Interaction Between Physical Performance and Health Metrics in Patients with Obstructive Sleep Apnea Syndrome

Abstract

Purpose: The study aimed to investigate the potential correlation between physical performance and health metrics in patients with obstructive sleep apnea syndrome (OSA), while also comparing variations in health metrics (such as obesity, hypoxia, quality of life, etc.) and physical performance across different severities of OSA. Material and Methods: Eighty-four participants undergoing polysomnography with the suspected presence of OSAS were included. Participants completed the Epworth Sleepiness Scale (ESS), 36-Item Short Form (SF-36), Hospital Anxiety-Depression Scale (HADS) questionnaires. Physical performance was assessed using the 30-Second Sit-to-Stand Test (30CST). Participants were categorized into two groups to compare health metrics based on the severity of OSA. Results: Body mass index, neck circumference, ESS scores, hypoxia levels, emotional well-being, and energy levels of SF-36, differed statistically according to the severity of OSA. While there was no correlation between 30CST scores and social functioning (r=.125, p=.290), all other SF-36 subheadings and 30CST were significantly correlated (p<.05). 30CST variance is predicted significantly by SF-36 (p˂.001), HADS (p˂.001), ESS (p˂.001), obesity (p=.001), and hypoxia (p=.011). Conclusion: These results indicate that the physical performance of patients with OSA is correlated with health metrics, including quality of life, daytime sleepiness, anxiety-depression, hypoxia, and obesity, irrespective of the severity of apnea-hypopnea.

Keywords

• Apnea
• Quality of Life
• Depression
• Obesity
• Physical Performance

References

1. Jonas DE, Amick HR, Feltner C, Weber RP, Arvanitis M, Stine A, et al. Screening for obstructive sleep apnea in adults: evidence report and systematic review for the US Preventive Services Task Force. Jama 2017;317:415-33.
2. Korson R, Guilleminault C. Obstructive sleep apnea syndrome. Sleep Disorders Medicine: Springer; 2017. p. 567-96.
3. Senaratna CV, Perret JL, Lodge CJ, Lowe AJ, Campbell BE, Matheson MC, et al. Prevalence of obstructive sleep apnea in the general population: a systematic review. Sleep Medicine Reviews 2017;34:70-81.
4. Cancino V, Rivera E. Symptoms during sleep among patients with obstructive sleep apnea. Revista Medica de Chile 2018;146:470-8.
5. Addison-Brown KJ, Letter AJ, Yaggi K, McClure LA, Unverzagt FW, Howard VJ, et al. Age differences in the association of obstructive sleep apnea risk with cognition and quality of life. Journal of Sleep Research 2014;23:69-76.
6. Lee W, Lee SA, Ryu HU, Chung YS, Kim WS. Quality of life in patients with obstructive sleep apnea: Relationship with daytime sleepiness, sleep quality, depression, and apnea severity. Chronic respiratory Disease 2016;13:33-9.
7. Stevens D, Jackson B, Carberry J, McLoughlin J, Barr C, Mukherjee S, et al. The impact of obstructive sleep apnea on balance, gait, and falls risk: a narrative review of the literature. The Journals of Gerontology: Series A 2020;75:2450-60.
8. Demir T, Aslan K, Demirkiran M. Evaluation of postural balance in patients with obstructive sleep apnoea syndrome. Neurologia Neurochirurgia Polska 2020;54:83-9.

9. Gokmen GY, Gurses HN, Zeren M, Ozyilmaz S, Kansu A, Akkoyunlu ME. Postural stability and fall risk in patients with obstructive sleep apnea: a cross-sectional study. Sleep and Breathing. 2021:1-7.
10. Saad HB, Hassen IB, Ghannouchi I, Latiri I, Rouatbi S, Escourrou P, et al. 6-Min walk-test data in severe obstructive-sleep-apnea-hypopnea-syndrome (OSAHS) under continuous-positive-airway-pressure (CPAP) treatment. Respiratory Medicine 2015;109:642-55.
11. Edwards MK, Loprinzi PD. Experimentally increasing sedentary behavior results in decreased sleep quality among young adults. Mental Health and Physical Activity 2017;12:132-40.
12. Kayabasi S, Iriz A, Cayonu M, Cengiz B, Acar A, Boynuegri S, et al. Vestibular functions were found to be impaired in patients with moderate‐to‐severe obstructive sleep apnea. The Laryngoscope 2015;125:1244-8.
13. Arnaud C, Bochaton T, Pépin J-L, Belaidi E. Obstructive sleep apnoea and cardiovascular consequences: pathophysiological mechanisms. Archives of cardiovascular diseases. 2020;113:350-8.
14. Emsellem HA, Murtagh KE. Sleep apnea and sports performance. Clinics in Sports medicine 2005;24:329-41.
15. Pływaczewski R, Stokłosa A, Bieleń P, Bednarek M, Czerniawska J, Jonczak L, et al. Six-minute walk test in obstructive sleep apnoea. Advances in Respiratory Medicine 2008;76:75-82.
16. Lee P-F, Ho C-C, Yeh D-P, Hung C-T, Chang Y-C, Liu C-C, et al. Cross-sectional associations of physical fitness performance level and sleep duration among older adults: Results from the national physical fitness survey in Taiwan. International Journal of Environmental Research and Public Health 2020;17:388.
17. Lord SR, Murray SM, Chapman K, Munro B, Tiedemann A. Sit-to-Stand Performance Depends on Sensation, Speed, Balance, and Psychological Status in Addition to Strength in Older People. The Journals of Gerontology: Series A 2002;57:M539-M43.
18. McDonald O, Perraton L, Osadnik C. Validity and clinical applicability of the 60-second sit-to-stand test in people with acute exacerbations of COPD. Respiratory Medicine 2023:107264.
19. Peterka RJ, Loughlin PJ. Dynamic regulation of sensorimotor integration in human postural control. Journal of nNeurophysiology 2004;91:410-23.
20. Byun H, Chung JH, Jeong JH, Ryu J, Lee SH. Incidence of peripheral vestibular disorders in individuals with obstructive sleep apnea. Journal of Vestibular Research 2021:1-8.
21. Gallina S, Dispenza F, Kulamarva G, Riggio F, Speciale R. Obstructive sleep apnoea syndrome (OSAS): effects on the vestibular system. Acta otorhinolaryngologica Itálica 2010;30.
22. Leger D, Stepnowsky C. The economic and societal burden of excessive daytime sleepiness in patients with obstructive sleep apnea. Sleep Medicine Reviews 2020;51:101275.
23. Vijayan VK. Morbidities associated with obstructive sleep apnea. Expert Review of Respiratory Medicine 2012;6:557-66.
24. Bailes S, Libman E, Baltzan M, Grad R, Kassissia I, Creti L, et al. Fatigue: The forgotten symptom of sleep apnea. Journal of Psychosomatic Research 2011;70:346-54.
25. Mutlu M, Bayır Ö, Yüceege MB, Karagöz T, Fırat H, Özdek A, et al. Vestibular evoked myogenic potential responses in obstructive sleep apnea syndrome. European Archives of Oto-Rhino-Laryngology 2015;272:3137-41.
26. Sforza E, Roche F. Chronic intermittent hypoxia and obstructive sleep apnea: an experimental and clinical approach. Hypoxia 2016:99-108.
27. Callow DD, Zipunnikov V, Spira AP, Wanigatunga SK, Pettigrew C, Albert M, et al. Actigraphy estimated sleep moderates the relationship between physical activity and cognition in older adults. Mental Health and Physical Activity 2024;26:100573.
28. Pae E. Chien P, and Harper RM. Intermittent hypoxia damages cerebellar cortex and deep nuclei Neurosci Lett. 2005;375:123-8.
29. Macey P. Henderson LA, Macey KE, Alger JR, Frysinger RC, Woo MA. Harper RK, Yan-Go FL, and Harper RM Brain morphology associated with obstructive sleep apnea Am J Respir Crit Care Med 2002;166:1382-7.
30. Stansbury RC, Strollo PJ. Clinical manifestations of sleep apnea. Journal of Thoracic Disease 2015;7:E298.
31. Carter III R, Watenpaugh DE. Obesity and obstructive sleep apnea: or is it OSA and obesity? Pathophysiology 2008;15:71-7.
32. Pamidi S, Knutson KL, Ghods F, Mokhlesi B. Depressive symptoms and obesity as predictors of sleepiness and quality of life in patients with REM-related obstructive sleep apnea: cross-sectional analysis of a large clinical population. Sleep Medicine 2011;12:827-31.
33. Micarelli A, Liguori C, Viziano A, Izzi F, Placidi F, Alessandrini M. Integrating postural and vestibular dimensions to depict impairment in moderate‐to‐severe obstructive sleep apnea syndrome patients. Journal of sleep research. 2017;26:487-94.
34. Lee S-A, Yoon H, Kim H-W. Is severe obstructive sleep apnea associated with less depressive symptoms? Journal of Psychosomatic Research 2019;122:6-12.
35. Asghari A, Mohammadi F, Kamrava SK, Tavakoli S, Farhadi M. Severity of depression and anxiety in obstructive sleep apnea syndrome. Eur Arch of Otorhinolaryngol 2012;269:2549-53.
36. Ye L. Factors influencing daytime sleepiness in Chinese patients with obstructive sleep apnea. Behavioral Sleep Medicine 2011;9:117-27.
37. Lee S-A, Han S-H, Ryu HU. Anxiety and its relationship to quality of life independent of depression in patients with obstructive sleep apnea. Journal of Psychosomatic Research. 2015;79:32-6.
38. Kawahara S, Akashiba T, Akahoshi T, HORIE T. Nasal CPAP improves the quality of life and lessens the depressive symptoms in patients with obstructive sleep apnea syndrome. Internal Medicin. 2005;44:422-7.
39. Schröder CM, O'Hara R. Depression and obstructive sleep apnea (OSA). Annals of General Psychiatry 2005;4:13.
40. Yosunkaya S, Kutlu R, Cihan FG. Evaluation of depression and quality of life in patients with obstructive sleep apnea syndrome. Nigerian Journal of Clinical Practice 2016;19:573-9.
41. Bjornsdottir E, Keenan BT, Eysteinsdottir B, Arnardottir ES, Janson C, Gislason T, et al. Quality of life among untreated sleep apnea patients compared with the general population and changes after treatment with positive airway pressure. Journal of Sleep Research 2015;24:328-38.
42. Huang W, Rangabashyam M, Hao Y, Liu J, Toh ST. Quality of Life in Obstructive Sleep Apnoea: A Role for Oxygen Desaturation Indices? Ann Aca of Med Singap 2016;45:404-12.
43. Kang JM, Kang SG, Cho SJ, Lee YJ, Lee HJ, Kim JE, et al. The quality of life of suspected obstructive sleep apnea patients is related to their subjective sleep quality rather than the apnea-hypopnea index. Sleep Breath 2017;21:369-75.
44. Asghari A, Mohammadi F, Kamrava SK, Jalessi M, Farhadi M. Evaluation of quality of life in patients with obstructive sleep apnea. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery 2013;270:1131-6.
45. Appleton SL, Vakulin A, McEvoy RD, Vincent A, Martin SA, Grant JF, et al. Undiagnosed obstructive sleep apnea is independently associated with reductions in quality of life in middle-aged, but not elderly men of a population cohort. Sleep Breath 2015;19:1309-16.
46. Baldwin CM, Ervin A-M, Mays MZ, Robbins J, Shafazand S, Walsleben J, et al. Sleep disturbances, quality of life, and ethnicity: the Sleep Heart Health Study. Journal of Clinical Sleep Medicine 2010;6:176-83.
47. Tasbakan MS, Gunduz C, Pirildar S, Basoglu OK. Quality of life in obstructive sleep apnea is related to female gender and comorbid insomnia. Sleep Breath 2018;22:1013-20.
48. Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM manual for the scoring of sleep and associated events: deliberations of the sleep apnea definitions task force of the American Academy of Sleep Medicine. Journal of Clinical Sleep Medicine 2012;8:597-619.
49. Izci B, Ardic S, Firat H, Sahin A, Altinors M, Karacan I. Reliability and validity studies of the Turkish version of the Epworth Sleepiness Scale. Sleep Breath 2008;12:161-8.
50. Roure N, Gomez S, Mediano O, Duran J, de la Peña M, Capote F, et al. Daytime sleepiness and polysomnography in obstructive sleep apnea patients. Sleep Medicine 2008;9:727-31.
51. Bohannon RW. Sit-to-stand test for measuring performance of lower extremity muscles. Perceptual and motor skills. 1995;80:163-6.
52. Fujimoto M, Chou L-S. Dynamic balance control during sit-to-stand movement: an examination with the center of mass acceleration. Journal of Biomechanics 2012;45:543-8.
53. Helbostad JL, Sturnieks DL, Menant J, Delbaere K, Lord SR, Pijnappels M. Consequences of lower extremity and trunk muscle fatigue on balance and functional tasks in older people: a systematic literature review. BMC Geriatrics 2010;10:1-8.
54. Pinar R. Reliability and construct validity of the SF-36 in Turkish cancer patients. Quality of Life Research 2005;14:259-64.
55. Aydemir O. Validity and Reliability of Turkish Version of Hospital Anxiety and Depression Scale. Turkish Journal of Psychiatry 1997;8:280-7.
56. Lee SA, Han SH, Ryu HU. Anxiety and its relationship to quality of life independent of depression in patients with obstructive sleep apnea. J Psychosom Res 2015;79:32-6.
57. Garbarino S, Bardwell WA, Guglielmi O, Chiorri C, Bonanni E, Magnavita N. Association of anxiety and depression in obstructive sleep apnea patients: a systematic review and meta-analysis. Behavioral sleep medicine. 2020;18:35-57.
58. Zouhal H, Ben Abderrahman A, Khodamoradi A, Saeidi A, Jayavel A, Hackney AC, et al. Effects of physical training on anthropometrics, physical and physiological capacities in individuals with obesity: A systematic review. Obesity Reviews 2020;21:e13039.