Effects of Continuous Positive Airway Pressure on Pulmonary Function and Exercise Tolerance in Patients With Congestive Heart Failure

Wittmer, Verônica Lourenço; Simoes, Giovana M.S.; Sogame, L Cm; Vasquez, Elisardo C.

doi:10.1378/chest.130.1.157

Cited by 28 publications

(42 citation statements)

References 32 publications

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“…The results of the present study are in accordance with those presented by the study of Wittmer et al 7 , which concluded that CPAP improves the tolerance to physical exertion. Although the aforementioned authors evaluated pulmonary function, they did not define the influence of the pulmonary function and/or hemodynamics on the attained results 7 .…”

Section: Discussionsupporting

confidence: 93%

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O impacto do CPAP na reabilitação cardíaca de pacientes com ICC: relato de caso

Costa¹,

Barros²,

Lima³

2010

Arq. Bras. Cardiol.

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Congestive heart failure is a pathology that limits the patient's physical function. This study analyzed one patient who was submitted to a cardiac rehabilitation program associated to Continuous Positive Airway Pressure (CPAP), by assessing the results of the six-minute walk test (6MWT) and a questionnaire on the quality of life and performing an echocardiographic assessment before the study and after six weeks. The distance walked by the patient increased from 152.5 m to 520.44 m at the 6MWT. The Minnesota questionnaire score decreased from 62 to 18. Ejection fraction increased from 33% to 36%. Therefore, the management chosen for this case improved the patient's physical performance and quality of life. Key wordsHeart failure; exercise; rehabilitation; quality of life. symptom relief. This improvement is attained through the increase in the intrathoracic pressure, which decreases the left ventricular (LV) preload and afterload such as the transmural pressure, culminating with an increased stroke volume and outflow volume. Thus, it can be stated that the CPAP improves the mechanics of a failing heart 4 .The main characteristic of these patients is the intolerance to physical exercise, detected through dyspnea and fatigue; based on this presupposed concept, it becomes necessary to promote a cardiovascular rehabilitation program for these patients, with the objective of allowing the patient with cardiopathy to resume an active and productive life as soon as possible 2 . MethodsThe present is a case study of a 51-year-old female patient with heart failure of Chagasic origin, who presented NYHA (New York Heart Association) functional class (FC) III 2 , without any musculoskeletal or pulmonary comorbidities. The patient was submitted to an echocardiogram, answered a quality of life questionnaire (adapted Minnesota Living with Heart Failure Questionnaire) 2 and performed the Six-minute Walk Test 5 (6MWT) before initiating the Cardiac Rehabilitation protocol and after the six-week program was completed. The patient was followed by the same examiner throughout the entire study, who was blinded to the treatment.The training protocol consisted of four weekly sessions for a period of six weeks, during which a continuous positive pressure of 10cmH 2 O was applied to the airways during the entire session time (CPAP ResMed LightWeight II).The training sessions consisted of aerobic activity on a treadmill or bicycle ergometer (Reebok TR1 and Reebok Power Bike, respectively), alternately on each day and resistance exercises for the upper and lower limbs (dumbbells and Reebok ankle weights, respectively), also alternately on each day.During the training sessions, the patient was always followed by the same examiner. During the first week of training, the aerobic activity lasted 20 minutes and three types of resistance exercises were performed. On the second week of training, the aerobic activity lasted 25 minutes and 4 resistance exercises were performed. From the third to the sixth weeks of training, the aerobic activity las...

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Section: Discussionsupporting

confidence: 93%

“…Such results correlated directly with the analysis of some , who reported that the practice of physical exercises decreases both systolic BP and HR, with a consequent decrease in VO 2max 7,9 .…”

Section: Discussionsupporting

confidence: 83%

O impacto do CPAP na reabilitação cardíaca de pacientes com ICC: relato de caso

Costa¹,

Barros²,

Lima³

2010

Arq. Bras. Cardiol.

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“…It is important to comment that many studies employing prescribed CPAP in exercise protocols did not refer to the measurement of P ao (Keilty et al, 1994;Wittmer et al 2006), and the level and stability of the applied CPAP may rest unknown. On the other side, the work of Petrof et al (1990) reported the range of the swings of the applied CPAP, certainly a more realistic and quantitative description of the procedure.…”

Section: Discussionmentioning

confidence: 99%

“…The Continuous Positive Airway Pressure (CPAP) is a ventilatory intervention employed in exercise rehabilitation for patients suffering from chronic obstructive pulmonary diseases or congestive heart failure, as a tool to unload the respiratory muscles and consequently leading to a reduced physiological work of breathing (WOB) (Ambrosino and Strambi, 2004;Keilty et al, 1994;Wittmer et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

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Continuous positive airway pressure setups evaluated at simulated exercise conditions

Nunes

Giannella-Neto

Tavares

2014

Rev. Bras. Eng. Bioméd.

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Beneficial Effects of Positive Airway Pressure Therapy for Sleep‐Disordered Breathing in Heart Failure Patients With Preserved Left Ventricular Ejection Fraction

Yoshihisa

Suzuki

Yokota

et al. 2015

Clinical Cardiology

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Background: Right-heart dysfunction is associated with poor prognosis in heart failure with preserved left ventricular ejection fraction (HFpEF). It remains unclear whether sleep-disordered breathing (SDB) treatment using positive airway pressure (PAP) improves right-heart and pulmonary function and exercise capacity and reduces mortality rates of HFpEF patients. Hypothesis: PAP may improve right-heart and pulmonary function, exercise capacity and prognosis in HFpEF patients with SDB. Methods: One hundred nine consecutive patients with HFpEF (left ventricular ejection fraction >50%) and moderate to severe SDB (apnea-hypopnea index ≥15/h) treated with medications were divided into 2 groups: 31 patients with PAP (PAP group) and 78 patients without PAP (non-PAP group). Right ventricular fractional area change (RV-FAC), tricuspid valve regurgitation pressure gradient (TR-PG), tricuspid valve E/E , forced expiratory volume in 1 second/forced vital capacity (FEV 1 /FVC), percentage of vital capacity, and peak VO 2 were determined before and 6 months later, and all-cause mortality was followed up for 916 days. Results: All parameters improved in the PAP group (RV-FAC, 36.0% -46.5%; TR-PG, 31.1 mm Hg-22.4 mm Hg; tricuspid valve E/E , 7.8-5.1; FEV 1 /FVC, 83.9%-89.8%; percentage of vital capacity, 83.5%-89.9%; and peak VO 2 , 16.6 mL/kg/min-19.6 mL/kg/min; P <0.05, respectively) but not in the non-PAP group. Importantly, all-cause mortality was significantly lower in the PAP group than in the non-PAP group (0% vs 12.8%; log-rank P = 0.014). Conclusions: Positive airway pressure improves right-heart and pulmonary function and exercise capacity and may reduce all-cause mortality in patients with HFpEF and SDB.

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Effects of Continuous Positive Airway Pressure on Pulmonary Function and Exercise Tolerance in Patients With Congestive Heart Failure

Cited by 28 publications

References 32 publications

O impacto do CPAP na reabilitação cardíaca de pacientes com ICC: relato de caso

O impacto do CPAP na reabilitação cardíaca de pacientes com ICC: relato de caso

Continuous positive airway pressure setups evaluated at simulated exercise conditions

Beneficial Effects of Positive Airway Pressure Therapy for Sleep‐Disordered Breathing in Heart Failure Patients With Preserved Left Ventricular Ejection Fraction

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