Impact of CPAP on activity patterns and diet in patients with obstructive sleep apnea (OSA).

STUDY OBJECTIVES: Patients with severe OSA consume greater amounts of cholesterol, protein, and fat as well as have greater caloric expenditure. However, it is not known whether their activity levels or diet change after treatment with CPAP. To investigate this issue, serial assessments of activity and dietary intake were performed in the Apnea Positive Pressure Long-term Efficacy Study (APPLES); a 6-month randomized controlled study of CPAP vs. sham CPAP on neurocognitive outcomes. METHODS: Subjects were recruited into APPLES at 5 sites through clinic encounters or public advertisement. After undergoing a diagnostic polysomnogram, subjects were randomized to CPAP or sham if their AHI was ≥ 10. Adherence was assessed using data cards from the devices. At the Tucson and Walla Walla sites, subjects were asked to complete validated activity and food frequency questionnaires at baseline and their 4-month visit. RESULTS: Activity and diet data were available at baseline and after 4 months treatment with CPAP or sham in up to 231 subjects (117 CPAP, 114 Sham). Mean age, AHI, BMI, and Epworth Sleepiness Score (ESS) for this cohort were 55 ± 13 [SD] years, 44 ± 27 /h, 33 ± 7.8 kg/m(2), and 10 ± 4, respectively. The participants lacking activity and diet data were younger, had lower AHI and arousal index, and had better sleep efficiency (p < 0.05). The BMI was higher among women in both CPAP and Sham groups. However, compared to women, men had higher AHI only in the CPAP group (50 vs. 34). Similarly, the arousal index was higher among men in CPAP group. Level of adherence defined as hours of device usage per night at 4 months was significantly higher among men in CPAP group (4.0 ± 2.9 vs. 2.6 ± 2.6). No changes in consumption of total calories, protein, carbohydrate or fat were noted after 4 months. Except for a modest increase in recreational activity in women (268 ± 85 vs. 170 ± 47 calories, p < 0.05), there also were no changes in activity patterns. CONCLUSION: Except for a modest increase in recreational activity in women, OSA patients treated with CPAP do not substantially change their diet or physical activity habits after treatment. .

Effects of exercise and nutritional intake on sleep architecture in adolescents.

PURPOSE: Few studies have evaluated the relationship between sleep architecture and body mass index (BMI), nutrition, and physical activity in children. This study determined the relationship between sleep architecture and diet and exercise. METHODS: Three hundred nineteen Caucasian and Hispanic children aged 10 to 17 years participated in the follow-up assessment of the Tucson Children's Assessment of Sleep Apnea study. The children and parents completed several questionnaires on dietary habits, amount of physical activity, and sleep habits. Subjects also underwent a home polysomnogram to characterize their sleep. RESULTS: Significant bivariate correlations were noted between stage II sleep percentage and the following: BMI (r = 0.246, p < 0.01), estimated total recreational energy expenditure (r = 0.205, p < 0.01), vigorous activity (r = 0.130, p = 0.009), and total estimated activity (r = 0.148, p = 0.009). In girls, significant correlations were noted between stage II percentage sleep and BMI score (r = 0.279, p < 0.01). Also in girls, significant negative correlation was noted between rapid eye movement (REM) sleep percentage and total fat intake (r = -0.168, p = 0.039). In boys, significant correlations were again seen between stage II percentage sleep and the following: BMI score (r = 0.218, p = 0.005), estimated total recreational energy expenditure (r = 0.265, p = 0.001), vigorous activity (r = 0.209, p = 0.008), and total estimated activity (r = 0.206, p = 0.010). When controlling for BMI percentile and age, significant bivariate correlation was also noted between REM sleep percentage and total fat intake (r = 0.176, p = 0.034) in boys. CONCLUSIONS: BMI and exercise were associated with increases in stage II sleep. In girls, total fat intake was associated with a reduction in REM sleep, while in boys (after controlling for BMI percentile and age), total fat intake correlated with REM sleep.

Longitudinal association between short sleep, body weight, and emotional and learning problems in Hispanic and Caucasian children.

STUDY OBJECTIVE: To determine the impact of lower amounts of childhood sleep assessed by polysomnogram on development of obesity, being anxious or depressed, or having learning problems 5 years later. DESIGN: Prospective cohort. PARTICIPANTS: Subjects were 304 community participants from the Tucson Children's Assessment of Sleep Apnea study, aged 6-12 years old at baseline. MEASUREMENTS AND RESULTS: Children were classified according to baseline sleep as those who slept ≥ 9 h/night, those who slept > 7.5 to < 9 h/night, and those who slept ≤ 7.5 h/night. Odds of overweight/obese (≥ 85(th) BMI percentile), obese (≥ 95(th) BMI percentile), anxious or depressed, and learning problems at follow-up were assessed according to baseline sleep categories. Children who slept ≤ 7.5 h/night had higher odds of being obese (OR = 3.3, P < 0.05) at follow-up than children who slept ≥ 9 h/night. Borderline significance for overweight/obese (OR = 2.2, P < 0.1), anxious or depressed (OR = 3.3, P < 0.1), and having learning problems (OR = 11.1, P < 0.1) were seen for children who slept ≤ 7.5 h/night as compared to those who slept ≥ 9 h/night. A mean increase in BMI of 1.7 kg/m(2) (P = 0.01) over the 5 years of follow-up was seen for children who slept ≤ 7.5 h/night compared to those who slept ≥ 9 h/night. These relationships did not differ between Hispanic and Caucasian children. CONCLUSIONS: Children with reduced amounts of sleep (≤ 7.5 h/night) had an increased risk for higher body weight in early adolescence. Similarly, children who slept ≤ 7.5 h/night had higher risk of being anxious or depressed or having learning problems in early adolescence.

Caffeine and screen time in adolescence: associations with short sleep and obesity.

OBJECTIVE: To investigate the associations between sleep duration and obesity incidence and risk factors among pre-adolescents and adolescents. DESIGN: Cross-sectional study of a community based cohort SETTING: The Tucson Children's Assessment of Sleep Apnea follow-up study (TuCASA) cohort. PARTICIPANTS: 319 Caucasian and Hispanics between 10-17 years. MAIN OUTCOME: Parent-reported sleep duration and BMI z-score. OUTCOME MEASURES: Surveys of electronic screen time, dietary and caffeine intake, exercise and sleep habits by parents, and anthropometric measures. RESULTS: Parent-reported total sleep time (TST) was inversely associated with BMI z-score, but not significantly correlated with any of the examined nutritional variables or exercise components. Hispanic ethnicity was associated with significantly lower parent-reported TST and higher BMI z-score. Parent-reported TST was inversely related to electronic screen time and caffeine use, but these findings were differentially related to age. Caffeine consumption was associated with decreasing parent-reported TST primarily in older adolescents. Electronic screen time was associated with lower parent-reported TST in younger adolescents. CONCLUSIONS: Hispanic ethnicity and parental reports of TST were found to be the most closely associated with BMI z-score. Decreased TST and increased caffeine intake and screen time may result in higher obesity risk in the adolescent population.

Associations of dietary intake and physical activity with sleep disordered breathing in the Apnea Positive Pressure Long-Term Efficacy Study (APPLES).

The purpose of this study was to examine whether dietary habits and physical activity patterns were independently associated with severity of sleep disordered breathing (SDB) in adults diagnosed with obstructive sleep apnea. Data collected from 320 adults participating in an ancillary study of The Apnea Positive Pressure Long-term Efficacy Study were analyzed as a cross-sectional assessment at study baseline. The respiratory disturbance index (RDI) was used as a measure of the severity of sleep disordered breathing. Separate linear regression models were fitted using RDI as the independent variable and various preselected components of dietary intake and physical activity as the dependent variables. The results indicated that even after adjusting for BMI, age, and daytime sleepiness, subjects with very severe and extremely severe SDB (RDI > or =50) consumed a diet that was higher in cholesterol, protein, total fat, and total saturated fatty acids. These findings were most evident among women. For all participants, those with RDI > or =50 in comparison to those <50, on average consumed 88.16 more mg of cholesterol per day (95% CI: 44.45 to 131.86, p < 0.001). Among the women participants only, those with RDI > or =50 in comparison to those <50, on average consumed 21.96 more grams of protein (95% CI: 2.64 to 41.29, p = 0.026), 27.75 more grams of total fat (95% CI: 3.38 to 52.11, p = 0.026), and 9.24 more grams of saturated fatty acids (95% CI: 0.67 to 17.80, p = 0.035). Furthermore, those with an RDI > or =50 had a 224.58 greater caloric expenditure than those with RDI <50 from all activities including work and sleep (95% CI: 40.98 to 408.18, p = 0.017). Although significant results were seen in a reduction of physical activity from recreational activities, this finding was explained by the increase in BMI associated with higher levels of RDI.