Assessment of the association between sleep disorders, postural balance and physical activity in individuals with moderate to very severe COPD

Author(s)

Caroline Maschio de Censo

• Document type: Master's Dissertation
• Press: São Paulo.
• Institution: Universidade de São Paulo (USP). Faculdade de Medicina (FM/SBD)
• Defense date: 2023-04-14

Examining board members

Celso Ricardo Fernandes de Carvalho; Amelia Pasqual Marques; Regina Maria de Carvalho Pinto; Selma Denis Squassoni

• Advisor: Celso Ricardo Fernandes de Carvalho

Abstract

Introduction: Individuals with chronic obstructive pulmonary disease (COPD) have greater decline in pulmonary function, physical activity levels, impairment in postural balance and sleep quality. However, the association between these factors is unclear. Aim: 1) To investigate the association between sleep disorders, postural balance, sedentary behavior and the physical activity level in individuals with COPD; 2) Investigate the association between sleep apnea with dyspnea, quality of life, symptoms of anxiety and depression and mood in this population. Methods: Cross-sectional study that included individuals with COPD, it was evaluated on two distinct days. On the first day, there were evaluated anthropometric/social, comorbidities, sleep quality (PSQI), dyspnea (mMRC), quality of life (CAT), anxiety and depression (HADS), mood (Brunel), sedentary behavior and physical activity (accelerometer) for one week. The individuals were submitted to polysomnography and according to Apnea and Hypopnea Index (AHI), they were classified as having obstructive sleep apnea (OSA). The individuals were then divided into the following groups: without OSA (wOSA), mild OSA (mOSA) and moderate to severe OAS (mgOAS). In the second visit, they performed postural balance (Mini-BESTest and posturography on force platform). Posturography was evaluated in natural position and semi tandem, without and with foam in the base of support. Statistical Analysis: The sample calculation was 69 individuals. The intergroup comparison was evaluated by the Analysis of Variance (ANOVA) one way or Kruskal-Wallis test, ANOVA two way, and the association between the variables by the linear correlation coefficient. Results: Seventy individuals (55.7% male), age 68.0[62.7-72.2] years, BMI 27.0[23.4- 30.2]kg/m2 and VEF1 of 42.5[32.7-56.5]% of predicted (median, CI25-75%) were evaluated. The mgOSA is older and it has better pulmonary function compared to wOSA group. There was no association between postural balance with age and pulmonary function. There was no intergroup difference in sedentary time, physical activity levels and quality of sleep, dyspnea, quality of life, symptoms of depression and mood. In a natural position without foam, there was an increase in the distance of trajectory (DOT) of Center of Pressure (CoP), the anteroposterior direction and average speed of the mgOSA group in relation to the wOSA group. After physical effort, an increase in DOT, displacement area and mediolateral and anteroposterior CoP were observed in the wOSA and mgOSA groups in the natural position, while in the mOSA group there were increased the CoP displacement area and the anteroposterior CoP in semi tandem. A linear association was observed between the variables of sleep disorders, postural balance, sedentary behavior and physical activity levels of the participants. A weak association of OSA with age and pulmonary function was observed. Sleep efficiency was associated with sedentary behavior, and total sleep time with the mild and moderate physical activity levels and daily steps. Conclusion: Our results show that individuals COPD with OSA present greater total and anteroposterior oscillation and it increases in the speed of postural adjustments. In addition, these individuals have changes in postural balance after physical effort. An association was observed between sleep disorders, static postural balance, sedentary behavior and physical activity levels (AU)

• FAPESP's process: 20/08827-5 - Assessment of the association between postural changes in balance, physical activity and sleep disorders in individuals with moderate to very severe COPD
• Grantee: Caroline Maschio de Censo
• Support Opportunities: Scholarships in Brazil - Master