CPAP Use Linked With Increased Physical Activity in Patients With Comorbid OSA, Cardiovascular Disease

Patients with obstructive sleep apnea (OSA) and a history of cardiovascular disease (CVD) undergoing continuous positive airway pressure (CPAP) therapy were found to be more likely to exercise than non-CPAP users, and at levels sufficient to those in clinical recommendations, according to study findings reported in the Journal of Clinical Sleep Medicine.

With more than 70% of patients with OSA classified as overweight or obese, physical activity can play a significant role in lessening the severity of the condition.

CPAP is the current gold standard for treating OSA, but researchers noted that the impact of CPAP therapy on activity levels has garnered conflicting findings. However, CPAP has been found to reduce risk of CVD, garnering a 4- to 5-beat-per-minute drop in heart rate that is comparable to what is achieved through regular exercise.

Researchers sought to further examine long-term CPAP treatment effects on physical activity among participants with moderate to severe OSA and comorbid CVD. Collected as part of the international, randomized, controlled Sleep Apnea cardioVascular Endpoints (SAVE) trial, 2601 participants with available data were randomized to receive either CPAP plus usual care (n = 1305) or usual care alone (n = 1296), with a mean follow-up of 3.7 years.

Each participant provided self-reported physical activity recordings at baseline and at 6, 24, and 48 months via the Godin-Shepard Leisure Time Exercise Questionnaire (LTEQ).

“We also determined effects on any limitation of physical activity reported on the physical functioning subscale of the 36-item short form questionnaire (SF-36) and proportions of participants reaching guideline recommended physical activity levels,” added researchers.

Among the study cohort, those who received CPAP plus usual care reported significantly more physical activity than the usual care group (adjusted mean, 26.6 points; 95% CI, 24.7-28.5 vs 24.4 points; 95% CI, 22.5-26.3; P = .003). In assessing the individual components of the LTEQ, CPAP users reported 20% higher moderate activities on the LTEQ during follow-up when compared with the non-CPAP group (adjusted mean, 8.7; 95% CI, 7.5-9.9 vs 7.3; 95% CI, 6.1-8.5; P = .003).

There were no significant differences between treatment groups in levels of vigorous or mild physical activity.

In addition to greater adherence to physical activity, the CPAP group reported less limitation in physical activity (adjusted between-group difference in SF-36 physical functioning subscale score, 1.66; 95% CI, 0.87-2.45; P < .001).

"We were pleased to find that our CPAP users reported that they were better able to maintain their levels of activity over the 4 years of the study, and that they reported fewer limitations in moderate and vigorous activities including those that are important for independent aging, like walking up the stairs," said study author Kelly Loffler, PhD, research fellow at the Adelaide Institute for Sleep Health at Flinders University in Adelaide, South Australia, in a statement.

Notably, patients of the CPAP group were more likely to report exercise levels that met clinical recommendations provided by the American College of Sports Medicine and American Medical Association–minimum of 150 minutes per week, or 30 minutes on 5 days, of moderate to vigorous physical activity.

"CPAP represents a useful tool to assist health care providers caring for populations with comorbidities and combined with lifestyle interventions like diet and targeted exercise will likely provide many users with a symptomatic benefit that goes beyond their reported sleep," said Loffler.

Reference

Stevens D, Loffler KA, Buman MP, et al. CPAP increases physical activity in obstructive sleep apnea with cardiovascular disease. J Clin Sleep Med. Published online February 1, 2021. doi:10.5664/jcsm.8792