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Volume 14 No. 07
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Scientific Investigations

Obstructive Sleep Apnea in Cardiac Rehabilitation Patients

David Hupin, MD, PhD1,2; Vincent Pichot, PhD1,2; Mathieu Berger, MSc2; Emilia Sforza, MD, PhD1,2; Jérémy Raffin, MSc2; Cécile Lietar3; Erkan Poyraz3; Delphine Maudoux1,2; Jean-Claude Barthelemy, MD, PhD1,2; Frédéric Roche, MD, PhD1,2
1EA SNA EPIS 4607, Autonomic Nervous System, University of Lyon, University Jean Monnet, Saint-Etienne, France; 2Department of Clinical and Exercise Physiology, University Hospital of Saint-Etienne, France; 3Jacques Lisfranc Medical Faculty, University of Lyon, University Jean Monnet, Saint-Etienne, France

Study Objectives:

Although regular physical activity improves obstructive sleep apnea (OSA) in the general population, this finding has not been assessed in postmyocardial infarction (MI) patients in a rehabilitation setting (coronary artery disease, CAD). We aimed to determine whether cardiac rehabilitation may benefit post-MI patients in terms of OSA disease and associated autonomic nervous system (ANS) activity.

Methods:

Consecutive post-MI patients participating in the ambulatory cardiac rehabilitation program of St-Etienne University Hospital were included in this study. The apnea-hypopnea index calculated from electrocardiogram (ECG)-derived respiration (AHIEDR) was obtained through nocturnal Holter ECG recordings. According to AHIEDR, patients were classified as normal, mild, moderate, or severe OSA (< 5, 5–14, 15–29, ≥ 30, respectively). Physiological performance (peak VO2) was established via cardiopulmonary exercise testing. ANS activity was evaluated through spontaneous baroreflex sensibility as well as heart rate variability analysis.

Results:

Of the 105 patients with CAD and OSA included (95 men, 55.2 ± 12.4 years), 100 had at least 1 cardiovascular risk factor (98%) and 52 patients (50%) had an ANS dysfunction. Surprisingly, 68 of these patients with OSA (65%) were free of classical diurnal symptoms usually associated with sleep apnea. In response to cardiac rehabilitation, AHIEDR decreased significantly (−9.3 ± 9.5, P < .0001) only in patients with severe OSA, and the decrease was even greater when peak VO2 and baroreflex sensibility improved beyond 20% compared to basal values (−11.6 ± 9.1, P < .001).

Conclusions:

Severe OSA in patients with CAD is significantly improved after 2 months of cardiopulmonary rehabilitation. Reviving ANS activity through physical activity might be a target for complementary therapy of OSA in patients with CAD.

Citation:

Hupin D, Pichot V, Berger M, Sforza E, Raffin J, Lietar C, Poyraz E, Maudoux D, Barthelemy JC, Roche F. Obstructive sleep apnea in cardiac rehabilitation patients. J Clin Sleep Med. 2018;14(7):1119–1126.




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