Examining the effects of exercise on vascular function in obstructive sleep apnea

摘要： 阻塞性睡眠呼吸暂停（OSA）是一种严重的医疗条件，影响估计15万美国成年人 其特征在于反复发作的上呼吸道阻塞、反复觉醒和间歇性 睡眠期间氧合血红蛋白去饱和。这些异常有助于血管的亚临床改变， 增加心血管疾病发病率和死亡率的风险。相反，锻炼 降低心血管事件的风险，促进身体活动仍然是最重要的 我们的国家公共卫生议程，正如1996年美国卫生部长关于 身体活动和健康。虽然这种保护性益处的确切机制尚不完全清楚， 是运动通过直接影响血管内皮细胞来保护心脏的有力证据 功能美国睡眠医学院建议运动作为一种行为治疗选择， OSA。然而，这一建议所依据的大多数临床试验都集中在建立 生活方式改变的有效性（例如，饮食引起的体重减轻和增加的身体活动参与） 改善肥胖个体的OSA严重程度，而较少关注OSA是否 缓和运动对心血管疾病底物的影响。我们的首要假设是 OSA减弱了运动对肥胖个体血管功能的有益作用， 患有未经治疗的OSA。本研究的目的是：1）检查血管功能的参数， 2）评估急性运动对肱动脉的影响 在患有和不患有OSA的肥胖者中的血流介导的扩张，以及3）检查6周的 运动训练对阻塞性睡眠呼吸暂停患者血管功能的影响。我们的数据将立即有用 在临床实践中，并告知我们如何规定运动和实施生活方式的改变，以减少 OSA患者的心血管疾病风险。

Abstract: Obstructive sleep apnea (OSA) is a serious medical condition that affects an estimated 15 million US adults and is characterized by repeated episodes of upper airway obstruction, recurrent arousals and episodic oxyhemoglobin desaturations during sleep. These abnormalities contribute to subclinical alterations in vascular function that increase the risk of cardiovascular disease morbidity and mortality. In contrast, exercise decreases the risk of cardiovascular events and the promotion of physical activity continues to be at the top of our national public health agenda, as seen in the publication of the 1996 report of the US Surgeon General on physical activity and health. While the exact mechanisms for this protective benefit are not entirely clear, there is good evidence that exercise confers cardioprotection through its direct impact on vascular endothelial function. The American College of Sleep Medicine recommends exercise as a behavioral treatment option for OSA. Yet, most clinical trials upon which this recommendation is based have focused on establishing the effectiveness of lifestyle change (e.g., dietary induced weight loss and increased physical activity participation) for improving OSA severity in obese individuals, whereas less attention has been given to whether OSA moderates the effects of exercise on the cardiovascular disease substrate. Our overarching hypothesis is that OSA attenuates the beneficial effect of exercise on vascular function in obese individuals suffering from untreated OSA. The aims of the study are to 1) examine parameters of vascular function in obese persons with and without OSA, 2) evaluate the effects of an acute bout of exercise on brachial artery flow mediated dilation in obese persons with and without OSA, and 3) examine the effects of 6 weeks of exercise training on vascular function among those with and without OSA. Our data will be immediately useful in clinical practice and inform how we prescribe exercise and implement lifestyle changes to reduce cardiovascular disease risk in OSA patients.