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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.

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.

Last updated: Jul 15, 2026•0 RCTs•📖 Read as article →

Evidence Score

Evidence Score34/100
Human RCT☆☆☆☆☆
Meta-analysis☆☆☆☆☆
Mechanism★★★★★
Safety★★★★☆
Confidencelow

Study Evidence

Study 1. Ticagrelor is associated with periodic breathing during exercise in coronary patients undergoing cardiac rehabilitation: a retrospective observational study.

observational

Pointel S, Delavenne X, Bonjean P, Mismetti V, Vergnon JM, Froudarakis M, Hupin D, Isaaz K, Roche F · Sleep &amp; breathing = Schlaf &amp; Atmung (2026)

Participants: N/A
Duration: October 2012-December 2021 (retrospective)
Intervention: Ticagrelor (reversible P2Y12 inhibitor) versus thienopyridines (irreversible P2Y12 inhibitors) after acute coronary syndrome
Outcome: Exercise-induced periodic breathing (≥3 consecutive oscillation cycles of VE, VO2, or VCO2 with amplitude ≥30% of mean values); secondary outcomes: peak VO2, end-tidal CO2 pressure (PETCO2), ventilatory equivalent for CO2 (EqCO2) at peak VO2
Effect Size: OR=7.17 (multivariable), 95% CI [2.31-25.19]
Population: 84 coronary patients (36 on ticagrelor, 48 on thienopyridines) who underwent cardiac rehabilitation following angioplasty with coronary stenting

Result:

PubMed: 42446764DOI: 10.1007/s11325-026-03737-5

Mechanism Graph

Ticagrelor affects respiratory centre activity
↓
This leads to dyspnoea and central sleep apnoea
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During exercise, it induces periodic breathing patterns
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Result: Increased risk of periodic breathing without impairing gas exchange or aerobic capacity

Limitations

  • ⚠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.

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References

  1. 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 &amp; breathing = Schlaf &amp; Atmung, 2026. PMID: 42446764 DOI: 10.1007/s11325-026-03737-5
Disclaimer: This content is for educational purposes only and is not medical advice. Evidence scores reflect the quality and quantity of available research, not clinical recommendations. Always consult a healthcare professional before starting any supplement or intervention.