Rehabilitation efficacy of aerobic exercise on patients with overlap syndrome of chronic obstructive pulmonary disease and obstructive sleep apnea

doi:10.16138/j.1673-6087.2024.05.02

Abstract

Abstract:

Objective To evaluate the rehabilitation efficacy of moderate intensity aerobic exercise on patients with chronic obstructive pulmonary disease (COPD)-obstructive sleep apnea (OSA) overlap syndrome. Methods A retrospective cohort study was used in the study. The patients who were diagnosed with COPD-OSA overlap syndrome and applied positive airway pressure (PAP) from January 2021 to December 2023 were selected in the Department of Respiratory Rehabilitation, at the Fourth Rehabilitation Hospital of Shanghai. A total of 29 patients [aged (62.2±5.9) years, male 65.5%] with overlap syndrome received moderate intensity aerobic training for 20 weeks were enrolled as the intervention group (IG). At the same time, 29 patients [(64.6±6.9) years, male 62.1%] with overlap syndrome who didn’t receive aerobic training were selected as the control group (CG). The differences in motor function, daily living abilities, body composition, respiratory function, psychological state and sleep parameters between two cohorts of patients before and after treatment were compared. Results After 20 weeks of aerobic exercise, the various parameters of IG demonstrated significant improvement compared with those before treatment: a notable increase in the 6 min walk distance (6MWD) [(268.62±47.02) m vs (316.97±58.44) m], quadriceps muscle strength [22.40 (20.40, 27.45) kg vs 25.40 (20.00, 30.45) kg], Barthel index (BI) scores [(66.03±12.42) vs (76.72±11.82)], a reduction in the 5 times sit-to-stand test (5TSTS) [19.50 (15.94, 31.10) s vs 13.50 (11.75, 18.50) s], body mass index (BMI) [(25.16±3.17) kg/m² vs (22.31±2.16) kg/m²] and fat mass (FM) [(24.13±9.22) kg vs (20.47±8.32) kg]. Additionally, there were significant enhancements observed in PSG parameters, blood gas analysis results, Hamilton depression scale (HAMD) and Hamilton anxiety scale (HAMA) scores after training in IG (all P<0.05). In contrast, the CG exhibited improvements in quadriceps muscle strength and the modified Medical Research Council (mMRC) as well as PSG parameters and psychological state; while there was an FM increase in this group (all P<0.05). Compared with the CG, the 6MWD [(316.97±58.44) m vs 239.93±37.80) m], quadriceps muscle strength [25.40 (20.00, 30.45) kg vs 23.70 (20.50, 25.60) kg], 5TSTS [13.50 (11.75, 18.50) s vs 19.50 (17.60, 23.12) s], BI [(76.72±11.82) vs （67.59±10.74)], mMRC, pH, PaO₂, TS90%, BMI [(22.31±2.16) kg/m² vs（26.17±3.83) kg/m²], FM, HAMD, HAMA of the IG patients showed significant improvement (all P<0.05). However, there were no significant differences observed between the two groups in terms of percentage of predicted forced expiratory volume in one second (FEV₁%） (43.72%±9.49% vs 43.97%±7.22%), PaCO₂, apnea hypopnea index, pulse oxygen saturation （L-SpO₂）%, fat free mass and fat free mass index (P>0.05). Conclusions The combination of a 20-week moderate-intensity aerobic training and PAP demonstrates significant improvements in motor function, reduction in body fat, alleviation of hypoxia and respiratory difficulties, enhancement of psychological state and daily life abilities. This intervention may be considered suitable for patients with COPD-OSA overlap syndrome.

Key words: Aerobic training, Positive airway pressure, Chronic obstructive pulmonary disease, Obstructive sleep apnea

CLC Number:

R563

LIU Jie, ZHANG Yin, XU Yiming, REN Lei, SHEN Honghua. Rehabilitation efficacy of aerobic exercise on patients with overlap syndrome of chronic obstructive pulmonary disease and obstructive sleep apnea[J]. Journal of Internal Medicine Concepts & Practice, 2024, 19(05): 295-302.

Figures/Tables 2

Table 1

Table 2

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项目	对照组	干预组	P
年龄（岁）	64.55±6.85	62.21±5.85	0.166
男性[n(%)]	18(62.1)	19(65.5)	0.785
身高（m）	1.66±0.09	1.67±0.10	0.833
体重（kg）	71.06±12.49	70.30±12.58	0.819
BMI（kg/m²）	25.76±4.47	25.16±3.17	0.558
基础疾病 [n(%)]
冠心病	12(41.4)	10(34.5)	0.588
2型糖尿病	10(34.5)	8(27.6)	0.570
高血压病	14(48.3)	16(55.2）	0.599
吸烟状态[n(%)]			0.860
目前吸烟者	13(44.8)	15(51.7)
已戒烟者	11(37.9)	10(34.5)
未吸烟者	5(17.2)	4(13.8)
药物使用[n(%)]
β受体激动剂	13(44.8)	15(51.7)	0.599
抗胆碱药物	12(41.4)	10(34.5)	0.588
吸入类糖皮质激素	6(20.7)	8(27.6)	0.539
GOLD分级[n(%)]			0.526
2级	7(24.1)	10(34.5)
3级	21(72.4)	17(58.6)
4级	1(3.4)	2(6.9)
OSA严重度 [n(%)]			0.695
轻度OSA (5≤AHI <15)	9(31.0)	11(37.9)
中度OSA (15≤AHI<30)	11(37.9)	8(27.6)
重度OSA (AHI≥30)	9(31.0)	10(34.5)
PAP使用时间（h/晚）	4.95±0.67	4.84±0.68	0.563
吸气相PAP(cmH₂O)	11.03±1.94	11.17±2.22	0.802
呼气相PAP(cmH₂O)	6.83±1.69	6.59±1.76	0.597

项目	对照组		干预组		P
项目	治疗前	治疗后	治疗前	治疗后	P
运动功能
6MWD (m)	248.83±64.43	239.93±37.80	268.62±47.02	316.97±58.44^1）	<0.001
伸膝肌肌力（kg）	22.80（20.35,25.30）	23.70（20.50,25.60）^1）	22.40（20.40,27.45）	25.40（20.00,30.45）^1）	0.010
5TSTS时间（s）	18.28（15.54,26.09）	19.50（17.60,23.12）	19.50（15.94,31.10）	13.50（11.75,18.50）^1）	<0.001
BI	62.59±9.41	67.59±10.74^1）	66.03±12.42	76.72±11.82^1）	0.003
呼吸功能
FEV₁%（%）	44.03±8.96	43.97±7.22	43.52±9.58	43.72±9.49	0.914
mMRC（0-1-2-3级）	0-4-14-11	0-16-11-2^1）	0-4-17-8	9-12-7-1^1）	0.014
pH	7.32（7.26,7.34）	7.34（7.32,7.38）^1）	7.32（7.25,7.33）	7.42（7.39,7.43）^1）	<0.001
PaO₂(mmHg)	61.17±8.98	63.48±5.90	57.24±8.40	68.07±5.00^1）	0.002
PaCO₂(mmHg)	48.97±5.42	47.21±4.84	50.97±5.74	46.00±5.15^1）	0.362
PSG参数
AHI（次/h）	19.50（12.45,31.20）	5.00（3.15,5.00）^1）	19.50（10.60,31.10）	3.40（2.60,5.00）^1）	0.067
L-SpO₂（%）	71.14±6.78	86.07±3.69^1）	73.00±6.58	87.69±2.80^1）	0.065
TS90（%）	5.60（2.45,15.20）	4.00（3.30,6.30）^1）	7.20（4.90,16.80）	3.00（2.60,4.45）^1）	0.007
心理状态（分）
HAMD	22.24±3.49	21.03±3.37^1）	22.66±3.57	18.62±3.08^1）	0.006
HAMA	18.38±3.45	17.00±3.64^1）	17.55±3.39	14.31±3.71^1）	0.007
体成分
BMI(kg/m²)	25.76±4.47	26.17±3.83	25.16±3.17	22.31±2.16^1）	<0.001
FM(kg)	28.31±8.60	31.31±8.54^1）	24.13±9.22	20.47±8.32^1）	<0.001
FMI(kg/m²)	9.70±3.14	10.73±3.15^1）	8.15±2.89	6.90±2.59^1）	<0.001
FFM( kg)	48.36±6.28	47.37±4.96	47.65±5.45	46.81±5.43^1）	0.685
FFMI(kg/m²)	16.47±1.57	16.13±0.91	16.23±0.67	15.95±0.81^1）	0.416