Loboda Danuta, Stepanik Michalina, Durmala Jacek, Gardas Rafal, Golba Krzysztof S
Department of Electrocardiology and Heart Failure, Medical University of Silesia in Katowice, 40-635 Katowice, Poland.
Department of Rehabilitation, Medical University of Silesia in Katowice, 40-635 Katowice, Poland.
Rev Cardiovasc Med. 2023 Oct 20;24(10):299. doi: 10.31083/j.rcm2410299. eCollection 2023 Oct.
Exercise capacity reflects the cardiovascular risk after myocardial infarction (MI). The study aims to evaluate the impact of sleep-disordered breathing (SDB) on exercise capacity after MI.
Consecutive patients referring to outpatient cardiac rehabilitation up to 28 days after MI and participating in the Polish Managed Care after Acute Myocardial Infarction (MC-AMI) program were included. On admission, we assessed the presence and the severity of SDB using the home sleep apnea test (HSAT), patients' maximum exercise capacity on a treadmill exercise stress test (EST), and a 6-minute walk test (6MWT), as well as the effect of SDB on the results obtained. In the multivariate analysis, we verified the strength of the observed associations concerning age, anthropometric parameters, and left ventricular ejection fraction (LVEF).
A total of 254 patients aged 60.00 (interquartile range 51.00-67.00), including 39 (15.4%) women, with technically adequate HSAT, constituted the study group. Mild SDB was found in 82 (32.3%), moderate in 54 (21.3%), and severe in 51 (20.1%) patients. Among those diagnosed with SDB, obstructive sleep apnea (OSA) was dominant in 167 (89.8%). With the worsening of SDB, the distance in 6MWT and the maximum physical exertion achieved in EST, expressed in metabolic equivalents (METs) and maximal heart rate (MHR), decreased. The linear regression analysis confirmed the following: (1) inversely proportional relationship between the respiratory event index and METs, MHR, and 6MWT distance ( = 0.005, = 0.008, and = 0.004), and the maximum apnea duration and MET and 6MWT distance ( = 0.042 and = 0.002); and (2) directly proportional relationship between mean arterial oxygen saturation ( ) during sleep and MET, MHR, and 6MWT distance ( = 0.019, = 0.006, and = 0.013), and minimum and MET and MHR ( = 0.040 and 0.001). However, the independent risk factors for impaired exercise capacity, determined using multivariable regression analysis, were age, female sex, higher body mass index (BMI), and decreased LVEF, but not SDB parameters.
SDB negatively impacts exercise capacity after MI. However, the strength of this association may be less pronounced due to the interaction of risk factors common for SDB and impaired exercise capacity, e.g., sex, age, BMI, and LVEF.
运动能力反映心肌梗死（MI）后的心血管风险。本研究旨在评估睡眠呼吸紊乱（SDB）对心肌梗死后运动能力的影响。
纳入心肌梗死后28天内转诊至门诊心脏康复科并参与波兰急性心肌梗死后管理式医疗（MC-AMI）项目的连续患者。入院时，我们使用家庭睡眠呼吸暂停测试（HSAT）评估SDB的存在和严重程度，通过跑步机运动应激测试（EST）和6分钟步行测试（6MWT）评估患者的最大运动能力，以及SDB对所得结果的影响。在多变量分析中，我们验证了观察到的与年龄、人体测量参数和左心室射血分数（LVEF）相关联的强度。
共有254名年龄为60.00（四分位间距51.00 - 67.00）的患者，包括39名（15.4%）女性，其HSAT技术上足够，构成研究组。82名（32.3%）患者存在轻度SDB，54名（21.3%）为中度，51名（20.1%）为重度。在诊断为SDB的患者中，阻塞性睡眠呼吸暂停（OSA）占主导地位，有167名（89.8%）。随着SDB的加重，6MWT中的距离以及EST中达到的最大体力消耗，以代谢当量（METs）和最大心率（MHR）表示，均降低。线性回归分析证实了以下几点：（1）呼吸事件指数与METs、MHR和6MWT距离之间呈反比关系（分别为 = 0.005、 = 0.008和 = 0.004），以及最长呼吸暂停持续时间与MET和6MWT距离之间呈反比关系（分别为 = 0.042和 = 0.002）；（2）睡眠期间平均动脉血氧饱和度（ ）与MET、MHR和6MWT距离之间呈正比关系（分别为 = 0.019、 = 0.006和 = 0.013），以及最低 与MET和MHR之间呈正比关系（分别为 = 0.040和 0.001）。然而，使用多变量回归分析确定的运动能力受损的独立危险因素是年龄、女性性别、较高的体重指数（BMI）和降低的LVEF，而非SDB参数。
SDB对心肌梗死后的运动能力有负面影响。然而，由于SDB和运动能力受损常见的危险因素（如性别、年龄、BMI和LVEF）之间的相互作用，这种关联的强度可能不太明显。
