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Xia Y, Liang C, Kang J, You K, Xiong Y. Obstructive Sleep Apnea and Obesity Are Associated with Hypertension in a Particular Pattern: A Retrospective Study. Healthcare (Basel) 2023; 11:healthcare11030402. [PMID: 36766978 PMCID: PMC9913941 DOI: 10.3390/healthcare11030402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/21/2023] [Accepted: 01/28/2023] [Indexed: 02/04/2023] Open
Abstract
Obstructive sleep apnea (OSA) and obesity can increase the risk of hypertension, but the combined effects of these two conditions on hypertension are not yet known. We collected the basic characteristics, sleep parameters, and glucose levels of subjects with a polysomnography test and divided them into four groups, according to whether they had severe OSA and obesity or not. The main effects of severe OSA and obesity and the interactions of the two on systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels were detected using analysis of covariance. The association between obesity and severe OSA and abnormal blood pressure and their combined effects were detected with logistic regression. In total, 686 subjects were included. After adjusting for multiple confounding factors, the strong main effects of obesity and severe OSA were detected in the SBP and DBP levels, with no combined effects from the two conditions on SBP or DBP. Obesity was independently associated with the presence of hyper-systolic blood pressure (hyper-SBP) and hypertension, and severe OSA was independently associated with the presence of hyper diastolic blood pressure (hyper-DBP) and hypertension. No effects of the interaction between severe OSA and obesity on the presence of abnormal blood pressure were observed. Both severe OSA and obesity were associated with hypertension, while obesity was closely associated with hyper-SBP, and severe OSA was associated with hyper-DBP. No effects of the interaction between these two on hypertension were observed.
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Affiliation(s)
- Yunyan Xia
- Department of Otorhinolaryngology–Head and Neck Surgery, First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Caihong Liang
- Department of Otorhinolaryngology–Head and Neck Surgery, First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Junxin Kang
- Department of Otorhinolaryngology–Head and Neck Surgery, First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Kai You
- Department of Anesthesiology, First Affiliated Hospital of Nanchang University, Nanchang 330006, China
- Correspondence: (K.Y.); (Y.X.)
| | - Yuanping Xiong
- Department of Otorhinolaryngology–Head and Neck Surgery, First Affiliated Hospital of Nanchang University, Nanchang 330006, China
- Correspondence: (K.Y.); (Y.X.)
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Camargo PF, Ditomaso-Luporini L, de Carvalho LCS, Goulart CDL, Batista Dos Santos P, Sebold R, Roscani MG, Mendes RG, Borghi-Silva A. Obstructive sleep apnea reduces functional capacity and impairs cardiac autonomic modulation during submaximal exercise in patients with chronic obstructive pulmonary disease: A follow-up study. Heart Lung 2023; 57:257-264. [PMID: 36332349 DOI: 10.1016/j.hrtlng.2022.10.007] [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: 05/09/2022] [Revised: 10/13/2022] [Accepted: 10/16/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Functional capacity and heart rate variability (HRV) are important prognostic markers in chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea syndrome (OSA). However, the impact of the overlap of these diseases and the one-year clinical follow-up has not yet been evaluated. OBJECTIVES To assess whether the presence of OSA can impair functional performance and cardiac autonomic control during exercise in patients with COPD; and to verify whether the overlap of these diseases could lead to worse clinical outcomes during the one-year follow-up. METHODS Thirty-four patients underwent pulmonary function tests, echocardiography and polysomnography for diagnostic confirmation, disease staging, exclusion of any cardiac changes, and allocation between groups. The patients underwent the six-minute walk test (6MWT) to assess functional capacity and HRV during exercise. Subsequently, patients were followed up for 12 months to record outcomes such as exacerbation, hospitalization, and deaths. At the end of this period, the patients were revaluated to verify the hypotheses of the study. RESULTS The OSA-COPD group showed greater functional impairment when compared to the COPD group (p=0.003) and showed worse cardiac autonomic responses during the 6MWT with greater parasympathetic activation (p=0.03) and less complexity of the autonomic nervous system, in addition to being more likely to exacerbate (p=0.03) during one year of follow-up. CONCLUSION OSA-COPD produces deleterious effects on functional performance and a greater autonomic imbalance that impairs clinical outcomes.
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Affiliation(s)
- Patrícia Faria Camargo
- Cardiopulmonary Physiotherapy Laboratory, Department of Physical Therapy, Federal University of Sao Carlos, Sao Carlos, Sao Paulo, Brazil
| | - Luciana Ditomaso-Luporini
- Cardiopulmonary Physiotherapy Laboratory, Department of Physical Therapy, Federal University of Sao Carlos, Sao Carlos, Sao Paulo, Brazil
| | - Luiz Carlos Soares de Carvalho
- Center for Science and Technology in Energy and Sustainability of Federal University of Reconcavo da Bahia, Feira de Santana, Bahia, Brazil
| | - Cássia da Luz Goulart
- Cardiopulmonary Physiotherapy Laboratory, Department of Physical Therapy, Federal University of Sao Carlos, Sao Carlos, Sao Paulo, Brazil
| | - Polliana Batista Dos Santos
- Cardiopulmonary Physiotherapy Laboratory, Department of Physical Therapy, Federal University of Sao Carlos, Sao Carlos, Sao Paulo, Brazil
| | - Rayane Sebold
- Cardiopulmonary Physiotherapy Laboratory, Department of Physical Therapy, Federal University of Sao Carlos, Sao Carlos, Sao Paulo, Brazil
| | - Meliza Goi Roscani
- Medicine Department, Federal University of Sao Carlos, Sao Carlos, Sao Paulo, Brazil
| | - Renata Gonçalves Mendes
- Cardiopulmonary Physiotherapy Laboratory, Department of Physical Therapy, Federal University of Sao Carlos, Sao Carlos, Sao Paulo, Brazil
| | - Audrey Borghi-Silva
- Cardiopulmonary Physiotherapy Laboratory, Department of Physical Therapy, Federal University of Sao Carlos, Sao Carlos, Sao Paulo, Brazil.
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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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Powell TA, Mysliwiec V, Brock MS, Morris MJ. OSA and cardiorespiratory fitness: a review. J Clin Sleep Med 2022; 18:279-288. [PMID: 34437054 PMCID: PMC8807904 DOI: 10.5664/jcsm.9628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The effects of untreated obstructive sleep apnea (OSA) on cardiopulmonary function remain unclear. Cardiorespiratory fitness (CRF), commonly reflected by VO2 max measured during cardiopulmonary exercise testing, has gained popularity in evaluating numerous cardiopulmonary conditions and may provide a novel means of identifying OSA patients with the most clinically significant disease. This emerging testing modality provides simultaneous assessment of respiratory and cardiovascular function with results helping uncover evidence of evolving pathology in either organ system. In this review, we highlight the current state of the literature in regard to OSA and CRF with a specific focus on changes in cardiovascular function that have been previously noted. While OSA does not appear to limit respiratory function during exercise, studies seem to suggest an abnormal cardiovascular exercise response in this population including decreased cardiac output, a blunted heart rate response (ie, chronotropic incompetence), and exaggerated blood pressure response. Surprisingly, despite these observed changes in the cardiovascular response to exercise, results involving VO2 max in OSA remain inconclusive. This is reflected by VO2 max studies involving middle-aged OSA patients showing both normal and reduced CRF. As prior studies have not extensively characterized oxygen desaturation burden, we propose that reductions in VO2 max may exist in OSA patients with only the most significant disease (as reflected by nocturnal hypoxia). Further characterizing this relationship remains important as some research suggests that positive airway pressure therapy or aerobic exercise may improve CRF in patients with OSA. In conclusion, while it likely that severe OSA, via an abnormal cardiovascular response to exercise, is associated with decreased CRF, further study is clearly warranted to include determining if OSA with decreased CRF is associated with increased morbidity or mortality. CITATION Powell TA, Mysliwiec V, Brock MS, Morris MJ. OSA and cardiorespiratory fitness: a review. J Clin Sleep Med. 2022;18(1):279-288.
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Affiliation(s)
- Tyler A. Powell
- Sleep Medicine Service, Wilford Hall Ambulatory Surgery Center, JBSA Lackland Air Force Base, Texas,Address correspondence to: Tyler A. Powell, MD, Sleep Medicine Service, Wilford Hall Ambulatory Service Center, JBSA Lackland Air Force Base, TX 78234; ,
| | - Vincent Mysliwiec
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Matthew S. Brock
- Sleep Medicine Service, Wilford Hall Ambulatory Surgery Center, JBSA Lackland Air Force Base, Texas
| | - Michael J. Morris
- Graduate Medical Education, Brooke Army Medical Center, JBSA Fort Sam Houston, Texas
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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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Barillas-Lara MI, Medina-Inojosa JR, Kolla BP, Smith JR, Bonikowske AR, Allison TG, Olson T, Lopez-Jimenez F, Somers VK, Caples SM, Mansukhani MP. The Association of Sleep Apnea and Cardiorespiratory Fitness With Long-Term Major Cardiovascular Events. Mayo Clin Proc 2021; 96:636-647. [PMID: 33673915 DOI: 10.1016/j.mayocp.2020.03.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/22/2020] [Accepted: 03/25/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To determine the risk of long-term major adverse cardiovascular events (MACE) when sleep-disordered breathing (SDB) and decreased cardiorespiratory fitness (CRF) co-occur. METHODS We included consecutive patients who underwent symptom-limited cardiopulmonary exercise tests between January 1, 2005, and January 1, 2010, followed by first-time diagnostic polysomnography within 6 months. Patients were stratified based on the presence of moderate-to-severe SDB (apnea/hypopnea index ≥15 per hour) and decreased CRF defined as <70% predicted peak oxygen consumption (VO2). Long-term MACE was a composite outcome of myocardial infarction (MI), coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI), stroke or transient ischemic attack (TIA), and death, assessed until May 21, 2018. Cox-proportional hazard models were adjusted for factors known to influence CRF and MACE. RESULTS Of 498 included patients (60±13 years, 28.1% female), 175 (35%) had MACE (MI=17, PCI=14, CABG=13, stroke=20, TIA=12, deaths=99) at a median follow-up of 8.7 years (interquartile range=6.5 to 10.3 years). After adjusting for age, sex, beta blockers, systemic hypertension, diabetes mellitus, coronary artery disease, cardiac arrhythmia, chronic obstructive pulmonary disease, smoking, and use of positive airway pressure (PAP), decreased CRF alone (hazard ratio [HR]=1.91, 95% confidence interval [CI], 1.15 to 3.18; P=.01), but not SDB alone (HR=1.26, 95% CI, 0.75 to 2.13, P=.39) was associated with increased risk of MACE. Those with SDB and decreased CRF had greater risk of MACE compared with patients with decreased CRF alone (HR=1.85; 95% CI, 1.21 to 2.84; P<.005) after accounting for these confounders. The risk of MACE was attenuated in those with reduced CRF alone after additionally adjusting for adequate adherence to PAP (HR=1.59; 95% CI, 0.77 to 3.31; P=.21). CONCLUSION The incidence of MACE, especially mortality, was high in this sample. Moderate-to-severe SDB with concurrent decreased CRF was associated with higher risk of MACE than decreased CRF alone. These results highlight the importance of possibly including CRF in the risk assessment of patients with SDB and, conversely, that of screening for SDB in patients with low peak VO2.
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Affiliation(s)
| | | | | | - Joshua R Smith
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - Thomas G Allison
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Thomas Olson
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - Virend K Somers
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Sean M Caples
- Center for Sleep Medicine, Mayo Clinic, Rochester, MN
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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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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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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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12
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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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13
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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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14
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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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15
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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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16
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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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17
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Gaudreault V, Després JP, Rhéaume C, Alméras N, Bergeron J, Tremblay A, Poirier P. Exercise-Induced Hypertension in Men with Metabolic Syndrome: Anthropometric, Metabolic, and Hemodynamic Features. Metab Syndr Relat Disord 2013. [DOI: 10.1089/met.2012.0071] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- Valérie Gaudreault
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Canada
| | - Jean-Pierre Després
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Canada
| | - Caroline Rhéaume
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Canada
| | - Natalie Alméras
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Canada
| | - Jean Bergeron
- Centre de recherche du Centre Hospitalier Universitaire de Québec, pavillon CHUL, Québec, Canada
| | - Angelo Tremblay
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Canada
| | - Paul Poirier
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Canada
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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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19
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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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Penzel T, Riedl M, Gapelyuk A, Suhrbier A, Bretthauer G, Malberg H, Schöbel C, Fietze I, Heitmann J, Kurths J, Wessel N. Effect of CPAP therapy on daytime cardiovascular regulations in patients with obstructive sleep apnea. Comput Biol Med 2012; 42:328-34. [DOI: 10.1016/j.compbiomed.2011.09.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 08/10/2011] [Accepted: 09/07/2011] [Indexed: 01/01/2023]
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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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Mak GS, Kern MJ, Patel PM. Influence of obstructive sleep apnea and treatment with continuous positive airway pressure on fractional flow reserve measurements for coronary lesion assessment. Catheter Cardiovasc Interv 2010; 75:207-13. [DOI: 10.1002/ccd.22207] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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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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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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Keles T, Durmaz T, Bayram NA, Ciftci B, Yeter E, Akcay M, Bozkurt E. Effect of continuous positive airway pressure therapy on aortic stiffness in patients with obstructive sleep apnea syndrome. Echocardiography 2009; 26:1217-24. [PMID: 19725854 DOI: 10.1111/j.1540-8175.2009.00957.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The most significant complications seen in patients with obstructive sleep apnea syndrome (OSAS) are associated with the cardiovascular system. The present study assessed aortic stiffness in patients with OSAS and evaluated the effect of continuous positive airway pressure (CPAP) therapy on aortic stiffness. METHOD Twenty-four patients with newly diagnosed, previously untreated, moderate or severe OSAS (apnea-hypopnea index > 15) and a control group of 17 healthy patients were included in the study. M-mode recordings of the ascending aorta were taken from the parasternal long axis by echocardiograhy, and systolic and diastolic diameters of the aorta were measured. Aortic elastic parameters, aortic strain, and distensibility were calculated. Measurements were repeated after 6 months of CPAP therapy in patients with OSAS and were compared with baseline values. RESULTS In patients with OSAS, compared with the control group, aortic strain (6.7%+/- 2.1% vs. 12.4%+/- 3.1%; P < 0.001) and aortic distensibility (2.8 +/- 0.9 x 10(-6) cm(2) dyn(-1) vs. 5.5 +/- 1.7 x 10(-6) cm(2) dyn(-1); P < 0.001) were evidently lower, and there was a significant correlation between aortic elastic parameters and AHI. After a 6-month course of CPAP therapy, significant increases were observed in aortic strain (6.1%+/- 1.5% vs. 7.3%+/- 1.7%; P < 0.001) and aortic distensibility (2.5 +/- 0.7 x 10(-6) cm(2) dyn(-1) vs. 3.1 +/- 0.9 x 10(-6) cm(2) dyn(-1); P < 0.001) in patients with OSAS. CONCLUSION Aortic strain and distensibility were lower in patients with OSAS than in control patients, and CPAP treatment provided improvement in aortic elastic parameters.
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Affiliation(s)
- Telat Keles
- Ataturk Education and Research Hospital, Cardiology Department, Ankara, Turkey
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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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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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Ursavas A, Karadag M, Nalci N, Ercan I, Gozu RO. Self-Reported Snoring, Maternal Obesity and Neck Circumference as Risk Factors for Pregnancy-Induced Hypertension and Preeclampsia. Respiration 2008; 76:33-9. [PMID: 17728529 DOI: 10.1159/000107735] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2007] [Accepted: 05/24/2007] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Physical and hormonal changes during pregnancy alter breathing patterns of pregnant women. It is possible that occult disordered breathing during sleep may be a risk factor for the development of pregnancy-induced hypertension (PIH) and preeclampsia. OBJECTIVE Our aim was to determine the incidence of self-reported snoring in pregnant women, and to investigate the relationship of snoring, obesity and neck circumference to PIH and preeclampsia. METHODS 469 pregnant women and 208 age-matched nonpregnant women were included in the study. Both groups were asked to complete a questionnaire. Maternal complications were retrieved from the medical records. RESULTS Habitual snoring was reported from 1.9% of nonpregnant women, 2.5% of pregnant women prior to pregnancy and 11.9% of those same women during the third trimester of pregnancy (p < 0.001). Age, smoking during pregnancy, and weight before delivery were independent risk factors for habitual snoring in pregnancy. PIH and preeclampsia developed in 20 and 10.9% of pregnant women with habitual snoring, as compared to 11 and 5.8% of non-snoring pregnant women (p = 0.045, p = 0.125, p = 0.415), respectively. In women who developed preeclampsia, weight before pregnancy, weight before delivery and neck circumference were significantly higher in univariate analysis. Neck circumference was an independent risk factor for PIH and preeclampsia according to logistic regression analysis. CONCLUSION The incidence of snoring is significantly higher in pregnant women than in nonpregnant women. Snoring may indicate a risk of PIH. Neck circumference was an independent risk factor for both PIH and preeclampsia.
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Affiliation(s)
- Ahmet Ursavas
- Department of Pulmonary Medicine, University of Uludağ School of Medicine, Bursa, Turkey.
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Kaleth AS, Chittenden TW, Hawkins BJ, Hargens TA, Guill SG, Zedalis D, Gregg JM, Herbert WG. Unique cardiopulmonary exercise test responses in overweight middle-aged adults with obstructive sleep apnea. Sleep Med 2007; 8:160-8. [PMID: 17275399 DOI: 10.1016/j.sleep.2006.08.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2006] [Revised: 08/10/2006] [Accepted: 08/10/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is characterized by repetitive nighttime obstructions of the upper airway that induce hypoxemia, hypercapnia, sympathetic activation, and arousals. This disorder induces cardiovascular autonomic imbalance and contributes to the development of hypertension. While the diagnostic and prognostic utility of exercise testing is well established in cardiology, the clinical utility of the exercise test in screening for OSA has not been carefully explored. To explore this potential application, we contrasted cardiopulmonary responses to exercise testing in patients recently diagnosed with OSA with apparently healthy counterparts of similar physical inactivity history, age, and body habitus. METHODS Twenty-three normotensive overweight adults with OSA [apnea-hypopnea index (AHI)=24.7+/-13.5 events h(-1); body mass index (BMI)=33.1+/-5.5 kg m(-2); age=45.6+/-10.7 years] and nine apparently healthy controls of similar age and morphology (BMI=29.5+/-5.5 kg m(-2); age=40.2+/-8.1 years; AHI=4.9+/-0.1) completed a maximal ramping cardiopulmonary exercise tolerance test on a cycle ergometer. Measures included oxygen consumption (VO(2)pk), ventilation (V(E)), heart rate (HR), blood pressure (BP), cardiac output (Qc), and stroke volume (SV). RESULTS Age, BMI, rest HR, rest BP, rest and exercise cardiac index (QI), rest and exercise stroke volume index (SVI), and V O(2)pk were not different between OSA patients and controls (p>0.05). Exercise heart rate was significantly lower and diastolic BP higher in the OSA group (p<0.05). In the physically active recovery (low-load pedaling), systolic BP recovery was delayed (p<0.05) in the OSA group while diastolic BP tended to remain higher (p=0.056). CONCLUSION Patients with OSA have a distinctive response to graded exercise, characterized by a blunted HR response, markedly delayed systolic BP response in early recovery, and elevated diastolic BP in both exercise and early recovery. Clinical trials are justified to determine the clinical utility of graded exercise testing to independently inform clinical decision-making for triaging patients to diagnostic polysomnography.
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Affiliation(s)
- Anthony S Kaleth
- Laboratory for Health and Exercise Sciences, Department of Human Nutrition, Foods and Exercise, Virgina Polytechnic Institute and State University, Blacksburg, VA 24061, USA
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Oflaz H, Cuhadaroglu C, Pamukcu B, Meric M, Ece T, Kasikcioglu E, Koylan N. Endothelial Function in Patients with Obstructive Sleep Apnea Syndrome but without Hypertension. Respiration 2006; 73:751-6. [PMID: 16804287 DOI: 10.1159/000094183] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2005] [Accepted: 03/30/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea syndrome (OSAS) influences endothelial function and causes hypertension. OBJECTIVES Our aim was to evaluate the role of endothelial dysfunction in the pathogenesis of hypertension in OSAS. METHODS Twenty-three patients with OSAS but without hypertension and 15 healthy normotensive subjects were investigated. The presence or absence of OSAS was evaluated with a sleep study. Endothelial function was investigated with brachial artery ultrasound examination. RESULTS Baseline characteristics were equivalent between the two groups. Minimal oxygen saturation and apnea-hypopnea indexes in the OSAS and control groups were 62.9 +/- 16.5 versus 94.9 +/- 1.1% (p < 0.0001) and 53.1 +/- 20.3 versus 3.8 +/- 0.9 (p < 0.0001), respectively. There was not statistically significant difference between basal brachial artery diameters measured in the morning and in the evening in all groups. Flow-mediated dilation (FMD) values measured in the morning were lower than those measured in the evening in both OSAS patients and the control group: FMD of OSAS patients was 6.04 +/- 3.18% in the morning and 10.38 +/- 4.23% in the evening hours (p = 0.001), and FMD of control subjects was 10.9 +/- 2.6% in the morning and 13.9 +/- 2.32 in the evening hours (p = 0.002). Differences in FMD values measured both in the morning and evening hours in OSAS patients were lower compared with those in control subjects (p < 0.0001 in the morning hours and p = 0.003 in the evening hours). CONCLUSIONS We detected a prominent diurnal deterioration in endothelial function in normotensive OSAS patients compared with healthy subjects. This deterioration may occur due to ongoing hypoxemia during the night and it may be a possible cause of hypertension and atherosclerotic cardiovascular diseases in patients with OSAS.
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Affiliation(s)
- Huseyin Oflaz
- Department of Cardiology, Faculty of Medicine, Istanbul University, Istanbul, Turkey.
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Tanriverdi H, Evrengul H, Kara CO, Kuru O, Tanriverdi S, Ozkurt S, Kaftan A, Kilic M. Aortic stiffness, flow-mediated dilatation and carotid intima-media thickness in obstructive sleep apnea: non-invasive indicators of atherosclerosis. Respiration 2006; 73:741-50. [PMID: 16717439 DOI: 10.1159/000093531] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2005] [Accepted: 02/16/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Obstructive sleep apnea (OSA) has a critical association with cardiovascular mortality and morbidity. Carotid intima-media thickness (IMT), flow-mediated dilatation (FMD) and aortic stiffness are early signs of atherosclerosis. The presence of subclinical atherosclerosis was assessed in OSA patients using these parameters. METHODS 40 patients with OSA showing an apnea-hypopnea index (AHI) > or =5 (mean age 51.3 +/- 9 years, 32 males) and 24 controls (AHI < 5, mean age 51.9 +/- 5.2 years, 19 males) were enrolled in the study. In all subjects, polysomnographic examination and recordings were performed during sleep. IMT of the carotid artery, endothelium-dependent/-independent vasodilation of the brachial artery and aortic elastic parameters were investigated using high-resolution Doppler echocardiography. RESULTS The demographic data of the patients with OSA and controls were not significantly different. Subjects with OSA demonstrated higher values of aortic stiffness (7.1 +/- 1.88 vs. 6.42 +/- 1.56, respectively) and IMT (0.85 +/- 0.13 vs. 0.63 +/- 0.11 mm, p = 0.0001, respectively) but lower distensibility (9.47 +/- 1.33 vs. 11.8 +/- 3.36 cm(2)/dyn/10(6)) and FMD (4.57 +/- 1.3 vs. 6.34 +/- 0.83%, p = 0.0001, respectively) than the controls. The respiratory disturbance index correlated positively with aortic stiffness and IMT and negatively with distensibility and FMD. CONCLUSION We observed blunted endothelium-dependent dilatation, increased carotid IMT and aortic stiffness in patients with OSA compared with matched control subjects. This is evident in the absence of other diseases, suggesting that OSA is an independent cause of atherosclerosis. These simple and non-invasive methods help to detect subclinical atherosclerosis in OSA.
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Affiliation(s)
- Halil Tanriverdi
- Department of Cardiology, Pamukkale University School of Medicine, Denizli, Turkey.
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Abstract
PURPOSE OF REVIEW Sleep-disordered breathing is a widely prevalent condition and may have serious medical, social, and economic consequences. This review evaluates the role of sleep-disordered breathing in cardiovascular morbidity and mortality on the basis of recent literature. RECENT FINDINGS Epidemiologic studies, retrospective reviews, and prospective clinical trials suggest a strong association between sleep-disordered breathing and adverse cardiovascular events. Individuals with sleep-disordered breathing have a higher prevalence of hypertension, which attenuates with treatment. Furthermore, the presence of sleep-disordered breathing augurs an increased risk of coronary artery disease, cardiac arrhythmias, and heart failure. SUMMARY Recent research provides an emerging evidence of the role of sleep-disordered breathing as a risk factor for diverse cardiovascular disorders.
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Affiliation(s)
- Rohit Budhiraja
- Division of Pulmonary and Critical Care, Southern Arizona Veterans Affairs Health Care System, University of Arizona College of Medicine, Tucson, Arizona 85723, USA.
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Alonso-Fernández A, García-Río F, Arias MA, Mediano O, Pino JM, Martínez I, Villamor J. Obstructive sleep apnoea–hypoapnoea syndrome reversibly depresses cardiac response to exercise. Eur Heart J 2005; 27:207-15. [PMID: 16267074 DOI: 10.1093/eurheartj/ehi621] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS To evaluate cardiac response to exercise in middle-aged normotensive obstructive sleep apnoea-hypoapnoea syndrome (OSAHS) adults with normal resting left ventricular systolic function and to test the hypothesis that nasal continuous positive airway pressure (CPAP) therapy might improve cardiac performance during exercise. METHODS AND RESULTS We performed a prospective, randomized, double-blind, placebo-controlled, cross-over clinical trial including 31 consecutive newly diagnosed OSAHS patients and 15 healthy subjects. Cardiopulmonary exercise testing with cardiac output measurement, blood pressure (BP) recordings, and urinary excretion of catecholamine levels were obtained at baseline and after 3 months on both effective and sham CPAP. OSAHS subjects had higher systolic and mean nocturnal BP and higher nocturnal levels of catecholamines. In contrast, they had lower increments in cardiac output (Qt) and in stroke volume (SV) in response to exercise than control subjects. CPAP therapy was associated with highly significant improvements in all the indices of left ventricular systolic performance response during exercise, whereas with sham CPAP, all of them remained unchanged. CONCLUSION OSAHS patients with normal resting left ventricular systolic function and no hypertension had a worse cardiac response to exercise than healthy subjects. In these patients, 3 months of CPAP improved both Qt and SV responses to exercise.
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Affiliation(s)
- Alberto Alonso-Fernández
- Servicio de Neumología, Hospital Universitario La Paz, Alfredo Marqueríe 11, 28034 Madrid, Spain
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