Skip to main content

Respiratory Rehabilitation, Work Capacity, and Sleep-Related Disorders in Obesity

  • Chapter
  • First Online:
Book cover Disabling Obesity

Abstract

Obesity has increased in the recent decades. It is the product of a multifactorial etiology and behavioral and social/cultural factors. Obesity implies a reduction in work capacity and a lower nocturnal sustainable level of ventilation. These conditions generally determine functional disabilities. Diet and physical activity are the classical therapeutic references of obesity, together with positive airway pressure in case of sleep-related disorders. This chapter describes the advisable indications and opportunities in recommending work programs at different power outputs considering the analysis in obese subjects of their work capacity and cardiopulmonary adaptation. Moreover, it describes biochemical modifications on some accepted drivers of cardiac and respiratory functions in normal subjects, and their likely effectiveness in conditioning work capacity in obesity. Finally, it talks about the most severe disorders related to sleep like obesity hypoventilation syndrome and obstructive sleep apnea syndrome and their standard treatment.

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

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Behazin N, Jones SB, Cohen RI, Loring SH (2010) Respiratory restriction and elevated pleural and esophageal pressures in morbid obesity. J Appl Physiol 108:212–218

    Article  PubMed  Google Scholar 

  • Berger KI, Ayappa I, Sorkin IB, Norman RG, Rapoport DM, Goldring RM (2002) Postevent ventilation as a function of CO2 load during respiratory events in obstructive sleep apnea. J Appl Physiol 93:917–924

    PubMed  Google Scholar 

  • Berry RB, Gleeson K (1997) Respiratory arousal from sleep: mechanisms and significance. Sleep 20:654–675

    PubMed  CAS  Google Scholar 

  • Braghiroli A, Marrone O, Sanna A, Vianello O, Ferini Strambi L, Manni R, Mondini S, Spaggiari C (2001). Linee guida di procedura diagnostica nella sindrome delle apnee nel sonno dell’adulto. Rassegna di Patologia dell’Apparato Respiratorio 16:278–280

    Google Scholar 

  • Braunwald E, Ross JJ, Sonnenblick ES (1976) In mechanisms of contraction of the normal and failing heart, Little Brown and Co, Boston, pp 166–200.

    Google Scholar 

  • Budweiser S, Riedl SG, Jorres RA, Heinemann F, Pfeifer M (2007) Mortality and prognostic factors in patients with obesity–hypoventilation syndrome undergoing noninvasive ventilation. J Intern Med 261:375–383

    Article  PubMed  CAS  Google Scholar 

  • Cerretelli P, Di Prampero E (1987) Gas exchange in exercise. In: Farhi LE, Tenney SM (eds) Handbook of physiology, the respiratory system. Gas exchange, American Physiology Society, Bethesda, pp 307–309

    Google Scholar 

  • Fanfulla F, Taurino AE, Lupo ND, Trentin R, D’Ambrosio C, Nava S (2007) Effect of sleep on patient/ventilator asynchrony in patients undergoing chronic non-invasive mechanical ventilation. Respir Med 101:1702–1707

    Article  PubMed  Google Scholar 

  • Fogel RB, Trinder J, White DP, Malhotra A, Raneri J, Schory K, Kleverlann D, Pierce RJ (2005) The effect of sleep onset on upper airway muscle activity in patients with sleep apnoea vs. controls. J Physiol 564:549–562

    Article  PubMed  CAS  Google Scholar 

  • Gibala MJ, Little JP, Macdonald MJ, Hawley JA (2012) Physiological adaptations to low-volume, high-intensity interval training in health and disease. J Physiol 590:1077–1084

    Article  PubMed  CAS  Google Scholar 

  • Guo YF, Sforza E, Janssens JP (2007) Respiratory patterns during sleep in obesity-hypoventilation patients treated with nocturnal pressure support: a preliminary report. Chest 131:1090–1099

    Article  PubMed  Google Scholar 

  • Hamilton MT, Booth FW (2000) Skeletal muscle adaptation to exercise: a century of progress. J Appl Physiol 88:327–331

    PubMed  CAS  Google Scholar 

  • Hardarson T, Skarphedinsson JO, Sveinsson T (1998) Importance of the lactate anion in control of breathing. J Appl Physiol 84:411–416

    Article  PubMed  CAS  Google Scholar 

  • Isono S, Remmers JE, Tanaka A, Sho Y, Sato J, Nishino T (1997) Anatomy of pharynx in patients with obstructive sleep apnea and in normal subjects. J Appl Physiol 82:1319–1326

    PubMed  CAS  Google Scholar 

  • Knochel JP, Blachley JD, Johnson JH, Carter NW (1985) Muscle cell electrical hyperpolarization and reduced exercise hyperkaliemia in physically conditioned dogs. J Clin Invest 75:740–745

    Article  PubMed  CAS  Google Scholar 

  • Kuna ST, Gurubhagavatula I, Maislin G, Hin S, Hartwig KC, McCloskey S, Hachadoorian R, Hurley S, Gupta R, Staley B, Atwood CW (2011) Noninferiority of functional outcome in ambulatory management of obstructive sleep apnea. Am J Respir Crit Care Med 183:1238–1244

    Article  PubMed  Google Scholar 

  • Lafortuna CL, Lazzer S, Agosti F, Busti C, Galli R, Mazzilli G, Sartorio A (2010) Metabolic responses to submaximal treadmill walking and cycle ergometer pedalling in obese adolescents. Scand J Med Sci Sports 20:630–637

    Article  PubMed  CAS  Google Scholar 

  • Lakoski SG, Barlow CE, Farrell SW, Berry ID, Morrow JR, Haskell WL (2011) Impact of body mass index, physical activity, and other clinical factors on cardiorespiratory fitness (from the Cooper Center Longitudinal Study). Am J Cardiol 108:34–39

    Article  PubMed  Google Scholar 

  • LaMonte MJ, Blair SN (2006) Physical activity, cardiorespiratory fitness, and adiposity: contributions to disease risk. Curr Opin Clin Nutr Metab Care 9:540–546

    Article  PubMed  Google Scholar 

  • Lauer MS, Anderson KM, Kannel WB, Levy D (1991) The impact of obesity on left ventricular mass and geometry. JAMA 266:231–236

    Article  PubMed  CAS  Google Scholar 

  • Marin JM, Carrizo SJ, Vicente E, Agusti AG (2005) Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 365:1046–1053

    PubMed  Google Scholar 

  • Masa JF, Celli BR, Riesco JA, Hernández M, Sánchez De Cos J, Disdier C (2001) The obesity hypoventilation syndrome can be treated with noninvasive mechanical ventilation. Chest 119:1102–1107

    Google Scholar 

  • Masa JF, Corral J, Pereira R, Joaquin Duran-Cantolla J, Cabello M, Hernàndez-Blasco L, Monasterio C, Alonso A, Chiner E, Rubio M, Garcia-Ledesma E, Cacelo L, Carpizo R, Sacristan L, Salord N, Carrera M, Sancho-Chust JN, Embid C, Vàsquez-Polo F-J, Negrin MA, Montserrat JM (2011) Effectiveness of home respiratory polygraphy for the diagnosis of sleep apnoea and hypopnoea syndrome. Thorax 66:567–573

    Article  PubMed  Google Scholar 

  • Matsumura N, Nishijma H, Koijma S, Hashimoto F, Minami M, Yasuda H (1983) Determination of anaerobic threshold for assessment of functional state in patients with chronic heart failure. Circulation 68:360–367

    Article  PubMed  CAS  Google Scholar 

  • Matus CD, Klaege K (2007) Exercise and weight management. Prim Care Clin Office Pract 34:109–116

    Article  Google Scholar 

  • Mitchell JH, Victor RG (1996) Neural control of the cardiovascular system: insights from muscle sympathetic nerve recordings in humans. Med Sci Sports Exerc 28(suppl 10):S60–S69

    Article  CAS  Google Scholar 

  • Mokhlesi B, Tulaimat A, Faibussowitsch I, Wang Y, Evans A (2007) Obesity hypoventilation syndrome: prevalence and predictors in patients with obstructive sleep apnea. Sleep Breat 11:117–124

    Article  Google Scholar 

  • Montserrat JM, Navajas D, Parra O, Farré R (2010) Continuous positive airway pressure treatment in patients with OSA. Eur Respir Mon 50:244–266

    Article  Google Scholar 

  • Mutlu GM, Rubinstein I (2005) The saga of obstructive sleep apnea syndrome and daytime hypercapnia: work in progress. Chest 127:698–699

    Article  PubMed  Google Scholar 

  • Naimark A, Cherniack RM (1960) Compliance of the respiratory system and its components in health and obesity. J Appl Physiol 15:377–382

    PubMed  CAS  Google Scholar 

  • Pérez de Llano LA, Golpe R, Piquer MO, Racamonde AV, Caruncho MV, Muinelos OC, Carro CA (2005) Short-term and long-term effects of nasal intermittent positive pressure ventilation in patients with obesity-hypoventilation syndrome. Chest 128:587–594

    Article  Google Scholar 

  • Perseghin G, Scifo P, De Corbelli F, Pagliato E, Battezzati A, Arcelloni C, Vanzulli A, Testolin G, Pozza G, Del Maschio A, Luzi L (1999) Intramyocellular triglyceride contents as a determinant of in vivo insulin resistance in humans. Diabetes 48:1600–1606

    Article  PubMed  CAS  Google Scholar 

  • Phillipson EA (1978) Control of breathing during sleep. Am Rev Respir Dis 118:909–939

    PubMed  CAS  Google Scholar 

  • Piper AJ, Wang D, Yee BJ, Barnes DJ, Grunstein RR (2008) Randomised trial of CPAP vs bilevel support in the treatment of obesity hypoventilation syndrome without severe nocturnal desaturation.Thorax 63:395–401

    Google Scholar 

  • Piper AJ (2010) Obesity hypoventilation syndrome: therapeutic implications for treatment. Expert Rev Resp Med 4:57–70

    Article  Google Scholar 

  • Powers MA (2008) The obesity hypoventilation syndrome. Respir Care 53:1723–1730

    PubMed  Google Scholar 

  • Priou P, Hamel J-F, Person C, Meslier N, Racineux J-L, Urban T, Gagnadoux F (2010) Long-term outcome of noninvasive positive pressure ventilation for obesity hypoventilation syndrome. Chest 138:84–90

    Article  PubMed  Google Scholar 

  • Salvadori A, Fanari P, Cavestri R, Mazza P, Baudo S, Longhini E (1991) Relationship between body mass and tolerance to physical stress in obese patients. Respiration 58:311–315

    Article  PubMed  CAS  Google Scholar 

  • Salvadori A, Fanari P, Mazza P, Agosti R, Longhini E (1992) Work capacity and cardiopulmonary adaptation of the obese subject during exercise testing. Chest 101:674–679

    Article  PubMed  CAS  Google Scholar 

  • Salvadori A, Fanari P, Fontana M, Buontempi L, Saezza A, Baudo S, Miserocchi G, Longhini E (1999a) Oxygen uptake and cardiac performance in obese and normal subjects during exercise. Respiration 66:25–33

    Article  PubMed  CAS  Google Scholar 

  • Salvadori A, Fanari P, Palmulli P, Giacomotti E, Arreghini M, Bolla G, Miserocchi G, Longhini E (1999b) Cardiovascular and adrenergic response to exercise in obese subjects. J Clin and Basic Cardiol 2:229–236

    Google Scholar 

  • Salvadori A, Fanari P, Giacomotti E, Palmulli P, Bolla G, Tovaglieri I, Luzi l, Longhini E (2003) Kinetics of catecholamines and potassium, and heart rate during exercise testing in obese subjects. Eur J Nutr 42:181–187

    Google Scholar 

  • Salvadori A, Fanari P, Dworzak F, Azan G, Brunani A, Tovaglieri I, Luzi L, Longhini E (2004) Respiratory and metabolic responses during exercise, and skeletal muscle morphology in obesity. Sport Sci Health 1:47–54

    Article  Google Scholar 

  • Salvadori A, Fanari P, Tovaglieri I, Giacomotti E, Nibbio F, Belardi F, Longhini E (2008) Ventilation and its control during incremental exercise in obesity. Respiration 75:26–33

    Article  PubMed  Google Scholar 

  • Salvadori A, Fanari P, Marzullo P, Codecasa F, Tovaglieri I, Cornacchia M, Walker G, Brunani A, Longhini E (2010) Dinamics of GH secretion during incremental exercise in obesity, before and after a short period of training at different work-loads. Clin Endocrinol 73: 491–496

    Google Scholar 

  • Schwab RJ, Pasirstein M, Pierson R, Mackley A, Hachadoorian R, Arens R, Maislin G, Pack AI (2003) Identification of upper airway anatomic risk factors for obstructive sleep apnea with volumetric magnetic resonance imaging. Am J Respir Crit Care Med 168:522–530

    Article  PubMed  Google Scholar 

  • Stadler DL, McEvoy RD, Bradley J, Paul D, Catcheside PG (2010) Changes in lung volume and diaphragm muscle activity at sleep onset in obese obstructive sleep apnea patients vs. healthy-weight controls. J Appl Physiol 109:1027–1036

    Article  PubMed  Google Scholar 

  • Steier J, Jolley CJ, Seymour JM, Roughton M, Polkey MI, Moxham J (2009) Neural respiratory drive in obesity. Thorax 64:719–725

    Article  PubMed  CAS  Google Scholar 

  • Storre JH, Seuthe B, Fiechter R, Milioglou S, Dreher M, Sorichter S, Windisch W (2006) Average volume-assured pressure support in obesity hypoventilation: A randomized crossover trial. Chest 130:815–821

    Article  PubMed  Google Scholar 

  • Tabachnik E, Muller NL, Bryan AC, Levison H (1981) Changes in ventilation and chest wall mechanics during sleep in normal adolescents. J Appl Physiol 51:557–564

    PubMed  CAS  Google Scholar 

  • Wasserman K, Whipp J (1975) Exercise physiology in health and disease. Am Rev Respir Dis 112:219–246

    PubMed  CAS  Google Scholar 

  • Wasserman K (1984) The anaerobic threshold measurement to evaluate exercise performance. Am Rev Respir Dis 129(Suppl):S35–S40

    PubMed  CAS  Google Scholar 

  • Wellman A, Eckert DJ, Jordan AS, Edwards BA, Passaglia CL, Jackson AC, Gautam S, Owens RL, Malhotra A, White DP (2011) A method for measuring and modelling the physiological traits causing obstructive sleep apnea. J Appl Physiol 110:1627–1637

    Article  PubMed  Google Scholar 

  • Whipp BJ, Wasserman K (1969) Efficiency of muscular work. J Appl Physiol 26:644–648

    PubMed  CAS  Google Scholar 

  • Yap JCH, Watson RA, Gilbey S, Pride NB (1995) Effects of posture on respiratory mechanics in obesity. J Appl Physiol 79:1199–1205

    PubMed  CAS  Google Scholar 

  • Younes M (2003) Contributions of upper airway mechanics and control mechanisms to severity of obstructive apnea. Am J Respir Crit Care Med 148:645–658

    Article  Google Scholar 

  • Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328:1230–1235

    Article  PubMed  CAS  Google Scholar 

  • Zarich SW, Kowalchuk EA, Nesto RW (1991) Left ventricular filling abnormalities in asymptomatic morbid obesity. Am J Cardiol 68:377–381

    Article  PubMed  CAS  Google Scholar 

  • Zipes DP (1992) Management of cardiac arrhythmias. Pharmacological, electrical, and surgical techniques. In: Braunwald E (ed) Heart disease: a textbook of cardiovascular medicine. Saunders, Philadelphia, pp 644–646

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Alberto Salvadori .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Salvadori, A., Fanari, P., Braghiroli, A. (2013). Respiratory Rehabilitation, Work Capacity, and Sleep-Related Disorders in Obesity. In: Capodaglio, P., Faintuch, J., Liuzzi, A. (eds) Disabling Obesity. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-35972-9_8

Download citation

Publish with us

Policies and ethics