1. OSA and cardiorespiratory fitness: a review
- Author
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Vincent Mysliwiec, Tyler A Powell, Michael J. Morris, and Matthew S. Brock
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Population ,Internal medicine ,Positive airway pressure ,medicine ,Aerobic exercise ,Humans ,Respiratory function ,education ,Exercise ,Review Articles ,education.field_of_study ,Sleep Apnea, Obstructive ,Exercise Tolerance ,business.industry ,VO2 max ,Cardiorespiratory fitness ,Middle Aged ,medicine.disease ,Obstructive sleep apnea ,Blood pressure ,Neurology ,Cardiorespiratory Fitness ,Cardiology ,Exercise Test ,Neurology (clinical) ,business - Abstract
The effects of untreated obstructive sleep apnea (OSA) on cardiopulmonary function remain unclear. Cardiorespiratory fitness (CRF), commonly reflected by VO(2) max measured during cardiopulmonary exercise testing, has gained popularity in evaluating numerous cardiopulmonary conditions and may provide a novel means of identifying OSA patients with the most clinically significant disease. This emerging testing modality provides simultaneous assessment of respiratory and cardiovascular function with results helping uncover evidence of evolving pathology in either organ system. In this review, we highlight the current state of the literature in regard to OSA and CRF with a specific focus on changes in cardiovascular function that have been previously noted. While OSA does not appear to limit respiratory function during exercise, studies seem to suggest an abnormal cardiovascular exercise response in this population including decreased cardiac output, a blunted heart rate response (ie, chronotropic incompetence), and exaggerated blood pressure response. Surprisingly, despite these observed changes in the cardiovascular response to exercise, results involving VO(2) max in OSA remain inconclusive. This is reflected by VO(2) max studies involving middle-aged OSA patients showing both normal and reduced CRF. As prior studies have not extensively characterized oxygen desaturation burden, we propose that reductions in VO(2) max may exist in OSA patients with only the most significant disease (as reflected by nocturnal hypoxia). Further characterizing this relationship remains important as some research suggests that positive airway pressure therapy or aerobic exercise may improve CRF in patients with OSA. In conclusion, while it likely that severe OSA, via an abnormal cardiovascular response to exercise, is associated with decreased CRF, further study is clearly warranted to include determining if OSA with decreased CRF is associated with increased morbidity or mortality. CITATION: Powell TA, Mysliwiec V, Brock MS, Morris MJ. OSA and cardiorespiratory fitness: a review. J Clin Sleep Med. 2022;18(1):279–288.
- Published
- 2023