Obstructive Sleep Apnea in Cardiac Rehabilitation Patients.
STUDY OBJECTIVES
Although regular physical activity improves obstructive sleep apnea (OSA) in the general population, this finding has not been assessed in postmyocardial infarction (MI) patients in a rehabilitation setting (coronary artery disease, CAD). We aimed to determine whether cardiac rehabilitation may benefit post-MI patients in terms of OSA disease and associated autonomic nervous system (ANS) activity.


METHODS
Consecutive post-MI patients participating in the ambulatory cardiac rehabilitation program of St-Etienne University Hospital were included in this study. The apnea-hypopnea index calculated from electrocardiogram (ECG)-derived respiration (AHIEDR) was obtained through nocturnal Holter ECG recordings. According to AHIEDR, patients were classified as normal, mild, moderate, or severe OSA (< 5, 5-14, 15-29, ≥ 30, respectively). Physiological performance (peak VO2) was established via cardiopulmonary exercise testing. ANS activity was evaluated through spontaneous baroreflex sensibility as well as heart rate variability analysis.


RESULTS
Of the 105 patients with CAD and OSA included (95 men, 55.2 ± 12.4 years), 100 had at least 1 cardiovascular risk factor (98%) and 52 patients (50%) had an ANS dysfunction. Surprisingly, 68 of these patients with OSA (65%) were free of classical diurnal symptoms usually associated with sleep apnea. In response to cardiac rehabilitation, AHIEDR decreased significantly (-9.3 ± 9.5, P < .0001) only in patients with severe OSA, and the decrease was even greater when peak VO2 and baroreflex sensibility improved beyond 20% compared to basal values (-11.6 ± 9.1, P < .001).


CONCLUSIONS
Severe OSA in patients with CAD is significantly improved after 2 months of cardiopulmonary rehabilitation. Reviving ANS activity through physical activity might be a target for complementary therapy of OSA in patients with CAD.
['Hupin|David|D|', 'Pichot|Vincent|V|', 'Berger|Mathieu|M|', 'Sforza|Emilia|E|', 'Raffin|Jérémy|J|', 'Lietar|Cécile|C|', 'Poyraz|Erkan|E|', 'Maudoux|Delphine|D|', 'Barthelemy|Jean-Claude|JC|', 'Roche|Frédéric|F|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D000072038:Cardiac Rehabilitation D015331:Cohort Studies D003324:Coronary Artery Disease D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D009203:Myocardial Infarction D017286:Polysomnography D020181:Sleep Apnea, Obstructive D016896:Treatment Outcome
obstructive sleep apnea cardiac rehabilitation physical activity coronary artery disease autonomic nervous system