Continuous Positive Airway Pressure (CPAP), Oral Appliance and Physical Exercise in the Obstructive Sleep Apnea

NCT ID: NCT01289392

Last Updated: 2013-05-03

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 25 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2010-10-31

Brief Summary

Introduction: It is unclear whether exercise training with or without Continuous Positive Airway Pressure (CPAP) and Oral Appliance (OA) is more effective in reducing symptoms of Obstructive Sleep Apnea (OSA) than treatment solely with CPAP or OA.

Objective: In patients with moderate OSA, the investigators will evaluate the effect on the subjective and objective measures of sleep, quality of life and mood of different forms of treatment: exercise training of 4 months; exercise training of 4 months associated with CPAP and OA; treatment with CPAP and treatment with OA.

Material and Methods: Sixty male patients (25-65 years, sedentary lifestyle, Body Mass Index (BMI) < 35kg/m2, Apnea-Hypopnea Index (AHI) between 15-30/h, Epworth sleepiness scale > 9) will be divided into three groups: CPAP+exercise group (CE; n=20), OA+exercise group (AE; n=20), and Exercise training group (E; n=20). The patients in groups CE and AE will complete two months of treatment with CPAP or OA to examine the separate effects of these devices. As the patients of the E group did not use the CPAP but will undergo four months of exercise training. After this initial step, patients in CE and AE groups will undergo four months of exercise training associated with CPAP or OA. The investigators will evaluate the subjective sleep parameters (sleep disorders questionnaire, the Epworth Sleepiness Scale, sleep diaries) and objective (polysomnography), Short Form Health Survey (SF-36), Questionnaire Profile of Mood States (POMS) and anthropometric measurements (neck circumference and body composition), the incremental exercise test (ergospirometry) and the one Repetition Maximum test (1RM).

Conditions

Obstructive Sleep Apnea

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: SINGLE

Study Groups

Continuous Positive Airway Pressure (CPAP)

CPAP is the gold standard treatment

Group Type: ACTIVE_COMPARATOR

Continuous Positive Airway Pressure (CPAP)

Intervention Type: DEVICE

Previously determinated airway pressure: used for two months unassociated with physical exercise and used for four months associated with physical exercise

Oral Appliance

Alternative treatment for obstructive sleep apnea patients

Group Type: ACTIVE_COMPARATOR

Oral Appliance (OA)

Intervention Type: DEVICE

Anterior mandibular repositioner: used for two months unassociated with physical exercise and used for four months associated with physical exercise

Physical Exercise

Aerobic and resistance physical exercises

Group Type: ACTIVE_COMPARATOR

Physical Exercise

Intervention Type: BEHAVIORAL

aerobic and resistance Physical exercise, three times a week, for four months

Interventions

Continuous Positive Airway Pressure (CPAP)

Previously determinated airway pressure: used for two months unassociated with physical exercise and used for four months associated with physical exercise

Intervention Type: DEVICE

Oral Appliance (OA)

Anterior mandibular repositioner: used for two months unassociated with physical exercise and used for four months associated with physical exercise

Intervention Type: DEVICE

Physical Exercise

aerobic and resistance Physical exercise, three times a week, for four months

Intervention Type: BEHAVIORAL

Eligibility Criteria

Inclusion Criteria

• Male subjects aged between 25 and 65 years old
• Sedentary according to the criteria of Godin and Shephard (1985) and / or ACSM (2000)
• Epworth Sleepiness Scale over score of nine
• Normal range of laboratory tests [blood count, cholesterol, High-density lipoprotein (HDL), triglycerides, fasting glucose, creatinine, Thyroid-stimulating hormone (TSH)]
• Lung function test (spirometry), chest X-ray (for smokers and former smokers) electrocardiogram (rest and stress) and ENT examination without significant changes

Exclusion Criteria

• Presence of clinical diseases (chronic obstructive pulmonary disease, asthma, interstitial lung diseases, neuromuscular diseases, heart failure, thyroid disease, rheumatologic and psychiatric) and other sleep disorders
• Presence of anatomical obstructive upper airway, tonsil grade III and IV septal deviation and grade III (severe) that may affect the outcome of CPAP
• Loss of posterior dental support to undermine the retention of oral appliance
• Active periodontal disease, compared Dental crown / dental root less than or equal to 1 (c / r ≤ 1), need for primary dental care (cavities, root canal treatment or retreatment, dentures, ie outlying), open bite
• Protrusive displacement less than five millimeters
• Limited mouth opening (would prevent the forming of the dental arches)
• Alcoholism
• Uuse of sleep-inducing medications
• Habits or occupations that lead to sleep deprivation or alteration of the sleep-wake cycle
• Inability to perform physical exercise, regular history sports activities
• Intolerance to Continuous Positive Airway Pressure (CPAP)
• Obesity grade II (moderate) and III (severe)

• Minimum Eligible Age: 25 Years
• Maximum Eligible Age: 65 Years
• Eligible Sex: MALE
• Accepts Healthy Volunteers: No

Sponsors

Associação Fundo de Incentivo à Pesquisa

OTHER

Sponsor Role: lead

Responsible Party

Prof. Dr. Lia Azeredo-Bittencourt

professor

Responsibility Role: PRINCIPAL_INVESTIGATOR

Locations

Instituto do Sono/Associação Fundo de Incentivo a Psicofarmacologia

São Paulo, São Paulo, Brazil

Countries

Brazil

References

Schutz TC, Cunha TC, Moura-Guimaraes T, Luz GP, Ackel-D'Elia C, Alves Eda S, Pantiga G Jr, Mello MT, Tufik S, Bittencourt L. Comparison of the effects of continuous positive airway pressure, oral appliance and exercise training in obstructive sleep apnea syndrome. Clinics (Sao Paulo). 2013;68(8):1168-74. doi: 10.6061/clinics/2013(08)17.

Reference Type: DERIVED

PMID: 24037015 (View on PubMed)

Other Identifiers

CEP 0352/09

Identifier Type: -

Identifier Source: org_study_id