Potential clinical use of cardiopulmonary exercise testing in obstructive sleep apnea hypopnea syndrome

A European Respiratory Society research seminar on ''Metabolic alterations in obstructive sleep apnoea (OSA)'' was jointly organised in October 2009 together with two EU COST actions (Cardiovascular risk in the obstructive sleep apnoea syndrome, action B26, and Adipose tissue and the metabolic syndrome, action BM0602) in order to discuss the interactions between obesity and OSA.Such interactions can be particularly significant in the pathogenesis of metabolic abnormalities and in increased cardiovascular risk in OSA patients. However, studying the respective role of OSA and obesity is difficult in patients, making it necessary to refer to animal models or in vitro systems. Since most OSA patients are obese, their management requires a multidisciplinary approach.This review summarises some aspects of the pathophysiology and treatment of obesity, and the possible effects of sleep loss on metabolism. OSA-associated metabolic dysfunction (insulin resistance, liver dysfunction and atherogenic dyslipidaemia) is discussed from the perspective of both obesity and OSA in adults and children.Finally, the effects of treatment for obesity or OSA, or both, on cardio-metabolic variables are summarised. Further interdisciplinary research is needed in order to develop new comprehensive treatment approaches aimed at reducing sleep disordered breathing, obesity and cardiovascular risk.

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“…Some studies have reported a low exercise capacity in OSA patients, suggesting that OSA may impact on muscle metabolism [201].…”

Section: Ectopic Fat and Dyslipidaemiamentioning

confidence: 99%

Adipose tissue in obesity and obstructive sleep apnoea

Bonsignore¹,

McNicholas²,

Montserrat³

et al. 2011

European Respiratory Journal

112

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“…In adults with untreated OSA, many CPET responses have been found to be abnormal when compared with age-, activity- and weight-matched non-OSA controls [11]. These abnormal CPET responses have included reduced cardiorespiratory fitness (VO 2peak ) [12–14], chronotropic impairment [15], exaggerated systolic (SBP) and/or diastolic blood pressure (DBP) [13,16], impaired ventilatory efficiency (V E /V CO2 slope) [17], and blunted heart rate recovery (HRR) [14,18].…”

Section: Introductionmentioning

confidence: 99%

Blunted heart rate recovery is improved following exercise training in overweight adults with obstructive sleep apnea

Kline

Crowley

Ewing

et al. 2013

International Journal of Cardiology

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Background Obstructive sleep apnea (OSA) predisposes individuals to cardiovascular morbidity, and cardiopulmonary exercise test (CPET) markers prognostic for cardiovascular disease have been found to be abnormal in adults with OSA. Due to the persistence of OSA and its cardiovascular consequences, whether the cardiovascular adaptations normally conferred by exercise are blunted in adults not utilizing established OSA treatment is unknown. The aims of this study were to document whether OSA participants have abnormal CPET responses and determine whether exercise modifies these CPET markers in individuals with OSA. Methods The CPET responses of 43 sedentary, overweight adults (body mass index [BMI]>25) with untreated OSA (apnea-hypopnea index [AHI]≥15) were compared against matched non-OSA controls (n=9). OSA participants were then randomized to a 12-week exercise training (n=27) or stretching control treatment (n=16), followed by a post-intervention CPET. Measures of resting, exercise, and post-exercise recovery heart rate (HRR), blood pressure, and ventilation, as well as peak oxygen consumption (VO2peak), were obtained. Results OSA participants had blunted HRR compared to non-OSA controls at 1 (P=.03), 3 (P=.02), and 5 min post-exercise (P=.03). For OSA participants, exercise training improved VO2peak (P=.04) and HRR at 1 (P=.03), 3 (P<.01), and 5 min post-exercise (P<.001) compared to control. AHI change was associated with change in HRR at 5-min post-exercise (r=−.30, P<.05), but no other CPET markers. Conclusions These results suggest that individuals with OSA have autonomic dysfunction, and that exercise training, by increasing HRR and VO2peak, may attenuate autonomic imbalance and improve functional capacity independent of OSA severity reduction.

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“…Relative to aerobic exercise capacity, five studies over the past decade showed peak aerobic capacity (VO 2pk ) was reduced in patients with untreated OSAS while six studies showed no difference. [11] The aim of the current study was to evaluate the independent association of OSAS severity on exercise capacity and HRQoL.…”

Section: Introductionmentioning

confidence: 99%

Association of obstructive sleep apnea severity with exercise capacity and health-related quality of life

Butner

Hargens²,

Kaleth

et al. 2013

North Am J Med Sci

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Background:Current research is inconclusive as to whether obstructive sleep apnea severity directly limits exercise capacity and lowers health-related quality of life (HRQoL).Aims:The aim of this study was to evaluate the association of obstructive sleep apnea severity with determinants of exercise capacity and HRQoL.Subjects and Methods:Subjects were evaluated by home somnography and classified as no obstructive sleep apnea (n = 43) or as having mild (n = 27), moderate or severe obstructive sleep apnea (n = 21). Exercise capacity was assessed by a ramping cycle ergometer test, and HRQoL was assessed with the SF-36 questionnaire.Results:Greater obstructive sleep apnea severity was associated with older age, higher body weight, higher body mass index, lower peak aerobic capacity, a higher percentage of peak aerobic capacity at a submaximal exercise intensity of 55 watts, and lower physical component summary score from the SF-36. None of these variables were statistically different among obstructive sleep apnea severity groups after controlling for age and body weight. Obstructive sleep apnea severity was not associated with any cardiorespiratory fitness or HRQoL parameter.Conclusions:Obstructive sleep apnea severity has no independent association with exercise capacity or HRQoL.

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Potential clinical use of cardiopulmonary exercise testing in obstructive sleep apnea hypopnea syndrome

Cited by 19 publications

References 94 publications

Adipose tissue in obesity and obstructive sleep apnoea

Adipose tissue in obesity and obstructive sleep apnoea

Blunted heart rate recovery is improved following exercise training in overweight adults with obstructive sleep apnea

Association of obstructive sleep apnea severity with exercise capacity and health-related quality of life

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