Soigner l’apnée du sommeil par un programme d’activités physiques adaptées

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A clinical trial testing the effectiveness of a tailored physical activity program on the severity of apnea and sleep quality in patients of obstructive sleep apnea syndrome (OSAS).

An American randomized controlled trial of Kline and colleagues, published in the journal Sleep in 2011, evaluates the effectiveness of an exercise program three months on reducing the severity of obstructive sleep apnea and on improve sleep quality in sedentary people, overweight or obese with a diagnosis of obstructive sleep apnea syndrome (OSAS). The results show that INM reduces the severity of apnea and improves sleep quality.

The Study Rationale

Obstructive sleep apnea is a medical condition that affects up to 15% of the US population. If that obstructive sleep apnea syndrome (OSAS) is not treated, it can have serious consequences such as cognitive impairment, diabetes, cardiovascular disease and premature death. There are no drug treatments today. A CPAP device improves sleep quality but generates considerable discomfort. Some patients do not use enough, as indicated by their doctor. Devices of oral surgery and upper respiratory tract are treatments that partially reduce the severity of OSA and often produce side effects.

An epidemiological study suggested that physically active people have a reduced risk of OSA compared with less active. Interventional research in these patients show conflicting results that justified this study.

The Question

A tailored program of physical activity of moderate intensity reduced it the severity of obstructive sleep apnea and he improves objective and subjective sleep quality?

The Protocol

The randomized controlled trial of Kline and colleagues, evaluated the effectiveness of a tailored physical activity program on the severity of OSA and sleep quality. The study covers 43 sedentary, overweight or obese, aged between 18 and 55 years, having been diagnosed with moderate to severe OSA. People should not have started treatment against OSAS and should not be undertaken to diet to lose weight. Participants were randomly placed either in the group with exercise program or in the control group receiving stretching sessions. The main measure was the severity of apnea recorded by a laboratory polysomnography device during overnight. Secondary measures included quality objective sleep (via data polysomnography and actigraphy) and subjective (Pittsburgh Sleep Quality Index Questionnaire). Participants assessed early intervention and at the end of the 12-week intervention.

The tested Non-Pharmacological Intervention (NPI)

The adapted physical activity program (APA) was to perform a re-training 4 times a week for 3 months. The sessions were supervised by a professional in adapted physical activities. The exercise dose was gradually increased during the first 4 weeks and was committed to prevent injuries. Between weeks 5 and 12, the amount of exercise should be of a duration of 150 minutes / week.

Four sessions per week were dedicated to moderate-intensity endurance exercise (60% of heart rate reserve). The sessions began with 5 minutes warm-up and ended with 5 minutes recovery. The exercises were carried out on a treadmill, a cycle ergometer or an elliptical trainer to patient preference.

Two sessions per non-consecutive week were dedicated to strengthening exercises. Two sets of 10 to 12 repetitions of 8 different exercises were performed. Resistance was was increased when the 12 repetitions could be performed on a second set.

Intervention included the combination of the two for a month.

Main Results

The results show a moderate reduction in the severity of sleep apnea and objective sleep quality after 3 months of program compared with the control group. Subjective and objective quality of sleep improved in the group receiving the intervention compared to the control group.

What it means for Patients

A tailored program of physical activity (APA) combining endurance and strength training can reduce the severity of sleep apnea and slightly improve sleep quality. Thus, a program in APA should be prescribed for these patients.

What it means for Healthcare Professionals

Four sessions of aerobic exercise and two sessions of strength training per week for 3 months significantly reduced the severity of OSA and improve objective and subjective quality of sleep. The magnitude of the benefit is modest and does not cure the disease especially in advanced stages.

What it means for Researchers

One limitation of this study was the fact that a single night of laboratory study was conducted at the beginning and end of the intervention. Future studies will need to confirm.

What it means for Policymakers

This clinical trial provides evidence of the effectiveness of a tailored physical activity program (APA) as first-line treatment in obstructive sleep apnea syndrome (OSAS) before the establishment of more invasive or more treatments binding.

The reference

Kline CE, Crowley EP, Ewing GB, Burch JB, Blair SN, Durstine JL (2011). The effect of exercise training on Obstructive Sleep Apnea and Sleep quality: a randomized controlled trial. Sleep, 34(12), 1631-1640.

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Same population

Same non-pharmacological intervention

To reference this Blog en Sante © article.

Ninot G (2016). An adapted physical activity program treats sleep apnea. Blog en Sante, A83.

© Copyright 2016 Grégory Ninot. All rights reserved.