SEATTLE, WA—In patients with heart failure and reduced ejection fraction, supervised exercise training has “important therapeutic benefits” when added to continuous positive airway pressure (CPAP) for the treatment of obstructive sleep apnea (OSA), according to results of a prospective randomized trial reported at SLEEP 2015.

Previous research has shown that patients with heart failure can benefit from exercise training, with improved functional class, exercise capacity, and quality of life, said Lia R.A. Bittencourt, MD, PhD, of the Universidade Federal de São Paulo in São Paulo, Brazil. Since OSA is common in patients with heart failure—and exercise can improve OSA—Dr. Bittencourt and colleagues hypothesized that “exercise may improve the functional capacity of patients with heart failure, in part, through attenuation of OSA.”

Of the 106 patients enrolled in the study, 70 met the inclusion criteria and were randomly assigned to Group 1 (control, n=18), Group 2 (exercise training, three session per week, every other day, n=17), Group 3 (CPAP, n=15), or Group 4 (exercise training with CPAP, n=15). A total of 65 patients completed the protocol. Patients were 30–70 years of age, with New York Heart Association (NHYA) class II-III, clinically stable for three months, with ejection fraction below 40%, on optimized medical therapy, and an OSA AHI score ≥5 with symptoms or AHI ≥15.

Excluded were patients with NYHA IV, any acute heart disease, valve disease, hypertrophic cardiomyopathy, pulmonary hypertension, COPD, or musculoskeletal disorders as well as those who had interventions within the past four months.

Polysomnography, cardiopulmonary exercise testing, isokinetic strength, and endurance tests were conducted at baseline and after three months. Patients also completed the SF-36, the Epworth Sleepiness Scale, and the Minnesota Living With Heart Failure and sexual function questionnaires.

There was no difference among groups at baseline. At three months, mean AHI score did not change significantly in the control group, but decreased significantly with exercise (28±17 to 18±12), with CPAP (32±25 to 8±11), and CPAP with exercise (25±15 to 10±16). Excessive daytime sleepiness, NYHA functional classification, and quality of life all improved with exercise; those randomized to exercise alone reported improved muscle strength.

Combining exercise training and CPAP treatment improved cardiopulmonary performance as well as increased sexual function, Dr. Bittencourt concluded.