心脏康复对冠心病合并阻塞性睡眠呼吸暂停患者的有益影响。

The beneficial impact of cardiac rehabilitation on obstructive sleep apnea in patients with coronary artery disease.

机构信息

Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland.

Department of Electrocardiology, Upper-Silesian Medical Centre, Katowice, Poland.

出版信息

J Clin Sleep Med. 2021 Mar 1;17(3):403-412. doi: 10.5664/jcsm.8900.

DOI:10.5664/jcsm.8900

PMID:33089775

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7927323/

Abstract

STUDY OBJECTIVES

To assess the impact of cardiac rehabilitation for decreasing sleep-disordered breathing in patients with coronary artery disease.

METHODS

The study included 121 patients aged 60.01 ± 10.08 years, 101 of whom were men, with an increased pretest probability of OSA. The cardiac rehabilitation program lasted 21-25 days. The improvement in cardiorespiratory fitness was assessed using the changes in peak metabolic equivalents, the maximal heart rate achieved, the proportion of the age- and sex-predicted maximal heart rate, and the Six-Minute Walk Test distance. Level 3 portable sleep tests with respiratory event index assessments were performed in 113 patients on admission and discharge.

RESULTS

Increases were achieved in metabolic equivalents (Δ1.20; 95% confidence interval [CI], 0.95-1.40; P < .0001), maximal heart rate (-Δ7.5 beats per minute; 95% CI, 5.00-10.50; P < .0001), proportion of age- and sex-predicted maximal heart rate (Δ5.50%; 95% CI, 4.00-7.50; P < .0001), and the Six-Minute Walk Test distance (Δ91.00 m; 95% CI, 62.50-120.00; P < .0001). Sleep-disordered breathing was diagnosed in 94 (83.19%) patients: moderate in 28 (24.8%) patients and severe in 27 (23.9%) patients, with a respiratory event index of 19.75 (interquartile range, 17.20-24.00) and 47.50 (interquartile range, 35.96-56.78), respectively. OSA was dominant in 90.40% of patients. The respiratory event index reduction achieved in the sleep-disordered breathing group was -Δ3.65 (95% CI, -6.30 to -1.25; P = .003) and was in parallel to the improvement in cardiorespiratory fitness in the subgroups with the highest effort load and with severe sleep-disordered breathing: -Δ6.40 (95% CI, -11.40 to -1.90; P = .03) and -Δ11.00 (95% CI, -18.65 to -4.40; P = .003), respectively.

CONCLUSIONS

High-intensity exercise training during cardiac rehabilitation resulted in a significant decrease in OSA, when severe, in parallel with an improvement in cardiorespiratory fitness in patients with coronary artery disease.

摘要

研究目的

评估心脏康复对降低冠状动脉疾病患者睡眠呼吸紊乱的影响。

方法

该研究纳入了 121 名年龄为 60.01±10.08 岁的患者，其中 101 名为男性，存在较高的阻塞性睡眠呼吸暂停（OSA）术前预测概率。心脏康复方案持续 21-25 天。心肺适能的改善通过峰值代谢当量的变化、最大心率的变化、达到的最大心率与年龄和性别预测值的比例、以及 6 分钟步行测试距离来评估。113 名患者在入院和出院时进行了三级便携式睡眠测试和呼吸事件指数评估。

结果

代谢当量增加（Δ1.20；95%置信区间[CI]，0.95-1.40；P<.0001）、最大心率降低（-Δ7.5 次/分钟；95%CI，5.00-10.50；P<.0001）、达到的最大心率与年龄和性别预测值的比例增加（Δ5.50%；95%CI，4.00-7.50；P<.0001）、以及 6 分钟步行测试距离增加（Δ91.00 m；95%CI，62.50-120.00；P<.0001）。94（83.19%）名患者诊断为睡眠呼吸紊乱：28 名（24.8%）患者为中度，27 名（23.9%）患者为重度，呼吸事件指数分别为 19.75（四分位间距，17.20-24.00）和 47.50（四分位间距，35.96-56.78）。90.40%的患者以 OSA 为主。睡眠呼吸紊乱组的呼吸事件指数降低为-Δ3.65（95%CI，-6.30 至-1.25；P=.003），与心肺适能在高负荷亚组和重度睡眠呼吸紊乱亚组中的改善平行：-Δ6.40（95%CI，-11.40 至-1.90；P=.03）和-Δ11.00（95%CI，-18.65 至-4.40；P=.003）。