Sleep Apnea and Physical Exercise
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Exercise has a certain auxiliary therapeutic effect on sleep apnea syndrome, but it cannot completely cure the disease.
Sleep apnea syndrome is a relatively complex disease, and its onset is related to many factors, such as obesity, abnormal upper respiratory tract structure, and abnormal nervous system regulation function. Exercise has a positive significance in improving sleep apnea syndrome. For patients whose obesity is the main cause, exercise helps to lose weight. Obese people often accumulate more fat in their necks, which can compress the airway. Exercise can consume calories and reduce fat accumulation, which can reduce this pressure, thereby alleviating the symptoms of sleep apnea to a certain extent.
Aerobic exercise, such as jogging and swimming, can improve cardiopulmonary function and strengthen the respiratory muscles. When the respiratory muscles are strengthened, they can better maintain the patency of the airway and reduce the frequency of apnea. At the same time, exercise can also regulate the body’s metabolism and endocrine function, and improve the regulation of the nervous system on breathing.
Exercise cannot solve all the problems that cause sleep apnea syndrome. For example, for those who suffer from sleep apnea due to congenital stenosis of the upper respiratory tract structure, such as nasal polyps, enlarged tonsils, etc., or facial structural abnormalities such as mandibular retraction, exercise cannot change these anatomical problems. Some central sleep apneas are caused by lesions or functional disorders of the nervous system. Although exercise may have a certain positive effect on the nervous system, it cannot fundamentally repair lesions in the central nervous system. Therefore, while patients with sleep apnea syndrome are undergoing exercise-assisted therapy, they also need to combine other treatments according to their own causes, such as continuous positive airway pressure therapy, surgical treatment, etc., to achieve better treatment results.
Benefits of Physical Exercise for Sleep Apnea
Weight loss and improvement of upper airway obstruction: For patients with sleep apnea syndrome caused by obesity, physical exercise can help lose weight. The fat accumulated in the neck of obese people can compress the airway and cause sleep apnea. Exercise can consume calories and reduce fat accumulation, which can reduce this pressure and relieve the symptoms of sleep apnea to a certain extent.
Strengthen respiratory muscles : Aerobic exercise such as jogging and swimming can improve cardiopulmonary function and strengthen respiratory muscles. When respiratory muscles are strengthened, they can better maintain the patency of the airway and reduce the frequency of apnea.
Improve cardiopulmonary function and sleep quality: Studies have shown that people who exercise more often sleep longer and more deeply, and are less likely to suffer from sleep apnea syndrome. Exercise can reduce the number of breathing stops during sleep and improve sleep quality.
Assisted treatment of other respiratory diseases: Breathing training such as abdominal breathing and pursed lip breathing can help deepen breathing, increase lung ventilation, exercise respiratory muscles, and improve lung function. This also has a positive effect on the auxiliary treatment of respiratory diseases such as bronchitis and asthma.
Effects of Physical Exercise on Sleep Apnea
Enhance Upper Airway Sphincter Function
Maintenance of the airway requires the cooperation of the upper airway and chest respiratory muscles. Contraction of the inspiratory muscles leads to an increase in negative pressure in the chest cavity, and air enters the respiratory system, while patients with pharyngeal collapse are blocked from completing this process. The movement and contraction of the upper airway dilator muscles and pharyngeal regulators in patients with pharyngeal collapse are decompensated.
Therefore, physical exercise can enhance the function of respiratory muscles. Long-term and sustained exercise can increase the vitality of the upper airway muscles, thereby increasing the radius of the upper airway and reducing airway resistance, thereby preventing pharyngeal collapse during sleep. Body exercise can enhance the function of the upper airway dilator muscles in OSA patients.
Reduce Fluid Accumulation In The Neck
Long-term sedentary lifestyle and people with reduced exercise capacity can lead to obstructed venous return and lower limb edema. When sleeping, the human body is in a supine position. The change in body position causes blood to return and increase the body fluid in the neck, thereby increasing the pressure of the jugular vein, aggravating the symptoms of patients with sleep apnea syndrome, daytime sleepiness, and reduced daytime activities.
White et al. conducted a test using elastic stockings, dividing patients with severe OSAHS and lower limb edema into an experimental group and a control group. The results showed that the apnea-hypopnea index of patients wearing elastic stockings was significantly reduced, because the amount of fluid returning from the lower limbs to the neck at night was significantly reduced in patients wearing elastic stockings, the amount of fluid returning from the neck did not change significantly, and the upper airway cross-sectional area increased significantly in the morning. Regular physical exercise can increase the fluid dynamics of the lower limbs, which has been confirmed in previous studies.
The results of the study confirmed that the apnea-hypopnea index of patients who underwent physical exercise was significantly reduced, while the cross-sectional area of the upper respiratory tract was significantly increased. Some studies also believe that physical exercise will increase the burden on patients with heart failure and aggravate the clinical symptoms of patients with sleep apnea syndrome. The effect of exercise on patients with high blood volume (such as patients with heart failure) is significantly better than that on patients without high blood volume.
Increase Slow-wave Sleep Time
Normal sleep is divided into rapid eye movement (REM) and non-rapid eye movement (NREM). From a physiological point of view, REM accounts for about 25% of the entire sleep process. During this process, the brain is in rapid, low-amplitude activity, the eyeballs move rapidly in bursts, the ventilation is unstable, and the muscle tension is reduced, all of which affect the patency of the upper airway. NREM is divided into stages 1, 2, and 3. Stage 3 is also called slow-wave sleep, which is characterized by the body being in deep sleep and an increased awakening threshold.
There have been studies evaluating patients with sleep apnea syndrome complicated by heart failure, patients with central apnea, and people without sleep apnea. All subjects underwent physical exercise for 4 months, 3 times/week, 60 min/time, and the main exercises were muscle stretching and cycling. The study showed that after 3 months of physical exercise, the slow-wave sleep time of all subjects increased. Currently, Kredlow et al. have conducted an analysis of the effects of strenuous exercise and regular exercise on sleep treatment. The study found that both subjective and objective sleep parameters (total sleep time, sleep efficiency, slow-wave sleep time) increased.
Reduce Body Mass Index
Physical exercise can alleviate the severity of OSA patients by reducing weight and abdominal fat. Studies have shown that a 10% reduction in body mass index can reduce the apnea-hypopnea index by 30%. Dobrosielski et al. found that OSAHS patients can reduce their body mass index and thus their apnea-hypopnea index through aerobic exercise and a proper diet.
Barnes et al. evaluated the Epworth Sleepiness Scale and body mass index of 21 patients with mild to moderate OSAHS who ate a low-energy diet and adhered to aerobic exercise, and found that the apnea-hypopnea index of these patients with OSAHS did not change significantly. The above research results show that there is still a lack of randomized controlled studies on the relationship between physical exercise, weight loss and the severity of OSA.
Reduce Systemic Inflammation
Adipose tissue (especially abdominal adipose tissue) is rich in pro-inflammatory cytokines. OSA can regulate the expression and release of inflammatory factors in visceral fat and other tissues. Studies have found that C-reactive protein in OSA patients is associated with sleepiness, fatigue, various metabolic diseases, and complications of cardiovascular diseases, but not obesity.
Studies have shown that regular exercise can help fight inflammation, especially in obese patients, but its mechanism of action is still unclear. Cavagnoli conducted a two-month aerobic exercise program on 20 non-obese adult men (10 of whom were OSAHS patients). The research team found that the C-reactive protein levels in the OSAHS group and the control group were similar. There was no significant decrease in C-reactive protein levels and apnea-hypopnea index after exercise.
Can Losing Weight Improve Sleep Apnea?
OSAHS patients should receive multi-faceted guidance. Currently, overweight or obesity is considered an independent risk factor for OSAHS. Therefore, all overweight or obese people diagnosed with OSAHS should effectively control their weight and lose weight, including diet control and increased exercise.
The goal of weight loss should be reasonable, feasible, individualized, and aimed at long-term effectiveness. Specific goals include: achieving a 5% to 15% weight loss in 6 months, which has been proven to be achievable and conducive to the restoration of health; severe obesity (such as BMI>35 kg/m2) may require more (20% or more) weight loss; maintaining weight, reducing weight, and preventing and treating concomitant diseases are the two keys to successful obesity treatment.
Specific treatment measures to improve body weight include medical nutrition therapy, physical activity, cognitive behavioral intervention, drug therapy and surgical treatment. Medical nutrition therapy, physical activity and cognitive behavioral therapy are the basis of obesity management and are also the treatment measures throughout. A considerable number of patients can achieve the treatment goals through these measures, but when necessary and for specific patients, they should also actively take drug or surgical treatment to achieve the purpose of controlling or losing weight, reducing and controlling complications.
For those who are overweight or who have not responded to general weight loss through diet and physical activity, medication or even surgery can be used to lose weight, but this must be done under the guidance of a doctor.
Another important aspect is that patients with OSAHS have leptin resistance and high ghrelin levels, which can aggravate the process of obesity. Therefore, treating the OSAHS disease itself will also help improve the effect of weight loss.
Sleep Apnea Exercise Rehabilitation Program
The following exercise methods are recommended: Carry out exercise rehabilitation training according to the “Three-Stage Rehabilitation Exercise Program” proposed by the American College of Cardiology. The training is divided into a warm-up period, an exercise period, and a recovery period.
- Warm-up period: Pre-exercise preparation of muscles, joints, and cardiovascular systems, mainly low-calorie warm-up exercises, lasting 10 to 15 minutes;
- Exercise period: including brisk walking, joint stretching exercises, dumbbells, power bikes, Tai Chi, etc. The initial intensity is controlled at 60% of the maximum oxygen uptake (VO2max), each time lasting 5 minutes, and then adjusted once every 2 weeks, gradually increasing the amount of exercise until VO2max reaches 80% and is maintained, each time lasting 5 minutes;
- Recovery period: Relaxation exercise for 5-10 minutes, training 5 times a week, during which you should pay attention to gradual progress and adopt individualized plans. Choice of exercise: You can use racket sports, swimming, aerobic exercise, running, and cycling are also good ways to exercise.
1. Aerobic Exercise
Aerobic exercise is a form of exercise that can improve cardiopulmonary function, including jogging, brisk walking, swimming, etc. These exercises can improve the strength and endurance of respiratory muscles, increase lung capacity, and help patients lose weight and improve sleep quality. Studies have shown that doing aerobic exercise 3-4 times a week for about 30 minutes each time can significantly reduce the risk of OSAS in patients.
2.Yoga and Tai Chi
Yoga and Tai Chi are comprehensive forms of exercise that can relieve stress and relax the body and mind through stable breathing and gentle body movements. These exercises can improve the patient’s sleep quality, regulate breathing rhythm, and reduce the risk of OSAS.
3.Breathing Exercises
The main goal of breathing training is to improve the strength and coordination of the muscles involved in breathing, particularly those surrounding the upper airway. This helps to:
Maintains upper airway patency: reduces the risk of airway collapse during sleep.
Improves lung function: increases lung capacity and ventilation efficiency.
Improves breathing patterns: promotes deep, even breathing, which helps with better oxygen exchange.
Reduces stress: Some breathing exercises incorporate relaxation techniques to help reduce stress levels.
Common Breathing Training Methods
(1) Abdominal breathing (diaphragmatic breathing)
Preparation: Choose a comfortable sitting or supine position and relax all the muscles in your body.
Hand position: Place one hand on your chest and the other on your abdomen to feel the rise and fall of your breathing.
Inhale: Inhale slowly through your nose, feel your abdomen bulge, and try to keep your chest still.
Exhale: Exhale slowly through your mouth, and gradually retract your abdomen.
Repeat practice: Practice 10-15 minutes a day, which can be completed in multiple times.
Function: Enhance the activity of the diaphragm, improve the ability to breathe deeply, and promote oxygen supply throughout the body.
(2) Oropharyngeal muscle exercises
Tongue pressure: Press the tip of the tongue against the palate, hold for 5 seconds, repeat 10 times.
Jaw protrusion: Extend the chin forward, feel the jaw muscles stretch, hold for 5 seconds, repeat 10 times.
Pronunciation practice: Clearly and forcefully pronounce vowels such as “ah”, “yi”, “ou”, etc., each lasting 3-5 seconds.
Effect: Enhance the strength and tension of the upper airway muscles to prevent airway collapse during sleep.
(3) Balloon blowing exercise
Deep breath: Take a deep breath through your nose and try to fill your lungs.
Blow up the balloon: Blow the air into the balloon forcefully and inflate it as much as possible.
Repeat the exercise: Blow 5-10 times a day, and gradually increase the number of times.
Effect: Improve lung capacity, strengthen the expiratory muscles, and improve breathing efficiency.
(4) Sing or play an instrument
Singing practice: sing for 15-30 minutes every day, and choose songs that require breathing control.
Wind instruments: learn and practice wind instruments, such as flute, harmonica, saxophone, etc.
Effect: strengthen the coordination and strength of the throat, oral cavity, and upper respiratory tract muscles, and promote breathing control.
(5) Yoga breathing method
Choose an environment: Practice in a quiet and comfortable place.
Sitting preparation: Sit cross-legged, with your back straight and shoulders relaxed.
Alternate nostril breathing: Gently press the right nostril with your right thumb and breathe in slowly from the left nostril. Press the left nostril with your ring finger, release the right nostril, and breathe out slowly from the right nostril. Reverse the operation and repeat for 5-10 minutes.
Focus on the mind: Stay focused throughout the process, feel the flow of breathing, and relax your body and mind.
Effects: Regulate the autonomic nervous system, reduce stress and anxiety, and improve sleep quality.
4. Psychological Rehabilitation
Due to repeated hypoxia or carbon dioxide retention, OSA patients suffer obvious brain damage, which can cause cerebrovascular disease, cognitive decline and emotional abnormalities. The latter often manifests as depression, anxiety, irritability, fatigue and drowsiness, which in turn lead to despair. OSAHS patients are prone to depression, especially moderate and severe OSAHS patients are the main affected group of depression. In terms of psychological rehabilitation, in addition to health education and psychological counseling for OSA patients, exercise also plays a certain role in psychological rehabilitation.
Studies have shown that for mental problems such as depression and stress, statistical results show that no matter what type of exercise is chosen, it is always better than no exercise. As for psychological rehabilitation, there is evidence that team activities, cycling, and aerobics occupy the top three. Among people with depressive disorders, the top two remain unchanged, and the third is replaced by recreational sports and others. The recreational sports here are actually a kind of team sports exercise, which refers to low-intensity basketball and football activities just for fun. From the above, it can be seen that group activities themselves are helpful for the treatment of depressive disorders.
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