Sleep Disorders |

Relationship Between Excessive Daytime Sleepiness and 6 Minute Walk Test in Patients With Coronary Artery Disease and Obstructive Sleep Apnea FREE TO VIEW

Faisal Siddiqui, MD; Madalina Macrea, MD; Mitchell Horowitz, MD; Thomas Martin, MD; Tomer Pelleg, DO; Adrian Aron
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Virginia Tech - Carilion School of Medicine, Roanoke, VA

Chest. 2015;148(4_MeetingAbstracts):1064A. doi:10.1378/chest.2258667
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SESSION TITLE: Sleep Disorders Posters II: Consequences of OSA and Treatment

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Excessive daytime sleepiness (EDS) is commonly considered a cardinal sign of obstructive sleep apnea (OSA) and it may lead to decrease physical activity and capacity (6 minute walk test, 6 MWT). It is often considered to be an independent risk factor for cardiovascular morbidity and mortality. Despite this strong association little is known about the impact of EDS on Cardiac Rehabilitation (CR) outcomes in OSA patients. The aim of this cross-sectional study was to examine the impact of EDS on 6MWT and various other physiological paramters by researching OSA patients referred to a CR program after coronary re-vascularization.

METHODS: Consecutive patients without history of OSA who underwent CR after coronary re-vascularization between January 2012 to December 2012 in Roanoke and Harrisonburg, VA were subsequently diagnosed with OSA after at-home polysomnography. OSA severity was reported as per American Academy of Sleep Medicine (AASM) guidelines i.e., Apnea/Hypopnea Index (AHI) = 5-15 for mild OSA, AHI = 16-30 for moderate OSA and AHI >30 for severe OSA. Normality of continuous variables was evaluated by Shapiro-Wilk test. Comparisons of continuous values between groups were performed using t test for data with normal distribution or Wilcoxon rank test, if skewed distribution. Linear regression was used to assess the relationship in Epworth Sleepiness Scale (ESS) and 6MWT (measured in minutes and meters). A two-sided p value of <0.05 was considered statistically significant.

RESULTS: Subjects groups did not differ by age, body mass index, blood pressure, heart rate, AHI, nocturnal desaturations or functional capacity. Pre-CR 6MWT in minutes (p=0.04, CI = -.007 to -.0001) and meters (p=0.04, CI = -.024 to -.0006) was significantly lower in OSA patients with excessive daytime sleepiness (EDS). This effect was maintained post-CR for 6MWT in meters (p=0.001, CI = -.021 to -.004).

CONCLUSIONS: EDS decreases functional capacity in OSA patients both at baseline and post-CR.

CLINICAL IMPLICATIONS: Through this study we confirm that patients with EDS have decreased functional capacity. This was an indepent risk factor in patients with similar AHI score and other physciological parameters. Patients with EDS should be identified early with or without OSA and/or other co-morbidities as a high risk group and should be followed more closely during a rehabilitation program.

DISCLOSURE: The following authors have nothing to disclose: Faisal Siddiqui, Madalina Macrea, Mitchell Horowitz, Thomas Martin, Tomer Pelleg, Adrian Aron

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