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Exercise Improves Daytime Fatigue in Sleep Apnea Patients
BOSTON — Depression, metabolic syndrome, and lack of exercise exacerbate daytime sleepiness in obese patients with sleep apnea, Dr. Alexios Sarrigiannidis said at the annual meeting of the Endocrine Society.
Dr. Sarrigiannidis and his colleagues in the Sleep Research and Treatment Center at Pennsylvania State University, Hershey, reviewed data for 708 consecutive patients, 470 men and 238 women, mean age 50 years, who had been referred for symptoms consistent with sleep apnea and had at least five episodes of apnea/hypopnea per hour. Mean body mass index was 34.9 kg/m2 for men and 39.2 for women.
All of the participants completed the General Health Questionnaire to assess for depression, diabetes, cardiovascular disease, hypertension, and sleep habits; the Epworth Sleepiness Scale; and the Physical Activity Questionnaire. They were all assessed for metabolic syndrome and underwent one standard, 8-hour nocturnal polysomnographic recording.
Among men, the mean apnea/hypopnea index score (representing the total number of either apnea or hypopnea episodes/hr of sleep) was 39.9, significantly higher than the 29.2 reported in the women. Measures of sleepiness and physical activity were similar for both groups.
Of the study population, 39% of the men and 62% of the women met the diagnostic criteria for major depressive disorder, and 69% of the men and 68% of the women fulfilled the criteria for metabolic syndrome. In both groups, approximately 43% did not get regular physical exercise, the investigators said.
Using logistic regression analysis, “exercise was the strongest [statistically significant] predictor of excess daytime sleepiness in men, followed by depression,” Dr. Sarrigiannidis reported in a poster presentation. “In the women, depression and metabolic syndrome, in that order, were the most important predictors.”
Independent of body weight, “participating in regular exercise appears to have somewhat of a protective effect in terms of daytime sleepiness, particularly among men,” Dr. Sarrigiannidis said. Exercise improves insulin resistance and reduces visceral adiposity, he said, noting that clinicians should encourage physical activity as a way to help combat daytime fatigue in individuals with sleep apnea.
Additionally, Dr. Sarrigiannidis advised physicians to evaluate sleep apnea patients routinely for depression and metabolic syndrome and to refer them for appropriate treatment when necessary.
Dr. Sarrigiannidis reported having no conflicts of interest with respect to his presentation.
PII: S0270-6644(06)71838-0
doi:10.1016/S0270-6644(06)71838-0
© 2006 Elsevier Inc. All rights reserved.
Copyright © 2009 Elsevier, Inc. All rights reserved | Privacy Policy | Terms & Conditions | Feedback | About Us | Help | Contact Us |
The content on this site is intended for health professionals.
Dr. Sarrigiannidis and his colleagues in the Sleep Research and Treatment Center at Pennsylvania State University, Hershey, reviewed data for 708 consecutive patients, 470 men and 238 women, mean age 50 years, who had been referred for symptoms consistent with sleep apnea and had at least five episodes of apnea/hypopnea per hour. Mean body mass index was 34.9 kg/m2 for men and 39.2 for women.
All of the participants completed the General Health Questionnaire to assess for depression, diabetes, cardiovascular disease, hypertension, and sleep habits; the Epworth Sleepiness Scale; and the Physical Activity Questionnaire. They were all assessed for metabolic syndrome and underwent one standard, 8-hour nocturnal polysomnographic recording.
Among men, the mean apnea/hypopnea index score (representing the total number of either apnea or hypopnea episodes/hr of sleep) was 39.9, significantly higher than the 29.2 reported in the women. Measures of sleepiness and physical activity were similar for both groups.
Of the study population, 39% of the men and 62% of the women met the diagnostic criteria for major depressive disorder, and 69% of the men and 68% of the women fulfilled the criteria for metabolic syndrome. In both groups, approximately 43% did not get regular physical exercise, the investigators said.
Using logistic regression analysis, “exercise was the strongest [statistically significant] predictor of excess daytime sleepiness in men, followed by depression,” Dr. Sarrigiannidis reported in a poster presentation. “In the women, depression and metabolic syndrome, in that order, were the most important predictors.”
Independent of body weight, “participating in regular exercise appears to have somewhat of a protective effect in terms of daytime sleepiness, particularly among men,” Dr. Sarrigiannidis said. Exercise improves insulin resistance and reduces visceral adiposity, he said, noting that clinicians should encourage physical activity as a way to help combat daytime fatigue in individuals with sleep apnea.
Additionally, Dr. Sarrigiannidis advised physicians to evaluate sleep apnea patients routinely for depression and metabolic syndrome and to refer them for appropriate treatment when necessary.
Dr. Sarrigiannidis reported having no conflicts of interest with respect to his presentation.
PII: S0270-6644(06)71838-0
doi:10.1016/S0270-6644(06)71838-0
© 2006 Elsevier Inc. All rights reserved.
Copyright © 2009 Elsevier, Inc. All rights reserved | Privacy Policy | Terms & Conditions | Feedback | About Us | Help | Contact Us |
The content on this site is intended for health professionals.
Views: 4
Replies to This Discussion
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Permalink Reply by susan mccord on
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Rock, thanks for posting this. I'm in a bit of a dilemma with this issue. I've always been a walker, increasingly so the past 4 years after dx of heart disease. In probably the past 8-10 months when, I suspect, this apnea stuff was starting to escalate, I've been increasingly unable to walk for exercise. My weight's within normal limits, and I'm even more alert to the weight issue due to warnings re: impact on apnea. (It is, of course, an issue for HD also).
I know that exercise raises energy. No doubt about it. But when fatigue has gotten to the point where I honestly can't walk any kind of program, nor walk up and down hills as is my habit, it leaves me at a loss re: what to do to try and get my energy moving. I have a little more than I did since on CPAP, but overall find myself feeling exhausted all the time. Not clear how much of that is due to HD and apnea in combination. Nonetheless, not walking is NOT good for me. For sure! I'm wondering who, possibly you, possibly someone else, would be a resource in this regard. I'm not unmotivated to do the walking I know I need. I simply cannot do it. I can be out and about doing normal things, at a reduced level, maybe 4 days a week at best. The other 3 days, I'm beached. I've tried walking around in parking lots of places I happen to be which I can do. But to walk out, where I would normally walk, scares me because I know I'll get to a place, physically, that I can't get back. I HATE that!! It's just not me, and I can't stand the thought that it may be my new normal.
If you, or anyone else on SG, has any thoughts about all this, I'd appreciate hearing about them. If it's so difficult for me, I can only imagine how challenging it must be for those folks who are extremely overweight. The fatigue (that's such a pleasant word to describe feeling like shit) issue is bigger than a lot of people seem to understand.
Susan McCord
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Permalink Reply by RockRpsgt on
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Baby steps Susan, baby steps. Walk up and down your street. Stay close to the safety of home. raising your heart beat just a little could get you to the next point. Talk to your doctor about setting up an exercise routine with a progressive schedule.
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Thanks, Rock--I needed a reminder of what I know!! I've taught patients with depression/anxiety/ surg.recovery issues/post chemo, etc., for many years the VERY SAME THING!, i.e., start by walking to the end of your driveway , walk to the fireplug and back, walk 5 houses down, etc., etc.--it's just contained progressive effort.....I find it odd, and extremely interesting, that it didn't occur to me to apply that to my own situation.....some indication, perhaps, of how pervasive apnea exhaustion can be.....my entire thought process has changed and slowed in some startling ways. On bad days it scares me to death, on better days, it makes me laugh......I think I need to be confined!!!!! LOL !!! Anyway, thanks for the encouragement. Psychology 101 seems out of the realm of my common sense these days.....startling......
Susan McCord :-)
Rock Hinkle said:Baby steps Susan, baby steps. Walk up and down your street. Stay close to the safety of home. raising your heart beat just a little could get you to the next point. Talk to your doctor about setting up an exercise routine with a progressive schedule.
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Permalink Reply by sleepycarol on
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It is funny how we sometimes get pushed into doing the things that are difficult for us.
Last year I switched from teaching high school to elementary. I had gotten burned out teaching high school and needed a break. There was an opening and I decided to take them up on the offer of switching positions.
What I hadn't expected was doing lunch duty. Long story I won't go into, but I was asked to do lunch duty since no one else would do it without a major fuss. I agreed, but at the time I was barely able to make it to the lunch room let alone stand for nearly 40 minutes and walk around helping kids and providing discipline where needed. It was hard at first, my knees bother me alot and I fatigue easily due to my weight. At first I dreaded the walk down to the cafeteria ( we are pre-k to 12th greade school on one level). After a time it got easier and I know that I needed that extra push to start exercising again. I did lose 30 pounds last spring. I need to lose more and plan on going back on my diet now that I am back into a routine.
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GOOD FOR YOU ON THE WEIGHT LOSS!!! It's hard to lose weight, really hard. Sounds like you've got a great start, Carol! I'll be sending you energy. (I have just a little to spare at the moment!!!) Don't know how old you are, but I'm 67 and it comes off so darn slow, really for the past 15 years or so. I'm finally right about where I need to be--4-5 more pounds.
Hey, I can tell you about what I did for my knees, probably 12-13 years ago. I started taking glucosamine 500mg/chondroitin 400 mg capsules, 4 every single day, never miss, and it's made a MAJOR improvement with my knees. Unbelievable!!! I think the key is to take enough daily, every day, and not give up. It took awhile to start noticing the difference, but I was just determined to see if it would work. It works!!!!! I think I'd give up one of my heart meds before I'd give up g/c. I couldn't climb hills, stairs, kneel in church, AT ALL in those days. Now, for the past several years, I can do ALL those things again. I'll take it till I die. I don't get on my knees to do misc. things--don't wanta take the chance. But the things I really need to do, I can do. I can't imagine where I'd be mobility-wise today without it. It IS pricey. The cheapest place I've found is Sam's Club and it's a LOT cheaper there. The reason I don't buy it there is that it's huge caplets which are hard for me to swallow. So I stick with the capsules. But it's the same combination that works for me. Just a thought. It's worked on horses for many years. Makes sense it would work for us. Just gotta keep after it every freakin' day. (jeez, that sounds familiar, doesn't it?) Anyway, I really wanted to congratulate you on such a great start at getting healthier. It's amazing what a few #s can do....
Susan McCord :-)
sleepycarol said:It is funny how we sometimes get pushed into doing the things that are difficult for us.
Last year I switched from teaching high school to elementary. I had gotten burned out teaching high school and needed a break. There was an opening and I decided to take them up on the offer of switching positions.
What I hadn't expected was doing lunch duty. Long story I won't go into, but I was asked to do lunch duty since no one else would do it without a major fuss. I agreed, but at the time I was barely able to make it to the lunch room let alone stand for nearly 40 minutes and walk around helping kids and providing discipline where needed. It was hard at first, my knees bother me alot and I fatigue easily due to my weight. At first I dreaded the walk down to the cafeteria ( we are pre-k to 12th greade school on one level). After a time it got easier and I know that I needed that extra push to start exercising again. I did lose 30 pounds last spring. I need to lose more and plan on going back on my diet now that I am back into a routine.
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I will have to try that. I took it for a short time when my doctor recommended it and when I didn't see results gave up -- but I only took it for a couple of weeks. I didn't realize it took time for it work!! Geez and I complain when the kids want instant gratification!!
Susan, did want to let you know I appreciate all you do for the forum!!! I try to read your posts and have found them informative and helpful.
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