Atef Hady, Gaber Marwa
School of Allied Health Professions (SAHP), Keele University, Staffordshire, ST5 5BG, United Kingdom.
Faculty of Physical Therapy, Cairo University, Cairo, Egypt.
Sleep Sci. 2023 Jul 6;16(2):265-270. doi: 10.1055/s-0043-1770808. eCollection 2023 Jun.
Sleep deprivation is common after coronary artery bypass grafting (CABG). It is mostly managed well by exercise. The number of reported post-CABG cases that respond negatively to exercise is scanty. The etiology is usually associated with the underlying sleep pathology, and how it responds to exercise. Cases with undiagnosed central sleep apnea post CABG have not been reported before. A medically stable male patient, 63 years old, hypertensive, but not diabetic, had entered coronary artery bypass grafting (CABG) 8 weeks before attending the outpatient cardiac rehabilitation unit and was referred for a cardiac rehabilitation program at this time. He entered a study in the cardiac rehabilitation center utilizing either aerobic or combined aerobic and resistance training for 10 weeks to improve sleep architecture and functional capacity post-CABG. After randomization, he entered the group doing combined aerobic and resistance exercises. All of the patients in this group improved except him, his sleep quality worsened, but his functional capacity improved. After a complete analysis of sleep on polysomnography, it was revealed that the patient had central sleep apnea that was mostly worsened by resistance training. The patient was withdrawn from the study by the 8th week, and his sleep condition improved gradually. After then, he was asked to attend the cardiac rehabilitation center again to share in aerobic exercise, having evidence that central sleep apnea does not respond negatively to this form of training. After 12 months of follow-up, the patient still shows no signs of sleep deprivation. Sleep deprivation is prevalent in post-CABG patients, but with different presentations and it can generally improve by exercise. Identification of the underlying cause of the sleeping difficulty is a cornerstone of targeted treatment.
冠状动脉搭桥术（CABG）后睡眠剥夺很常见。大多数情况下通过运动可得到良好控制。报道的冠状动脉搭桥术后对运动反应不佳的病例数量很少。其病因通常与潜在的睡眠病理状况以及它对运动的反应有关。此前尚未有冠状动脉搭桥术后未确诊的中枢性睡眠呼吸暂停病例的报道。
一名63岁的男性患者，病情稳定，患有高血压但非糖尿病，在前往门诊心脏康复科就诊前8周接受了冠状动脉搭桥术（CABG），此时被转诊至心脏康复项目。他进入心脏康复中心的一项研究，采用有氧或有氧与抗阻联合训练，为期10周，以改善冠状动脉搭桥术后的睡眠结构和功能能力。随机分组后，他进入了进行有氧与抗阻联合运动的组。该组除他之外的所有患者都有改善，他的睡眠质量恶化，但功能能力有所提高。经多导睡眠图对睡眠进行全面分析后发现，该患者存在中枢性睡眠呼吸暂停，且主要因抗阻训练而加重。该患者在第8周退出研究，其睡眠状况逐渐改善。此后，他再次被要求前往心脏康复中心参加有氧运动，因为有证据表明中枢性睡眠呼吸暂停对这种训练形式没有负面反应。经过12个月的随访，该患者仍无睡眠剥夺的迹象。
睡眠剥夺在冠状动脉搭桥术后患者中很普遍，但表现各异，一般可通过运动改善。识别睡眠困难的潜在原因是针对性治疗的基石。
