Does CPAP mitigate cardiovascular responses to submaximal effort in subjects with obstructive sleep apnea? A cross-sectional study
DOI:
https://doi.org/10.33448/rsd-v10i6.15941Keywords:
Obstructive sleep apnea; Continuous Positive Airway Pressure; Hemodynamic Responses; Submaximal stress test.Abstract
Objective: To compare functional exercise capacity (FEC) and cardiovascular responses to submaximal exercise in individuals with obstructive sleep apnea (OSA) with and without treatment with continuous positive airway pressure (CPAP). Methods: 73 individuals diagnosed with moderate or severe OSA were divided into 2 groups: CPAP group (good adherence ≥ 4 hours / night, n = 36) and nCPAP group (did not use the device, n = 37) and were submitted to the six-minute step test (6MST). Results: There was no difference between groups in the FEC (nCPAP 132.95 ± 27.12 steps vs CPAP 125.11 ± 26.15 steps; p = 0.213). The pressure response immediately after exercise (final - rest) was higher in the nCPAP group for both systolic blood pressure (SBP) (57.56 ± 19.91mmHg vs 28.88 ± 15.07mmHg; p = 0.000) and blood pressure diastolic (DBP) (14.05 ± 8.64 vs 1.38 ± 7.23; p = 0.000). The percentage of variation in recovery (recovery - initial) was lower in the CPAP group, both for PAS (24.2 ± 12.04% vs 4.6 ± 7.31%; p = 0.000) and for PAD (10.66 % ± 9.41% vs 0.43% ± 6.88%; p = 0.000). There was no difference in the percentage of HR variation (nCPAP 18.6 ± 15.34% vs. CPAP 15.08 ± 10.59%; p = 0.260). Conclusions: The results suggest an attenuated pressure response to submaximal effort and a faster recovery of SBP and DBP in individuals with OSA treated with CPAP compared to untreated ones.
References
Barbé, F., Durán-Cantolla, J., Sánchez-de-la-Torre, M., Martínez-Alonso, M., Carmona, C., Barceló, A., Spanish Sleep and Breathing Network, for the. (2012). Effect of Continuous Positive Airway Pressure on the Incidence of Hypertension and Cardiovascular Events in Nonsleepy Patients With Obstructive Sleep Apnea. JAMA, 307(20).
Bayram, N. A., Ciftci, B., Keles, T., Durmaz, T., Turhan, S., Bozkurt, E., & Peker, Y. (2009). Endothelial Function in Normotensive Men with Obstructive Sleep Apnea Before and 6 Months After CPAP Treatment. Sleep, 32(10), 1257–1263.
Bertolazi, A. N. (2008). Tradução , Adaptação Cultural E Validação De Dois Instrumentos De Avaliação Do Sono : Escala De Sonolência De Epworth E Índice De Qualidade Tradução , Adaptação Cultural E Validação De Dois Instrumentos De Avaliação Do Sono : Escala. Neurologia, 92.
BLACK, J. (2003). Sleepiness and residual sleepiness in adults with obstructive sleep apnea. Respiratory physiology & neurobiology, 136(2–3), 211–220.
Dursunoglu, D. (2005). Impact of obstructive sleep apnoea on left ventricular mass and global function. European Respiratory Journal, 26(2), 283–288.
Estrela, C. (2018). Metodologia científica: ciência, ensino, pesquisa. In Artes Médicas.
Fernandes, D. S. da S., Guimarães, M. P., Brito, E. Z. A. de, Lima, J. D. C., Rodrigues, M. de S., Neves, V. R., & Mesquita, F. O. de S. (2021). Prevalence and analysis of respiratory and anthropometric parameters in patients with obstructive sleep apnea. Research, Society and Development, 10(3), e32410313455.
Hargens, T. A., Guill, S. G., Zedalis, D., Gregg, J. M., Nickols-Richardson, S. M., & Herbert, W. G. (2008). Attenuated Heart Rate Recovery Following Exercise Testing in Overweight Young Men with Untreated Obstructive Sleep Apnea. Sleep, 31(1), 104–110.
Hedner, J. (2006). Hypertension prevalence in obstructive sleep apnoea and sex: a population-based case-control study. European Respiratory Journal, 27(3), 564–570.
Javaheri, S., Barbe, F., Campos-Rodriguez, F., Dempsey, J. A., Khayat, R., Javaheri, S., & Somers, V. K. (2017). Sleep Apnea. Journal of the American College of Cardiology, 69(7), 841–858.
& Herbert, W. G. (2007). Unique cardiopulmonary exercise test responses in overweight middle-aged adults with obstructive sleep apnea. Sleep Medicine, 8(2), 160–168.
Kasiakogias, A., Tsioufis, C., Thomopoulos, C., Aragiannis, D., Alchanatis, M., Tousoulis, D., & Stefanadis, C. (2013). Effects of continuous positive airway pressure on blood pressure in hypertensive patients with obstructive sleep apnea. Journal of Hypertension, 31(2), 352–360.
Macey, P. M., Kumar, R., Woo, M. A., Yan-Go, F. L., Harper, R. M. (2013). Heart rate responses to autonomic challenges in obstructive sleep apnea. PLoS ONE, 8(10), 1–15.
Maeder, M. T., Ammann, P., Münzer, T., Schoch, O. D., Korte, W., Hürny, C., & Rickli, H. (2009). Continuous positive airway pressure improves exercise capacity and heart rate recovery in obstructive sleep apnea. International journal of cardiology, 132(1), 75–83.
Magalhães, M. G. S., Teixeira, J. B., Santos, A. M. B., Clímaco, D. C. S., Silva, T. N. S., & Lima, A. M. J. D. (2020). Construct validity and reproducibility of the six-minute step test in subjects with obstructive sleep apnea treated with continuous positive airway pressure. Jornal Brasileiro de Pneumologia2, 46(3), e20180422.
Marin, J. M., Carrizo, S. J., Vicente, E., & Agusti, A. G. (2005). Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. The Lancet, 365(9464), 1046–1053.
Mateika, J. H., & Syed, Z. (2013). Intermittent hypoxia, respiratory plasticity and sleep apnea in humans: present knowledge and future investigations. Respiratory physiology & neurobiology, 188(3), 289–300.
Matsudo, S., Araújo, T., Matsudo, V., Andrade, D., Andrade, E., Oliveira, L. C., & Braggion, G. (2012). Questionário Internacional De Atividade Física (Ipaq): Estupo De Validade E Reprodutibilidade No Brasil. Revista Brasileira de Atividade Física & Saúde, 6(2), 5–18.
Nguyên, X. L., Rakotonanahary, D., Chaskalovic, J., Philippe, C., Hausser-Hauw, C., Lebeau, B., & Fleury, B. (2008). Residual subjective daytime sleepiness under CPAP treatment in initially somnolent apnea patients: a pilot study using data mining methods. Sleep Medicine, 9(5), 511–516.
Pepin, J. L., Viot-Blanc, V., Escourrou, P., Racineux, J. L., Sapene, M., Lévy, P., & Mallart, A. (2009). Prevalence of residual excessive sleepiness in CPAP-treated sleep apnoea patients: the French multicentre study. European Respiratory Journal, 33(5), 1062–1067.
Quadri, F., Boni, E., Pini, L., Bottone, D., Venturoli, N., Corda, L., & Tantucci, C. (2017). Exercise tolerance in obstructive sleep apnea-hypopnea (OSAH), before and after CPAP treatment: Effects of autonomic dysfunction improvement. Respiratory Physiology & Neurobiology, 236, 51–56.
Romero-Corral, A., Somers, V. K., Pellikka, P. A., Olson, E. J., Bailey, K. R., Korinek, J., & Lopez-Jimenez, F. (2007). Decreased Right and Left Ventricular Myocardial Performance in Obstructive Sleep Apnea. Chest, 132(6), 1863–1870.
Talwar, D., Jain, S., & Goel, A. (2015). Evaluation of short-term use of nocturnal nasal continuous positive airway pressure for a clinical profile and exercise capacity in adult patients with obstructive sleep apnea-hypopnea syndrome. Lung India, 32(3), 225.
Vanuxem, D., Badier, M., Guillot, C., Delpierre, S., Jahjah, F., & Vanuxem, P. (1997). Impairment of muscle energy metabolism in patients with sleep apnoea syndrome. Respiratory Medicine, 91(9), 551–557.
Wimms, A., Woehrle, H., Ketheeswaran, S., Ramanan, D., & Armitstead, J. (2016). Obstructive Sleep Apnea in Women : Specific Issues and Interventions. 2016.
Yokhana, S. S., Gerst, D. G., Lee, D. S., Badr, M. S., Qureshi, T., & Mateika, J. H. (2020). Impact of repeated daily exposure to intermittent hypoxia and mild sustained hypercapnia on apnea severity. (30), 367–377.
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Copyright (c) 2021 Sulyvan Ítalo Daher Chaves; Matheus Gustavo Silva Magalhães; Alice Santana Valadares Ribeiro; Pedro Paulo Simões de Siqueira; Anna Myrna Jaguaribe de Lima
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