Field Notes

Severity of Sleep-Disordered Breathing
Predicts Glycemic Health

The severity of sleep-disordered breathing and nocturnal hypoxemia independently predict both glycosylated hemoglobin (HbA1c) levels and type 2 diabetes mellitus (T2DM), according to a new study presented at the American Thoracic Society’s recent international conference.

“Because people with obstructive sleep apnea syndrome [OSAS] are often overweight or obese, it’s been difficult to interpret earlier studies of the relationship between sleep disordered breathing and metabolic disorders,” says Brian Kent, MBBCh, research fellow at St Vincent's University Hospital in Dublin, Ireland. “We found that OSAS severity and low nocturnal oxygen levels were significant independent predictors of prevalent T2DM and HbA1c levels, even after adjustment for a number of confounding variables, including obesity.”

The study involved 7,886 prospectively assessed subjects from 22 sleep laboratories in 16 European countries. All subjects completed overnight sleep studies.

After adjustment for comorbidities and demographic and anthropometric variables, moderate and severe OSAS were each significant (P = 0.003) predictors of having a diagnosis of T2DM. Apnea/hypopnea index, oxyhemoglobin desaturation index, and mean oxygen saturation were significant (P < 0.0001) predictors of HbA1c levels.

“A diagnosis of T2DM is associated with a significantly increased risk of cardiovascular morbidity and death, and elevated HbA1c levels predict cardiovascular mortality in nondiabetic subjects,” Kent said. “OSAS also has been shown to be associated with adverse cardio-metabolic outcomes, although whether OSAS independently predicts these outcomes is not clear.

“Our study shows that OSAS is independently associated with metabolic disturbances,” Kent continues. “This is important because individuals with T2DM or elevated HbA1c levels are more likely to die of cardiovascular disease.”

Kent notes, however, that further detailed studies are needed to understand the mechanism underlying this relationship.

— Source: American Thoracic Society


Exercising in Your 50s, 60s, 70s, and Beyond

A recent study has shown that exercise can add years to a person’s life. Still, as we age, it can become more tedious and sometimes more difficult to exercise.

“Exercise is important for almost everyone. There are very few medical conditions that exercise won’t benefit. In fact, I sometimes write a prescription to get my patients to start taking this seriously and help them understand exercise can be just as helpful as medication,” says Keith Veselik, MD, director of primary care at Loyola University Health System and an associate professor in the department of medicine at Loyola University Chicago Stritch School of Medicine. “Around age 35 is when our muscle mass and resting metabolism starts to decrease. When this happens, our bodies require more, not less, exercise to manage our caloric intake. When this starts to happen we can eat the same things, do the same things and may gain 3 lbs a year. That’s 30 lbs in a decade.”

Though exercising is beneficial to nearly everyone, before starting a program, Veselik advises that people, especially those who haven’t been active, consult a doctor to determine their baseline and get guidance about what exercises would be most beneficial.

“In my own life, I’ve seen the benefits of exercising. When that alarm goes off in the morning, I want to just roll over, but I’ve seen such a positive change in so many ways. It can be difficult, especially at first, but the benefits truly outweigh the struggles,” Veselik says.

The best workout program balances cardiovascular exercise, strength training, and flexibility, Veselik says. He recommends an hour of cardiovascular exercise four days per week, two days of strength training for 30 minutes, and balance and flexibility exercises such as stretching, yoga, or Pilates one to two times per week.

But what’s optimal doesn’t always translate into what’s doable. Each decade has unique challenges. Veselik gives some ideas of how to use exercise to counter those health hurdles.

In Your 50s
Muscle and joint aches and pains start becoming more apparent, so Veselik says get creative about how to keep up cardiovascular exercise that’s easy on the joints but gets the heart rate up. He suggests trying exercising in a pool or riding a bike instead of running. If you do run, make sure you have good shoes and try to run on softer surfaces.

Cardiovascular exercise also helps fight many of the most common and deadly medical concerns, including heart disease, asthma, and chronic obstructive pulmonary disease.

“But don’t go from doing nothing to running a marathon. Talk to your doctor; ask about risk factors and together create a plan that’s right for you,” Veselik says.

Another nearly universal complaint for people in their 50s is back pain. “The best way to protect your back is to build strong core muscles and make sure you’re lifting heavy objects correctly,” Veselik says.

In Your 60s
As we enter our 60s, balance and strength should be a major focus. Many people are scared of breaking a hip, which can limit independence. Also, our bones aren’t as strong, and both men and women become more susceptible to osteoporosis.

To help battle these concerns, Veselik suggests incorporating balance and leg-strengthening exercises to increase flexibility as well as balance to help prevent accidental falls. Weight-bearing exercise is crucial to bone health and keeping bone density strong.

In addition, many adults in their 60s begin to experience arthritis symptoms, which can make exercise difficult.

“Exercise has been proven to help people deal with their arthritis. It’s just making sure your exercise routine is working for you, not against you. Some people forget that walking is a great form of exercise. Just make sure you get your heart rate up. Also, aquatic classes or swimming are a great way for people with arthritis or fibromyalgia to exercise,” Veselik says.

In Your 70s and Beyond
“The biggest worry I hear from my patients who are entering their 70s, 80s, and beyond is dementia. The two most common forms are Alzheimer’s and vascular dementia,” Veselik says.

Exercise may help delay the onset of dementia, and it can counter many of the major risk factors for vascular dementia, high blood pressure, high cholesterol, and diabetes.

“Exercise is important, but it’s not the end-all. It needs to be coupled with eating right and incorporating other healthful habits to lead to a better quality of life,” Veselik says.

— Source: Loyola University Health System