title: Effects of exercise training in patients with chronic heart failure and sleep apnea.
abstract: 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.
authors.affiliation: School of Arts, Sciences and Humanities, University of São Paulo, São Paulo, Brazil.
authors.forename: Linda M
authors.initials: LM
authors.lastname: Ueno
authors.forename: Luciano F
authors.initials: LF
authors.lastname: Drager
authors.forename: Ana C T
authors.initials: AC
authors.lastname: Rodrigues
authors.forename: Maria U P B
authors.initials: MU
authors.lastname: Rondon
authors.forename: Ana M F W
authors.initials: AM
authors.lastname: Braga
authors.forename: Wilson
authors.initials: W
authors.lastname: Mathias
authors.forename: Eduardo M
authors.initials: EM
authors.lastname: Krieger
authors.forename: Antonio C P
authors.initials: AC
authors.lastname: Barretto
authors.forename: Holly R
authors.initials: HR
authors.lastname: Middlekauff
authors.forename: Geraldo
authors.initials: G
authors.lastname: Lorenzi-Filho
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Negrão
mesh_terms: 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
chemical_list: D010100:Oxygen