Do you suffer from obstructive sleep apnea? Are you tired during the day? In middle-aged adults, the prevalence of obstructive sleep apnea is estimated to be 4%-9%, although the condition is often undiagnosed and untreated (1).
What is it? “Obstructive sleep apnea is defined by the occurrence of daytime sleepiness, loud snoring, witnessed breathing interruption, or awakenings due to gasping or choking in the presence of at least 5 obstructive respiratory events per hour of sleep,” (1). The number of apnea or hypopnea events per hour of sleep reflects the Apnea– Hypopnea Index (AHI), which classifies the severity of obstructive sleep apnea. An AHI of 5-15 is mild, 15-30 is moderate, and > 30 events per hour characterize severe sleep apnea (1).
What are the risk factors? Risk factors for obstructive sleep apnea are dependent on gender, age, weight, neck girth, snoring, and frequent breathing pauses. With that being said, obstructive sleep apnea is a risk factor in itself for a number of chronic diseases, such as hypertension, diabetes, stroke, and cardiovascular disease (1).
Can your diet really help improve your quality of sleep?
Fat. A recent publication (1) examined dietary intake in patients with newly diagnosed obstructive sleep apnea. Of particular interest was the percentage of fat contributing to their total caloric intake. Participants with a BMI < 30 kg/m2 who received 35% or more energy from fat had significantly higher AHI than those with less than 35% energy from fat (P = .022). Among those with BMI ≥ 30 kg/m2, elevated fat intake was associated with a higher AHI although the difference is not significant.
Processed meats. Although not significant, the intake of processed meats was associated with sleep apnea (P = .056)
Dairy. Low-fat dairy was found to be significantly associated with less severity of sleep apnea in overweight participants.
Snacks. Consumption of snacks was associated with increased apnea in subjects with BMI < 30 kg/m2 (P = .016 but not in participants with BMI ≥ 30 kg/m2.
Key Takeaways (1).
1. In overweight patients, severity of sleep apnea was related to an increased intake of saturated fats
2. Intake of processed meats was associated with sleep apnea
3. Low-fat dairy was associated with a decreased severity of obstructive sleep apnea on presentation.
Tart cherries and kiwifruit. Additional research found an association between consumption of fruit, specifically tart cherries and kiwifruit, and enhanced sleep in individuals with sleep disorders. This association may be due to the presence of antioxidants in cherries, which help to reduce oxidative stress in patients with obstructive sleep apnea. It is also important to note the influence of consumption time and quantity on total sleep time and sleep efficacy. The consumption of 2 kiwifruits, 1 hour before bedtime enhanced the sleep of individuals with sleep disorders (2).
What are the dietary recommendations if I suffer from obstructive sleep apnea (1)?
1. Fat intake should be less than 10% total calories per day
2. Encourage the consumption monounsaturated “healthy” fats and limit saturated “unhealthy” fats
3. If dairy products are eaten, they should be of the low-fat variety.
What about exercise?
As a whole, the scientific literature indicates improved clinical outcomes for obstructive sleep apnea patients who are physically active. These improved clinical outcomes include a “reduction in disease severity and in daytime sleepiness, as well as an increase in sleep efficiency and in peak oxygen consumption, regardless of weight loss,” (3). Furthermore, exercise has been shown to improve AHI and cardiorespiratory fitness in patients with obstructive sleep apnea (4,5).
Obstructive sleep apnea has become quite common in the United States and, just as with any other disease state or condition, nutrition and exercise can play a significant role in improving clinical outcomes. If you are suffering from obstructive sleep apnea and are looking for a longer and better-quality sleep, try to reduce fat to < 10% of your daily caloric intake and take part in at least 150 minutes/week of moderate-intensity, or 75 minutes/week of vigorous-intensity aerobic physical activity.
(1) Bove C, Jain V, Younes N, Hynes M. What You Eat Could Affect Your Sleep: Dietary Findings in Patients With Newly Diagnosed Obstructive Sleep Apnea. American Journal of Lifestyle Medicine 2018;
(2) St-Onge MP, Mikic A, Pietrolungo CE. Effects of Diet on Sleep Quality. American Society for Nutrition 2016; 7: 938-949.
(3) de Andrade FM, Pedrosa RP. The role of physical exercise in obstructive sleep apnea. Jornal Brasileiro de Pneumologia 2016; 42(6): 457-464
(4) Aiello KD, Caughey WG, Nelluri B, Sharma A, Mookadam F, Mookadam M. Effect of exercise training on sleep apnea: A systematic review and meta-analysis. Respiratory Medicine 2016; 116: 85-92.
(5) Iftikhar IH, Kline CE, Youngstedt, SD. Effects of Exercise Training on Sleep Apnea: A Meta-analysis. Lung 2014; 192(1): 175-184.
Written by Nicole Lindel ~ Nutrition Education Master’s Student at Columbia University