Maintaining an active lifestyle may help protect against obstructive sleep apnea (OSA), according to research that found higher levels of physical activity and fewer hours spent sitting were associated with a lower risk of OSA, writes MedicalBrief.
“The results are fairly expected, because we know that being physically active and less sedentary are effective in reducing obesity, which is a strong risk factor for OSA,” said Tianyi Huang, with Brigham & Women's Hospital in Boston.
According to a Reuters article published in Medscape, Huang said that in addition to reducing obesity, an active lifestyle improves insulin resistance and lowers inflammation. Insulin resistance and inflammation are important mechanisms that may cause OSA.
“An active lifestyle during the day also reduces excessive body fluid retention; when people lie down asleep, these excessive body fluids can pressure the lung to reduce its volume and cause OSA," Huang explained.
The findings are based on data from more than 118,000 women from the Nurses' Health Study (2002-2012) and Nurses' Health Study II (1995- 2013) and more than 19,000 men from the Health Professionals Follow-up Study (1996-2012).
Every two to four years, participants reported their recreational physical activity (quantified by metabolic equivalent of task, or MET hours per week) and time spent sitting. Physician-diagnosed OSA was self- reported. During roughly two million person-years of follow-up, 8,733 people developed OSA.
After adjusting for potential confounders, people who got 36 or more MET-hours per week of physical activity (vs less than six MET- hours/week) had a 54% lower risk of OSA (hazard ratio: 0.46; 95% CI: 0.43 to 0.50; P for trend<0.001), the researchers report in the European Respiratory Journal.
Compared with those spending less than four hours each week sitting watching TV, those spending 28 or more hours in front of the TV had a 78% increased risk of OSA (HR: 1.78; 95% CI: 1.60 to 1.98; P<0.001). The corresponding HR was 1.49 (95% CI: 1.38 to 1.62; P<0.001) for 28+ weekly hours sitting at work/away from home.
With additional adjustment for several metabolic factors including body mass index and waist circumference, the associations with physical activity and sitting hours at work/away from home were attenuated but remained significant (P<0.001), whereas the association with sitting hours watching TV was no longer statistically significant (P=0.18).
“Most prior observational studies on the associations of physical activity and sedentary behaviour with OSA were cross-sectional, with incomplete exposure assessment and inadequate control for confounding,” Huang said. “This is the first prospective study that simultaneously evaluates physical activity and sedentary behaviour in relation to OSA risk. Promoting an active lifestyle can prevent OSA, and should not only focus on increasing physical activity but also reducing sedentary hours.”
Study details
Physical activity, sedentary behaviour, and incidence of obstructive sleep apnea in three prospective US cohorts
Yue Liu, Lin Yang, Meir J. Stampfer, Susan Redline, Shelley S. Tworoger, Tianyi Huang
Published in European Respiratory Journal July 2021
Abstract
Reduced physical activity and increased sedentary behavior may independently contribute to development of obstructive sleep apnea (OSA) through increased adiposity, inflammation, insulin resistance and body fluid retention. However, epidemiologic evidence remains sparse, and is primarily limited to cross-sectional studies.
We prospectively followed 50 332 women from the Nurses’ Health Study (2002–2012), 68 265 women from the Nurses’ Health Study II (1995–2013), and 19 320 men from the Health Professionals Follow-up Study (1996–2012). Recreational physical activity (quantified by metabolic equivalent of task [MET]-hours/week) and sitting time spent watching TV and at work/away from home were assessed by questionnaires every two–four years. Physician-diagnosed OSA was identified by validated self-report. Cox models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for OSA incidence associated with physical activity and sedentary behavior.
During 2 004 663 person-years of follow-up, we documented 8733 incident OSA cases.
After adjusting for potential confounders, the pooled HR for OSA comparing participants with ≥36.0 versus <6.0 MET-hours/week of physical activity was 0.46 (95% CI: 0.43, 0.50; ptrend<0.001). Compared with participants spending <4.0 h/week sitting watching TV, the multivariable-adjusted HR (95% CI) was 1.78 (1.60, 1.98) for participants spending ≥28.0 h/week (ptrend<0.001).
The comparable HR (95% CI) was 1.49 (1.38, 1.62) for sitting hours at work/away from home (ptrend<0.001). With additional adjustment for several metabolic factors including BMI and waist circumference, the associations with physical activity and sitting hours at work/away from home were attenuated but remained significant (ptrend<0.001), whereas the association with sitting hours watching TV was no longer statistically significant (ptrend=0.18).
Higher levels of physical activity and fewer sedentary hours were associated with lower OSA incidence. The potential mediating role of metabolic factors in the association between sedentary behaviour and OSA incidence may depend on type of sedentary behaviour.
Our results suggest that promoting an active lifestyle may reduce OSA incidence.
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