Internal Medicine (Drs Sykes, Sonners, Raphelson, Roberts, and Feldman), Pulmonary, Critical Care, Sleep Medicine and Physiology (Drs Schmickl and Malhotra), and Cardiovascular Medicine (Drs Swiatkiewicz and Taub), UC San Diego, La Jolla, California; and Department of Cardiology and Internal Medicine, Collegium Medicum Bydgoszcz, Nicolaus Copernicus University Torun, Bydgoszcz, Poland (Dr Swiatkiewicz).
J Cardiopulm Rehabil Prev. 2023 May 1;43(3):186-191. doi: 10.1097/HCR.0000000000000745. Epub 2022 Dec 14.
Obstructive sleep apnea (OSA)-related pulmonary hypertension (PH) can often be reversed with treatment of OSA via continuous positive airway pressure. We hypothesized that treatment of OSA would be associated with a greater improvement in exercise capacity (EC) with cardiac rehabilitation (CR), especially in patients with PH as compared with those who are untreated.
We reviewed medical records of 315 consecutive patients who participated in CR. Pulmonary hypertension status was assessed on the basis of peak tricuspid regurgitant velocity (>2.8 m/sec) on pre-CR echocardiograms. The OSA status (no, untreated, or treated OSA) was determined on the basis of results from sleep studies, continuous positive airway pressure device data, and physician notes. Exercise capacity was assessed by measuring metabolic equivalents (METs) using a treadmill stress test before and after CR.
We included 290 patients who participated in CR with available echocardiographic data: 44 (15%) had PH, and 102 (35%) had known OSA (30 treated and 72 untreated). Patients with OSA versus those with no OSA were more likely to have PH ( P = .06). Patients with PH versus no-PH were associated with significantly lower baseline METs in crude and adjusted analyses ( P ≤. 004). The PH and OSA status in isolation were not associated with changes in METs ( P > .2) with CR. There was a significant interaction between OSA treatment and PH in crude and adjusted analyses ( P ≤.01): treatment vs no treatment of OSA was associated with a clinically and statistically greater improvement in METs in patients who participated in CR with but not without PH.
Baseline PH was associated with decreased baseline EC but did not attenuate CR-related improvements in METs. However, in the subset of OSA patients with PH, OSA therapy was associated with improved EC after CR.
阻塞性睡眠呼吸暂停（OSA）相关肺动脉高压（PH）通常可以通过持续气道正压通气（CPAP）治疗 OSA 得到逆转。我们假设，与未经治疗的患者相比，治疗 OSA 与心脏康复（CR）期间运动能力（EC）的改善更相关，尤其是在 PH 患者中。
我们回顾了 315 名连续参加 CR 的患者的病历。根据 CR 前超声心动图上的峰值三尖瓣反流速度（>2.8m/sec）评估 PH 状态。OSA 状态（无、未治疗或治疗 OSA）基于睡眠研究、CPAP 设备数据和医生记录确定。通过在 CR 前后进行跑步机压力测试来测量代谢当量（METs）来评估运动能力。
我们纳入了 290 名参加 CR 并提供了超声心动图数据的患者：44 名（15%）患有 PH，102 名（35%）患有已知的 OSA（30 名治疗和 72 名未治疗）。有 OSA 的患者比没有 OSA 的患者更有可能患有 PH（P=0.06）。在未经调整和调整分析中，PH 组与无 PH 组的基线 METs 均显著较低（P≤0.004）。在 CR 中，PH 和 OSA 状态单独与 METs 的变化无关（P>.2）。在未经调整和调整分析中，OSA 治疗与 PH 之间存在显著的交互作用（P≤0.01）：与未治疗的 OSA 相比，接受 CPAP 治疗的 OSA 患者在参加 CR 时，PH 有或没有时，METs 的改善程度更大。
基线 PH 与基线 EC 降低相关，但并未减弱 CR 相关的 METs 改善。然而，在 PH 合并 OSA 的亚组中，CR 后 OSA 治疗与 EC 改善相关。
