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Influence of Sleep-Disordered Breathing on Quality of Life and Exercise Capacity in Lung Transplant Recipients
The prevalence of sleep-disordered breathing (SDB) after lung transplantation (LTX) is high. It is well-established that SDB is associated with decreased health-related quality of life (HRQoL), but the impact of SDB on exercise capacity is less clear. In this study we investigated HRQoL and exercise capacity in LTX recipients with or without SDB. In addition, we also investigated associations between sleep parameters and both HRQoL and exercise capacity. There were 53 stable LTX recipients (age > 18 years, 31 males, time from LTX 9–120 months) enrolled into the study. They all underwent polysomnography examination. HRQoL was assessed using the Short Form-36 (SF-36). Exercise capacity was measured using the 6-min walk test and cardiopulmonary exercise testing (CPET). We found inverse correlations between severity of SDB and both the predicted maximal workload (r = 0.24, p = 0.04) and maximal oxygen uptake (r = −0.26, p = 0.03) during CPET. Relative oxygen uptake positively correlated with sleep efficiency (r = 0.27, p = 0.03). SF-36 scores did not differ between patients with and without SDB, and were not significantly associated with SDB parameters. In conclusion, the presence of SDB is associated with a slight reduction in maximal exercise capacity in LTX recipients, and there is no appreciable relationship between SDB and HRQoL.
KeywordsCardiopulmonary exercise testing Disordered breathing Exercise capacity Lung transplantation Quality of life Sleep
We acknowledge the English language editing assistance provided by Nicola Ryan, an independent medical writer.
Conflicts of Interest
The authors declare no conflicts of interest in relation to this article.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the Ethics Committee of the Medical Faculty of the University of Duisburg-Essen.
Written informed consent was obtained from all individual participants included in the study.
- Aggarwal S, Nadeem R, Loomba RS, Nida M, Vieira D (2014) The effects of continuous positive airways pressure therapy on cardiovascular end points in patients with sleep–disordered breathing and heart failure: a meta–analysis of randomized controlled trials. Clin Cardiol 37(1):57–65Google Scholar
- Armstrong HF, Lederer DJ, Bacchetta M, Bartels MN (2016) Primary graft dysfunction: long–term physical function outcomes among lung transplant recipients. Heart Lung 45(6):544–549Google Scholar
- Arzt M, Schulz M, Wensel R, Montalvàn S, Blumberg FC, Riegger GA, Pfeifer M (2005) Nocturnal continuous positive airway pressure improves ventilatory efficiency during exercise in patients with chronic heart failure. Chest 127(3):794–802Google Scholar
- ATS (2002) American Thoracic Society Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories ATS statement: guidelines for the six–minute walk test. Am J Respir Crit Care Med 166(1):111–1117Google Scholar
- Baldwin CM, Griffith KA, Nieto FJ, O’Connor GT, Walsleben JA, Redline S (2001) The association of sleep–disordered breathing and sleep symptoms with quality of life in the Sleep Heart Health Study. Sleep 24(1):96–105Google Scholar
- Bartels MN, Armstrong HF, Gerardo RE, Layton AM, Emmert–Aronson BO, Sonett JR, Arcasoy SM (2011) Evaluation of pulmonary function and exercise performance by cardiopulmonary exercise testing before and after lung transplantation. Chest 140(6):1604–1611Google Scholar
- Ben Saad H, Ben Hassen I, Ghannouchi I, Latiri I, Rouatbi S, Escourrou P, Ben Salem H, Benzarti M, Abdelghani A (2015) 6–Min walk–test data in severe obstructive–sleep–apnea–hypopnea–syndrome (OSAHS) under continuous–positive–airway–pressure (CPAP) treatment. Respir Med 109(5):642–655Google Scholar
- Bitter T, Westerheide N, Hossain SM, Prinz C, Horstkotte D, Oldenburg O (2012) Symptoms of sleep apnoea in chronic heart failure – results from a prospective cohort study in 1500 patients. Sleep Breath 16(3):781–791Google Scholar
- Bonanni E, Pasquali L, Manca ML, Maestri M, Prontera C, Fabbrini M, Berrettini S, Zucchelli G, Siciliano G, Murri L (2004) Lactate production and catecholamine profile during aerobic exercise in normotensive OSAS patients. Sleep Med 5(2):137–145Google Scholar
- Brooks D, Solway S, Gibbons WJ (2003) ATS statement on six–minute walk test. Am J Respir Crit Care Med 167(9):1287Google Scholar
- Bullinger M, Kirchberger I (1998) Medical outcomes study short–form general health survey SF–36 manual. German version. Hogrefe Verlag, GöttingenGoogle Scholar
- Dudley KA, El–Chemaly S (2012) Cardiopulmonary exercise testing in lung transplantation: a review. Pulm Med 2012:237852Google Scholar
- Estenne M, Maurer JR, Boehler A, Egan JJ, Frost A, Hertz M, Mallory GB, Snell GI, Yousem S (2002) Bronchiolitis obliterans syndrome 2001: an update of the diagnostic criteria. J Heart Lung Transplant 21(3):297–310Google Scholar
- Gottlieb DJ, Punjabi NM, Mehra R, Patel SR, Quan SF, Babineau DC, Tracy RP, Rueschman M, Blumenthal RS, Lewis EF, Bhatt DL, Redline S (2014) CPAP versus oxygen in obstructive sleep apnea. N Engl J Med 370(24):2276–2285Google Scholar
- Hernandez Voth AR, Benavides Manas PD, De Pablo Gafas A, de Atauri Rodriguez MJ (2015) Sleep–related breathing disorders and lung transplantation. Transplantation 99(9):e127–e131Google Scholar
- Hong S, Dimsdale JE (2003) Physical activity and perception of energy and fatigue in obstructive sleep apnea. Med Sci Sports Exerc 35(7):1088–1092Google Scholar
- Iber C, Ancoli–Israel S, Chesson A, and Quan SF (2007) The American academy of sleep and associated events: rules, terminology and technical specifications. Version 2.0. Darien: American Academy of Sleep Medicine. https://www.aasmnet.org. Accessed on 9 Dec 2018
- Krawczyk M, Flinta I, Garncarek M, Jankowska EA, Banasiak W, Germany R, Javaheri S, Ponikowski P (2013) Sleep disordered breathing in patients with heart failure. Cardiol J 20(4):345–355Google Scholar
- Kugler C, Tegtbur U, Gottlieb J, Bara C, Malehsa D, Dierich M, Simon A, Haverich A (2010) Health–related quality of life in long–term survivors after heart and lung transplantation: a prospective cohort study. Transplantation 90(4):451–457Google Scholar
- Lin CC, Hsieh WY, Chou CS, Liaw SF (2006) Cardiopulmonary exercise testing in obstructive sleep apnea syndrome. Respir Physiol Neurobiol 150(1):27–34Google Scholar
- Mansukhani MP, Allison TG, Lopez–Jimenez F, Somers VK, Caples SM (2013) Functional aerobic capacity in patients with sleep–disordered breathing. Am J Cardiol 111(11):1650–1654Google Scholar
- Marin JM, Carrizo SJ, Vicente E, Agusti AG (2005) Long–term cardiovascular outcomes in men with obstructive sleep apnoea–hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 365:1046–1053Google Scholar
- Naraine VS, Bradley TD, Singer LG (2009) Prevalence of sleep disordered breathing in lung transplant recipients. J Clin Sleep Med 5(5):441–447Google Scholar
- Rizzi CF, Cintra F, Risso T, Pulz C, Tufik S, de Paola A, Poyares D (2010) Exercise capacity and obstructive sleep apnea in lean subjects. Chest 137(1):109–114Google Scholar
- Seiler A, Klaghofer R, Ture M, Komossa K, Martin–Soelch C, Jenewein J (2016) A systematic review of health–related quality of life and psychological outcomes after lung transplantation. J Heart Lung Transplant 35(2):195–202Google Scholar
- Shahar E, Whitney CW, Redline S, Lee ET, Newman AB, Nieto FJ, O’Connor GT, Boland LL, Schwartz JE, Samet JM (2001) Sleep–disordered breathing and cardiovascular disease: cross–sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med 163(1):19–25Google Scholar
- Singer LG, Brazelton TR, Doyle RL, Morris RE, Theodore J, International Lung Transplant Database Study Group (2003) Weight gain after lung transplantation. J Heart Lung Transplant 22(8):894–902Google Scholar
- Singer JP, Chen J, Katz PP, Blanc PD, Kagawa–Singer M, Stewart AL (2015) Defining novel health–related quality of life domains in lung transplantation: a qualitative analysis. Qual Life Res 24(6):1521–1533Google Scholar
- Sommerwerck U, Kleibrink BE, Kruse F, Scherer MJ, Wang Y, Kamler M, Teschler H, Weinreich G (2016) Predictors of obstructive sleep apnea in lung transplant recipients. Sleep Med 21:121–125Google Scholar
- Vanhecke TE, Franklin BA, Zalesin KC, Sangal RB, deJong AT, Agrawal V, McCullough PA (2008) Cardiorespiratory fitness and obstructive sleep apnea syndrome in morbidly obese patients. Chest 134(3):539–545Google Scholar
- Young T, Shahar E, Nieto FJ, Redline S, Newman AB, Gottlieb DJ, Walsleben JA, Finn L, Enright P, Samet JM, Sleep Heart Health Study Research Group (2002) Predictors of sleep–disordered breathing in community–dwelling adults: the Sleep Heart Health Study. Arch Intern Med 162(8):893–900Google Scholar
- Yusen RD, Edwards LB, Kucheryavaya AY, Benden C, Dipchand AI, Goldfarb SB, Levvey BJ, Lund LH, Meiser B, Rossano JW, Stehlik J (2015) The registry of the International Society for Heart and Lung Transplantation: thirty–second official adult lung and heart–lung transplantation report––2015; focus theme: early graft failure. J Heart Lung Transplant 34(10):1264–1277Google Scholar