Exercise as it relates to Disease/Obstructive Sleep apnea and exercise

The term sleep apnea or obstructive sleep apnea (OSA) first appeared in medical literature around the 1950’s. Patients were reported to have heavily decreased blood oxygen levels and many were suffering from congestive heart failure.LAWS, J. (1948). Legislative Implications of Adequate Tuberculosis Control.CHEST Journal, 14(1), 121-131.Ingman, W. (1951). Portable Test-Type. The British journal of ophthalmology,35(10), 631.Hetherington, L. H., & Spencer, G. E. (1947). Treatment of Recurrent Spontaneous Pneumothorax with Gomenol. CHEST Journal, 13(6), 652-657. The term Pickwickian syndrome was used to describe obstructive sleep apnea by an early 20th century physician who drew a link between what he was seeing in his patients and the association with excessive day time sleepiness in overweight young people like the fat boy in the novel The Pickwick Papers by Charles Dickens.Sidney Burwell, C., Robin, E. D., Whaley, R. D., & Bickelmann, A. G. (1956). Extreme obesity associated with alveolar hypoventilation—a Pickwickian syndrome. The American journal of medicine, 21(5), 811-818. In his Novel Charles Dickens Accurately described the symptoms of sleep apnea.Dickens, C., & Eyre, J. (1996). The Pickwick Papers. Alex Catalogue. 66-73. The first sleep clinic was established at Stanford University in 1970 by William Dement and they were joined by Christian Guilleminault and concentrated mainly on Respiratory disorders during sleep.Stanford Hospital. Sleep Centre. History of the Centre. Retrieved 21 October 2013, from, http://stanfordhospital.org/clinicsmedServices/clinics/sleep/about_us/history.html It was not till the publication of Sullivan et al. paper in 1981 that sleep apnea and specifically CPAP treatment became more widely recognised.Sullivan, C., E., Berthon-Jones, M., Issa, F., G., Eves, l., (1981) Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet , 862–5. That is more than 30 years ago. Symptoms Hypertension,Arruda-Olson, A. M., Olson, L. J., Nehra, A., & Somers, V. K. (2003). Sleep Apnea and Cardiovascular Disease. Herz, 28(4), 298-303. Depression,Schroder, C. M., & O'Hara, R. (2005). Depression and obstructive sleep apnea (OSA). Ann Gen Psychiatry, 4(1), 13.Baran, A. S., & Richert, A. C. (2003). Obstructive sleep apnea and depression. CNS spectrums, 8, 128-134. Daytime sleepiness, fatigue and tiredness,Johns, M. W. (1991). A new method for measuring daytime sleepiness: the Epworth sleepiness scale. sleep, 14(6), 540-545.Derderian, S. S., Bridenbaugh, R. H., & Rajagopal, K. R. (1988). Neuropsychologic symptoms in obstructive sleep apnea improve after treatment with nasal continuous positive airway pressure. CHEST Journal, 94(5), 1023-1027. Poor concentration,Kales, A., Caldwell, A.B., Cadieux, R.J.(1995) Severe obstructive sleep apnea: associated psychopathology and psychosocial consequences. Journal of Chronic Disease, 38:427 Irritability and mood changes,Kales, A., Caldwell, A.B., Cadieux, R.J.(1995) Severe obstructive sleep apnea: associated psychopathology and psychosocial consequences. Journal of Chronic Disease, 38:427 Nocturia,Kales, A., Caldwell, A.B., Cadieux, R.J.(1995) Severe obstructive sleep apnea: associated psychopathology and psychosocial consequences. Journal of Chronic Disease, 38:427 Morning headaches,Kales, A., Caldwell, A.B., Cadieux, R.J.(1995) Severe obstructive sleep apnea: associated psychopathology and psychosocial consequences. Journal of Chronic Disease, 38:427 Impotence and reduced sex drive,Arruda-Olson, A. M., Olson, L. J., Nehra, A., & Somers, V. K. (2003). Sleep Apnea and Cardiovascular Disease. Herz, 28(4), 298-303. Restless legs.Winkelman, J. W., Shahar, E., Sharief, I., & Gottlieb, D. J. (2008). Association of restless legs syndrome and cardiovascular disease in the Sleep Heart Health Study. Neurology, 70(1), 35-42. Causes and Treatment OSA is caused when the soft tissue in the throat collapses and obstructs the airways which stops the normal flow of air to the lungs and this can be caused by a very small airway and abnormally large larynx, enlarged Tonsils, an enlarged jaw and/or obesity. Theatment: 1. Positional devices:Epstein, L. J., Kristo, D., Strollo Jr, P. J., Friedman, N., Malhotra, A., Patil, S. P., ... & Weinstein, M. D. (2009). Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine, 5(3), 263-276.Oksenberg, A., Khamaysi, I., Silverberg, D. S., & Tarasiuk, A. (2000). Association of body position with severity of apneic events in patients with severe nonpositional obstructive sleep apnea. CHEST Journal, 118(4), 1018-1024. 2. PROVENT® THERAPY:Adams, G. (2011, January). Retrospective cases series analysis of a nasal expiratory positive airway pressure (EPAP) device to treat obstructive sleep apnea in a clinical practice. In SLEEP Abstract Supplement (Vol. 34, p. A146). 3. Mandibular Advancement Splints:O'Sullivan, R. A., Hillman, D. R., Mateljan, R., Pantin, C., & Finucane, K. E. (1995). Mandibular advancement splint: an appliance to treat snoring and obstructive sleep apnea. American journal of respiratory and critical care medicine, 151(1), 194-198. 4. "Continuous Positive Airway Pressure" Therapy: Commonly referred to as CPAP therapy is the gold standard for non-invasive treatment of OSA. This is accomplished by forcing air into the airways by using a flow generator that is connected to a mask that is situated on the nose and/or nose and mouth.McARDLE, N. I. G. E. L., Devereux, G., Heidarnejad, H., Engleman, H. M., Mackay, T. W., & Douglas, N. J. (1999). Long-term use of CPAP therapy for sleep apnea/hypopnea syndrome. American Journal of Respiratory and Critical Care Medicine, 159(4), 1108-1114. Role of exercise in reducing the effects of Obstructive Sleep Apnoea The only cause OSA that can be alleviated by exercise is Obesity. Two major comorbidities that OSA and Obesity have in common are hypertension and depression.Schroder, C. M., & O'Hara, R. (2005). Depression and obstructive sleep apnea (OSA). Ann Gen Psychiatry, 4(1), 13.Esler, M., Straznicky, N., Eikelis, N., Masuo, K., Lambert, G., & Lambert, E. (2006). Mechanisms of sympathetic activation in obesity-related hypertension. Hypertension, 48(5), 787-796. While obesity is the only cause that can be alleviated by adhering to a regular exercise program, there are a number of the comorbidities or symptoms that OSA and Obesity have in common that have generally been said to improve with increased physical activity and weight loss.Dixon, J. B., Schachter, L. M., & O'Brien, P. E. (2005). Polysomnography before and after weight loss in obese patients with severe sleep apnea. International journal of obesity, 29(9), 1048-1054. I have observed this to be true in a clinical setting where severely obese patients suffering from OSA were able to lose weight through regular diet and exercise after receiving treatment for OSA. After their weight was brought to within the normal range many of them were able to discontinue the use of CPAP therapy, many were able to go off medications for hypertension and they seemed happier and more hopeful. Poirier et al. (2001) recommended that together with a controlled diet exercise that consists of long duration (90 –240 minutes) and low-intensity(30%-50% of VO2 MAX) is preferred for the loss of body fat.Poirier, P., & Després, J. P. (2001). Exercise in weight management of obesity. Cardiology clinics, 19(3), 459-470. It is therefore recommended that patients suffering from OSA due to obesity aim engage in regular intensity exercise for at least 90 minutes per day. As it can be extremely difficult for severely obese individuals participate in a lot of weight bearing exercise because of the strain placed on joints it would be advisable to start by walking and/or swimming. It would be wise to start with shorter periods, like 10mins twice a day, this will keep one from getting discouraged. The key is to stay consistent and as weight decreases and mobility increases this will become easier and one can increase the time and intensity of the exercise. Further reading References