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Review
. 2022 Jan 1;18(1):279-288.
doi: 10.5664/jcsm.9628.

OSA and cardiorespiratory fitness: a review

Tyler A Powell  1 , Vincent Mysliwiec  2 , Matthew S Brock  1 , Michael J Morris  3
Affiliations
Review

OSA and cardiorespiratory fitness: a review

Tyler A Powell et al. J Clin Sleep Med. .

Abstract

The effects of untreated obstructive sleep apnea (OSA) on cardiopulmonary function remain unclear. Cardiorespiratory fitness (CRF), commonly reflected by VO2 max measured during cardiopulmonary exercise testing, has gained popularity in evaluating numerous cardiopulmonary conditions and may provide a novel means of identifying OSA patients with the most clinically significant disease. This emerging testing modality provides simultaneous assessment of respiratory and cardiovascular function with results helping uncover evidence of evolving pathology in either organ system. In this review, we highlight the current state of the literature in regard to OSA and CRF with a specific focus on changes in cardiovascular function that have been previously noted. While OSA does not appear to limit respiratory function during exercise, studies seem to suggest an abnormal cardiovascular exercise response in this population including decreased cardiac output, a blunted heart rate response (ie, chronotropic incompetence), and exaggerated blood pressure response. Surprisingly, despite these observed changes in the cardiovascular response to exercise, results involving VO2 max in OSA remain inconclusive. This is reflected by VO2 max studies involving middle-aged OSA patients showing both normal and reduced CRF. As prior studies have not extensively characterized oxygen desaturation burden, we propose that reductions in VO2 max may exist in OSA patients with only the most significant disease (as reflected by nocturnal hypoxia). Further characterizing this relationship remains important as some research suggests that positive airway pressure therapy or aerobic exercise may improve CRF in patients with OSA. In conclusion, while it likely that severe OSA, via an abnormal cardiovascular response to exercise, is associated with decreased CRF, further study is clearly warranted to include determining if OSA with decreased CRF is associated with increased morbidity or mortality.

Citation: Powell TA, Mysliwiec V, Brock MS, Morris MJ. OSA and cardiorespiratory fitness: a review. J Clin Sleep Med. 2022;18(1):279-288.

Keywords: VO2 max; cardiopulmonary exercise testing; cardiorespiratory fitness; obstructive sleep apnea.

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Conflict of interest statement

All authors have seen and approved this manuscript. Dr. Mysliwiec is Vice President, Medical Affairs for NOCTEM. He has served as a consultant for CPAP Medical, Bluegrass Oxygen, and Sleep Care Inc. He has previously consulted for Ebb Therapeutics and Nightware and received honoraria from Springer Healthcare LLC and Jazz Pharmaceuticals. Dr. Morris is a paid speaker for Janssen Pharmaceuticals and Vyaire Medical. The other authors report no conflicts of interest, and there is no other funding to disclose for this study. The views expressed herein are those of the authors and do not reflect the official policy or position of Brooke Army Medical Center, the U.S. Army Medical Department, the U.S. Army Office of the Surgeon General, the Department of the Army, the Department of the Air Force, and the Department of Defense or the U.S. government.

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