We compared the effects of 2‐month CPAP or exercise training (ET) therapies on the autonomic balance in moderate to severe obstructive sleep apnea (OSA) through heart rate variability (HRV) analysis. Thirty‐nine OSA patients were divided into CPAP (n = 18) and ET (n = 21) groups, being further split into hypertensive and non‐hypertensive subgroups. All patients were submitted to continuous ECG recordings for HRV analysis. Hemodynamic parameters were recorded by oscillometry. Excessive daytime sleepiness and sleep quality were assessed through the Epworth Sleepiness Scale and the Pittsburgh questionnaire, respectively. ET decreased systolic arterial pressure in hypertensive and non‐hypertensive participants when compared to baseline values, whereas diastolic arterial pressure was decreased only in non‐hypertensive ones. CPAP had no effect over hemodynamic parameters in either subgroup. ET significantly increased the HRV parameters SDNN and pNN50 in non‐hypertensive participants, while reducing the LF/HF ratio in both subgroups. CPAP significantly decreased SDNN in both subgroups. ET significantly decreased excessive daytime sleepiness in both subgroups, but did not affect sleep quality. CPAP significantly improved sleep quality in both subgroups, although global scores were still those of poor sleepers, while excessive daytime sleepiness was normalized only in hypertensive patients. In conclusion, while short‐term ET modulated different HRV parameters, leading to a predominant vagal tone in the cardiac sympathovagal balance and decreasing blood pressure in moderate to severe OSA, short‐term CPAP had next to no effect in these parameters. We believe ET should be considered as an adjunct interventional strategy in the conservative management of hypertensive or non‐hypertensive OSA patients.

中文翻译：

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短期有氧训练与 CPAP 治疗对中重度 OSA 患者心率变异性的影响

我们通过心率变异性 (HRV) 分析比较了 2 个月 CPAP 或运动训练 (ET) 疗法对中重度阻塞性睡眠呼吸暂停 (OSA) 自主神经平衡的影响。39 名 OSA 患者分为 CPAP（n  = 18）和 ET（n = 21) 组，进一步分为高血压和非高血压亚组。所有患者均接受连续心电图记录以进行 HRV 分析。通过示波法记录血液动力学参数。白天过度嗜睡和睡眠质量分别通过 Epworth 嗜睡量表和匹兹堡问卷进行评估。与基线值相比，ET 降低了高血压和非高血压参与者的收缩动脉压，而舒张动脉压仅在非高血压参与者中降低。CPAP 对任一亚组的血流动力学参数均无影响。ET 显着增加了非高血压参与者的 HRV 参数 SDNN 和 pNN50，同时降低了两个亚组的 LF/HF 比率。CPAP 在两个亚组中都显着降低了 SDNN。ET 显着降低了两个亚组的白天过度嗜睡，但不影响睡眠质量。CPAP 显着改善了两个亚组的睡眠质量，尽管总体评分仍然是睡眠不佳者的评分，而白天过度嗜睡仅在高血压患者中正常化。总之，虽然短期 ET 调节不同的 HRV 参数，导致心脏交感迷走神经平衡的主要迷走神经张力和中度至重度 OSA 的血压降低，但短期 CPAP 对这些参数几乎没有影响。我们认为 ET 应被视为高血压或非高血压 OSA 患者保守治疗的辅助干预策略。CPAP 显着改善了两个亚组的睡眠质量，尽管总体评分仍然是睡眠不佳者的评分，而白天过度嗜睡仅在高血压患者中正常化。总之，虽然短期 ET 调节不同的 HRV 参数，导致心脏交感迷走神经平衡的主要迷走神经张力和中度至重度 OSA 的血压降低，但短期 CPAP 对这些参数几乎没有影响。我们认为 ET 应被视为高血压或非高血压 OSA 患者保守治疗的辅助干预策略。CPAP 显着改善了两个亚组的睡眠质量，尽管总体评分仍然是睡眠不佳者的评分，而白天过度嗜睡仅在高血压患者中正常化。总之，虽然短期 ET 调节不同的 HRV 参数，导致心脏交感迷走神经平衡的主要迷走神经张力和中度至重度 OSA 的血压降低，但短期 CPAP 对这些参数几乎没有影响。我们认为 ET 应被视为高血压或非高血压 OSA 患者保守治疗的辅助干预策略。导致心脏交感迷走神经平衡的主要迷走神经张力和中度至重度 OSA 的血压降低，短期 CPAP 对这些参数几乎没有影响。我们认为 ET 应被视为高血压或非高血压 OSA 患者保守治疗的辅助干预策略。导致心脏交感迷走神经平衡的主要迷走神经张力和中度至重度 OSA 的血压降低，短期 CPAP 对这些参数几乎没有影响。我们认为 ET 应被视为高血压或非高血压 OSA 患者保守治疗的辅助干预策略。