Lifestyle modification based on cluster cardiovascular risk assessment reduced the risk of sleep apnea

Abstract Background Sleep apnea is associated with cardiovascular events, nonetheless, the early concern for multi-risk factor management, complied with guideline-based clinical care pathways, is limit. Objective The present study aimed to investigate the impact on the burden of sleep apnea with lifestyle and physical activity modification based on cardiovascular cluster risk factors assessment, supported by a mobile health and wearable devices technologies. Methods The adult subjects aged over 18 years were enrolled in China between March 2, 2020 and August 4, 2020, who used a smart phone application “IamHealthy”, to assess the CV risk profile, including weight/activity, diet (the quality of diet was assessed using Alternative Healthy Eating Index,AHEI-2010), psychological status, sleep apnea, cardiac rhythm, blood pressure, blood lipid, diabetes. Once the subjects had compatible smart devices (Huawei Technologies Co., Ltd., Shenzhen, China), they achieved photoplethysmography (PPG)-based sleep apnea monitoring. The healthy lifestyle score (five aspects: diet, smoking, physical activity, alcohol consumption, and Body Mass Index) were calculated and a 3-month personalized App-based lifestyle and physical activity package was proposed for those with sleep apnea. The change on risk of sleep apnea monitored were evaluated. Results There were 775 subjects (mean age 48 years old, standard deviation, SD, 14, 90.1% male) with the “IamHealthy” App and 487 subjects (mean age 46 years old, standard deviation, SD, 13, 94.4% male) for sleep apnea monitoring with smart devices. Among these subjects, there were 42.3% subjects with overweight, 13.2% with obese; 44.3% with poor quality of healthy diet (AHEI scores <66), 40.0% with inactive physical activity of <1 time/week. The reported depression (Patient Health Questionnaire, PHQ-9 ≥5) and the anxiety (Generalised Anxiety Disorder, GAD-7 scale ≥5) were 41.2% and 62.5%, respectively. Only 22.4% subjects remained healthy lifestyle with over three low risk lifestyle scores. Dietary Approaches to Control weight (61.6%), to Stop Hypertension (24%), and Mediterranean dietary (5%); Physical activities to control the weight (84.2%), control blood pressure (8.5%), and CV prevention (6.8%) were commonly proposed. For subjects using IamHealthy to monitor sleep apnea after matching PPG -smart devices on baseline, the proportion of high-risk of sleep apnea decreased over time (baseline, 1 mon, 3 mons, and 6 mons, 60.67%, 47.25%, 44.12%, and 34.19%, p<0.001, Figure). Conclusions Lifestyle modification based on cluster cardiovascular risk assessment reduced the high-risk sleep apnea. Funding Acknowledgement Type of funding sources: None.