d’apnées du sommeil et le syndrome...

Effet de la rehabilitation sur le syndrome

d’apnées du sommeil et le syndrome métabolique

Samuel VERGES, PhD

Hypoxia Physiopathology Laboratory (HP2), U1042Grenoble Alpes University & INSERM, Grenoble, France

Aucun conflit d’intérêt à déclarer

Obstructive and central sleep apnea syndromes

Somers et al. JACC 2008 Bradley & Floras Circulation 2003

Obstructive and central sleep apnea syndromes

Pépin et al. Thorax 2012

Obstructive sleep apnea and mortality

Marin et al. Lancet 2005

Somers et al. JACC 2008

McEvoy et al. N Eng J Med 2016

Continuous positive airway pressure

15% of patients refuse CPAP and 35% not adherent at 1 year (France, CNAM 2016)

Sleep apnea: Alternative treatment options ?

Obstructive sleep apnea and fitness level

Meta-analysis : Peak Oxygen Consumption (VO2peak) in patients with sleep apnea

Mendelson et al. In preparation

Without Heart failure

With Heart failure

Obstructive sleep apnea and fitness level

Meta-analysis : Peak Oxygen Consumption (VO2peak) in patients with sleep apnea

Mendelson et al. In preparation

BMI ≤30 kg.m-2

BMI >30 kg.m-2

Objectively measured physical activity in OSA patients

Meta-analysis : OSA patients present low levels of physical activity

Mendelson et al. Submitted

Modifying physical activity behaviors in sleep apnea patients


Standardized meandifference in steps per day

(95% CI)

Meta-analysis of randomized controlled trials: CPAP alone has little to no effect on physical activity levels

in patients with sleep apnea

Focus on exercise training

Randomized Controlled Trial

43 sedentary overweight/obese OSA patients (18-55 yrs)

Moderate intensity aerobic and resistance exercise training (4 sessions/week, 12 weeks EX) versuscontrol (stretching, STR)

Kline et al. Sleep 2011

Exercise training in patients with OSA

Improvement in sleep quality

No change in spontaneous physical activity

No change in body mass index

No change in respiratory muscle strength

**

Exercise group:

-7.6 ± 2.5 events/h

Apnea-Hypopnea Index

N = 138

Total random effect:

- 0.05

Body mass index

Aiello et al. Respir Med 2016

N = 184

Total random effect:

- 0.54

Exercise training in patients with OSA

Systematic review and meta-analysis

Effects of exercise training in patients with OSA


Meta-analysis of randomized controlled trials: Change in Apnea-Hypopnea index after exercise training programs



Meta-analysis of randomized controlled trials: Change in Epworth score after exercise training programs



A 3.5 mL/kg/min increase in VO2peak is associated with 13 and 15% decrements in risk of all cause mortality and coronary artery diseases (Kokkinos et al. 2009)

Meta-analysis of randomized controlled trials: Change in peak oxygen consumption (VO2peak) after exercise training



Meta-analysis of randomized controlled trials: Change in body mass index after exercise training programs



Meta-analysis of randomized controlled trials: Change in physical activity after exercise training programs

Iftikhar et al. Sleep Med 2017

Comparative efficacy of CPAP, mandibular advancement device (MAD), exercise training, and dietary weight loss for sleep apnea: a network meta-analysis

EpworthApnea-Hypopnea Index


Exercise training in patients with central sleep apnea and heart failure

Yamamoto et al. J Card Fail 2007 Ueno et al. Sleep 2009

Aerobic exercise training,

60 min/day, 3 times/week,

for 6 months

Aerobic exercise training,

30 min/day, 3 times/week,

for 4 months

Exercisetraining and sleep apnea

Reduction in AHI following exercise training is independent of weight loss

Alternative mechanism ?

White & Bradley, J Physiol, 2013

Sleep apnea and the rostral fluid shift

Redolfi et al. AJRCCM 2015

Influence of 45 min of walking twice a day for 1 week on fluid shift

Exercise training in SAS patients with coronary artery disease

Mendelson et al. ERJ 2016

0

5

10

15

20

25

30

35

Exercise Control

VO

2p

eak

(mL/

kg/m

in)

P=0.03 P=0.32

P=0.31

75

80

85

90

95

100

105

110

Exercise Control

Bo

dy

we

igh

t (k

g)

P=0.81 P=0.71

P=0.59

Unblinded randomised controlled trial

34 coronary artery disease patients with

sleep apnea syndrome (17 exercise

training group versus 17 control group)

30 min moderate intensity walking, 5

sessions/week, during 4 weeks

Exercise training in SAS patients with coronary artery disease

4000

4200

4400

4600

4800

5000

5200

Exercise Control

Eve

nin

g L

eg

Flu

id V

olu

me

(m

L)

P=0.003 P=0.41

P=0.042

-800

-700

-600

-500

-400

-300

-200

-100

0

Exercise Control

Ove

rnig

ht

Le

g F

luid

Vo

lum

e (

mL

)

P=0.02 P=0.46

P=0.023

Mendelson et al. ERJ 2016

Increased cardiometabolic riskMyocardial damage

Pépin et al. Thorax 2012

Exercise training for the management of sleep apnea

Take home message

Exercise training programs induce a (modest) but significant

reduction in the severity of sleep apnea.

Besides the improvement in sleep apnea severity, exercise has the

potential to influence a number of cardiovascular and metabolic risk

factors.

Exercise training should be part of a multicomponent and

individualized management of sleep apnea syndrome and should be

encouraged in patients with sleep apnea and cardiovascular and

metabolic diseases.

Grenoble

Thank you for your attention

Patrick Levy

Jean-Louis Pépin

Renaud Tamisier

Stéphane Doutreleau

Bernard Wuyam

Patrice Flore

Monique Mendelson

Sébastien Baillieul

Guillaume Millet

Anna Borowik

Samarmar Chacaroun

Mathieu Marillier

Instabilitéducontrôlerespiratoire Obésité Dysfonc ondesVAS

Apnéedusommeil

ìac vitésympathique

Dysrégula onmétabolique

Inflamma onStressoxyda f

Dysfonc onendothéliale

Hypoxieintermi ente

Fibrilla onauriculaireHypertensionMaladiescardiaques

PhaseterminaleMaladiescardiovasculaires

Javaheri et al. JACC 2017

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