Effect of continuous positive airway pressure on maximal exercise capacity in patients with obstructive sleep apnea: a systematic review and meta-analysis

TY - JOUR

T1 - Effect of continuous positive airway pressure on maximal exercise capacity in patients with obstructive sleep apnea

T2 - a systematic review and meta-analysis

AU - Fletcher, Hannah V

AU - Pan Cho, Peter Siu

AU - Lee Loong, Stewart

AU - Estrada-Petrocelli, Luis

AU - Patel, Amit S

AU - Birring, Surinder S

AU - Lee, Kai K

N1 - © 2020 American Academy of Sleep Medicine.

PY - 2020/11/15

Y1 - 2020/11/15

N2 - Study Objectives: Exercise capacity is impaired in obstructive sleep apnea (OSA). There are conflicting reports on the effect of continuous positive airway pressure (CPAP) on maximal exercise capacity. The objective of this review was to determine if there is a change in exercise capacity and anaerobic threshold following CPAP treatment in OSA patients. Methods: We conducted a systematic review and meta-analyses to summarize the changes in peak rate of oxygen uptake (VO 2 peak) or maximum rate of oxygen uptake (VO2 max) and anaerobic threshold (AT) during cardiopulmonary exercise testing following CPAP intervention in patients with OSA. A systematic literature review was conducted to identify published literature on markers of VO 2 peak, VO 2 max, and AT pre- vs post-CPAP using a web-based literature search of PubMed/MEDLINE, Embase, CINAHL, and Cochrane review (CENTRAL) databases. Two independent reviewers screened the articles for data extraction and analysis. Results: The total search of all the databases returned 470 relevant citations. Following application of eligibility criteria, 6 studies were included in the final meta-analysis for VO 2 peak, 2 studies for VO 2 max, and five studies for AT. The meta-analysis showed a mean net difference in VO 2 peak between pre- and post-CPAP of 2.69 mL$kg –1$min– 1, P = .02, favoring treatment with CPAP. There was no difference in VO 2 max or AT with CPAP treatment (mean net difference 0.66 mL$kg –1$min– 1 [P = .78] and –144.98 mL$min– 1 [P = .20] respectively). Conclusions: There is a paucity of high-quality studies investigating the effect of CPAP on exercise capacity. Our meta-analysis shows that VO 2 peak increases following CPAP treatment in patients with OSA, but we did not observe any change in VO 2 max or AT. Our findings should be considered preliminary and we recommend further randomized controlled trials to confirm our findings and to clarify the peak and maximum rates of oxygen uptake adaptations with CPAP therapy.

AB - Study Objectives: Exercise capacity is impaired in obstructive sleep apnea (OSA). There are conflicting reports on the effect of continuous positive airway pressure (CPAP) on maximal exercise capacity. The objective of this review was to determine if there is a change in exercise capacity and anaerobic threshold following CPAP treatment in OSA patients. Methods: We conducted a systematic review and meta-analyses to summarize the changes in peak rate of oxygen uptake (VO 2 peak) or maximum rate of oxygen uptake (VO2 max) and anaerobic threshold (AT) during cardiopulmonary exercise testing following CPAP intervention in patients with OSA. A systematic literature review was conducted to identify published literature on markers of VO 2 peak, VO 2 max, and AT pre- vs post-CPAP using a web-based literature search of PubMed/MEDLINE, Embase, CINAHL, and Cochrane review (CENTRAL) databases. Two independent reviewers screened the articles for data extraction and analysis. Results: The total search of all the databases returned 470 relevant citations. Following application of eligibility criteria, 6 studies were included in the final meta-analysis for VO 2 peak, 2 studies for VO 2 max, and five studies for AT. The meta-analysis showed a mean net difference in VO 2 peak between pre- and post-CPAP of 2.69 mL$kg –1$min– 1, P = .02, favoring treatment with CPAP. There was no difference in VO 2 max or AT with CPAP treatment (mean net difference 0.66 mL$kg –1$min– 1 [P = .78] and –144.98 mL$min– 1 [P = .20] respectively). Conclusions: There is a paucity of high-quality studies investigating the effect of CPAP on exercise capacity. Our meta-analysis shows that VO 2 peak increases following CPAP treatment in patients with OSA, but we did not observe any change in VO 2 max or AT. Our findings should be considered preliminary and we recommend further randomized controlled trials to confirm our findings and to clarify the peak and maximum rates of oxygen uptake adaptations with CPAP therapy.

KW - aerobic exercise

KW - cardiopulmonary exercise test

KW - continuous positive airway pressure

KW - obstructive sleep apnea

KW - physical activity

UR - http://www.scopus.com/inward/record.url?scp=85096347831&partnerID=8YFLogxK

U2 - 10.5664/jcsm.8686

DO - 10.5664/jcsm.8686

M3 - Article

C2 - 32662419

SN - 1550-9389

VL - 16

SP - 1847

EP - 1855

JO - Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine

JF - Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine

IS - 11

ER -