Inspiratory muscle strength and lung function in patients with heart failure and obstructive sleep apnea




Sleep Apnea Syndromes; Heart Failure; Respiratory Muscles; Respiratory Function Tests.


Aim: Assessing inspiratory muscle strength and lung function in patients with chronic heart failure (CHF) and obstructive sleep apnea (OSA). Methods: Cross-sectional study carried out with 18 CHF participants (12 men) who presented reduced left ventricular ejection fraction (LVEF) (< 51% for men and < 53% for women), and who also had OSA (from light to severe), which was diagnosed through portable polysomnography exam. Inspiratory muscle strength was measured by determining the maximum inspiratory pressure (Ipmax) through manovacuometry; it was compared to values predicted by sex and age. Forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and tiffenau index (FVC/FEV1) were measured in computerized spirometer; they were compared to predicted values. Results: Inspiratory muscle strength of CHF and OSA (109 ± 29 cmH2O) patients was preserved in comparison to values predicted by sex and age (100 ± 13cmH2O; p= 0.22). Both, CVF and VEF1 recorded lower values in comparison to the predicted ones (p= 0.001). Conclusions: CHF and OSA patients presented preserved inspiratory muscle strength and reduced lung function in comparison to reference values.


American Academy of Sleep Medicine. (2014). International Classification of Sleep Disorders. (3a ed.).

Azarbarzin, A., Sands, S. A., Stone, K. L., Taranto-Montemurro, L., Messineo, L., Terrill, P. I., ... & Wellman, A. (2019). The hypoxic burden of sleep apnoea predicts cardiovascular disease-related mortality: the Osteoporotic Fractures in Men Study and the Sleep Heart Health Study. European heart journal, 40(14), 1149-1157.

Belén, A. (2002). ATS/ERS Statement on respiratory muscle testing. Am J Respir Crit Care Med, 166, 518-624.

Berry, R. B., Budhiraja, R., Gottlieb, D. J., Gozal, D., Iber, C., Kapur, V. K., ... & Tangredi, M. M. (2012). Rules for scoring respiratory events in sleep: update of the 2007 AASM manual for the scoring of sleep and associated events: deliberations of the sleep apnea definitions task force of the American Academy of Sleep Medicine. Journal of clinical sleep medicine, 8(5), 597-619.

Bikov, A., Losonczy, G., & Kunos, L. (2017). Role of lung volume and airway inflammation in obstructive sleep apnea. Respiratory investigation, 55(6), 326-333.

Callegaro, C. C., Martinez, D., Ribeiro, P. A., Brod, M., & Ribeiro, J. P. (2010). Augmented peripheral chemoreflex in patients with heart failure and inspiratory muscle weakness. Respiratory physiology & neurobiology, 171(1), 31-35.

Callegaro, C. C., Ribeiro, J. P., Tan, C. O., & Taylor, J. A. (2011). Attenuated inspiratory muscle metaboreflex in endurance-trained individuals. Respiratory physiology & neurobiology, 177(1), 24-29.

Carvalho, T. M. D. C. S., Soares, A. F., Climaco, D. C. S., Secundo, I. V., & Lima, A. M. J. D. (2018). Correlation of lung function and respiratory muscle strength with functional exercise capacity in obese individuals with obstructive sleep apnea syndrome. Jornal Brasileiro de Pneumologia, 44, 279-284.

Chien, M. Y., Wu, Y. T., Lee, P. L., Chang, Y. J., & Yang, P. C. (2010). Inspiratory muscle dysfunction in patients with severe obstructive sleep apnoea. European Respiratory Journal, 35(2), 373-380.

de Oliveira, A. C. T., Martinez, D., Vasconcelos, L. F. T., Gonçalves, S. C., do Carmo Lenz, M., Fuchs, S. C., ... & Fuchs, F. D. (2009). Diagnosis of obstructive sleep apnea syndrome and its outcomes with home portable monitoring. Chest, 135(2), 330-336.

Forgiarini Junior, L. A., Rubleski, A., Douglas, G., Tieppo, J., Vercelino, R., Dal Bosco, A., ... & Dias, A. S. (2007). Avaliação da força muscular respiratória e da função pulmonar em pacientes com insuficiência cardíaca. Arquivos Brasileiros de Cardiologia, 89, 36-41.

Frankenstein, L., Nelles, M., Meyer, F. J., Sigg, C., Schellberg, D., Remppis, B. A., ... & Zugck, C. (2009). Validity, prognostic value and optimal cutoff of respiratory muscle strength in patients with chronic heart failure changes with beta-blocker treatment. European Journal of Preventive Cardiology, 16(4), 424-429.

Genta, P. R., Schorr, F., Eckert, D. J., Gebrim, E., Kayamori, F., Moriya, H. T., ... & Lorenzi-Filho, G. (2014). Upper airway collapsibility is associated with obesity and hyoid position. Sleep, 37(10), 1673-1678.

Hillman, D. R., Walsh, J. H., Maddison, K. J., Platt, P. R., Schwartz, A. R., & Eastwood, P. R. (2013). The effect of diaphragm contraction on upper airway collapsibility. Journal of Applied Physiology, 115(3), 337-345.

Hoffmeister, A. D., Lima, K. S. D., Albuquerque, I. M. D., Binotto, V., & Callegaro, C. C. (2018). Inspiratory muscle endurance in obese and eutrophic individuals. Fisioterapia e Pesquisa, 25, 438-443.

Johnson, B. D., Beck, K. C., Olson, L. J., O’Malley, K. A., Allison, T. G., Squires, R. W., & Gau, G. T. (2001). Pulmonary function in patients with reduced left ventricular function: influence of smoking and cardiac surgery. Chest, 120(6), 1869-1876.

Joho, S., Ushijima, R., Akabane, T., Hirai, T., & Inoue, H. (2017). Restrictive lung function is related to sympathetic hyperactivity in patients with heart failure. Journal of cardiac failure, 23(2), 96-103.

Kapur, V. K., Auckley, D. H., Chowdhuri, S., Kuhlmann, D. C., Mehra, R., Ramar, K., & Harrod, C. G. (2017). Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine, 13(3), 479-504.

Kasai, T., & Bradley, T. D. (2011). Obstructive sleep apnea and heart failure: pathophysiologic and therapeutic implications. Journal of the American College of Cardiology, 57(2), 119-127.

Lang, R. M., Badano, L. P., Mor-Avi, V., Afilalo, J., Armstrong, A., Ernande, L., ... & Voigt, J. U. (2015). Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. European Heart Journal-Cardiovascular Imaging, 16(3), 233-271.

Meurling, I. J., O’Shea, D., & Garvey, J. F. (2019). Obesity and sleep: a growing concern. Current opinion in pulmonary medicine, 25(6), 602-608.

Nakagawa, N. K., Diz, M. A., Kawauchi, T. S., de Andrade, G. N., Umeda, I. I. K., Murakami, F. M., ... & Cahalin, L. P. (2020). Risk Factors for Inspiratory Muscle Weakness in Chronic Heart Failure. Respiratory care, 65(4), 507-516.

Neder, J. A., Andreoni, S., Lerario, M. C., & Nery, L. E. (1999). Reference values for lung function tests: II. Maximal respiratory pressures and voluntary ventilation. Brazilian journal of medical and biological research, 32, 719-727.

Pereira, C. A.C. (2002) Espirometria. J Pneumol, 2002.

Pinto, J. A., Ribeiro, D. K., Cavallini, A. F. D. S., Duarte, C., & Freitas, G. S. (2016). Comorbidities associated with obstructive sleep apnea: a retrospective study. International archives of otorhinolaryngology, 20, 145-150.

Rehling, T., Banghøj, A. M., Kristiansen, M. H., Tarnow, L., & Molsted, S. (2017). Reduced inspiratory muscle strength in patients with type 2 diabetes mellitus and obstructive sleep apnoea. Journal of diabetes research, 2017.

Reuter, H., Herkenrath, S., Treml, M., Halbach, M., Steven, D., Frank, K., ... & Randerath, W. J. (2018). Sleep-disordered breathing in patients with cardiovascular diseases cannot be detected by ESS, STOP-BANG, and Berlin questionnaires. Clinical Research in Cardiology, 107(11), 1071-1078.

Ribeiro, J. P., Chiappa, G. R., & Callegaro, C. C. (2012). The contribution of inspiratory muscles function to exercise limitation in heart failure: pathophysiological mechanisms. Brazilian Journal of Physical Therapy, 16, 261-267.

Santos, M. A., Aguiar, M., Sacramento, V., Rodrigues, S., & Furtado, S. (2018). Obstructive Sleep Apnea severity and lung function.

Sarkar, P., Mukherjee, S., Chai-Coetzer, C. L., & McEvoy, R. D. (2018). The epidemiology of obstructive sleep apnoea and cardiovascular disease. Journal of thoracic disease, 10(Suppl 34), S4189.

Shepherd, K. L., Jensen, C. M., Maddison, K. J., Hillman, D. R., & Eastwood, P. R. (2006). Relationship between upper airway and inspiratory pump muscle force in obstructive sleep apnea. Chest, 130(6), 1757-1764.

Shortt, C. M., Fredsted, A., Chow, H. B., Williams, R., Skelly, J. R., Edge, D., ... & O'Halloran, K. D. (2014). Reactive oxygen species mediated diaphragm fatigue in a rat model of chronic intermittent hypoxia. Experimental physiology, 99(4), 688-700.

Tassinari, C. C., Piccin, C. F., Beck, M. C., Scapini, F., Oliveira, L. C., Signori, L. U., & Silva, A. M. (2016). Capacidade funcional e qualidade de vida entre sujeitos saudáveis e pacientes com apneia obstrutiva do sono. Medicina (Rib Preto), 49(2), 152-159.

Tufik, S., Santos-Silva, R., Taddei, J. A., & Bittencourt, L. R. A. (2010). Obstructive sleep apnea syndrome in the Sao Paulo epidemiologic sleep study. Sleep medicine, 11(5), 441-446.

Wong, E., Selig, S., & Hare, D. L. (2011). Respiratory muscle dysfunction and training in chronic heart failure. Heart, lung and circulation, 20(5), 289-294.



How to Cite

PARIZOTTO, J. G. C. .; BORTAGARAI, F. M. .; MOREIRA, P. R. .; DONADUSSI, J. C. .; MEDEIROS, C. da S. .; PEREIRA, S. N. .; KREBES, C. de M. .; PASQUALOTO, A. S. .; ALBUQUERQUE, I. M. de .; CALLEGARO, C. C. . Inspiratory muscle strength and lung function in patients with heart failure and obstructive sleep apnea. Research, Society and Development, [S. l.], v. 10, n. 12, p. e333101220115, 2021. DOI: 10.33448/rsd-v10i12.20115. Disponível em: Acesso em: 21 feb. 2024.



Health Sciences