Sleep + exercise + diet = good health for obstructive sleep apnea patients

Published on December 17, 2007 at 8:33 AM · No Comments

Research has shown a strong relationship between weight and obstructive sleep apnea (OSA). Your neck gets thicker as you gain weight.

This increases the level of fat in the back of the throat, making your airway more likely to be blocked. Because exercise reduces body weight, it has been suggested as a potential intervention for mild to moderate OSA. In an effort to answer the question as to how ready OSA patients are to engage in exercise, a study published in the December 15 issue of the Journal of Clinical Sleep Medicine (JCSM) features the Stages of Change, a construct of the Transtheoretical Model (TTM) of behavior change.

The study focused on 255 patients attending a public hospital based sleep disorders center in Queensland who were being tested for probable OSA. The participants filled out questionnaires that assessed their intention to exercise.

The Stages of Change in the Transtheoretical Model are as follows:

Stage: Pre-contemplation
Intent / Action: No intention to exercise in next six months, no action
Stage: Contemplation
Intent / Action: Serious intent to exercise in next six months, no action
Stage: Preparation
Intent / Action: Serious intent to exercise in next 30 days, some action
Stage: Action
Intent / Action: Exercise regularly, but for less than six months
Stage: Maintenance
Intent / Action: Exercise regularly, for more than six months
The following measures were used in this study to assess demographic variables and level of habitual self-reported exercise, and to assess the TTM:
- The Decisional Balance Inventory (consists of 10 items assessing the Pros of exercise and 10 items assessing the Cons of exercise).
- Self-Efficacy Scale (represents situations that may be considered as potential barriers to exercising).
- Stages of Change for Regular Exercise (measure assessed exercise-related intentions and self-reported exercise behavior).
- Godin Leisure-Time Exercise Questionnaire (assesses a person's habitual leisure-time exercise level).
- Epworth Sleepiness Scale (evaluates a patient's level of habitual sleepiness during the day).
- Sleep Architecture Variables (assessed with a standard clinical polysomnogram, which evaluates various physiologic and respiratory variables).

The findings of the study provide support for the validity of applying the TTM to exercise intention in patients with OSA. Over 60 percent of the patients were at a pre-Action stage (Pre-contemplation, Contemplation or Preparation), with less than 30 percent reporting that they were at the Maintenance stage.

“The Transtheoretical Model, and Stages of Change, now has a long history of use in a range of health behaviors such as quitting smoking and use of sun screen,” said Simon S. Smith, PhD, of the University of Queensland and the Queensland Sleep Health Group in Queensland, Australia, lead author of the study. “We used a standard measure of Stages of Change. First we found that the patients could be differentiated into stages (intention), but then checked that intention against their habitual levels of exercise. You'd expect that folks with no contemplation of exercise would exercise less, and we found that was the case.”

According to Dr. Smith, standard medical approaches to managing OSA, such as continuous positive airway pressure (CPAP), can be effective for patients with moderate to severe disease. However, for patients with mild sleep apnea, for those who have trouble using CPAP, or for those who would like to take charge of their own health, increasing exercise and reducing body mass may be one practical route, added Dr. Smith.

Continued on Next page >>