Lowering Risk of Obstructive Sleep Apnea Prevention Is Possible, But More Work Is Needed

The research is in: people who live sedentary lifestyles face a higher risk of obstructive sleep apnea (OSA). However, getting the research from “the bench to the clinic” in a meaningful way can be unusually challenging in this increasingly central corner of sleep medicine.

At least two issues are at play. First, the remedy for the risk factor is exercise and an active lifestyle, something patients who do not lead active lifestyles are all too used to hearing from their doctors. The second problem, though, is that most of the research has focused on risk factors and on treating patients who already have OSA, rather than on preventing the condition before it develops.

Tianyi Huang, ScD, MSc, said it is clear exercise has a number of health benefits, including improving inflammation and reducing obesity. However, Huang told Managed Healthcare Executive that there are also some specific mechanisms by which exercise can help OSA.

“For example, an active lifestyle during the day helps reduce excessive body fluid retention in the lower body,” said Huang, an assistant professor and associate epidemiologist at Brigham and Women’s Hospital and Harvard Medical School. “At night, when people lie down to sleep, these excessive body fluids in the lower body can flow back to the upper part of the body, pressure the lung to reduce its volume and cause sleep apnea.”

Huang and colleagues recently investigated links between exercise, a sedentary lifestyle, and OSA risk. The results, published in the European Respiratory Journal, were based on more than 138,000 people who were tracked for between 10 and 18 years. About 8,700 of the patients were eventually diagnosed with OSA.

Huang and his co-authors found that people who did exercise equivalent to 3 hours of running each week had a 54% lower risk of OSA compared to people who did activities equivalent to 2 hours of walking per week.

Similarly, people who sat and watched TV for more than 4 hours per day had a 78% higher risk than those in the least sedentary category of people in the study. Those who sat for long periods of time for work had a 49% higher risk than the least sedentary group.

The good news is that all of these risk factors are modifiable. People have the power to reduce their OSA risk by becoming more active, the authors found. Huang noted that while obesity is a risk factor for OSA, even people who are not obese can benefit from increasing their activity.

“[W]e found more physical activity and less sedentary behavior are also associated with lower OSA risk even among normal-weight individuals,” Huang said.

However, recommendations for more physical activity are already a standard part of primary care for patients with sedentary lifestyles or obesity. Huang said physicians need to be on the lookout for patients who specifically are at risk for OSA.

“Clinicians should be aware of this evidence and recommend exercise-based interventions to those at risk of OSA (e.g., heavy snorers),” Huang said.

In fact, other research has suggested that even if a patient develops OSA, increasing physical activity can lower the severity of OSA and improve related symptoms.

Though physicians already have evidence to help them lower OSA risk, Huang said more should be done. While OSA has garnered significant attention from the research community, the research is usually focused on risk factors or treatment.

“I think there is not sufficient focus on prevention of OSA, either in clinical practice or in research,” Huang said. “This is in contrast to other chronic diseases, for which large efforts have been put to identify modifiable risk factors for effective prevention strategies.”

Huang said ultimately OSA prevention warrants a greater share of attention, both from researchers and from the general healthcare community.