Elsevier

Journal of Cardiac Failure

Volume 13, Issue 10, December 2007, Pages 825-829
Journal of Cardiac Failure

Clinical Investigation
Six-Month Aerobic Exercise Training Ameliorates Central Sleep Apnea in Patients With Chronic Heart Failure

https://doi.org/10.1016/j.cardfail.2007.08.001Get rights and content

Abstract

Background

Sleep-disordered breathing (SDB) is common in patients with heart failure and carries an independent risk for poor long-term prognosis. We aimed to study the effects of supervised, aerobic exercise training for 6 months on SDB in patients with chronic heart failure.

Methods and Results

We enrolled 18 patients having both systolic dysfunction (left ventricular ejection fraction <45%) and SDB (apnea-hypopnea index [AHI] >10). The exercise group comprised 10 patients who participated in our cardiac rehabilitation program for 6 months, and the remaining 8 patients served as control. AHI (median [interquartile range]) was unchanged in the control group patients at 6-month intervals (30.4 [19.9–36.3] versus 36.6 [8.6–39.4], NS). In contrast, AHI was significantly decreased in the exercise group from 24.9 [19.2–37.1] to 8.8 [5.3–10.1] (P < .01). In the exercise group, the numbers of central sleep apnea per night was significantly decreased (152 [124–244] versus 50 [24–67], P < .01) after exercise training, but those of obstructive apnea/hypopnea were unchanged (42 [7–94] versus 18 [7–54], NS). In addition, exercise training significantly increased peak oxygen consumption and decreased minute ventilation to carbon dioxide production slope (both P < .01).

Conclusions

Six-month, aerobic exercise training increased exercise capacity and improved central sleep apnea in patients with chronic heart failure from systolic dysfunction.

Section snippets

Patients

We studied 18 patients (17 men and 1 woman) with symptomatic (New York Heart Association functional Class II or III), chronic heart failure and SDB (apnea-hypopnea index [AHI] of >10). All patients had left ventricular systolic dysfunction (left ventricular ejection fraction <45%), were in a clinically stable condition for at least 1 month, and were free of pulmonary or peripheral edema. No patient had been treated with continuous positive airway pressure or had ever participated in cardiac

Control Group

In the control group, there was no difference in body mass index (25.7 [24.4–27.2] versus 25.5 [23.7–25.9]) or plasma BNP concentrations (177.8 [161.5–241.7] pg/mL versus 158.1 [92.2–202.6] pg/mL) in 6-month intervals. There was no significant difference in AHI between the 2 sleep studies (30.4 [19.9–36.3] versus 36.6 [8.6–39.4], Fig. 1A). Furthermore, the numbers per night of central apnea and obstructive apnea/hypopnea in these patients were comparable between the 2 examinations (158.5

Discussion

SDB, especially central sleep apnea, is common in heart failure patients and is an independent predictor of poor prognosis.2, 3, 4 Although cardiac rehabilitation has been recommended as a nonpharmacologic approach in the management of chronic heart failure, the effect of exercise training on sleep-related breathing abnormalities has not been studied in this patient group. Thus we aimed to evaluate the effects of 6-month, aerobic exercise training on central and obstructive sleep apnea in

Conclusions

Supervised, aerobic exercise training over a period of 6 months was safe, and improved central sleep apnea in association with increased exercise capacity in patients with chronic heart failure from systolic dysfunction. Thus regular physical activities may be an important therapeutic option in the management of this patient population.

Acknowledgment

The authors thank Kiyomi Kanoh, RN, and Yasuhiro Takanaga, BS, for assistance in cardiac rehabilitation.

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This study was supported in part by a grant-in-aid from Kitakyushu Medical Association, Kita-kyushu, Japan.

Conflict of interest: None.

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