Cardiopulmonary Physiotherapy Laboratory, Department of Physical Therapy, Federal University of Sao Carlos, Sao Carlos, Sao Paulo, Brazil.
Center for Science and Technology in Energy and Sustainability of Federal University of Reconcavo da Bahia, Feira de Santana, Bahia, Brazil.
Heart Lung. 2023 Jan-Feb;57:257-264. doi: 10.1016/j.hrtlng.2022.10.007. Epub 2022 Oct 28.
Functional capacity and heart rate variability (HRV) are important prognostic markers in chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea syndrome (OSA). However, the impact of the overlap of these diseases and the one-year clinical follow-up has not yet been evaluated.
To assess whether the presence of OSA can impair functional performance and cardiac autonomic control during exercise in patients with COPD; and to verify whether the overlap of these diseases could lead to worse clinical outcomes during the one-year follow-up.
Thirty-four patients underwent pulmonary function tests, echocardiography and polysomnography for diagnostic confirmation, disease staging, exclusion of any cardiac changes, and allocation between groups. The patients underwent the six-minute walk test (6MWT) to assess functional capacity and HRV during exercise. Subsequently, patients were followed up for 12 months to record outcomes such as exacerbation, hospitalization, and deaths. At the end of this period, the patients were revaluated to verify the hypotheses of the study.
The OSA-COPD group showed greater functional impairment when compared to the COPD group (p=0.003) and showed worse cardiac autonomic responses during the 6MWT with greater parasympathetic activation (p=0.03) and less complexity of the autonomic nervous system, in addition to being more likely to exacerbate (p=0.03) during one year of follow-up.
OSA-COPD produces deleterious effects on functional performance and a greater autonomic imbalance that impairs clinical outcomes.
在慢性阻塞性肺疾病（COPD）和阻塞性睡眠呼吸暂停综合征（OSA）中，功能能力和心率变异性（HRV）是重要的预后标志物。然而，这些疾病重叠以及一年临床随访的影响尚未得到评估。
评估 OSA 的存在是否会损害 COPD 患者运动期间的功能表现和心脏自主控制；并验证这些疾病的重叠是否会导致一年随访期间临床结局恶化。
34 名患者接受了肺功能测试、超声心动图和多导睡眠图检查，以进行诊断确认、疾病分期、排除任何心脏变化，并在组间进行分配。患者进行了 6 分钟步行测试（6MWT），以评估运动期间的功能能力和 HRV。随后，对患者进行了 12 个月的随访，以记录恶化、住院和死亡等结果。在这段时间结束时，重新评估患者以验证研究的假设。
与 COPD 组相比，OSA-COPD 组的功能障碍更严重（p=0.003），在 6MWT 期间表现出更差的心脏自主反应，表现为副交感神经激活增加（p=0.03）和自主神经系统复杂性降低，并且在一年的随访期间更有可能恶化（p=0.03）。
OSA-COPD 对功能表现产生有害影响，并导致更大的自主神经失衡，从而影响临床结局。
