Obstructive sleep apnea (OSA) causes recurrent apneas due to upper respiratory tract collapse, leading to sympathetic nervous system hyperactivation and increased cardiovascular risk. Moderate and severe forms of obstructive sleep apnea are associated with increased atrial volumes and affect left ventricular diastolic and then systolic function. Right ventricular ejection fraction can be accurately assessed via three-dimensional echocardiography, while bidimensional imaging can only provide a set of surrogate parameters to characterize systolic function (tricuspid annulus plane systolic excursion, right ventricular fractional area change, and lateral S'). Tissue Doppler imaging is a more sensitive tool in detecting functional ventricular impairment, but its use is limited by angle dependence and the unwanted influence of tethering forces. Two-dimensional speckle tracking echocardiography is considered more suitable for the assessment of ventricular function, as it is able to distinguish between active and passive wall motion. Abnormal strain values, a marker of subclinical myocardial dysfunction, can be detected even in patients with normal ejection fraction and chamber volumes. The left ventricular longitudinal strain is more affected by the presence of obstructive sleep apnea than circumferential strain values. Although the observed OSA-induced changes are subtle, the benefit of a detailed echocardiographic screening for subclinical heart failure in OSA patients on therapy adherence and outcome should be addressed by further studies.
Background and Objectives: Functional capacity (FC) assessed via cardiopulmonary exercise testing (CPET) is a novel, independent prognostic marker for patients with coronary artery disease (CAD). Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are two readily available predictors of systemic inflammation and cardiovascular event risk, which could be used as cost-effective predictors of poor FC. The purpose of this study was to evaluate the utility of NLR and PLR in predicting poor FC in patients with CAD and recent elective percutaneous coronary intervention (PCI). Materials and Methods: Our cross-sectional retrospective analysis included 80 patients with stable CAD and recent elective PCI (mean age 55.51 ± 11.83 years, 71.3% male) who were referred to a cardiovascular rehabilitation center from January 2020 to June 2021. All patients underwent clinical examination, cardiopulmonary exercise testing on a cycle ergometer, transthoracic echocardiography and standard blood analysis. Results: Patients were classified according to percent predicted oxygen uptake (% VO2 max) in two groups—poor FC (≤70%, n = 35) and preserved FC (>70%, n = 45). There was no significant difference between groups regarding age, gender ratio, presence of associated comorbidities, left ventricular ejection fraction and NLR. PLR was higher in patients with poor FC (169.8 ± 59.3 vs. 137.4 ± 35.9, p = 0.003). A PLR cut-off point of 139 had 74% sensitivity and 60% specificity in predicting poor FC. After multivariate analysis, PLR remained a significant predictor of poor functional status. Conclusions: Although CPET is the gold standard test for assessing FC prior to cardiovascular rehabilitation, its availability remains limited. PLR, a cheap and simple test, could predict poor FC in patients with stable CAD and recent elective PCI and help prioritize referral for cardiovascular rehabilitation in high-risk patients.
Cardiopulmonary exercise testing (CPET) has become the golden standard in the assessment of exercise capacity and intensity of the patients who are performing cardiac rehabilitation. The purpose of our study was to objectify the relationships between the parameters of CPET and the lipid profile after the cardiovascular rehabilitation. We found a significant increase in oxygen consumption (VO2) values, anaerobic threshold, effort capacity and maximum heart rate and an improvement in the lipid profile, marking a reduced cardiovascular risk.
Background and Objectives: Obstructive sleep apnea (OSA) is associated with daytime somnolence, cognitive impairment and high cardiovascular morbidity and mortality. Obesity, associated cardiovascular comorbidities, accelerated erythropoiesis and muscular mitochondrial energetic dysfunctions negatively influence exercise tolerance in moderate-severe OSA patients. The cardiopulmonary exercise testing (CPET) offers an integrated assessment of the individual's aerobic capacity and helps distinguish the main causes of exercise limitation. The purpose of this study is to evaluate the aerobic capacity of OSA patients, before and after short-term continuous positive airway pressure (CPAP). Materials and Methods: Our prospective study included 64 patients with newly diagnosed moderate-severe OSA (apnea hypopnea index (AHI) 39.96 ± 19.04 events/h) who underwent CPET before and after CPAP. Thirteen patients were unable to tolerate CPAP or were lost during follow-up. Results: 49.29% of our patients exhibited a moderate or severe decrease in functional capacity (Weber C or D). CPET performance was influenced by gender but not by apnea severity. Eight weeks of CPAP induced significant improvements in maximal exercise load (∆ = 14.23 W, p = 0.0004), maximum oxygen uptake (∆ = 203.87 mL/min, p = 0.004), anaerobic threshold (∆ = 316.4 mL/min, p = 0.001), minute ventilation (∆ = 5.1 L/min, p = 0.01) and peak oxygen pulse (∆ = 2.46, p = 0.007) as well as a decrease in basal metabolic rate (BMR) (∆ = −8.3 kCal/24 h, p = 0.04) and average Epworth score (∆ = −4.58 points, p < 0.000001). Conclusions: Patients with moderate-severe OSA have mediocre functional capacity. Apnea severity (AHI) was correlated with basal metabolic rate, resting heart rate and percent predicted maximum effort but not with anaerobic threshold or maximum oxygen uptake. Although CPET performance was similar in the two apnea severity subgroups, short-term CPAP therapy significantly improved most CPET parameters, suggesting that OSA per se has a negative influence on effort capacity.
Obstructive sleep apnea (OSA) is the most common type of sleep disordered breathing, with a signifi cant impact on health-related quality of life (HR-QoL). Continuous positive airway pressure (CPAP) is the gold-standard treatment for moderate-severe OSA, but is associated with poor patient compliance (due to fi nancial issues and frequent side eff ects). The purpose of this study is to evaluate HR-QoL among patients with moderate-severe OSA from NorthEastern Romania, at baseline and after 2 months of CPAP. 75 patients were initially included in our study but only 59 subjects returned for a second evaluation. HR-QoL was assessed using the European Quality of Life 5 Domain questionnaire (EQ-5D-5L). OSA has a signifi cant impact on quality of life in our group, with an average EQ-5D-5L index of 0.70±0.27 and an EQ-5D-5L Visual Analogue Scale (VAS) of 63.71±17.74%. Short-term CPAP use was associated with a statistically signifi cant improvement in Epworth Sleepiness Scale (Δ = 4.44, p <0.0000001), EQ-5D-5L index (Δ = 0.1, p=0.0008) and EQ-5D-5L VAS (Δ = 9.38%, p=0.00002). All patients with a high income (> 4000 lei/month) decided to continue using the device, while the decision not to continue CPAP was signifi cantly more frequent among patients with a low income (< 1000 lei /month-52.63% versus 21.21%, p=0.01). Our results suggest that income level signifi cantly infl uences CPAP compliance.
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