Elsevier

Sleep Medicine

Volume 10, Issue 9, October 2009, Pages 1056-1058
Sleep Medicine

Brief Communication
The effect of continuous positive airway pressure treatment on physical activity in patients with obstructive sleep apnoea: A randomised controlled trial

https://doi.org/10.1016/j.sleep.2008.11.007Get rights and content

Abstract

Background

Continuous positive airway pressure (CPAP) improves daytime sleepiness in patients with obstructive sleep apnoea (OSA). The effect of CPAP on physical activity is unclear. We hypothesized that activity would increase after CPAP treatment.

Methods

A double blind, parallel, randomised, controlled trial using therapeutic and placebo CPAP was performed in men with newly diagnosed OSA (more than 10 > 4% SaO2 dips/hour and Epworth Sleepiness Score [ESS] ⩾9). Activity was measured by wrist actigraphy before and after three months of CPAP therapy.

Results

Thirty-six men completed 1 week of continuous actigraphy before and after therapeutic CPAP (n = 16) or placebo CPAP (n = 20). The two groups were well-matched at baseline, with no significant differences in mean age, body mass index, ESS and SaO2 dips/hour. Mean (SD) ESS and modified maintenance of wakefulness test (OSLER) improved significantly after CPAP. ESS change in the therapeutic group was −6.1 (4.4), compared to placebo, −2.8 (5.0); difference between groups p = 0.04; OSLER (minutes), therapeutic +10.4 (14.4), placebo −5.0 (12.0), p = 0.003. There was no significant difference between groups in mean hourly activity levels for the seven days at baseline; activity levels did not significantly change in either group after CPAP [daytime activity (arbitrary units): therapeutic −13.9 (93.1) vs. placebo +8.3 (62.9), p = 0.4]. There was no correlation between change in activity and CPAP use.

Conclusion

Activity does not increase after CPAP in men with OSA, despite improvements in daytime sleepiness. The reasons for this are not clear, but may be due to longstanding, habitual patterns of activity.

Introduction

Obstructive sleep apnoea (OSA) is characterised by recurrent episodes of upper airway obstruction during sleep, apnoeas and arousals. The resulting sleep fragmentation causes excessive daytime sleepiness. Continuous positive airway pressure (CPAP) is a well-established, effective treatment for OSA, which improves daytime sleepiness and self-reported health status, particularly the energy and vitality domain of the Short Form-36 [1], [2], [3]. Previous studies have not assessed whether physical activity increases after commencing CPAP therapy. We performed a randomised controlled trial, using therapeutic and placebo CPAP, primarily to investigate the hypothesis that CPAP would improve glycaemic control and insulin resistance; this has been reported elsewhere [4]. Patients had other measurements made, including physical activity using wrist actigraphy, before and after three months of CPAP therapy to investigate any possible mechanisms for changes in glycaemia and insulin resistance that might have occurred. We reported overall activity data in this previous paper, having analysed the most active 10 h (M10, representing wakefulness) and the least active 5 h (L5, representing sleep) per day over a 7 day period. These activity measures were highly variable, and changes after CPAP in those receiving therapeutic CPAP were not statistically significant. We hypothesized that M10 and L5 may not have been sensitive to changes in activity, and we therefore have performed a more detailed analysis of the actigraphy to determine whether an hour-by-hour breakdown of the 24 h cycle was more sensitive to detect changes in activity following CPAP. We present these results here.

Section snippets

Methods

Eligible patients were men aged between 18 and 75, with established type 2 diabetes. They had excessive daytime sleepiness (Epworth Sleepiness Score (ESS)  9) and a diagnosis of OSA (established from overnight laboratory sleep studies [VisiLab, Stowood Scientific Instruments, Oxford, UK]), with ten or more per hour oxygen saturation dips of equal to or greater than 4%. Participants were seen for a baseline study visit ten days prior to commencing CPAP and were asked not to deliberately change

Results

Thirty-six men completed one week of continuous actigraphy before and after therapeutic CPAP (n = 16) or placebo CPAP (n = 20). The two groups were well-matched at baseline, with no significant differences in mean age, body mass index, ESS and SaO2 dips/hour (Table 1). Mean (SD) CPAP use on the nights used was 3.8 (2.8) hours in the therapeutic group and 3.7 (2.9) hours in the placebo group (difference between groups p = 1.0). Mean ESS and modified maintenance of wakefulness test (OSLER) [7], [8]

Discussion

The reasons for this lack of improvement in activity levels are not clear. Patients with symptomatic OSA may have adapted their lifestyle to cope with their daytime sleepiness and may find it difficult to change this after their symptoms improve with CPAP therapy. This group of patients had type 2 diabetes as well as OSA, two conditions with a strong causative relationship with obesity, confirmed in the mean body mass index (36.8 kg/m2). It may be that activity in these patients is limited by

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