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Original Research: SLEEP MEDICINE |

Determinants of Postexercise Heart Rate Recovery in Patients With the Obstructive Sleep Apnea Syndrome

Micha T. Maeder, MD; Peter Ammann, MD; Otto D. Schoch, MD, FCCP; Hans Rickli, MD; Wolfgang Korte, MD; Christoph Hürny, MD; Jonathan Myers, PhD; Thomas Münzer, MD
Author and Funding Information

From the Baker IDI Heart and Diabetes Institute (Dr Maeder), Melbourne, Australia; the Division of Cardiology (Drs Ammann and Rickli), the Multidisciplinary Sleep Center and Division of Pulmonary Medicine (Dr Schoch), and the Institute for Clinical Chemistry and Hematology (Dr Korte), Kantonsspital St. Gallen, St. Gallen; the Geriatrische Klinik (Drs Hürny and Münzer), St. Gallen, and Department of Geriatrics (Dr Münzer), University of Bern, Switzerland; and the Cardiology Division (Dr Myers), Palo Alto Veterans Affairs Medical Center, Stanford University, Palo Alto, CA.

Correspondence to: Micha T. Maeder, MD, Baker IDI Heart and Diabetes Institute, PO Box 6492 St Kilda Road Central, Melbourne 8008 VIC, Australia; e-mail: micha.maeder@bluewin.ch


Funding/Support: Supported by the Swiss National Science Foundation, Berne, Switzerland [Grant 3200-068115 to T.M., O.D.S., and C.H., Grant PBZHB-121007 to M.T.M.] and the Robert Bosch Foundation, Stuttgart, Germany (T.M.).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(2):310-317. doi:10.1378/chest.09-1424
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Background:  Young patients with obstructive sleep apnea syndrome (OSAS) display an attenuated heart rate recovery (HRR) during the first minute (HRR-1) and the first 2 min (HRR-2) postexercise. We sought to compare determinants of HRR-1 and HRR-2 in OSAS and to assess whether these associations depend on age.

Methods:  Exercise testing with measurements of HRR-1 and HRR-2 was performed in 54 patients with untreated OSAS (median [interquartile range] apnea-hypopnea index 27.5 [12.0-42.4] h−1, desaturation index [DSI] 10.6 [5.1-25.0] h−1).

Results:  Overall, higher DSI (P < .001) and higher total cholesterol ([TC] P = .02) were independent predictors of lower HRR-1, whereas lower peak heart rate (P < .001), higher resting heart rate (P = .006), and higher DSI (P = .01) were independently associated with lower HRR-2. In the below-median age group (age ≤ 48 years; n = 27), higher DSI (P = .002) was the only independent predictor of lower HRR-1, and lower peak heart rate (P < .001) and higher DSI (P = .003) were independently associated with lower HRR-2. In contrast, in the above-median age group (age > 48 years; n = 27) higher TC (P = .006), higher insulin resistance (P = .009), and higher resting heart rate (P = .048) were independently associated with lower HRR-1, and lower estimated glomerular filtration rate (P = .001), higher resting heart rate (P = .002), higher TC (P = .005), and lower peak heart rate (P = .01) were independently associated with HRR-2.

Conclusions:  Assessment of HRR-2 provides additional information on different aspects of OSAS compared with HRR-1. Markers of OSAS severity, such as DSI, are independently associated with HRR in younger patients only, whereas in older patients, HRR reflects OSAS-related metabolic and renal dysfunction.

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