Ticagrelor is associated with a greater than 7-fold increased risk of periodic breathing during exercise in coronary patients undergoing cardiac rehabilitation.
In a retrospective observational study of 84 coronary patients, ticagrelor was independently associated with a >7-fold increased risk of exercise-induced periodic breathing compared to thienopyridines (OR=7.17, 95% CI [2.31-25.19], p<0.001). Despite this ventilatory disturbance, ticagrelor did not impair gas exchange or aerobic capacity, and patients on ticagrelor had significantly higher peak VO2.
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Ticagrelor is associated with a greater than 7-fold increased risk of periodic breathing during exercise in coronary patients undergoing cardiac rehabilitation. The current body of evidence comprises 1 study. EvidenceHub rates the overall confidence at 34/100 (low).
The Claim
Ticagrelor is associated with a greater than 7-fold increased risk of periodic breathing during exercise in coronary patients undergoing cardiac rehabilitation.
This conclusion is most relevant to: 84 coronary patients (36 on ticagrelor, 48 on thienopyridines) who underwent cardiac rehabilitation following angioplasty with coronary stenting.
What the Research Shows
The conclusion draws on 1 linked study. Highlights from the cited literature:
- ▸Ticagrelor is associated with periodic breathing during exercise in coronary patients undergoing cardiac rehabilitation: a retrospective observational study. (Sleep & breathing = Schlaf & Atmung, 2026) —
How It Works
The proposed biological pathway:
- ▸Ticagrelor affects respiratory centre activity
- ▸This leads to dyspnoea and central sleep apnoea
- ▸During exercise, it induces periodic breathing patterns
- ▸Result: Increased risk of periodic breathing without impairing gas exchange or aerobic capacity
Who Might Benefit
Evidence fit by population:
- ▸84 coronary patients (36 on ticagrelor, 48 on thienopyridines) who underwent cardiac rehabilitation following angioplasty with coronary stenting
Recommended Dose
N/A
Limitations & Caveats
Important context when interpreting this evidence:
- ▸Retrospective, single-centre design limits generalizability
- ▸Small sample size (n=84) and potential for unmeasured confounders
Frequently Asked Questions
Does ticagrelor cause periodic breathing during exercise?▼
Yes, the study found ticagrelor was associated with a >7-fold increased risk of exercise-induced periodic breathing compared to thienopyridines.
Does this breathing disturbance affect exercise capacity?▼
No, despite the periodic breathing, patients on ticagrelor had significantly higher peak VO2, indicating no impairment in aerobic capacity.
Should ticagrelor be discontinued if periodic breathing occurs?▼
The authors suggest maintaining ticagrelor therapy, as the ventilatory disturbance does not impair gas exchange or functional performance.
What is the mechanism linking ticagrelor to periodic breathing?▼
Ticagrelor is thought to affect respiratory centre activity, leading to dyspnoea and central sleep apnoea, which may manifest as periodic breathing during exercise.
References
- 1.Pointel S, Delavenne X, Bonjean P, Mismetti V, Vergnon JM, Froudarakis M, Hupin D, Isaaz K, Roche F. “Ticagrelor is associated with periodic breathing during exercise in coronary patients undergoing cardiac rehabilitation: a retrospective observational study..” Sleep & breathing = Schlaf & Atmung, 2026. PMID: 42446764 DOI: 10.1007/s11325-026-03737-5