Alternatives to continuous positive airway pressure treatment in sleep apnoeas and hypopnoeas syndrome related to myofunctional and postural reeducation therapy: protocol for a systematic review

INTRODUCTION

The main treatment for sleep apnoeas and hypopnoeas syndrome (SAHS) is continuous positive airway pressure (CPAP). However, patients sometimes do not adhere to the treatment protocol. Supplementary and complementary therapies have appeared as alternatives. Some of the therapies which are especially important are those related to myofunctional (MFT) and postural therapy (PT), as all of them are non-invasive, and their application is simpler than that of CPAP. We aim to present a protocol for a systematic review and meta-analysis for investigating new SAHS treatments, including the protocols and frequency of use and the effects they have on patient signs, symptoms and quality of life.

METHODS AND ANALYSIS

The literature search will be conducted using the Cochrane, Web of Science, Medline (via PubMed) and Scopus databases, from January 2020 to December 2020. All types of studies written in English and Spanish that investigate the use of alternative SAHS treatments related to MFT, or more importantly, the combination of MFT and PRT, will be selected. To evaluate their quality, the Critical Appraisal Checklist for Analytical Cross-Sectional will be applied. The primary factor valued in the studies will be the inclusion of MFT and PT reeducation in the treatment. Subgroup analyses will be carried out evaluating the specific type of treatments chosen and the improvements or deteriorations in the level of health and quality of life in the patients. Finally, several patient-related outcomes, namely sleep quality, quality of life and sleep Apnoeas and Hypoapnoeas Index, will be examined.

ETHICS AND DISSEMINATION

In this case, ethical approval is not necessary. The data used in the review will be exclusively obtained from published studies, implying there are no privacy concerns. The information obtained will be relevant to understand if the new treatments applied in SAHS are effective, and if postural and MFT therapy used together can be considered an appropriate approach to treat this disease.The results will be published in a peer-reviewed journal.

Does Cardiorespiratory Fitness Attenuate the Adverse Effects of Severe/Morbid Obesity on Cardiometabolic Risk and Insulin Resistance in Children? A Pooled Analysis

OBJECTIVE

To investigate 1) differences in cardiometabolic risk and HOMA of insulin resistance (HOMA-IR) across BMI categories (underweight to morbid obesity), 2) whether fit children have lower cardiometabolic risk/HOMA-IR than unfit children in each BMI category, and 3) differences in cardiometabolic risk/HOMA-IR in normal-weight unfit children and obese fit children.

RESEARCH DESIGN AND METHODS

A pooled study including cross-sectional data from three projects (n = 1,247 children aged 8-11 years). Cardiometabolic risk was assessed using the sum of the sex- and age-specific z scores for triglycerides, HDL cholesterol, glucose, and the average of systolic and diastolic blood pressure and HOMA-IR.

RESULTS

A significant linear association was observed between the risk score and BMI categories (P trend ≤0.001), with every incremental rise in BMI category being associated with a 0.5 SD higher risk score (standardized β = 0.474, P < 0.001). A trend was found showing that as BMI categories rose, cardiorespiratory fitness (CRF) attenuated the risk score, with the biggest differences observed in the most obese children (-0.8 SD); however, this attenuation was significant only in mild obesity (-0.2 SD, P = 0.048). Normal-weight unfit children had a significantly lower risk score than obese fit children (P < 0.001); however, a significant reduction in the risk score was found in obese fit compared with unfit children (-0.4 SD, P = 0.027). Similar results were obtained for HOMA-IR.

CONCLUSIONS

As BMI categories rose so did cardiometabolic risk and HOMA-IR, which highlights the need for obesity prevention/treatment programs in childhood. Furthermore, CRF may play an important role in lowering the risk of cardiometabolic diseases in obese children.

Levels and Patterns of Objectively Assessed Physical Activity and Compliance with Different Public Health Guidelines in University Students

BACKGROUND

Physical activity (PA) is associated with health enhancement. The aim of this study was to assess: 1) levels and patterns of PA in university students by using accelerometers; and 2) the percentage of fulfilment of PA recommendations for adults, according to different public health guidelines.

METHODS

Observational cross-sectional study (Cuenca's Adults Study) involving 296 (206 women) healthy Spanish university students aged 18-25 years old. Participants wore the ActiGraph GT1M accelerometer for seven consecutive days. Total PA, steps and time spent in sedentary time, light, moderate, vigorous, and moderate to vigorous PA (MVPA) was assessed, and the prevalence of sufficient PA was calculated according to various public health guidelines.

RESULTS

No sex differences in total PA were found. University students were more sedentary during weekend days than weekdays (p<0.05). Only 30.3% of participants accumulated 30 min/day at least five days a week of MVPA. A total of 5.4% of students met the recommendation of 150 min/week of MVPA or 75 min/week of vigorous PA, in PA bouts of at least 10 min. using the same definition, but on five or more days a week, only 0.5% students were found to meet the recommendation. In addition, only 0.5% of students met the recommendation of 30 min/day of MVPA, at least five days a week and in bouts of at least 10 min. Finally, 28.1% of the students met the recommendation of 10,000 steps/day.

CONCLUSIONS

Our study shows a high incidence of sedentary time in university students. The number of students meeting PA recommendations significantly differed depending on the recommendation proposed. Specific strategies to promote PA in this population are necessary as well as an agreement as to which PA guidelines should be used.

The relationship between beverage intake and weight status in children: the Cuenca study

INTRODUCTION

Beverage consumption is becoming more important in current research regarding its possible association with the childhood obesity epidemic. The influence of physical activity on fluid intake has been poorly studied, and cardiorespiratory fitness (CRF) may be a reliable marker for this type of assessment. The present study analysed beverage intake related to weight, adjusted by CRF, in children aged 9 to 11 years.

METHODS

A cross-sectional, school-based study was conducted on 373 children, aged 9 to 11 years, from the Cuenca province in Spain. To obtain beverage consumption we averaged two 24-h recalls, collected using the YANA-C assessment tool, validated for HELENA study. CRF was assessed by the 20-m shuttle run test.

RESULTS

Fluid intake was 1483.39 mL/day, and energy ascribed to fluids was 16% of total energy intake. Beverages were 40% of total sugar intake from diet. The largest amount of fluid consumed among thinness boys came from fruit juices and milk drinks. Thinner girls consumed more diet drinks and whole milk than their normal and overweight counterparts, after adjusting for age and CRF.

CONCLUSIONS

Overweight-obese boys consumed less fruit juices and milk drinks and girls ingested less diet drinks and whole milk than their normal-weight counterparts. These results suggest the importance of investigating the hydration habits of children to draw reliable conclusions about the best way to hydrate in different situations to avoid adiposity increases.

Physical fitness, obesity, and academic achievement in schoolchildren

OBJECTIVE

To examine the association of physical fitness and obesity with academic achievement and the independent association between fitness and academic achievement after controlling for relevant confounders such as age, parental education, and body mass index in school aged children.

STUDY DESIGN

Cross-sectional study including 893 schoolchildren, aged 9-11 years, from Cuenca, Spain. Data were collected from September to November 2010. We measured academic achievement (mean of the grades obtained in several core subjects), physical fitness (cardio-respiratory fitness, muscular fitness, and speed/agility), weight, height, and parental education. Multivariate logistic regression models were used to estimate the probability of being in high quartiles for academic achievement after controlling for potential confounders.

RESULTS

Overall, academic achievement scores were positively related to fitness levels. Obese boys had lower scores for academic achievement than overweight or normal weight boys. Good cardio-respiratory and speed/agility levels were associated with high academic achievement after controlling for confounders (OR 3.06; 95% CI, 1.35-6.91; P = .007 and OR 4.25; 95% CI, 1.91-9.44; P < .001, respectively).

CONCLUSIONS

Academic success is associated with higher fitness levels. Schools should consider strategies to improve fitness as part of their overall strategy for improving academic achievement.