Effect of a Graduated Walking Program on the Severity of Obstructive Sleep Apnea Syndrome. A Randomized Clinical Trial

Abstract

Background: Obstructive sleep apnea syndrome (OSAS) is a common disease. The objective of this research was to determine the effectiveness of a graduated walking program in reducing the apnea–hypopnea index number in patients with obstructive sleep apnea syndrome (OSAS). Methods: A randomized controlled clinical trial with a two-arm parallel in three tertiary hospitals was carried out with seventy sedentary patients with moderate to severe OSAS. Twenty-nine subjects in each arm were analyzed by protocol. The control group received usual care, while usual care and an exercise program based on progressive walks without direct supervision for 6 months were offered to the intervention group. Results: The apnea–hypopnea index decreased by six points in the intervention group, and improvements in oxygen desaturation index, total cholesterol, and Low-Density Lipoprotein of Cholesterol (LDL-c) were observed. A higher decrease in sleep apnea–hypopnea index (45 ± 20.6 vs. 34 ± 26.3/h; p = 0.002) was found in patients with severe vs. moderate OSAS, as well as in oxygen desaturation index from baseline values (43.3 vs. 34.3/h; p = 0.046). Besides, High-Density Lipoprotein of Cholesterol (HDL-c) values showed a higher increase in the intervention group (45.3 vs. 49.5 mg/dL; p = 0.009) and also, a higher decrease in LDL-c was found in this group (141.2 vs. 127.5 mg/dL; p = 0.038). Conclusion: A home physical exercise program is a useful and viable therapeutic measure for the management of OSAS.

Effects of Exercise on Patients with Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis

“…A total of 249 publications were excluded after screening titles and abstracts, and the full text of 29 studies that were potentially suitable for inclusion was reviewed. Finally, 9 studies [ 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ] met the eligibility criteria, including 444 patients. The main reasons for exclusion were described in the flowchart, which is shown in Figure 1 .…”

“…The characteristics of the included studies are summarized in Table 1 , Table 2 and Table 3 . Four studies [ 27 , 28 , 29 , 34 ] had protocols with aerobic exercise, and five studies [ 26 , 30 , 31 , 32 , 33 ] had protocols with aerobic exercise combined with resistance exercise. All the exercise interventions followed the principle of exercise prescription, regardless of the exercise modality.…”

“…Nine studies [ 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ] showed a significant pooled estimate of mean change in AHI of −6.65 events/h (95% CI −7.77 to −5.53; p < 0.00001) with an I 2 = 39%. All studies were divided into two groups according to the modality of exercise for subgroup analysis, and the results show that aerobic exercise alone [ 27 , 28 , 29 , 34 ] contributed to a mean change in AHI of −4.36 events/h (95% CI −6.67 to −2.06; p = 0.0002) with an I 2 = 0%, while aerobic exercise combined with resistance exercise [ 26 , 30 , 31 , 32 , 33 ] contributed to a mean change in AHI of −7.36 events/h (95% CI −8.64 to −6.08; p < 0.00001) with an I 2 = 40%. The difference between subgroups was statistically significant ( p = 0.03) ( Figure 3 ).…”

Obstructive Sleep Apnea Syndrome: The Effect of Acute and Chronic Responses of Exercise

“…However, only one study by Cavagnolli et al (52), aimed to distinguish the anti -inflammatory effect of exercise in OSAS from its comorbidities and found C-RP was not significantly different between control and non-obese OSAS group. In a recent clinical trial by Jurado-García et al (53), demonstrated that metabolic profile of obese OSAS patients improved after lowintensity exercise. Therefore, it becomes apparent that exercise acts indirectly through obesity in the amelioration of the systemic inflammatory environment.…”

Changes in Sleep Quality in Heart Disease Patients Following a Cardiac Rehabilitation Program

“…Exercise improves the quality of sleep in healthy adults with sleep problems 11 and may reduce obstructive apneas during sleep 12 . Other works showed how exercise may increase sleep duration 13 , e ciency, as well as sleep-associated breathing disorders 14 in patients with heart failure.…”