Muscle Metaboreflex Control of Sympathetic Activity in Obstructive Sleep Apnea

Ueno-Pardi, Linda M; Guerra, Renan S; Goya, Thiago Tanaka; Silva, Rosyvaldo F; Gara, Elisangela Macedo; Lima, Marta Fernandes; Nobre, Thais S.; Alves, Maria Janieire N. N.; Trombetta, Ivani C.; Lorenzi-Filho, Geraldo

doi:10.1249/mss.0000000000001242

Cited by 20 publications

(32 citation statements)

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“…The remarkable finding of the present study is the fact that ET decreased the levels of MSNA in individuals with moderate to severe OSA. Our results are in line with previous studies that showed that ET reduces resting MSNA in OSA ( 24 ) as well as other pathologies, including systolic heart failure ( 22 ) and myocardial infarction ( 25 ). In the present study, ET reduced MSNA (∼28.6%) towards levels lower than those observed in subjects with no OSA (∼28 bursts/min) ( 9 ).…”

Section: Discussionsupporting

confidence: 93%

“…MSNA was directly recorded from the peroneal nerve (leg) using microneurography (662C-4 Nerve Traffic Analysis System, The University of Iowa, Iowa City, IA, USA), according to well established methods ( 20 , 22 ). Muscle sympathetic bursts (bursts per min), and bursts per 100 heartbeats, were identified by visual inspection conducted by a single investigator, blind to the status of study participants (control vs exercise-trained).…”

Section: Methodsmentioning

confidence: 99%

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

Goya¹,

Ferreira-Silva²,

Gara³

et al. 2021

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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 (VO 2 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 VO 2 (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.

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Section: Discussionsupporting

confidence: 93%

Section: Methodsmentioning

confidence: 99%

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

Goya¹,

Ferreira-Silva²,

Gara³

et al. 2021

Clinics

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“…Medium to long‐term aerobic training, at a minimum frequency of three times a week, has been shown to prevent the unwanted decline in nighttime HRV parameters in patients with moderate OSA, due to a decrease in sympathetic nerve activity (Berger et al., 2019; Kline et al., 2013; Ueno‐Pardi et al., 2017). Studies conducted in patients with OSA and heart failure have shown, through microneurography, that exercise training can decrease sympathetic nerve activity following a 4‐month training program, at a frequency of three times a week (Ueno‐Pardi et al., 2017). Recently, it has been also shown that regular aerobic exercise is capable of increasing parasympathetic tone in OSA patients already by the 12th week of intervention (Yang et al., 2018).…”

Section: Discussionmentioning

confidence: 99%

Effects of short‐term aerobic training versus CPAP therapy on heart rate variability in moderate to severe OSA patients

et al. 2021

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We compared the effects of 2‐month CPAP or exercise training (ET) therapies on the autonomic balance in moderate to severe obstructive sleep apnea (OSA) through heart rate variability (HRV) analysis. Thirty‐nine OSA patients were divided into CPAP (n = 18) and ET (n = 21) groups, being further split into hypertensive and non‐hypertensive subgroups. All patients were submitted to continuous ECG recordings for HRV analysis. Hemodynamic parameters were recorded by oscillometry. Excessive daytime sleepiness and sleep quality were assessed through the Epworth Sleepiness Scale and the Pittsburgh questionnaire, respectively. ET decreased systolic arterial pressure in hypertensive and non‐hypertensive participants when compared to baseline values, whereas diastolic arterial pressure was decreased only in non‐hypertensive ones. CPAP had no effect over hemodynamic parameters in either subgroup. ET significantly increased the HRV parameters SDNN and pNN50 in non‐hypertensive participants, while reducing the LF/HF ratio in both subgroups. CPAP significantly decreased SDNN in both subgroups. ET significantly decreased excessive daytime sleepiness in both subgroups, but did not affect sleep quality. CPAP significantly improved sleep quality in both subgroups, although global scores were still those of poor sleepers, while excessive daytime sleepiness was normalized only in hypertensive patients. In conclusion, while short‐term ET modulated different HRV parameters, leading to a predominant vagal tone in the cardiac sympathovagal balance and decreasing blood pressure in moderate to severe OSA, short‐term CPAP had next to no effect in these parameters. We believe ET should be considered as an adjunct interventional strategy in the conservative management of hypertensive or non‐hypertensive OSA patients.

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“…Repeated events of hypoxia and reoxygenation lead to an increase of reactive oxygen species (2), insulin resistance (3), systemic inflammation, vascular dysfunction, and increase in sympathetic nervous activity (4), placing OSA patients at risk for cardiovascular disorders and neuropsychological symptoms that include mood changes (5). These changes in patients with OSA lead to impaired daytime performance (6) and increased occupational and motor vehicle accidents (7), which translate into difficulties in social adjustment related to fatigue (8,9).…”

Section: Introductionmentioning

confidence: 99%

Effects of exercise training on autonomic modulation and mood symptoms in patients with obstructive sleep apnea

Araujo

Ferreira-Silva

Gara

et al. 2021

Braz J Med Biol Res

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We evaluated the effects of exercise training (ET) on the profile of mood states (POMS), heart rate variability, spontaneous baroreflex sensitivity (BRS), and sleep disturbance severity in patients with obstructive sleep apnea (OSA). Forty-four patients were randomized into 2 groups, 18 patients completed the untrained period and 16 patients completed the exercise training (ET). Beat-to-beat heart rate and blood pressure were simultaneously collected for 5 min at rest. Heart rate variability (RR interval) was assessed in time domain and frequency domain (FFT spectral analysis). BRS was analyzed with the sequence method, and POMS was analyzed across the 6 categories (tension, depression, hostility, vigor, fatigue, and confusion). ET consisted of 3 weekly sessions of aerobic exercise, local strengthening, and stretching exercises (72 sessions, achieved in 40 ± 3.9 weeks). Baseline parameters were similar between groups. The comparisons between groups showed that the changes in apnea-hypopnea index, arousal index, and O 2 desaturation in the exercise group were significantly greater than in the untrained group (Po0.05). The heart rate variability and BRS were significantly higher in the exercise group compared with the untrained group (Po0.05). ET increased peak oxygen uptake (Po0.05) and reduced POMS fatigue (Po0.05). A positive correlation (r=0.60, Po0.02) occurred between changes in the fatigue item and OSA severity. ET improved heart rate variability, BRS, fatigue, and sleep parameters in patients with OSA. These effects were associated with improved sleep parameters, fatigue, and cardiac autonomic modulation, with ET being a possible protective factor against the deleterious effects of hypoxia on these components in patients with OSA.

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Muscle Metaboreflex Control of Sympathetic Activity in Obstructive Sleep Apnea

Abstract: These findings suggest an association between OSA and decreased metaboreflex control of MSNA. Muscle vasodilation during handgrip static exercise is preserved in patients with OSA.

Cited by 20 publications

References 45 publications

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

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

Effects of short‐term aerobic training versus CPAP therapy on heart rate variability in moderate to severe OSA patients

Effects of exercise training on autonomic modulation and mood symptoms in patients with obstructive sleep apnea

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