Abstract
The objectives of this study are to describe physical activity (PA) and sedentary time (ST) in adults with the sleep apnea/hypopnea syndrome (SAHS) in Puerto Rico, to explore possible sex-based differences, and to evaluate the link between PA, ST, anthropometric characteristics and pulmonary function. Fifteen adults (10 M and 5 F, with average age 44.3 9.4 years) with an SAHS diagnosis completed the measurements of height, weight and spirometry, and used an accelerometer for 7 days in order to assess PA and ST. The Wilcoxon test was used for identifying sex-based differences, and Spearman correlation tests were carried out in order to evaluate the association between PA, ST and anthropometric and lung function characteristics. The results indicate that the average of moderate to vigorous PA (MVPA) was 276.8 196.3 min/week, ST was 8.8 1.3 hrs/day, IMC was 34.7 5.9 kg/m2, waist circumference (WC) was 109.5 15.8 cm, and the percentage of prediction of forced exhalation volume in one second related to forced vital capacity (%FEV1/FVC) was 107.4 7.8%. No sex-based differences were observed, nor significant correlations between MVPA and IMC (ρ = -0.39, p = 0.15), MVPA and WC (ρ = -0.12, p = .07), ST and IMC (ρ = 0.05, p = .86) or ST and WC (ρ = -0.03, p = .92). The MVPA was correlated to %FEV1/FVC (ρ = 0.60, p = .02). The conclusion is that, even though MVPA was within the recommended minimum, obesity and ST were concerning characteristics in participants. In addition, the results suggest that those with higher MVPA have a better pulmonary function.
References
Andrade, F. M. D., y Pedrosa, R. P. (2016). The role of physical exercise in obstructive sleep apnea. Jornal Brasileiro De Pneumologia, 42(6), 457-464. https://doi.org/10.1590/s1806-37562016000000156
Banda, J. A., Haydel, K. F., Dávila, T., Desai, M., Bryson, S., Haskell, W. L., Matheson, D., y Robinson, T. N. (2016). Effects of Varying Epoch Lengths, Wear Time Algorithms, and Activity Cut-Points on Estimates of Child Sedentary Behavior and Physical Activity from Accelerometer Data. PLOS ONE, 11(3), e0150534. https://doi.org/10.1371/journal.pone.0150534
Bull, F. C., Al-ansari, S. S., Borodulin, K., Buman, M. P., Cardon, G., Carty, C., Chaput, J.-P. Chastin, S., Chou, R., Dempsey, P.C., DiPietro, L., Ekelund, U., Firth, J., Friedenreich, C.M., Garcia, L., Gichu, M., Jago, R., Katzmarzyk, P.T., Lambert. E., … y Willumsen J. F. (2020). World Health Organization 2020 guidelines on physical activity and sedentary behavior. British journal of sports medicine, 54(24), 1451-1462. https://doi.org/10.1136/bjsports-2020-102955
Dicker, R. C., Coronado, F., Koo, D., y Parrish, R.G. (2006). Principles of epidemiology in public health practice; an introduction to applied epidemiology and biostatistics (3rd ed.). https://stacks.cdc.gov/view/cdc/6914
Dobrosielski, D. A., Patil, S., Schwartz, A. R., Bandeen-Roche, K., y Stewart, K. J. (2015). Effects of Exercise and Weight Loss in Older Adults with Obstructive Sleep Apnea. Medicine and Science in Sports and Exercise, 47(1), 20-26. http://doi.org/10.1249/MSS.0000000000000387
Ekelund, U., Tarp, J., Steene-Johannessen, J., Hansen, B. H., Jefferis, B., Fagerland, M. W., Whincup, P., Diaz, K. M., Hooker, S. P., Chernofsky, A., Larson, M. G., Spartano, N. , Vasan, R. S., Dohrn, I., Hagströmer, M., Edwardson, C., Yates, T., Shiroma, E., Anderssen, S. A., y Lee, I.-M. (2019). Dose-response associations between accelerometry measured physical activity and sedentary time and all-cause mortality: systematic review and harmonised meta-analysis. BMJ, (366), l4570. https://doi.org/10.1136/bmj.l4570
Ekelund, U., Steene-Johannessen, J., Brown, W. J., Fagerland, M. W., Owen, N., Powell, K. E., Bauman, A., y Lee, I-M. (2016). Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonized meta-analysis of data from more than 1 million men and women. The Lancet, 388 (10051), 1302-1310. https://doi.org/10.1016/s0140-6736(16)30370-1
Epstein, L.J., Kristo, D., Strollo, P.J., Friedman, N., Malhotra, A., Patil, S.P., Ramar, K., Rogers, R., Schwab, R. J., Weaver, E.M., y Weinstein, M.D. (2009). Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. Journal of Clinical Sleep Medicine, 5(3), 263-276. https://doi.org/10.5664/jcsm.27497
Gunta, S. P., Jakulla, R. S., Ubaid, A., Mohamed, K., Bhat, A., López-Candales, A., y Norgard, N. B. (2022). Obstructive Sleep Apnea and Cardiovascular Diseases: Sad Realities and Untold Truths regarding Care of Patients in 2022. Cardiovascular Therapeutics, 2022 (1), 6006127. https://doi.org/10.1155/2022/6006127
Heyward, V. H. (2014). Evaluación avanzada de la aptitud y prescripción de ejercicio. Editorial Médica Panamericana S.A.
Hidalgo-Martínez, P., y Lobelo, R. (2017). Epidemiología mundial, latinoamericana y colombiana y mortalidad del síndrome de apnea-hipopnea obstructiva del sueño (SAHOS). Revista De La Facultad De Medicina, 65(1Sup), 17-20. https://doi.org/10.15446/revfacmed.v65n1sup.59565
Hoffstein, V., y Oliver, Z. (2003). Pulmonary function and sleep apnea. Sleep and Breathing, 7, 159-165. https://doi.org/10.1007/s11325-003-0159-8
Igelstrom, H., Emtner, M., Lindberg, E., y ésenl-f, P. (2013a). Nivel de acuerdo entre los métodos para medir la actividad física moderada a vigorosa y el tiempo sedentario en personas con apnea obstructiva del sueño y obesidad. Terapia Física, 93(1), 50-59.
Igelstrom, H., Emtner, M., Lindberg, E., y ésenl-f, P. (2013b). La actividad física y el tiempo sedentario en personas con apnea obstructiva del sueño y sobrepeso se inscribieron en un ensayo controlado aleatorizado para mejorar la actividad física y una alimentación saludable. Sueño y respiración, 17(4), 1257-1266.
Kappes, M. S., y Riquelme, V. (2021). El valor P y medidas de efecto: su interpretación en investigación cuantitativa en enfermería. Ene, 15(2), 1247. http://ene-enfermeria.org/ojs/index.php/ENE/article/download/1247/valorp
Knaier, R., Höchsmann, C., Infanger, D., Hinrichs, T., y Schmidt‐Trucksäss, A. (2019). Validation of automatic wear-time detection algorithms in a free-living setting of wrist-worn and hip-worn ActiGraph GT3X+. BMC Public Health, 19(1). https://doi.org/10.1186/s12889-019-6568-9
Koster, A., Caserotti P., Patel, K. V., Matthews, C. E., Berrigan, D., Van Domele, D. R., Brychta, R. J., Chen, K. Y., y Harris, T. B. (2012). Association of Sadentary Time with Mortality Independent of Moderate to Vigorous Physical Activity. PLoS ONE, 7(6) e37696. https://doi.org/10.1371/journal.pone.0037696
Kraus, W.E., Janz, K.F., Powell, K.E., Campbell, W.W., Jakicic, J.M., Troiano, R.P., Kyle, S., Torres, A., y Piercy, K.L. (2019). Daily step counts for measuring physical activity exposure and its relation to health. Medicine & Science in Sports & Exercise, 51(6), 1206-1212. https://doi.org/10.1249/mss.0000000000001932
Marshall, M. N. (1996). Sampling for qualitative research. Family Practice,13(6), 522-526. https://doi.org/10.1093/fampra/13.6.522
Mayo Clinic. (2023). Sleep apnea - Symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/sleep-apnea/symptoms-causes/syc-20377631
MIR. (2023, 19 de septiembre). Understanding normal values in spirometry: what to expect during a lung function test. https://spirometry.com/en/news/understanding-normal-values-in-spirometry-what-to-expect-during-a-lung-function-test/
Murillo, R., Reid, K. J., Arredondo, E. M., Cai, J., Gellman, M. D., Gotman, N. M., Marquez, D.X., Penedo, F.J., Ramos, A.R., Zee, P.C., y Daviglus, M. L. (2016). Association of self-reported physical activity with obstructive sleep apnea: results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Preventive medicine, 93, 183-188. https://doi.org/10.1016/j.ypmed.2016.10.009
Oslen, J., Christensen, K., Murray, J., y Ekbom, A. (2010). An Introduction to Epidemiology for Health Professional. Springer. https://doi.org/10.1007/978-1-4419-1497-2
Paluch, A.E., Bajpai, S., Bassett, D.R., Carnethon, M.R., Ekelund, U., Evenson, K.R., Galuska, D.A., Jefferis, B.J., Kraus, W. E., Lee, I.-M., Matthews C. E., Omura, J. D. Patel, A.V., Pieper, C.F., Rees-Punia, E., Dallmeier, D., Klenk, J., Whincup, P.H., Dooley, E. E., y .... Fulton, J.E. (2022). Daily steps and all-cause mortality: a meta-analysis of 15 international cohorts. Lancet Public Health, 7(3), e219-e228. https://doi.org/10.1016/s2468-2667(21)00302-9
Ponce, M. C., Sankari, A., y Sharma, S. (2023). Pulmonary function tests. StatPearls - NCBI
Sengul, Y.S., Ozalevli, S., Oztura, I., Itil, O., y Baklan. B. (2011). The effect of exercise on obstructive sleep apnea: a randomized and controlled trial. Sleep Breath, 15, 49-56. https://doi.org/10.1007/s11325-009-0311-1
Summer, J. V., y Singh, A. (2022, October 13). Hypopnea. Sleep Foundation. https://www.sleepfoundation.org/sleep-apnea/hypopnea
Suni, E., y Singh, A. (2023, March 29). Sleep Apnea. Sleep Fundation. https://www.sleepfoundation.org/sleep-apnea
Tan, X., Titova, O. E., Lindberg, E., Elmståhl, S., Lind, L., Schiöth, H. B., y Benedict, C. (2019). Association between self-reported sleep duration and body composition in middle-aged and older adults. Journal of Clinical Sleep Medicine, 15(3), 431-435. https://doi.org/10.5664/jcsm.7668
Wientzek, A., Tormo Díaz, M. -J., Castaño, J. M. H., Amiano, P., Arriola, L., Overvad, K., Nautrup Østergaard, J., Charles, M.-A., Fagherazzi, G., Palli, D., Bendinelli, B., Skeie, G., Benjaminsen Borch, K., Wendel-Vos, W., de Hollander, E., May, A.M., EM den Ouden, M., Trichopoulou, A., Valanou, E., ... y Ekelund, U. (2014). Asociaciones‐transversales de actividad física objetivamente medida, aptitud cardiorrespiratoria y antropometría en adultos europeos. Obesidad, 22(5), E127-E134. https://doi.org/10.1002/oby.20530
World Health Organization: WHO. (2022). Physical activity. https://www.who.int/news-room/fact-sheets/detail/physical-activity
Xiao, Q., Keadle, S. K., Hollenbeck, A. R., y Matthews, C. E. (2014). Sleep duration and total and cause-specific mortality in a large US cohort: interrelationships with physical activity, sedentary behavior, and body mass index. American journal of epidemiology, 180(10), 997-1006. https://doi.org/10.1093/aje/kwu222
Zhao, M., Veeranki, S. P., Magnussen, C. G., y Xi, B. (2020). Recommended physical activity and all cause and cause specific mortality in US adults: prospective cohort study. BMJ, 370. https://doi.org/10.1136/bmj.m2031

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