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Obstructive sleep apnea (OSA) in cardiac rehabilitation setting

OSA has been recognized as an independent risk factor for cardiovascular disease (CVD). Cardiac rehabilitation is an essential part in managing the health needs of cardiovascular patients, although currently, there is no mention of OSA in the guidelines for evaluation and intervention applicable to cardiac rehabilitation centers (CR). Investigating whether the presence of OSA significantly influences the outcomes of CR participation can aid in optimizing CVD risk reduction programming and the overall clinical effectiveness of CR. 

The research is conducted in collaboration between Radford University and James Madison University at the CR departments of Rockingham Memorial Hospital (RMH), Harrisonburg, Virginia and Carilion Memorial Hospital, Roanoke, Virginia.  Two groups of CR patients will be recruited (with and without OSA) and will undergo baseline and follow-up testing before and after participation in early outpatient (Phase II) CR.

CPAP treatment in OSA patients

Treatment with continuous positive airway pressure (CPAP) has been proven to abolish the disease and improve the health condition of the OSA patients. Efficacy of clinical treatment can be determined by measuring heart variables while a simple cardiac test is performed.  The purpose of this study was to measure the effect of treatment on the acute changes in hemodynamic responses to negative intrathoracic pressure in OSA patients. This information can be used to improve standard of practice for treating OSA patients.

Thirty-six OSA patients were tested using a non-invasive bioimpedance device. After 6 weeks of CPAP therapy, patients were retested using the same protocol. We are in the process of analyzing the pre and post treatment data to determine any cardiac improvements. Data will be differentiated based on treatment compliance and comparisons between users and non-users of the CPAP technology will be available for analysis.

Gerontology

Obstructive Sleep Apnea is often undiagnosed in the geriatric population.  OSA is associated with increased risk of falls, cardiovascular disease, morbidity, and mortality.  The prevalence of sleep apnea risk in older adults in the general and in the rehabilitation population has not been studied. This study is to determine the prevalence of obstructive sleep apnea risk in the older adult population of Southwestern Virginia.

This multiple site study will be in collaboration with Genesis Healthcare.  Data regarding the risk for sleep apnea is based on questionnaire results. Study population includes the general community dwelling older adults as well as those receiving healthcare services.

Once the prevalence of sleep apnea is established, we plan to proceed to investigate Physical Therapy guidelines in working with OSA patients.  Currently, The Guide to Physical Therapy Practice by APTA (2nd edition, 2003) does not specifically address OSA patients. Research questions regarding rehabilitation interventions and outcomes will be addressed in future research efforts.