RESUMEN
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.
Asunto(s)
Ejercicio Físico , Apnea Obstructiva del Sueño/rehabilitación , Análisis de Varianza , Trastornos de Somnolencia Excesiva/rehabilitación , Femenino , Humanos , Vida Independiente , Masculino , Salud Mental , Persona de Mediana Edad , Cooperación del Paciente , Estudios Prospectivos , Calidad de Vida , Índice de Severidad de la Enfermedad , Apnea Obstructiva del Sueño/fisiopatología , Factores de TiempoRESUMEN
We compared the effects of 2-month CPAP or exercise training (ET) therapies on the autonomic balance in moderate to severe obstructive sleep apnea (OSA) through heart rate variability (HRV) analysis. Thirty-nine OSA patients were divided into CPAP (n = 18) and ET (n = 21) groups, being further split into hypertensive and non-hypertensive subgroups. All patients were submitted to continuous ECG recordings for HRV analysis. Hemodynamic parameters were recorded by oscillometry. Excessive daytime sleepiness and sleep quality were assessed through the Epworth Sleepiness Scale and the Pittsburgh questionnaire, respectively. ET decreased systolic arterial pressure in hypertensive and non-hypertensive participants when compared to baseline values, whereas diastolic arterial pressure was decreased only in non-hypertensive ones. CPAP had no effect over hemodynamic parameters in either subgroup. ET significantly increased the HRV parameters SDNN and pNN50 in non-hypertensive participants, while reducing the LF/HF ratio in both subgroups. CPAP significantly decreased SDNN in both subgroups. ET significantly decreased excessive daytime sleepiness in both subgroups, but did not affect sleep quality. CPAP significantly improved sleep quality in both subgroups, although global scores were still those of poor sleepers, while excessive daytime sleepiness was normalized only in hypertensive patients. In conclusion, while short-term ET modulated different HRV parameters, leading to a predominant vagal tone in the cardiac sympathovagal balance and decreasing blood pressure in moderate to severe OSA, short-term CPAP had next to no effect in these parameters. We believe ET should be considered as an adjunct interventional strategy in the conservative management of hypertensive or non-hypertensive OSA patients.
Asunto(s)
Sistema Nervioso Autónomo/fisiopatología , Presión de las Vías Aéreas Positiva Contínua , Trastornos de Somnolencia Excesiva/terapia , Terapia por Ejercicio , Frecuencia Cardíaca/fisiología , Hipertensión/rehabilitación , Apnea Obstructiva del Sueño/terapia , Adulto , Presión Sanguínea/fisiología , Trastornos de Somnolencia Excesiva/etiología , Trastornos de Somnolencia Excesiva/rehabilitación , Electrocardiografía , Femenino , Humanos , Hipertensión/fisiopatología , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Índice de Severidad de la Enfermedad , Apnea Obstructiva del Sueño/complicaciones , Apnea Obstructiva del Sueño/rehabilitación , Calidad del SueñoRESUMEN
BACKGROUND: The aim of this study was to investigate the effects on subjective and objective sleepiness of a stay above a large struck singing bowl compared to a relaxation period in a silent singing bowl. METHODS: Fifty-eight healthy subjects were recruited for the study, 48 participated on two days, one week apart, during the same timeslot. The Karolinska sleepiness scale was used to evaluate current subjective sleepiness, and the relative pupillary unrest index to assess objective sleepiness. In this randomized cross-over study, the intervention consisted of a 20-minute stay in a hammock while the singing bowl, positioned beneath, was struck seven times. The controlled comparator was a 20-minute stay in the same hammock above the singing bowl, but without being struck. After these two interventions subjective and objective sleepiness were re-evaluated. RESULTS: The mean relative pupillary unrest index values after relaxation in the struck and silent singing bowl groups were 0.74 and respectively 0.71 (p = 0.460). The median Karolinska sleepiness scale value after relaxation with the struck singing bowl was 3 compared with 4 (p = 0.041) for the silent singing bowl. DISCUSSION: This study evaluated the influence of a struck singing bowl on sleepiness during daytime. Subjective sleepiness was significantly lower after relaxation above a struck singing bowl. After gender stratification, the difference was still significant in women. Objective sleepiness was not different in both groups. Finally, we can only speculate if women may be more susceptible to subjective improvements in case of sleepiness and show another perception of relaxation in a struck singing bowl compared to men.
Asunto(s)
Estimulación Acústica/instrumentación , Trastornos de Somnolencia Excesiva/rehabilitación , Relajación/fisiología , Somnolencia , Vigilia/fisiología , Estimulación Acústica/métodos , Adulto , Estudios Cruzados , Trastornos de Somnolencia Excesiva/diagnóstico , Trastornos de Somnolencia Excesiva/fisiopatología , Femenino , Voluntarios Sanos , Humanos , Masculino , Persona de Mediana Edad , Polisomnografía , Estudios Prospectivos , Pupila/fisiología , Fases del Sueño/fisiología , Adulto JovenRESUMEN
Apathy and hypersomnia occur after stroke and, by definition, reduce participation in rehabilitation, but their effect on outcome from acute rehabilitation is not known. We performed a retrospective review of 213 patients admitted to a stroke-specialized acute rehabilitation unit in the United States. All patients had ischemic or hemorrhagic stroke, and no dementia or dependence on others pre-stroke. We diagnosed apathy and hypersomnia using standardized documentation by treating therapists. We used multiple regression analysis to control for overall impairment (combination of strength, cognitive and sensory measures), age, time since stroke, and stroke type (ischemic or hemorrhagic). Forty-four (21%) of the patients had persistent apathy, and 12 (5.6%) had persistent hypersomnia. Both groups were more impaired in cognition, sustained attention, and more likely to be treated for depression. Patients with apathy were 2.4 times more likely to go to a nursing home, and had discharge FIM scores 12 points below the mean. Patients with hypersomnia were ten times more likely to go to a nursing home, and had discharge FIM scores 16 points below the mean. These findings indicate that studies to prospectively define these clinical factors and potential confounds using standardized tools are indicated, and if confirmed, justify studies to identify these patients early and develop targeted interventions.
Asunto(s)
Apatía , Trastornos de Somnolencia Excesiva/rehabilitación , Recuperación de la Función , Rehabilitación de Accidente Cerebrovascular , Anciano , Anciano de 80 o más Años , Evaluación de la Discapacidad , Trastornos de Somnolencia Excesiva/etiología , Trastornos de Somnolencia Excesiva/psicología , Femenino , Humanos , Masculino , Centros de Rehabilitación , Estudios Retrospectivos , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/psicología , Resultado del TratamientoRESUMEN
OBJECTIVES: Excessive daytime sleeping is associated with poorer functional outcomes in rehabilitation populations and may be improved with targeted interventions. The purpose of this study was to test simple methods of screening for excessive daytime sleeping among older adults admitted for postacute rehabilitation. DESIGN: Secondary analysis of data from 2 clinical samples. SETTING: Two postacute rehabilitation (PAR) units in southern California. PARTICIPANTS: Two hundred twenty-six patients older than 65 years with Mini-Mental State Examination (MMSE) score higher than 11 undergoing rehabilitation. MEASUREMENTS: The primary outcome was excessive daytime sleeping, defined as greater than 15% (1.8 hours) of daytime hours (8 am to 8 pm) sleeping as measured by actigraphy. RESULTS: Participants spent, on average, 16.2% (SD 12.5%) of daytime hours sleeping as measured by actigraphy. Thirty-nine percent of participants had excessive daytime sleeping. The Pittsburgh Sleep Quality Index (PSQI) was significantly associated with actigraphically measured daytime sleeping (P = .0038), but the Epworth Sleepiness Scale (ESS) was not (P = .49). Neither the ESS nor the PSQI achieved sufficient sensitivity and specificity to be used as a screening tool for excessive daytime sleeping. Two additional models using items from these questionnaires were not significantly associated with the outcome. CONCLUSIONS: In an older PAR population, self-report items from existing sleep questionnaires do not identify excessive daytime sleeping. Therefore we recommend objective measures for the evaluation of excessive daytime sleeping as well as further research to identify new self-report items that may be more applicable in PAR populations.
Asunto(s)
Trastornos de Somnolencia Excesiva/diagnóstico , Cooperación del Paciente/estadística & datos numéricos , Sueño/fisiología , Encuestas y Cuestionarios/normas , Anciano , Anciano de 80 o más Años , California , Estudios de Cohortes , Trastornos de Somnolencia Excesiva/rehabilitación , Femenino , Evaluación Geriátrica , Humanos , Masculino , Tamizaje Masivo/métodos , Selección de Paciente , Modalidades de Fisioterapia , Polisomnografía , Centros de Rehabilitación , Sensibilidad y Especificidad , Resultado del TratamientoRESUMEN
STUDY OBJECTIVE: To examine obstructive sleep apnea (OSA) as a risk factor for work disability. PATIENTS AND SETTING: Consecutive patients referred to the University of California San Francisco Sleep Disorders Center with suspected OSA (n = 183). DESIGN: All patients underwent overnight polysomnography after completing a written survey which assessed work disability due to sleep problems, occupational characteristics and excessive daytime sleepiness (EDS) defined as an Epworth Sleepiness Scale score > 10. RESULTS: Among 150 currently employed patients, 83 had OSA on polysomnography (apnea-hypopnea index > or = 5). Compared with patients in whom both OSA and EDS were absent, patients with the combination of OSA and EDS were at higher risk of both recent work disability (adjusted odds ratio [OR], 13.7; 95% confidence interval [CI], 3.9-48) and longer-term work duty modification (OR, 3.6; CI, 1.1-12). When either OSA or EDS were absent, the strength of the association with work disability was less than when both OSA and EDS were present. When OSA was examined without respect to EDS, patients with OSA were at increased risk of recent work disability relative to patients without OSA (OR 2.6; 95% CI 1.2-5.8), but the association of OSA with longer-term work duty modification did not meet standard criteria for statistical significance (OR = 2.0, 95% CI 0.8-5.0). CONCLUSIONS: The combination of OSA and EDS contributes to work disability, and OSA by itself contributes to recent work disability. These findings should highlight to employers and clinicians the importance of OSA in the workplace to encourage patients to be screened for OSA, particularly in situations of decreased productivity associated with EDS.
Asunto(s)
Evaluación de la Discapacidad , Trastornos de Somnolencia Excesiva/diagnóstico , Enfermedades Profesionales/diagnóstico , Polisomnografía , Apnea Obstructiva del Sueño/diagnóstico , Absentismo , Adulto , Índice de Masa Corporal , Comorbilidad , Trastornos de Somnolencia Excesiva/rehabilitación , Evaluación del Rendimiento de Empleados , Femenino , Humanos , Perfil Laboral , Masculino , Persona de Mediana Edad , Enfermedades Profesionales/rehabilitación , Rehabilitación Vocacional , Factores de Riesgo , Apnea Obstructiva del Sueño/rehabilitación , Tolerancia al Trabajo ProgramadoRESUMEN
To assess the usefulness of a sleep disorders center the authors sent follow-up questionnaires to patients and referring physicians 9 months after each diagnostic evaluation. Findings suggest that sleep disorders centers provide a useful diagnostic service, especially for patients suffering from excessive daytime sleepiness. This problem usually has a medical etiology, and sleep laboratory evaluations seemed crucial for about two-thirds of all such patients. Insomnia was more likely to involve behavioral/psychological factors; about 30% of the patients with long-term, serious insomnia seemed to benefit markedly from the sleep center evaluation.