The beneficial impact of cardiac rehabilitation on obstructive sleep apnea in patients with coronary artery disease.

STUDY OBJECTIVES: To assess the impact of cardiac rehabilitation for decreasing sleep-disordered breathing in patients with coronary artery disease. METHODS: The study included 121 patients aged 60.01 ± 10.08 years, 101 of whom were men, with an increased pretest probability of OSA. The cardiac rehabilitation program lasted 21-25 days. The improvement in cardiorespiratory fitness was assessed using the changes in peak metabolic equivalents, the maximal heart rate achieved, the proportion of the age- and sex-predicted maximal heart rate, and the Six-Minute Walk Test distance. Level 3 portable sleep tests with respiratory event index assessments were performed in 113 patients on admission and discharge. RESULTS: Increases were achieved in metabolic equivalents (Δ1.20; 95% confidence interval [CI], 0.95-1.40; P < .0001), maximal heart rate (-Δ7.5 beats per minute; 95% CI, 5.00-10.50; P < .0001), proportion of age- and sex-predicted maximal heart rate (Δ5.50%; 95% CI, 4.00-7.50; P < .0001), and the Six-Minute Walk Test distance (Δ91.00 m; 95% CI, 62.50-120.00; P < .0001). Sleep-disordered breathing was diagnosed in 94 (83.19%) patients: moderate in 28 (24.8%) patients and severe in 27 (23.9%) patients, with a respiratory event index of 19.75 (interquartile range, 17.20-24.00) and 47.50 (interquartile range, 35.96-56.78), respectively. OSA was dominant in 90.40% of patients. The respiratory event index reduction achieved in the sleep-disordered breathing group was -Δ3.65 (95% CI, -6.30 to -1.25; P = .003) and was in parallel to the improvement in cardiorespiratory fitness in the subgroups with the highest effort load and with severe sleep-disordered breathing: -Δ6.40 (95% CI, -11.40 to -1.90; P = .03) and -Δ11.00 (95% CI, -18.65 to -4.40; P = .003), respectively. CONCLUSIONS: High-intensity exercise training during cardiac rehabilitation resulted in a significant decrease in OSA, when severe, in parallel with an improvement in cardiorespiratory fitness in patients with coronary artery disease.

[Kinesiophobia in patients with cardiovascular disease].

OBJECTIVE: Introduction: Kinesiophobia - a fear of physical activity - is a common and worsening rehabilitation outcomes phenomenon in patients with cardiovascular diseases. The aim: To assess the level of kinesiophobia in relation to heart's function evaluated using echocardiography and clinical parameters in patients with cardiovascular disease. PATIENTS AND METHODS: Material and methods:101 patients (28 women) aged 61,9±13,56 years and hospitalized for implantation or replacement of a pacemaker or cardioverter-defibrillator were included in the study. Their heart's function and morphology were evaluated echocardiographically. Level of kinesiophobia was evaluated with the Polish version of Tampa Scale of Kinesiophobia Heart (TSK-Heart) questionnaire. RESULTS: Results: The TSK score in these patients was 41,6±5,39. It's value was increasing with age (p=0,0264), was higher in women than in men (43,5±5,36 vs. 40,8±5,27, p=0,0287) and in patients with coronary artery disease (42,3±6,28 vs. 40,9±4,62, p=0,031). In patients with heart failure, it was decreasing with an increase of body mass index (p=0,0185). Severe mitral insufficiency resulted in higher index value in comparison with moderate or mild one (42,7±4,05 vs. 40,9 ± 5,58, p=0,0369). The TSK index increases with a decrease in tricuspid annular plane systolic excursion (p=0,0033). Patients in NYHA IV class exhibited higher TSK value than those in lower classes (p<0,001). An inverse dependency of TSK index value and hemoglobin level were established (p=0,0041). CONCLUSION: Conclusions: In patients with cardiovascular diseases, kinesiophobia has multicausal nature and is higher in NYHA IV patients. The independent predictors of kinesiophobia are right ventricular dysfunction and anemia.