Overview of Sleep Apnea Syndrome
This disorder causes interrupted sleep patterns and respiratory gas exchange. The syndrome results in significant daytime sleepiness due to upper airway obstruction and sleep disturbances. The three types of sleep apnea are obstructive, central, and mixed. Obstructive apnea results from collapse of the pharyngeal tissues, and central apnea results from decreased cerebral respiratory control. Sleep apnea syndrome is related to obesity, large neck circumference, eating disorders, depression, and sedentary activity levels. Clients are commonly treated with continuous positive airway pressure during sleep. Clients do not attain deep restorative sleep, which results in daytime fatigue, headaches, and cognitive impairments. The lack of regular exercise has been associated with increased levels of sleep apnea.1
Comorbidities to Consider
Keys to Examination of Clients
Clients are diagnosed through overnight polysomnography to monitor sleep patterns and blood oxygen saturation.
The apnea-hypopnea or respiratory disturbance index (RDI) is determined based on the number of cessations of breathing occurring per hour of sleep.2
Clients' RDI can help classify their level of sleep apnea, and daily levels of sleepiness can be assessed with the Epworth Sleepiness Scale.3,4
Respiratory Disturbance Index
Mild: 5–15 sleep disturbances per hour
Moderate: 15–30 sleep disturbances per hour
Severe: More than 30 disturbances per hour
Recommended Baseline Testing of Fitness Levels
Use a walking test to assess cardiorespiratory function and aerobic fitness
Clients may have hypertension and other heart disease–related conditions that will require frequent monitoring during exercise programs.
Type: Walking, treadmill walking, cycling
Intensity: Low to moderate intensities
Frequency: Three to five times per week
Exercise programs should be used as an adjunct treatment strategy for patients with mild to moderate obstructive sleep apnea, as limited evidence exists for the efficacy of exercise programs improving sleep apnea.5,6 Aerobic activities of walking, treadmill walking, or cycling with the goal of improving RDI and daytime sleepiness and reducing body adipose tissues and health risk factors should be the main mode of exercise. Clients should also be encouraged to make moderate reductions in their daily caloric intake.
Aerobic exercise prescription based on a patient's age and baseline fitness should be used to start the exercise program. Clients should be encouraged to exercise daily at low to moderate intensity levels with a goal of 150 to 250 minutes of total physical activity per week, or 1500 to 1800 kcal of physical activities along with appropriate caloric intake limits, to bring ...