Effects of exercise training in patients with chronic heart failure and sleep apnea.
OBJECTIVE
To test the effects of exercise training on sleep and neurovascular control in patients with systolic heart failure with and without sleep disordered breathing.


METHODS
Prospective interventional study.


METHODS
Cardiac rehabilitation and exercise physiology unit and sleep laboratory.


METHODS
Twenty-five patients with heart failure, aged 42 to 70 years, and New York Heart Association Functional Class I-III were divided into 1 of 3 groups: obstructive sleep apnea (n=8), central sleep apnea (n=9) and no sleep apnea (n=7). INTERVENTIONS Four months of no-training (control) followed by 4 months of an exercise training program (three 60-minute, supervised, exercise sessions per week).


RESULTS
Sleep (polysomnography), microneurography, forearm blood flow (plethysmography), peak VO2, and quality of life were evaluated at baseline and at the end of the control and trained periods. No significant changes occurred in the control period. Exercise training reduced muscle sympathetic nerve activity (P < 0.001) and increased forearm blood flow (P < 0.01), peak VO2( P < 0.01), and quality of life (P < 0.01) in all groups, independent of the presence of sleep apnea. Exercise training improved the apnea-hypopnea index, minimum 0O saturation, and amount stage 3-4 sleep (P < 0.05) in patients with obstructive sleep apnea but had no significant effects in patients with central sleep apnea.


CONCLUSIONS
The beneficial effects of exercise training on neurovascular function, functional capacity, and quality of life in patients with systolic dysfunction and heart failure occurs independently of sleep disordered breathing. Exercise training lessens the severity of obstructive sleep apnea but does not affect central sleep apnea in patients with heart failure and sleep disordered breathing.
Ueno
Linda M
LM
School of Arts, Sciences and Humanities, University of São Paulo, São Paulo, Brazil.
Drager
Luciano F
LF
Rodrigues
Ana C T
AC
Rondon
Maria U P B
MU
Braga
Ana M F W
AM
Mathias
Wilson
W
Krieger
Eduardo M
EM
Barretto
Antonio C P
AC
Middlekauff
Holly R
HR
Lorenzi-Filho
Geraldo
G
Negrão
Carlos E
CE
D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity / Q000502:physiology; D015444:Exercise / Q000502:physiology; D005260:Female; D005542:Forearm / Q000098:blood supply; D006333:Heart Failure / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000294:innervation; D010100:Oxygen / Q000097:blood; D010991:Plethysmography; D017286:Polysomnography; D011446:Prospective Studies; D011788:Quality of Life; D020182:Sleep Apnea, Central / Q000503:physiopathology / Q000534:rehabilitation*; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology / Q000534:rehabilitation*; D013564:Sympathetic Nervous System / Q000503:physiopathology
D010100:Oxygen