O CPAP atenua as respostas cardiovasculares ao esforço submáximo na apneia obstrutiva do sono? Um estudo transversal

Abstract

Objetivo: Comparar a capacidade funcional de exercício (CFE) e as respostas cardiovasculares ao exercício submáximo em indivíduos com apneia obstrutiva do sono (AOS) com e sem tratamento com pressão positiva contínua nas vias aéreas (CPAP). Métodos: 73 indivíduos com diagnóstico de AOS moderada ou grave foram divididos em 2 grupos: grupo CPAP (boa adesão ≥ 4 horas/noite, n = 36) e grupo nCPAP (não utilizaram o dispositivo, n = 37) e submetidos ao teste de degrau de seis minutos (TD6M). Resultados: Não houve diferença entre os grupos na CFE (nCPAP 132,95 ± 27,12 degraus vs CPAP 125,11 ± 26,15 degraus; p=0,213). A resposta pressórica imediatamente após o exercício (final – repouso) foi superior no grupo nCPAP tanto para pressão arterial sistólica (PAS) (57,56 ± 19,91mmHg vs 28,88 ± 15,07mmHg; p = 0,000) quanto para pressão arterial diastólica (PAD) (14,05 ± 8,64 vs 1,38 ± 7,23; p = 0,000). O percentual de variação de recuperação (recuperação – inicial) foi menor no grupo CPAP, tanto para PAS (24,2 ± 12,04% vs 4,6 ± 7,31%; p = 0,000) quanto para PAD (10,66% ± 9,41% vs 0,43% ± 6,88%; p = 0,000). Não houve diferença no percentual de variação da FC (nCPAP 18,6 ± 15,34% vs. CPAP 15,08 ± 10,59%; p = 0,260). Conclusões: Os resultados sugerem uma resposta pressórica atenuada ao esforço submáximo e uma recuperação mais rápida da PAS e da PAD em indivíduos com AOS tratados com CPAP em comparação aos não tratados.

Procedures and measurement properties of the 6-min step test: A systematic review with clinical recommendations

“…Two studies (14%) 41,42 did not use a 20-cm step and 9 studies (64%) either did not allow upper limb support (five studies; 36%), 22,36,39,42,45,49 or did not provide information related to upper limb support (four studies; 28%). 27,41,43,44 When upper limb support was allowed, the participants used a wall or parallel bars to keep balance (Table 1).…”

“…15 In addition, the results of this review indicated that the 6-min step test provided expected changes in physiological variables that are very similar to other submaximal tests (i.e., 6-min walk test, sit-to-stand test). 36,[44][45][46] However, in some studies, the number of included participants was too small to guarantee confidence related to safety or tolerability.…”

“…Among the 14 included studies, 12 studies reported that the American Thoracic Society guideline was used to perform the 6-min step test, and two studies did not report which recommendations were used during the test. 44,48 Although all studies reported that the test duration was 6 min, only five studies (36%) 37,38,40,46,47 reported the other two criteria in accordance with the test recommendations. Two studies (14%) 41,42 did not use a 20-cm step and 9 studies (64%) either did not allow upper limb support (five studies; 36%), 22,36,39,42,45,49 or did not provide information related to upper limb support (four studies; 28%).…”

“…Seventeen papers failed to meet the inclusion criteria (see Supplemental Material for a summary of the excluded papers), leaving 15 papers to be included. 22,27,[36][37][38][39][40][41][42][43][44][45][46][47][48] Two papers 22,36 had the same sample and were, therefore, reported as a single study (Figure 3). Therefore, 14 studies were analyzed in this systematic review.…”

“…The mean age of the participants ranged from 35 to 68 years old across studies. Five studies included participants with chronic obstructive pulmonary disease, 22,36,[37][38][39][40] three studies included participants with obesity, [41][42][43] two studies included participants with obstructive sleep apnea, 44,45 and the remaining four studies included participants with pulmonary resection, 46 stroke, 47 heart failure, 27 and cardiac diseases 48 (Table 1).…”