Effects Of Aerobic Exercise On Cardiopulmonary Function In Patients With Phlegm-dampness Obstructive Sleep Apnea Hypopnea Syndrome

Objective:OSAHS can cause abnormal heart function,decreased lung ventilation function and impaired muscle function through multiple mechanisms.It is a high risk factor for cardiovascular diseases such as hypertension,coronary heart disease and stroke.cardiopulmonary exercise testing（CPET）is a noninvasive examination that can comprehensively evaluate the cardiopulmonary reserve function and exercise endurance of the patient.By observing the changes of cardiopulmonary exercise test indexes（oxygen intake,metabolic equivalent,respiratory reserve,ventilation equivalent,etc.）before and after exercise,this study analyzed the effects of aerobic exercise intervention on cardiopulmonary function in patients with phlegm and humidity OSAHS.Methods:In this study,43 patients who were hospitalized and out-patients in Yan’an Hospital of Kunming City from October 2021 to November 2022 and whose Western medicine diagnosis was consistent with OSAHS standard and TCM syndrome classification was phlegm-dampness-type were enrolled.All patients had completed Polysomnography（PCG）and signed informed consent form.Complete the first cardiopulmonary exercise test and have the exercise prescription formulated by the rehabilitator.Carry out regular aerobic exercise for 3 months,and then conduct the second cardiopulmonary exercise test.General information and sleep monitoring index of patients were recorded,including Apnea hypopnea index,Lowest Oxygen Saturation,Mean Blood Oxygen Saturation,and Oxygen Desaturation Index.Aerobic exercise is power bicycle or treadmill;Exercise intensity was the bullseye rate at the anaerobic threshold,combined with RPE subjective physical feeling（15-16 points）and Borg dyspnea score（patients felt slightly breathless）.The exercise frequency was3 times/week for 3 months,with 36 times in total.The exercise time is 30-40min each time,including warm-up period,exercise period and relaxation period.Cardiopulmonary exercise test and TCM syndrome score table were performed before and after treatment.Observation indicators:Heart rate,Heart Rate Reserve,Systolic blood pressure,Diastolic blood pressure,Incremental oxygen uptake per watt;Peak volume oxygen,anaerobic threshold oxygen uptake,Peak VO₂/kg,anaerobic threshold oxygen uptake,peak metabolic equivalent,anaerobic threshold metabolic equivalent,Peak oxygen pulse,expected percentage of oxygen Pulse,anaerobic threshold load,Peak load power,Respiratory reserve,Peak ventilatory equivalent,threshold oxygen ventilation equivalent,carbon dioxide ventilation equivalent in anaerobic zone,respiratory exchange rate,etc.collected data and carried out statistical analysis.Results:1.General information:A total of 43 patients with sputum dampness OSAHS were included,including 36 males,accounting for 83.7%,and 7 females,accounting for16.3%;The age varied from 22 to 68 years old,with an average age of48.18±10.68years old.The mean BMI was 25.57±3.40Kg/m².There were 17patients with coronary heart disease,9 with diabetes,15 with smoking,6 with hyperlipidemia,and 27 with beta-blockers.2.Comparison of CPET indexes:（1）Before and after aerobic exercise:After intervention,Peak VO₂,VO₂@AT,Peak VO₂/kg,VO2/kg@AT,RER,ΔVO₂/ΔWR,Mets@AT,Peak Mets,Peak VE,HR Peak,Peak O₂Pulse,Peak O₂Pulse%was higher than before intervention,and the difference was statistically significant（P<0.05）.VE/VCO₂@AT,BR%,VE/VCO₂slope and HRR decreased compared with before intervention,and the differences were statistically significant（P<0.05）.There was no significant difference in other indexes（P>0.05）.（2）Cardiopulmonary indexes after aerobic exercise intervention（Peak VO₂,Peak Mets,Peak WR,Peak VE,BR%,VE/VCO₂@AT,VE/VCO₂slope）increase or decrease amplitude and age,BMI,AHI,MSa O₂,LSa O₂and ODI.Pearson correlation analysis showed that the increase amplitude of Peak VO₂was negatively correlated with AHI and MSa O₂（P<0.05）.Peak Mets were negatively correlated with AHI and MSa O₂（P<0.05）.The increase of Peak WR was negatively correlated with MSa O₂（P<0.05）.VE/VCO₂@AT decreased significantly with AHI and ODI（P<0.05）.Peak VE lifting amplitude,BR%decreasing amplitude and VE/VCO₂slope decreasing amplitude had no correlation with related indexes（P>0.05）.（3）AHI group,mild group（AHI≤15）,moderate and severe group（AHI>15）for analysis,differences within groups:The cardiopulmonary indexes(WR,Peak VO₂,VO₂@AT,Peak VO₂/kg,VO₂/kg@AT,Mets@AT,Peak O₂Pulse,Peak O2 Pulse%pred of the two groups after aerobic exercise intervention were higher than before intervention,and the difference was statistically significant（P<0.05）.There was no significant difference among all groups（P>0.05）.3.Comparison of total symptom score and symptom score of TCMAfter aerobic exercise intervention,the total symptom score and symptom score decreased after intervention compared with before intervention,and the difference was statistically significant（P<0.05）.Conclusion:1.Patients with phlegm-dampness OSAHS have increased Peak VO₂,VO₂@AT,Peak VO₂/kg,VO₂/kg@AT,Mets@AT,Peak Mets,Peak O₂Pulse and Peak O₂Pulse%pred after aerobic exercise intervention.It is suggested that exercise can improve patients’heart function and exercise tolerance.2.After aerobic exercise intervention,Peak VE increased and VE/VCO₂@AT,VE/VCO₂slope and BR%decreased in patients with phlegm and humidity OSAHS,suggesting that aerobic exercise can improve lung ventilation function in patients with OSAHS.3.Patients with phlegm-dampness OSAHS experienced a decrease in phlegm-dampness syndrome scores after aerobic exercise intervention,suggesting that exercise can improve clinical symptoms of phlegm-dampness OSAHS and improve patients’ quality of life.