Obstructive Sleep Apnea Effects on Pulmonary and Respiratory Muscle Function of Obese Children and Adolescents: A Preliminary Study.

OBJECTIVE: Obstructive sleep apnea causes a marked decrease in lung volume and increases lung elasticity in obese adults. However, pulmonary and respiratory muscle function of obese children with obstructive sleep apnea who are more prone to develop airway obstruction than adults is less understood. This study aimed to determine the effects of obstructive sleep apnea on pulmonary and respiratory muscle function in obese children and adolescents compared to those without obstructive sleep apnea. MATERIAL AND METHODS: This cross-sectional study enrolled 12 obese children and adolescents with a known polysomnographic diagnosis of obstructive sleep apnea and 12 controls that were matched for age, gender, and body mass index. Pulmonary function, maximal inspiratory pressure, maximum voluntary ventilation, and anthropometric variables were measured. RESULTS Obese children and adolescents with obstructive sleep apnea exhibited significantly lower maximal mid-expiratory flow and displayed a forced expiratory flow at 50% and 75% of vital capacity (all P < .05) compared to the control group. However, there were no changes in other pulmonary function variables (all P > .05). Their maximal inspiratory pressure and maximum voluntary ventilation were lower than those of the controls, but this was not statistically significant (all P > .05). CONCLUSION: Obstructive sleep apnea did not change pulmonary and respiratory muscle function in obese children and adolescents. The special assessment should be warranted to identify a reduction in maximal mid-expiratory flow and forced expiratory flow at 50% and 75% of vital capacity observed in this population.

High-intensity interval training combined with resistance training improved apnea-hypopnea index but did not modify oxygen desaturation index and oxygen saturation nadir in obese children with obstructive sleep apnea.

PURPOSE: To investigate the effect of high-intensity interval training (HIIT) combined with resistance training (RT) on sleep indices and vascular functions in obese children with obstructive sleep apnea (OSA). METHODS: A quasi-experimental study. Forty-four obese children with OSA were allocated into either an exercise intervention (n = 22) or a usual care control group (n = 22). The exercise group received 24 min of HIIT (> 60% heart rate reserved) and 20 min of RT (50-80% one-repetition maximum), three times per week for 8 weeks. Primary outcomes included the apnea-hypopnea index (AHI), oxygen desaturation index (ODI), and oxygen saturation (SaO2) nadir. Secondary outcomes included the Sleep-Related Breathing Disorder-Pediatric Sleep Questionnaire (SRBD-PSQ) scores, vascular functions (flow-mediated dilation and mean blood flow velocity), and anthropometric variables. Outcomes were measured at baseline, at week 8, and at week 16. RESULTS: No baseline differences were observed between groups. The compliance rate of exercise training was 99.47%. The AHI significantly decreased in the exercise group compared with the control group at week 16 (median AHI 1.30 to 0.60 and 1.00 to 1.60 episode/h, p = 0.01), but not at week 8. There were no differences between the groups in regard to the ODI and SaO2 nadir and any secondary outcomes at weeks 8 and 16 (all p > 0.05). CONCLUSIONS: The eight-week HIIT combined with RT decreased AHI in obese children with OSA at week 16 follow-up. No changes in the ODI, SaO2 nadir, SRBD-PSQ, vascular function, and anthropometric outcomes were revealed at any time point. Further research is warranted.

Translation, cross-cultural adaptation and psychometric properties of the Sleep-Related Breathing Disordered-Pediatric Sleep Questionnaire for obese Thai children with obstructive sleep apnea.

OBJECTIVE: Obstructive sleep apnea (OSA) is a comorbid condition with obesity that can produce deleterious effects on children's health and well-being. Unfortunately, valid instruments for screening OSA in obese Thai children are limited. This study aimed to translate and cross-culturally adapt, from English to Thai, the Sleep-Related Breathing Disordered-Pediatric Sleep Questionnaire (SRBD-PSQ) and to determine its psychometric properties. METHODS: The SRBD-PSQ was translated into Thai and cross-culturally adapted. It was administered to 62 parents of obese children and adolescents 7-18 years of age who had polysomnographically confirmed OSA. The psychometric properties including validity, reliability, and diagnostic accuracy were examined. RESULTS: The Thai SRBD-PSQ possessed excellent content validity index for scale (S-CVI = 0.95). An acceptable internal consistency (cronbach's α ≥ 0.7) and good to excellent test-retest reliability (intraclass correlation coefficients [ICCs] = 0.82-0.90) of the Thai SRBD-PSQ and subdomain were observed. There was a significant correlation between the SRBD scale and polysomnography (PSG) indices: apnea-hypopnea index (AHI) and oxygen desaturation index (ODI) (r = 0.35, p < 0.01, and r = 0.27, p < 0.05, respectively). The Thai SRBD-PSQ had an area under the curve of 0.71 (p < 0.05) with a sensitivity of 72% and a specificity of 54%. CONCLUSION: The Thai SRBD-PSQ is a reliable and valid instrument for use in obese children with OSA. However, the Thai SRBD-PSQ should be used in combination with other investigations.

Vernonia cinerea Less. supplementation and strenuous exercise reduce smoking rate: relation to oxidative stress status and beta-endorphin release in active smokers.

PURPOSE: The aim of this study was to evaluate the effects of Vernonia cinerea Less. (VC) supplementation and exercise on oxidative stress biomarkers, beta-endorphin release, and the rate of cigarette smoking. METHODS: Volunteer smokers were randomly divided into four groups: group 1: VC supplement; group 2: exercise with VC supplement; group 3: exercise; and group 4: control. VC was prepared by wash and dry techniques and taken orally before smoking, matching the frequency of strenuous exercise (three times weekly). Before and after a two month period, exhaled carbon monoxide (CO), blood oxidative stress (malondialdehyde [MDA], nitric oxide [NOx], protein hydroperoxide [PrOOH] and total antioxidant capacity [TAC]), beta-endorphin and smoking rate were measured, and statistically analyzed. RESULTS: In Group 1, MDA, PrOOH, and NOx significantly decreased, whereas TAC increased (p < 0.05). In Group 2, MDA and PrOOH decreased (p < 0.05), with no other changes noted (p > 0.05). In Group 3, MDA, PrOOH, NOx, TAC, and beta-endorphin levels increased significantly (p < 0.05). Group 4 showed no change in oxidative stress variables or beta-endorphine levels (p > 0.05). All groups had lower levels of CO after the intervention. The smoking rate for light cigarette decreased in group 2(62.7%), 1(59.52%), 3 (53.57%) and 4(14.04%), whereas in self-rolled cigarettes it decreased in group 1 (54.47%), 3 (42.30%), 2 (40%) and 4 (9.2%). CONCLUSION: Supplementation with Vernonia cinerea Less and exercise provided benefit related to reduced smoking rate, which may be related to oxidaive stress and beta-endorphine levels.

Acute clinical benefits of chest wall-stretching exercise on expired tidal volume, dyspnea and chest expansion in a patient with chronic obstructive pulmonary disease: a single case study.

Chest physical therapy (CPT) has an important role in a medical team to assist in resolving the critical problems deriving from chronic lung disease. These critical problems include increased secretion volume, difficult breathing or dyspnea, ineffective coughing, inability to be weaned off a ventilator, and physical deterioration resulting from low aerobic capacity and endurance after prolonged bed rest. The inability to be weaned off a ventilator does not only result from secretion production or muscle weakness, but other conditions including chest stiffness or immobility. The procedure to increase chest mobility includes specific chest stretching and mobilization. Chest wall-stretching exercises were composed of thoracic rotation and anterior compression with stretching in sitting position, trunk extension and rib torsion in supine lying, and lateral stretching in side lying. These exercises were given to the patient as a regular daily program along with postural drainage, percussion, breathing exercise and limb exercises. The expired tidal volume, dyspnea level, and chest expansion were evaluated and clinical efficiency was analyzed during CPT, compared to Pre-CPT and Post-CPT with Bloom table. The results showed a significant clinical improvement of expired tidal volume, reduction in dyspnea level, and increase in chest expansion.