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Association of physical activity with sleep-disordered breathing

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Abstract

This study was performed to determine whether there is a protective association between participation in vigorous or vigorous/moderately vigorous physical activity and the prevalence of sleep-disordered breathing (SDB). Polysomnographic and questionnaire data from the baseline examination of 4,275 participants in the Sleep Heart Health Study (SHHS) were analyzed in relation to information on amount of physical activity and other potentially relevant factors collected from five SHHS parent cohorts (Atherosclerosis Risk in Communities Study, Cardiovascular Health Study, Framingham Heart Study, Strong Heart Study, and Tucson Epidemiologic Study of Airways Obstructive Diseases). Logistic regression models were fitted to determine if amount and strenuousness of physical activity was associated with the presence of SDB. At least 3 h per week of vigorous physical activity reduced the odds of SDB, defined as a respiratory disturbance index (RDI) of at least 15 apneas/hypopneas per hour (Adjusted OR, 0.68; 95%CI, 0.51–0.91). A qualitatively similar but slightly weaker association was observed when SDB was defined as a RDI ≥ 10 per hour (Adjusted OR, 0.81; 95%CI, 0.64–1.02). These findings remained after adjustment for sleepiness and restricting analyses to participants with good health. Three or more hours of moderately vigorous or vigorous physical activity also appeared to confer some protection against SDB, but these associations were weaker. Gender- and obesity-stratified analyses suggested that the protective association between physical activity and SDB occurred primarily in men and those who were obese. A program of regular vigorous physical activity of at least 3 h per week may be a useful adjunctive treatment modality for SDB, but this association needs confirmation with a prospective clinical trial.

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Acknowledgments

This work was supported by National Heart, Lung, and Blood Institute cooperative agreements U01HL53940 (University of Washington), U01HL53941 (Boston University), U01HL53938 (University of Arizona), U01HL53916 (University of California, Davis), U01HL53934 (University of Minnesota), U01HL53931 (New York University), U01HL53937 and U01HL64360 (Johns Hopkins University), U01HL63463 (Case Western Reserve University), and U01HL63429 (Missouri Breaks Research).

SHHS acknowledges the ARIC, the CHS, the FHS, the Cornell/Mt. Sinai Worksite and Hypertension Studies, the SHS, the TESOAD, and the Tucson Health and Environment Study for allowing their cohort members to be part of the SHHS and for permitting data acquired by them to be used in the study. SHHS is particularly grateful to the members of these cohorts who agreed to participate in SHHS as well. SHHS further recognizes all of the investigators and staff who have contributed to its success. A list of SHHS investigators, staff, and their participating institutions is available on the SHHS website, http://www.jhucct.com/shhs.

The opinions expressed in the paper are those of the authors and do not necessarily reflect the views of the Indian Health Service.

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Correspondence to Stuart F. Quan.

Appendix

Appendix

Atherosclerosis Risk in Communities Study (ARIC). For ARIC participants, the following questions were asked during their clinic visit.

  1. 1.

    Do you exercise or play sports?Possible responses: Yes or No

  2. 2.

    Which sport or exercise do you do most frequently?Possible response: Open ended

  3. 3.

    How many hours a week do you do this activity?Possible responses: Less than 1; At least 1 but not quite 2; At least 2 but not quite 3; At least 3 but not quite 4; 4 or more

  4. 4.

    How many months a year do you do this activity?Possible responses: Less than 1; At least 1 but not quite 4; At least 4 but not quite 7; At least 7 but not quite 10; 10 or more

  5. 5.

    Do you do other exercises or play other sports?Possible responses: Yes or No

  6. 6.

    What is your second most frequent sports or exercise?Possible response: Open ended

  7. 7.

    How many hours a week do you do this activity?Possible responses: Less than 1; At least 1 but not quite 2; At least 2 but not quite 3; At least 3 but not quite 4; 4 or more

  8. 8.

    How many months a year do you do this activity?Less than 1; At least 1 but not quite 4; At least 4 but not quite 7; At least 7 but not quite 10; 10 or more

  9. 9.

    Do you do other exercises or play other sports?Possible responses: Yes or No

  10. 10.

    What is your third most frequent sports or exercise?Possible response: Open ended

  11. 11.

    How many hours a week do you do this activity?Possible responses: Less than 1; At least 1 but not quite 2; At least 2 but not quite 3; At least 3 but not quite 4; 4 or more

  12. 12.

    How many months a year do you do this activity?Possible responses: Less than 1; At least 1 but not quite 4; At least 4 but not quite 7; At least 7 but not quite 10; 10 or more

  13. 13.

    Do you do other exercises or play other sports?Possible responses: Yes or No

  14. 14.

    What is your fourth most frequent sports or exercise?Possible response: Open ended

  15. 15.

    How many hours a week do you do this activity?Possible responses: Less than 1; At least 1 but not quite 2; At least 2 but not quite 3; At least 3 but not quite 4; 4 or more

  16. 16.

    How many months a year do you do this activity?Possible responses: Less than 1; At least 1 but not quite 4; At least 4 but not quite 7; At least 7 but not quite 10; 10 or more

Cardiovascular Health Study (CHS). During their clinic visit, CHS participants were instructed to do the following: “I am going to read a list of activities. Please tell me which activities you have done in the past two weeks: walking for exercise; moderately strenuous household chores, for example, scrubbing or vacuuming; mowing the lawn; raking the lawn; gardening; hiking; jogging; biking; exercise cycle; dancing; aerobics/aerobic dance; bowling; golf; calisthenics/general exercise; swimming.” They also were asked “Have you done any other physical activities during the past two weeks in addition to those listed above?” Participants were allowed to answer “no”, “yes”, “refuse to answer”. Those who answered “yes” to any of the physical activities listed or volunteered another unlisted physical activity were asked the following questions.

  1. 1.

    How often have you {name of activity} in the last two weeks?

  2. 2.

    What is the average amount of time that you spent per session?

  3. 3.

    How many months per year do you {name of activity}?

Strong Heart Study (SHS). SHS participants completed a questionnaire, which asked for the following information.

  1. 1.

    List all activities done over the past year along with the average amount of time spent in each activity:

  2. 2.

    Possible responses: Participants were allowed to list 10 activities from the following list: Running for exercise, Swimming, Bicycling, Softball/Baseball, Volleyball, Bowling Basketball, Skating (roller or ice), Football/Soccer, Racquetball/Handball, Horseback riding, Hunting, Fishing, Non-Indian Dancing, Gardening or Yardwork, Weight lifting, Calisthenics, Walking for exercise, Hiking through Mountains, Rodeo, Tennis, Golf, Canoeing, Indian Dancing and Other. For each activity, the following information was requested: # months, # times/week, # weeks/month, # h/time.

Tucson Epidemiologic Study of Obstructive Airways Disease (TESOAD). TESOAD participants completed a questionnaire on which they were asked “On a usual weekday and a weekend day, how much time do you spend on the following activities?”

  1. 1.

    Vigorous activity (digging in the garden, strenuous sports, jogging, chopping wood, sustained swimming, brisk walking, heavy carpentry, bicycling on hills, etc.)Possible response: # h per day

  2. 2.

    Moderate activity (housework, light sports, regular walking, golf, yard work, lawn mowing, painting, light carpentry, dancing, bicycling on level ground, etc.)Possible response: # h per day

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Quan, S.F., O’Connor, G.T., Quan, J.S. et al. Association of physical activity with sleep-disordered breathing. Sleep Breath 11, 149–157 (2007). https://doi.org/10.1007/s11325-006-0095-5

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