Effect of strength training on sleep apnea severity in the elderly: study protocol for a randomized controlled trial

Trials, Oct 2017

Obstructive sleep apnea (OSA) occurs due to sleep-induced upper airway muscle relaxation resulting in increased pharyngeal collapsibility. Clinical trials have shown a favorable effect of exercise training on OSA severity in middle-aged adults. Aging is characterized by motor-unit loss. Force training may affect the whole body muscle tone. We hypothesize that interventions increasing muscle strength might propagate to motor units at the abductor pharyngeal muscles, reducing collapsibility and, hence, sleep apnea severity in elderly patients with obstructive sleep apnea. This is a randomized clinical trial including patients between 65 and 80 years of age, with obstructive sleep apnea, and an apnea-hypopnea index (AHI) between 20 and 50 events/hour, diagnosed by out-of-center in-home type III polysomnography. Forty subjects will be included and randomly assigned to two equal sized groups. The participants allocated to the intervention group will attend two sessions per week of one-hour strength training for the legs, arms, chest, back, and abdomen and the controls will receive advice on lifestyle change. The primary outcome measure of the study will be the change in apnea-hypopnea index and the secondary outcomes will be the body composition, evaluated by anthropometric and bioelectrical impedance variables; maximum dynamic force, appraised by one-repetition maximum strength test; muscle quality and thickness by ultrasound; physical function assessed by sit-to-stand test, timed up and go test, handgrip strength test. The study duration will be 12 weeks. Intention-to-treat and per-protocol analyses will be performed. The high prevalence of obstructive sleep apnea in elderly people is a public health issue. OSA is a recognized cause of cardiovascular disease and reduces quality of life due to sleepiness and fatigue. Exercise is a low-cost intervention that could help to detain the trend towards age-dependent loss of pharyngeal motor units and progressive severity of obstructive sleep apnea. Home-based strength exercises may represent a more practical approach than aerobic exercise for elderly patients. If the results confirm our hypothesis, further research on the clinical application of our findings will be warranted. ClinicalTrials.gov, NCT02742792 . Registered on 1 April 2016.

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Effect of strength training on sleep apnea severity in the elderly: study protocol for a randomized controlled trial

Silva et al. Trials Effect of strength training on sleep apnea severity in the elderly: study protocol for a randomized controlled trial Roberto Pacheco da Silva 2 Denis Martinez 1 2 Pedro Lopez 0 Eduardo Lusa Cadore 0 3 0 Exercise Research Laboratory , UFRGS, Porto Alegre, RS , Brazil 1 Cardiology Unit, Hospital de Clinicas de Porto Alegre (HCPA) , UFRGS, Porto Alegre, RS , Brazil 2 Graduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul (UFRGS) , Porto Alegre, RS , Brazil 3 Physical Education School , UFRGS, Porto Alegre, RS , Brazil Background: Obstructive sleep apnea (OSA) occurs due to sleep-induced upper airway muscle relaxation resulting in increased pharyngeal collapsibility. Clinical trials have shown a favorable effect of exercise training on OSA severity in middle-aged adults. Aging is characterized by motor-unit loss. Force training may affect the whole body muscle tone. We hypothesize that interventions increasing muscle strength might propagate to motor units at the abductor pharyngeal muscles, reducing collapsibility and, hence, sleep apnea severity in elderly patients with obstructive sleep apnea. Methods/design: This is a randomized clinical trial including patients between 65 and 80 years of age, with obstructive sleep apnea, and an apnea-hypopnea index (AHI) between 20 and 50 events/hour, diagnosed by out-of-center in-home type III polysomnography. Forty subjects will be included and randomly assigned to two equal sized groups. The participants allocated to the intervention group will attend two sessions per week of one-hour strength training for the legs, arms, chest, back, and abdomen and the controls will receive advice on lifestyle change. The primary outcome measure of the study will be the change in apnea-hypopnea index and the secondary outcomes will be the body composition, evaluated by anthropometric and bioelectrical impedance variables; maximum dynamic force, appraised by one-repetition maximum strength test; muscle quality and thickness by ultrasound; physical function assessed by sit-to-stand test, timed up and go test, handgrip strength test. The study duration will be 12 weeks. Intention-to-treat and per-protocol analyses will be performed. Discussion: The high prevalence of obstructive sleep apnea in elderly people is a public health issue. OSA is a recognized cause of cardiovascular disease and reduces quality of life due to sleepiness and fatigue. Exercise is a low-cost intervention that could help to detain the trend towards age-dependent loss of pharyngeal motor units and progressive severity of obstructive sleep apnea. Home-based strength exercises may represent a more practical approach than aerobic exercise for elderly patients. If the results confirm our hypothesis, further research on the clinical application of our findings will be warranted. Trial registration: ClinicalTrials.gov, NCT02742792. Registered on 1 April 2016. Exercise; Training; Sleep apnea; Elderly; Strength; Functional capacity Background Obstructive sleep apnea (OSA) causes repeated surges of hypoxia and awakenings during sleep [ 1 ]. OSA occurs in up to one third of the population [ 2 ], constituting a public health problem [ 3 ]. The prevalence of sleep apnea increases with age. In young women, the prevalence is 1.4%. In both men and women 70 years or older, it reaches 90% and more [ 2, 4 ]. This remarkable increase in prevalence is explainable, at least in part, by escalating body weight with age, but several contributing factors, which deserve medical attention, should be considered. The repeated arousals caused by the need to restore breathing after each one of the recurrent breathing interruptions have as a consequence sympathetic hyperactivity, somnolence, and fatigue. Intermittent hypoxia is associated to oxidative stress, inflammation, and cardiovascular impairments [ 5 ]. Periods of sleep-dependent hypoxia also cause motor cortex dysfunction [ 6 ] Intermittent hypoxia was shown to cause demyelination [ 7 ] and neuronal damage, notably in the cerebellum [ 8 ]. In addition, OSA is a risk factor for hypertension [ 9 ], coronary artery disease [ 10 ] , heart failure [ 11 ], and arrhythmias [ 12 ]. Treatment options for OSA are several and the most effective is the use of a continuous positive airway pressure (CPAP) device [ 13 ]. Oral appliances for mandibular advancement [ 14, 15 ], surgery [16], weight reduction, and lifestyle change, including recommendation of regular exercise [ 17 ] are alternatives to CPAP. Physical exercise is accepted culturally and scientifically as a non-pharmacological intervention beneficial to health [ 18, 19 ]. Aerobic and resistance training improves general wellbeing and particularly sleep quality [ 20, 21 ]. A sedentary lifestyle is linked with higher prevalence and severity of sleep apnea. On the other hand, exercise gives consistent results in treating OSA, and increas (...truncated)


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Roberto Pacheco da Silva, Denis Martinez, Pedro Lopez, Eduardo Lusa Cadore. Effect of strength training on sleep apnea severity in the elderly: study protocol for a randomized controlled trial, Trials, 2017, pp. 489,