title: Short-term modulation of the ventilatory response to exercise is preserved in obstructive sleep apnea.
abstract: The ventilatory response to exercise can be transiently adjusted in response to environmentally (e.g., breathing apparatus) or physiologically altered conditions (e.g., respiratory disease), maintaining constant relative arterial PCO2regulation from rest to exercise (Mitchell and Babb, 2006); this augmentation is called short-term modulation (STM) of the exercise ventilatory response. Obesity and/or obstructive sleep apnea could affect the exercise ventilatory response and the capacity for STM due to chronically increased mechanical and/or ventilatory loads on the respiratory system, and/or recurrent (chronic) intermittent hypoxia experienced during sleep. We hypothesized that: (1) the exercise ventilatory response is augmented in obese OSA patients compared with obese non-OSA adults, and (2) the capacity for STM with added dead space is diminished in obese OSA patients.
  
  
  
  Nine obese adults with OSA (age: 39±6 yr, BMI: 40±5kg/m2, AHI: 25±24 events/h [range 6-73], mean±SD) and 8 obese adults without OSA (age: 38±10 yr, BMI: 37±6kg/m2, AHI: 1±2) completed three, 20-min bouts of constant-load submaximal cycling exercise (8min rest, 6min at 10 and 30W) with or without added external dead space (200 or 400mL; 20min rest between bouts). Steady-state measurements were made of ventilation (V˙E),oxygen consumption V˙O2), carbon dioxide production (V˙CO2), and end-tidal PCO2(PETCO2). The exercise ventilatory response was defined as the slope of the V˙E-V˙CO2relationship (ΔV˙E/ΔV˙CO2).
  
  
  
  In control (i.e. no added dead space), the exercise ventilatory response was not significantly different between non-OSA and OSA groups (ΔV˙E/ΔV˙CO2slope: 30.5±4.2 vs 30.5±3.8, p>0.05); PETCO2regulation from rest to exercise did not differ between groups (p>0.05). In trials with added external dead space, ΔV˙E/ΔV˙CO2increased with increased dead space (p < 0.05) and the PETCO2change from rest to exercise remained small (<2mmHg) in both groups, demonstrating STM. There were no significant differences between groups.
  
  
  
  Contrary to our hypotheses: (1) the exercise ventilatory response is not increased in obese OSA patients compared with obese non-OSA adults, and (2) the capacity for STM with added dead space is preserved in obese OSA and non-OSA adults.
authors.affiliation: Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and UT Southwestern Medical Center, Dallas, TX, USA; Texas A&M University-Commerce, Department of Health and Human Performance, Commerce, TX, USA. Electronic address: Vipa.Bernhardt@tamuc.edu.
authors.forename: Vipa
authors.initials: V
authors.lastname: Bernhardt
authors.affiliation: University of Florida, Department of Physical Therapy, Gainesville, FL, USA. Electronic address: gsmitche@phhp.ufl.edu.
authors.forename: Gordon S
authors.initials: GS
authors.lastname: Mitchell
authors.affiliation: Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA. Electronic address: Won.Lee@utsouthwestern.edu.
authors.forename: Won Y
authors.initials: WY
authors.lastname: Lee
authors.affiliation: Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and UT Southwestern Medical Center, Dallas, TX, USA. Electronic address: TonyBabb@TexasHealth.org.
authors.forename: Tony G
authors.initials: TG
authors.lastname: Babb
mesh_terms: D000328:Adult; D000886:Anthropometry; D001784:Blood Gas Analysis; D002245:Carbon Dioxide / Q000378:metabolism; D015444:Exercise / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption / Q000502:physiology; D012123:Pulmonary Ventilation / Q000502:physiology*; D012119:Respiration; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology*; D018709:Statistics, Nonparametric; D013997:Time Factors
chemical_list: D002245:Carbon Dioxide
keywords: Obesity; Obesity hypoventilation syndrome; P(CO2); Sleep apnea