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. 2023 Mar;27(1):137-144.
doi: 10.1007/s11325-022-02587-1. Epub 2022 Feb 25.

Exercise capacity remains supernormal, though mildly reduced in middle-aged military personnel with Moderate to Severe Obstructive Sleep Apnea

Subodh K Arora  1   2 , Tyler A Powell  3 , Shannon N Foster  3 , Shana L Hansen  3 , Michael J Morris  4
Affiliations

Exercise capacity remains supernormal, though mildly reduced in middle-aged military personnel with Moderate to Severe Obstructive Sleep Apnea

Subodh K Arora et al. Sleep Breath. 2023 Mar.

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, overweight patients. We aimed to study this relationship in a similarly aged population of military personnel with previously undiagnosed moderate to severe OSA.

Methods: We studied late-career male military personnel who underwent CPET and polysomnography (PSG). Patients were categorized either into an OSA group (apnea-hypopnea index (AHI) ≥ 15 events/h) or a control group (AHI < 15 events/h). VO2 max was compared between groups.

Results: 170 male military personnel met criteria for the study. Mean AHI was 29.0/h in the OSA group (n = 58) versus 7.4/h in the controls (n = 112) while SpO2 nadir was slightly lower (86.0% vs. 89.0%). Patients were of similar age (53.1 vs. 53.7 years), and BMI was slightly higher in the OSA group (27.5 kg/m2 vs. 26.3 kg/m2). Percent-predicted VO2 max was supernormal in both groups, though it was comparatively lower in the OSA group (117% vs. 125%; p < 0.001).

Conclusions: Military personnel with moderate to severe OSA were able to achieve supernormal VO2 max values, yet had an 8% decrement in exercise capacity compared to controls. These findings suggest that OSA without significant hypoxemia may not significantly influence exercise capacity. It remains likely that the effects of untreated OSA on exercise capacity are complex and are affected by several variables including BMI, degree of associated hypoxemia, and regularity of exercise. Statistically lower VO2 max noted in this study may suggest that untreated OSA in less fit populations may lead to significant decrements in exercise capacity.

Keywords: Cardiopulmonary exercise testing; Military; Obstructive sleep apnea; VO2 max.

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