Exercise, Occupational Activity, and Risk of Sleep Apnea: A Cross-Sectional Study

Silva, Roberto P. da; Martinez, Dênis; Pedroso, Martina Madalena; Righi, Camila Gosenheimer; Martins, Emerson Ferreira; Silva, Leticia M T; Lenz, Maria do Carmo Sfreddo; Fiori, Cíntia Zappe

doi:10.5664/jcsm.6446

Cited by 17 publications

(15 citation statements)

References 35 publications

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“…adjusted odds ratio for moderate to severe OSA, 0.76; 95% CI, 0.59–0.98; Murillo et al., ). A cross‐sectional study of 5,453 Brazilian adults reported that structured physical exercise was associated with 23% lower odds of moderate OSA and 34% lower odds of severe OSA, after adjusting for BMI (da Silva et al., ). All of these studies examined physical activity or exercise, but not CRF, and most studies have examined effects on symptom severity in patients with existing OSA.…”

Section: Discussionmentioning

confidence: 99%

“…TA B L E 1 Characteristics of 18-year-old men who were or were not subsequently diagnosed with sleep apnea, Sweden, 1969Sweden, -2012 To our knowledge, this is the first study to examine CRF in relation to the risk of sleep apnea. Prior studies have suggested that high physical activity or exercise levels are associated with reduced symptoms and improved outcomes in patients with existing OSA, irrespective of body weight or BMI (Aiello et al, 2016;Iftikhar et al, 2014;Mendelson et al, 2018;Murillo et al, 2016;da Silva et al, 2017). For example, three meta-analyses of small clinical trials reported that exercise training was independently associated with reduced severity of apnea symptoms in patients with OSA (Aiello et al, 2016;Iftikhar et al, 2014;Mendelson et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

“…Selfreported high physical activity or exercise has been associated with improved symptoms and outcomes in patients with existing OSA, irrespective of weight loss (Aiello et al, 2016;Iftikhar, Kline, & Youngstedt, 2014;Mendelson et al, 2018). However, few studies have examined physical activity in relation to the risk of developing OSA (Murillo et al, 2016;da Silva et al, 2017), and none has examined objectively measured cardiorespiratory fitness (CRF). Selfreported physical activity is a poor proxy for CRF, the underlying physiological factor affected by physical activity that may more directly influence sleep apnea risk (Lee et al, 2011).…”

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confidence: 99%

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

Crump

Sundquist

Winkleby

et al. 2019

Journal of Sleep Research

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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

Crump

Sundquist

Winkleby

et al. 2019

Journal of Sleep Research

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“…, 7 One confounder in the OSA-exercise association is exercise intensity 8 . In a previous study conducted by our group, exercise was associated with a 34% lower adjusted risk of severe OSA 9 …”

Section: Introductionmentioning

confidence: 94%

“…A considerable proportion of individuals with OSA exercise. It has been reported that 34% of patients with moderate-to-severe OSA exercise regularly, 8 as do 21% of those with severe OSA, 9 indicating the relevance of studying the relationship between OSA and exercise.…”

Section: Introductionmentioning

confidence: 99%

Effects of exercise on sleep symptoms in patients with severe obstructive sleep apnea

et al. 2019

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Objective: To investigate the extent to which exercise is associated with symptoms in patients with severe obstructive sleep apnea (OSA). Methods: We included subjects with an apnea-hypopnea index (AHI) > 30 events/h who completed validated sleep and exercise questionnaires. We compared symptom frequency/scores between exercisers and nonexercisers, adjusting for the usual confounders. Results: The sample included 907 nonexercisers and 488 exercisers (mean age, 49 ± 14 years; mean AHI, 53 ± 20 events/h; 81% men). Nonexercisers and exercisers differed significantly in terms of obesity (72% vs. 54%), the mean proportion of sleep in non-rapid eye movement stage 3 sleep (9 ± 8% vs. 11 ± 6%), and tiredness (78% vs. 68%). Nonexercisers had a higher symptom frequency/scores and poorer sleep quality. Adjustment for exercise weakened the associations between individual symptoms and the AHI, indicating that exercise has a mitigating effect. In binary logistic models, exercise was associated with approximately 30% lower adjusted questionnaire1 score > 2, tiredness; poor-quality sleep, unrefreshing sleep, and negative mood on awakening. Although the odds of an Epworth Sleepiness Scale score > 10 were lower in exercisers, that association did not withstand adjustment for confounders. Conclusions: Exercise is associated with lower frequency/intensity of symptoms in patients with severe OSA. Because up to one third of patients with severe OSA might exercise regularly and therefore be mildly symptomatic, it is important not to rule out a diagnosis of OSA in such patients.

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Exercise and Sleep

Lins-Filho¹,

Lyra²,

Kline³

2021

Sleep Medicine and Physical Therapy

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Exercise, Occupational Activity, and Risk of Sleep Apnea: A Cross-Sectional Study

Cited by 17 publications

References 35 publications

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

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

Effects of exercise on sleep symptoms in patients with severe obstructive sleep apnea

Exercise and Sleep

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