Elsevier

Sleep Medicine

Volume 10, Issue 3, March 2009, Pages 368-373
Sleep Medicine

Original Article
Cardiorespiratory response to exercise in men and women with obstructive sleep apnea

https://doi.org/10.1016/j.sleep.2008.04.006Get rights and content

Abstract

Background

OSA severity has been associated with self-reported lack of exercise. Most of the research has been done with men recruited from sleep clinics. There is limited data on the exercise performance of women with OSA. Therefore, the aim of this study was to assess exercise performance in a prospective, consecutive sample of men and women with OSA to compare their cardio respiratory parameters, arterial blood pressure and heart rate responses during and after exercise.

Methods

Sixty-two subjects (32 men) completed the protocol. Men had a higher peak VO2, percent predicted peak VO2, VCO2, heart rate, systolic BP, and oxygen pulse than women.

Results

There were no differences between men and women for peak oxygen saturation, peak Borg scales for dyspnea and leg fatigue and diastolic BP. A significant negative correlation was found between severity of OSA as measured by AHI, and peak VO2 (r = −0.4) in women, but not in men.

Conclusion

Men with OSA have higher peak VO2 and higher peak exercise heart rate than women with OSA; they also have higher end-exercise systolic BP than women and higher SBP during recovery from exercise; although this difference is not significant when adjusted for peak systolic BP. In men with OSA, there is no correlation between peak VO2 and AHI, but there is a significant correlation between these variables in women. Heart rate and blood pressure behaved similarly during exercise in both groups.

Introduction

Obstructive sleep apnea (OSA) is a common condition caused by an intermittent collapse of the upper airway during sleep that results in repetitive hypoxemia and nighttime arousals, poor sleep quality, and excessive daytime somnolence. OSA has been named a risk factor for a number of cardiovascular conditions, such as arterial hypertension [1], [2], congestive heart failure [3], and stroke [4], and has been associated with increased cardiovascular mortality [5]. Physical exercise poses significant stress for the cardiovascular and pulmonary system and often leads to early diagnosis of cardiovascular (CV) abnormalities, such as coronary artery disease or cardiac arrhythmias [6], [7], [8].

OSA severity has been associated with self-reported lack of exercise, independent of body habitus, after adjusting for body mass index (BMI) [9]. OSA subjects are frequently overweight and often complain of fatigue and exercise intolerance, yet it is not clear whether OSA impairs exercise performance. A significant decrease in peak oxygen consumption was noted in patients with moderate to severe OSA in some studies [10], [11], [12], while, in others, the exercise performance of OSA subjects was normal [13], [14]. Most of the research has been done with men recruited from sleep clinics. There are limited data on the exercise performance of women with OSA or on cardiovascular response to exercise for men and women with OSA.

The aim of this study was to assess exercise performance in a prospective, consecutive sample of men and women with OSA to compare cardiorespiratory parameters, blood pressure, and heart rate responses during and after exercise.

Section snippets

Subjects

Patients eligible were those subjected to polysomnography at the Sleep Institute Universidade Federal de São Paulo (UNIFESP) due to clinical suspicion of OSA with an apnea hypopnea index (AHI) > 5. A total of 108 patients with AHI > 5 were consecutively selected in March and April 2006, and 68 of them agreed to participate. Subjects were included if they were over 18 years old, sedentary, capable of performing a treadmill test, and reported no recent hospitalization or change in medication.

Results

Sixty-two subjects (32 men) completed the protocol. Six subjects were excluded: four because of poorly controlled hypertension, one because of musculoskeletal disease, and one because of morbid obesity. Their baseline characteristics are presented in Table 1. There were no differences between men and women in age, BMI, ESS, AHI, and resting systolic and diastolic BP. Spirometry variables [FEV1 (L) and FVC (L)] differed in men and women, but not from the predicted percentage as expected. The

Discussion

We analyzed cardiopulmonary exercise behavior in men and women with OSA. The main finding of this study was an association between exercise performance and AHI in women but not in men in the absence of heart or lung disease. This finding suggests a gender difference in exercise performance in patients with OSA.

OSA is a recognized risk factor for certain cardiovascular disorders, such as arterial hypertension [2], [1], heart failure [21], cardiac arrhythmias [22], [23], metabolic syndrome [24],

References (32)

  • E. Antunes et al.

    Functional significance of premature ventricular complex morphology evaluated during treadmill exercise stress test in patients with coronary artery disease

    Rev Port Cardiol

    (1992)
  • P.E. Peppard et al.

    Exercise and sleep-disordered breathing: an association independent of body habitus

    Sleep

    (2004)
  • L.Q. Guillermo et al.

    Does obstructive sleep apnea affect aerobic fitness?

    Ann Otol Rhinol Laryngol

    (2006)
  • Schlosser BM, Walther JW, Rasche K, Bauer TT, Orth M, de Zeeuw J, et al. Improvement of cardiopulmonary exercise...
  • T. Przybylowski et al.

    Influence of nasal continuous positive airway pressure on response to exercise in patients with obstructive sleep apnea syndrome

    Pneumonol Alergol Pol

    (2006)
  • Duchna HW, Hauptmeier B, Orth M, Schultze-Werninghaus G, Schäfer. Daytime ventilatory efficiency in obstructive sleep...
  • Cited by (0)

    View full text