| Trials | |
| Effects of exercise and diet interventions on obesity-related sleep disorders in men: study protocol for a randomized controlled trial | |
| Sulin Cheng5  Markku Alen4  Markku Partinen2  Yining Sun5  Ina Tarkka6  Yajun Zhang5  Xi Wang5  Fengyu Cong3  Xinfei Wen6  Eveliina Munukka6  Petri Wiklund6  Satu Pekkala6  Niklas Eklund2  Shumei Cheng6  Aki Rahikainen6  Samu Martinmäki6  Jarkko Tenhunen6  Tuija M Mikkola6  Antti Saarinen1  Xiao Tan6  | |
| [1] Central Finland Central Hospital, Central Finland Health Care District, Keskussairaalantie 19, 40620 Jyväskylä, Finland;Helsinki Sleep Clinic, Vitalmed Research Center, Sitratori 3, Third floor, 00420 Helsinki, Finland;Department of Mathematical Information Technology, University of Jyväskylä, (Agora), PO Box 35, 40014 Jyväskylä, Finland;Institute of Health Sciences, University of Oulu, Kajaanintie 50, Oulu 90220, Finland;Institute of Intelligent Machines, Chinese Academy of Sciences, 350 Shushan Road, Hefei 230031, Anhui, People’s Republic of China;Department of Health Sciences, University of Jyväskylä, Rautpohjankatu 8, PO Box 35, 40700 Jyväskylä, Finland | |
| 关键词: Neurotransmitters; Gut microbiota; Obesity; Sleep measurement; Insomnia; Obstructive sleep apnea; Quality of sleep; Sleep disorders; Lifestyle intervention; | |
| Others : 1093333 DOI : 10.1186/1745-6215-14-235 |
|
| received in 2013-02-26, accepted in 2013-07-16, 发布年份 2013 | |
PDF
|
|
【 摘 要 】
Background
Sleep is essential for normal and healthy living. Lack of good quality sleep affects physical, mental and emotional functions. Currently, the treatments of obesity-related sleep disorders focus more on suppressing sleep-related symptoms pharmaceutically and are often accompanied by side effects. Thus, there is urgent need for alternative ways to combat chronic sleep disorders. This study will investigate underlying mechanisms of the effects of exercise and diet intervention on obesity-related sleep disorders, the role of gut microbiota in relation to poor quality of sleep and day-time sleepiness, as well as the levels of hormones responsible for sleep-wake cycle regulation.
Methods/design
Participants consist of 330 (target sample) Finnish men aged 30 to 65 years. Among them, we attempt to randomize 180 (target sample) with sleep disorders into exercise and diet intervention. After screening and physician examination, 101 men with sleep disorders are included and are randomly assigned into three groups: exercise (n = 33), diet (n = 35), and control (n = 33). In addition, we attempt to recruit a target number of 150 healthy men without sleep disorders as the reference group. The exercise group undergoes a six-month individualized progressive aerobic exercise program based on initial fitness level. The diet group follows a six month specific individualized diet program. The control group and reference group are asked to maintain their normal activity and diet during intervention. Measurements are taken before and after the intervention. Primary outcomes include objective sleep measurements by polysomnography and a home-based non-contact sleep monitoring system, and subjective sleep evaluation by questionnaires. Secondary outcome measures include anthropometry, body composition, fitness, sleep disorder-related lifestyle risk factors, composition of gut microbiota and adipose tissue metabolism, as well as specific hormone and neurotranmitter levels and inflammatory biomarkers from venous blood samples.
Discussion
It is expected that the improvement of sleep quality after exercise and diet intervention will be evident both in subjective and objective measures of quality of sleep. Additionally, the change of sleep quality induced by exercise and diet intervention is expected to be related to the changes in specific hormones and inflammatory biomarkers, and in the composition of gut microbiota.
Trial registration
Current Controlled Trials ISRCTN77172005
【 授权许可】
2013 Tan et al.; licensee BioMed Central Ltd.
【 预 览 】
| Files | Size | Format | View |
|---|---|---|---|
| 20150130162422517.pdf | 314KB | ||
| Figure 1. | 102KB | Image |
【 图 表 】
Figure 1.
【 参考文献 】
- [1]Morriss RK, Wearden AJ, Battersby L: The relation of sleep difficulties to fatigue, mood and disability in chronic fatigue syndrome. J Psychosom Res 1997, 42(6):597-605.
- [2]Fava M: Daytime sleepiness and insomnia as correlates of depression. J Clin Psychiatry 2004, 65(Suppl 16):27-32.
- [3]Vgontzas AN: Does obesity play a major role in the pathogenesis of sleep apnea and its associated manifestations via inflammation, visceral adiposity, and insulin resistance. Arch Physiol Biochem 2008, 114(4):211-223.
- [4]Barcelo A, Barbe F, Llompart E, Mayoralas LR, Ladaria A, Bosch M, Agusti AG: Effects of obesity on C-reactive protein level and metabolic disturbances in male patients with obstructive sleep apnea. Am J Med 2004, 117(2):118-121.
- [5]Panossian LA, Avidan AY: Review of sleep disorders. Med Clin North Am 2009, 93(2):407-425.
- [6]Alves ES, Lira FS, Santos RV, Tufik S, de-Mello MT: Obesity, diabetes and OSAS induce of sleep disorders: exercise as therapy. Lipids Health Dis 2011, 10:148. BioMed Central Full Text
- [7]Vgontzas AN, Papanicolaou DA, Bixler EO, Hopper K, Lotsikas A, Lin HM, Kales A, Chrousos GP: Sleep apnea and daytime sleepiness and fatigue: relation to visceral obesity, insulin resistance, and hypercytokinemia. J Clin Endocrinol Metab 2000, 85(3):1151-1158.
- [8]Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V: Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med 2005, 353(19):2034-2041.
- [9]Yang PY, Ho KH, Chen HC, Chien MY: Exercise training improves sleep quality in middle-aged and older adults with sleep problems: a systematic review. J Physiother 2012, 58(3):157-163.
- [10]Morin CM, LeBlanc M, Daley M, Gregoire JP, Mérette C: Epidemiology of insomnia: prevalence, self-help treatments, consultations, and determinants of help-seeking behaviors. Sleep Med 2006, 7(2):123-130. Epub 2006 Feb 3
- [11]Ohayon MM, Partinen M: Insomnia and global sleep dissatisfaction in Finland. J Sleep Res 2002, 11(4):339-346.
- [12]King AC, Pruitt LA, Woo S, Castro CM, Ahn DK, Vitiello MV, Woodward SH, Bliwise DL: Effects of moderate-intensity exercise on polysomnographic and subjective sleep quality in older adults with mild to moderate sleep complaints. J Gerontol A Biol Sci Med Sci 2008, 63(9):997-1004.
- [13]Algul A, Ates MA, Semiz UB, Basoglu C, Ebrinc S, Gecici O, Gülsün M, Kardesoglu E, Cetin M: Evaluation of general psychopathology, subjective sleep quality, and health-related quality of life in patients withobesity. Int J Psychiatry Med 2009, 39(3):297-312.
- [14]Patel SR, Blackwell T, Redline S, Ancoli-Israel S, Cauley JA, Hillier TA, Lewis CE, Orwoll ES, Stefanick ML, Taylor BC, Yaffe K, Stone KL, Osteoporotic Fractures in Men Research Group, Study of Osteoporotic Fractures Research Group: The association between sleep duration and obesity in older adults. Int J Obes (Lond) 2008, 32(12):1825-1834. Epub 2008 Oct 21
- [15]Gangwisch JE, Malaspina D, Boden-Albala B, Heymsfield SB: Inadequate sleep as a risk factor for obesity: analyses of the NHANES I. Sleep 2005, 28(10):1289-1296.
- [16]Chaput JP, Després JP, Bouchard C, Tremblay A: The association between short sleep duration and weight gain is dependent on disinhibited eating behavior in adults. Sleep 2011, 34(10):1291-1297.
- [17]St-Onge MP, Roberts AL, Chen J, Kelleman M, O’Keeffe M, Roychoudhury A, Jones PJ: Short sleep duration increases energy intakes but does not change energy expenditure in normal-weight individuals. Am J Clin Nutr 2011, 94(2):410-416. Epub 2011 Jun 29
- [18]Taheri S, Lin L, Austin D, Young T, Mignot E: Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index. PLoS Med 2004, 1(3):e62. Epub 2004 Dec 7
- [19]Visser M, Bouter LM, McQuillan GM, Wener MH, Harris TB: Elevated C-reactive protein levels in overweight and obese adults. JAMA 1999, 282(22):2131-2135.
- [20]Cancello R, Clément K: Is obesity an inflammatory illness? Role of low-grade inflammation and macrophage infiltration in human white adipose tissue. BJOG 2006, 113(10):1141-1147. Epub 2006 Aug 10
- [21]Shamsuzzaman AS, Winnicki M, Lanfranchi P, Wolk R, Kara T, Accurso V, Somers VK: Elevated C-reactive protein in patients with obstructive sleep apnea. Circulation 2002, 105(21):2462-2464.
- [22]Yokoe T, Minoguchi K, Matsuo H, Oda N, Minoguchi H, Yoshino G, Hirano T, Adachi M: Elevated levels of C-reactive protein and interleukin-6 in patients with obstructive sleep apnea syndrome are decreased by nasal continuous positive airway pressure. Circulation 2003, 107(8):1129-1134.
- [23]Carpagnano GE, Kharitonov SA, Resta O, Foschino-Barbaro MP, Gramiccioni E, Barnes PJ: Increased 8-isoprostane and interleukin-6 in breath condensate of obstructive sleep apnea patients. Chest 2002, 122(4):1162-1167.
- [24]Entzian P, Linnemann K, Schlaak M, Zabel P: Obstructive sleep apnea syndrome and circadian rhythms of hormones and cytokines. Am J Respir Crit Care Med 1996, 153(3):1080-1086.
- [25]Patel SR, Zhu X, Storfer-Isser A, Mehra R, Jenny NS, Tracy R, Redline S: Sleep duration and biomarkers of inflammation. Sleep 2009, 32(2):200-204.
- [26]Williams CJ, Hu FB, Patel SR, Mantzoros CS: Sleep duration and snoring in relation to biomarkers of cardiovascular disease risk among women with type 2 diabetes. Diabetes Care 2007, 30(5):1233-1240. Epub 2007 Feb 23
- [27]Meier-Ewert HK, Ridker PM, Rifai N, Regan MM, Price NJ, Dinges DF, Mullington JM: Effect of sleep loss on C-reactive protein, an inflammatory marker of cardiovascular risk. J Am Coll Cardiol 2004, 43(4):678-683.
- [28]Irwin MR, Wang M, Campomayor CO, Collado-Hidalgo A, Cole S: Sleep deprivation and activation of morning levels of cellular and genomic markers of inflammation. Arch Intern Med 2006, 166(16):1756-1762.
- [29]Pickup JC: Inflammation and activated innate immunity in the pathogenesis of type 2 diabetes. Diabetes Care 2004, 27(3):813-823.
- [30]Wang Z, Nakayama T: Inflammation, a link between obesity and cardiovascular disease. Mediators Inflamm 2010, 2010:535918. Epub 2010 Aug 5
- [31]Rohleder N, Aringer M, Boentert M: Role of interleukin-6 in stress, sleep, and fatigue. Ann N Y Acad Sci 2012, 1261:88-96.
- [32]Patel SR, Hu FB: Short sleep duration and weight gain: a systematic review. Obesity (Silver Spring) 2008, 16(3):643-653. Epub 2008 Jan 17
- [33]Kline CE, Crowley EP, Ewing GB, Burch JB, Blair SN, Durstine JL, Davis JM, Youngstedt SD: The effect of exercise training on obstructive sleep apnea and sleep quality: a randomized controlled trial. Sleep 2011, 34(12):1631-1640.
- [34]Tuomilehto HP, Seppä JM, Partinen MM, Peltonen M, Gylling H, Tuomilehto JO, Vanninen EJ, Kokkarinen J, Sahlman JK, Martikainen T, Soini EJ, Randell J, Tukiainen H, Uusitupa M, Kuopio SleepApnea Group: Lifestyle intervention with weight reduction: first-line treatment in mild obstructive sleep apnea. Am J Respir Crit Care Med 2009, 179(4):320-327. Epub 2008 Nov 14
- [35]Foster GD, Borradaile KE, Sanders MH, Millman R, Zammit G, Newman AB, Wadden TA, Kelley D, Wing RR, Pi-Sunyer FX, Reboussin D, Kuna ST, Sleep AHEAD Research Group of Look AHEAD Research Group: A randomized study on the effect of weight loss on obstructive sleep apnea among obese patients with type 2 diabetes: the Sleep AHEAD study. Arch Intern Med 2009, 169(17):1619-1626.
- [36]Thomson CA, Morrow KL, Flatt SW, Wertheim BC, Perfect MM, Ravia JJ, Sherwood NE, Karanja N, Rock CL: Relationship between sleep quality and quantity and weight loss in women participating in a weight-loss intervention trial. Obesity (Silver Spring) 2012, 20(7):1419-1425. Epub 2012 Mar 8
- [37]Peuhkuri K, Sihvola N, Korpela R: Diet promotes sleep duration and quality. Nutr Res 2012, 32(5):309-319. Epub 2012 Apr 25
- [38]Bäckhed F, Ding H, Wang T, Hooper LV, Koh GY, Nagy A, Semenkovich CF, Gordon JI: The gut microbiota as an environmental factor that regulates fat storage. Proc Natl Acad Sci USA 2004, 101(44):15718-15723. Epub 2004 Oct 25
- [39]DiBaise JK, Zhang H, Crowell MD, Krajmalnik-Brown R, Decker GA, Rittmann BE: Gut microbiota and its possible relationship with obesity. Mayo Clin Proc 2008, 83(4):460-469.
- [40]Munukka E, Wiklund P, Pekkala S, Völgyi E, Xu L, Cheng S, Lyytikäinen A, Marjomäki V, Alen M, Vaahtovuo J, Keinänen-Kiukaanniemi S, Cheng S: Women with and without metabolic disorder differ in their gut microbiota composition. Obesity (Silver Spring) 2012, 20(5):1082-1087. Epub 2012 Jan 30
- [41]Fetissov SO, Déchelotte P: The new link between gut-brain axis and neuropsychiatric disorders. Curr Opin Clin Nutr Metab Care 2011, 14(5):477-482.
- [42]Forsythe P, Sudo N, Dinan T, Taylor VH, Bienenstock J: Mood and gut feelings. Brain Behav Immun 2010, 24(1):9-16. Epub 2009 May 28
- [43]Wu GD, Chen J, Hoffmann C, Bittinger K, Chen YY, Keilbaugh SA, Bewtra M, Knights D, Walters WA, Knight R, Sinha R, Gilroy E, Gupta K, Baldassano R, Nessel L, Li H, Bushman FD, Lewis JD: Linking long-term dietary patterns with gut microbial enterotypes. Science 2011, 334(6052):105-108. Epub 2011 Sep 1
- [44]Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M: Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med 2008, 4(5):487-504.
- [45]Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee IM, Nieman DC, Swain DP, American College of Sports Medicine: American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc 2011, 43(7):1334-1359.
- [46]Partinen M, Gislason T: Basic Nordic Sleep Questionnaire (BNSQ): a quantitated measure of subjective sleep complaints. J Sleep Res 1995, 4(S1):150-155.
- [47]Johns MW: A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 1991, 14(6):540-545.
- [48]Rastas M, Seppänen R, Knuts LR, Karvetti RL, Varo P: Ruokien ravintoainesisälto (Nutrient Composition of Foods). Turku: Kansaneläkelaitos; 1997.
- [49]Laukkanen R, Oja P, Pasanen M, Vuori I: Validity of a two kilometer walking test for estimating maximal aerobic power in overweight adults. Int J Obes Relat Metab Disord 1992, 16(4):263-268.
- [50]Paalasmaa J, Waris M, Toivonen H, Leppäkorpi L, Partinen M: Unobtrusive online monitoring of sleep at home. In Proceedings of the The 34th Annual International Conference of the IEEE Engineering in Medicine and Biology Society: 28 August- 1 September. San Diego; 2012.
- [51]Yang CY, Chiou AF: Predictors of sleep quality in community-dwelling older adults in Northern Taiwan. J Nurs Res 2012, 20(4):249-260.
- [52]Länsimies-Antikainen H, Pietilä AM, Laitinen T, Kiviniemi V, Rauramaa R: Is informed consent related to success in exercise and diet intervention as evaluated at 12 months?DR’s EXTRA study. BMC Med Ethics 2010, 11:9. BioMed Central Full Text
PDF