Sleep and Breathing

, Volume 23, Issue 1, pp 143–151 | Cite as

Diet associated with exercise improves baroreflex control of sympathetic nerve activity in metabolic syndrome and sleep apnea patients

  • Edgar Toschi-DiasEmail author
  • Ivani C. Trombetta
  • Valdo J. D. Silva
  • Cristiane Maki-Nunes
  • Felipe X. Cepeda
  • Maria Janieire N. N. Alves
  • Glauce L. Carvalho
  • Luciano F. Drager
  • Geraldo Lorenzi-Filho
  • Carlos E. Negrão
  • Maria Urbana P. B. Rondon
Sleep Breathing Physiology and Disorders • Original Article



We tested the hypothesis that (i) diet associated with exercise would improve arterial baroreflex (ABR) control in metabolic syndrome (MetS) patients with and without obstructive sleep apnea (OSA) and (ii) the effects of this intervention would be more pronounced in patients with OSA.


Forty-six MetS patients without (noOSA) and with OSA (apnea-hypopnea index, AHI > 15 events/h) were allocated to no treatment (control, C) or hypocaloric diet (− 500 kcal/day) associated with exercise (40 min, bicycle exercise, 3 times/week) for 4 months (treatment, T), resulting in four groups: noOSA-C (n = 10), OSA-C (n = 12), noOSA-T (n = 13), and OSA-T (n = 11). Muscle sympathetic nerve activity (MSNA), beat-to-beat BP, and spontaneous arterial baroreflex function of MSNA (ABRMSNA, gain and time delay) were assessed at study entry and end.


No significant changes occurred in C groups. In contrast, treatment in both patients with and without OSA led to a significant decrease in weight (P < 0.05) and the number of MetS factors (P = 0.03). AHI declined only in the OSA-T group (31 ± 5 to 17 ± 4 events/h, P < 0.05). Systolic BP decreased in both treatment groups, and diastolic BP decreased significantly only in the noOSA-T group. Treatment decreased MSNA in both groups. Compared with baseline, ABRMSNA gain increased in both OSA-T (13 ± 1 vs. 24 ± 2 a.u./mmHg, P = 0.01) and noOSA-T (27 ± 3 vs. 37 ± 3 a.u./mmHg, P = 0.03) groups. The time delay of ABRMSNA was reduced only in the OSA-T group (4.1 ± 0.2 s vs. 2.8 ± 0.3 s, P = 0.04).


Diet associated with exercise improves baroreflex control of sympathetic nerve activity and MetS components in patients with MetS regardless of OSA.


Metabolic syndrome Obstructive sleep apnea Sympathetic nervous system Baroreflex control Exercise Diet 



This study was supported by Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP, no. 2011/17533-6 and no. 2010/50048-1) and, in part, by Fundação Zerbini. Edgar Toschi-Dias was supported by Conselho Nacional de Pesquisa (CNPq) and FAPESP (no. 140643/2009-5 and no. 2013/07651-7, respectively). Ivani C. Trombetta (no. 2008/03714-6), Luciano F. Drager (no. 2012/02953-2), and Felipe X. Cepeda (no. 2015/17533-6 and no. 2016/16831-7) were supported by FAPESP. Cristiane Maki-Nunes was supported by CAPES. Carlos E. Negrao, Geraldo Lorenzi-Filho, and Maria Urbana P.B. Rondon were supported by CNPq (no. 303573/2015-5, no. 309737/2013-3, and no. 309821/2014-2, respectively).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical standards

The study has been performed in accordance with the ethical standards laid down by the 1964 Declaration of Helsinki. The study was approved by the Scientific Commission of the Heart Institute (InCor), University of São Paulo Medical School and by the Human Subject Protection Committee of the Clinical Hospital Medical School of the University of São Paulo (no. 1038/07). Informed consent was obtained from all subjects prior to inclusion.


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Edgar Toschi-Dias
    • 1
    Email author
  • Ivani C. Trombetta
    • 2
  • Valdo J. D. Silva
    • 3
  • Cristiane Maki-Nunes
    • 1
  • Felipe X. Cepeda
    • 1
  • Maria Janieire N. N. Alves
    • 1
  • Glauce L. Carvalho
    • 1
  • Luciano F. Drager
    • 1
  • Geraldo Lorenzi-Filho
    • 1
  • Carlos E. Negrão
    • 1
    • 4
  • Maria Urbana P. B. Rondon
    • 4
  1. 1.Heart Institute (InCor)University of São Paulo Medical SchoolSão PauloBrazil
  2. 2.Universidade Nove de JulhoSão PauloBrazil
  3. 3.Biological Sciences InstituteTriangulo Mineiro Federal UniversityUberabaBrazil
  4. 4.School of Physical Education and SportUniversity of São PauloSão PauloBrazil

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