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Meyer EJ, Wittert GA. Approach the Patient With Obstructive Sleep Apnea and Obesity. J Clin Endocrinol Metab 2024; 109:e1267-e1279. [PMID: 37758218 PMCID: PMC10876414 DOI: 10.1210/clinem/dgad572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/31/2023] [Accepted: 09/25/2023] [Indexed: 10/03/2023]
Abstract
Obstructive sleep apnea (OSA) and obesity are highly prevalent and bidirectionally associated. OSA is underrecognized, however, particularly in women. By mechanisms that overlap with those of obesity, OSA increases the risk of developing, or having poor outcomes from, comorbid chronic disorders and impairs quality of life. Using 2 illustrative cases, we discuss the relationships between OSA and obesity with type 2 diabetes, dyslipidemia, cardiovascular disease, cognitive disturbance, mood disorders, lower urinary tract symptoms, sexual function, and reproductive disorders. The differences in OSA between men and women, the phenotypic variability of OSA, and comorbid sleep disorders are highlighted. When the probability of OSA is high due to consistent symptoms, comorbidities, or both, a diagnostic sleep study is advisable. Continuous positive airway pressure or mandibular advancement splints improve symptoms. Benefits for comorbidities are variable depending on nightly duration of use. By contrast, weight loss and optimization of lifestyle behaviors are consistently beneficial.
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Affiliation(s)
- Emily Jane Meyer
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
- Endocrine and Diabetes Services, The Queen Elizabeth Hospital, Woodville South, SA 5011, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA 5000, Australia
| | - Gary Allen Wittert
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA 5000, Australia
- Freemasons Centre for Male Health and Wellbeing, South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
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Zota IM, Roca M, Leon MM, Cozma CD, Anghel L, Statescu C, Sascau R, Hancianu M, Mircea C, Ciocoiu M, Cumpat CM, Mitu F. Long-Term Adherence in Overweight Patients with Obstructive Sleep Apnea and Hypertension-A Pilot Prospective Cohort Study. Diagnostics (Basel) 2023; 13:diagnostics13081447. [PMID: 37189548 DOI: 10.3390/diagnostics13081447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 05/17/2023] Open
Abstract
Obstructive sleep apnea (OSA) is associated with increased cardiovascular risk, sedentarism, depression, anxiety and impaired quality of life. The long-term effectiveness of positive airway pressure (PAP) is insufficiently studied and limited by poor patient compliance. The aim of this pilot prospective cohort study was to evaluate long-term adherence in overweight patients with moderate-severe OSA and hypertension and to analyze changes in weight, sleepiness and quality of life. We performed a prospective study that included overweight patients with moderate-severe OSA and hypertension who had not undergone previous PAP therapy. All subjects received a standard physical examination, education regarding lifestyle changes and free PAP therapy for 2 months. After five years, the patients were invited to participate in a telephone-based interview regarding PAP compliance and completed standard questionnaires assessing adherence to medication, physical activity, diet, anxiety and quality of life (QoL). Only 39.58% of the patients were adherent to PAP 5 years (58.42 ± 3.70 months) after being diagnosed with moderate-severe OSA. Long-term PAP use results in sustained weight loss; improved blood pressure control, sleepiness and QOL; and lower anxiety and depression scores. PAP compliance was not associated with a higher level of daily physical activity or a healthier diet.
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Affiliation(s)
- Ioana Madalina Zota
- Department of Medical Specialties (I), Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 16 University Street, 700115 Iasi, Romania
| | - Mihai Roca
- Department of Medical Specialties (I), Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 16 University Street, 700115 Iasi, Romania
| | - Maria Magdalena Leon
- Department of Medical Specialties (I), Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 16 University Street, 700115 Iasi, Romania
| | - Corina Dima Cozma
- Department of Medical Specialties (I), Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 16 University Street, 700115 Iasi, Romania
| | - Larisa Anghel
- Department of Medical Specialties (I), Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 16 University Street, 700115 Iasi, Romania
| | - Cristian Statescu
- Department of Medical Specialties (I), Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 16 University Street, 700115 Iasi, Romania
| | - Radu Sascau
- Department of Medical Specialties (I), Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 16 University Street, 700115 Iasi, Romania
| | - Monica Hancianu
- Department of Pharmacognosy, Faculty of Pharmacy, "Grigore T. Popa" University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania
| | - Cornelia Mircea
- Department of Pharmaceutical Sciences (II), Faculty of Pharmacy, "Grigore T. Popa" University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania
| | - Manuela Ciocoiu
- Department of Morpho-Functional Sciences (Pathophysiology), Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
| | - Carmen Marinela Cumpat
- Department of Medical Specialties (III), Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 16 University Street, 700115 Iasi, Romania
| | - Florin Mitu
- Department of Medical Specialties (I), Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 16 University Street, 700115 Iasi, Romania
- Academy of Medical Sciences, Ion C. Brătianu Boulevard No 1, 030167 Bucharest, Romania
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Worku A, Ayele E, Alemu S, Legese GL, Yimam SM, Kassaw G, Diress M, Asres MS. Obstructive sleep apnea risk and determinant factors among type 2 diabetes mellitus patients at the chronic illness clinic of the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. Front Endocrinol (Lausanne) 2023; 14:1151124. [PMID: 37082123 PMCID: PMC10110920 DOI: 10.3389/fendo.2023.1151124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/17/2023] [Indexed: 04/07/2023] Open
Abstract
IntroductionObstructive sleep apnea is a sleep complaint among type 2 diabetes mellitus patients that has a deleterious effect on health with immediate and long-term impacts. Despite its impacts, data on the magnitude and predictors of obstructive sleep apnea among type 2 diabetes mellitus patients in Ethiopia is still limited. Thus, this study was conducted to determine how common a high risk of obstructive sleep apnea is and its predictors among type 2 diabetes mellitus patients receiving follow-up care at the chronic illness follow-up clinic at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2022.MethodsAn institution-based cross-sectional study was conducted. Interviewer-administered questionnaires and physical measurements with standard instruments were used to collect the required data. The collected data were entered into EpiData 4.6 and exported into STATA 14. Both Bivariable and multivariable binary logistic regression analyses were done to identify factors associated with a high risk of obstructive sleep apnea. Variables with a p-value ≤0.05 in the multivariable logistic regression analysis were declared as significantly associated with a high risk of obstructive sleep apnea.ResultsA total of 319 type 2 diabetes mellitus patients with a median age of 58 years participated in our current study. The overall prevalence of a high risk of obstructive sleep apnea among the study participants was 31.97% (95%CI: 27.06, 37.32). On multivariable logistic analysis, a neck circumference of ≥40 cm (AOR=4.33, 95%CI 1.37, 13.72), physical inactivity (AOR=2.29, 95%CI 1.15, 4.53), comorbid hypertension (AOR=4.52, 95%CI 2.30, 9.18), and male sex (AOR=8.01, 95%CI 3.02, 21.24) were associated with a high risk of obstructive sleep apnea.Conclusion and recommendationThe prevalence of a high risk of obstructive sleep apnea among type 2 diabetes mellitus patients remains high. A neck circumference of ≥40 cm, physical inactivity, comorbid hypertension, and male sex were significantly associated with a high risk of obstructive sleep apnea among type 2 diabetes mellitus patients. Screening and evaluation of type 2 diabetes mellitus patients for obstructive sleep apnea are recommended to avoid the negative impacts.
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Affiliation(s)
- Abebe Worku
- Department of Internal Medicine, University of Gondar, Gondar, Ethiopia
| | - Eleni Ayele
- Department of Internal Medicine, University of Gondar, Gondar, Ethiopia
| | - Shitaye Alemu
- Department of Internal Medicine, University of Gondar, Gondar, Ethiopia
| | | | - Samrawit Meles Yimam
- Internal Medicine, University of Gondar Comprehensive and Specialized Referral Hospital, Gondar, Ethiopia
| | - Getasew Kassaw
- Department of Internal Medicine, University of Gondar, Gondar, Ethiopia
| | - Mengistie Diress
- Department of Human Physiology, University of Gondar, Gondar, Ethiopia
- *Correspondence: Mengistie Diress,
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Rhodes S, Waters D, Brockway B, Skinner M. Exercise and motivational text messaging to support physical activity behaviour change in a population with obstructive sleep apnoea: a feasibility study. J Prim Health Care 2022; 14:318-325. [PMID: 36592765 DOI: 10.1071/hc22033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/17/2022] [Indexed: 01/05/2023] Open
Abstract
Introduction Patients with obstructive sleep apnoea (OSA) commonly present in primary care. Increasing physical activity reduces symptoms and severity of OSA. Low motivation is a barrier to physical activity in adults with OSA. Aim To investigate the feasibility and acceptability of an exercise and personalised text messaging programme to enhance motivation and support physical activity behaviour change in adults with OSA. Methods Participants were recruited from the local Sleep Clinic. Exclusion criteria were unstable angina, and/or poorly controlled hypertension. The intervention comprised three groups, who received either individual exercise prescription, personalised text messages or both over a 24-week period. Participants were allocated to one of the three groups. The primary outcome was feasibility of study design including participant recruitment and retention. Secondary outcomes were a change in 6-min walk distance and exercise self-efficacy over time. Results Thirty participants were recruited, 17 male and 13 female, with a mean age of 54.6 years. The study design appears feasible and the outcome measures used were acceptable to participants. Recruitment and retention rates were lower than anticipated. A trend towards increased functional exercise capacity was identified in all three groups, along with a corresponding increase in exercise self-efficacy over time. Discussion Exercise and personalised text messaging both appear to offer an acceptable and feasible means to increase physical activity in adults with OSA. A larger scale trial may provide justification for physiotherapist input to support patients with OSA to address physical inactivity.
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Affiliation(s)
- Sarah Rhodes
- School of Physiotherapy, University of Otago, 325 Great King Street, Dunedin 9016, New Zealand
| | - Debra Waters
- Department of Medicine/School of Physiotherapy, University of Otago, 325 Great King Street, Dunedin 9016, New Zealand
| | - Ben Brockway
- Department of Medicine, University of Otago, 201 Great King Street, Dunedin, New Zealand
| | - Margot Skinner
- School of Physiotherapy, University of Otago, 325 Great King Street, Dunedin 9016, New Zealand
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Choi H, Kim SH, Han K, Park TS, Park DW, Moon JY, Kim SH, Kim TH, Sohn JW, Yoon HJ, Lee H. Association between exercise and risk of cardiovascular diseases in patients with non-cystic fibrosis bronchiectasis. Respir Res 2022; 23:288. [PMID: 36258193 PMCID: PMC9580142 DOI: 10.1186/s12931-022-02202-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although cardiovascular comorbidities negatively impact survival in patients with bronchiectasis, there is limited evidence to recommend exercise in this population. We aimed to evaluate whether exercise habit changes are related to reduced cardiovascular disease risk and explore an optimal exercise amount. METHODS This study identified 165,842 patients with newly diagnosed bronchiectasis during 2010-2016 who underwent two health examinations and were followed up until December 2020. The exposure was the change in weekly habits of moderate- or vigorous-intensity physical activity between the two examinations, classified into non-exercisers and exercisers (further classified into new exercisers, exercise dropouts, and exercise maintainers). The amount of exercise was measured using metabolic equivalents of task (MET). The outcome was the incidence of myocardial infarction (MI) or stroke. RESULTS During a mean of 6.2 ± 2.1 follow-up years, 4,233 (2.6%) and 3,745 (2.3%) of patients with bronchiectasis had MI or stroke, respectively. Compared to non-exercisers, exercisers had a significantly lower risk of MI or stroke by 9-28% (p < 0.001 for both). Among exercisers, exercise maintainers showed the lowest risk of MI (adjusted hazard ratio [aHR], 0.72; 95% confidence interval [CI], 0.64-0.81) and stroke (aHR, 0.72; 95% CI, 0.64-0.82) compared to non-exercisers. Regarding exercise amount, a significant risk reduction was observed only in patients with bronchiectasis who exercised for ≥ 500 MET-min/wk. CONCLUSION Exercise was associated with a reduced risk of cardiovascular diseases in patients with bronchiectasis. In particular, the risk was lowest in exercise maintainers, and cardiovascular risk reduction was significant when exercising more than 500 MET-min/wk.
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Affiliation(s)
- Hayoung Choi
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.,Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Sang Hyuk Kim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Tai Sun Park
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Dong Won Park
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Ji-Yong Moon
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Sang-Heon Kim
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Tae-Hyung Kim
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jang Won Sohn
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Ho Joo Yoon
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Hyun Lee
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea. .,Divsion of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, 222 Wangsimni-ro, Seongdong-gu, 04763, Seoul, Korea.
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Berger M, Barthélémy JC, Garet M, Raffin J, Labeix P, Roche F, Hupin D. Longer-term effects of supervised physical activity on obstructive sleep apnea and subsequent health consequences. Scand J Med Sci Sports 2021; 31:1534-1544. [PMID: 33772900 DOI: 10.1111/sms.13961] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 03/12/2021] [Accepted: 03/23/2021] [Indexed: 11/29/2022]
Abstract
Although recent trials have shown promising benefits of exercise on obstructive sleep apnea (OSA) severity, the long-term effect of these interventions remains unknown. The aim of this study was to assess the effect of a 9-month community physical activity program on OSA severity one year later in free-living conditions. OSA patients, previously included in a 9-month randomized controlled trial (EXESAS study) evaluating the effects of supervised community physical activity on OSA severity, were invited to participate in an extra one-year observational study. Twenty-eight patients completed the study. Although OSA severity did not significantly worsen over the real-life period (9 to 21 months of follow-up), reductions in apnea-hypopnea index (AHI) and oxygen desaturation index were no longer significant after 21 months of follow-up compared to baseline (baseline AHI: 22.2 ± 6.3 /h; 9 months: 16.3 ± 6.4 /h; 21 months: 18.7 ± 8.9 /h). Benefits observed at 9 months on daytime sleepiness and mental health were preserved at 21 months, whereas cardiorespiratory fitness slightly decreased. Per-protocol analysis revealed that patients who stopped exercise at 9 months had worsened OSA severity compared to those who continued exercise during the real-life period (AHI: +9.0 ± 8.8 vs. -1.3 ± 5.3 /h; p < .01). In conclusion, our study suggested that improvements in OSA severity remain transient and is dependent on long-term adherence to regular physical activity practice.
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Affiliation(s)
- Mathieu Berger
- SNA-EPIS Laboratory, University of Lyon, Saint-Etienne, France.,Department of Clinical and Exercise Physiology, University Hospital of Saint-Etienne, Saint-Etienne, France.,IRAPS, French Federation for Physical Education and Voluntary Gymnastics (FFEPGV), Montreuil, France
| | - Jean-Claude Barthélémy
- SNA-EPIS Laboratory, University of Lyon, Saint-Etienne, France.,Department of Clinical and Exercise Physiology, University Hospital of Saint-Etienne, Saint-Etienne, France.,INSERM SAINBIOSE, U1059, Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint-Etienne, France
| | - Martin Garet
- SNA-EPIS Laboratory, University of Lyon, Saint-Etienne, France.,Department of Clinical and Exercise Physiology, University Hospital of Saint-Etienne, Saint-Etienne, France.,INSERM SAINBIOSE, U1059, Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint-Etienne, France
| | - Jérémy Raffin
- SNA-EPIS Laboratory, University of Lyon, Saint-Etienne, France.,Department of Clinical and Exercise Physiology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Pierre Labeix
- SNA-EPIS Laboratory, University of Lyon, Saint-Etienne, France.,Department of Clinical and Exercise Physiology, University Hospital of Saint-Etienne, Saint-Etienne, France.,INSERM SAINBIOSE, U1059, Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint-Etienne, France
| | - Frédéric Roche
- SNA-EPIS Laboratory, University of Lyon, Saint-Etienne, France.,Department of Clinical and Exercise Physiology, University Hospital of Saint-Etienne, Saint-Etienne, France.,INSERM SAINBIOSE, U1059, Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint-Etienne, France
| | - David Hupin
- SNA-EPIS Laboratory, University of Lyon, Saint-Etienne, France.,Department of Clinical and Exercise Physiology, University Hospital of Saint-Etienne, Saint-Etienne, France.,INSERM SAINBIOSE, U1059, Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint-Etienne, France
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Rhodes S, Waters D, Brockway B, Skinner M. Physical activity behaviour and barriers to activity in adults at high risk of obstructive sleep apnoea. J Prim Health Care 2020; 12:257-264. [PMID: 32988447 DOI: 10.1071/hc19102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 08/24/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Physical inactivity is a risk factor for disease severity among people with obstructive sleep apnoea. AIM To determine physical activity levels in patients at risk of obstructive sleep apnoea and explore their perceptions about barriers to participation in physical activity. METHODS This was a cross-sectional observational study. Eligible participants were adults with symptoms of obstructive sleep apnoea hypopnea syndrome and Epworth Sleepiness Scale score ≥11, awaiting prioritisation for a diagnostic overnight sleep study at the local sleep clinic. Sixty participants (mean age±standard deviation: 51±12 years) each attended an individual appointment. Anthropometric measurements were taken and standardised questionnaires regarding quality of life, physical activity behaviour and perceptions of physical activity were completed. RESULTS Over one-third of the cohort did not meet World Health Organization guidelines for weekly physical activity. Hypertension, type 2 diabetes and obesity were also more prevalent in this subgroup. Low motivation and pain were commonly reported barriers to activity in participants not meeting the physical activity guidelines. Overall, 53 (88%) participants stated they would like to be more active. DISCUSSION Physical inactivity represents an additional risk factor for adults at high risk of obstructive sleep apnoea. Lack of motivation and pain were the most commonly perceived barriers to participation in activity. Physical activity interventions tailored to the individual, and including a motivational component, need to be included as integral components of management to reduce cardiovascular and metabolic risk factors more effectively in this group.
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Affiliation(s)
- Sarah Rhodes
- School of Physiotherapy, University of Otago, 325 Great King Street, Dunedin, New Zealand; and Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand; and Corresponding author.
| | - Debra Waters
- Department of Medicine and School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Ben Brockway
- Dept of Medicine, University of Otago, Dunedin, New Zealand
| | - Margot Skinner
- School of Physiotherapy, University of Otago, 325 Great King Street, Dunedin, New Zealand; and Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
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Di Ciaula A, Portincasa P. The environment as a determinant of successful aging or frailty. Mech Ageing Dev 2020; 188:111244. [PMID: 32335099 DOI: 10.1016/j.mad.2020.111244] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 04/01/2020] [Accepted: 04/03/2020] [Indexed: 02/07/2023]
Abstract
The number of elderly persons is rising rapidly, and healthspan is a key factor in determining the well-being of individuals and the sustainability of national health systems. Environmental health is crucial for a "successful aging". Complex relationships between environmental factors and non-communicable diseases play a major role, causing or accelerating disabilities. Besides genetic factors, aging results from the concurrence of several environmental factors starting from early (i.e. in utero) life, able to increase susceptibility to diseases in adulthood, and to promote frailty in the elderly. In aged people, an unhealthy environment contributes to a fast and early decline and increases vulnerability. Exposure to pollutants facilitates the onset and progression of cardiovascular, respiratory, metabolic and neurologic diseases through direct effects and epigenetic mechanisms negatively affecting biological age. Healthy diet, healthy environment and constant physical activity could counteract, at least in part, the negative effects of environmental stressors. Almost all environmental factors generating detrimental effects on aging are modifiable, with relevant implications in terms of primary prevention measures potentially leading to decreased frailty, to an increase in the number of years lived without diseases or disability, and to a significant reduction in health expenditure.
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Affiliation(s)
- Agostino Di Ciaula
- Clinica Medica "A. Murri", Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy; Division of Internal Medicine, Hospital of Bisceglie (ASL BAT), Bisceglie, Italy; International Society of Doctors for Environment (ISDE).
| | - Piero Portincasa
- Clinica Medica "A. Murri", Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy
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Berger M, Kline CE, Cepeda FX, Rizzi CF, Chapelle C, Laporte S, Hupin D, Raffin J, Costes F, Hargens TA, Barthélémy JC, Roche F. Does obstructive sleep apnea affect exercise capacity and the hemodynamic response to exercise? An individual patient data and aggregate meta-analysis. Sleep Med Rev 2019; 45:42-53. [PMID: 30933881 DOI: 10.1016/j.smrv.2019.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 02/14/2019] [Accepted: 03/07/2019] [Indexed: 10/27/2022]
Abstract
Obstructive sleep apnea (OSA) has been linked to altered cardiovascular response to exercise. A systematic review and individual patient data (IPD) meta-analysis were conducted to assess whether OSA patients present reduced exercise capacity. PubMed, Embase and Web of Science were searched until September 2018. Studies which performed sleep recording in both OSA patients and controls and measured maximal oxygen consumption (VO2peak) via a maximal exercise test were included. IPD were provided for five trials upon the 18 eligible (N = 289) and a two-stage IPD meta-analysis model was used, allowing to standardize the apnea cutoff and adjust for confounders. IPD meta-analysis demonstrated that moderate to severe OSA patients had similar VO2peak (mean difference: -1.03 mL·kg-1 min-1; 95% CI: -3.82 to 1.76; p = 0.47) and cardiovascular response to exercise compared to mild or non-OSA patients. By contrast, aggregate data (AD) meta-analysis including the 13 trials for which IPD were unavailable (N = 605) revealed that VO2peak was reduced in OSA patients compared to controls (mean difference: -2.30 mL·kg-1 min-1; 95% CI: -3.96 to -0.63; p < 0.001) with high heterogeneity. In conclusion, IPD meta-analysis suggests that VO2peak and the cardiovascular response to exercise are preserved in moderate to severe OSA patients while AD meta-analysis suggests lower VO2peak in severe OSA.
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Affiliation(s)
- Mathieu Berger
- SNA-EPIS Laboratory, University of Lyon, University Jean Monnet Saint-Etienne, EA 4607, France; Department of Clinical and Exercise Physiology, University Hospital of Saint-Etienne, France.
| | - Christopher E Kline
- Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, PA, United States
| | - Felipe X Cepeda
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Camila F Rizzi
- Cardiology Discipline, Medicine Department, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Céline Chapelle
- INSERM, UMR 1059, SAINBIOSE, Dysfonction Vasculaire et Hémostase, Université Jean Monnet, Saint-Etienne, France
| | - Silvy Laporte
- INSERM, UMR 1059, SAINBIOSE, Dysfonction Vasculaire et Hémostase, Université Jean Monnet, Saint-Etienne, France
| | - David Hupin
- SNA-EPIS Laboratory, University of Lyon, University Jean Monnet Saint-Etienne, EA 4607, France; Department of Clinical and Exercise Physiology, University Hospital of Saint-Etienne, France
| | - Jérémy Raffin
- SNA-EPIS Laboratory, University of Lyon, University Jean Monnet Saint-Etienne, EA 4607, France; Department of Clinical and Exercise Physiology, University Hospital of Saint-Etienne, France
| | - Frédéric Costes
- Department of Physiology, University Hospital Gabriel Montpied, Clermont-Ferrand, France
| | - Trent A Hargens
- Human Performance Laboratory, Department of Kinesiology, James Madison University, Harrisonburg, VA, United States
| | - Jean-Claude Barthélémy
- SNA-EPIS Laboratory, University of Lyon, University Jean Monnet Saint-Etienne, EA 4607, France; Department of Clinical and Exercise Physiology, University Hospital of Saint-Etienne, France
| | - Frédéric Roche
- SNA-EPIS Laboratory, University of Lyon, University Jean Monnet Saint-Etienne, EA 4607, France; Department of Clinical and Exercise Physiology, University Hospital of Saint-Etienne, France
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Mendelson M, Flore P. Physical activity: the key to cardiometabolic risk reduction in obstructive sleep apnoea. Eur Respir J 2018; 52:52/4/1801775. [DOI: 10.1183/13993003.01775-2018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 09/20/2018] [Indexed: 11/05/2022]
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