Benefits of High-Intensity Exercise Training to Patients with Chronic Obstructive Pulmonary Disease: A Controlled Study.

BACKGROUND: Various exercise training programs are used for patients with chronic obstructive pulmonary disease (COPD) of different severity. OBJECTIVES: To investigate the impact of individualized high-intensity training on exercise capacity with COPD. METHODS: A total of 49 patients agreed to participate. Of these, 31 were assigned to the training group and 18 served as controls. The training group exercised twice a week for 90 min with consecutively increasing loads. At the time of enrollment (T0), as well as after 3 (T1) and 6 (T2) months, a 6-min walk test (6-MWT) was performed and data on health-related quality of life, femoral muscle thickness, and various serum markers were obtained. RESULTS: The training group improved in their 6-MWT results (T0 = 407 ± 152 m vs. T1 = 459 ± 127 m, p = 0.002, vs. T2 = 483.2 ± 130.1 m, p = 0.004), in their cross-sectional area of the musculus rectus femoris (T0 = 6.2 ± 1.2 cm2 vs. T1 = 6.9 ± 1.2 cm2, p = 0.003, vs. 7.5 ± 1.6 cm2, p = 0.002), and in their St. George's Respiratory Questionnaire (SGRQ) score (T0 = 43.3 ± 18.0 vs. T1 = 36.0 ± 18.4, p = 0.001, vs. T2 = 34.7 ± 18. 0, p = 0.004). Serum levels of myostatin, irisin, resistin, and α-Klotho did not change significantly within the training period. Of note, the exercise group showed an inverse relationship between serum levels of resistin and those of α-Klotho after 6 months (r = -0.608, p = 0.021). CONCLUSIONS: COPD patients undergoing an individualized, structured, high-intensity training program improved their exercise capacity, gained muscle mass, and improved their quality of life.

Severe central sleep apnea is associated with atrial fibrillation in patients with left ventricular systolic dysfunction.

BACKGROUND: The results of previous studies investigating the association between atrial fibrillation (AF) and central sleep apnea (CSA) in patients with left ventricular (LV) systolic dysfunction are contradictory. METHODS: We prospectively enrolled 267 patients in this cross-sectional study with LV ejection fractions ≤50%, who were screened for sleep disordered breathing using cardiorespiratory polysomnography after patients with predominantly obstructive sleep apnea or insufficient sleep studies had been excluded. RESULTS: AF at study entry was found in 70 of 267 patients (26%). CSA with an apnea/hypopnea index (AHI) ≥15/hour was present in 116 patients (43%) and 67 patients (25%) had severe CSA with an AHI > 30/hour. Univariate analysis revealed a significant association between AF and severe CSA, age, male gender, arterial hypertension, left atrial diameter, brain natriuretic peptide, chronic kidney disease, New York Heart Association class, digitalis, and the lack of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Multivariate analysis revealed a significant association between AF and severe CSA (odds ratio [OR]: 5.21; 95% confidence interval [CI]: 1.67-16.27, P = 0.01), age (OR: 1.22 per 5-year increase; 95% CI: 1.05-1.40, P = 0.01), left atrial diameter (OR 1.61 per 5-mm increase; 95% CI: 1.22-2.01, P < 0.01), and digitalis (OR: 2.7; 95% CI: 1.26-5.79, P = 0.01). CONCLUSIONS: AF is associated with severe CSA but not with moderate CSA in addition to age, use of digitalis, and left atrial size in patients with LV systolic dysfunction. Future studies evaluating the potential benefit of adaptive servo-ventilation therapy to prevent AF or to decrease the AF burden in heart failure patients should therefore focus on patients with severe central sleep apnea.

Benefits of whole body vibration training in patients hospitalised for COPD exacerbations - a randomized clinical trial.

BACKGROUND: Patients with stable COPD show improvements in exercise capacity and muscular function after the application of whole body vibration. We aimed to evaluate whether this modality added to conventional physiotherapy in exacerbated hospitalised COPD patients would be safe and would improve exercise capacity and quality of life. METHODS: 49 hospitalised exacerbated COPD patients were randomized (1:1) to undergo physiotherapy alone or physiotherapy with the addition of whole body vibration. The primary endpoint was the between-group difference of the 6-minute walking test (day of discharge - day of admission). Secondary assessments included chair rising test, quality of life, and serum marker analysis. RESULTS: Whole body vibration did not cause procedure-related adverse events. Compared to physiotherapy alone, it led to significantly stronger improvements in 6-minute walking test (95.55 ± 76.29 m vs. 6.13 ± 81.65 m; p = 0.007) and St. Georges Respiratory Questionnaire (-6.43 ± 14.25 vs. 5.59 ± 19.15, p = 0.049). Whole body vibration increased the expression of the transcription factor peroxisome proliferator receptor gamma coactivator-1-α and serum levels of irisin, while it decreased serum interleukin-8. CONCLUSION: Whole body vibration during hospitalised exacerbations did not cause procedure-related adverse events and induced clinically significant benefits regarding exercise capacity and health-related quality of life that were associated with increased serum levels of irisin, a marker of muscle activity. TRIAL REGISTRATION: German Clinical Trials Register DRKS00005979. Registered 17 March 2014.

Sleep-disordered breathing in patients with implantable cardioverter-defibrillator.

AIMS: To assess the prognostic significance of screening for sleep-disordered breathing in patients with implantable cardioverter-defibrillator (ICD) with regard to appropriate ICD therapy and total mortality. METHODS AND RESULTS: Overnight sleep studies were performed in 204 ICD recipients not known to have sleep apnoea and with no history of daytime sleepiness. Sleep-disordered breathing was diagnosed in the presence of an apnoea-hypopnea index of five or more events per hour. Seventy patients (34%) had no sleep apnoea, 105 patients (51%) had central sleep apnoea, and 29 patients (14%) had obstructive sleep apnoea. During 38 ± 26 months follow-up, 80 patients (39%) received appropriate ICD therapy for ventricular tachycardia (VT) or ventricular fibrillation (VF), and 54 patients (26%) died. On multivariate Cox regression analysis, age, left ventricular (LV) end-diastolic diameter, secondary prevention ICD indication, use of diuretics, and absence of aldosterone antagonist therapy but not sleep apnoea were associated with appropriate ICD therapy for VT or VF. In addition, multivariate Cox analysis identified age and LV ejection fraction but not sleep apnoea as predictors of total mortality. CONCLUSION: Undiagnosed sleep-disordered breathing is common in ICD recipients. The presence and severity of previously unknown sleep apnoea in ICD recipients, however, does not appear to be an independent predictor of appropriate ICD therapy or morality during follow-up.

[Sleep disordered breathing and nonsustained ventricular tachycardia in patients with chronic heart failure]. / Schlafbezogene Atmungsstörungen und maligne ventrikuläre Arrhythmien bei Patienten mit chronischer Herzinsuffizienz.

BACKGROUND: Patients with chronic heart failure (CHF) have a high incidence of sleep disordered breathing (SDB). It is assumed that patients with the combination of CHF and SDB have more ventricular couplets and nonsustained ventricular tachycardia (NSVT) than patients without SDB. METHODS: In 63 patients, 49 men and 14 women with chronic heart failure (EF < 45%), all-night polysomnography and long-term-ECG were performed. Mean age was 59 ± 15 years, mean BMI 27 ± 5 kg/m(2). 56% had an ischemic, 44% a nonischemic heart disease. 51% had heart insufficiency classification NYHA III. RESULTS: 42 of the 63 patients (67%) had sleep disordered breathing (SDB) with an AHI ≥5/h. In 24 patients (38%) SDB was central, in 18 (29%) obstructive. More patients with SDB than patients without SDB had NSVT (50% vs. 19%). Nocturnal frequency of NSVT in patients with SDB was about twice as high as the rate observed during daytime (0.48/h vs. 0.21/h). In patients without SDB there was no relevant difference between day and night (0.23/h vs. 0.21/h). AHI correlated with NSVT (r = 0.329, p < 0.01). Day/night comparison of couplets was 2.3/h vs. 1.9/h in SDB patients and 2.0/h vs. 1.6/h in patients without SDB. CONCLUSIONS: Patients with chronic heart failure have a high prevalence of SDB. The combination of CHF and SDB predisposes for nocturnal malignant ventricular arrhythmias.