CARDIOPULMONARY STRESS TEST PERFORMANCE IN PATIENTS WITH MODERATE-SEVERE OBSTRUCTIVE SLEEP APNEA
Abstract
CARDIOPULMONARY STRESS TEST PERFORMANCE IN PATIENTS WITH MODERATE-SEVERE OBSTRUCTIVE SLEEP APNEA (Abstract): Introduction: Cardiopulmonary stress test (CPET) is an important part of risk stratification and prognostic assessment of a cardiovascular patient. Since obstructive sleep apnea (OSA) is a frequent finding in patients with cardiovascular and metabolic comorbidities, the role of CPET in the evaluation of patients with sleep disordered breathing is a subject of great interest. Aim: To illustrate the role of CPET evaluation in OSA patients, before and after noninvasive ventilation. Material and methods: We performed a prospective study that included 27 patients with newly diagnosed moderate-severe OSA (apnea hypopnea index (AHI) ≥ 15) who underwent a cardiopulmonary stress test before and after 2 months of continuous positive airway pressure (CPAP therapy). We compared baseline CPET performance between OSA patients and 27 age and BMI matched controls. Results: OSA severity was not significantly correlated with any of the analyzed baseline CPET parameters. CPET performance did not significantly differ between controls and patients with moderate-severe, moderate or severe OSA. Eight weeks of CPAP therapy lead to a significant improvement in weight status and several CPET parameters, including effort capacity (maximal and percent predicted load), oxygen pulse and percent-predicted oxygen uptake. Conclusions: Age, but not AHI, influence baseline CPET results. Although we did not find significant differences between CPET performance in OSA patients and controls, 2 months of CPAP therapy was associated with a significant improvement in exercise tolerance and CPET parameters, suggesting that OSA negatively impacts exercise tolerance.
References
2. Amihaesei IC, Chelaru L. Metabolic syndrome a widespread threatening condition; risk factors, diag-nostic criteria, therapeutic options, prevention and controversies: an overview. Rev Med Chir Soc Med Nat Iasi 2014; 118: 896-900.
3. Tapan OO, Sevinc C, Itil BO, Oztura I, Kayatekin BM, Demiral Y. Effect of Nasal Continuous Positive Airway Pressure Therapy on the Functional Respiratory Parameters and Cardiopulmonary Exercise Test in Obstructive Sleep Apnea Syndrome. Turk Thorac J 2016; 17: 1-6.
4. Guazzi M, Bandera F, Ozemek C, Systrom D, Arena R. Cardiopulmonary Exercise Testing: What Is its Value? J Am Coll Cardiol 2017; 70: 1618-1636.
5. Vanuxem D, Badier M, Guillot C, Delpierre S, Jahjah F, Vanuxem P. Impairment of muscle energy metabolism in patients with sleep apnoea syndrome. Respir Med 1997; 91: 551-557.
6. Alonso-Fernández, A., García-Río, et al. J. Obstructive sleep apnoea-hypoapnoea syndrome reversibly depresses cardiac response to exercise. Eur Heart J 2006; 27: 207-215.
7. Przybyłowski T, Bielicki P, et al. Exercise capacity in patients with obstructive sleep apnea syndrome. J Physiol Pharmacol 2007; 58(Suppl 5): 563-574.
8. Beitler JR, Awad KM, et al. Obstructive sleep apnea is associated with impaired exercise capacity: a cross-sectional study. J Clin Sleep Med 2014; 10: 1199-1204.
9. Lin CC, Hsieh WY, Chou CS, Liaw SF. Cardiopulmonary exercise testing in obstructive sleep apnea syndrome. Respir Physiol Neurobiol 2006; 150: 27-34.
10. Stavrou V, Vavougios G, Pastaka C, Daniil Z, Gourgoulianis K, Karetsi E. The cardio-pulmonary exercise testing as a predictive tool of sleep apnea syndrome. Euro Respir J 2015; 46(Suppl 59): 2321-2325.
11. Vanhecke TE, Franklin BA, et al. Cardiorespiratory fitness and obstructive sleep apnea syndrome in morbidly obese patients. Chest 2008; 134: 539-545.
12. Rizzi CF, Cintra F, et al. Exercise capacity and obstructive sleep apnea in lean subjects. Chest 2011; 137: 109-114.
13. Rizzi CF, Cintra F, et al. Does obstructive sleep apnea impair the cardiopulmonary response to exer-cise? Sleep 2013; 36: 547-553.
14. Hargens TA, Guill SG, Zedalis D, Gregg JM, Nickols-Richardson SM, Herbert WG. Attenuated heart rate recovery following exercise testing in overweight young men with untreated obstructive sleep apnea. Sleep 2008; 31: 104-110.
15. Hargens TA, Guill SG, et al. Altered ventilatory responses to exercise testing in young adult men with obstructive sleep apnea. Respir Med 2009; 103: 1063-1069.
16. Rotenberg BW, Murariu D, Pang KP. Trends in CPAP adherence over twenty years of data collection: a flattened curve. J Otolaryngol Head Neck Surg 2016; 45: 43.
17. Lin CC, Lin CK, Wu KM, Chou CS. Effect of treatment by nasal CPAP on cardiopulmonary exercise test in obstructive sleep apnea syndrome. Lung 2004; 182: 199-212.
18. Goel AK, Talwar D, Jain SK. Evaluation of short-term use of nocturnal nasal continuous positive airway pressure for a clinical profile and exercise capacity in adult patients with obstructive sleep apnea-hypopnea syndrome. Lung India 2015; 32: 225-232.
19. 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: 302-307.
20. 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: 1565-1571.
21. Thurnheer R, Bloch KE, Laube I, Gugger M, Heitz M. Respiratory polygraphy in sleep apnoea diag-nosis. Report of the Swiss respiratory polygraphy registry and systematic review of the literature. Swiss Med Wkly 2007; 137: 97-102.
22. Escourrou P, Grote L, et al. The diagnostic method has a strong influence on classification of obstruc-tive sleep apnea. J Sleep Res 2015; 24: 730-738.
Additional Files
Published
Issue
Section
License
COPYRIGHT
Once an article is accepted for publication, MSJ requests a transfer of copyrights for published articles.
COPYRIGHT TRANSFER FORM FOR
REVISTA MEDICO-CHIRURGICALĂ A SOCIETĂȚII DE MEDICI ȘI NATURALIȘTI DIN IAȘI /
THE MEDICAL-SURGICAL JOURNAL OF THE SOCIETY OF PHYSICIANS AND NATURALISTS FROM IASI
We, the undersigned authors of the manuscript entitled
_____________________________________________________________________________________
_____________________________________________________________________________________
warrant that this manuscript, which is submitted for publication in the REVISTA MEDICO-CHIRURGICALĂ, has not been published and it is not under consideration for publication in another journal.
- we give the consent for publication in the REVISTA MEDICO-CHIRURGICALĂ, in printed and electronic format and we transfer unconditioned and complete the copyright of this manuscript to the REVISTA MEDICO-CHIRURGICALĂ, in the event of its acceptance.
- the manuscript does not break the intellectual property rights of any other person.
- we have read the submitted version of the manuscript and we are fully responsible for the content.
Names and signatures of authors / copyright owners (the following sequence is the authorship of the article):
- ______________________________/_________________________
- ______________________________/_________________________
- ______________________________/_________________________
N.B. All the authors must sign this form
