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. 2021 Mar 1;17(3):403-412.
doi: 10.5664/jcsm.8900.

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

Danuta Loboda  1   2 , Michalina Stepanik  3 , Agata Golba  3 , Monika Dzierzawa  1 , Anna Szajerska-Kurasiewicz  2 , Karolina Simionescu  1   2 , Maciej Turski  4 , Sylwia Kucia-Kuzma  5 , Jacek Durmala  3 , Krzysztof S Golba  1   2
Affiliations

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

Danuta Loboda et al. J Clin Sleep Med. .

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 sleep-disordered 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.

Keywords: OSA; cardiac rehabilitation; cardiorespiratory fitness; coronary artery disease.

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Conflict of interest statement

All authors have seen and approved the manuscript. Work for this study was performed at the Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland. The authors report no conflicts of interest.

Figures

Figure 1
Figure 1. Improvement in CRF parameters (entire group of patients).
(A) ΔMET. (B) ΔMHR. (C) ΔMHR%. (D) Δ6MWT. The lines show the changes in parameters over time for each of the patients. The values given reflect the median and interquartile range (in parentheses) for the parameter under study at two time points. CRF = cardiorespiratory fitness, METs = metabolic equivalents, MHR = maximal heart rate, MHR% = proportion of the age- and sex-predicted maximal heart rate, on admission = the start of the rehabilitation program, on discharge = the end of the rehabilitation program, 6MWT = 6-Minute Walk Test.
Figure 2
Figure 2. Reduction in REI.
(A) The entire group. (B) Severe SDB group. (C) Model A group. The lines show the changes in parameters over time for each of the patients. The values given reflect the median and interquartile range (in parentheses) for the REI at two time points for the entire group, the group with severe SBD, and the group rehabilitated by model A, respectively. on admission = the start of the rehabilitation program, on discharge = the end of the rehabilitation program, REI = respiratory event index, SDB = sleep-disordered breathing.
Figure 3
Figure 3. The relationship between the improved REI and METs in patients with initially severe sleep apnea.
METs = metabolic equivalents, REI = respiratory event index.
See this image and copyright information in PMC

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