The beneficial impact of cardiac rehabilitation on obstructive sleep apnea in patients with coronary artery disease

Abstract

Study Objectives: To assess the impact of cardiac rehabilitation for decreasing sleep-disordered breathing in patients with coronary artery disease. Methods: The study included 121 patients aged 60.01 ± 10.08 years, 101 of whom were men, with an increased pretest probability of OSA. The cardiac rehabilitation program lasted 21-25 days. The improvement in cardiorespiratory fitness was assessed using the changes in peak metabolic equivalents, the maximal heart rate achieved, the proportion of the age-and sex-predicted maximal heart rate, and the Six-Minute Walk Test distance. Level 3 portable sleep tests with respiratory event index assessments were performed in 113 patients on admission and discharge. Results: Increases were achieved in metabolic equivalents (Δ1.20; 95% confidence interval [CI], 0.95-1.40; P < .0001), maximal heart rate (-Δ7.5 beats per minute; 95% CI, 5.00-10.50; P <.0001), proportion of age-and sex-predicted maximal heart rate (Δ5.50%; 95% CI, 4.00-7.50; P <.0001), and the Six-Minute Walk Test distance (Δ91.00 m; 95% CI, 62.50-120.00; P <.0001). Sleep-disordered breathing was diagnosed in 94 (83.19%) patients: moderate in 28 (24.8%) patients and severe in 27 (23.9%) patients, with a respiratory event index of 19.75 (interquartile range, 17.20-24.00) and 47.50 (interquartile range, 35.96-56.78), respectively. OSA was dominant in 90.40% of patients. The respiratory event index reduction achieved in the sleep-disordered breathing group was -Δ3.65 (95% CI, -6.30 to -1.25; P = .003) and was in parallel to the improvement in cardiorespiratory fitness in the subgroups with the highest effort load and with severe sleepdisordered breathing: -Δ6.40 (95% CI, -11.40 to -1.90; P = .03) and -Δ11.00 (95% CI, -18.65 to -4.40; P = .003), respectively. Conclusions: High-intensity exercise training during cardiac rehabilitation resulted in a significant decrease in OSA, when severe, in parallel with an improvement in cardiorespiratory fitness in patients with coronary artery disease.

Long COVID-19 Syndrome Severity According to Sex, Time from the Onset of the Disease, and Exercise Capacity—The Results of a Cross-Sectional Study

“…A total of 33.8% of patients had a significantly reduced capacity to exercise. The mean distance in 6MWT assessed as 373.7 m was lower than in a comparable age group of patients we evaluated during rehabilitation after myocardial infarction (627.0 m) [ 57 ]. Mean spirometric parameters in the study group were mildly reduced (FVC% 93.2% pred and FEV1% 88.6% pred), although they were lower than 80% of the predicted value in 21.1% (FVC) and 32.7% (FEV1) of participants.…”

An individualized mobile health intervention to promote physical activity in adults with obstructive sleep apnea: An intervention mapping approach

“…Despite the benefit of PA in the context of OSA, 10 – 13 , 16 – 41 , 125 few studies have incorporated an outcome associated with PA level to measure the effect of interventions on the PA behavior itself. 24 – 29 , 40 , 41 The results are nevertheless heterogeneous, and more RCTs that integrate behavioral outcomes are needed.…”

“… 24 – 29 , 40 , 41 The results are nevertheless heterogeneous, and more RCTs that integrate behavioral outcomes are needed. 11 The analysis of PA interventions from 20 experimental studies targeting patients with OSA 12 , 24 – 41 , 125 indicate that only 2 (10%) studies provided educational content 12 , 32 and 3 (15%) included motivational content 26 , 27 , 40 in addition to the PA practice. The only intervention 26 to have precisely described its content based on BCTs formed the basis of the latter three studies.…”

“… 29 Many studies have focused on the effects of PA interventions on the parameters associated with OSA. 12 , 24 , 25 , 27 , 28 , 30 – 41 By contrast, few have explicitly investigated the effect of a PA intervention on PA behavior itself using objective 26 or subjective measurements. 29 This limited number of studies integrating the outcome of PA is surprising insofar as CPAP, as the first-line treatment of OSA, has a limited impact on cardiometabolic risk factors, whereas exercise training has a well-documented effect on numerous cardiometabolic risk factors.…”

Sleep behaviour and cardiorespiratory fitness in patients after percutaneous coronary intervention during cardiac rehabilitation: protocol for a longitudinal study

“…20 Relevant studies have found that adherence to exercise-based CR can effectively reduce the risk of further cardiac insults, improve sleep quality, enhance cardiorespiratory fitness (CRF) and minimise hospital readmission and mortality. [21][22][23][24] In the process of CR, CRF is used to assess the severity of the patient's cardiac limitation and the recovery after a cardiac event, and it is an important independent risk factor for cardiovascular disease. 25 26 Moreover, the risk of long-term major adverse cardiovascular events (MACEs) is further increased when sleep disturbances and decreased CRF co-occur.…”