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Open AccessArticle

CPAP Effect on Cardiopulmonary Exercise Testing Performance in Patients with Moderate-Severe OSA and Cardiometabolic Comorbidities

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Department of Medical Specialties (I), Faculty of Medicine, Grigore T. Popa—University of Medicine and Pharmacy, 700115 Iași, Romania
2
Department of Medical Specialties (III), Faculty of Medicine, Grigore T. Popa—University of Medicine and Pharmacy, 700115 Iași, Romania
*
Author to whom correspondence should be addressed.
The study was part of the Ph.D. Thesis of Zota Ioana Mădălina.
Medicina 2020, 56(2), 80; https://doi.org/10.3390/medicina56020080
Received: 27 January 2020 / Revised: 11 February 2020 / Accepted: 12 February 2020 / Published: 15 February 2020
(This article belongs to the Special Issue Obstructive Sleep Apnea: Epidemiology, Pathomechanism and Treatment)
Background and Objectives: Obstructive sleep apnea (OSA) is associated with daytime somnolence, cognitive impairment and high cardiovascular morbidity and mortality. Obesity, associated cardiovascular comorbidities, accelerated erythropoiesis and muscular mitochondrial energetic dysfunctions negatively influence exercise tolerance in moderate-severe OSA patients. The cardiopulmonary exercise testing (CPET) offers an integrated assessment of the individual’s aerobic capacity and helps distinguish the main causes of exercise limitation. The purpose of this study is to evaluate the aerobic capacity of OSA patients, before and after short-term continuous positive airway pressure (CPAP). Materials and Methods: Our prospective study included 64 patients with newly diagnosed moderate-severe OSA (apnea hypopnea index (AHI) 39.96 ± 19.04 events/h) who underwent CPET before and after CPAP. Thirteen patients were unable to tolerate CPAP or were lost during follow-up. Results: 49.29% of our patients exhibited a moderate or severe decrease in functional capacity (Weber C or D). CPET performance was influenced by gender but not by apnea severity. Eight weeks of CPAP induced significant improvements in maximal exercise load (Δ = 14.23 W, p = 0.0004), maximum oxygen uptake (Δ = 203.87 mL/min, p = 0.004), anaerobic threshold (Δ = 316.4 mL/min, p = 0.001), minute ventilation (Δ = 5.1 L/min, p = 0.01) and peak oxygen pulse (Δ = 2.46, p = 0.007) as well as a decrease in basal metabolic rate (BMR) (Δ = −8.3 kCal/24 h, p = 0.04) and average Epworth score (Δ = −4.58 points, p < 0.000001). Conclusions: Patients with moderate-severe OSA have mediocre functional capacity. Apnea severity (AHI) was correlated with basal metabolic rate, resting heart rate and percent predicted maximum effort but not with anaerobic threshold or maximum oxygen uptake. Although CPET performance was similar in the two apnea severity subgroups, short-term CPAP therapy significantly improved most CPET parameters, suggesting that OSA per se has a negative influence on effort capacity. View Full-Text
Keywords: obstructive sleep apnea; continuous positive airway treatment; cardiopulmonary exercise testing; functional capacity; cardiovascular rehabilitation obstructive sleep apnea; continuous positive airway treatment; cardiopulmonary exercise testing; functional capacity; cardiovascular rehabilitation
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Zota, I.M.; Stătescu, C.; Sascău, R.A.; Roca, M.; Gavril, R.S.; Vasilcu, T.F.; Boișteanu, D.; Maștaleru, A.; Jitaru, A.; Leon Constantin, M.M.; Mitu, F. CPAP Effect on Cardiopulmonary Exercise Testing Performance in Patients with Moderate-Severe OSA and Cardiometabolic Comorbidities. Medicina 2020, 56, 80.

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