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Lee K, Jung YJ, Cho JS, Jung JH, Kwon W, Kwon J. Effects of Positive Airway Pressure on Cardiorespiratory Fitness in Patients with Concomitant Obstructive Sleep Apnea and Cardiovascular Disease. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1029. [PMID: 39064458 PMCID: PMC11278883 DOI: 10.3390/medicina60071029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/08/2024] [Accepted: 06/21/2024] [Indexed: 07/28/2024]
Abstract
Background and Objectives: Obstructive sleep apnea (OSA) is common in cardiovascular disease (CVD), although positive airway pressure (PAP) treatment has not been demonstrated to improve the cardiovascular outcome. The objective of this study is to investigate the impact of adherence to PAP therapy on cardiopulmonary exercise testing (CPET) performance in patients with concomitant OSA and CVD. Materials and Methods: This preliminary study involved symptomatic OSA patients requiring PAP treatment who had CVD. All subjects underwent polysomnography, echocardiography, and CPET at baseline. After 6 to 12 months of PAP treatment, CPET performance was re-assessed. The changes in CPET parameters before and after PAP treatment were compared between patients who were adherent to PAP and patients who were not adherent to PAP. Results: A total of 16 OSA patients with an apnea-hypopnea index of 32.0 ± 23.4 were enrolled. Patients were classified into the adherent (n = 9) and non-adherent (n = 7) groups with regard to PAP adherence. After 6 to 12 months of PAP treatment, the PAP-adherent group showed a greater increase in peak VO2 than the PAP-non-adherent group, but the difference between the two groups was not significant (p = 0.581). The decrease in ventilatory equivalent for the carbon dioxide slope (VE/VCO2) was significantly greater in the PAP-adherent group compared to the PAP-non-adherent group (p = 0.030). Conclusions: Adherence to PAP therapy for OSA is associated with an improvement in the VE/VCO2 slope, as an index of the ventilatory response to exercise, in patients with CVD. Screening for sleep apnea in CVD patients may be warranted, and strategies to optimize adherence to PAP in these patients are beneficial. Further evidence is needed to elucidate whether CPET could be routinely used to monitor treatment responses of OSA to PAP therapy in patients with CVD.
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Affiliation(s)
- Kyusup Lee
- Department of Cardiology, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (K.L.); (J.S.C.)
| | - Yu Jin Jung
- Department of Neurology, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Jung Sun Cho
- Department of Cardiology, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (K.L.); (J.S.C.)
| | - Ji-Hoon Jung
- Korea Institute of Toxicology, Daejeon 34114, Republic of Korea;
| | - Woojin Kwon
- Department of Anesthesiology and Pain Medicine, Konyang University Hospital, College of Medicine, Konyang University, Daejeon 35365, Republic of Korea;
| | - Jongbum Kwon
- Department of Thoracic and Cardiovascular Surgery, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea;
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Exercise capacity remains supernormal, though mildly reduced in middle-aged military personnel with Moderate to Severe Obstructive Sleep Apnea. Sleep Breath 2023; 27:137-144. [PMID: 35217932 DOI: 10.1007/s11325-022-02587-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/15/2022] [Accepted: 02/18/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The relationship between moderate to severe OSA and exercise capacity remains unclear. Prior studies showing a reduction in VO2 max in this population have mostly involved middle-aged, overweight patients. We aimed to study this relationship in a similarly aged population of military personnel with previously undiagnosed moderate to severe OSA. METHODS We studied late-career male military personnel who underwent CPET and polysomnography (PSG). Patients were categorized either into an OSA group (apnea-hypopnea index (AHI) ≥ 15 events/h) or a control group (AHI < 15 events/h). VO2 max was compared between groups. RESULTS 170 male military personnel met criteria for the study. Mean AHI was 29.0/h in the OSA group (n = 58) versus 7.4/h in the controls (n = 112) while SpO2 nadir was slightly lower (86.0% vs. 89.0%). Patients were of similar age (53.1 vs. 53.7 years), and BMI was slightly higher in the OSA group (27.5 kg/m2 vs. 26.3 kg/m2). Percent-predicted VO2 max was supernormal in both groups, though it was comparatively lower in the OSA group (117% vs. 125%; p < 0.001). CONCLUSIONS Military personnel with moderate to severe OSA were able to achieve supernormal VO2 max values, yet had an 8% decrement in exercise capacity compared to controls. These findings suggest that OSA without significant hypoxemia may not significantly influence exercise capacity. It remains likely that the effects of untreated OSA on exercise capacity are complex and are affected by several variables including BMI, degree of associated hypoxemia, and regularity of exercise. Statistically lower VO2 max noted in this study may suggest that untreated OSA in less fit populations may lead to significant decrements in exercise capacity.
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Elbehairy AF, Geneidy NM, Elhoshy MS, Elsanhoury D, Elfeky MK, Abd-Elhameed A, Horsley A, O'Donnell DE, Abd-Elwahab NH, Mahmoud MI. Exercise Intolerance in Untreated OSA: Role of Pulmonary Gas Exchange and Systemic Vascular Abnormalities. Chest 2023; 163:226-238. [PMID: 36183785 DOI: 10.1016/j.chest.2022.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 08/12/2022] [Accepted: 09/15/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Reduced exercise capacity has been reported previously in patients with OSA hypopnea syndrome (OSAHS), although the underlying mechanisms are unclear. RESEARCH QUESTION What are the underlying mechanisms of reduced exercise capacity in untreated patients with OSAHS? Is there a role for systemic or pulmonary vascular abnormalities? STUDY DESIGN AND METHODS This was a cross-sectional observational study in which 14 patients with moderate to severe OSAHS and 10 control participants (matched for age, BMI, smoking history, and FEV1) underwent spirometry, incremental cycle cardiopulmonary exercise test (CPET) with arterial line, resting echocardiography, and assessment of arterial stiffness (pulse wave velocity [PWV] and augmentation index [AIx]). RESULTS Patients (age, 50 ± 11 years; BMI, 30.5 ± 2.7 kg/m2; smoking history, 2.4 ± 4.0 pack-years; FEV1 to FVC ratio, 0.78 ± 0.04; FEV1, 85 ± 14% predicted, mean ± SD for all) had mean ± SD apnea hypopnea index of 43 ± 19/h. At rest, PWV, AIx, and mean pulmonary artery pressure (PAP) were higher in patients vs control participants (P < .05). During CPET, patients showed lower peak work rate (WR) and oxygen uptake and greater dyspnea ratings compared with control participants (P < .05 for all). Minute ventilation (V·E), ventilatory equivalent for CO2 output (V·E/V·CO2), and dead space volume (VD) to tidal volume (VT) ratio were greater in patients vs control participants during exercise (P < .05 for all). Reduction in VD to VT ratio from rest to peak exercise was greater in control participants compared with patients (0.24 ± 0.08 vs 0.04 ± 0.14, respectively; P = .001). Dyspnea intensity at the highest equivalent WR correlated with corresponding values of V·E/V·CO2 (r = 0.65; P = .002), and dead space ventilation (r = 0.70; P = .001). Age, PWV, and mean PAP explained approximately 70% of the variance in peak WR, whereas predictors of dyspnea during CPET were rest-to-peak change in VD to VT ratio and PWV (R2 = 0.50; P < .001). INTERPRETATION Patients with OSAHS showed evidence of pulmonary gas exchange abnormalities during exercise (in the form of increased dead space) and resting systemic vascular dysfunction that may explain reduced exercise capacity and increased exertional dyspnea intensity.
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Affiliation(s)
- Amany F Elbehairy
- Department of Chest Diseases, Faculty of Medicine, Alexandria University, Alexandria, Egypt; Division of Infection, Immunity and Respiratory Medicine, The University of Manchester, and Manchester University NHS Foundation Trust, Manchester, England.
| | - Nesma M Geneidy
- Department of Chest Diseases, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mona S Elhoshy
- Department of Chest Diseases, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Doha Elsanhoury
- Department of Anesthesia, Alexandria University Students' Hospital, Alexandria, Egypt
| | - Mohamed K Elfeky
- Department of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Asmaa Abd-Elhameed
- Department of Biomedical Informatics and Medical Statistics, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Alexander Horsley
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester, and Manchester University NHS Foundation Trust, Manchester, England
| | - Denis E O'Donnell
- Respiratory Investigation Unit, Department of Medicine, Queen's University, and Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Nashwa H Abd-Elwahab
- Department of Chest Diseases, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mahmoud I Mahmoud
- Department of Chest Diseases, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Pigakis KM, Voulgaris A, Nena E, Kontopodi A, Steiropoulos P. Changes in Exercise Capacity of Patients With Obstructive Sleep Apnea Following Treatment With Continuous Positive Airway Pressure. Cureus 2022; 14:e21729. [PMID: 35223327 PMCID: PMC8860713 DOI: 10.7759/cureus.21729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction: Patients with obstructive sleep apnea (OSA) frequently complain of fatigue during exercise. Treatment with continuous positive airway pressure (CPAP) ameliorates OSA-related symptoms and may reduce the burden of OSA on coexistent diseases. However, the role of CPAP on exercise capacity in OSA has not been fully investigated. Aim: The aim of this study is to assess exercise capacity in a group of newly diagnosed OSA patients, without known comorbidities, following treatment with CPAP. Methods: Consecutively diagnosed OSA patients by polysomnography completed the International Physical Activity Questionnaire (IPAQ) and underwent cardiopulmonary exercise testing (CPET) and pulmonary function testing at baseline of OSA diagnosis three months after adherence to CPAP treatment. Results: A total of 40 OSA patients (Apnea-Hypopnea Index (ΑΗΙ)>15 events/hour) of whom 29 (72.5%) males with an average age of 42±2.5 years were enrolled in the study. OSA patients had a mean peak oxygen uptake (V̇O2) value of 40.3 ±8.4 ml/kg/min (77.7±15%), which was improved after three months on CPAP treatment, 47.6±7.9 ml/kg/min (92.9±10.5%). (p=0.002). In addition, patients’ mean work (W) value increased significantly from baseline to three months of treatment with CPAP (101.5±30 watts vs 78.6±18.5 watts. p=0.015, respectively). There were no significant differences in terms of physical activity, as noted in IPAQ, before and after OSA therapy (p=0.075). Conclusions: In the present study, OSA is associated with impaired exercise capacity, which seems to be improved after short-term treatment with PAP. Further evidence is warranted to elucidate whether CPET could be routinely used to monitor treatment responses of OSA with CPAP.
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Stavrou VT, Astara K, Tourlakopoulos KN, Papayianni E, Boutlas S, Vavougios GD, Daniil Z, Gourgoulianis KI. Obstructive Sleep Apnea Syndrome: The Effect of Acute and Chronic Responses of Exercise. Front Med (Lausanne) 2022; 8:806924. [PMID: 35004785 PMCID: PMC8738168 DOI: 10.3389/fmed.2021.806924] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/07/2021] [Indexed: 11/22/2022] Open
Abstract
Obstructive Sleep Apnea Syndrome (OSAS) is a sleep disorder with high prevalence in general population, but alarmingly low in clinicians' differential diagnosis. We reviewed the literature on PubMed and Scopus from June 1980–2021 in order to describe the altered systematic pathophysiologic mechanisms in OSAS patients as well as to propose an exercise program for these patients. Exercise prevents a dysregulation of both daytime and nighttime cardiovascular autonomic function, reduces body weight, halts the onset and progress of insulin resistance, while it ameliorates excessive daytime sleepiness, cognitive decline, and mood disturbances, contributing to an overall greater sleep quality and quality of life.
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Affiliation(s)
- Vasileios T Stavrou
- Laboratory of Cardio-Pulmonary Testing and Pulmonary Rehabilitation, Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Kyriaki Astara
- Laboratory of Cardio-Pulmonary Testing and Pulmonary Rehabilitation, Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Konstantinos N Tourlakopoulos
- Laboratory of Cardio-Pulmonary Testing and Pulmonary Rehabilitation, Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Eirini Papayianni
- Laboratory of Cardio-Pulmonary Testing and Pulmonary Rehabilitation, Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Stylianos Boutlas
- Laboratory of Cardio-Pulmonary Testing and Pulmonary Rehabilitation, Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - George D Vavougios
- Laboratory of Cardio-Pulmonary Testing and Pulmonary Rehabilitation, Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Zoe Daniil
- Laboratory of Cardio-Pulmonary Testing and Pulmonary Rehabilitation, Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Konstantinos I Gourgoulianis
- Laboratory of Cardio-Pulmonary Testing and Pulmonary Rehabilitation, Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
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Vecchiato M, Neunhaeuserer D, Quinto G, Bettini S, Gasperetti A, Battista F, Vianello A, Vettor R, Busetto L, Ermolao A. Cardiopulmonary exercise testing in patients with moderate-severe obesity: a clinical evaluation tool for OSA? Sleep Breath 2021; 26:1115-1123. [PMID: 34487305 PMCID: PMC9418285 DOI: 10.1007/s11325-021-02475-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/24/2021] [Accepted: 08/11/2021] [Indexed: 11/25/2022]
Abstract
Purpose Obstructive sleep apnea (OSA) is a widespread comorbidity of obesity. Nasal continuous positive airway pressure (CPAP) has been demonstrated very effective in treating patients with OSA. The aims of this study were to investigate whether or not cardiopulmonary exercise testing (CPET) can characterize patients with OSA and to evaluate the effect of nasal CPAP therapy. Methods An observational study was conducted on patients with moderate to severe obesity and suspected OSA. All patients underwent cardiorespiratory sleep study, spirometry, and functional evaluation with ECG-monitored, incremental, maximal CPET. Results Of the 147 patients, 94 presented with an apnea–hypopnea index (AHI) ≥ 15 events/h and were thus considered to have OSA (52 receiving nasal CPAP treatment; 42 untreated) while 53 formed a control group (AHI < 15 events/h). Patients with untreated OSA showed significantly lower oxygen uptake (VO2), heart rate, minute ventilation (VE), and end tidal carbon dioxide (PETCO2) at peak exercise compared to controls. Patients receiving nasal CPAP showed higher VE and VO2 at peak exercise compared to untreated patients. A difference in PETCO2 between the maximum value reached during test and peak exercise (ΔPETCO2 max-peak) of 1.71 mmHg was identified as a predictor of OSA. Conclusion Patients with moderate to severe obesity and untreated OSA presented a distinctive CPET-pattern characterized by lower aerobic and exercise capacity, higher PETCO2 at peak exercise associated with a lower ventilatory response. Nasal CPAP treatment was shown to positively affect these cardiorespiratory adaptations during exercise. ΔPETCO2 max-peak may be used to suggest OSA in patients with obesity.
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Affiliation(s)
- Marco Vecchiato
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
- Clinical Network of Sport and Exercise Medicine of the Veneto Region, Padova, Italy
| | - Daniel Neunhaeuserer
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy.
- Clinical Network of Sport and Exercise Medicine of the Veneto Region, Padova, Italy.
| | - Giulia Quinto
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
- Clinical Network of Sport and Exercise Medicine of the Veneto Region, Padova, Italy
| | - Silvia Bettini
- Center for the Study and Integrated Treatment of Obesity (CeSTIO), Internal Medicine 3, Department of Medicine, University of Padova, Padova, Veneto Region, Italy
| | - Andrea Gasperetti
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
- Clinical Network of Sport and Exercise Medicine of the Veneto Region, Padova, Italy
| | - Francesca Battista
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
- Clinical Network of Sport and Exercise Medicine of the Veneto Region, Padova, Italy
| | - Andrea Vianello
- Respiratory Pathophysiology Unit, Department of Cardiological, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Roberto Vettor
- Center for the Study and Integrated Treatment of Obesity (CeSTIO), Internal Medicine 3, Department of Medicine, University of Padova, Padova, Veneto Region, Italy
| | - Luca Busetto
- Center for the Study and Integrated Treatment of Obesity (CeSTIO), Internal Medicine 3, Department of Medicine, University of Padova, Padova, Veneto Region, Italy
| | - Andrea Ermolao
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
- Clinical Network of Sport and Exercise Medicine of the Veneto Region, Padova, Italy
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Han T, Zhang L, Yu CY, Li YM, Wang Y, Zhang XL. Ventilatory response to exercise is preserved in patients with obesity hypoventilation syndrome. J Clin Sleep Med 2021; 16:2089-2098. [PMID: 32895118 DOI: 10.5664/jcsm.8766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Blunted ventilatory responses to hypoxia and hypercapnia during resting conditions are common findings in patients with obesity hypoventilation syndrome (OHS). Exercise increases the work and oxygen cost of breathing and produces excessive carbon dioxide (CO₂). The aim of this investigation was to study ventilatory responses to incremental exercise in patients with OHS. METHODS Sixty-eight obese adults with OHS (n = 15), eucapnic obstructive sleep apnea (n = 26), or simple obesity (n = 27) participated in an incremental exercise test on a cycle ergometer and an in-laboratory sleep study. RESULTS The peak oxygen uptake (peak VO₂) and peak pulse oxygen was decreased in patients with OHS compared with patients with either obstructive sleep apnea or simple obesity. The ventilatory response to exertional metabolic demand (nadir VE/VCO₂, ∆VE/∆VCO₂ slope, and VE/VCO₂ at peak exercise) did not significantly differ among the 3 groups. Minute ventilation, tidal volume, respiratory frequency, tidal volume/respiratory frequency, and inspiratory time/total time ratio at a given work rate were comparable among the 3 groups. Among the whole cohort, apnea-hypopnea index was not independently associated with peak VO₂, and no association was found between the ∆VE/∆VCO₂ slope and resting arterial partial pressure of CO₂. CONCLUSIONS The ventilatory response to incremental exercise is preserved in patients with OHS compared with patients with obstructive sleep apnea and simple obesity who were matched for age and body mass index. This result highlights the complexity of the respiratory control system during exercise for patients with OHS, which may be uncoupled with the ventilatory response during sleep and resting conditions.
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Affiliation(s)
- Teng Han
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Li Zhang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China.,Peking University Health Science Center, Beijing, China
| | - Chun Yan Yu
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Yi Ming Li
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Yan Wang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Xiao Lei Zhang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China.,Peking University Health Science Center, Beijing, China.,Capital Medical University, Beijing, China.,The Graduate School of Peking Union Medical College, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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Jen R, Orr JE, Gilbertson D, Fine J, Li Y, Wong D, Bosompra NO, Hopkins SR, Raisinghani A, Malhotra A. Impact of obstructive sleep apnea on cardiopulmonary performance, endothelial dysfunction, and pulmonary hypertension during exercise. Respir Physiol Neurobiol 2020; 283:103557. [PMID: 33010457 DOI: 10.1016/j.resp.2020.103557] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/21/2020] [Accepted: 09/26/2020] [Indexed: 11/15/2022]
Abstract
RATIONALE OSA has been associated with reduced exercise capacity. Endothelial dysfunction and exercise-induced pulmonary hypertension (ePH) may be mediators of this impairment. We hypothesized that OSA severity would be associated with impaired exercise performance, endothelial dysfunction, and ePH. METHODS Subjects with untreated OSA were recruited. Subjects underwent endothelial function, and cardiopulmonary exercise testing with an echocardiogram immediately before and following exercise. RESULTS 22 subjects were recruited with mean age 56 ± 8 years, 74 % male, BMI 29 ± 3 kg/m2, and AHI 22 ± 12 events/hr. Peak V˙O2 did not differ from normal (99.7 ± 17.3 % predicted; p = 0.93). There was no significant association between OSA severity (as AHI, ODI) and exercise capacity, endothelial function, or pulmonary artery pressure. However, ODI, marker of RV diastolic dysfunction, and BMI together explained 59.3 % of the variability of exercise performance (p < 0.001) via our exploratory analyses. CONCLUSIONS Exercise capacity was not impaired in this OSA cohort. Further work is needed to elucidate mechanisms linking sleep apnea, obesity, endothelial dysfunction and exercise impairment.
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Affiliation(s)
- Rachel Jen
- Division of Respiratory Medicine, University of British Columbia, Vancouver, BC, Canada; Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, La Jolla, CA, United States.
| | - Jeremy E Orr
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, La Jolla, CA, United States
| | - Dillon Gilbertson
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, La Jolla, CA, United States
| | - Janelle Fine
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, La Jolla, CA, United States
| | - Yanru Li
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, La Jolla, CA, United States; Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology, Head and Neck Surgery (Ministry of Education of China), Beijing, China
| | - Darrin Wong
- Division of Cardiology, University of California, San Diego, La Jolla, CA, United States
| | - Naa-Oye Bosompra
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, La Jolla, CA, United States
| | - Susan R Hopkins
- Departments of Medicine and Radiology, University of California, San Diego, La Jolla, CA, United States
| | - Ajit Raisinghani
- Division of Cardiology, University of California, San Diego, La Jolla, CA, United States
| | - Atul Malhotra
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, La Jolla, CA, United States
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CPAP Effect on Cardiopulmonary Exercise Testing Performance in Patients with Moderate-Severe OSA and Cardiometabolic Comorbidities. ACTA ACUST UNITED AC 2020; 56:medicina56020080. [PMID: 32075328 PMCID: PMC7074283 DOI: 10.3390/medicina56020080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 02/11/2020] [Accepted: 02/12/2020] [Indexed: 02/06/2023]
Abstract
Background and Objectives: Obstructive sleep apnea (OSA) is associated with daytime somnolence, cognitive impairment and high cardiovascular morbidity and mortality. Obesity, associated cardiovascular comorbidities, accelerated erythropoiesis and muscular mitochondrial energetic dysfunctions negatively influence exercise tolerance in moderate-severe OSA patients. The cardiopulmonary exercise testing (CPET) offers an integrated assessment of the individual's aerobic capacity and helps distinguish the main causes of exercise limitation. The purpose of this study is to evaluate the aerobic capacity of OSA patients, before and after short-term continuous positive airway pressure (CPAP). Materials and Methods: Our prospective study included 64 patients with newly diagnosed moderate-severe OSA (apnea hypopnea index (AHI) 39.96 ± 19.04 events/h) who underwent CPET before and after CPAP. Thirteen patients were unable to tolerate CPAP or were lost during follow-up. Results: 49.29% of our patients exhibited a moderate or severe decrease in functional capacity (Weber C or D). CPET performance was influenced by gender but not by apnea severity. Eight weeks of CPAP induced significant improvements in maximal exercise load (Δ = 14.23 W, p = 0.0004), maximum oxygen uptake (Δ = 203.87 mL/min, p = 0.004), anaerobic threshold (Δ = 316.4 mL/min, p = 0.001), minute ventilation (Δ = 5.1 L/min, p = 0.01) and peak oxygen pulse (Δ = 2.46, p = 0.007) as well as a decrease in basal metabolic rate (BMR) (Δ = -8.3 kCal/24 h, p = 0.04) and average Epworth score (Δ = -4.58 points, p < 0.000001). Conclusions: Patients with moderate-severe OSA have mediocre functional capacity. Apnea severity (AHI) was correlated with basal metabolic rate, resting heart rate and percent predicted maximum effort but not with anaerobic threshold or maximum oxygen uptake. Although CPET performance was similar in the two apnea severity subgroups, short-term CPAP therapy significantly improved most CPET parameters, suggesting that OSA per se has a negative influence on effort capacity.
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Dumortier L, Bricout VA. Obstructive sleep apnea syndrome in adults with down syndrome: Causes and consequences. Is it a "chicken and egg" question? Neurosci Biobehav Rev 2020; 108:124-138. [DOI: 10.1016/j.neubiorev.2019.10.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/11/2019] [Accepted: 10/26/2019] [Indexed: 12/31/2022]
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11
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Skoczyński S, Nowosielski K, Minarowski Ł, Brożek G, Oraczewska A, Glinka K, Ficek K, Kotulska B, Tobiczyk E, Skomro R, Mróz R, Barczyk A. May Dyspnea Sensation Influence the Sexual Function in Men With Obstructive Sleep Apnea Syndrome? A Prospective Control Study. Sex Med 2019; 7:303-310. [PMID: 31327723 PMCID: PMC6728763 DOI: 10.1016/j.esxm.2019.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 05/26/2019] [Accepted: 06/17/2019] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Dyspnea sensation is frequently present in obstructive sleep apnea syndrome (OSA) patients; however, its possible influence on sexual function and body image has not been well analyzed. AIMS To evaluate sexual function, the prevalence of sexual dysfunction (SD), and body image during sexual activity and its relationship with dyspnea in men with OSA. METHODS 129 men were included in the prospective study, with 61 diagnosed with OSA (cases) and 68 age- and BMI-matched healthy control subjects. Patients were assessed for the severity of heart failure by the New York Heart Association scale and dyspnea by the Visual Analogue Scale. OSA was confirmed by in-laboratory polysomnography. MAIN OUTCOME MEASURES International Index of Erectile Function (IIEF) was used as a measure of sexual function, body image during sexual activity was assessed by the Body Exposure During Sexual Activity Questionnaire, whereas SD was diagnosed using criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition. RESULTS The mean age of the studied population was 57.9 ± 10.8 years. Presence of dyspnea interfered with sexual life in 20% of men diagnosed with OSA and with work performance in 33%. Men with OSA had worse scores in IIEF-15 compared with control subjects and higher frequency of sexual distress compared with men with OSA. There were no differences in the rate of SD according to criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. The presence of OSA worsened the perceived body image during sexual activity. The presence of dyspnea was the only negative factor affecting sexual function in general (IIEF-15 score) and 1 of the factors affecting erectile function and orgasmic function. CONCLUSION In men with OSA, body image is negatively influenced by the presence of OSA. Furthermore, the presence of dyspnea assessed by the New York Heart Association scale impairs sexual function in that group of men. Skoczyński S, Nowosielski K, Minarowski Ł, et al. May Dyspnea Sensation Influence the Sexual Function in Men With Obstructive Sleep Apnea Syndrome? A Prospective Control Study. Sex Med 2019;7:303-310.
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Affiliation(s)
- Szymon Skoczyński
- Department of Pneumonology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | | | - Łukasz Minarowski
- 2(nd) Department of Lung Diseases and Tuberculosis, Medical University of Białystok, Poland
| | - Grzegorz Brożek
- Department of Epidemiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Aleksandra Oraczewska
- Department of Pneumonology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Klaudia Glinka
- Department of Pneumonology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland; 2(nd) Department of Lung Diseases and Tuberculosis, Medical University of Białystok, Poland
| | - Karolina Ficek
- Department of Pneumonology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Beata Kotulska
- Department of Pneumonology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Ewelina Tobiczyk
- Department of Pneumonology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Robert Skomro
- Division of Respiratory, Critical Care and Sleep Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Division of Angiology, Wroclaw Medical University, Wroclaw, Poland
| | - Robert Mróz
- 2(nd) Department of Lung Diseases and Tuberculosis, Medical University of Białystok, Poland
| | - Adam Barczyk
- Department of Pneumonology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
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Holley AB. OSA, Exercise, and the Military. J Clin Sleep Med 2019; 15:819-820. [PMID: 31138394 DOI: 10.5664/jcsm.7824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 05/13/2019] [Indexed: 11/13/2022]
Affiliation(s)
- Aaron B Holley
- Pulmonary/Sleep and Critical Care Medicine Service, Walter Reed National Military Medical Center, Bethesda, Maryland
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Powell TA, Mysliwiec V, Aden JK, Morris MJ. Moderate to Severe Obstructive Sleep Apnea in Military Personnel Is Not Associated With Decreased Exercise Capacity. J Clin Sleep Med 2019; 15:823-829. [PMID: 31138386 DOI: 10.5664/jcsm.7828] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 01/17/2019] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Studies of older and less active patients with obstructive sleep apnea (OSA) have reported decreased exercise capacity as measured by peak oxygen uptake (VO2 max) during cardiopulmonary exercise testing (CPET). We looked to determine whether VO2 max was decreased in younger patients with OSA who regularly exercise as would be encountered in the military. METHODS We evaluated military personnel who had undergone pulmonary function testing (PFT), CPET, and polysomnography (PSG) as part of the larger STAMPEDE III study for comprehensive evaluation of exertional dyspnea. For analysis, patients were classified into two groups, the OSA group with an apnea-hypopnea index (AHI) ≥ 15 events/h and a control group with an AHI < 15 events/h. RESULTS Mean AHI was 32.7 in the OSA group (n = 40) versus 5.8 in the control group (n = 58) with no significant difference in age (40.7 years versus 39.4 years) or body mass index (30.4 kg/m2 versus 29.9 kg/m2). PFT was normal in both groups including diffusing capacity (100.7% versus 96.5%) and FEV1 (89.2% versus 86.2%). VO2 max was not significantly different in the OSA group compared to the control group (101.3% versus 102.8%; P = .60) with both groups having normal exercise capacity. Exercise blood pressure response was normal and peak heart rate trended toward a blunted response in the OSA group (166.0 bpm versus 171.6 bpm, P = .09). CONCLUSIONS Younger military personnel with moderate to severe OSA do not have decreased exercise capacity. The effect of OSA on exercise tolerance may be influenced by additional factors and is likely too small to be noted in this population. COMMENTARY A commentary on this article appears in this issue on page 819.
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Affiliation(s)
- Tyler A Powell
- Sleep Medicine Service, Wilford Hall Ambulatory Surgery Center, JBSA Lackland AFB, Texas
| | - Vincent Mysliwiec
- Sleep Medicine Service, Wilford Hall Ambulatory Surgery Center, JBSA Lackland AFB, Texas
| | - James K Aden
- Graduate Medical Education, Brooke Army Medical Center, JBSA Fort Sam Houston, Texas
| | - Michael J Morris
- Graduate Medical Education, Brooke Army Medical Center, JBSA Fort Sam Houston, Texas
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Berger M, Kline CE, Cepeda FX, Rizzi CF, Chapelle C, Laporte S, Hupin D, Raffin J, Costes F, Hargens TA, Barthélémy JC, Roche F. Does obstructive sleep apnea affect exercise capacity and the hemodynamic response to exercise? An individual patient data and aggregate meta-analysis. Sleep Med Rev 2019; 45:42-53. [PMID: 30933881 DOI: 10.1016/j.smrv.2019.03.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 02/14/2019] [Accepted: 03/07/2019] [Indexed: 10/27/2022]
Abstract
Obstructive sleep apnea (OSA) has been linked to altered cardiovascular response to exercise. A systematic review and individual patient data (IPD) meta-analysis were conducted to assess whether OSA patients present reduced exercise capacity. PubMed, Embase and Web of Science were searched until September 2018. Studies which performed sleep recording in both OSA patients and controls and measured maximal oxygen consumption (VO2peak) via a maximal exercise test were included. IPD were provided for five trials upon the 18 eligible (N = 289) and a two-stage IPD meta-analysis model was used, allowing to standardize the apnea cutoff and adjust for confounders. IPD meta-analysis demonstrated that moderate to severe OSA patients had similar VO2peak (mean difference: -1.03 mL·kg-1 min-1; 95% CI: -3.82 to 1.76; p = 0.47) and cardiovascular response to exercise compared to mild or non-OSA patients. By contrast, aggregate data (AD) meta-analysis including the 13 trials for which IPD were unavailable (N = 605) revealed that VO2peak was reduced in OSA patients compared to controls (mean difference: -2.30 mL·kg-1 min-1; 95% CI: -3.96 to -0.63; p < 0.001) with high heterogeneity. In conclusion, IPD meta-analysis suggests that VO2peak and the cardiovascular response to exercise are preserved in moderate to severe OSA patients while AD meta-analysis suggests lower VO2peak in severe OSA.
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Affiliation(s)
- Mathieu Berger
- SNA-EPIS Laboratory, University of Lyon, University Jean Monnet Saint-Etienne, EA 4607, France; Department of Clinical and Exercise Physiology, University Hospital of Saint-Etienne, France.
| | - Christopher E Kline
- Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, PA, United States
| | - Felipe X Cepeda
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Camila F Rizzi
- Cardiology Discipline, Medicine Department, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Céline Chapelle
- INSERM, UMR 1059, SAINBIOSE, Dysfonction Vasculaire et Hémostase, Université Jean Monnet, Saint-Etienne, France
| | - Silvy Laporte
- INSERM, UMR 1059, SAINBIOSE, Dysfonction Vasculaire et Hémostase, Université Jean Monnet, Saint-Etienne, France
| | - David Hupin
- SNA-EPIS Laboratory, University of Lyon, University Jean Monnet Saint-Etienne, EA 4607, France; Department of Clinical and Exercise Physiology, University Hospital of Saint-Etienne, France
| | - Jérémy Raffin
- SNA-EPIS Laboratory, University of Lyon, University Jean Monnet Saint-Etienne, EA 4607, France; Department of Clinical and Exercise Physiology, University Hospital of Saint-Etienne, France
| | - Frédéric Costes
- Department of Physiology, University Hospital Gabriel Montpied, Clermont-Ferrand, France
| | - Trent A Hargens
- Human Performance Laboratory, Department of Kinesiology, James Madison University, Harrisonburg, VA, United States
| | - Jean-Claude Barthélémy
- SNA-EPIS Laboratory, University of Lyon, University Jean Monnet Saint-Etienne, EA 4607, France; Department of Clinical and Exercise Physiology, University Hospital of Saint-Etienne, France
| | - Frédéric Roche
- SNA-EPIS Laboratory, University of Lyon, University Jean Monnet Saint-Etienne, EA 4607, France; Department of Clinical and Exercise Physiology, University Hospital of Saint-Etienne, France
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Passos VMM, Lima AMJD, Leite BRAFDB, Pedrosa RP, Barros IMLD, Costa LOBF, Santos ADC, Brasileiro-Santos MDS. Influence of obesity in pulmonary function and exercise tolerance in obese women with obstructive sleep apnea. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2019; 63:40-46. [PMID: 30864630 PMCID: PMC10118846 DOI: 10.20945/2359-3997000000101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 11/24/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the influence of obesity on pulmonary function and exercise tolerance in women with obstructive sleep apnea (OSA). SUBJECTS AND METHODS A descriptive analytic cross- sectional study was carried out. Thirty-nine (39) sedentary climacteric women, aged 45 to 60 years, were evaluated and submitted to polysomnography. The participants were divided into 4 groups: a) 'eutrophic non-OSA' (n = 13); b) 'eutrophic OSA' (n = 5); c) 'obese non-OSA' (n = 6); d) 'obese OSA' (n = 15). All subjects underwent clinical and anthropometric evaluation, followed by pulmonary function tests and 6-minute walk test (6MWT). RESULTS There was a significant difference in the predicted percentage values of FEV1/FVC when comparing 'eutrophic OSA' and 'obese OSA' (97.6% ± 6.1% vs. 105.7% ± 5.7%, respectively; p = 0.025). The other spirometric variables did not show any differences between the studied groups. There was no significant difference in the maximum distance walked when the 'eutrophic non-OSA', 'eutrophic OSA', 'obese non-OSA' and 'obese OSA' groups were compared. CONCLUSION Considering the results of this study, OSA itself did not influence pulmonary function or functional capacity parameters compared to eutrophic women. However, not only isolated obesity but also obesity associated with OSA can negatively impact sleep quality and lung function.
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16
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Impaired cerebral oxygenation and exercise tolerance in patients with severe obstructive sleep apnea syndrome. Sleep Med 2018; 51:37-46. [DOI: 10.1016/j.sleep.2018.06.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 06/25/2018] [Accepted: 06/27/2018] [Indexed: 11/19/2022]
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MARILLIER MATHIEU, GRUET MATHIEU, BAILLIEUL SÉBASTIEN, LE ROUX MALLOUF THIBAULT, WUYAM BERNARD, TAMISIER RENAUD, LEVY PATRICK, PEPIN JEANLOUIS, VERGES SAMUEL. Neuromuscular Dysfunction and Cortical Impairment in Sleep Apnea Syndrome. Med Sci Sports Exerc 2018; 50:1529-1539. [DOI: 10.1249/mss.0000000000001625] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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18
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Brief Review: Ergospirometry in Patients with Obstructive Sleep Apnea Syndrome. J Clin Med 2018; 7:jcm7080191. [PMID: 30065219 PMCID: PMC6111535 DOI: 10.3390/jcm7080191] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 07/23/2018] [Accepted: 07/29/2018] [Indexed: 01/23/2023] Open
Abstract
This brief review summarizes the available literature on the intersection of obstructive sleep apnea syndrome (OSAS) and ergospirometry. Ergospirometry provides an assessment of integrative exercise responses involving pulmonary, cardiovascular, neuropsychological, and skeletal muscle systems, which are not adequately reflected through the measurement of individual organ system functions. Sleep disorders, including OSAS, often exacerbate problems in the operation of the autonomic nervous system, heart function, lung mechanics, anxiety, and muscle metabolism. Patients with OSAS have low aerobic capacity due to dysfunction of these systems, which often affect quality of sleep. Further research is necessary to elucidate the precise mechanisms through which ergospirometry can be useful in the assessment and early identification of patients with OSAS.
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Mendelson M, Marillier M, Bailly S, Flore P, Borel JC, Vivodtzev I, Doutreleau S, Tamisier R, Pépin JL, Verges S. Maximal exercise capacity in patients with obstructive sleep apnoea syndrome: a systematic review and meta-analysis. Eur Respir J 2018; 51:13993003.02697-2017. [PMID: 29700103 DOI: 10.1183/13993003.02697-2017] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Accepted: 04/13/2018] [Indexed: 01/27/2023]
Abstract
Maximal aerobic capacity is a strong health predictor and peak oxygen consumption (V'O2peak) is considered a reflection of total body health. No systematic reviews or meta-analyses to date have synthesised the existing data regarding V'O2peak in patients with obstructive sleep apnoea (OSA).A systematic review of English and French articles using PubMed/MEDLINE and Embase included studies assessing V'O2peak in OSA patients either in mL·kg-1·min-1 compared with controls or in % predicted. Two independent reviewers analysed the studies, extracted the data and assessed the quality of evidence.Mean V'O2peak expressed in mL·kg-1·min-1 was significantly lower in patients with OSA than in controls (mean difference -2.7 mL·kg-1·min-1; p<0.001; n=850). This reduction in V'O2peak was found to be larger in non-obese patients (body mass index <30 kg·m-2). Mean V'O2peak % pred was 89.9% in OSA patients (n=643).OSA patients have reduced maximal aerobic capacity, which can be associated with increased cardiovascular risks and reduced survival in certain patient subgroups. Maximal exercise testing can be useful to characterise functional limitation and to evaluate health status in OSA patients.
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Affiliation(s)
- Monique Mendelson
- HP2 Laboratory, University Grenoble Alpes, Grenoble, France.,Inserm U1042, Grenoble, France.,Grenoble Alps University Hospital, Grenoble, France.,Both authors contributed equally and share the first authorship
| | - Mathieu Marillier
- HP2 Laboratory, University Grenoble Alpes, Grenoble, France.,Inserm U1042, Grenoble, France.,Grenoble Alps University Hospital, Grenoble, France.,Both authors contributed equally and share the first authorship
| | - Sébastien Bailly
- HP2 Laboratory, University Grenoble Alpes, Grenoble, France.,Inserm U1042, Grenoble, France.,Grenoble Alps University Hospital, Grenoble, France
| | - Patrice Flore
- HP2 Laboratory, University Grenoble Alpes, Grenoble, France.,Inserm U1042, Grenoble, France.,Grenoble Alps University Hospital, Grenoble, France
| | - Jean-Christian Borel
- HP2 Laboratory, University Grenoble Alpes, Grenoble, France.,Inserm U1042, Grenoble, France.,Grenoble Alps University Hospital, Grenoble, France
| | - Isabelle Vivodtzev
- HP2 Laboratory, University Grenoble Alpes, Grenoble, France.,Inserm U1042, Grenoble, France.,Grenoble Alps University Hospital, Grenoble, France
| | - Stéphane Doutreleau
- HP2 Laboratory, University Grenoble Alpes, Grenoble, France.,Inserm U1042, Grenoble, France.,Grenoble Alps University Hospital, Grenoble, France
| | - Renaud Tamisier
- HP2 Laboratory, University Grenoble Alpes, Grenoble, France.,Inserm U1042, Grenoble, France.,Grenoble Alps University Hospital, Grenoble, France
| | - Jean-Louis Pépin
- HP2 Laboratory, University Grenoble Alpes, Grenoble, France.,Inserm U1042, Grenoble, France.,Grenoble Alps University Hospital, Grenoble, France.,Both authors share senior authorship
| | - Samuel Verges
- HP2 Laboratory, University Grenoble Alpes, Grenoble, France.,Inserm U1042, Grenoble, France.,Grenoble Alps University Hospital, Grenoble, France.,Both authors share senior authorship
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Adimi Naghan P, Aloosh O, Torang HA, Malekmohammad M. Can 6-minute walk test predict severity of obstructive sleep apnea syndrome? SLEEP SCIENCE AND PRACTICE 2017. [DOI: 10.1186/s41606-017-0018-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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21
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Obstructive sleep apnea does not impair cardiorespiratory responses to progressive exercise performed until exhaustion in hypertensive elderly. Sleep Breath 2017; 22:431-437. [DOI: 10.1007/s11325-017-1557-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 08/02/2017] [Accepted: 08/14/2017] [Indexed: 10/19/2022]
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22
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Effects of Obstructive Sleep Apnea on Hemodynamic Parameters in Patients Entering Cardiac Rehabilitation. J Cardiopulm Rehabil Prev 2015; 35:181-5. [DOI: 10.1097/hcr.0000000000000102] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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23
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Beitler JR, Awad KM, Bakker JP, Edwards BA, DeYoung P, Djonlagic I, Forman DE, Quan SF, Malhotra A. Obstructive sleep apnea is associated with impaired exercise capacity: a cross-sectional study. J Clin Sleep Med 2014; 10:1199-204. [PMID: 25325602 DOI: 10.5664/jcsm.4200] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 07/06/2014] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Obstructive sleep apnea (OSA) is associated with increased risk of adverse cardiovascular events. Because cardiopulmonary exercise testing (CPET) aids in prognostic assessment of heart disease, there is rising interest in its utility for cardiovascular risk stratification of patients with OSA. However, the relationship between OSA and exercise capacity is unclear. This study was conducted to test the hypothesis that OSA is associated with impaired exercise capacity. METHODS Fifteen subjects with moderate-to-severe OSA (apnea-hypopnea index [AHI] ≥15 events/h) and 19 controls with mild or no OSA (AHI <15 events/h) were enrolled. Subjects underwent standard polysomnography to determine AHI and exclude other sleep disorders. Resting metabolic rate was measured via indirect calorimetry, followed by maximum, symptom-limited CPET. Subjects completed a sleep diary and physical activity questionnaire characterizing behaviors in the week prior to testing. RESULTS Percent predicted peak oxygen uptake (V˙O2) was significantly lower in OSA subjects than controls (70.1%±17.5% vs 83.8%±13.9%; p = 0.02). Each 1-unit increase in log-transformed AHI was associated with a decrease in percent predicted peak V˙O2 of 3.20 (95% CI 0.53-5.88; p = 0.02). After adjusting for baseline differences, this association remained significant (p < 0.01). AHI alone explained 16.1% of the variability observed in percent predicted peak V˙O2 (p = 0.02). CONCLUSIONS OSA is associated with impaired exercise capacity. Further study is needed to evaluate the utility of CPET for prognostic assessment of patients with OSA.
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Affiliation(s)
- Jeremy R Beitler
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Karim M Awad
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Jessie P Bakker
- Division of Sleep Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Bradley A Edwards
- Division of Sleep Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Pam DeYoung
- Division of Pulmonary and Critical Care Medicine, University of California, San Diego, San Diego, CA
| | - Ina Djonlagic
- Division of Sleep Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Daniel E Forman
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Stuart F Quan
- Division of Sleep Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA and Arizona Respiratory Center, University of Arizona College of Medicine, Tucson, AZ
| | - Atul Malhotra
- Division of Pulmonary and Critical Care Medicine, University of California, San Diego, San Diego, CA
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Ozsarac I, Bayram N, Uyar M, Kosovali D, Gundogdu N, Filiz A. Effects of positive airway pressure therapy on exercise parameters in obstructive sleep apnea. Ann Saudi Med 2014; 34:302-7. [PMID: 25811202 PMCID: PMC6152564 DOI: 10.5144/0256-4947.2014.302] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Obstructive sleep apnea (OSA) is common in adult population and may cause many adverse clinical results. We aimed to investigate possible changes in cardiopulmonary exercise capacity in OSA patients after positive airway pressure treatment. DESIGN AND SETTINGS Patients who were admitted to Gaziantep University Pulmonary Diseases Sleep Center and diagnosed OSA were included. Studies carried out between May 2010 and July 2011. Sixty-five consecutive patients were included in this prospective study. PATIENTS AND METHODS Sixty-five adult sleep clinic patients diagnosed with OSA by polysomnography and in whom continuous positive airway pressure (CPAP) ventilation therapy was indicated were included. Cardiopulmonary exercise capacity was assessed by bicycle ergometry during diagnostic workup and at least 4 weeks later. RESULTS There were 57 (87.7%) males. The mean age was 45.29 (10.57) years, apnea-hypopnea index 38.02 (23.19 events/h, body mass index 31.72 (4.87) kg/m2. Patients were grouped with respect to compliance with CPAP. The peak oxygen consumption (VO2) did not change in the CPAP compliant group (n=33) (22.52 [6.62] mL/[min.kg] to 21.32 [5.26] mL/[min.kg]; P=.111), and decreased from 21.31 (5.66) mL/(min.kg) to 19.92 (5.40) mL/(min.kg) (P=.05) in the CPAP noncompliant group. Work rate increased from 84.0% to 85.0% in the CPAP compliant group and decreased from 79.6% to 77.1% in the noncompliant group (P=.041). In the group that used the device, ventilation (VE)/VCO2 at anaerobic threshold (AT) declined from 28.42 to 27.36; however, it increased from 27.41 to 27.81 in the group that did not use the device (P=.033). CONCLUSIONS Decline in the exercise capacity was prevented in patients with OSA after 4 weeks of CPAP therapy. The changes in VE/VCO2 at AT suggest the reversal of pathophysiologic changes in OSA with the CPAP therapy that may improve cardiac function and cause more efficient ventilation.
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Affiliation(s)
| | | | - Meral Uyar
- Dr. Meral Uyar, Department of Pulmonary Medicine, Gaziantep University, Gaziantep 2700, Turkey, T: 90-342-3606060 (76183 ext.), F: 90-342-3606306,
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Evans CA, Selvadurai H, Baur LA, Waters KA. Effects of obstructive sleep apnea and obesity on exercise function in children. Sleep 2014; 37:1103-10. [PMID: 24882905 DOI: 10.5665/sleep.3770] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
STUDY OBJECTIVES Evaluate the relative contributions of weight status and obstructive sleep apnea (OSA) to cardiopulmonary exercise responses in children. DESIGN Prospective, cross-sectional study. Participants underwent anthropometric measurements, overnight polysomnography, spirometry, cardiopulmonary exercise function testing on a cycle ergometer, and cardiac doppler imaging. OSA was defined as ≥ 1 obstructive apnea or hypopnea per hour of sleep (OAHI). The effect of OSA on exercise function was evaluated after the parameters were corrected for body mass index (BMI) z-scores. Similarly, the effect of obesity on exercise function was examined when the variables were adjusted for OAHI. SETTING Tertiary pediatric hospital. PARTICIPANTS Healthy weight and obese children, aged 7-12 y. INTERVENTIONS N/A. MEASUREMENTS AND RESULTS Seventy-one children were studied. In comparison with weight-matched children without OSA, children with OSA had a lower cardiac output, stroke volume index, heart rate, and oxygen consumption (VO2 peak) at peak exercise capacity. After adjusting for BMI z-score, children with OSA had 1.5 L/min (95% confidence interval -2.3 to -0.6 L/min; P = 0.001) lower cardiac output at peak exercise capacity, but minute ventilation and ventilatory responses to exercise were not affected. Obesity was only associated with physical deconditioning. Cardiac dysfunction was associated with the frequency of respiratory-related arousals, the severity of hypoxia, and heart rate during sleep. CONCLUSIONS Children with OSA are exercise limited due to a reduced cardiac output and VO2 peak at peak exercise capacity, independent of their weight status. Comorbid OSA can further decrease exercise performance in obese children.
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Affiliation(s)
- Carla A Evans
- The Children's Hospital at Westmead Clinical School, Discipline of Paediatrics & Child Health, Faculty of Medicine, The University of Sydney NSW Australia
| | - Hiran Selvadurai
- The Children's Hospital at Westmead Clinical School, Discipline of Paediatrics & Child Health, Faculty of Medicine, The University of Sydney NSW Australia ; The Department of Respiratory Medicine, The Children's Hospital at Westmead, Westmead NSW Australia
| | - Louise A Baur
- The Children's Hospital at Westmead Clinical School, Discipline of Paediatrics & Child Health, Faculty of Medicine, The University of Sydney NSW Australia ; Weight Management Service, The Children's Hospital at Westmead, Westmead NSW Australia
| | - Karen A Waters
- The Children's Hospital at Westmead Clinical School, Discipline of Paediatrics & Child Health, Faculty of Medicine, The University of Sydney NSW Australia ; The Department of Respiratory Medicine, The Children's Hospital at Westmead, Westmead NSW Australia
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Cholidou KG, Manali ED, Kapsimalis F, Kostakis ID, Vougas K, Simoes D, Markozannes E, Vogiatzis I, Bakakos P, Koulouris N, Alchanatis M. Heart rate recovery post 6-minute walking test in obstructive sleep apnea: cycle ergometry versus 6-minute walking test in OSA patients. Clin Res Cardiol 2014; 103:805-15. [PMID: 24820928 DOI: 10.1007/s00392-014-0721-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 04/24/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To examine the clinical usefulness of heart rate recovery (HRR) post 6-minute walking test (6MWT) as a simple marker of cardiovascular risk in obstructive sleep apnea (OSA) patients in comparison to HRR post cycle ergometry, the validated and more sophisticated protocol. METHODS Seventy-four participants underwent full overnight polysomnography, cycle ergometry and 6MWT. The HRR at 1, 2 and 3 min (HRR-1, HRR-2 and HRR-3) 6MWT was compared to HRR at 1, 2, and 3 min post cycle ergometry in normal subjects and in moderate and severe OSA patients before and after 6-month CPAP treatment. RESULTS The HRR-1, HRR-2 and HRR-3 in 6MWT were significantly different between normal, moderate and severe OSA patients with higher rates achieved in normal. The higher the severity of OSA the lower the HRR was. There were also no differences found between work rate and distance walked during cycle ergometry or 6MWT, respectively, concerning normal, moderate and severe OSA patients. Heart rate recovery was further associated with minimum saturation of oxygen during sleep independently of the duration of apnea episodes of BMI and ESS. The treatment with CPAP had a beneficial effect on HRR both post-6MWT and post cycle ergometry. CONCLUSIONS Autonomic nervous system dysfunction in OSA can be found even with submaximal exertion. Heart rate recovery post-6MWT, such as HRR post cycle ergometry, was significantly impaired in OSA patients in comparison to normals and was favorably influenced from CPAP treatment. Furthermore, it was found to be more sensitive compared with distance walked in 6MWT in discriminating severity of OSA. The HRR post-6MWT was found to be an easily measured and reliable marker of OSA severity both before and after CPAP treatment.
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Affiliation(s)
- Kyriaki G Cholidou
- 1st Respiratory Medicine Department, National and Kapodistrian University of Athens, Medical School, "Sotiria" Chest Diseases Hospital, Athens, Greece,
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Damianidou L, Eboriadou M, Giannopoulos A, Haidopoulou K, Markou K, Tzimou I, Kirvasilis F, Kontouli K, Tsanakas I, Athanassiadou F. Reduced exercise capacity in Greek children with mild to moderate obstructive sleep apnea syndrome. Pediatr Pulmonol 2013. [PMID: 23192889 DOI: 10.1002/ppul.22730] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Obstructive sleep apnea syndrome (OSAS) is a common disease that is increasingly recognized among pediatric population. The exercise capacity of adults with OSAS has been demonstrated to be impaired, but there are no data about pediatric exercise response. AIM The aim of this study was to evaluate cardiopulmonary response to exercise in children with OSAS and to correlate exercise capacity and severity of OSAS. METHODS Twenty-seven children with habitual snoring (Group A) (mean age 10.5 ± 1.8 years) referred for overnight polysomnography and 13 apparently healthy controls (mean age 11 ± 1.5 years) were recruited. According to the apnea hypopnea index (AHI) group A consisted of 15 (55.6%) children with mild OSAS and 12 (44.4%) with moderate-severe OSAS. All children completed a maximal ramping cardiopulmonary exercise test (CPET) on cycle ergometer. RESULTS According to CPET children with OSAS had significantly lower VO2max (40.3 ± 8.4 ml/kg/min vs. 47.6 ± 7.9 ml/kg/min, P = 0.013) significantly lower VO2max (%) (77.7 ± 15 vs. 92.9 ± 10.5, P = 0.002), lower maximum heart-rate at peak exercise (86.6 ± 8.8 beat/min vs. 90.6 ± 7.2 beat/min) and higher systolic blood pressure level at peak exercise (145 ± 27.4 mmHg vs. 143.92 ± 20 mmHg) compared to control group. CONCLUSION The present study demonstrates that young patients with OSAS, even with mild OSAS, had reduced exercise capacity as compared to control group.
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Affiliation(s)
- Labrini Damianidou
- 2nd Pediatric Department, School of Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
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Butner KL, Hargens TA, Kaleth AS, Miller LE, Zedalis D, Herbert WG. Association of Obstructive Sleep Apnea Severity with Exercise Capacity and Health-related Quality of Life. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2013; 5:362-6. [PMID: 23923110 PMCID: PMC3731867 DOI: 10.4103/1947-2714.114168] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: Current research is inconclusive as to whether obstructive sleep apnea severity directly limits exercise capacity and lowers health-related quality of life (HRQoL). Aims: The aim of this study was to evaluate the association of obstructive sleep apnea severity with determinants of exercise capacity and HRQoL. Subjects and Methods: Subjects were evaluated by home somnography and classified as no obstructive sleep apnea (n = 43) or as having mild (n = 27), moderate or severe obstructive sleep apnea (n = 21). Exercise capacity was assessed by a ramping cycle ergometer test, and HRQoL was assessed with the SF-36 questionnaire. Results: Greater obstructive sleep apnea severity was associated with older age, higher body weight, higher body mass index, lower peak aerobic capacity, a higher percentage of peak aerobic capacity at a submaximal exercise intensity of 55 watts, and lower physical component summary score from the SF-36. None of these variables were statistically different among obstructive sleep apnea severity groups after controlling for age and body weight. Obstructive sleep apnea severity was not associated with any cardiorespiratory fitness or HRQoL parameter. Conclusions: Obstructive sleep apnea severity has no independent association with exercise capacity or HRQoL.
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Affiliation(s)
- Katrina L Butner
- Department of Human Nutrition, Foods and Exercise, Laboratory for Health and Exercise Science, Virginia Tech, Blacksburg, Virginia, USA
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Kasiakogias A, Tsioufis C, Thomopoulos C, Andrikou I, Kefala A, Papadopoulos D, Dima I, Milkas A, Kokkinos P, Stefanadis C. A hypertensive response to exercise is prominent in patients with obstructive sleep apnea and hypertension: a controlled study. J Clin Hypertens (Greenwich) 2013; 15:497-502. [PMID: 23815538 PMCID: PMC8033915 DOI: 10.1111/jch.12111] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 03/01/2013] [Accepted: 03/06/2013] [Indexed: 11/30/2022]
Abstract
Blood pressure (BP) behavior during exercise is not clear in hypertensive patients with obstructive sleep apnea (OSA). The authors studied 57 men with newly diagnosed essential hypertension and untreated OSA (apnea-hypopnea index [AHI] ≥5) but without daytime sleepiness (Epworth Sleepiness Scale score ≤10), and an equal number of hypertensive controls without OSA matched for age, body mass index, and office systolic BP. All patients underwent ambulatory BP measurements, transthoracic echocardiography, and exercise treadmill testing according to the Bruce protocol. A hypertensive response to exercise (HRE) was defined as peak systolic BP ≥210 mm Hg. Patients with OSA and control patients had similar ambulatory and resting BP, ejection fraction, and left ventricular mass. Peak systolic BP was significantly higher in patients with OSA (197.6±25.6 mm Hg vs 187.8±23.6 mm Hg; P=.03), while peak diastolic BP and heart rate did not differ between groups. Furthermore, an HRE was more prevalent in patients with OSA (44% vs 19%; P=.009). Multiple logistic regression revealed that an HRE is independently predicted by both the logAHI and minimum oxygen saturation during sleep (odds ratio, 3.94; confidence interval, 1.69-9.18; P=.001 and odds ratio, 0.94; confidence interval, 0.89-0.99; P=.02, respectively). Exaggerated BP response is more prevalent in nonsleepy hypertensives with OSA compared with their nonapneic counterparts. This finding may have distinct diagnostic and prognostic implications.
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Affiliation(s)
| | - Costas Tsioufis
- First Cardiology ClinicUniversity of Athens Medical SchoolHippokration Hospital
| | - Costas Thomopoulos
- First Cardiology ClinicUniversity of Athens Medical SchoolHippokration Hospital
| | - Ioannis Andrikou
- First Cardiology ClinicUniversity of Athens Medical SchoolHippokration Hospital
| | - Anna Kefala
- First Cardiology ClinicUniversity of Athens Medical SchoolHippokration Hospital
| | | | - Ioanna Dima
- First Cardiology ClinicUniversity of Athens Medical SchoolHippokration Hospital
| | - Anastasios Milkas
- First Cardiology ClinicUniversity of Athens Medical SchoolHippokration Hospital
| | - Peter Kokkinos
- Cardiology DivisionVeterans Affairs Medical CenterWashingtonDC
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Functional aerobic capacity in patients with sleep-disordered breathing. Am J Cardiol 2013; 111:1650-4. [PMID: 23578347 DOI: 10.1016/j.amjcard.2013.02.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 02/05/2013] [Accepted: 02/05/2013] [Indexed: 11/21/2022]
Abstract
Few studies have examined exercise capacity or cardiovascular responses to maximal exercise testing and recovery in patients with sleep-disordered breathing (SDB), and results from these studies are conflicting. The objective of this cross-sectional study conducted at a tertiary referral center was to examine the association between SDB and exercise testing outcomes independent of body mass index (BMI) and other cardiopulmonary risk factors. Between January 1, 2005 and January 1, 2010, 1,424 adults underwent exercise testing and within 6 months before first-time diagnostic polysomnography. Subjects were categorized by apnea-hypopnea index (AHI) into 4 groups: <5, 5 to 14, 15 to 29, and ≥30. A logistic regression model incorporated age, gender, BMI, smoking, hypertension, diabetes, beta-blocker use, and cardiac and pulmonary disease as covariates. The primary variable of interest was functional aerobic capacity (FAC). Mean age was 56.4 ± 12.4 years; 75% were men. Mean BMI was 32.4 ± 7.1 kg/m², and mean AHI 19.5 ± 22.1 per hour. On multivariate analysis, AHI as a continuous variable showed a negative correlation with FAC (R²adj = 0.30, p <0.001) and postexercise SBP (R²adj = 0.23, p = 0.03), and positively correlated with resting and peak DBP (R²adj = 0.09, p = 0.01 and R²adj = 0.09, p = 0.04 respectively). When comparing patients with severe SDB (AHI ≥30) with those without SDB (AHI <5), FAC and heart rate recovery were significantly lower, and resting, peak, and postexercise DBP were higher in those with severe apnea (all p <0.05), after accounting for confounders. In conclusion, SDB severity was associated with reduced FAC and increased resting and peak DBP. Even after accounting for confounders, severe SDB was associated with attenuated FAC, impaired heart rate recovery, and higher resting, peak, and postexercise DBP.
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Rizzi CF, Cintra F, Mello-Fujita L, Rios LF, Mendonca ET, Feres MC, Tufik S, Poyares D. Does obstructive sleep apnea impair the cardiopulmonary response to exercise? Sleep 2013; 36:547-53. [PMID: 23565000 DOI: 10.5665/sleep.2542] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES The aim of this study was to evaluate cardiopulmonary exercise performance in lean and obese patients with obstructive sleep apnea (OSA) compared with controls. DESIGN Case-control study. SETTING The study was carried out in Sao Paulo Sleep Institute, Sao Paulo, Brazil. PATIENTS AND PARTICIPANTS INDIVIDUALS WITH SIMILAR AGES WERE ALLOCATED INTO GROUPS: 22 to the lean OSA group, 36 to the lean control group, 31 to the obese OSA group, and 26 to the obese control group. INTERVENTIONS The participants underwent a clinical evaluation, polysomnography, a maximum limited symptom cardiopulmonary exercise test, two-dimensional transthoracic echocardiography, and spirometry. MEASUREMENTS AND RESULTS The apnea-hypopnea index, arousal index, lowest arterial oxygen saturation (SaO2) and time of SaO2 < 90% were different among the groups. There were differences in functional capacity based on the following variables: maximal oxygen uptake (VO2max), P < 0.01 and maximal carbon dioxide production (VCO2max), P < 0.01. The obese patients with OSA and obese controls presented significantly lower VO2max and VCO2max values. However, the respiratory exchange ratio (RER) and anaerobic threshold (AT) did not differ between groups. Peak diastolic blood pressure (BP) was higher among the obese patients with OSA but was not accompanied by changes in peak systolic BP and heart rate (HR). When multiple regression was performed, body mass index (P < 0.001) and male sex in conjunction with diabetes (P < 0.001) independently predicted VO2max (mL/kg/min). CONCLUSIONS The results of this study suggest that obesity alone and sex, when associated with diabetes but not OSA, influenced exercise cardiorespiratory function.
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Affiliation(s)
- Camila F Rizzi
- Sleep Medicine and Biology Discipline, Psychobiology Department, Universidade Federal de São Paulo, São Paulo, Brazil
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Hargens TA, Kaleth AS, Edwards ES, Butner KL. Association between sleep disorders, obesity, and exercise: a review. Nat Sci Sleep 2013; 5:27-35. [PMID: 23620691 PMCID: PMC3630986 DOI: 10.2147/nss.s34838] [Citation(s) in RCA: 134] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Decreased sleep duration and quality is associated with an increase in body weight and adiposity. Insomnia, obstructive sleep apnea, and restless legs syndrome are three of the most prevalent types of sleep disorder that lead to an increased risk for numerous chronic health conditions. Various studies have examined the impact of these sleep disorders on obesity, and are an important link in understanding the relationship between sleep disorders and chronic disease. Physical activity and exercise are important prognostic tools in obesity and chronic disease, and numerous studies have explored the relationship between obesity, sleep disorders, and exercise. As such, this review will examine the relationship between sleep disorders and obesity. In addition, how sleep disorders may impact the exercise response and how exercise may impact patient outcomes with regard to sleep disorders will also be reviewed.
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Affiliation(s)
- Trent A Hargens
- Department of Kinesiology, James Madison University, Harrisonburg, VA, USA
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Measurement of dyspnea in patients with obstructive sleep apnea. Sleep Breath 2012; 17:753-61. [DOI: 10.1007/s11325-012-0759-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 07/09/2012] [Accepted: 07/23/2012] [Indexed: 01/22/2023]
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Blunted heart rate recovery is improved following exercise training in overweight adults with obstructive sleep apnea. Int J Cardiol 2012; 167:1610-5. [PMID: 22572632 DOI: 10.1016/j.ijcard.2012.04.108] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Revised: 03/21/2012] [Accepted: 04/16/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) predisposes individuals to cardiovascular morbidity, and cardiopulmonary exercise test (CPET) markers prognostic for cardiovascular disease have been found to be abnormal in adults with OSA. Due to the persistence of OSA and its cardiovascular consequences, whether the cardiovascular adaptations normally conferred by exercise are blunted in adults not utilizing established OSA treatment is unknown. The aims of this study were to document whether OSA participants have abnormal CPET responses and determine whether exercise modifies these CPET markers in individuals with OSA. METHODS The CPET responses of 43 sedentary, overweight adults (body mass index [BMI]>25) with untreated OSA (apnea-hypopnea index [AHI]≥ 15) were compared against matched non-OSA controls (n=9). OSA participants were then randomized to a 12-week exercise training (n=27) or stretching control treatment (n=16), followed by a post-intervention CPET. Measures of resting, exercise, and post-exercise recovery heart rate (HRR), blood pressure, and ventilation, as well as peak oxygen consumption (VO(2peak)), were obtained. RESULTS OSA participants had blunted HRR compared to non-OSA controls at 1 (P=.03), 3 (P=.02), and 5-min post-exercise (P=.03). For OSA participants, exercise training improved VO2 peak (P=.04) and HRR at 1 (P=.03), 3 (P<.01), and 5-min post-exercise (P<.001) compared to control. AHI change was associated with change in HRR at 5-min post-exercise (r=-.30, P<.05), but no other CPET markers. CONCLUSIONS These results suggest that individuals with OSA have autonomic dysfunction, and that exercise training, by increasing HRR and VO2 peak, may attenuate autonomic imbalance and improve functional capacity independent of OSA severity reduction.
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Pendharkar SR, Tsai WH, Eves ND, Ford GT, Davidson WJ. CPAP increases exercise tolerance in obese subjects with obstructive sleep apnea. Respir Med 2011; 105:1565-71. [DOI: 10.1016/j.rmed.2011.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Accepted: 06/16/2011] [Indexed: 11/26/2022]
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Tonini J, Michallet AS, Flore P, Nespoulet H, Pepin JL, Wuyam B, Levy P, Tamisier R. Effect of chronic intermittent hypoxia on exercise adaptations in healthy subjects. Respir Physiol Neurobiol 2011; 179:287-93. [PMID: 21930252 DOI: 10.1016/j.resp.2011.09.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Revised: 09/07/2011] [Accepted: 09/08/2011] [Indexed: 10/17/2022]
Abstract
Reduced exercise tolerance has been reported in obstructive sleep apnea syndrome (OSAS) patients, although the associated hypertension, obesity and/or metabolic disorder may underlie this reduction. Therefore, we evaluated the effects of chronic intermittent hypoxia (CIH) in 12 healthy subjects on exercise capacity, cardio-respiratory responses, and substrate oxidation during maximal and sub-maximal exercise. Subjects were exposed to 30 cycles of hypoxia-reoxygenation per hour for 14 nights. Although exercise capacity was unaltered PETCO(2) was reduced and V˙E/V˙CO(2) increased during both maximal and submaximal exercise tests, indicating a hyperventilatory response. Maximal heart rate was lower and diastolic arterial blood pressure (DBP) was higher in the 1st min of recovery after submaximal exercise. Subjects reached maximal lipid oxidation at a higher power output and had decreased blood lactate for a given power output. This suggests that although the metabolic adaptations to CIH in healthy subjects may improve exercise performance, the cardio-pulmonary modifications are similar to those observed in OSAS patients and could limit exercise capacity.
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Chien MY, Lee P, Tsai YF, Yang PC, Wu YT. C-reactive protein and heart rate recovery in middle-aged men with severe obstructive sleep apnea. Sleep Breath 2011; 16:629-37. [PMID: 21706288 DOI: 10.1007/s11325-011-0549-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Revised: 03/30/2011] [Accepted: 06/16/2011] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The study aimed to evaluate whether the inflammatory marker "high-sensitivity C-reactive protein (hsCRP)" level was associated with impaired heart rate recovery at 1 min after exercise termination (HRR-1) in middle-aged patients with severe obstructive sleep apnea (OSA). METHODS Thirty middle-aged male patients (40-64 years old) with severe OSA (apnea-hypopnea index [AHI] ≥ 30 h(-1)) and 30 subjects without OSA (AHI < 5 h(-1)), matched with age and body mass index (BMI), were recruited. All subjects underwent an overnight polysomnography and completed a symptom-limited maximal exercise test. Cardiopulmonary parameters included peak oxygen consumption (VO(2peak)) and heart rate response during and immediately after exercise. Fasting blood samples were drawn for hsCRP analysis. RESULT Patients with severe OSA had significantly higher hsCRP levels (0.18 vs. 0.07 mg/dl, P < 0.01), lower reduced HRR-1, peak heart rate, and VO(2peak) values than those in the controls. The hsCRP levels significantly correlated with HRR-1 in the OSA group (r = -0.69, P < 0.01) after adjustment for VO(2peak) (r = -0.66, P < 0.01). Furthermore, stepwise multiple regression analysis showed that HRR-1 and AHI were significant predictors of hsCRP levels in all participants (adjusted R(2) = 0.53, P < 0.01). CONCLUSIONS Blunted HRR was shown in middle-aged men with severe OSA, and it was associated with high hsCRP levels significantly.
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Affiliation(s)
- Meng-Yueh Chien
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
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Guill S, Hargens T, Nickols-Richardson S, Bassaganya-Riera J, Miller L, Zedalis D, Gregg J, Gwazdauskas F, Herbert W. Early evidence of increased risk for metabolic syndrome in young men with latent obstructive sleep apnea. Metab Syndr Relat Disord 2010; 8:33-8. [PMID: 19943797 DOI: 10.1089/met.2009.0041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is characterized by a repetitive collapse of the upper airway during sleep and may affect as many as 1 in 5 adults. Although OSA appears to increase risk for metabolic syndrome in middle-aged adults, no data currently exist in a younger, preclinical cohort. METHODS Forty-five sedentary young men: 12 overweight with OSA (OSA), 18 overweight without OSA (NOSA), and 15 normal-weight without OSA (CON). Respiratory distress index (RDI) was determined using an at-home, unsupervised, portable polygraphy device. Total and subcutaneous abdominal fat (SAF) were quantified using dual-energy X-ray absorptiometry (DXA). Blood pressure was obtained manually via auscultation. Fasting triglycerides, glucose, and high-density lipoprotein cholesterol (HDL-C) concentrations were analyzed from whole blood using a commercial lipid profile kit. RESULTS The OSA group had 25% more SAF than the NOSA group (P < 0.05) and higher triglycerides (136.7 +/- 21.3 mg/dL versus 92.2 +/- 7.5, P < 0.05). RDI was directly related to fasting triglycerides (R = 0.32, P < 0.05) after controlling for SAF. The number of metabolic syndrome components was directly correlated to indices of adiposity, but not RDI. Using multiple linear regression analysis, triglycerides were the only independent predictor of RDI. CONCLUSIONS Results from this study demonstrate that unique physiologic and anthropometric abnormalities exist in young men with occult OSA, beyond those that are seen in uncomplicated obesity. These findings may indicate early pathogenesis of metabolic syndrome in these young men.
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Affiliation(s)
- Stephen Guill
- Laboratory for Health and Exercise Science, Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, Virginia 24061, USA
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Rizzi CF, Cintra F, Risso T, Pulz C, Tufik S, de Paola A, Poyares D. Exercise Capacity and Obstructive Sleep Apnea in Lean Subjects. Chest 2010; 137:109-14. [DOI: 10.1378/chest.09-1201] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Nanas S, Sakellariou D, Kapsimalakou S, Dimopoulos S, Tassiou A, Tasoulis A, Anastasiou‐Nana M, Vagiakis E, Roussos C. Heart rate recovery and oxygen kinetics after exercise in obstructive sleep apnea syndrome. Clin Cardiol 2010; 33:46-51. [PMID: 20063292 PMCID: PMC6653309 DOI: 10.1002/clc.20707] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Patients who suffer from obstructive sleep apnea (OSA) have a decreased exercise capacity and abnormal autonomic nervous function. However, the kinetics of early oxygen (O2) and heart rate recovery (HRR) have not been described. MATERIALS AND METHODS We evaluated 21 men with moderate to severe OSA (mean age: 48 +/- 11 yrs, mean apnea-hypopnea index [AHI]: 55 +/- 13) and without known heart disease and 10 healthy men matched for age and body mass index (BMI; controls). Men with OSA underwent overnight polysomnography, and both groups underwent symptom-limited incremental cardiopulmonary exercise testing (CPET). We recorded the CPET parameters including peak O2 uptake (VO2p), kinetics of early O2 recovery by the first degree slope of VO2 during the first minute (VO2/t slope), the time required for a 50% decline of VO2p during recovery (T(1/2)), and early heart rate recovery (HRR = HR at maximal exercise - HR at 1 min of recovery), as well as the chronotropic reserve to exercise ([CR] = [peak HR - resting HR/220 - age - resting HR] x 100). Patients with OSA had a lower VO2p (28.7 +/- 4.0 vs 34.7 +/- 6.2 mL/kg/min), VO2/t slope (1.04 +/- 0.3 vs 1.4 +/- 0.17 mL/kg/min2), and T(1/2) (74 +/- 10 vs 56 +/- 6 sec) compared to controls (all P < 0.001). In addition, both HRR and CR were lower in the OSA group (22.0 +/- 7.0 vs 31.0 +/- 6.0 bpm, P:0.003, and 79.0% +/- 15% vs 99.0% +/- 13.0%, P:0.01, respectively). CONCLUSIONS Patients with OSA demonstrate reduced exercise capacity, delayed oxygen kinetics, and reduced HRR. These data point to abnormal oxygen delivery and/or oxidative function of the peripheral muscles and impaired autonomic nervous activity in OSA patients.
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Affiliation(s)
- Serafim Nanas
- Pulmonary and Critical Care Medicine Department, Cardiopulmonary Exercise Testing and Rehabilitation and Sleep Laboratories, National and Kapodestrian University of Athens, Athens, Greece
| | - Dimitrios Sakellariou
- Pulmonary and Critical Care Medicine Department, Cardiopulmonary Exercise Testing and Rehabilitation and Sleep Laboratories, National and Kapodestrian University of Athens, Athens, Greece
| | - Smaragda Kapsimalakou
- Pulmonary and Critical Care Medicine Department, Cardiopulmonary Exercise Testing and Rehabilitation and Sleep Laboratories, National and Kapodestrian University of Athens, Athens, Greece
| | - Stavros Dimopoulos
- Pulmonary and Critical Care Medicine Department, Cardiopulmonary Exercise Testing and Rehabilitation and Sleep Laboratories, National and Kapodestrian University of Athens, Athens, Greece
| | - Antonia Tassiou
- Pulmonary and Critical Care Medicine Department, Cardiopulmonary Exercise Testing and Rehabilitation and Sleep Laboratories, National and Kapodestrian University of Athens, Athens, Greece
| | - Athanasios Tasoulis
- Pulmonary and Critical Care Medicine Department, Cardiopulmonary Exercise Testing and Rehabilitation and Sleep Laboratories, National and Kapodestrian University of Athens, Athens, Greece
| | - Maria Anastasiou‐Nana
- Clinical Therapeutics Department, National and Kapodestrian University of Athens, Athens, Greece
| | - Emmanouil Vagiakis
- Pulmonary and Critical Care Medicine Department, Cardiopulmonary Exercise Testing and Rehabilitation and Sleep Laboratories, National and Kapodestrian University of Athens, Athens, Greece
| | - Charalampos Roussos
- Pulmonary and Critical Care Medicine Department, Cardiopulmonary Exercise Testing and Rehabilitation and Sleep Laboratories, National and Kapodestrian University of Athens, Athens, Greece
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Maeder MT, Ammann P, Schoch OD, Rickli H, Korte W, Hürny C, Myers J, Münzer T. Determinants of postexercise heart rate recovery in patients with the obstructive sleep apnea syndrome. Chest 2009; 137:310-7. [PMID: 19837829 DOI: 10.1378/chest.09-1424] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Young patients with obstructive sleep apnea syndrome (OSAS) display an attenuated heart rate recovery (HRR) during the first minute (HRR-1) and the first 2 min (HRR-2) postexercise. We sought to compare determinants of HRR-1 and HRR-2 in OSAS and to assess whether these associations depend on age. METHODS Exercise testing with measurements of HRR-1 and HRR-2 was performed in 54 patients with untreated OSAS (median [interquartile range] apnea-hypopnea index 27.5 [12.0-42.4] h(-1), desaturation index [DSI] 10.6 [5.1-25.0] h(-1)). RESULTS Overall, higher DSI (P < .001) and higher total cholesterol ([TC] P = .02) were independent predictors of lower HRR-1, whereas lower peak heart rate (P < .001), higher resting heart rate (P = .006), and higher DSI (P = .01) were independently associated with lower HRR-2. In the below-median age group (age <or= 48 years; n = 27), higher DSI (P = .002) was the only independent predictor of lower HRR-1, and lower peak heart rate (P < .001) and higher DSI (P = .003) were independently associated with lower HRR-2. In contrast, in the above-median age group (age > 48 years; n = 27) higher TC (P = .006), higher insulin resistance (P = .009), and higher resting heart rate (P = .048) were independently associated with lower HRR-1, and lower estimated glomerular filtration rate (P = .001), higher resting heart rate (P = .002), higher TC (P = .005), and lower peak heart rate (P = .01) were independently associated with HRR-2. CONCLUSIONS Assessment of HRR-2 provides additional information on different aspects of OSAS compared with HRR-1. Markers of OSAS severity, such as DSI, are independently associated with HRR in younger patients only, whereas in older patients, HRR reflects OSAS-related metabolic and renal dysfunction.
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Affiliation(s)
- Micha T Maeder
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia.
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Alameri H, Al-Kabab Y, BaHammam A. Submaximal exercise in patients with severe obstructive sleep apnea. Sleep Breath 2009; 14:145-51. [PMID: 19779938 DOI: 10.1007/s11325-009-0300-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2009] [Accepted: 09/03/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE Several studies have used the cardiopulmonary exercise test to assess patients with obstructive sleep apnea (OSA). However, no report has investigated the use of the 6-min walk test (6MWT) in this group of patients. METHODS We studied consecutive, newly diagnosed, OSA patients (aged >18 years). The control group was composed of matched healthy subjects with no clinical history indicative of sleep breathing disorders. The study population was divided into three groups: an OSA group, a control obese group, and a control lean group. The obese controls were gender-, age- (+/-2 years), height- (+/-5 cm), and weight- (+/-2 kg) matched to the OSA patients, while the lean controls were matched in gender, age, and height, but not weight. All patients underwent sleep study at our Sleep Disorders Center. Each subject underwent a single 6MWT within 1 week of the sleep study. RESULTS A total of 55 patients were recruited to the OSA group (age 36.7 +/- 7.9 years, body mass index 38.7 +/- 8.6 kg/m(2), and apnea hypopnea index 66.6 +/- 34.8/h), 32 subjects to the control obese group, and 30 to the control lean group. There was no difference in distance walked (6-min walk distance (6MWD)) between the OSA group (389 +/- 70 m) and the obese group (408 +/- 66 m). In the OSA group, the 6MWD results did not correlate with patient age, apnea hypopnea index, or other polysomnographic variables. At the end of the test, heart rate, systolic and diastolic blood pressure, and dyspnea perception were significantly increased in the OSA group compared with healthy subjects. CONCLUSIONS The 6MWT is easy to perform and well tolerated by patients with OSA. There were no correlations between the 6MWD and the severity of OSA or other polysomnographic parameters. However, patients with OSA exhibited abnormal hemodynamic responses to submaximal exercise.
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Affiliation(s)
- Hatem Alameri
- Pulmonary Division and Pulmonary Physiology Laboratory, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Altered ventilatory responses to exercise testing in young adult men with obstructive sleep apnea. Respir Med 2009; 103:1063-9. [PMID: 19217270 DOI: 10.1016/j.rmed.2009.01.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2008] [Revised: 01/06/2009] [Accepted: 01/14/2009] [Indexed: 11/23/2022]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a disorder characterized by repetitive obstructions of the upper airway. Individuals with OSA experience intermittent hypoxia, hypercapnia, and arousals during sleep, resulting in increased sympathetic activation. Chemoreflex activation, arising from the resultant oscillatory disturbances in blood gases from OSA, exerts control over ventilation, and may induce increases in sympathetic vasoconstriction, contributing to increased long-term risks for hypertension (HTN) and cardiovascular disease (CVD). METHODS To evaluate whether OSA elicits exaggerated ventilatory responses to exercise in young men, 14 overweight men with OSA and 16 overweight men without OSA performed maximal ramping cycle ergometer exercise tests. Oxygen consumption (VO(2)), ventilation, (V(E)), ventilatory equivalents for oxygen (V(E)/VO(2)) and carbon dioxide (V(E)/VCO(2)), and V(E)/VCO(2) slope were measured. RESULTS The VO(2) response to exercise did not differ between groups. The V(E), V(E)/VCO(2), V(E)/VO(2) were higher (p< 0.05, 0.002, and p<0.02, respectively) in the OSA group across all workloads. The V(E)/VCO(2) slope was greater in the OSA group (p<0.05). The V(E)/VCO(2) slope and AHI were significantly correlated (r=0.56, p<0.03). Thus, young, overweight men with OSA exhibit increased ventilatory responses to exercise when compared to overweight controls. This may reflect alterations in chemoreflex sensitivity, and contribute to increased sympathetic drive and HTN risk.
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Aron A, Zedalis D, Gregg JM, Gwazdauskas FC, Herbert WG. Potential clinical use of cardiopulmonary exercise testing in obstructive sleep apnea hypopnea syndrome. Int J Cardiol 2008; 132:176-86. [PMID: 19042045 DOI: 10.1016/j.ijcard.2008.11.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2008] [Accepted: 11/01/2008] [Indexed: 11/29/2022]
Abstract
There is growing evidence linking obstructive sleep apnea hypopnea syndrome (OSAHS) with multiple cardiovascular and metabolic diseases. Exercise testing is generally available and routinely used to provide valuable information on cardiopulmonary function in healthy and diseased populations. This review summarizes and integrates recent findings on exercise testing in OSAHS and discusses the potential mechanisms that may contribute to the responses that seem to differentiate these patients from apparently healthy subjects and patients with other cardiopulmonary diseases. Although exercise testing is widely used in the evaluation and diagnosis of coronary artery disease patients, recent studies showed distinctive cardiopulmonary responses in OSAHS that raise the possibility of similar applications in this disorder, as well. Several studies illustrated in this review found that OSAHS patients have a reduced exercise capacity, as shown by low peak oxygen uptake achieved. Also, their exercise HR response was reported as significantly lower than in healthy peers, suggesting chronotropic incompetence. Exercise blood pressure response were atypical as well. OSAHS patients had increased systolic and diastolic BP during exercise and a persistently elevated systolic BP during the early post-exercise recovery period. Possible explanations for these responses include cardiac dysfunction, impaired muscle metabolism, chronic sympathetic over-activation, and endothelial dysfunction. Early identification of OSAHS using cardiopulmonary exercise testing (CPXT) shows promise for selecting patients at risk for this disorder in the clinical setting. A uniform definition and measurement of OSAHS together with more rigorous trials are necessary to establish the utility of exercise responses in clinical settings.
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Affiliation(s)
- Adrian Aron
- Department of Human Nutrition, Foods and Exercise, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States.
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Ucok K, Aycicek A, Sezer M, Genc A, Akkaya M, Caglar V, Fidan F, Unlu M. Aerobic and anaerobic exercise capacities in obstructive sleep apnea and associations with subcutaneous fat distributions. Lung 2008; 187:29-36. [PMID: 19023624 DOI: 10.1007/s00408-008-9128-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Accepted: 10/23/2008] [Indexed: 11/27/2022]
Abstract
Obesity is a strong risk factor for the development and progression of sleep apnea. Responses to exercise by patients with obstructive sleep apnea syndrome (OSAS) are clinically relevant to reducing body weight and cardiovascular risk factors. This study aimed to clarify the aerobic and anaerobic exercise capacities and their possible relationships with other findings in patients with OSAS. Forty patients (30 males, 10 females) and 40 controls (30 males, 10 females) were enrolled in this study. Questionnaires (excessive daytime sleepiness, daytime tiredness, morning headache, waking unrefreshed, and imbalance), overnight polysomnography, indirect laryngoscopy, and aerobic and anaerobic exercise tests were performed. Triceps, subscapular, abdomen, and thigh skinfold thicknesses were measured. Subcutaneous abdominal fat (abdomen skinfold) was significantly higher in OSAS patients than in controls. Maximal anaerobic power and anaerobic capacity were not different significantly between the patients and controls. We found that aerobic capacity was significantly lower in OSAS patients than in controls. Aerobic capacity was negatively correlated with upper-body subcutaneous fat (triceps and subscapular skinfolds) but not correlated with subcutaneous abdominal fat in OSAS patients. In multivariate analyses using all patients, the apnea-hypopnea index remained a significant independent predictor of aerobic capacity after controlling for a variety of potential confounders including body mass index. Our data confirm that central obesity (subcutaneous abdominal fat) is prominent in patients with OSAS. Our results suggest that lower aerobic exercise capacity in patients with OSAS might be due to daily physical activity that is restricted by OSA itself. This study also suggests that the degree of subcutaneous abdominal fat cannot be used for predicting aerobic capacity level. We think that upper-body subcutaneous fat might be suitable for determining the physical fitness of patients with OSAS.
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Affiliation(s)
- Kagan Ucok
- A.K.U. Tip Fakultesi, Pembe Hastane, Fizyoloji AD, Konya Caddesi Karayollari Kavsagi, 03040 Afyonkarahisar, Turkey.
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Querido JS, Rupert JL, McKenzie DC, Sheel AW. Effects of intermittent hypoxia on the cerebrovascular responses to submaximal exercise in humans. Eur J Appl Physiol 2008; 105:403-9. [DOI: 10.1007/s00421-008-0917-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2008] [Indexed: 11/28/2022]
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Younes M. Role of respiratory control mechanisms in the pathogenesis of obstructive sleep disorders. J Appl Physiol (1985) 2008; 105:1389-405. [PMID: 18787092 DOI: 10.1152/japplphysiol.90408.2008] [Citation(s) in RCA: 169] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Obstructive sleep disorders develop when the normal reduction in pharyngeal dilator activity at sleep onset occurs in an individual whose pharynx requires a relatively high level of dilator activity to remain sufficiently open. They range from steady snoring, to slowly evolving hypopneas, to fast-recurring obstructive hypopneas and apneas. A fundamental observation is that the polysomnographic picture differs substantially among subjects with the same pharyngeal collapsibility, and even in the same subject at different times, indicating that the type and severity of the disorder is determined to a large extent by the individual's response to the obstruction. The present report reviews the various mechanisms involved in the response to sleep-induced obstructive events. When the obstructive event takes the form of mild-moderate flow limitation, compensation can take place through an increase in the fraction of time spent in inspiration (Ti/Ttot) without any increase in maximum flow (V(MAX)). With more severe obstructions, V(MAX) must increase. Recent data indicate that the obstructed upper airway can reopen reflexly, without arousal, if chemical drive is allowed to reach a threshold (T(ER)) but that this is often preempted by a low arousal threshold. The relation between T(ER) and arousal threshold, as well as the lung-to-carotid circulation time and the rate of rise of chemical drive during the obstructive event, determine the magnitude of ventilatory overshoot at the end of an event and, by extension, whether initial obstructive events will be followed by stable breathing, slow evolving hypopneas with occasional arousals, or repetitive events.
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Affiliation(s)
- Magdy Younes
- Sleep Centre, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada.
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Vanhecke TE, Franklin BA, Zalesin KC, Sangal RB, deJong AT, Agrawal V, McCullough PA. Cardiorespiratory Fitness and Obstructive Sleep Apnea Syndrome in Morbidly Obese Patients. Chest 2008; 134:539-545. [DOI: 10.1378/chest.08-0567] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Mueller PDTG, Gomes MD, Viegas CADA, Neder JA. Efeitos sistêmicos da hipoxemia noturna em pacientes com doença pulmonar obstrutiva crônica sem síndrome da apnéia obstrutiva do sono. J Bras Pneumol 2008; 34:567-74. [DOI: 10.1590/s1806-37132008000800005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2007] [Accepted: 11/05/2007] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Estudar os efeitos da hipoxemia noturna em pacientes com doença pulmonar obstrutiva crônica sem síndrome da apnéia obstrutiva do sono. MÉTODOS: Estudamos 21 pacientes-10 dessaturadores e 11 não-dessaturadores-submetidos a gasometria arterial, polissonografia, espirometria, teste de exercício cardiopulmonar (cicloergômetro), dinamometria manual e medidas de pressão inspiratória máxima, pressão expiratória máxima e proteína C reativa (PCR). Incluíram-se os pacientes com pressão parcial arterial de oxigênio > 60 mmHg; excluíram-se os com índice de apnéia-hipopnéia > 5 eventos/hora de sono. Foram medidos consumo máximo de oxigênio, potência máxima, pressão arterial sistólica, pressão arterial diastólica (PAD) e frequência cardíaca máxima durante exercício, visando detectar alterações hemodinâmicas. A PCR foi considerada positiva quando acima de 3 mg/L. RESULTADOS: A saturação periférica de oxigênio mínima durante o sono foi significativamente maior nos não-dessaturadores (p = 0,03). Mais dessaturadores apresentaram PCR > 3 mg/L (p < 0,05). Não houve diferença quanto a capacidade de exercício e demais variáveis. No entanto, PAD (p < 0,001) e pressão inspiratória máxima (p = 0,001) correlacionaram-se com saturação periférica de oxigênio média durante o sono. CONCLUSÕES: A hipoxemia noturna não reduz a capacidade de exercício e a força de preensao manual em pacientes com DPOC leve/moderada, mas o ajuste da PAD durante o exercício máximo parece depender do grau de hipoxemia. Além disso, há uma relação positiva entre pressão inspiratória máxima e saturação periférica de oxigênio média durante o sono, bem como indícios de ativação inflamatória diferenciada em pacientes com hipoxemia noturna.
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Abstract
Obstructive sleep apnea hypopnea syndrome (OSAHS) is largely under-diagnosed and unrecognized by primary care practitioners. Insidious changes within the respiratory and cardiovascular systems occur over time in untreated OSAHS. Respiratory manifestations of OSAHS include changes in the hypoxic ventilatory response, which can lead to long-term facilitation of ventilation in breathing and production of oxidative stress. Cardiovascular manifestations of OSAHS include increased sympathetic activity, endothelial dysfunction, and over-production of inflammatory cytokines. These changes are likely responsible for many of the pathologic sequelae associated with OSAHS.
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