395 Exercise Capacity is Maintained in Older Military Personnel with Moderate to Severe Obstructive Sleep Apnea

Abstract Introduction The relationship between moderate to severe OSA and exercise capacity remains unclear. Prior studies showing a reduction in VO2 max in this population have mostly involved middle-aged and overweight patients. We looked to determine if this trend in VO2 max was present in a similarly aged population of military personnel with previously undiagnosed moderate to severe OSA. Methods We studied 170 middle-aged male military members who underwent cardiopulmonary exercise testing (CPET) and polysomnography (PSG) as a part of a comprehensive evaluation for an established military program. For analysis, patients were categorized either into an OSA group (apnea-hypopnea index (AHI) ≥ 15 events/h) or control group (AHI < 15 events/h). VO2 max was compared between groups. Results Mean AHI was 29.0 in the OSA group (n =58) versus 7.4 in the controls (n = 112). Patients were of similar age (53.1 vs. 53.7 years) and BMI was slightly higher in the OSA group (27.5kg/m2 versus 26.3 kg/m2, P = .0077). Percent-predicted VO2 max was supernormal in both groups, though was comparatively lower in the OSA group (117% vs. 125%; P <.001). There was a trend toward a blunted heart rate response to exercise in the OSA group as represented by peak heart rate (163 vs. 178; p=0.07). Conclusion Older military personnel with moderate to severe OSA have normal exercise capacity. This may suggest that the low-arousal OSA phenotype often noted in military personnel does not significantly influence exercise capacity or that regular exercise helps limit its impact. It remains likely that the effect of untreated OSA on exercise capacity is influenced by several variables including age, BMI, OSA phenotype, and regularity of exercise. Trends in VO2 max and peak heart rate noted in this study may suggest that untreated OSA in certain populations can negatively impact exercise capacity Support (if any) No external funding

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Continuous positive airway pressure improves exercise capacity and heart rate recovery in obstructive sleep apnea

International Journal of Cardiology ◽

10.1016/j.ijcard.2007.10.040 ◽

2009 ◽

Vol 132 (1) ◽

pp. 75-83 ◽

Cited By ~ 20

Author(s):

Micha T. Maeder ◽

Peter Ammann ◽

Thomas Münzer ◽

Otto D. Schoch ◽

Wolfgang Korte ◽

...

Keyword(s):

Heart Rate ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Continuous Positive Airway Pressure ◽

Exercise Capacity ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Heart Rate Recovery ◽

Obstructive Sleep

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Endothelial Function and Arterial Stiffness Should Be Measured to Comprehensively Assess Obstructive Sleep Apnea in Clinical Practice

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.716916 ◽

2021 ◽

Vol 8 ◽

Author(s):

Jinmei Luo ◽

Xiaona Wang ◽

Zijian Guo ◽

Yi Xiao ◽

Wenhao Cao ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Arterial Stiffness ◽

Endothelial Function ◽

Augmentation Index ◽

Reactive Hyperemia ◽

Control Group ◽

Apnea Hypopnea Index ◽

Obstructive Sleep ◽

Tnf Α

Objective: An effective clinical tool to assess endothelial function and arterial stiffness in patients with obstructive sleep apnea (OSA) is lacking. This study evaluated the clinical significance of subclinical markers for OSA management in males without serious complications.Patients/Methods: Males without serious complications were consecutively recruited. Clinical data, biomarker tests, reactive hyperemia index (RHI), and augmentation index at 75 beats/min (AIx75) measured by peripheral arterial tonometry were collected. An apnea hypopnea index (AHI) cutoff of ≥15 events/h divided the patients into two groups.Results: Of the 75 subjects, 42 had an AHI ≥15 events/h. Patients with an AHI ≥15 events/h had higher high-sensitivity C-reactive protein, tumor necrosis factor-alpha (TNF-α), vascular endothelial growth factor, and AIx75 values than the control group but no statistical difference in RHI was observed. After controlling for confounders, TNF-α was negatively correlated with the average oxygen saturation (r = −0.258, P = 0.043). RHI was correlated with the rapid eye movement (REM) stage percentage (r = 0.306, P = 0.016) but not with AHI (P > 0.05). AIx75 was positively correlated with the arousal index (r = 0.289, P = 0.023) but not with AHI (r = 0.248, P = 0.052).Conclusions: In males with OSA without severe complications, TNF-α and AIx75 are independently related to OSA. The role of RHI in OSA management requires further elucidation. These markers combined can comprehensively evaluate OSA patients to provide more evidence for the primary prevention of coronary heart disease and treatment response assessment.

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Aerobic exercise capacity is maintained over a 5-year period in mild-to-moderate chronic kidney disease: a longitudinal study

BMC Nephrology ◽

10.1186/s12882-020-02110-2 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Helena Wallin ◽

Eva Jansson ◽

Carin Wallquist ◽

Britta Hylander Rössner ◽

Stefan H. Jacobson ◽

...

Keyword(s):

Physical Activity ◽

Chronic Kidney Disease ◽

Heart Rate ◽

Renal Function ◽

Aerobic Exercise ◽

Exercise Capacity ◽

Activity Level ◽

Peak Heart Rate ◽

Aerobic Exercise Capacity ◽

Over Time

Abstract Background Aerobic exercise capacity is reduced in non-dialysis chronic kidney disease (CKD), but the magnitude of changes in exercise capacity over time is less known. Our main hypothesis was that aerobic ExCap would decline over 5 years in individuals with mild-to-moderate CKD along with a decline in renal function. A secondary hypothesis was that such a decline in ExCap would be associated with a decline in muscle strength, cardiovascular function and physical activity. Methods We performed a 5-year-prospective study on individuals with mild-to-moderate CKD, who were closely monitored at a nephrology clinic. Fiftytwo individuals with CKD stage 2–3 and 54 age- and sex-matched healthy controls were included. Peak workload was assessed through a maximal cycle exercise test. Muscle strength and lean body mass, cardiac function, vascular stiffness, self-reported physical activity level, renal function and haemoglobin level were evaluated. Tests were repeated after 5 years. Statistical analysis of longitudinal data was performed using linear mixed models. Results Exercise capacity did not change significantly over time in either the CKD group or controls, although the absolute workloads were significantly lower in the CKD group. Only in a CKD subgroup reporting low physical activity at baseline, exercise capacity declined. Renal function decreased in both groups, with a larger decline in CKD (p = 0.05 between groups). Peak heart rate, haemoglobin level, handgrip strength, lean body mass and cardiovascular function did not decrease significantly over time in CKD individuals. Conclusions On a group level, aerobic exercise capacity and peak heart rate were maintained over 5 years in patients with well-controlled mild-to-moderate CKD, despite a slight reduction in glomerular filtration rate. In line with the maintained exercise capacity, cardiovascular and muscular function were also preserved. In individuals with mild-to-moderate CKD, physical activity level at baseline seems to have a predictive value for exercise capacity at follow-up.

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Olfactory Bulb Volume and Olfactory Sulcus Depth in Patients With OSA: An MRI Evaluation

Ear Nose & Throat Journal ◽

10.1177/0145561319881571 ◽

2019 ◽

Vol 99 (7) ◽

pp. 442-447

Author(s):

Adil Doğan ◽

Nuray Bayar Muluk ◽

Hamza Şahin

Keyword(s):

Olfactory Bulb ◽

Upper Airway ◽

Magnetic Resonance Images ◽

Control Group ◽

Apnea Hypopnea Index ◽

Female Patients ◽

Proinflammatory Mediators ◽

Obstructive Sleep ◽

Picture Archiving And Communication ◽

The Right

Objectives: We evaluated olfactory functions in patients with obstructive sleep apnea (OSA). Methods: The cranial magnetic resonance images of 58 adult patients (36 males and 22 females) aged 27 to 79 years were retrieved from the hospital picture archiving and communication system (PACS) system. There were 29 patients with OSA (17 males and 12 females), diagnosed according to the polysomnography results. A control group consisted of 29 healthy patients without OSA. Olfactory bulb (OB) volume and olfactory sulcus (OS) depth measurements were performed. Nasal septal deviation (SD) was also evaluated and recorded as no SD, deviation to the right, and deviation to the left in all groups. Results: Olfactory bulb volumes of the OSA group were significantly lower than those of the control group ( P < .05), whereas OS depth values were not different ( P > .05). There was a positive correlation between the right and left OB volumes and right and left OS depth values ( P < .05). In older patients with OSA and in female patients with OSA, OB volumes decreased bilaterally ( P < .05). Olfactory sulcus depth of the right side was lower in the female patients with OSA compared to the male patients with OSA ( P < .05). There were no significant correlations between apnea–hypopnea index and OB volumes and OS depth values in the OSA group ( P > .05) Conclusion: In patients with OSA, OB volumes decreased bilaterally. It may be related to intermittent nocturnal hypoxia/reoxygenation episodes, which may be a trigger for upper airway inflammation; and proinflammatory mediators maybe harmful on olfactory neuroepithelium and olfactory impairment may occur.

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Prognostic value of the heart rate profile during exercise in patients with atrial fibrillation

European Journal of Preventive Cardiology ◽

10.1177/2047487318797398 ◽

2018 ◽

Vol 25 (15) ◽

pp. 1634-1641 ◽

Cited By ~ 4

Author(s):

Kazufumi Aihara ◽

Yuko Kato ◽

Shinya Suzuki ◽

Takuto Arita ◽

Naoharu Yagi ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Heart Rate ◽

Sinus Rhythm ◽

Exercise Capacity ◽

Resting Heart Rate ◽

Peak Heart Rate ◽

Chronotropic Response ◽

Response Peak ◽

Rate Profile

Aims This study aimed to investigate the correlation of heart rate profile during exercise with exercise capacity and heart failure occurrence in patients with atrial fibrillation compared with patients with sinus rhythm. Methods We analyzed 2231 patients (atrial fibrillation: n = 321, sinus rhythm: n = 1910) who underwent a symptom-limited maximal cardiopulmonary exercise test at our institute. Their heart rate profile during exercise was assessed using peak heart rate and chronotropic response; (peak heart rate−resting heart rate)/(220−age−resting heart rate). The endpoint was the occurrence of heart failure events, defined as hospitalization for heart failure or heart failure-related death. Results There were significant positive correlations of peak heart rate and chronotropic response to peak oxygen consumption, both in atrial fibrillation and sinus rhythm. During a median follow-up period of 1262 (interquartile range 974–2921) days, 117 (5.2%) heart failure events were observed. Multivariate analyses showed that peak heart rate and chronotropic response were statistically significant predictors of heart failure events both in atrial fibrillation (peak heart rate: heart rate 0.975, p = 0.002, chronotropic response: heart rate 0.196, p = 0.003) and in sinus rhythm (peak heart rate: heart rate 0.988, p = 0.036, chronotropic response: heart rate 0.347, p = 0.020). Bivariate models showed that compared with chronotropic response, peak heart rate was a stronger predictor of heart failure in atrial fibrillation, whereas the finding was reversed in sinus rhythm. Conclusion The exercise- heart rate profile was significantly related to exercise capacity and future heart failure events, regardless of rhythm. However, the impacts of peak heart rate and chronotropic response on the endpoint varied according to the cardiac rhythm.

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Influence of heart rate control on exercise capacity and quality of life in patients with permanent atrial fibrillation

BMC Cardiovascular Disorders ◽

10.1186/s12872-019-01293-3 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Fei She ◽

Yuan Ma ◽

Yi Li ◽

Lei Li ◽

Weixian Xu ◽

...

Keyword(s):

Quality Of Life ◽

Atrial Fibrillation ◽

Heart Rate ◽

Exercise Capacity ◽

Rate Control ◽

Short Form ◽

Linear Regression Analysis ◽

Control Group ◽

Cardiopulmonary Exercise

Abstract Background The optimal level of heart rate (HR) control in patients with atrial fibrillation (AF) is unknown. To assess the effect of rate control on cardiopulmonary exercise capacity and quality of life (QoL) in permanent AF. Methods One hundred forty-three patients with permanent AF were enrolled in this study. All patients received rate control medications and were followed up for 1 year. After 1-year therapy, the exercise capacity and QoL were evaluated by cardiopulmonary exercise testing (CPET) and 36-item Short-Form Health Survey, respectively. Data were compared by dividing the patients according to the following criteria: (1) whether the resting HR was ≤80 or > 80 bpm; (2) whether the exercise HR during moderate exercises on CPET was ≤110 or > 110 bpm; and (3) whether the resting HR was ≤80 bpm and exercise HR was ≤110 bpm. Results No significant differences in peak oxygen uptake, peak metabolic equivalent, and anaerobic threshold were found between the strict control and lenient control groups. Both physical component summary (PCS) and mental component summary (MCS) were significantly higher for the strict rate control group than for the lenient control group. The single-factor correlation analysis revealed a negative correlation between resting HR and both PCS and MCS. The multivariable linear regression analysis indicated that both exercise HR and duration of AF linearly correlated with PCS and MCS. Conclusions Therefore, in patients with permanent AF, exercise capacity may not be affected by the stringency of rate control, and strict rate control may be associated with better QoL.

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Prevalence of Obstructive Sleep Apnea and Obesity Among Middle-Aged Women: Implications for Exercise Capacity

Journal of Clinical Sleep Medicine ◽

10.5664/jcsm.7316 ◽

2018 ◽

Vol 14 (09) ◽

pp. 1471-1475 ◽

Cited By ~ 4

Author(s):

Martinha Millianny Barros de Carvalho ◽

Ricardo Quental Coutinho ◽

Isly Maria L. Barros ◽

Laura O.B.F. Costa ◽

Ana Kelley L. Medeiros ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Exercise Capacity ◽

Middle Aged ◽

Obstructive Sleep

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Obstructive Sleep Apnea as a Predictor of Abnormal Heart Rate Turbulence

Journal of Clinical Medicine ◽

10.3390/jcm9010001 ◽

2019 ◽

Vol 9 (1) ◽

pp. 1 ◽

Cited By ~ 1

Author(s):

Dominika Urbanik ◽

Paweł Gać ◽

Helena Martynowicz ◽

Małgorzata Poręba ◽

Maciej Podgórski ◽

...

Keyword(s):

Risk Factors ◽

Heart Rate ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Holter Monitoring ◽

Older Age ◽

Apnea Hypopnea Index ◽

Heart Rate Turbulence ◽

Obstructive Sleep ◽

Independent Risk Factors

Obstructive sleep apnea (OSA) causes dysfunction of the autonomic nervous system, but the exact mechanism has not been fully understood. The aim of this study was to analyse the relationship between the incidence and severity of OSA and heart rate turbulence (HRT). Seventy one patients with clinical suspicion of OSA were qualified to participate in the study. All participants took part in a survey and were subjected to laboratory tests, 24-hour electrocardiogram (ECG) Holter monitoring with HRT analysis and polysomnography. The group with OSA manifested significantly higher turbulence onset (TO) and lower turbulence slope (TS) as compared to the group without OSA. Older age, diabetes, hypertension and higher apnea/hypopnea index (AHI) were found to be independent risk factors for increased TO, whereas older age, higher body mass index (BMI), higher blood glucose levels, hypertension and higher AHI were independent risk factors for TS reduction. The AHI ≥65 criterion indicates abnormal HRT in patients with OSA with 94.9% sensitivity and 50.0% specificity, which gives a prediction accuracy of 85.7%. In summary, OSA should be considered as a predictor of abnormal HRT.

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Ultrasonic Measurement of Lingual Artery and Its Application for Midline Glossectomy

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489420913581 ◽

2020 ◽

Vol 129 (9) ◽

pp. 856-862

Author(s):

Chun Liu ◽

Jie Qin ◽

Dengxiang Xing ◽

Haibo Lu ◽

Ruiyi Yue ◽

...

Keyword(s):

Body Mass Index ◽

High Sensitivity ◽

Ultrasonic Measurement ◽

Lingual Artery ◽

Control Group ◽

Apnea Hypopnea Index ◽

Tube Insertion ◽

Obstructive Sleep ◽

Operative Planning ◽

Tongue Position

Objective: To explore the application of lingual artery ultrasound (US) for midline glossectomy in patients with obstructive sleep apnea (OSA). Methods: Lingual artery US was performed in 57 OSA patients (OSA group) and 20 normal persons (control group). The differences in the depths of the lingual arteries and the distances between the bilateral lingual arteries were compared between two groups. The correlations between apnea-hypopnea index (AHI), AHI after the nasopharyngeal tube insertion (NPT-AHI), Friedman tongue position (FTP) and all the parameters of lingual arteries were analyzed. Results: Both the depths of the lingual arteries and the distances between the bilateral lingual arteries in the OSA group were larger than those in the control group ( P < .01). All the parameters of the lingual arteries in OSA patients were positively correlated with AHI, NPT-AHI and FTP ( P < .05). While controlling for body mass index (BMI), all the parameters of the lingual arteries in OSA patients were still correlated with NPT-AHI positively ( P ≤ .01). Conclusion: Pre-operative US can show the course of the lingual artery clearly for pre-operative planning. The depth and width of the lingual artery in OSA patients were different from controls. NPT-AHI has high sensitivity in predicting all the parameters of the lingual arteries. FTP is closely correlated with the depth of the lingual arteries.

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