Impaired Functional Capacity Predicts Mortality in Patients with Obstructive Sleep Apnea

Nisar, Shiraz; Muppidi, Raghunandan; Duggal, Sumit; Hernandez, Adrián V.; Kalahasti, Vidyasagar; Jaber, Wael A.; Minai, Omar A.

doi:10.1513/annalsats.201309-315oc

Cited by 8 publications

(5 citation statements)

References 50 publications

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“…Thus, independent risk factors for exercise capacity impairment assessed by multivariate regression analysis were female sex, older age, higher BMI, and decreased LVEF, but not SDB severity. Similar conclusions were drawn by other researchers [ 10 , 12 , 52 , 53 ], stating that among patients with OSA, the influence of sex, obesity/BMI, and comorbidities on physical performance may outweigh that of SDB.…”

Section: Discussionsupporting

confidence: 89%

“…However, in patients with severe SDB, this value was outside the normal range (i.e., 6.80 [5.60–7.90] METs), which may indicate a higher risk in this subgroup. It was documented that, with the coexistence of CAD, the CV risk associated with OSA further increases [ 22 , 23 ], and impaired exercise capacity in patients with OSA and CAD has a more serious prognostic value and is associated with an increased risk of all-cause mortality [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…One of them is sleep-disordered breathing (SDB), predominantly obstructive sleep apnea (OSA) [ 9 , 10 , 11 ]. Poorer exercise capacity measured in metabolic equivalents (METs) is also a predictor of increased all-cause mortality in patients with SDB, particularly in the presence of CAD [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

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Effect of Sleep-Disordered Breathing on Exercise Capacity after Myocardial Infarction -- A Cross-Sectional Study

Loboda,

Stepanik,

Durmala

et al. 2023

Rev. Cardiovasc. Med.

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Background: 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. Methods: 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). Results: 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 ( p = 0.005, p = 0.008, and p = 0.004), and the maximum apnea duration and MET and 6MWT distance ( p = 0.042 and p = 0.002); and (2) directly proportional relationship between mean arterial oxygen saturation ( ) during sleep and MET, MHR, and 6MWT distance ( p = 0.019, p = 0.006, and p = 0.013), and minimum and MET and MHR ( p = 0.040 and p 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. Conclusions: 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.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

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Effect of Sleep-Disordered Breathing on Exercise Capacity after Myocardial Infarction -- A Cross-Sectional Study

Loboda,

Stepanik,

Durmala

et al. 2023

Rev. Cardiovasc. Med.

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“…Although different methodologies, in agreement with a study by Nisar et al evaluated on 1,533 individuals, assessed the presence of OSA by polysomnography and the functional capacity by exercise stress echocardiogram, only 404 showed impaired functional capacity. In addition, another recent study highlights the impact of OSA on cardiorespiratory fitness 12 .…”

Section: Discussionmentioning

confidence: 99%

Relationship between obstructive sleep apnea syndrome and functional capacity in patients with diabetes mellitus type 2: an observational transversal study

Fonseca

Moreira

Lima

et al. 2021

Rev. Assoc. Med. Bras.

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OBJECTIVE:The aim of this study was to verify the association among obstructive sleep apnea, functional capacity, and metabolic control. METHODS: This was a cross-sectional study involving individuals of both sexes with clinical diagnosis of diabetes mellitus type 2 who were above 18 years of age. The assessment consisted of a volunteer identification form, a 2-minute step test, and the Stop-Bang questionnaire. In order to assess metabolic control, HbA1c and fasting glucose data were collected from medical records. RESULTS: A total of 100 individuals with diabetes mellitus type 2, of whom 61% were women, were included in this study. According to the Stop-Bang instrument, 26, 57, and 17% of patients had low, intermediate, and high risk of developing OSA, respectively. There was no association between the 2-minute step test and metabolic variables and diabetes mellitus type 2 chronicity with Stop-Bang. CONCLUSIONS: We concluded that there is no association among obstructive sleep apnea measured by means of Stop-Bang instrument, functional capacity measured by means of 2-minute step test, and metabolic variables in individuals with diabetes mellitus type 2.

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“…[3][4][5][6] The prevalence of CHD in patients with OSA is approximately 20% to 30%, and the 5-year mortality of patients with CHD combined with OSA is 62%. 7,8 However, the detailed mechanism of CHD induced by OSA remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Ghrelin suppresses migration of macrophages via inhibition of ROCK2 under chronic intermittent hypoxia

Chen

Zhang

et al. 2020

J Int Med Res

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Objectives Migration of macrophages and atherosclerosis result in various diseases, including coronary heart disease. This study aimed to clarify the roles that ghrelin and Rho-associated coiled-coil-containing protein kinase 2 (ROCK2) play in migration of macrophages under chronic intermittent hypoxia (CIH). Methods A rat model of CIH was constructed and changes in ghrelin and ROCK2 protein expression were measured by western blot assay. The migratory ability of macrophages was determined by the transwell assay. Hematoxylin and eosin staining was applied to detect the changes in intima-media thickness. Results We found that CIH enhanced migration of macrophages, and this effect was attenuated by exogenous ghrelin. Additionally, the facilitative effect of CIH on migration of macrophages was strengthened or decreased by upregulation or downregulation of ROCK2, respectively. This phenomenon indicated that ROCK2 was involved in CIH-induced migration in macrophages. Furthermore, western blot and transwell assays showed that ghrelin inhibited CIH-induced migration via ROCK2 suppression in macrophages. Conclusions In summary, the present study shows that ghrelin inhibits CIH-induced migration via ROCK2 suppression in macrophages. Our research may help lead to identifying a new molecular mechanism for targeted therapy of atherosclerosis and its associated coronary artery diseases under intermittent hypoxia.

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Impaired Functional Capacity Predicts Mortality in Patients with Obstructive Sleep Apnea

Cited by 8 publications

References 50 publications

Effect of Sleep-Disordered Breathing on Exercise Capacity after Myocardial Infarction -- A Cross-Sectional Study

Effect of Sleep-Disordered Breathing on Exercise Capacity after Myocardial Infarction -- A Cross-Sectional Study

Relationship between obstructive sleep apnea syndrome and functional capacity in patients with diabetes mellitus type 2: an observational transversal study

Ghrelin suppresses migration of macrophages via inhibition of ROCK2 under chronic intermittent hypoxia

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