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Effects of short-term aerobic training versus CPAP therapy on heart rate variability in moderate to severe OSA patients
Cardiac autonomic function imbalance, resulting by chemoreflex hyperactivity and increased heart rate variability (HRV) during the night, continuing throughout the day have been reported in OSA patients. However, the effects of non-pharmacological therapies, such as CPAP and physical activity, on HRV in OSA are not yet fully understood.
To compare the effects of short-term CPAP therapy and regular aerobic exercise training on the autonomic balance in moderate to severe OSA patients through HVR analysis.
39 participants (ET group n = 21 and CPAP group n=18) had been fully evaluated before and after 2 months of treatments. All participants were submitted to continuous ECG recordings for HRV analysis, with hemodynamic parameters being recorded by oscillometry. Excessive daytime sleepiness and sleep quality were assessed through the Epworth Sleepiness Scale and the Pittsburgh questionnaire, respectively. Pre- and post-therapy data were compared using paired Student-t test for dependent samples when the Shapiro test indicated parametric and non-parametric data were submitted to Chi-squared test after Wilcoxon test. A 95% confidence interval and a significance level of 5% were considered.
ET decreased systolic arterial pressure in hypertensive and non-hypertensive participants when compared to baseline values. CPAP had no effect over hemodynamic parameters in hypertensive and non-hypertensive participants. ET significantly reducing the HRV parameters mainly LF/HF ratio in hypertensive and non-hypertensive participants. ET significantly decreased excessive daytime sleepiness but did not affect sleep quality. CPAP significantly improved sleep quality, although global scores were still those of poor sleepers, while excessive daytime sleepiness was normalized only in hypertensive patients.
Short-term ET modulated different HRV parameters, leading to a predominant vagal tone in the cardiac sympathovagal balance and decreasing blood pressure in moderate to severe OSA, short-term CPAP had next to no effect in these parameters. We believe ET should be considered as an adjunct interventional strategy in the conservative management of hypertensive or non-hypertensive OSA patients.
Exercise; CPAP; Heart Rate Variability; Hypertension; OSA.
UNIVERSIDADE FEDERAL DO ESPIRITO SANTO - Espírito Santo - Brasil
Luís Henrique Ceia Cipriano, Ytalo Gonçalves Borges, José Geraldo Mill, Helder Mauad, Maria Teresa Martins Araújo, Sonia Alves Gouvea