The impact of obstructive sleep apnea on exercise capacity in a cardiac rehabilitation program

Purpose Cardiac rehabilitation (CR) improves clinical outcomes in patients with cardiovascular disease (CDV). Patients with CVD often have multiple comorbidities, including obstructive sleep apnea (OSA), potentially affecting their ability to participate and achieve functional improvement during CR. We aimed to test the hypothesis that OSA reduces peak exercise capacity (EC) in patients undergoing CR and to explore if OSA treatment modifies this relationship. Methods Data from a retrospective cohort of CR patients was analyzed. OSA was defined as a respiratory event index > 5/h or physician diagnosis. Patients with OSA were considered “treated” if using continuous positive airway pressure regularly during the CR period. Change in METs was the primary study outcome. Results Among 312 CR patients, median age of 67 years, 103 (33%) had known OSA (30 treated, 73 untreated). Patients with OSA vs. those with no OSA were more likely to be obese and male; otherwise, groups were similar. Compared with the no OSA group, patients with OSA had lower pre-CR METs (3.3 [2.9–4.5] vs. 3.9 [3.1–5], P = .01) and lower post-CR METs (5.3 [4–7] vs. 6 [4.6–7.6], P = .04), but achieved a similar increase in METs post-CR (1.8 [0.6–2.6] vs. 2.0 [0.9–3], P = .22). Furthermore, compared to no OSA, pre-CR and post-CR METs tended to be similar in patients with treated OSA, but lower in untreated patients, with similar increases in METs across all groups, even when adjusting for covariates via multivariable regression. Conclusion OSA is prevalent in patients with CVD undergoing CR. CR substantially improves exercise capacity independent of OSA status, but screening for—and treatment of—OSA may improve the absolute exercise capacity achieved through CR.