Avaliação do efeito do treinamento físico e da terapia com CPAP na variabilidade da freqüência cardíaca em pacientes com apneia obstrutiva do sono

Abstract

Introduction: Obstructive sleep apnea (OSA) is a disease characterized by episodes of complete or partial upper airway obstruction and its prevalence is increasing. Its main risk factors are: age, male gender and obesity. In addition to problems related to sleep fragmentation, OSA can lead to problems related to the cardiovascular system, due to its potential to cause hypertension. These problems are due to some factors such as elevated sympathetic tone, oxidative stress, inflammatory mediators and changes in intrathoracic pressure. However, the autonomic disbalance generated by increased activation of central and peripheral chemoreflex and baroreflex inhibition seems to be the main factor responsible for elevated blood pressure. Thus, it is important to investigate methods that aim to improve the cardiovascular health of these individuals. Objective: To investigate whether physical training can increase the Heart Rate Variability (HRV) and clinical parameters of patients with OSA compared to CPAP. Methods: Open clinical trial with 39 subjects with moderate to severe sleep apnea. Subjects were divided in two groups receiving either exercise therapy or CPAP. The evaluation of HRV, blood pressure, resting heart rate (HR), body composition and application of questionnaires were obtained before and after treatments. Data were analyzed by the Student t test and the Wilcoxon test, using the 95% confidence interval and significance level of 5%. Mean and standard deviation were used. Results: It was observed that individuals with OSA presented autonomic disbalance at the LF/HF ratio when compared to the reference values (P = 0.04, table 1), with a reduction in the HF parameter (P = 0.02, table 1). At sleep scales, there was a significant difference only after CPAP therapy on the Pittsburg scale (P = 03, table 3). After 8 weeks of physical training, a decrease in SBP and HRrest, LF reduction and LF / HF sympatho-vagal ratio were observed (P