during 1969–1997 (97%–98% of all 18‐year‐old men) in relation to risk of sleep apnea through 2012 (maximum age 62 years). Cardiorespiratory fitness was measured as maximal aerobic workload in Watts, and sleep apnea was identified from nationwide outpatient and inpatient diagnoses. A total of 44,612 (2.9%) men were diagnosed with sleep apnea in 43.7 million person‐years of follow‐up. Adjusting for age, height, weight, socioeconomic factors and family history of sleep apnea, low cardiorespiratory fitness at age 18 years was associated with a significantly increased risk of sleep apnea in adulthood (lowest versus highest cardiorespiratory fitness tertile: incidence rate ratio, 1.44; 95% confidence interval, 1.40–1.49; p < 0.001; continuous cardiorespiratory fitness per 100 Watts: incidence rate ratio, 0.71; 95% confidence interval, 0.70–0.73; p < 0.001). An increased risk was observed even among men with normal body mass index (lowest versus highest cardiorespiratory fitness tertile: incidence rate ratio, 1.30; 95% confidence interval, 1.26–1.35; p < 0.001). These findings identify low cardiorespiratory fitness early in life as a new modifiable risk factor for development of sleep apnea in adulthood.

Is Less Sedentary Behavior, More Physical Activity, or Higher Fitness Associated with Sleep Quality? A Cross-Sectional Study in Singapore

“…In line with our estimated CRF findings, observational studies using laboratory measured CRF have shown independent inverse associations with higher CRF and lower insomnia, sleep apnea, and difficulty sleeping [8,[14][15][16]. Although there is some evidence to suggest reducing weight may improve SQ, results from meta-analyses suggest that exercise improves SQ independent of weight change.…”

“…CRF is a comprehensive marker of exercise/physical activity patterns, heredity, age, smoking, diet, body composition, and health status [3,13]. There is emerging evidence from large observational studies that low CRF may be a risk factor for sleep-related disorders independent of MVPA or body mass index [8,[14][15][16]. Uchida et al have hypothesized that the chronic effect of exercise on sleep may be mediated through improvements in fitness.…”

Practice recommendations for the role of physiotherapy in the management of sleep disorders: the 2022 Brazilian Sleep Association Guidelines

“…Patients with OSA have worse maximal aerobic capacity and lower levels of physical activity when compared to individuals without OSA 139 , 140 . Longitudinal studies have reported that low cardiorespiratory fitness seems to be an important factor for the development of OSA 141 and, low levels of exercise are associated with increased AHI 142 .…”

The risk factors for insomnia and sleep-disordered breathing in military communities: A meta-analysis

“…Thirteen studies explored SDB's risk factors, and 19 explored risk factors for insomnia. SDB patients were diagnosed using the Berlin Questionnaire (BQ) in two studies [34,43], the 9 th and 10 th edition of ICD in three studies PLOS ONE [44][45][46], the 2 nd or 3 rd edition of ICSD in two studies [47,48], the Apnea Hypopnea Index (AHI) in four studies [47][48][49][50], previously documented information in two studies [51,52], self-reported SDB in one study [53], and no diagnose tool in one study [54]. As for the definition of insomnia, two studies used the 9 th and 10 th edition of ICD [44,55], three used the 2 nd and 3 rd edition of ICSD [47,48,56], seven used the ISI [48,[57][58][59][60][61][62], one used the Brief Insomnia Questionnaire (BIQ) [63], four used a self-edited questionnaire [63][64][65][66], two used selfreported data [53,67], and one used documented information [52].…”