Obstructive sleep apnea syndrome (OSAS) is a complex disorder characterized by repetitive bouts of upper airway collapse during sleep, causing subsequent intermittent hypoxia, hypercapnia, and fragmented sleep and is also associated with significant morbidity including daytime sleepiness, hypertension, and elevated cardiovascular risk. OSAS affects at least 4% of men and 2% of women; unfortunately, it is estimated that 80% to 90% of adults with OSAS remain undiagnosed. Both clinical characteristics and complex genetic and environmental interactions have made it difficult to understand OSAS disease etiology and identifying patients at risk is still elusive. A pattern of gene expression in cells or tissues related to a disease state for OSAS would provide beneficial information to be most effective in screening or diagnosing this disease. Objectives: The objectives of this study were to: 1) map out the study design and bench assay strategies by which to investigate this issue; 2) find out if there are specific differences in the global gene expression profiles of adult females with OSAS compared to those without OSAS, under conditions in which subjects were clinically similar (BMI, diabetes, cardiovascular disease, etc.); and 3) assess the protein expression differences that could potentially be linked via well-established molecular pathways associated with any differences found in global gene expression profiles in the presence and absence of OSAS. Methods: Subjects were overweight premenopausal Caucasian women with untreated OSAS (n=6; age = 40.7 ± 3.4; BMI = 49.04 ± 6.97; apnea-hypopnea index = 27.3 ± 16.02), and control subjects (n=10) (age = 38.2 ± 7.6; BMI = 47.94 ± 6.15; apnea-hypopnea index < 5), and matched for other clinical characteristics (diabetes, cardiovascular disease status, medications, etc.) recruited from either Carilion Clinic Pulmonary/Sleep Medicine or Carilion Clinic Bariatric Surgery practices. Subjects provided a fasting blood sample in which the monocytes were isolated from whole blood. The RNA was extracted from the monocytes, assessed for purity and quantity, frozen and shipped to collaborators at Dana-Farber Cancer Institute and hybridized to Affymetrix whole human genome chips on a gene chip. The initial computational evaluation and interpretation generated the hypothesis. Two-step quantitative real time polymerase chain reaction (qPCR) was performed to verify the results from the microarray analysis. The laminin enzyme immunoassay (EIA), and cellular adhesion assays were performed to determine if genomic changes resulted in proteomic and phenotypic assessments. Results: OSAS subjects had nine aberrantly regulated genes, of which three genes (LAMC-1, CDC42, and TACSTD2) showed a pattern in segregation between OSAS and controls subjects based on expression patterns. In addition, qPCR indicated a 2.1 fold increase in LAMC-1 and a 1.1 fold increase CDC42 expression unique to the tissue samples of patients with OSAS. Though the serum laminin EIA did not differ between groups, a statistically significant increase in peripheral blood mononuclear cells (PBMC) cellular adhesion in OSAS patients versus control subjects was found. The OSAS subjects had a well cell count of 9.27 ± 1.54 cells vs. controls 5.75 ± 0.78 cells (p Ë‚ 0.05), which is relative to the 103 cells/field that were plated. Conclusions: Cells isolated from women with moderate-severe OSAS show an abnormality in cellular adhesion, a process driven in part by the gene LAMC-1, which was also aberrantly expressed in these subjects. This suggests that inflammation may be linked to the pathogenesis of OSAS. This pilot study has provided the framework and preliminary data needed to propose a larger study with extramural research funding. / Ph. D.

Bakgrund: Obstruktivt sömnapnésyndrom (OSAS) är en vanlig sömnrelaterad andningsstörning som innebär att patienten får apnéer (totalt andningsflödesstopp) och/eller hypoapnéer (delvis andningsflödesstopp) under nattsömnen. Dessa leder till störd nattsömn, vilket leder till kroppslig påverkan. OSAS ger både fysisk och psykisk påverkan, vilket i sin tur resulterar i att många patienter upplever sämre livskvalité. En av de vanligaste behandlingarna för OSAS är CPAP (Continuous Positive Airway Pressure) som med hjälp av övertrycksandning hjälper till att hålla de övre luftvägarna öppna under sömn.   Syfte: Syftet med litteraturöversikten var att undersöka hur patienters livskvalité påverkas av behandling med CPAP samt om det finns vetenskapligt bevisade omvårdnadsåtgärder som underlättar för patienter att uppnå god livskvalité vid CPAP-behandling. Metod: En systematisk litteraturöversikt baserad på 10 kvantitativa originalartiklar. Resultat: Majoriteten av de genomgångna studierna visade att användning av CPAP minskar psykiska och fysiska symptom och därmed förbättrar patienternas livskvalité. Genom att följa upp patienter i sjukvården, erbjuda dem utbildningar samt gruppdiskussioner främjar man deras hälsa och höjer livskvalitén. Studierna visade också att grunden för en god omvårdnad är att sjuksköterskan har evidensbaserade kunskaper för att kunna planera och genomföra omvårdnadsåtgärder samt följa upp hur CPAP-behandlingen påverkar patienternas livskvalité. Slutsats: Användningen av CPAP förbättrar OSAS-patienternas livskvalité, bland annat genom att minska symptom. Det är av stor vikt att sjuksköterskan har tillräckliga kunskaper för att kunna undervisa samt informera patienten om sin sjukdom och behandling. Detta hjälper patienter till en bättre egenvård, vilket har en stor betydelse för livskvalitet.

Sleep represents a third of our life, from birth to death. Sleep allows our body and mind to rest, and breaking its structure may lead to severe physical and nervous damage. Breathing disorders, like apneas, hypopneas or RERA events, alter the recovering feature of sleep by fragmenting its structure. They usually lead to daytime sleepiness, depression, hypertension, cardiovascular disease,... In order to give the most suitable treatment to a patient, the gold standard polysomnography (PSG) is recorded in a hospital setting and the huge amount of data is visually analyzed the day after. The PSG is expensive, time-consuming for the clinicians and unpleasant for the patient. Thus, portable monitoring devices and automatic analysis methods are welcome. Four physiological parameters are required to score the three breathing disorders mentioned above: nasal airflow, oximetry, arousals and respiratory effort markers. While arousals are defined in the EEG traces, the esophageal pressure is the gold standard but invasive measure of effort. Surrogates (signals) exist for both arousal, like PAT, PTT or ECG, and effort markers, like TAM, PTT or FOT. This thesis was dedicated to a novel one, the maxillo-mandibular movements. This signal is not only able to point arousals and effort, but it has also the capability to distinguish sleep from wake as a mandibular actimeter, like the wrist actigraphy. These three features make it worth of interest. At first, the jaw movements signal essence was extracted, automatic methods 1) to point arousals, 2) to indicate periodic patterns like respiratory effort or salvo of sleep events, 3) to detect and classify apneas, hypopneas and RERA and 4) to separate sleep from wake were developed and evaluated. Then, the sleep apneas/hypopneas and the sleep/wake detectors were then improved by adding the oximetry in a first step. Finally, the nasal airflow brought its potential in both detection and classification of breathing disorders, especially to overcome the inherent classification problem between apneas and hypopneas since the jaw movements sensor is an effort sensor. All the methods developed in this thesis were applied to a huge database of 150 consecutive recordings at the Sleep Laboratory of the University of Liege for sleep apneas and hypopneas detection assessment. Moreover, an APAP device, that applies a regulated pressure throughout a nasal mask to prevent from upper airways collapse, was designed using only features computed from jaw movements in real-time, and showed similar results to the widely tested iS20i from BREAS. In conclusion, the maxillo-mandibular movements signal does bring usefull information about respiratory effort and arousals, and coupled with the nasal flow and oximetry signal provides an accurate detection and classification of sleep apneas, hypopneas and RERA. Besides, this jaw actimeter and its ad-hoc algorithm allows to distinguish sleep from wake. All in all, the jaw movements signal is a very valuable and a unique physiological signal for home sleep studies.

Great progress has been made in sleep medical research in recent years and sleep medicine has thus evolved into a specialized medical field. Sleep apnea syndrome is one of the mostly commonly seen sleep disorders. It is now clear that sleep apnea has adverse effects on the heart and is a risk factor for several cardiovascular diseases. Studies have found that decreased heart rate variability (HRV) is a prognostic factor for cardiovascular disease and it also associated with higher mortality rate. Considering the confounding effect of BMI and sleep apnea severity, this work investigates the correlation between heart rate variability and AHI (apnea-hypopnea index which is used to characterize the severity of sleep apnea) by dividing patients into different BMI subgroups. This work includes 1068 male subjects with complete overnight ECG recordings. The low-frequency (LF), the high-frequency (HF) component and the LF/HF ratio of HRV are computed for the 10 BMI subgroups. The Bootstrap method and the BCa technique for confidence interval estimation are employed to verify the linear association between the HRV measures and the severity of sleep apnea. The experimental results show that statically significant correlation exist between LF/HF ratio and AHI for BMI ¡Ù28 patient groups. Statically significant correlation between LF and AHI also exists for BMI ¡Ù27 patient groups. These results demonstrate that the associations between some of the HRV measures and AHI are clearly BMI dependent.

Tyrimo metu apibendrinti ir išanalizuoti 74 knarkiančiųjų bei lengvu ir vidutinio sunkumo obstrukcinės miego apnėjos hipopnėjos sindromu (OMAHS) sergančių pacientų klinikiniai duomenys, ir įvertinta 38 jų miego partnerių emocinė būklė prieš pacientų gydymą ir praėjus 2–4 mėn. po pacientams taikyto knarkimo ir OMAHS gydymo – radiodažnuminės termoabliacijos (RDTA). Šio darbo uždaviniai: 1. Ištirti ir palyginti knarkiančiųjų bei sergančių lengvu ir vidutinio sunkumo OMAHS pacientų viršutinių kvėpavimo takų anatomines ir funkcines savybes, apnėjų hipopnėjų indeksą, nusiskundimus sveikata ir emocinę būklę. 2. Įvertinti knarkiančiųjų bei sergančių lengvu ir vidutinio sunkumo OMAHS pacientų gyvenimo kokybę prieš pradedant gydymą ir po gydymo RDTA. 3. Įvertinti su RDTA operacijomis susijusių pacientų nusiskundimų intensyvumą ir pooperacinių komplikacijų dažnį. 4. Ištirti ir įvertinti knarkiančiųjų bei sergančių lengvu ir vidutinio sun¬kumo OMAHS pacientų nusiskundimus ir apnėjų hipopnėjų indeksą po gydymo RDTA. 5. Ištirti ir įvertinti knarkiančiųjų bei sergančių lengvu ir vidutinio sunkumo OMAHS pacientų emocinę būklę po gydymo RDTA. 6. Ištirti ir įvertinti knarkiančiųjų bei sergančių lengvu ir vidutinio sunkumo OMAHS miego partnerių emocinę būklę ir jos pokyčius po pacientų gydymo RDTA. Po pacientų gydymo RDTA nustatytas pacientų nusiskundimų intensyvumo ir apnėjų hipopnėjų indekso sumažėjimas bei emocinės būklės pagerėjimas, ir pacientų miego part¬ne¬rių depresiškumo sumažėjimas... [toliau žr. visą tekstą] / A total of 74 snoring and mild to moderate obstructive sleep apnea hypopnea syndrome (OSAHS) patients underwent complete full night polysomnography (PSG) and clinical examination and were treated with two sessions of radiofrequency tissue ablation (RFTA). The emotional state of 38 bed partners of snoring and mild to moderate OSAHS patients were evaluated at the baseline and 2–4 months after the patients completed the treatment. Objectives of the study: 1. To examine and evaluate the relationship between complaints, anatomical features, PSG results, and emotional state of snoring and mild to moderate OSAHS patients. 2. To assess the quality of life among snoring and mild to moderate OSAHS patients before and after the RFTA treatment. 3. To analyze the morbidity and the rate of postoperative compli¬ca¬tions of RFTA. 4. To evaluate the influence of RFTA on the objective (PSG results) and subjective (complaints) outcomes in snoring and mild to moderate OSAHS patients. 5. To evaluate the influence of RFTA on the outcomes of anxiety and depression in snoring and mild to moderate OSAHS patients. 6. To examine the emotional state and to evaluate the effect of RFTA on anxiety and depression in bed partners of snoring and mild to moderate OSAHS patients. A remarkable improvement in patients’ complaints, PSG results and emotional state after RFTA was observed. RFTA therapy resulted in improved depression scores for the bed partners of snoring and mild to moderate OSAHS patients.

Introdução: O desenvolvimento de hipertensão arterial e doença cardiovascular relacionado à síndrome das apnéia obstrutiva do sono (SAOS) parece estar relacionado a alterações sobre a regulação autonômica cardiovascular. Este estudo investigou se a SAOS influência a variabilidade da pressão arterial (PA). Métodos: Estudo transversal, com pacientes hipertensos que foram submetidos à polissonografia nível III, por meio de um monitor portátil de uso domiciliar para detectar SAOS (índice de apnéia-hipopnéia (IAH) ≥ 10). A variabilidade da PA foi avaliada pela taxa de variação da pressão arterial no tempo (índice “time rate” - a primeira derivada da pressão arterial ao longo do tempo) e desvio padrão (DP) da PA obtidos dos dados da monitorização ambulatorial da pressão arterial (MAPA). Análises univariadas e multivariadas foram utilizadas para testar a associação entre a SAOS, IAH e variabilidade da pressão arterial. Resultados: Os pacientes com SAOS (n = 57) eram mais velhos, apresentavam pressão arterial mais elevada e maior duração da hipertensão do que pacientes sem SAOS (n = 50). Não houve nenhuma associação consistente entre o diagnóstico de SAOS e variabilidade da PA aferida pelo DP e pela taxa de variação da PA no tempo, tanto na análise univariada como após o ajuste para idade, IMC e respectiva medida de PA na MAPA. Não houve correlação significativa entre o AIH e os índices de variabilidade da PA em um modelo de regressão linear múltipla, controlando para idade, IMC e PA correspondente. Conclusão: SAOS não influencou a variabilidade da pressão arterial, aferida por estes métodos, em pacientes com hipertensão. / Background The risk of obstructive sleep apnea syndrome (OSAS) for the development of hypertension and cardiovascular disease may be intermediate by influence over autonomic cardiovascular regulation. This study investigated if OSAS influences blood pressure (BP) variability. Methods In a cross-sectional study, patients with hypertension underwent level III polysomnography by means of a home portable monitor to detect OSAS, (apnea-hypopnea index (AHI) ≥10). BP variability was assessed by the time rate index (the first derivative of BP over time) and standard deviation (SD) of BP measured by 24-h ambulatory blood pressure measurement (ABPM). The association between OSAS, AHI and blood pressure variability was tested by univariate and multivariate methods. Results: Patients with OSAS (n = 57) were older, had higher blood pressure, and longer duration of hypertension than patients without OSAS (n = 50). There was no consistent association between the diagnosis of OSAS and BP variability assessed by the time-rate index and SD both in the univariate and after adjustment for age, BMI and the respective BP. There was no significant correlation between AIH and the indexes of BP variability in a multiple linear regression model controlling for age, BMI and the corresponding BP. Conclusion OSAS does not influence blood pressure variability in patients with hypertension.

Introdução: O desenvolvimento de hipertensão arterial e doença cardiovascular relacionado à síndrome das apnéia obstrutiva do sono (SAOS) parece estar relacionado a alterações sobre a regulação autonômica cardiovascular. Este estudo investigou se a SAOS influência a variabilidade da pressão arterial (PA). Métodos: Estudo transversal, com pacientes hipertensos que foram submetidos à polissonografia nível III, por meio de um monitor portátil de uso domiciliar para detectar SAOS (índice de apnéia-hipopnéia (IAH) ≥ 10). A variabilidade da PA foi avaliada pela taxa de variação da pressão arterial no tempo (índice “time rate” - a primeira derivada da pressão arterial ao longo do tempo) e desvio padrão (DP) da PA obtidos dos dados da monitorização ambulatorial da pressão arterial (MAPA). Análises univariadas e multivariadas foram utilizadas para testar a associação entre a SAOS, IAH e variabilidade da pressão arterial. Resultados: Os pacientes com SAOS (n = 57) eram mais velhos, apresentavam pressão arterial mais elevada e maior duração da hipertensão do que pacientes sem SAOS (n = 50). Não houve nenhuma associação consistente entre o diagnóstico de SAOS e variabilidade da PA aferida pelo DP e pela taxa de variação da PA no tempo, tanto na análise univariada como após o ajuste para idade, IMC e respectiva medida de PA na MAPA. Não houve correlação significativa entre o AIH e os índices de variabilidade da PA em um modelo de regressão linear múltipla, controlando para idade, IMC e PA correspondente. Conclusão: SAOS não influencou a variabilidade da pressão arterial, aferida por estes métodos, em pacientes com hipertensão. / Background The risk of obstructive sleep apnea syndrome (OSAS) for the development of hypertension and cardiovascular disease may be intermediate by influence over autonomic cardiovascular regulation. This study investigated if OSAS influences blood pressure (BP) variability. Methods In a cross-sectional study, patients with hypertension underwent level III polysomnography by means of a home portable monitor to detect OSAS, (apnea-hypopnea index (AHI) ≥10). BP variability was assessed by the time rate index (the first derivative of BP over time) and standard deviation (SD) of BP measured by 24-h ambulatory blood pressure measurement (ABPM). The association between OSAS, AHI and blood pressure variability was tested by univariate and multivariate methods. Results: Patients with OSAS (n = 57) were older, had higher blood pressure, and longer duration of hypertension than patients without OSAS (n = 50). There was no consistent association between the diagnosis of OSAS and BP variability assessed by the time-rate index and SD both in the univariate and after adjustment for age, BMI and the respective BP. There was no significant correlation between AIH and the indexes of BP variability in a multiple linear regression model controlling for age, BMI and the corresponding BP. Conclusion OSAS does not influence blood pressure variability in patients with hypertension.

Introdução: O desenvolvimento de hipertensão arterial e doença cardiovascular relacionado à síndrome das apnéia obstrutiva do sono (SAOS) parece estar relacionado a alterações sobre a regulação autonômica cardiovascular. Este estudo investigou se a SAOS influência a variabilidade da pressão arterial (PA). Métodos: Estudo transversal, com pacientes hipertensos que foram submetidos à polissonografia nível III, por meio de um monitor portátil de uso domiciliar para detectar SAOS (índice de apnéia-hipopnéia (IAH) ≥ 10). A variabilidade da PA foi avaliada pela taxa de variação da pressão arterial no tempo (índice “time rate” - a primeira derivada da pressão arterial ao longo do tempo) e desvio padrão (DP) da PA obtidos dos dados da monitorização ambulatorial da pressão arterial (MAPA). Análises univariadas e multivariadas foram utilizadas para testar a associação entre a SAOS, IAH e variabilidade da pressão arterial. Resultados: Os pacientes com SAOS (n = 57) eram mais velhos, apresentavam pressão arterial mais elevada e maior duração da hipertensão do que pacientes sem SAOS (n = 50). Não houve nenhuma associação consistente entre o diagnóstico de SAOS e variabilidade da PA aferida pelo DP e pela taxa de variação da PA no tempo, tanto na análise univariada como após o ajuste para idade, IMC e respectiva medida de PA na MAPA. Não houve correlação significativa entre o AIH e os índices de variabilidade da PA em um modelo de regressão linear múltipla, controlando para idade, IMC e PA correspondente. Conclusão: SAOS não influencou a variabilidade da pressão arterial, aferida por estes métodos, em pacientes com hipertensão. / Background The risk of obstructive sleep apnea syndrome (OSAS) for the development of hypertension and cardiovascular disease may be intermediate by influence over autonomic cardiovascular regulation. This study investigated if OSAS influences blood pressure (BP) variability. Methods In a cross-sectional study, patients with hypertension underwent level III polysomnography by means of a home portable monitor to detect OSAS, (apnea-hypopnea index (AHI) ≥10). BP variability was assessed by the time rate index (the first derivative of BP over time) and standard deviation (SD) of BP measured by 24-h ambulatory blood pressure measurement (ABPM). The association between OSAS, AHI and blood pressure variability was tested by univariate and multivariate methods. Results: Patients with OSAS (n = 57) were older, had higher blood pressure, and longer duration of hypertension than patients without OSAS (n = 50). There was no consistent association between the diagnosis of OSAS and BP variability assessed by the time-rate index and SD both in the univariate and after adjustment for age, BMI and the respective BP. There was no significant correlation between AIH and the indexes of BP variability in a multiple linear regression model controlling for age, BMI and the corresponding BP. Conclusion OSAS does not influence blood pressure variability in patients with hypertension.

Senare års forskning visar på att obstruktivt sömnapnésyndrom, OSAS, är en både underdiagnostiserad och underbehandlad sjukdom. Detta beror delvis på att många personer med OSAS är omedvetna om sitt tillstånd. Sjukdomen innebär återkommande totala andningsuppehåll under sömn och en hypoxi som leder till en rad olika komplikationer, däribland hjärtkärlsjukdomar. Syftet med denna studie var att utreda vad som påverkar OSAS och vilken roll sjuksköterskan kan spela i vården av dessa patienter. Metoden som användes var en litteraturundersökning. Resultatet baseras på tio vetenskapliga artiklar som erhölls genom databaserna PUBMED samt SAMSÖK. Teman som utkristalliserades var sömnposition, kroppsvikt och tandstatus. Trots att behandlingen av OSAS till stor del bygger på medicinska åtgärder visar resultaten i denna litteraturundersökning att sjuksköterskor har en viktig funktion i både upptäckten av nya fall samt i behandlingen. Omvårdnadsåtgärder såsom information om förändrad sömnposition och viktnedgång har visat sig ha signifikant betydelse för obstruktiv andning. / Medical research in recent years has shown that Obstructive Sleep Apnea Syndrome, OSAS, is an affliction for which both diagnosis and treatment are often inadequate. In part, this is due to the fact that many people suffering from OSAS are not aware of the problem. The disease causes recurrent complete stops of breathing during sleep and hypoxia that may bring about various complications, for instance cardiovascular disorders. The purpose of this study, carried out as a literature survey, was to determine what factors affect OSAS and what role the nurse may play in the care of patients suffering from this disease. The survey of the literature by means of the data bases PUBMED and SAMSÖK yielded ten scientific articles showing that although various medical measures constitute the treatment of choice of OSAS the nurse plays an important role in the treatment and the diagnosis of new cases. Preventive care measures such as information about appropriate sleeping positions and reduction of weight have proven to be of significant value in the treatment of OSAS.

Bakgrund: Obstruktivt sömnapnésyndrom (OSA) kan påverkas positivt av fysioterapeutiska interventioner. Det är därför intressant att veta hur initial motivation och self-efficacy påverkar livsstilsförändring i form av fysisk aktivitetsnivå och fysisk kapacitet. Syfte: Undersöka hur initial motivation och self-efficacy förändrar fysisk aktivitetsnivå, och hur initial self-efficacy förändrar fysisk kapacitet, hos personer med OSA. Metod: Kvantitativ dataanalys med data från en tidigare RCT där personer med OSA fick Behavioral Sleep Medicine. Motivation (vid baslinje) och self-efficacy (vid baslinje) korrelerades med förändringen av fysisk aktivitetsnivå (från baslinje till 6 månader), och motivation (vid baslinje) korrelerades med förändringen av fysisk kapacitet (från baslinje till 6 månader). Kontroll- och interventionsgruppen jämfördes även i skillnad på aktivitetsnivå mellan baslinje och 6 månader. Resultat: Inga statistiskt signifikanta samband kunde påvisas mellan motivation och förändring av fysisk aktivitetsnivå (p = 0.439 och 0.615 för kontroll- respektive interventionsgruppen), motivation och förändring av fysisk kapacitet (p = 0.538 och 0.375 för kontroll- respektive interventionsgruppen), self-efficacy och förändring av fysisk aktivitetsnivå (p = 0.392 och 0.925 för kontroll- respektive interventionsgruppen), eller skillnad i förändring av aktivitetsnivå mellan kontroll- respektive interventionsgrupp (p = 0.545). Konklusion: Ingen tydlig koppling mellan initial motivation och self-efficacy till förändring av fysisk aktivitetsnivå och fysisk kapacitet kunde påvisas hos personer med OSA. / Background: Obstructive sleep apnea (OSA) can be positively affected by physiotherapeutic interventions. It is therefore interesting to know how motivation and self-efficacy affects lifestyle changes in the form of physical activity level and physical capacity. Purpose: To analyze how initial motivation and self-efficacy changes physical activity levels, and how initial motivation changes physical capacity, in people with OSA. Method: Quantitative data analysis using data from a previous RCT in which people with OSA were treated with Behavioral Sleep Medicine. Motivation (at baseline) and self-efficacy (at baseline) was correlated with the change in physical activity levels (from baseline to 6 months), and motivation (at baseline) was correlated with the change in physical capacity (from baseline to 6 months). The difference in the change in activity levels from baseline to 6 months was also compared between the control and intervention groups. Results: No statistically significant correlations were found between motivation and physical activity level (p = 0.439 and 0.615 for the control and intervention group respectively), motivation and physical capacity (p = 0.538 and 0.375 for the control and intervention group respectively), self-efficacy and change of physical activity level (p = 0.392 and 0.925 for the control and intervention group respectively), or difference in the control versus intervention group regarding change in physical activity level (p = 0.545). Conclusion: No clear connection between initial motivation and self-efficacy to change in physical activity levels and physical capacity could be found in people with OSA.