Maximal exercise capacity in patients with obstructive sleep apnoea syndrome: a systematic review and meta-analysis

Abstract

Maximal aerobic capacity is a strong health predictor and peak oxygen consumption (') is considered a reflection of total body health. No systematic reviews or meta-analyses to date have synthesised the existing data regarding ' in patients with obstructive sleep apnoea (OSA).A systematic review of English and French articles using PubMed/MEDLINE and Embase included studies assessing ' in OSA patients either in mL·kg·min compared with controls or in % predicted. Two independent reviewers analysed the studies, extracted the data and assessed the quality of evidence.Mean ' expressed in mL·kg·min was significantly lower in patients with OSA than in controls (mean difference -2.7 mL·kg·min; p<0.001; n=850). This reduction in ' was found to be larger in non-obese patients (body mass index <30 kg·m). Mean ' % 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.

CPAP Effect on Cardiopulmonary Exercise Testing Performance in Patients with Moderate-Severe OSA and Cardiometabolic Comorbidities

“…Powell et al [28] studied exercise performance among military personnel with and without moderate-severe OSAS. The lack of significant differences among the two subgroups could be explained by the low average age in the OSAS and control groups (40.7 and 39.4, respectively) but also by the higher grade of habitual physical activity (characteristic for this population subset) [29].…”

“…Previous studies [24,25,29] reported that OSAS patients have higher DBP values and decreased HR recovery compared to controls. When analyzing the two apnea severity subgroups, we observed significantly higher baseline and AT-SBP values (but no significant differences regarding HR response during exercise) in the severe OSA subgroup.…”

“…Literature reports regarding the impact of CPAP on VO2 max in OSAS patients have yielded inconsistent results. Different CPAP therapy lengths (1 week-8 months) were associated with significant VO2 max improvements [29,[31][32][33]. However, in another study [34], VO2 max displayed a mild negative trend (22.52 ± 6.62 mL/min/kg to 21.32 ± 5.26 mL/min/kg; p = 0.111) in CPAP compliant patients and a borderline statistically significant decline in patients with suboptimal CPAP use (21.31 ± 5.66 mL/min/kg to 19.92 ± 5.40 mL/min/kg, p = 0.05).…”

“…However, a recent meta-analysis [29] has shown that VO2 max is significantly lower in OSA subjects compared to controls (∆ = 2.7 mL/kg/min), the difference being of greater clinical impact among non-obese patients (∆ = 4.1 mL/kg/min).…”

Obstructive sleep apnoea and exercise functional capacity: time to move?

“…In this issue of the European Respiratory Journal, MENDELSON et al [11] report a systematic review and meta-analysis to clarify the possible alterations of V′O 2 peak in patients with OSA. When all relevant studies were compiled, the authors found that V′O 2 peak is significantly lower in OSA patients than proper controls (mean difference −2.7 mL•kg −1 •min −1 , 95% CI −4.0 to −1.4; p<0.001; n=850) and that mean±SD V′O 2 peak is 90.7±21.0% of predicted in OSA patients.…”