Beneficial effects of a multifaceted 1-year lifestyle intervention on metabolic abnormalities in obese adolescents with and without sleep-disordered breathing.

Obesity is considered a chronic subinflammatory disease and is a risk factor for many diseases such as sleep-disordered breathing (SDB). Although the interaction between obesity and sleep has been explored, not much is known about SDB in the adolescent population. Thus, the aims of this study were, first, to verify the effect of 1 year of interdisciplinary therapy on inflammatory markers in SDB and without SDB and, second, to investigate the influence of SDB on the result of the therapy by comparing these groups. A total of 36 obese adolescents were enrolled; however, only 24 completed the therapy (SDB group, n=12; non-SDB obese group, n=12). Sleep, anthropometric, metabolic, and inflammatory profiles were evaluated at baseline and after the treatment. In both groups, the therapy was able to improve all anthropometric variables. Metabolic parameters such as insulin, homeostasis model assessment (HOMA), and quantitative insulin sensitivity check index (QUICKI) were significantly improved only in non-SDB group. In both groups, the inflammatory state was significantly improved by the reduction in the leptin/adiponectin ratio. After the intervention, both groups no longer presented the hyperleptinemic state, favoring not only the inflammatory state, but also neuroendocrine regulation. Regarding the sleep parameter, the SDB group improved significantly in all respiratory events, and after therapy only four patients remained with SDB. Furthermore, there was an increase in sleep time. The lifestyle intervention was able to improve anthropometric, metabolic, and inflammatory parameters in both groups; however, the presence of SDB impaired better results. The data supported that the inclusion of SDB in the metabolic syndrome because of the link shown between them.

Aerobic exercise does not change C-reactive protein levels in non-obese patients with obstructive sleep apnoea.

The aim of this study is to evaluate the effects of a 2-month aerobic exercise training programme on C-reactive protein (CRP) levels in non-obese patients with obstructive sleep apnoea. Twenty non-obese and sedentary adult male volunteers underwent polysomnography (PSG) to assess their sleep parameters. After the PSG analysis, the subjects were divided into two groups (CTRL, control and OSA, obstructive sleep apnoea). Twenty-four sessions of aerobic exercise were performed, and PSG was repeated on the night that followed the last physical training session (24th). Blood samples were collected for CRP analysis before the first exercise session and after the last session. The OSA group demonstrated a reduction in sleep latency (SL) after 2 months of physical exercise, and 80% of them showed a lower apnoea-hypopnoea index (AHI), although this difference was not statistically significant. The differences between the CRP values for the CTRL and OSA groups were also not statistically significant at baseline or after 2 months of physical exercise. Furthermore, there was no correlation between the CRP levels and body mass index (BMI) in the two groups assessed. Our results suggest that in non-obese patients with OSA, CRP levels were normal and did not change after 2 months of aerobic exercise training.

Comparison of the effects of continuous positive airway pressure, oral appliance and exercise training in obstructive sleep apnea syndrome.

OBJECTIVE: There are several treatments for obstructive sleep apnea syndrome, such as weight loss, use of an oral appliance and continuous positive airway pressure, that can be used to reduce the signs and symptoms of obstructive sleep apnea syndrome. Few studies have evaluated the effectiveness of a physical training program compared with other treatments. The aim of this study was to assess the effects of physical exercise on subjective and objective sleep parameters, quality of life and mood in obstructive sleep apnea patients and to compare these effects with the effects of continuous positive airway pressure and oral appliance treatments. METHODS: Male patients with moderate to severe obstructive sleep apnea and body mass indices less than 30 kg/m2 were randomly assigned to three groups: continuous positive airway pressure (n = 9), oral appliance (n = 9) and physical exercise (n = 7). Polysomnographic recordings, blood samples and daytime sleepiness measurements were obtained prior to and after two months of physical exercise or treatment with continuous positive airway pressure or an oral appliance. Clinicaltrials.gov: NCT01289392 RESULTS: After treatment with continuous positive airway pressure or an oral appliance, the patients presented with a significant reduction in the apnea-hypopnea index. We did not observe changes in the sleep parameters studied in the physical exercise group. However, this group presented reductions in the following parameters: T leukocytes, very-low-density lipoprotein and triglycerides. Two months of exercise training also had a positive impact on subjective daytime sleepiness. CONCLUSIONS: Our results suggest that isolated physical exercise training was able to modify only subjective daytime sleepiness and some blood measures. Continuous positive airway pressure and oral appliances modified the apnea-hypopnea index.

Does physical exercise reduce excessive daytime sleepiness by improving inflammatory profiles in obstructive sleep apnea patients?

INTRODUCTION: Obstructive sleep apnea syndrome (OSAS) is associated with a variety of long-term consequences such as high rates of morbidity and mortality, due to excessive diurnal somnolence as well as cardiovascular and metabolic diseases. Obesity, recurrent episodes of upper airway obstruction, progressive hypoxemia, and sleep fragmentation during sleep cause neural, cardiovascular, and metabolic changes. These changes include activation of peripheral sympathetic nervous system and the hypothalamic-pituitary-adrenal axis, insulin sensitivity, and inflammatory cytokines alterations, which predispose an individual to vascular damage. DISCUSSION: Previous studies proposed that OSAS modulated the expression and secretion of inflammatory cytokines from fat and other tissues. Independent of obesity, patients with OSAS exhibited elevated levels of C-reactive protein, tumor necrosis factor-α and interleukin-6, which are associated with sleepiness, fatigue, and the development of a variety of metabolic and cardiovascular diseases. OSAS and obesity are strongly associated with each other and share many common pathways that induce chronic inflammation. Previous studies suggested that the protective effect of exercise may be partially attributed to the anti-inflammatory effect of regular exercise, and this effect was observed in obese patients. Although some studies assessed the effects of physical exercise on objective and subjective sleep parameters, the quality of life, and mood in patients with OSAS, no study has evaluated the effects of this treatment on inflammatory profiles. In this review, we cited some studies that directed our opinion to believe that since OSAS causes increased inflammation and has excessive daytime sleepiness as a symptom and being that physical exercise improves inflammatory profiles and possibly OSAS symptoms, it must be that physical exercise improves excessive daytime sleepiness due to its improvement in inflammatory profiles.

Effects of exercise training associated with continuous positive airway pressure treatment in patients with obstructive sleep apnea syndrome.

PURPOSE: The aim of this study was to evaluate the effects of a 2-month exercise training associated with continuous positive airway pressure (CPAP) treatment on the subjective and objective sleep measurements, quality of life, and mood in moderate to severe obstructive sleep apnea syndrome (OSAS) patients. METHODS: Male patients were randomized into two treatment groups: CPAP (n = 19) and CPAP + exercise (n = 13). All patients completed 1 month of sleep hygiene, 2 months of treatment (CPAP or CPAP + exercise), and 1 week of washout (no treatment). Fletcher and Luckett sleep questionnaire, Epworth sleepiness scale, sleep diaries, polysomnography, SF-36 inventory of quality of life, Profile of Mood States (POMS) questionnaire, neck circumference, and body composition were evaluated. CPAP + exercise group also underwent cardiopulmonary exercise test before and after treatment. RESULTS: Both treatments were effective in improving subjective sleepiness but CPAP + exercise treatment was more effective in maintaining this improvement after washout. No significant differences were found in most of the sleep parameters studied in both groups. CPAP + exercise group showed lower values of tension and fatigue on POMS and higher values of physical functioning, general health perception, and vitality on SF-36 after treatment. CONCLUSIONS: A 2-month exercise training associated with CPAP treatment for OSAS patients has a positive impact on subjective daytime sleepiness, quality of life (physical functioning and general health perception), and mood state (tension and fatigue).

Absence of the predisposing factors and signs and symptoms usually associated with overreaching and overtraining in physical fitness centers.

OBJECTIVE: The aim of this study was to evaluate the occurrence of the well-known predisposing factors and signs and symptoms usually associated with either overreaching or overtraining syndrome in physical fitness centers in São Paulo City, Brazil. METHOD: A questionnaire consisting of 13 question groups pertaining to either predisposing factors (1-7) or signs and symptoms (8-13) was given to 413 subjects. The general training schedule of the volunteers was characterized by workout sessions of 2.18 ± 0.04 h for a total of 11.0 ± 0.3 h/week for 33 ± 2 months independent of the type of exercise performed (walking, running, spinning, bodybuilding and stretching). A mean score was calculated ranging from 1 (completely absent) to 5 (severe) for each question group. A low occurrence was considered to be a question group score lower than 4, which was observed in all 13 question groups. RESULTS: The psychological evaluation by POMS Mood State Questionnaire indicated a normal non-inverted iceberg. The hematological parameters, creatine kinase activity, cortisol, total testosterone and free testosterone concentrations were within the normal ranges for the majority of the volunteers selected for this analysis (n = 60). CONCLUSION: According to the questionnaire score analysis, no predisposing factors or signs and symptoms usually associated with either overreaching or overtraining were detected among the members of physical fitness centers in São Paulo City, Brazil. This observation was corroborated by the absence of any significant hematological or stress hormone level alterations in blood analyses of the majority of the selected volunteers (n = 60).

Absence of the predisposing factors and signs and symptoms usually associated with overreaching and overtraining in physical fitness centers

OBJECTIVE: The aim of this study was to evaluate the occurrence of the well-known predisposing factors and signs and symptoms usually associated with either overreaching or overtraining syndrome in physical fitness centers in São Paulo City, Brazil. METHOD: A questionnaire consisting of 13 question groups pertaining to either predisposing factors (1-7) or signs and symptoms (8-13) was given to 413 subjects. The general training schedule of the volunteers was characterized by workout sessions of 2.18 ± 0.04 h for a total of 11.0 ± 0.3 h/week for 33 ± 2 months independent of the type of exercise performed (walking, running, spinning, bodybuilding and stretching). A mean score was calculated ranging from 1 (completely absent) to 5 (severe) for each question group. A low occurrence was considered to be a question group score lower than 4, which was observed in all 13 question groups. RESULTS: The psychological evaluation by POMS Mood State Questionnaire indicated a normal non-inverted iceberg. The hematological parameters, creatine kinase activity, cortisol, total testosterone and free testosterone concentrations were within the normal ranges for the majority of the volunteers selected for this analysis (n = 60). CONCLUSION: According to the questionnaire score analysis, no predisposing factors or signs and symptoms usually associated with either overreaching or overtraining were detected among the members of physical fitness centers in São Paulo City, Brazil. This observation was corroborated by the absence of any significant hematological or stress hormone level alterations in blood analyses of the majority of the selected volunteers (n = 60).