# Exercise as it relates to Disease/Aerobic exercise as an intervention for sleep apnea

Sleep apnea is a sleeping disorder characterised by abnormal interruptions in breathing, or instances of unusually low breathing during sleep$^{[1][4]}$. Obstructive sleep apnea (OSA)is the most common form of sleep apnea effecting 84% of all cases$^{[9]}$. In OSA, breathing is interrupted by repetitive episodes of upper airway obstruction causing increased respiratory efforts and starving the brain of oxygen$^{[1][8][12]}$. Approximately 70% of patients with OSA are obese, and 40% of obese individuals have OSA$^{[5]}$. The risk of OSA rises with increasing body weight, active smoking and age$^{[5][12][14]}$. This paper will primarily focus on interventions for obstructive sleep apnea and provide recommendations how to manage this particular type of disorder.

## Issue

OSA decreases the quality and quantity of sleep$^{[4]}$, thus having a detrimental effect on daily functioning and mental health$^{[5][14][15]}$. Children suffering from OSA can display issues including growth problems, cardiovascular disease, learning and memory problems, and decreased attention$^{[3][4]}$. Studies have shown that OSA increases the risk of hypertension$^{[2][4][5]}$, obesity$^{[1][2][5]}$, depression$^{[4]}$, cardiovascular disease$^{[1][15]}$, diabetes$^{[7][15]}$, coronary artery disease$^{[4}$, stroke$^{[5][12][15]}$, accidents$^{[4][12][15]}$, heart attack$^{[4]}$ and sudden death$^{[15]}$. If left untreated, it can lead to more serious medical conditions$^{[8]}$ and seriously decrease quality of life$^{[9][13]}$.

## Signs and Symptoms of Obstructive Sleep Apnea

It can be tough to identify OSA on your own, since the most prominent symptoms only occur when you’re asleep. However, you can get around this difficulty by asking a bed partner to observe your sleep habits, or by recording yourself during sleep.
| Major signs and symptoms of OSA | Other signs and symptoms of OSA |
| Loud and chronic snoring$^{[2][3][7]}$ | Forgetfulness and difficulty concentrating$^{[2][5][8]}$ |
| Daytime sleepiness or fatigue$^{[3][5][8]}$ | Restless or fitful sleep$^{[12]}$ |
| Choking, snorting, or gasping during sleep$^{[7][12]}$ | Loss of libido$^{[8][12]}$ |
| Morning headaches$^{[5][7][8]}$ | Insomnia or nighttime awakenings$^{[3][7][12]}$ |
| Unusual sleeping positions | Anxiety and panic attacks$^{[8][12]}$ |
| Frequent urination at night$^{[7]}$ | Waking up feeling out of breath$^{[7]}$ |
| | Moodiness, irritability, or depression$^{[2][6][12]}$ |

## Treatment

There are various types of treatments available for obstructive sleep apnea:
* Continuous positive airway pressure (CPAP): Which continuously adjusts pressure in your airway to deliver the amount required to keep the airway open$^{[1][7][8]}$
* Cognitive-behavioural therapy (CBT): Which focuses on eliminating stress and tension from the mind and improves sleep hygiene$^{[10]}$
* Is surgery an option?:There are numerous of techniques available for treating OSA $^{[5]}$

## Aerobic Exercise

Research has shown that aerobic exercise can help reduce the effects of obstructivc sleep apnea by:
* Decreasing body weight to reduce OSA severity$^{[1][5][8]}$
* Decreasing the risk of developing correlated morbidity's$^{[5]}$
* Increasing sleep quality and total sleep time$^{[1][11][14]}$
* Increasing cardiac and vascular function and in turn, decreasing breathing abnormalities during sleep$^{[13]}$
These improvements in sleeping patterns effectively lead to: decreases in daytime dysfunction and pre-sleep anxiety$^{[11]}$, increases in mood and quality of life$^{[13][14]}$.

## Recommendations

Recommendations to manage and reduce the effects of obstructive sleep apnea.
Aerobic Exercise
* 3–5 days per week for 30–40 minutes at a moderate intensity$^{[6][14]}$
* Exercises can include walking, cycling, stair stepping and moderate intensity activities$^{[6]}$
* Exercising in the morning has displayed positive effects on nighttime rest, making it easier to fall asleep and improving overall sleep quantity and quality$^{[11]}$
As OSA is strongly correlated to obesity and hypertension, it is important to ensure that an appropriate training program is created before commencing high intensity exercise. Persons with OSA should complete a pre-training questionnaire, consult a doctor or a healthcare professional prior to commencing a training program.
Other Recommendations
* Avoid alcohol, sleeping pills, and other sedatives, which can relax throat muscles causing the airway to collapse at night$^{[8]}$
* Sleeping on one's side and avoiding the supine position (on your back) can reduce the effects of OSA$^{[8][12]}$
* Diet interventions can also improve quality and duration of sleep$^{[14]}$

### Further reading

* Help Guide- http://www.helpguide.org/life/sleep_apnea.htm
* Medline Plus- http://www.nlm.nih.gov/medlineplus/sleepapnea.html
* National Institute of Health (NIH)- http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea/
* National Sleep Foundation- http://www.sleepfoundation.org/article/sleep-topics/sleep-apnea-and-sleep

## References

* Alves, E., Lira, F., Santos, R., Tufik, S., & de Mello, M. (2011). Obesity, diabetes and OSAS induce of sleep disorders: exercise as therapy. Lipids In Health And Disease, 10148. doi:10.1186/1476-511X-10-148
* Budden, L. (2013). Obstructive Sleep Apnea. Australian Nursing Journal, 21(1), 45.
* Caple, C., & Schub, T. (2012). Obstructive Sleep Apnea in Children.
* Church, E. J. (2012). Imaging Sleep and Sleep Disorders. Radiologic Technology, 83(6), 585-606.
* Gutierrez, C. (2013). Obstructive sleep apnea: A diagnostic and treatment guide. Journal Of Family Practice, 62(10), 565-572.
* Igelström, H., Emtner, M., Lindberg, E., & Åsenlöf, P. (2013). Level of Agreement Between Methods for Measuring Moderate to Vigorous Physical Activity and Sedentary Time in People With Obstructive Sleep Apnea and Obesity. Physical Therapy, 93(1), 50-59.
* Miller, I. M. (2010). IT'S ALL About the ZZZs. American Fitness, 28(1), 20-24.
* New options for treating sleep apnea. (2012). Harvard Men's Health Watch, 17(1), 3.
* Obstructive sleep apnea and hypopnea. (2013). Canadian Nursing Home, 24(2), 16-24.
* Perfect, M. R. (2010). Cognitive-behavioral therapy and hypnotic relaxation to treat sleep problems in an adolescent with diabetes. Journal Of Clinical Psychology, 66(11), 1205-1215.
* Roveda, E., Sciolla, C., Montaruli, A., Calogiuri, G., Angeli, A., & Carandente, F. (2011). Effects of endurance and strength acute exercise on night sleep quality. # International Sportmed Journal,12(3), 113-124.
* Schub, T., & Buckley, L. (2012). Obstructive Sleep Apnea in Adults.
* Servantes, D., Pelcerman, A., Salvetti, X., Salles, A., de Albuquerque, P., de Salles, F., & ... Filho, J. (2012). Effects of home-based exercise training for patients with chronic heart failure and sleep apnoea: a randomized comparison of two different programmes. Clinical Rehabilitation, 26(1), 45-57. doi:10.1177/0269215511403941
* Tan, X., Saarinen, A., Mikkola, T., Tenhunen, J., Martinmäki, S., Rahikainen, A., & ... Cheng, S. (2013). Effects of exercise and diet interventions on obesity-related sleep disorders in men: study protocol for a randomized controlled trial. Trials, 14235. doi:10.1186/1745-6215-14-235
* Wells, M., & Vaughn, B. V. (2012). Poor Sleep Challenging the Health of a Nation. Neurodiagnostic Journal, 52(3), 233-249.