Respiratory Medicine
Volume 103, Issue 7 , Pages 1063-1069 , July 2009

Altered ventilatory responses to exercise testing in young adult men with obstructive sleep apnea

  • Trent A. Hargens

      Affiliations

    • Laboratory for Health and Exercise Science, Department of Human Nutrition, Foods and Exercise, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
    • Human Performance Laboratory, Clinical Exercise Physiology Program, Ball State University, Muncie, IN, USA
  • ,
  • Stephen G. Guill

      Affiliations

    • Laboratory for Health and Exercise Science, Department of Human Nutrition, Foods and Exercise, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
  • ,
  • Adrian Aron

      Affiliations

    • Laboratory for Health and Exercise Science, Department of Human Nutrition, Foods and Exercise, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
  • ,
  • Donald Zedalis

      Affiliations

    • Sleep Disorders Network of Southwest Virginia, Christiansburg, VA, USA
    • Edward Via Virginia College of Osteopathic Medicine, Blacksburg, VA, USA
  • ,
  • John M. Gregg

      Affiliations

    • Sleep Disorders Network of Southwest Virginia, Christiansburg, VA, USA
    • Health Research Group, LLC, Blacksburg, VA, USA
  • ,
  • Sharon M. Nickols-Richardson

      Affiliations

    • Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
  • ,
  • William G. Herbert

      Affiliations

    • Laboratory for Health and Exercise Science, Department of Human Nutrition, Foods and Exercise, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
    • Health Research Group, LLC, Blacksburg, VA, USA
    • Corresponding Author InformationCorresponding author. Department of Human Nutrition, Foods & Exercise, Virginia Polytechnic Institute and State University, 213 War Memorial Hall (0531), Blacksburg, VA 24061, USA. Tel.: +1 540 231 6565; fax: +1 540 231 8476.

Received 3 June 2008 ,Accepted 14 January 2009.

References 

  1. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328(17):1230–1235
  2. Kapur V, Strohl KP, Redline S, Iber C, O'Connor G, Nieto J. Underdiagnosis of sleep apnea syndrome in US communities. Sleep Breath. 2002;6(2):49–54
  3. Young T, Evans L, Finn L, Palta M. Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep. 1997;20(9):705–706
  4. Somers VK, White DP, Amin R, et al. Sleep apnea and cardiovascular disease: an American Heart Association/American College Of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council On Cardiovascular Nursing. In collaboration with the National Heart, Lung, and Blood Institute National Center on Sleep Disorders Research (National Institutes of Health). Circulation. 2008;118(10):1080–1111
  5. Young T, Finn L, Peppard PE, et al. Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep. 2008;31(8):1071–1078
  6. Marshall NS, Wong KK, Liu PY, Cullen SR, Knuiman MW, Grunstein RR. Sleep apnea as an independent risk factor for all-cause mortality: the Busselton Health Study. Sleep. 2008;31(8):1079–1085
  7. Marin JM, Carrizo SJ, Vicente E, Agusti AG. Long-term cardiovascular outcomes in men with obstructive sleep apnoea–hypopnoea with or without treatment with continuous positive airway pressure: an observational study Lancet. 2005;365(9464):1046–1053
  8. Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med. 2000;342(19):1378–1384
  9. Nieto FJ, Young TB, Lind BK, et al. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. JAMA. 2000;283(14):1829–1836
  10. Grassi G, Facchini A, Trevano FQ, et al. Obstructive sleep apnea-dependent and -independent adrenergic activation in obesity. Hypertension. 2005;46(2):321–325
  11. Somers VK, Dyken ME, Clary MP, Abboud FM. Sympathetic neural mechanisms in obstructive sleep apnea. J Clin Invest. 1995;96(4):1897–1904
  12. Narkiewicz K, Kato M, Phillips BG, Pesek CA, Davison DE, Somers VK. Nocturnal continuous positive airway pressure decreases daytime sympathetic traffic in obstructive sleep apnea. Circulation. 1999;100(23):2332–2335
  13. Kara T, Narkiewicz K, Somers VK. Chemoreflexes – physiology and clinical implications. Acta Physiol Scand. 2003;177(3):377–384
  14. Narkiewicz K, van de Borne PJ, Pesek CA, Dyken ME, Montano N, Somers VK. Selective potentiation of peripheral chemoreflex sensitivity in obstructive sleep apnea. Circulation. 1999;99(9):1183–1189
  15. Narkiewicz K, van de Borne PJ, Montano N, Dyken ME, Phillips BG, Somers VK. Contribution of tonic chemoreflex activation to sympathetic activity and blood pressure in patients with obstructive sleep apnea. Circulation. 1998;97(10):943–945
  16. Narkiewicz K, Kato M, Pesek CA, Somers VK. Human obesity is characterized by a selective potentiation of central chemoreflex sensitivity. Hypertension. 1999;33(5):1153–1158
  17. Weil JV, Byrne-Quinn E, Sodal IE, Kline JS, McCullough RE, Filley GF. Augmentation of chemosensitivity during mild exercise in normal man. J Appl Physiol. 1972;33(6):813–819
  18. Meguro K, Adachi H, Oshima S, Taniguchi K, Nagai R. Exercise tolerance, exercise hyperpnea and central chemosensitivity to carbon dioxide in sleep apnea syndrome in heart failure patients. Circ J. 2005;69(6):695–699
  19. Arzt M, Harth M, Luchner A, et al. Enhanced ventilatory response to exercise in patients with chronic heart failure and central sleep apnea. Circulation. 2003;107(15):1998–2003
  20. American College of Sports Medicine, Whaley MH, Brubaker PH, Otto RM, Armstrong LE. ACSM's guidelines for exercisetesting and prescription. 7th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2005.
  21. Pate RR, Pratt M, Blair SN, et al. Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA. 1995;273(5):402–407
  22. Dingli K, Coleman EL, Vennelle M, et al. Evaluation of a portable device for diagnosing the sleep apnoea/hypopnoea syndrome. Eur Respir J. 2003;21(2):253–259
  23. Redline S, Tosteson T, Boucher MA, Millman RP. Measurement of sleep-related breathing disturbances in epidemiologic studies. Assessment of the validity and reproducibility of a portable monitoring device. Chest. 1991;100(5):1281–1286
  24. Collop NA, Anderson WC, Boehlecke B, et al. Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. J Clin Sleep Med. 2007;3(7):737–747
  25. Kamel EG, McNeill G, Van Wijk MC. Usefulness of anthropometry and DXA in predicting intra-abdominal fat in obese men and women. Obes Res. 2000;8(1):36–42
  26. Nickols-Richardson SM, Miller LE, Wootten DF, et al. Distal tibia areal bone mineral density: use in detecting low aBMD of the hip in young women. J Clin Densitom. 2005;8(1):74–79
  27. Miller LE, Nickols-Richardson SM, Wootten DF, Ramp WK, Herbert WG. Relationships among bone mineral density, body composition, and isokinetic strength in young women. Calcif Tissue Int. 2004;74(3):229–235
  28. Kaleth AS, Chittenden TW, Hawkins BJ, et al. Unique cardiopulmonary exercise test responses in overweight middle-aged adults with obstructive sleep apnea. Sleep Med. 2007;8(2):160–168
  29. Arena R, Myers J, Aslam SS, Varughese EB, Peberdy MA. Peak VO2 and VE/VCO2 slope in patients with heart failure: a prognostic comparison. Am Heart J. 2004;147(2):354–360
  30. Bard RL, Gillespie BW, Clarke NS, Egan TG, Nicklas JM. Determining the best ventilatory efficiency measure to predict mortality in patients with heart failure. J Heart Lung Transplant. 2006;25(5):589–595
  31. Hargens TA, Guill SG, Zedalis D, Gregg JM, Nickols-Richardson SM, Herbert WG. Attenuated heart rate recovery following exercise testing in overweight young men with untreated obstructive sleep apnea. Sleep. 2008;31(1):104–110
  32. Lin CC, Hsieh WY, Chou CS, Liaw SF. Cardiopulmonary exercise testing in obstructive sleep apnea syndrome. Respir Physiol Neurobiol. 2006;150(1):27–34
  33. Ponikowski P, Francis DP, Piepoli MF, et al. Enhanced ventilatory response to exercise in patients with chronic heart failure and preserved exercise tolerance: marker of abnormal cardiorespiratory reflex control and predictor of poor prognosis. Circulation. 2001;103(7):967–972
  34. Kleber FX, Vietzke G, Wernecke KD, et al. Impairment of ventilatory efficiency in heart failure: prognostic impact. Circulation. 2000;101(24):2803–2809
  35. Arena R, Myers J, Hsu L, et al. The minute ventilation/carbon dioxide production slope is prognostically superior to the oxygen uptake efficiency slope. J Card Fail. 2007;13(6):462–469
  36. Cooper VL, Pearson SB, Bowker CM, Elliott MW, Hainsworth R. Interaction of chemoreceptor and baroreceptor reflexes by hypoxia and hypercapnia – a mechanism for promoting hypertension in obstructive sleep apnoea. J Physiol. 2005;568(Pt 2):677–687
  37. Weiss JW, Liu MD, Huang J. Physiological basis for a causal relationship of obstructive sleep apnoea to hypertension. Exp Physiol. 2007;92(1):21–26
  38. Prabhakar NR, Dick TE, Nanduri J, Kumar GK. Systemic, cellular and molecular analysis of chemoreflex-mediated sympathoexcitation by chronic intermittent hypoxia. Exp Physiol. 2007;92(1):39–44
  39. Peng YJ, Prabhakar NR. Effect of two paradigms of chronic intermittent hypoxia on carotid body sensory activity. J Appl Physiol. 2004;96(3):1236–1242(discussion 196)
  40. Peng YJ, Overholt JL, Kline D, Kumar GK, Prabhakar NR. Induction of sensory long-term facilitation in the carotid body by intermittent hypoxia: implications for recurrent apneas. Proc Natl Acad Sci U S A. 2003;100(17):10073–10078
  41. Greenberg HE, Sica A, Batson D, Scharf SM. Chronic intermittent hypoxia increases sympathetic responsiveness to hypoxia and hypercapnia. J Appl Physiol. 1999;86(1):298–305
  42. Rey S, Del Rio R, Iturriaga R. Contribution of endothelin-1 and endothelin A and B receptors to the enhanced carotid body chemosensory responses induced by chronic intermittent hypoxia. Adv Exp Med Biol. 2008;605:228–232
  43. Gjorup PH, Sadauskiene L, Wessels J, Nyvad O, Strunge B, Pedersen EB. Abnormally increased endothelin-1 in plasma during the night in obstructive sleep apnea: relation to blood pressure and severity of disease. Am J Hypertens. 2007;20(1):44–52
  44. Zamarron-Sanz C, Ricoy-Galbaldon J, Gude-Sampedro F, Riveiro-Riveiro A. Plasma levels of vascular endothelial markers in obstructive sleep apnea. Arch Med Res. 2006;37(4):552–555
  45. Jordan W, Reinbacher A, Cohrs S, et al. Obstructive sleep apnea: plasma endothelin-1 precursor but not endothelin-1 levels are elevated and decline with nasal continuous positive airway pressure. Peptides. 2005;26(9):1654–1660
  46. Rey S, Del Rio R, Alcayaga J, Iturriaga R. Chronic intermittent hypoxia enhances cat chemosensory and ventilatory responses to hypoxia. J Physiol. 2004;560(Pt 2):577–586
  47. Bonanni E, Pasquali L, Manca ML, et al. Lactate production and catecholamine profile during aerobic exercise in normotensive OSAS patients. Sleep Med. 2004;5(2):137–145
  48. Vanuxem D, Badier M, Guillot C, Delpierre S, Jahjah F, Vanuxem P. Impairment of muscle energy metabolism in patients with sleep apnoea syndrome. Respir Med. 1997;91(9):551–557

PII: S0954-6111(09)00026-2

doi: 10.1016/j.rmed.2009.01.010

Respiratory Medicine
Volume 103, Issue 7 , Pages 1063-1069 , July 2009