ObjectiveTo determine the risk of long-term major adverse cardiovascular events (MACE) when sleep-disordered breathing (SDB) and decreased cardiorespiratory fitness (CRF) co-occur.MethodsWe included consecutive patients who underwent symptom-limited cardiopulmonary exercise tests between January 1, 2005, and January 1, 2010, followed by first-time diagnostic polysomnography within 6 months. Patients were stratified based on the presence of moderate-to-severe SDB (apnea/hypopnea index ≥15 per hour) and decreased CRF defined as <70% predicted peak oxygen consumption (VO2). Long-term MACE was a composite outcome of myocardial infarction (MI), coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI), stroke or transient ischemic attack (TIA), and death, assessed until May 21, 2018. Cox-proportional hazard models were adjusted for factors known to influence CRF and MACE.ResultsOf 498 included patients (60±13 years, 28.1% female), 175 (35%) had MACE (MI=17, PCI=14, CABG=13, stroke=20, TIA=12, deaths=99) at a median follow-up of 8.7 years (interquartile range=6.5 to 10.3 years). After adjusting for age, sex, beta blockers, systemic hypertension, diabetes mellitus, coronary artery disease, cardiac arrhythmia, chronic obstructive pulmonary disease, smoking, and use of positive airway pressure (PAP), decreased CRF alone (hazard ratio [HR]=1.91, 95% confidence interval [CI], 1.15 to 3.18; P=.01), but not SDB alone (HR=1.26, 95% CI, 0.75 to 2.13, P=.39) was associated with increased risk of MACE. Those with SDB and decreased CRF had greater risk of MACE compared with patients with decreased CRF alone (HR=1.85; 95% CI, 1.21 to 2.84; P<.005) after accounting for these confounders. The risk of MACE was attenuated in those with reduced CRF alone after additionally adjusting for adequate adherence to PAP (HR=1.59; 95% CI, 0.77 to 3.31; P=.21).ConclusionThe incidence of MACE, especially mortality, was high in this sample. Moderate-to-severe SDB with concurrent decreased CRF was associated with higher risk of MACE than decreased CRF alone. These results highlight the importance of possibly including CRF in the risk assessment of patients with SDB and, conversely, that of screening for SDB in patients with low peak VO2.

Objective: To compare cardiovascular responses in a whirlpool bath at 40 degrees C versus user-controlled water temperature (UCT).Material and Methods: In an experimental study, sis healthy men, 36 to 43 years of age, participated in two randomly assigned trials of whirlpool bath use for 25 minutes at 40 degrees C and UCT, Water temperature, esophageal temperature (T-es), heart rate (HR), systolic blood pressure (SEP), and perceived comfort were monitored before immersion and at 5-minute intervals during immersion.Results: Although the mean mater temperature during the UCT trial was slightly below 40 degrees C (39.4 +/- 2.O degrees C), it varied considerably among subjects (from 36.5 +/- 2.1 degrees C to 42.5 +/- 1.7 degrees C). Peak T-es, HR, and SBP mere not significantly-different between the two trials, although the UCT trial had greater variability, No adverse effects mere observed. Mild or moderate overheating was reported by four subjects in the 40 degrees C trial and two subjects in the UCT trial, and mild chest pain, light-headedness, dyspnea, and nausea were reported by one subject during the UCT trial. A trend toward higher comfort ratings was noted in the UCT than in the 40 degrees C trial, especially during the final 10 minutes of immersion.Conclusion: These data show, that cardiovascular responses to whirlpool bathing for 25 minutes at 40 degrees C are mild, In comparison with the 40 degrees C trial, peak T-es, HR, and SEP under UCT conditions were not, on the average, significantly higher, although more variability existed among the subjects.

OBJECTIVETo determine the effect of psychologic distress, measured with a commonly used screening questionnaire, on 6-month morbidity and rehospitalization costs in coronary patients.DESIGNPsychologic distress was determined by screening with the Symptom Checklist-90--Revised (SCL-90-R) self-report inventory during the second week of cardiac rehabilitation. Costs associated with cardiovascular rehospitalization during a 6-month follow-up period were recorded, and differences between "distressed" and "nondistressed" patients were analyzed statistically.MATERIAL AND METHODSThe study cohort consisted of 381 patients (311 men and 70 women) referred for cardiac rehabilitation after an index hospitalization for unstable angina, myocardial infarction, coronary angioplasty, or coronary bypass procedure. Patients with SCL-90-R scores above the 90th percentile for outpatient adults were considered distressed (N = 41); patients with scores below this level were considered nondistressed (N = 340).RESULTSThe 6-month follow-up was complete in all but 1 of the 381 patients. Distressed patients had significantly higher rates of cardiovascular rehospitalization, any recurrent events, and recurrent "hard events" (cardiac death, myocardial infarction, or cardiac arrest and resuscitation) within 6 months after dismissal from their index hospitalization in comparison with nondistressed patients. Adjustment for other factors associated with a risk of early rehospitalization and recurrent events did not reduce the strength or significance of the association between psychologic distress and early cardiovascular rehospitalization or recurrent events. The mean rehospitalization costs were significantly higher in the distressed than in the nondistressed patients ($9,504 versus $2,146).CONCLUSIONThese data add support to the hypothesis that psychologic distress adversely affects the prognosis in coronary patients, confirm the added morbidity and rehospitalization costs attributable to psychologic distress, and suggest the potential for improving the prognosis in selected coronary patients by identification and appropriate treatment of psychologic distress.

The aim of this study was to examine selected substrate and hormone responses to 30-min treadmill runs performed several days before and after a competitive marathon (42.2 km) to determine the time course for return of altered responses to pre-race levels. Six experienced male runners (30.8 +/- 9.1 years) ran at their predicted race pace (77.1% +/- 4.1% of VO2max) 8-7 days prior (S-1) to the Boston Marathon and 2-3 (S-2), 6-7 (S-3), and 13-14 days (S-4) post-marathon. All 30-min runs were performed in the morning at a constant time for each subject following a 12-h fast. Blood samples were drawn immediately before and immediately after (within 1 min) the 30-min runs. Post-exercise glucose responses were higher (P less than 0.05) during S-2 and S-3 compared with S-1 values. S-2 post-exercise lactate concentrations were also higher than the corresponding S-1 value. Pre-exercise free fatty acid (FFA) levels during S-4, and the post-exercise FFA values during S-2, S-3, and S-4, were lower (P less than 0.05) than the corresponding S-1 concentrations. Pre- and post-exercise alanine levels during S-2 were higher (P less than 0.05) than the S-1 values. Both pre- and post-exercise insulin levels during S-2, S-3, and S-4 were greater (P less than 0.05) than corresponding S-1 concentrations. Glucagon concentrations were unchanged across all sessions.(ABSTRACT TRUNCATED AT 250 WORDS)

Seven male runners (21--42 years) were examined before and after the 1976 Boston Marathon to provide data concerning the cardio-respiratory and perceptual recovery from the performance. Treadmill runs, 30 min in duration, were administered 1 week prior to the marathon and 2--3, 6--7 and 13--15 days following. Treadmill speed was held constant and based on each runner's planned race pace. Maximal performance data were collected 1 week before and 2 weeks after the race. Data were analyzed using a 2-way ANOVA (4 thirty min run data collection periods and 3 exercise time points--5, 15 and 30 min) and "t" tests. Treatment effects were not observed for either HR or VE, however, perceived exertion (RPE) was significantly elevated 2--3 and 6--7 days post-marathon and VO2 was significantly lower at 13--15 days. HR and RPE showed significant time effects indicating a non-steady state response. None of the maximal test variables were significantly displaced. All variables were returned to pre-marathon levels by 13--15 days except VO2 which was lower. Aerobic capacity was not a limiting factor in the recovery from a marathon run. Muscle soreness and stiffness seem to be related to the increased perceptual ratings following a marathon run.