Exercise training reduces sympathetic nerve activity and improves executive performance in individuals with obstructive sleep apnea

Goya, Thiago Tanaka; Ferreira-Silva, Rosyvaldo; Gara, Elisangela Macedo; Guerra, Renan Segalla; Barbosa, Eline Rozária Ferreira; Toschi-Dias, Edgar; Cunha, Paulo Jannuzzi; Negrão, Carlos Eduardo; Lorenzi-Filho, Geraldo; Ueno-Pardi, Linda Massako

doi:10.6061/clinics/2021/e2786

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ORIGINAL ARTICLE • Clinics 76 • 2021 • https://doi.org/10.6061/clinics/2021/e2786 copy

Exercise training reduces sympathetic nerve activity and improves executive performance in individuals with obstructive sleep apnea

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE:

To investigate the effects of exercise training (ET) on muscle sympathetic nerve activity (MSNA) and executive performance during Stroop Color Word Test (SCWT) also referred to as mental stress test.

METHODS:

Forty-four individuals with obstructive sleep apnea (OSA) and no significant co-morbidities were randomized into 2 groups; 15 individuals completed the control period, and 18 individuals completed the ET. Mini-mental state of examination and intelligence quotient were also assessed. MSNA assessed by microneurography, heart rate by electrocardiography, blood pressure (automated oscillometric device) were measured at baseline and during 3 min of the SCWT. Peak oxygen uptake (VO₂ peak) was evaluated using cardiopulmonary exercise testing. Executive performance was assessed by the total correct responses during 3 min of the SCWT. ET consisted of 3 weekly sessions of aerobic exercise, resistance exercises, and flexibility (72 sessions, achieved in 40±3.9 weeks).

RESULTS:

Baseline parameters were similar between groups. Heart rate, blood pressure, and MSNA responses during SCWT were similar between groups (p>0.05). The comparisons between groups showed that the changes in VO₂ (4.7±0.8 vs -1.2±0.4) and apnea-hypopnea index (-7.4±3.1 vs 5.5±3.3) in the exercise-trained group were significantly greater than those observed in the control group respectively (p<0.05) after intervention. ET reduced MSNA responses (p<0.05) and significantly increased the number of correct answers (12.4%) during SCWT. The number of correct answers was unchanged in the control group (p>0.05).

CONCLUSIONS:

ET improves sympathetic response and executive performance during SCWT, suggesting a prominent positive impact of ET on prefrontal functioning in individuals with OSA. ClinicalTrials.gov: NCT002289625.

Exercise Training; Sympathetic Nervous System; Executive Function; Obstructive Sleep Apnea

	Control (n=15)	Exercise (n=18)	p
Physical characteristics
Sex, female/male	5/10	9/9	0.46
Age, years	49.3±1.7	53.8±1.7	0.07
Body weight	83.20±3.6	81.51±3.8	0.75
BMI, kg/m²	29.7±0.9	29.3±0.9	0.77
ESS, score	12.7±1.4	11.3±1.4	0.50
Mental Status
MEEM, score	27.7±0.5	27.1±0.6	0.44
Education, years	14.1±1.7	11.7±0.9	0.20
Estimated IQ, score	85.1±3.2	91.3±3.2	0.18
BAI, score	7.1±2.4	7.9±1.5	0.78
BDI, score	7.0±1.2	7.4±1.3	0.83
Metabolic parameters
Fasting glucose, mg/Dl	98.9±2.9	103.2±1.6	0.18
Total Cholesterol, mg/dL	206.4±11.9	208.6±9.7	0.89
HDLc, mg/dL	44.1±3.2	48.6±2.2	0.24
LDLc, mg/Dl	130.5±12.1	136.1±8.2	0.70
Peak VO_2, mL/kg/min	24.2±1.3	24.6±1.3	0.83
Cardiovascular and neurovascular parameters
Heart rate, beats/min	66.0±2.5	65.4±1.7	0.84
Systolic BP, mm Hg	122.9±3.1	121.3±2.4	0.69
Diastolic BP, mm Hg	79.9±2.3	78.6±1.5	0.62
MSNA, bursts/min	30.6±0.5	34.7±0.8	0.34
MSNA, bursts/100 heart beats	47.5±0.97	51.9±1	0.48
Sleep status
Total sleep time, min	387.8±11.9	361.4±12.8	0.15
Sleep efficiency, %	84.7±1.7	81.2±2.4	0.25
AHI, events/h	39.8±5.5	45.8±7.8	0.55
Arousal index, events/h	28.3±2.3	33.9±4.2	0.27
O₂ desaturation, events	29.1±5.3	41.0±7.7	0.23

	Pre	Post	Change
Physical characteristics
Body weight, kg
Control	83.2±3.6	84.3±3.6	1.1±0.4
Exercise	81.5±3.8	79.9±3.3*	-1.6±0.7^††
BMI, kg/m²
Control	29.7±0.9	29.9±0.9	0.2±0.3
Exercise	29.3±0.9	28.5±0.8*	-0.8±0.3^††
Physical parameter
Heart rate
Control	66.0±2.5	65.0±2.7	-1.0±2.2
Exercise	65.4±1.7	64.2±1.6	-1.2±1.0
Systolic BP, mm Hg
Control	122.9±3.1	122.2±3.9	-0.7±4.2
Exercise	121.3±2.4	114.1±2.9	-7.3±3.9
Diastolic BP, mm Hg
Control	79.9±2.3	77.8±2.2	-2.1±3.0
Exercise	78.6±1.5	76.4±1.5	-2.1±2.3
VO₂ peak_, mL.kg^-1.min^-1
Control	24.2±1.3	23.0±1.5	-1.2±0.4
Exercise	24.6±1.3	29.3±1.5*^†	4.7±0.8^††
Sleep status
Total sleep time, min
Control	387.8±11.9	398.6±12.6	10.8±9.5
Exercise	361.4±12.8	370.2±12.7	8.8±12.3
Sleep efficiency, %
Control	84.7±1.7	84.5±1.9	-0.2±2.0
Exercise	81.2±2.4	84.4±2.0	3.2±2.3
Arousal index, events/h
Control	28.3±2.3	28.7±3.0	0.5±1.9
Exercise	33.9±4.2	26.3±3.3^†	-7.6±3.0^††
O₂ desaturation, events
Control	29.1±5.3	39.2±6.5	10.1±5.6
Exercise	41.0±7.7	34.1±6.1	-6.9±3.2^††
AHI, events/h
Control	39.8±5.5	45.3±6.9	5.5±3.3
Exercise	45.8±7.8	38.4±6.3	-7.4±3.1^††

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[1] *Corresponding author. E-mail: lindabrz@usp.br