Exercise May Reduce Sleep Apnea and Improve Brain Health

Laura Williamson wrote . . . . . . . . .

Exercise may help reduce symptoms of a common sleep disorder and improve brain function, a small study finds.

Exercise training could be a useful supplemental treatment for people with moderate to severe obstructive sleep apnea, the research showed. The condition is characterized by loud snoring and disrupted breathing and can raise the risk for heart disease, stroke and cognitive decline. It is typically treated with continuous positive airway pressure, or CPAP, a machine that pushes air through a mask into the airway to keep it open while a person sleeps.

“Exercise training appears to be an attractive and adjunctive (add-on) non-pharmacological treatment,” said lead investigator Linda Massako Ueno-Pardi, an associate professor at the School of Arts, Science and Humanities at the University of São Paulo in Brazil. She also is a research collaborator at the university’s Heart Institute and Institute of Psychiatry, Faculty of Medicine.

Estimates show obstructive sleep apnea affects roughly 9% to 38% of U.S. adults, though many cases are thought to be undiagnosed. It is more common in men than women and becomes more prevalent as people age.

According to a scientific statement by the American Heart Association published in June, between 40% and 80% of people with cardiovascular disease have sleep apnea.

The condition often is associated with obesity, which can narrow the airway at the back of the throat, making it harder to breathe while lying down. Cigarette smoking, family history, nasal congestion, back sleeping, drinking alcohol, having a thicker neck or narrow throat and some hormone abnormalities also can contribute to the condition. Some medical conditions, such as Type 2 diabetes, also raise the risk for sleep apnea.

Previous studies have shown people with sleep apnea experience a decrease in brain glucose metabolism, or the brain’s ability to upload and properly use glucose, its main source of fuel. This can impair cognitive function. Ueno-Pardi and her team explored whether exercise could help correct that.

The new work builds upon a small 2019 study in the journal Brain Plasticity that concluded increased aerobic activity improved brain glucose metabolism and executive function in older, middle-aged adults at risk for Alzheimer’s disease.

The new research included 47 Brazilian adults with moderate to severe obstructive sleep apnea. Half took part in 60 minutes of supervised exercise three times per week for six months. The other half did not. The supervised exercise included five minutes of warming up; 25-40 minutes riding a stationary bicycle, 10 minutes of muscle strengthening and five minutes of cooling down.

Participants in both groups were given a series of tests to measure exercise capacity, brain glucose metabolism and cognitive function, including attention and executive function – the ability to plan and carry out tasks. Researchers also measured the severity of obstructive sleep apnea symptoms, such as disruptions to breathing and reductions in the body’s oxygen levels, or hypoxia, which has been shown to impact attention and executive function skills.

At the end of six months, those in the exercise group showed an increased capacity for exercise; improvements in the brain’s ability to use glucose; reductions in sleep apnea symptoms; and a boost in cognitive function, including a 32% improvement in attention and executive function. Those who did not exercise experienced no changes except a decline in brain glucose metabolism.

The findings, reported this week at the AHA’s Hypertension Scientific Sessions virtual conference, are considered preliminary until published in a peer-reviewed journal.

The research makes a good case as to why exercise should be added to the treatment strategy for sleep apnea, said Michael Grandner, director of the Sleep and Health Research Program and associate professor of psychiatry at the University of Arizona College of Medicine in Tucson. He was not involved in the study.

The findings are important because they show exercise could benefit brain health in people with sleep disorders, he said.

“Our current treatments largely involve pushing air down people’s airways, which is great, and it works. But it is kind of a blunt instrument. Exercise training is one option that could add benefit and maybe even be curative. This is especially important with a disease where our gold standard treatment is not curative.”

CPAP machines do little to address obesity, the largest cause of obstructive sleep apnea. Exercise training may be effective in reducing the excess fat around the airways that makes it harder for people to breathe at night, Grandner said.

That’s one of the outcomes Ueno-Pardi believes happened in her study. While she and her team didn’t measure weight loss or muscle tone, they did measure percentage of body fat and found a “significant reduction” in the exercise group, she said. The exercise may have improved sleep apnea severity by decreasing body fat, especially around the airways.

“There’s a lot of research out there that weight loss is a really powerful strategy for treating sleep apnea,” Grandner said.

Source: American Heart Association

Kids Who Snore Could be at Risk for Blood Pressure, Heart Problems

Obstructive sleep apnea, a type of sleep disorder characterized by disrupted breathing, may be linked to changes in blood pressure and heart structure in children and adolescents, according to a new scientific statement.

The American Heart Association report urges parents and health care providers to consider testing for children who exhibit symptoms, have obesity or have enlarged tonsils, which puts them at higher risk.

Estimates show up to 6% of all children and adolescents have obstructive sleep apnea, according to the statement published Wednesday in the Journal of the American Heart Association.

Symptoms of obstructive sleep apnea include habitual snoring, gasps, snorting or labored breathing while sleeping, daytime sleepiness, sleeping while seated with a distended neck, a headache upon waking and signs of an upper airway obstruction. The condition often occurs in children with obesity. About 30%-60% of children who meet the criteria for obesity – having a body mass index in the 95th percentile or higher – also have sleep apnea.

“We need to increase awareness about how the rising prevalence of obesity may be impacting sleep quality in kids and recognize sleep-disordered breathing as something that could contribute to risks for hypertension and later cardiovascular disease,” statement writing group chair Dr. Carissa M. Baker-Smith said in a news release. Baker-Smith is director of pediatric preventive cardiology at the Nemours/Alfred I. duPont Hospital for Children in Wilmington, Delaware. She also is associate professor of pediatric cardiology at Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia.

Obstructive sleep apnea is associated with cardiovascular disease in adults but less is known about how the condition affects the immediate and long-term heart health of children and adolescents. A review of the most current research included in the statement found evidence it can impact emotional health, as well as the immune, metabolic and cardiovascular systems in children and adolescents.

Obstructive sleep apnea risk factors vary with age. In addition to obesity, they include upper and lower airway disease; allergic rhinitis, inflammation and swelling in the nose’s mucous membrane; low muscle tone; enlarged tonsils and adenoids; craniofacial malformations; and neuromuscular disorders. Sickle cell disease, an inherited blood disorder, also is a risk factor.

Children born prematurely, who have delayed development of respiratory control and smaller upper airways, also may be at higher risk for sleep-disordered breathing. However, this risk gets smaller as children grow.

The statement supports recommendations from the American Academy of Otolaryngology and Head and Neck Surgery that say sleep studies, or polysomnographies, are the best test for diagnosing sleep-disordered breathing. Prior to getting a tonsillectomy, children should take this test if they have conditions that raise their risk for breathing complications during surgery. These include obesity, Down syndrome, craniofacial abnormalities such as a cleft palate, and disorders such as muscular dystrophy or sickle cell disease.

Children and adolescents with obstructive sleep apnea also may have trouble regulating blood pressure. While blood pressure typically dips during sleep, children with this condition see smaller dips than those without it. Adults whose blood pressure fails to dip during sleep have a higher risk for cardiovascular events. Because of this, the statement calls for 24-hour blood pressure monitoring to check levels in children with sleep apnea.

Even mild cases of sleep apnea – defined as just two pauses in breathing per hour – are associated with a higher risk for metabolic syndrome in children. Metabolic syndrome is a cluster of factors including high insulin and triglyceride levels, elevated blood pressure and low levels of high-density lipoprotein, or HDL, the “good” cholesterol. Continuous positive airway pressure, or CPAP, is a treatment for sleep apnea that delivers pressurized air through a mask that can lower triglyceride and improve HDL levels.

Long-term, severe sleep apnea also may put children at higher risk for pulmonary hypertension, when pressure in the blood vessels from the heart to the lungs is too high. The statement committee recommends that future research on how sleep apnea affects children’s risk for heart problems incorporates 24-hour blood pressure monitoring and measures of metabolic syndrome factors.

Source: American Heart Association

Want to Avoid Sleep Apnea? Get Off the Sofa

Here’s yet another reason to limit screen time and get moving: Boosting your activity levels could reduce your risk of sleep apnea, according to a new study.

Compared to the most active people in the study, those who spent more than four hours a day sitting watching TV had a 78% higher risk of obstructive sleep apnea (OSA), and those with sedentary jobs had a 49% higher risk.

And that added risk was not due to their weight.

“We saw a clear relationship between levels of physical activity, sedentary behavior and OSA risk. People who followed the current World Health Organization physical activity guidelines of getting at least 150 minutes of moderate activity per week, and who spent less than four hours per day sitting watching TV, had substantially lower OSA risk,” said study leader Tianyi Huang, an assistant professor and associate epidemiologist at Brigham and Women’s Hospital and Harvard Medical School, in Boston.

People with this disorder stop and start breathing many times during sleep. Common symptoms include snoring, disrupted sleep and excessive tiredness. Poorly managed sleep apnea can increase the risk of high blood pressure, stroke, heart attack, irregular heartbeat and type 2 diabetes.

After accounting for risk factors such as obesity, age, smoking and drinking, the researchers found that people whose activity levels were equivalent to three hours of running a week had a 54% lower risk of sleep apnea than those whose activity levels were equivalent to two hours a week of walking at an average pace.

The study included more than 138,000 U.S. women and men without a diagnosis of sleep apnea. They were followed for 10 to 18 years. Over that time, more than 8,700 were diagnosed with the condition.

So are desk jockeys doomed? Not necessarily.

The researchers said folks with sedentary jobs could lower their risk by getting more exercise in their leisure time. Also, those who can’t do much physical activity due to physical limitations could lower their risk of sleep apnea by standing or doing other gentle activities more often.

The study was published in the European Respiratory Journal.

“Importantly, we saw that any additional increase in physical activity, and/or a reduction in sedentary hours, could have benefits that reduce the risk of developing OSA,” Huang explained in a journal news release.

The difference in risk between sedentary work and time spent sitting watching TV could be explained by other behaviors related to those activities, the researchers suggested.

“For example, snacking and drinking sugary drinks is more likely to go along with watching TV compared with being sedentary at work or elsewhere, such as sitting during traveling. This could lead to additional weight gain, which we know to be a risk factor for OSA,” Huang noted.

It’s estimated that 1 billion adults worldwide, aged 30 to 69, have mild to severe sleep apnea.

Anita Simonds, president of the European Respiratory Society, was not involved with the study but commented on the report. She said, “It is encouraging that even a small increase in physical activity or reduction in sedentary hours could reap potential benefits. It is therefore an important message to get across to our patients and their families in primary care and respiratory clinics.”

Source: HealthDay

Sleep Apnea Worsens Heart Disease, Yet Often Untreated

Health care experts urge increased awareness of obstructive sleep apnea among people with cardiovascular disease or risk factors such as high blood pressure, according to a new scientific statement from the American Heart Association, published today in Circulation, the Association’s flagship journal.

Obstructive sleep apnea (OSA) occurs in 40% to 80% of people with cardiovascular disease, yet it is under-recognized and undertreated, according to the statement. OSA occurs when an upper airway obstruction causes repeated episodes of disrupted breathing during sleep. Symptoms include snoring, lapses in breathing, fragmented sleep and daytime sleepiness. In general, about 34% of middle-aged men and 17% of middle-aged women meet the criteria for OSA.

“Obstructive sleep apnea can negatively impact patients’ health and increase the risk of cardiovascular events and death. This statement is to encourage increased awareness, screening and treatment as appropriate for sleep apnea,” said Chair of the scientific statement writing group Yerem Yeghiazarians, M.D., FAHA, professor of medicine and the Leone-Perkins Family Endowed Chair in Cardiology at the University of California, San Francisco.

Risk factors for OSA include obesity, large neck circumference, craniofacial abnormalities, smoking, family history and nighttime nasal congestion. OSA is associated with several cardiovascular complications:

  • high blood pressure – OSA is present in 30-50% of people with high blood pressure, and up to 80% of those who have resistant, or hard-to-treat high blood pressure;
  • heart rhythm disorders such as atrial fibrillation and sudden cardiac death;
  • Stroke;
  • worsening heart failure;
  • worsening coronary artery disease and risk of heart attack;
  • Pulmonary hypertension (PH) – as many as 80% of people with PH have OSA; and
    Metabolic syndrome and Type 2 diabetes.

While there’s no consensus that screening for OSA alters clinical outcomes, the high prevalence of OSA among people with cardiovascular disease, along with evidence that OSA treatment improves patient quality of life, are reasons to screen and provide treatment, according to the statement writing group.

“Patients report better mood, less snoring, less daytime sleepiness, improved quality of life and work productivity with OSA treatment,” Yeghiazarians said. “In addition, screening advances have changed how we diagnose and treat obstructive sleep apnea. For example, many patients do not have to go to an overnight sleep study center anymore. There are now sleep devices approved by the FDA that patients use at home and send back to their doctor for assessment. And, while a continuous positive airway pressure (CPAP) machine is one form of treatment, there are numerous therapeutic options – from positional therapy and weight loss to oral appliances and surgery – depending on the cause and severity of someone’s OSA.”

The authors suggest:

  • Screening for OSA in patients with resistant or difficult to control hypertension, pulmonary hypertension and atrial fibrillation that recurs despite treatment.
  • Screening for OSA via a sleep study for some patients with heart failure, especially if sleep-disordered breathing or excessive daytime sleepiness are suspected.
  • Treating patients diagnosed with OSA with available therapies, potentially including lifestyle and behavior modifications and weight loss.
  • When possible, treating patients with severe OSA with a CPAP machine.
  • Treating mild to moderate OSA cases with oral appliances that adjust the jaw and tongue placement during sleep to prevent obstructed breathing.
  • Routine follow-up including overnight sleep testing to confirm if treatment is effective.

“Improvements in home diagnostic tools and more research on ways to identify cardiovascular risk in people with OSA are needed,” Yeghiazarians said. “Still, the overall message is clear: we need to increase awareness about screening for and treating OSA, especially in patients with existing cardiovascular risk factors.”

Source: American Heart Association

More Than a Snore? Recognize the Signs of Sleep Apnea

Does your bed partner claim that you snore?

If so, don’t just tune him or her out. It may mean you have obstructive sleep apnea (OSA).

Untreated sleep apnea — which causes repeated breathing interruptions during sleep — can lead to serious health problems, so the American Academy of Sleep Medicine (AASM) wants you to consider: Is it more than a snore?

“While not everyone who snores has sleep apnea, snoring is a warning sign that should be taken seriously,” said AASM President Dr. Kannan Ramar. “If your bed partner snores, or if you’ve been told that you snore, then it is important to talk to a medical provider about screening or testing for sleep apnea.”

Treating obstructive sleep apnea can improve overall health and quality of life, he added.

Nearly 70% of Americans who sleep with a partner say their bed mate snores, according to a 2021 AASM survey. The same survey found that 26% of Americans are unfamiliar with OSA, and 48% don’t know its symptoms.

Nearly 30 million U.S. adults have OSA, but AASM estimates that 23.5 million of those cases are undiagnosed.

These are the five warning signs to be aware of: snoring, choking or gasping during sleep; fatigue or daytime sleepiness; obesity; and high blood pressure.

Other indications of apnea include: unrefreshing sleep, insomnia, morning headaches, waking during the night to go to the bathroom, difficulty concentrating, memory loss, decreased sexual desire, irritability, or difficulty staying awake while watching TV or driving.

“Delaying treatment for sleep apnea can lead to more serious health problems,” Ramar said. “Fortunately, many of the damaging effects of sleep apnea can be stopped, and even reversed, through diagnosis and treatment by the sleep team at an accredited sleep center, where patients receive care in safe and comfortable accommodations.”

The typical treatment for sleep apnea is continuous positive airway pressure (CPAP) therapy. CPAP keeps the airway open by providing a steady stream of air through a mask that’s worn while sleeping.

Using CPAP can improve quality of sleep, boost daytime alertness, concentration and mood and even improve brain and heart health, according to AASM.

Other treatments include positional therapy, oral appliance therapy and surgery.

Source: HealthDay