High-intensity interval training combined with resistance training improved apnea-hypopnea index but did not modify oxygen desaturation index and oxygen saturation nadir in obese children with obstructive sleep apnea

Abstract

Purpose

To investigate the effect of high-intensity interval training (HIIT) combined with resistance training (RT) on sleep indices and vascular functions in obese children with obstructive sleep apnea (OSA).

Methods

A quasi-experimental study. Forty-four obese children with OSA were allocated into either an exercise intervention (n = 22) or a usual care control group (n = 22). The exercise group received 24 min of HIIT (> 60% heart rate reserved) and 20 min of RT (50–80% one-repetition maximum), three times per week for 8 weeks. Primary outcomes included the apnea-hypopnea index (AHI), oxygen desaturation index (ODI), and oxygen saturation (SaO2) nadir. Secondary outcomes included the Sleep-Related Breathing Disorder-Pediatric Sleep Questionnaire (SRBD-PSQ) scores, vascular functions (flow-mediated dilation and mean blood flow velocity), and anthropometric variables. Outcomes were measured at baseline, at week 8, and at week 16.

Results

No baseline differences were observed between groups. The compliance rate of exercise training was 99.47%. The AHI significantly decreased in the exercise group compared with the control group at week 16 (median AHI 1.30 to 0.60 and 1.00 to 1.60 episode/h, p = 0.01), but not at week 8. There were no differences between the groups in regard to the ODI and SaO2 nadir and any secondary outcomes at weeks 8 and 16 (all p > 0.05).

Conclusions

The eight-week HIIT combined with RT decreased AHI in obese children with OSA at week 16 follow-up. No changes in the ODI, SaO2 nadir, SRBD-PSQ, vascular function, and anthropometric outcomes were revealed at any time point. Further research is warranted.

This is a preview of subscription content, log in to check access.

Fig. 1

References

  1. 1.

    Hakim F, Kheirandish-Gozal L, Gozal D (2015) Obesity and altered sleep: a pathway to metabolic derangements in children? Semin Pediatr Neurol 22(2):77–85. https://doi.org/10.1016/j.spen.2015.04.006

  2. 2.

    Ernst G, Bosio M, Salvado A, Dibur E, Nigro C, Borsini E (2016) Difference between apnea-hypopnea index (AHI) and oxygen desaturation index (ODI): proportional increase associated with degree of obesity. Sleep Breath 20(4):1175–1183. https://doi.org/10.1007/s11325-016-1330-3

  3. 3.

    Atkeson A, Yeh SY, Malhotra A, Jelic S (2009) Endothelial function in obstructive sleep apnea. Prog Cardiovasc Dis 51(5):351–362. https://doi.org/10.1016/j.pcad.2008.08.002

  4. 4.

    Van Hoorenbeeck K, Franckx H, Debode P, Aerts P, Wouters K, Ramet J et al (2012) Weight loss and sleep-disordered breathing in childhood obesity: effects on inflammation and uric acid. Obesity 20(1):172–177. https://doi.org/10.1038/oby.2011.282

  5. 5.

    Verhulst SL, Franckx H, Van Gaal L, De Backer W, Desager K (2009) The effect of weight loss on sleep-disordered breathing in obese teenagers. Obesity 17(6):1178–1183. https://doi.org/10.1038/oby.2008.673

  6. 6.

    Davis CL, Tkacz J, Gregoski M, Boyle CA, Lovrekovic G (2006) Aerobic exercise and snoring in overweight children: a randomized controlled trial. Obesity 14(11):1985–1991. https://doi.org/10.1038/oby.2006.232

  7. 7.

    Chuensiri N, Suksom D, Tanaka H (2018) Effects of high-intensity intermittent training on vascular function in obese preadolescent boys. Child Obes 14(1):41–49. https://doi.org/10.1089/chi.2017.0024

  8. 8.

    Costigan SA, Eather N, Plotnikoff RC, Taaffe DR, Lubans DR (2015) High-intensity interval training for improving health-related fitness in adolescents: a systematic review and meta-analysis. Br J Sports Med 49(19):1253–1261. https://doi.org/10.1136/bjsports-2014-094490

  9. 9.

    Ramos JS, Dalleck LC, Tjonna AE, Beetham KS, Coombes JS (2015) The impact of high-intensity interval training versus moderate-intensity continuous training on vascular function: a systematic review and meta-analysis. Sports Med 45(5):679–692. https://doi.org/10.1007/s40279-015-0321-z

  10. 10.

    Dias I, Farinatti P, De Souza MG, Manhanini DP, Balthazar E, Dantas DL, De Andrade Pinto EH, Bouskela E, Kraemer-Aguiar LG (2015) Effects of resistance training on obese adolescents. Med Sci Sports Exerc 47(12):2636–2644. https://doi.org/10.1249/MSS.0000000000000705

  11. 11.

    Tjønna AE, Stølen TO, Bye A, Volden M, Slørdahl SA, Odegård R, Skogvoll E, Wisløff U (2009) Aerobic interval training reduces cardiovascular risk factors more than a multitreatment approach in overweight adolescents. Clin Sci (Lond) 116:317–326. https://doi.org/10.1042/CS20080249

  12. 12.

    Dixon JB, Schachter LM, O’Brien PE (2003) Predicting sleep apnea and excessive day sleepiness in the severely obese: indicators for polysomnography. Chest 123(4):1134–1141. https://doi.org/10.1378/chest.123.4.1134

  13. 13.

    Katz ES, Marcus CL (2005) Diagnosis of obstructive sleep apnea syndrome in infants and children. In: Sheldon SH, Ferber RF, Kryger MH (eds) Principle and practice of pediatric sleep medicine. Elsevier Saunders, Philadelphia, pp 197–210

    Google Scholar 

  14. 14.

    Cole TJ, Bellizzi MC, Flegal KM, Dietz WH (2000) Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 320(7244):1240–1243. https://doi.org/10.1136/bmj.320.7244.1240

  15. 15.

    Logan GR, Harris N, Duncan S, Schofield G (2014) A review of adolescent high-intensity interval training. Sports Med 44(8):1071–1085. https://doi.org/10.1007/s40279-014-0187-5

  16. 16.

    Norton K, Norton L, Sadgrove D (2010) Position statement on physical activity and exercise intensity terminology. J Sci Med Sport 13(5):496–502. https://doi.org/10.1016/j.jsams.2009.09.008

  17. 17.

    American Colleage of Sports Medicine (2014) ACSM’s guidelines for exercise testing and prescription, 9th edn. Wolters Kluwer, Lippincott Williams & Wilkins

  18. 18.

    Lloyd RS, Faigenbaum AD, Stone MH, Oliver JL, Jeffreys I, Moody JA, Brewer C, Pierce KC, McCambridge TM, Howard R, Herrington L, Hainline B, Micheli LJ, Jaques R, Kraemer WJ, McBride MG, Best TM, Chu DA, Alvar BA, Myer GD (2014) Position statement on youth resistance training: the 2014 international consensus. Br J Sports Med 48(7):498–505. https://doi.org/10.1136/bjsports-2013-092952

  19. 19.

    Ficker JH, Wiest GH, Wilpert J, Fuchs FS, Hahn EG (2001) Evaluation of a portable recording device (Somnocheck) for use in patients with suspected obstructive sleep apnoea. Respiration 68(3):307–312. https://doi.org/10.1159/000050515

  20. 20.

    Longlalerng K, Sonsuwan N, Uthaikhup S, Kumsaiyai W, Sitilertpisan P, Traisathit P, Pratanaphon S (2019) Translation, cross-cultural adaptation and psychometric properties of the Sleep-Related Breathing Disordered−Pediatric Sleep Questionnaire for obese Thai children with obstructive sleep apnea. Sleep Med 53:45–50. https://doi.org/10.1016/j.sleep.2018.08.033

  21. 21.

    Corretti MC, Anderson TJ, Benjamin EJ, Celermajer D, Charbonneau F, Creager MA, Deanfield J, Drexler H, Gerhard-Herman M, Herrington D, Vallance P, Vita J, Vogel R (2002) Guidelines for the ultrasound assessment of endothelial-dependent flow-mediated vasodilation of the brachial artery: a report of the International Brachial Artery Reactivity Task Force. J Am Coll Cardiol 39(2):257–265. https://doi.org/10.1016/s0735-1097(01)01746-6

  22. 22.

    Karlsen T, Nes BM, Tjønna AE, Engstrøm M, Støylen A, Steinshamn S (2017) High-intensity interval training improves obstructive sleep apnoea. BMJ Open Sport Exerc Med 2(1). https://doi.org/10.1136/bmjsem-2016-000155

  23. 23.

    Kheirandish-Gozal L, Gozal D (2008) The multiple challenges of obstructive sleep apnea in children: diagnosis. Curr Opin Pediatr 20(6):650–653. https://doi.org/10.1097/MOP.0b013e328316bdb2

  24. 24.

    Giebelhaus V, Strohl KP, Lormes W, Lehmann M, Netzer N (2000) Physical exercise as an adjunct therapy in sleep apnea—an open trial. Sleep Breath 4(4):173–176. https://doi.org/10.1007/s11325-000-0173-z

  25. 25.

    Nourry C, Deruelle F, Guinhouya C, Baquet G, Fabre C, Bart F, Berthoin S, Mucci P (2005) High-intensity intermittent running training improves pulmonary function and alters exercise breathing pattern in children. Eur J Appl Physiol 94(4):415–423. https://doi.org/10.1007/s00421-005-1341-4

  26. 26.

    Ueno LM, Drager LF, Rodrigues ACT, Rondon MUPB, Braga AMFW, Mathias W Jr, Krieger EM, Barretto AC, Middlekauff HR, Lorenzi-Filho G, Negrão CE (2009) Effects of exercise training in patients with chronic heart failure and sleep apnea. Sleep 32(5):637–647. https://doi.org/10.1093/sleep/32.5.637

  27. 27.

    Tsai CM, Kang CH, Su MC, Lin HC, Huang EY, Chen CC, Hung JC, Niu CK, Liao DL, Yu HR (2013) Usefulness of desaturation index for the assessment of obstructive sleep apnea syndrome in children. Int J Pediatr Otorhinolaryngol 77(8):1286–1290. https://doi.org/10.1016/j.ijporl.2013.05.011

  28. 28.

    Iftikhar IH, Kline CE, Youngstedt SD (2014) Effects of exercise training on sleep apnea: a meta-analysis. Lung 192:175–184. https://doi.org/10.1007/s00408-013-9511-3

  29. 29.

    Farpour-Lambert NJ, Aggoun Y, Marchand LM, Martin XE, Herrmann FR, Beghetti M (2009) Physical activity reduces systemic blood pressure and improves early markers of atherosclerosis in pre-pubertal obese children. J Am Coll Cardiol 54(25):2396–2406. https://doi.org/10.1016/j.jacc.2009.08.030

  30. 30.

    Bruyndoncky L, Hoymans VY, Craenenbroeck AHV, Vissers DK, Vrints CJ, Ramet J, Conraads VM (2013) Assessment of endothelial dysfunction in childhood obesity and clinical use. Oxidative Med Cell Longev 2013:1–18. https://doi.org/10.1155/2013/174782

Download references

Acknowledgments

The authors would like to thank Miss Pimchanok Malasam, Miss Duanghathai Pasanta, and Mr. Porama Thepsiri for the data collection process and Mr. Nitinet Ketsuwan for assisting in exercise training sessions. Importantly, we are obliged to all of the children and their parents, who dedicated time to participate in this study.

Funding

This study was supported financially by the Faculty of Associated Medical Sciences (AMS Research Grant 6/2560) and the Graduate School of Chiang Mai University, Chiang Mai, Thailand.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Sainatee Pratanaphon.

Ethics declarations

This study was approved by the Research Ethics Committee, Faculty of Medicine, Chiang Mai University (#033/2017). All participants and their parents provided written informed consent (Thai Clinical Trials Registry: TCTR20170209001).

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Written informed consent was received from parents or legal guardians of the children, and written assent was obtained from children over 7 years old prior to commencement of this study.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and the 1964 Helsinki Declaration and its later amendment or comparable ethical standards. This study was approved by the Research Ethics Committee, Faculty of Medicine, Chiang Mai University.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Longlalerng, K., Sonsuwan, N., Uthaikhup, S. et al. High-intensity interval training combined with resistance training improved apnea-hypopnea index but did not modify oxygen desaturation index and oxygen saturation nadir in obese children with obstructive sleep apnea. Sleep Breath 24, 571–580 (2020). https://doi.org/10.1007/s11325-019-01899-z

Download citation

Keywords

  • High-intensity interval training
  • Resistance training
  • Polysomnographic indices
  • Vascular function
  • Obstructive sleep apnea