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Eduardo Salazar, Mayank Gupta, Meynard Toledo, Qiao Wang, Pavan Turaga, James M. Parish and Matthew P. Buman

Obstructive sleep apnea (OSA) is a condition characterized by upper airway obstruction during sleep leading to intermittent periods of hypoxia and nighttime awakening. It has been identified as a major risk factor for cardiovascular disease, stroke, and sudden death ( Drager, Togeiro, Polotsky

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Julie K. Black, Anna C. Whittaker and George M. Balanos

sleep disorder called obstructive sleep apnea (OSA; Al Lawati, Patel, & Ayas, 2009 ; Banno & Kryger, 2005 ). OSA is caused by upper airway collapse resulting in repeated incidence of airflow cessation (apnea) or airflow reduction (hypopnea), and consequently leads to arousals from sleep, alongside

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Kristin L. Jonvik, Jan-Willem van Dijk, Joan M.G. Senden, Luc J.C. van Loon and Lex B. Verdijk

et al., 2010 ). Although “systemic hypoxia” has also been used with respect to maximal underwater exercise ( Schagatay, 2010 ), the term “dynamic apnea” more appropriately reflects the different physiological characteristics associated with these breath-holding activities. Interestingly, recent work

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Matthew J. Barlow, Antonis Elia, Oliver M. Shannon, Angeliki Zacharogianni and Angelica Lodin-Sundstrom

Competitive apnea also known as free diving or breath-hold diving is an increasingly popular sport in which individuals attempt to achieve the greatest possible stationary breath-hold duration (i.e., static apnea) or maximal underwater distance or depth (i.e., dynamic apnea). During apnea, oxygen

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Raymonde E. Jean, Manideep Duttuluri, Charlisa D. Gibson, Sadaf Mir, Katherine Fuhrmann, Edward Eden and Azhar Supariwala

Background:

Exercise improves sleep quality, yet people with untreated obstructive sleep apnea (OSA) may engage in less physical activity (PA) due to fatigue and daytime sleepiness. We examined changes in PA and sleep quality before and after treatment with continuous positive airway pressure (CPAP) in OSA patients.

Methods:

In this prospective longitudinal study, persons with a primary diagnosis of OSA were enrolled at a community-based hospital in New York City. At 3 time intervals pre- and post-CPAP (3–8 months), we measured sleep quality using validated questionnaires, perceived PA using the International Physical Activity Questionnaire (IPAQ), and actual PA using pedometer steps per day. We sought to investigate how CPAP use and changes in sleep quality impacted the number of steps taken, as recorded in pedometer steps.

Results:

In total, 62 patients were enrolled in the study from March 2012 to July 2014. In all, patients averaged 53 years of age, and 26 patients (42%) were female. Among all participants, 86% of persons had moderate to severe sleep apnea (AHI ≥15). Approximately 73% of participants were compliant with CPAP use. Poor sleep quality correlated with lower actual PA (P = .004) at baseline. At 3 and 7 months, there was significant improvement in sleep quality (Δ –2.63 ± 3.4 and Δ –3.5 ± 3.8; P < .001) and actual PA (Δ 840 ± 1313 and Δ 1431 ± 1419 steps/day, P < .001) compared with baseline. On multivariate analyses, participants with a higher waist circumference had a significantly greater increase in actual PA (P = .018).

Conclusion:

Treatment of OSA with CPAP had a progressive incremental improvement in sleep quality and actual PA.

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Mònica Solana-Tramunt, Jose Morales, Bernat Buscà, Marina Carbonell and Lara Rodríguez-Zamora

Synchronized swimming (SS) is an Olympic sport involving routines that are technically and physically very demanding and require intense whole-body work performed during apneic episodes 1 , 2 interspersed by short breathing intervals. 2 During the voluntary apnea periods, which constitute up to

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Kay Tetzlaff, Holger Schöppenthau and Jochen D. Schipke

Context:

It has been widely believed that tissue nitrogen uptake from the lungs during breath-hold diving would be insufficient to cause decompression stress in humans. With competitive free diving, however, diving depths have been ever increasing over the past decades.

Methods:

A case is presented of a competitive free-diving athlete who suffered stroke-like symptoms after surfacing from his last dive of a series of 3 deep breath-hold dives. A literature and Web search was performed to screen for similar cases of subjects with serious neurological symptoms after deep breath-hold dives.

Case Details:

A previously healthy 31-y-old athlete experienced right-sided motor weakness and difficulty speaking immediately after surfacing from a breathhold dive to a depth of 100 m. He had performed 2 preceding breath-hold dives to that depth with surface intervals of only 15 min. The presentation of symptoms and neuroimaging findings supported a clinical diagnosis of stroke. Three more cases of neurological insults were retrieved by literature and Web search; in all cases the athletes presented with stroke-like symptoms after single breath-hold dives of depths exceeding 100 m. Two of these cases only had a short delay to recompression treatment and completely recovered from the insult.

Conclusions:

This report highlights the possibility of neurological insult, eg, stroke, due to cerebral arterial gas embolism as a consequence of decompression stress after deep breath-hold dives. Thus, stroke as a clinical presentation of cerebral arterial gas embolism should be considered another risk of extreme breath-hold diving.

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Bailey Peck, Timothy Renzi, Hannah Peach, Jane Gaultney and Joseph S. Marino

college athletes will allow for timely intervention that may enhance the student-athlete’s academic and sports performance. The term SDB encompasses a number of breathing-related disorders of sleep, such as central apnea, obstructive apnea, and snoring. 5 Although SDB is often undiagnosed, especially

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Kai Roecker, Jule Metzger, Tobias Scholz, Kay Tetzlaff, Stephan Sorichter and Stephan Walterspacher

Specific adjustments to repeated extreme apnea are not fully known and understood. While a blunted ventilatory chemosensitivity to CO2 is described for elite breath-hold divers (BHDs) at rest, it is unclear whether specific adaptations affect their response to dynamic exercise. Eight elite BHDs with a previously validated decrease in CO2 chemosensitivity, 8 scuba divers (SCDs), and 8 matched control subjects were included in a study where markers of ventilatory response, Fowler’s dead space, partial pressure of carbon dioxide (pCO2), and blood lactate concentrations during cycle exercise were measured. Maximal power output did not differ between the groups, but lactate threshold (θL) appeared at a significantly lowered respiratory compensation point (RCP) and at a higher VO2 for the BHDs. End-tidal (petCO2) and estimated arterial pCO2 (paCO2) were significantly higher in BHDs at θL, the RCP, and maximum exhaustion. BHDs showed a significantly (P < .01) slower breathing pattern in relation to a given tidal volume at a specific work rate. In summary, BHDs presented signs of a metabolic shift from aerobic to anaerobic energy supply, decreased chemosensitivity during exercise, and a distinct ventilatory-response pattern during cycle exercise that differs from SCDs and controls.

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Ozcan Esen, Ceri Nicholas, Mike Morris and Stephen J. Bailey

function of enhanced reduction of NO 2 − to NO, 17 NO 3 − supplementation might represent an effective ergogenic aid for swimmers. In addition, swimming is accompanied by periods of dynamic apnea, 18 – 20 with apnea duration linked to swimming performance. 21 Since there is some evidence that NO 3