The effect of exercise on systemic inflammation in veterans with COPD and OSA.

术语“重叠综合征”(OS)被用来描述慢性阻塞性肺疾病 一名退伍军人患有慢性阻塞性肺疾病(COPD)和阻塞性睡眠呼吸暂停疾病(OSA)。鉴于艾滋病的高流行率 COPD和OSA，预计三分之一患有OSA的退伍军人可能会受到OS的影响。我们 两项横断面研究表明，我们患有COPD的退伍军人人群中OS的患病率为 超过44%。重要的是，患有OS的退伍军人的心血管发病率和死亡率高于任何一种 OSA或仅患有COPD的退伍军人，可能是由于夜间缺氧和随后的炎症 内皮功能障碍。我们的初步数据显示，患有OS的退伍军人血清hs-CRP水平较高 而不是只患有慢性阻塞性肺病的退伍军人。因此，对于患有OS的退伍军人来说，减少心血管疾病的治疗 通过靶向炎症来治疗疾病(CVD)是一个高度优先的问题。以家庭为基础的锻炼干预措施，转化为 增加体力活动(PA)的生活方式是一种理想的策略，因为PA每周有150分钟的闲暇时间 与降低心血管疾病相关事件和死亡的风险有关。此外，PA减少了生物标记物 全身炎症(IL-6和CRP)。然而，目前还没有关于运动对生物标记物的影响的数据。 患有OS的退伍军人的全身炎症。成人慢性阻塞性肺疾病患者的闲暇时间难以增加 和阻塞性睡眠呼吸暂停综合症，因为这一人群由于肥胖、日间嗜睡的增加而更加久坐 还有呼吸困难。因此，家庭锻炼将是这些退伍军人的理想选择。在一项对19个人进行的初步研究中 患有慢性阻塞性肺疾病的退伍军人我们证明了Wii Fit程序在家庭锻炼中的使用 可行且安全。12周后，平均6分钟步行距离增加了23米(p=0.01 使用Wii Fit进行中等强度运动。因此，将此练习策略调整为适用于具有操作系统的退伍军人 新的治疗方法，其目标是持久增加PA的闲暇时间。随机对照试验 未能证明目前治疗阻塞性睡眠呼吸暂停综合征的标准疗法，即持续气道正压 (CPAP)，改变OSA中的炎症标志物。这项提议的目标是进行一个单一的手臂12- 为期一周的家庭锻炼试点干预对系统性红斑狼疮生物标志物的影响 50例退伍军人慢性阻塞性肺疾病患者的炎症反应我们假设1)PA的基线强度和持续时间 将与独立于夜间缺氧的全身炎症的生物标志物负相关；以及2) 使用家庭电脑运动程序进行运动训练将降低系统性红斑狼疮的生物标志物 退伍军人的炎症和增加运动能力。为了检验这些假设，我们将分析 患有OS的退伍军人的基线PA强度和持续时间(加速计量学)和全身炎症的生物标志物 (目标1)。然后，将在基线和12周的家庭锻炼后评估以下参数 训练：a)全身炎症的生物标志物；b)PA强度和持续时间；c)运动能力(AIM 2)。 研究结果将支持未来的随机运动试验，该试验将影响降低心血管疾病风险的战略和 通过增加体力活动获得OS的退伍军人。长期的临床目标是成功地实施 家庭锻炼干预在广大退伍军人睡眠障碍人群常规医疗护理中的应用 呼吸(SDB)，最终目标是通过以下方式降低他们发生心血管相关事件和死亡的风险 增加体力活动。鉴于操作系统的高流行率及其对 退伍军人和普通人群的发病率、死亡率和与医疗保健相关的费用。

The term "overlap syndrome" (OS) is used to describe the association of both chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea disease (OSA) in a single Veteran. Given the high prevalence of both COPD and OSA, it is expected that a third of Veterans with OSA could be affected by OS. We demonstrated in 2 cross-sectional studies that the prevalence of OS in our Veteran population with COPD was above 44%. Importantly, Veterans with OS have a higher cardiovascular morbidity and mortality than either OSA or COPD-only Veterans, likely due to worse nocturnal hypoxia and subsequent inflammation and endothelial dysfunction. Our preliminary data shows that serum hs-CRP levels are higher in Veterans with OS than Veterans with COPD-only. Therefore, therapy for Veterans with OS that decreases cardiovascular disease (CVD) by targeting inflammation is a high priority. Home-based exercise interventions that translate to a lifestyle with increased physical activity (PA) are an ideal strategy as 150 minutes of leisure time PA a week is associated with reduction in risk of CVD-related events and death. Further, PA decreases biomarkers of systemic inflammation (IL-6 and CRP). However, no data is available on the effect of exercise on biomarkers of systemic inflammation in Veterans with OS. It is difficult to increase the leisure time PA in adults with COPD and OSA as this population is more sedentary due to a combination of increased obesity, daytime sleepiness and dyspnea. Therefore, home-based exercise would be ideal for these Veterans. In a pilot study of 19 Veterans with COPD we demonstrated that the use of the Wii Fit program for home-based exercise was feasible and safe. The mean six-minute walk distance increased by 23 meters (p=0.01) after 12 weeks of moderate intensity exercise with the Wii Fit. Thus, adapting this exercise strategy to Veterans with OS is a novel treatment approach whose goal is durable increases in leisure time PA. Randomized controlled trials have failed to demonstrate that the current standard therapy for OSA, i.e. continuous positive airway pressure (CPAP), alters inflammatory markers in OSA. The objective of this proposal is to conduct a single arm 12- week home-based exercise pilot intervention to determine the effect on biomarkers of systemic inflammation in 50 Veterans with OS on CPAP. We hypothesize that 1) Baseline PA intensity and duration will correlate inversely with the biomarkers of systemic inflammation independently of nocturnal hypoxia; and 2) Exercise training using a home-based computer exercise program will decrease biomarkers of systemic inflammation and increase exercise capacity in Veterans. To test these hypotheses, we will analyze measures of baseline PA intensity and duration (accelerometry) and biomarkers of systemic inflammation in Veterans with OS (AIM 1). Then the following parameters will be assessed at baseline and after 12 weeks of home exercise training: a) biomarkers of systemic inflammation; b) PA intensity and duration; c) exercise capacity (AIM 2). Findings will support a future randomized exercise trial that will impact strategies to reduce CVD risk and in Veterans with OS through increased physical activity. The long-term clinical goal is to successfully implement a home exercise intervention in the routine medical care of the large Veteran population with sleep disordered breathing (SDB) with the ultimate goal of reducing their risk of CVD-related events and death through increased physical activity. This research area is a high priority given the high prevalence of OS and impact on Veterans' and general population morbidity, mortality and health-care associated costs.