# Exercise as it relates to Disease/Exercise as a Treatment for Obstructive Sleep Apnea

This page is an analysis of the journal article "The Effect of Exercise Training on Obstructive Sleep Apnea and Sleep Quality: A Randomized Controlled Trial" by C Kline, P Crowley, G Ewing, J Burch, S Blair,L Durstine, M Davis and S Youngstedt (2011)

## What is the background to this research?

Obstructive Sleep Apnea is a condition which occurs at night when the muscle tone between the back of the nose and the top of the larynx relaxes causing an obstruction in the upper respiratory track, this can cause issues such as frequent awakening, disrupted sleep and daytime sleepiness. Treating obstructive sleep Apnea can greatly improve the quality of life for the suffers by allowing for a much better night’s sleep. Exercise is an inexpensive treatment which can be easily and widely administered. Using exercise to manage obstructive sleep Apnea can lead to benefits beyond weight loss. Health professionals have identified a link between the incidence of obstructive sleep Apnea and other health issues such as obesity, hypertension, diabetes and metabolic syndrome, Exercise has been found to be of benefit in alleviating the symptoms of all of these conditions.

## Where is the research from?

This research was conducted by Christopher E. Kline; E. Patrick Crowley; Gary B. Ewing; James B. Burch; Steven N. Blair, J. Larry Durstine, J. Mark Davis and Shawn D. Youngstedt, PhD for the Sleep Research Society journal. This article was published in the 34th volume in 2011.

## What kind of research was this?

This research was conducted as a randomised control trial involving forty-three sedentary and overweight/obese adults aged between 18–55 years old, all with some form of obstructive sleep Apnea. The group was split into two where one half was maintained as a control and participated in a stretching program, The second group performed 150 minutes of moderate intensity exercise. Exercise was performed primarily on a treadmill although participants may substitute an elliptical or cycle if they have not fully recovered from the last exercise session. The study ran over 12 weeks with the treatment group exercising four times per week and the control meeting twice a week.

## What were the basic results?

Participants took a polysomnography (PSG) in a laboratory setting to assess the severity of their obstructive sleep Apnea (OSA). Which is assessed through the screening Apnea-hypopnea index (AHI). The group that performed the exercise showed a statistically different difference from the control group (AHI reduction of 7.6), which was represented strongly through participants in the exercise group also showing significant differences in oxygen desaturation index (ODI), which is the amount of times an individual’s oxygen saturation drops below a normal baseline level. This is a very important measure in assessing how well an individual is breathing while they sleep as it indicates the amount of oxygen present in the bloodstream. This gives the researchers an idea of how much oxygen the body is taking in, therefore showing how well the participants are breathing. Individuals completed a Pittsburgh Sleep Quality Index (PSQI) which gave the researchers a subjective understanding of how well the participants are sleeping, through this participants taking part in the exercise program reported having a better night sleep. Participants taking part in the exercise group had a significant reduction in body fat percentage with a mean loss of 0.3% compared to the control group though no significant weight losses were made.

## What conclusions can we take from this research?

We can conclude that exercise may improve sleep quality in individuals suffering from obstructive sleep Apnea due to the decline in AHI. Individuals taking part in the exercise reported better night’s sleep than the control group. Exercise showed a greater decrease in body fat percentage compared to the control. Additionally we can conclude that exercise has benefits to obstructive sleep Apnea beyond only weight loss as body mass remained the same. Finally we can conclude that exercise is an inexpensive treatment that appears to yield positive results. Further research should be conducted to assess whether results such as the AHI reduction of 7.6 can be further reduced with an increase in exercise duration and intensity. Exercise was performed primarily exercise was performed on a treadmill, further research should be conducted to assess whether exercise type plays a large role in treating obstructive sleep Apnea.

## Practical advice

Australian guidelines for physical activity advise adults perform 150 to 300 minutes of moderate intensity physical every week. This level of physical activity matches the prescribed to the treatment group, which indicates that individuals participating in the study were not performing the recommended amount of physical activity dictated by the Australian guidelines as the participants were overweight/ obese individuals who are classified as sedentary individuals. I would advise following the advised 150 to 300 minutes moderate to high intensity physical activity to possibly prevent the incidence of obstructive sleep Apnea. The participants in the exercise group achieved a decrease in body fat percentage of 0.3% though the participants were only meeting the minimum requirements of the Australian guidelines Perhaps increasing the duration and intensity of the exercise may yield more beneficial results. Participants noticed an improvement in sleep quality as recorded through the PSQI which shows that the participants in this group were more satisfied with their treatment than the control group. I feel as the best practical advice to take from this study is to follow the Australian physical activity guidelines. Following these has been shown to have a positive effect on obstructive sleep Apnea patients, and many of the positive outcomes of the study could be applicable to non-sufferers such as decreases in body fat percentage.

## References

* ↑ Australian Sleep Association, Obstructive Sleep Apnea, Obtained from www.sleep.org.au, accessed on 20/09/2016.
* ↑ Mannarino M; Di Filippo F; Pirro M, (2012). Obstructive sleep apnea syndrome, European Journal of Internal Medicine, 23, 586–593.
* 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Kline CE; Crowley EP; Ewing GB; Burch JB; Blair SN; Durstine JL; Davis JM; Youngstedt SD.(2011). The effect of exercise training on obstructive sleep apnea and sleep quality:a randomized controlled trial. SLEEP ,34(12):1631-1640.
* ↑ Chung F; Liao P; Elsaid H; Islam S; Shapiro C; Sun Y, (2012), Oxygen Desaturation Index from Nocturnal Oximetry: A Sensitive and Speciﬁc Tool to Detect Sleep Disordered Breathing in Surgical Patients, ANESTHESIA & ANALGESIA, 114, 993–1000.
* 1 2 3 Australian Government Department of Health, Fact Sheet: Adults 18-64 years, Australia’s Physical Activity and Sedentary Behavior Guidelines, (10/07/2014), Obtained from http://www.health.gov.au/internet/main/publishing.nsf/content/health-pubhlth-strateg-phys-act-guidelines, accessed on 21/09/2016.