Increased physical activity associated with lower risk for OSA

Adults with increased levels of physical activity, including vigorous-intensity exercise and walking, had a lower risk for obstructive sleep apnea, according to a cross-sectional study published in the Journal of Clinical Sleep Medicine.

“Our results highlight the importance of physical activity as a preventive measure against developing sleep apnea,” Lyle J. Palmer, PhD, professor of genetic epidemiology at the University of Adelaide in South Australia, told Healio. “One surprising finding was that not only vigorous physical activity, but also just walking alone, was associated with a decreased risk of sleep apnea.”

Researchers collected self-reported data from an online questionnaire provided to participants of the Ontario Health Study. The population-based cohort study included 155,448 adults (mean age, 46 years; mean BMI, 26.9 kg/m²; 60.2% women) from Ontario, Canada. About 7% of the cohort had physician-diagnosed OSA before the study. The researchers analyzed health-related behaviors, medical history, education history, sociodemographic characteristics and health service utilization.

Among those with OSA, the mean age was 54 years, mean BMI was 31.8 kg/m² and were 62.4% men. Participants with OSA were more sedentary, with a median time of 2,785 minutes sitting per week compared with those without OSA who had a median time of 2,520 minutes of sitting per week. Participants with OSA had higher rates of physician-diagnosed comorbidities, lower average sleep duration and lower sleep quality (P < .001 for all).

In multivariable analyses adjusted for confounding factors, the researchers found that increased total physical activity (OR = 0.98; 95% CI, 0.96-1), vigorous-intensity physical activity (OR = 0.98; 95% CI, 0.96-1) and walking (OR = 0.98; 95% CI, 0.96-1) were all associated with decreased risk for OSA (P < .045 for all). Palmer and colleagues reported no association between moderate-intensity activity and OSA (OR = 1; 95% CI, 0.98-1.02).

These findings were independent of other known risk factors for OSA such as sex, age, ethnicity and obesity, Palmer told Healio.

“The rates of sleep apnea in children and adults are continuing to rise. Therefore, understanding the role of modifiable protective factors for sleep apnea is important,” Palmer said.

The researchers said these results build on previous findings that demonstrate physical activity is a contributing factor to OSA severity. In addition, these results provide an avenue for future research into the relationship between exercise and upper airway anatomy.

“Further prospective studies of sleep health in large, general population cohorts will be essential, together with randomized trials of physical activity in sleep apnea patients,” Palmer said.

In a commentary also published in the Journal of Clinical Sleep Medicine, Joyce K. Lee-Iannotti, MD, with the Sleep Disorders Center at Banner University Medical Center in Phoenix, and James M. Parish, MD, with the Center for Sleep Medicine in the division of pulmonary medicine at Mayo Clinic, Phoenix, said the mechanisms of the association between physical activity and OSA remain unclear due to no direct physiologic relationship of the upper airway. Lee-Iannotti and Parish noted that one possibility is that aerobic activity may affect genioglossus of pharyngeal dilator muscle tone and another possibility is that physical activity may affect fluid volume in the neck area.

“Nevertheless, from a clinical basis, this relationship provides another option in the toolbox of recommendations for patients with mild OSA or mild to moderate OSA without symptoms since it does not require a prescription for an expensive and potentially uncomfortable device and is totally under the control of the patient,” Lee-Iannotti and Parish wrote.

Reference:

• Lee-Iannotti JK, et al. J Clin Sleep Med. 2020;doi:10.5664/jcsm.8582.

For more information:

Lyle J. Palmer, PhD, can be reached at lyle.palmer@adelaide.edu.au.