Abstract
BackgroundObstructive sleep apnea (OSA) occurs due to sleep-induced upper airway muscle relaxation resulting in increased pharyngeal collapsibility. Clinical trials have shown a favorable effect of exercise training on OSA severity in middle-aged adults. Aging is characterized by motor-unit loss. Force training may affect the whole body muscle tone. We hypothesize that interventions increasing muscle strength might propagate to motor units at the abductor pharyngeal muscles, reducing collapsibility and, hence, sleep apnea severity in elderly patients with obstructive sleep apnea.Methods/designThis is a randomized clinical trial including patients between 65 and 80 years of age, with obstructive sleep apnea, and an apnea-hypopnea index (AHI) between 20 and 50 events/hour, diagnosed by out-of-center in-home type III polysomnography. Forty subjects will be included and randomly assigned to two equal sized groups. The participants allocated to the intervention group will attend two sessions per week of one-hour strength training for the legs, arms, chest, back, and abdomen and the controls will receive advice on lifestyle change. The primary outcome measure of the study will be the change in apnea-hypopnea index and the secondary outcomes will be the body composition, evaluated by anthropometric and bioelectrical impedance variables; maximum dynamic force, appraised by one-repetition maximum strength test; muscle quality and thickness by ultrasound; physical function assessed by sit-to-stand test, timed up and go test, handgrip strength test. The study duration will be 12 weeks. Intention-to-treat and per-protocol analyses will be performed.DiscussionThe high prevalence of obstructive sleep apnea in elderly people is a public health issue. OSA is a recognized cause of cardiovascular disease and reduces quality of life due to sleepiness and fatigue. Exercise is a low-cost intervention that could help to detain the trend towards age-dependent loss of pharyngeal motor units and progressive severity of obstructive sleep apnea. Home-based strength exercises may represent a more practical approach than aerobic exercise for elderly patients. If the results confirm our hypothesis, further research on the clinical application of our findings will be warranted.Trial registrationClinicalTrials.gov, NCT02742792. Registered on 1 April 2016.
Highlights
Obstructive sleep apnea (OSA) occurs due to sleep-induced upper airway muscle relaxation resulting in increased pharyngeal collapsibility
Exercise is a low-cost intervention that could help to detain the trend towards age-dependent loss of pharyngeal motor units and progressive severity of obstructive sleep apnea
Reduction in the severity of OSA induced by physical training has been shown in randomized clinical trials and meta-analyses, but none of the studies to date have investigated the effect of strength training on sleep apnea severity in elderly individuals
Summary
The present study is designed to evaluate the effects of resistance training on OSA severity in elderly persons. Our hypothesis is that resistance training will reduce OSA severity while improving neuromuscular function. Little is known about the effect of resistance training alone without aerobic training on OSA in the elderly population. None of the studies found in an ample PubMed and Embase search mentioned any randomized controlled trials (RCTs) of treatments for OSA. Resistance training enhances the neuromuscular function, i.e., lower limb strength, and specific tension in elderly persons [67]. The enhancements of performance in functional tests have seldom been described in elderly people [68]. Our RCT will provide data for analyses of the relationship between OSA and functional performance.
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