ISSN: 1302-1192 / E-ISSN: 2458-9101
Cardiovascular Performance Following Continuous Positive Airway Pressure in Patients with Severe Obstructive Sleep Apnea
Khanaphaphon Wuttiumporn, Wilaiwan Khrisanapant, Orapin Pasurivong, Watchara Boonsawat , Banjamas Intarapoka
Sleep and Hypnosis: A Journal of Clinical Neuroscience and Psychopathology 2017; Online Ahead of Print
Background: Obstructive sleep apnea (OSA) may lead to decreased exercise capacity. We investigated whether continuous positive airway pressure (CPAP) treatment improved cardiovascular performance in OSA patients.

Methods: Forty healthy subjects (control group) and 40 severe OSA patients were recruited. The two groups were matched for age, gender, and body mass index. OSA patients were assigned to CPAP and non-CPAP treatment groups in equal numbers. All subjects underwent cardiopulmonary exercise testing (CPET) using a treadmill and an incremental protocol until symptom limitation (Day 0). CPET was repeated at Day 180 in the CPAP treatment group.

Results: OSA patients had lower maximal oxygen consumption (V’O2max) (1666.3 ± 451.3 vs. 1375.6 ± 227.7 ml/min, 28.2 ± 5.5 vs. 18.9 ± 3.8 ml/min/kg) (p < 0.001), higher maximal V’E/V’CO2 (p < 0.01), V’E/V’O2 (p < 0.001), heart rate (HR) reserve (p < 0.001), and blunted HR recovery (HRR) at 1-5 min (p < 0.001) compared to controls. V’O2max was negatively correlated with AHI (R2 = 0.1363, p < 0.05). In the CPAP but not in non-CPAP treatment group, both V’O2max (p < 0.05), HRR (p < 0.001), and HR reserve (p < 0.05) were improved on Day 180 compared to Day 0.

Conclusion: Our study demonstrates that CPAP therapy for six months provides clinical benefits by improving cardiovascular performance.
Keywords: Obstructive sleep apnea, continuous positive airway pressure, cardiopulmonary exercise testing, heart rate recovery
REFERENCES
Albouaini, K., Egred, M., & Alahmar, A. (2007). Cardiopulmonary exercise testing and its application. Postgraduate Medical Journal, 83(985), 675-682. doi: 10.1136/hrt.2007.121558

Alonso-Fernandez, A., Garcia-Rio, F., Arias, M. A., Mediano, O., Pino, J. M., Martinez, I., & Villamor, J. (2006). Obstructive sleep apnoea-hypopnoea syndrome reversibly depresses cardiac response to exercise. European Heart Journal, 27(2), 207-215. doi: 10.1093/eurheartj/ehi621

Aron, A., Zedalis, D., Gregg, J. M., Gwazdauskas, F. C., & Herbert, W. G. (2009). Potential clinical use of cardiopulmonary exercise testing in obstructive sleep apnea hypopnea syndrome. International Journal of Cardiology, 132(2), 176-186. doi: 10.1016/j.ijcard.2008.11.014

Becker, H. F., Jerrentrup, A., Ploch, T., Grote, L., Penzel, T., Sullivan, C. E., & Peter, J. H. (2003). Effect of nasal continuous positive airway pressure treatment on blood pressure in patients with obstructive sleep apnea. Circulation, 107(1), 68-73.

Chest., A. T. S. a. A. C. o. (2003). ATS/ACCP Statement on cardiopulmonary exercise testing. American Journal of Respiratory and Critical Care Medicine, 167(2), 211-277. doi: 10.1164/rccm.167.2.211

Cintra, F., Poyares, D., Rizzi, C. F., Risso, T. T., Skomro, R., Montuori, E., Tufik, S. (2009). Cardiorespiratory response to exercise in men and women with obstructive sleep apnea. Sleep Medicine, 10(3), 368-373. doi: 10.1016/j.sleep.2008.04.006

Dopp, J. M., Reichmuth, K. J., & Morgan, B. J. (2007). Obstructive sleep apnea and hypertension: mechanisms, evaluation, and management. Current Hypertension Reports, 9(6), 529-534.

Edvardsen, E., Hem, E., & Anderssen, S. A. (2014). End Criteria for Reaching Maximal Oxygen Uptake Must Be Strict and Adjusted to Sex and Age: A Cross-Sectional Study. PLOS ONE, 9(1), e85276. doi: 10.1371/journal.pone.0085276

Edward Shifflett, D., Walker, E. W., Gregg, J. M., Zedalis, D., & Herbert, W. G. (2001). Effects of short-term PAP treatment on endurance exercise performance in obstructive sleep apnea patients. Sleep Medicine, 2(2), 145-151. doi: http://dx.doi.org/10.1016/S1389-9457(00)00070-8

Evans, C. A., Selvadurai, H., Baur, L. A., & Waters, K. A. (2014). Effects of obstructive sleep apnea and obesity on exercise function in children. Sleep, 37(6), 1103-1110. doi: 10.5665/sleep.3770

Grote, L., Hedner, J., & Peter, J. H. (2004). The heart rate response to exercise is blunted in patients with sleep-related breathing disorder. Cardiology, 102(2), 93-99. doi: 10.1159/000077911

Hargens, T. A., Guill, S. G., Aron, A., Zedalis, D., Gregg, J. M., Nickols-Richardson, S. M., & Herbert, W. G. (2009). Altered ventilatory responses to exercise testing in young adult men with obstructive sleep apnea. Respiratory Medicine, 103(7), 1063-1069. doi: 10.1016/j.rmed.2009.01.010

Hargens, T. A., Guill, S. G., Zedalis, D., Gregg, J. M., Nickols-Richardson, S. M., & Herbert, W. G. (2008). Attenuated heart rate recovery following exercise testing in overweight young men with untreated obstructive sleep apnea. Sleep, 31(1), 104-110.

Heinrich, J., Spiesshofer, J., Bitter, T., Horstkotte, D., & Oldenburg, O. (2015). Implications of revised AASM rules on scoring apneic and hypopneic respiratory events in patients with heart failure with nocturnal Cheyne-Stokes respiration. Sleep Breath, 19(2), 489-494. doi: 10.1007/s11325-014-1014-9

Innocenti Bruni, G., Gigliotti, F., & Scano, G. (2012). Obstructive sleep apnea (OSA) does not affect ventilatory and perceptual responses to exercise in morbidly obese subjects. Respiratory Physiology and Neurobiology, 183(3), 193-200. doi: 10.1016/j.resp.2012.06.029

Kaleth, A. S., Chittenden, T. W., Hawkins, B. J., Hargens, T. A., Guill, S. G., Zedalis, D. & Herbert, W. G. (2007). Unique cardiopulmonary exercise test responses in overweight middle-aged adults with obstructive sleep apnea. Sleep Medicine, 8(2), 160-168. doi: 10.1016/j.sleep.2006.08.005

Kline, C. E., Crowley, E. P., Ewing, G. B., Burch, J. B., Blair, S. N., Durstine, J. L. & Youngstedt, S. D. (2013). Blunted heart rate recovery is improved following exercise training in overweight adults with obstructive sleep apnea. International Journal of Cardiology, 167(4), 1610-1615. doi: 10.1016/j.ijcard.2012.04.108

Lin, C.-C., Lin, C.-K., Wu, K.-M., & Chou, C.-S. (2004). Effect of Treatment by Nasal CPAP on Cardiopulmonary Exercise Test in ObstructiveSleep Apnea Syndrome. Lung, 182(4), 199-212. doi: 10.1007/s00408-004-2502-7

Maeder, M. T., Ammann, P., Münzer, T., Schoch, O. D., Korte, W., Hürny, C. & Rickli, H. (2009). Continuous positive airway pressure improves exercise capacity and heart rate recovery in obstructive sleep apnea. International Journal of Cardiology, 132(1), 75-83. doi: http://dx.doi.org/10.1016/j.ijcard.2007.10.040

Masa, J. F., Corral, J., Teran, J., Martin, M. J., Disdier, C., Rubio, M. & Montserrat, J. M. (2009). Apnoeic and obstructive nonapnoeic sleep respiratory events. European Respiratory Journal, 34(1), 156-161. doi: 10.1183/09031936.00160208

McDaid, C., Duree, K. H., Griffin, S. C., Weatherly, H. L., Stradling, J. R., Davies, R. J. & Westwood, M. E. (2009). A systematic review of continuous positive airway pressure for obstructive sleep apnoea-hypopnoea syndrome. Sleep Medicine Review, 13(6), 427-436. doi: 10.1016/j.smrv.2009.02.004

Mohammad, M. M., Dadashpour, S., & Adimi, P. (2012). Predicted values of cardiopulmonary exercise testing in healthy individuals (a pilot study). Tanaffos, 11(1), 18-25.

Nanas, S., Sakellariou, D., Kapsimalakou, S., Dimopoulos, S., Tassiou, A., Tasoulis, A. & Roussos, C. (2010). Heart rate recovery and oxygen kinetics after exercise in obstructive sleep apnea syndrome. Clinical Cardiology, 33(1), 46-51. doi: 10.1002/clc.20707

Nelesen, R. A., Dimsdale, J. E., Mills, P. J., Clausen, J. L., Ziegler, M. G., & Ancoli-Israel, S. (1996). Altered cardiac contractility in sleep apnea. Sleep, 19(2), 139-144.

Nogueira, F. S., & Pompeu, F. A. (2006). [Maximal workload prediction models in the clinical cardio-pulmonary effort test]. Arquivos Brasileiros de Cardiologia, 87(2), 137-145.

Pendharkar, S. R., Tsai, W. H., Eves, N. D., Ford, G. T., & Davidson, W. J. (2011). CPAP increases exercise tolerance in obese subjects with obstructive sleep apnea. Respiratory Medicine, 105(10), 1565-1571. doi: http://dx.doi.org/10.1016/j.rmed.2011.06.007

Porszasz, J., Casaburi, R., Somfay, A., Woodhouse, L. J., & Whipp, B. J. (2003). A treadmill ramp protocol using simultaneous changes in speed and grade. Medicine and Science in Sports and Exercise, 35(9), 1596-1603. doi: 10.1249/01.mss.0000084593.56786.da

Promsrisuk, T., Khrisanapant, W., Pasurivong, O., Boonsawat, W., Patjanasoontorn, B. & Pussadhamma, B. (2017). Equations to predict maximal oxygen consumption during cardiopulmonary exercise testing in healthy Thai adults. Gazzetta Medica Italiana Archivio per le Scienze Mediche, In-press.

Przybylowski, T., Bielicki, P., Kumor, M., Hildebrand, K., Maskey-Warzechowska, M., Korczynski, P., & Chazan, R. (2007). Exercise capacity in patients with obstructive sleep apnea syndrome. Journal of Physiology and Pharmacology, 58 Suppl 5(Pt 2), 563-574.

Quadri, F., Boni, E., Pini, L., Bottone, D., Venturoli, N., Corda, L., & Tantucci, C. (2017). Exercise tolerance in obstructive sleep apnea-hypopnea (OSAH), before and after CPAP treatment: Effects of autonomic dysfunction improvement. Respiratory Physiology and Neurobiology, 236, 51-56. doi: https://doi.org/10.1016/j.resp.2016.11.004

Ryan, S., Taylor, C. T., & McNicholas, W. T. (2005). Selective activation of inflammatory pathways by intermittent hypoxia in obstructive sleep apnea syndrome. Circulation, 112(17), 2660-2667. doi: 10.1161/circulationaha.105.556746

Santamit, S., Khrisanapant, W., Ishida,W., Pasurivong,O., Boonsawat, W., Intarapoka, B., & Zaeoue, W. (2015). Heart Rate Variability in Thai Patients with Obstructive Sleep Apnea. Srinagarind Medical Journal, 30(5), 518-526.

Shah, N. A., Yaggi, H. K., Concato, J., & Mohsenin, V. (2010). Obstructive sleep apnea as a risk factor for coronary events or cardiovascular death. Sleep Breath, 14(2), 131-136. doi: 10.1007/s11325-009-0298-7

Tichanon, P., Wilaiwan, K., Sopida, S., Orapin, P., Watchara, B., & Banjamas, I. (2016). Effect of Continuous Positive Airway Pressure on Airway Inflammation and Oxidative Stress in Patients with Obstructive Sleep Apnea. Canadian Respiratory Journal, 2016, 3107324. doi: 10.1155/2016/3107324

Vanhecke, T. E., Franklin, B. A., Zalesin, K. C., Sangal, R. B., deJong, A. T., Agrawal, V., & McCullough, P. A. (2008). Cardiorespiratory fitness and obstructive sleep apnea syndrome in morbidly obese patients. Chest, 134(3), 539-545. doi: 10.1378/chest.08-0567

Vanuxem, D., Badier, M., Guillot, C., Delpierre, S., Jahjah, F., & Vanuxem, P. (1997). Impairment of muscle energy metabolism in patients with sleep apnoea syndrome. Respiratory Medicine, 91(9), 551-557.

Vgontzas, A. N., & Kales, A. (1999). Sleep and its disorders. Annual Review of Medicine, 50, 387-400. doi: 10.1146/annurev.med.50.1.387
GUIDE FOR AUTHORS
EDITORIAL BOARD
ABOUT JOURNAL
INDEXED IN
AHEAD OF PRINT
ARCHIVES
CURRENT ISSUE
CONTACT US