Purpose

Cardiac rehabilitation (CR) improves clinical outcomes in patients with cardiovascular disease (CDV). Patients with CVD often have multiple comorbidities, including obstructive sleep apnea (OSA), potentially affecting their ability to participate and achieve functional improvement during CR. We aimed to test the hypothesis that OSA reduces peak exercise capacity (EC) in patients undergoing CR and to explore if OSA treatment modifies this relationship.

Methods

Data from a retrospective cohort of CR patients was analyzed. OSA was defined as a respiratory event index > 5/h or physician diagnosis. Patients with OSA were considered “treated” if using continuous positive airway pressure regularly during the CR period. Change in METs was the primary study outcome.

Results

Among 312 CR patients, median age of 67 years, 103 (33%) had known OSA (30 treated, 73 untreated). Patients with OSA vs. those with no OSA were more likely to be obese and male; otherwise, groups were similar. Compared with the no OSA group, patients with OSA had lower pre-CR METs (3.3 [2.9–4.5] vs. 3.9 [3.1–5], P = .01) and lower post-CR METs (5.3 [4–7] vs. 6 [4.6–7.6], P = .04), but achieved a similar increase in METs post-CR (1.8 [0.6–2.6] vs. 2.0 [0.9–3], P = .22). Furthermore, compared to no OSA, pre-CR and post-CR METs tended to be similar in patients with treated OSA, but lower in untreated patients, with similar increases in METs across all groups, even when adjusting for covariates via multivariable regression.

Conclusion

OSA is prevalent in patients with CVD undergoing CR. CR substantially improves exercise capacity independent of OSA status, but screening for—and treatment of—OSA may improve the absolute exercise capacity achieved through CR.

中文翻译：

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阻塞性睡眠呼吸暂停对心脏康复计划中运动能力的影响

目的

心脏康复（CR）可改善心血管疾病（CDV）患者的临床结果。CVD 患者通常患有多种合并症，包括阻塞性睡眠呼吸暂停 (OSA)，可能会影响他们参与 CR 期间并实现功能改善的能力。我们的目的是检验 OSA 会降低接受 CR 的患者的峰值运动能力 (EC) 的假设，并探讨 OSA 治疗是否会改变这种关系。

方法

对 CR 患者回顾性队列的数据进行了分析。OSA 定义为呼吸事件指数 > 5/h 或医生诊断。如果 OSA 患者在 CR 期间定期使用持续气道正压通气，则被视为“得到治疗”。MET 的变化是主要研究结果。

结果

在 312 名 CR 患者中，中位年龄为 67 岁，其中 103 名 (33%) 患有已知的 OSA（30 名接受治疗，73 名未接受治疗）。与没有 OSA 的患者相比，患有 OSA 的患者更有可能是肥胖者和男性；除此之外，各组相似。与无 OSA 组相比，OSA 患者的 CR 前 MET 较低（3.3 [2.9–4.5] vs. 3.9 [3.1–5]，P  = .01）和 CR 后 MET 较低（5.3 [4–7]） vs. 6 [4.6–7.6]，P  = .04），但 CR 后 MET 也实现了类似的增加（1.8 [0.6–2.6] vs. 2.0 [0.9–3]，P  = .22）。此外，与无 OSA 相比，接受治疗的 OSA 患者的 CR 前和 CR 后 MET 往往相似，但未经治疗的患者较低，即使通过多变量回归调整协变量，所有组的 MET 也有相似的增加。

结论

OSA 在接受 CR 的 CVD 患者中很常见。CR 可以显着提高运动能力，而与 OSA 状态无关，但 OSA 的筛查和治疗可以提高通过 CR 实现的绝对运动能力。