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Regmi B, Borrelli C, Giannoni A, Kahles F, Macefield VG, Dreher M, Spiesshoefer J. Effective non-invasive ventilation reduces muscle sympathetic nerve activity in patients with stable hypercapnic COPD. Clin Auton Res 2024; 34:297-301. [PMID: 38502257 DOI: 10.1007/s10286-024-01027-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/01/2024] [Indexed: 03/21/2024]
Abstract
Increased sympathetic drive is of prognostic significance in chronic obstructive pulmonary disease (COPD) but its determinants remain poorly understood. One potential mechanism may be chemoreflex-mediated adrenergic stimulation caused by sustained hypercapnia. This study determined the impact of non-invasive ventilation (NIV) on muscle sympathetic nerve activity (MSNA) in patients with stable hypercapnic COPD. Ten patients (age 70 ± 7 years, GOLD stage 3-4) receiving long-term NIV (mean inspiratory positive airway pressure 21 ± 7 cmH2O) underwent invasive MSNA measurement via the peroneal nerve during spontaneous breathing and NIV. Compared with spontaneous breathing, NIV significantly reduced hypercapnia (PaCO2 51.5 ± 6.9 vs 42.6 ± 6.1 mmHg, p < 0.0001) along with the burst rate (64.4 ± 20.9 vs 59.2 ± 19.9 bursts/min, p = 0.03) and burst incidence (81.7 ± 29.3 vs 74.1 ± 26.9 bursts/100 heartbeats, p = 0.04) of MSNA. This shows for the first time that correcting hypercapnia with NIV decreases MSNA in COPD.
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Affiliation(s)
- Binaya Regmi
- Department of Pneumology and Intensive Care Medicine, University Hospital RWTH Aachen, 52074, Aachen, Germany
| | - Chiara Borrelli
- Department of Neurology, University of Iowa, Iowa City, IA, USA
- Interdisciplinary Health Science Centre, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Alberto Giannoni
- Interdisciplinary Health Science Centre, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Florian Kahles
- Department of Cardiology and Vascular Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Vaughan G Macefield
- Human Autonomic Neurophysiology Laboratory, Department of Neuroscience, Monash University, Victoria, Australia
- Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, VIC, Australia
| | - Michael Dreher
- Department of Pneumology and Intensive Care Medicine, University Hospital RWTH Aachen, 52074, Aachen, Germany
| | - Jens Spiesshoefer
- Department of Pneumology and Intensive Care Medicine, University Hospital RWTH Aachen, 52074, Aachen, Germany.
- Interdisciplinary Health Science Centre, Scuola Superiore Sant'Anna, Pisa, Italy.
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Labeix P, Court Fortune I, Muti D, Berger M, Chomette-Ballereau S, Barthelemy JC, Féasson L, Costes F. The effect of a pressure ventilatory support on quadriceps endurance is maintained after exercise training in severe COPD patients. A longitudinal randomized, cross over study. Front Physiol 2022; 13:1055023. [DOI: 10.3389/fphys.2022.1055023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/14/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose: In severe chronic obstructive pulmonary disease (COPD) patients, the application of an inspiratory pressure support (IPS) during exercise increases exercise tolerance and the benefit of exercise training during pulmonary rehabilitation (PR). Moreover, it improves quadriceps endurance after a session of cycling exercise suggesting a reduced muscle fatigue. We looked for the persistence of this effect after PR and sought an association between the improved quadriceps endurance with IPS and the training load during PR.Patients and methods: We studied 20 patients with severe COPD (6 in stage 3and 14 in stage 4 of GOLD) before and after PR. As part of a PR program, patients completed 16 cycling sessions over 6 weeks with the addition of IPS during exercise. As a surrogate of muscular fatigue, quadriceps endurance was measured at 70% of maximal strength in a control condition, after a constant work rate exercise test (CWR) with IPS (TlimQ IPS) or with a sham ventilation (TlimQsham), in a random order. These tests were repeated similarly at the end of PR.Results: PR was associated with a significant increase in maximal power output, cycling endurance, quadriceps strength and endurance. Session training load (power output x duration of the session) increased by 142% during the course of the program. Before PR, CWR duration increases with IPS compared to sham ventilation (Δtime = +244s, p = 0.001). Compared to control condition, post-exercise TlimQ reduction was lower with IPS at isotime than at the end of CWR or than with sham ventilation (−9 ± 21%, −18 ± 16% and −23 ± 18%, respectively, p = 0.09, p < 0.0001 and p < 0.0001). After PR, the post-exercise decrease of TlimQ was reduced after IPS compared to sham (−9 ± 18% vs. −21 ± 17%, respectively, p = 0.004). No relationship was found between the prevention of quadriceps fatigue and the training load.Conclusion: In severe COPD patients, the beneficial effect of a ventilator support on quadriceps endurance persisted after PR with IPS. However, it was not related to the increase in training load, and could not predict the training response to non-invasive ventilation during exercise.
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Heubel AD, Kabbach EZ, Schafauser NS, Phillips SA, Pires Di Lorenzo VA, Borghi Silva A, Mendes RG. Noninvasive ventilation acutely improves endothelial function in exacerbated COPD patients. Respir Med 2021; 181:106389. [PMID: 33831730 DOI: 10.1016/j.rmed.2021.106389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 03/11/2021] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is associated with an elevated risk of cardiovascular events, which can be linked to endothelial dysfunction. In this study, we aimed to investigate whether noninvasive ventilation (NIV) acutely changes endothelial function in hospitalized AECOPD patients. METHODS Twenty-one AECOPD patients were assessed in a hospital ward setting from 24 to 48 h after admission. NIV was applied using a ventilator with bilevel pressure support. Before and after NIV protocol, patients were evaluated regarding (1) endothelium-dependent function, assessed non-invasively using the flow-mediated dilation (FMD) method; (2) arterial blood gas analysis. Other baseline evaluations included clinical and anthropometric data, and laboratory tests. RESULTS The total group showed a significant improvement in FMD as a result of NIV effect (P = 0.010). While arterial carbon dioxide and oxygen were not altered, oxygen saturation increased after NIV (P = 0.045). The subgroup comparison of responders (FMD ≥ 1%) and non-responders (FMD < 1%) showed significant baseline differences in body mass index (BMI) (P = 0.019) and predicted forced expiratory volume in one second (FEV1) (P = 0.007). In univariate and multivariate analyses, both BMI and FEV1 were determinant for endothelial response to NIV. CONCLUSION NIV acutely improves endothelial function in hospitalized AECOPD patients. Overweight and COPD severity may represent important characteristics for the magnitude of peripheral vascular response.
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Affiliation(s)
- Alessandro Domingues Heubel
- Cardiopulmonary Physiotherapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil.
| | - Erika Zavaglia Kabbach
- Cardiopulmonary Physiotherapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil.
| | - Nathany Souza Schafauser
- Cardiopulmonary Physiotherapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil.
| | - Shane Aaron Phillips
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, Illinois, United States of America.
| | - Valéria Amorim Pires Di Lorenzo
- Cardiopulmonary Physiotherapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil.
| | - Audrey Borghi Silva
- Cardiopulmonary Physiotherapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil.
| | - Renata Gonçalves Mendes
- Cardiopulmonary Physiotherapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil.
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Hamid M, Akhtar MI, Ahmed S. Immediate changes in hemodynamics and gas exchange after initiation of noninvasive ventilation in cardiac surgical patients. Ann Card Anaesth 2021; 23:59-64. [PMID: 31929249 PMCID: PMC7034218 DOI: 10.4103/aca.aca_69_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction Cardiac surgery is associated with pulmonary dysfunction and complications such as prolonged intubation and reintubation. Bilevel positive airway pressure (BiPAP) machine has been used in the clinical settings to improve oxygenation, reduce work of breathing, and avoid reintubation. The effect of BiPAP on cardiovascular parameters is not well established, and very few studies have targeted hemodynamic changes. The aim of the study was to assess the immediate effect of BiPAP on respiratory and hemodynamic parameters in post-cardiac surgery patients. Materials and Methods This quasi-experimental study was done on 33 adult cardiac surgery patients. Ethical review committee approval was sought and consent was taken. All patients who were in respiratory distress with respiratory rate of >30/min and/or PaO2:FiO2 ratio of <200 were included. Hemodynamic and respiratory parameters were recorded just before and 15 min after BiPAP application. Sample size was determined on the basis of BiPAP effect on one of the variables, PaO2:FiO2 ratio. Results A total of 33 patients were included in the study. The average age of the patients was 60.97 ± 10.8, of which 23 (69.7%) were males and 10 (30.7%) females. BiPAP application leads to statistically significant improvement in ventilator parameters including SaO2 29 (87.7%), PaO2 29 (87.8%), PaCO2 21 (63.6%), and PaO2:FiO2 ratio in 27 (81.8%). Conclusion Ventilatory parameters were significantly improved after BiPAP application in this study, but hemodynamic parameters showed no statistically significant change. BiPAP application was also able to decrease the need for reintubation in post-cardiac surgery patients.
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Affiliation(s)
- Mohammad Hamid
- Department of Anaesthesia, Aga Khan University, Karachi, Pakistan
| | | | - Saba Ahmed
- Department of Anaesthesia, Aga Khan University, Karachi, Pakistan
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Adler D, Bailly S, Benmerad M, Joyeux-Faure M, Jullian-Desayes I, Soccal PM, Janssens JP, Sapène M, Grillet Y, Stach B, Tamisier R, Pépin JL. Clinical presentation and comorbidities of obstructive sleep apnea-COPD overlap syndrome. PLoS One 2020; 15:e0235331. [PMID: 32645005 PMCID: PMC7347183 DOI: 10.1371/journal.pone.0235331] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 06/14/2020] [Indexed: 12/21/2022] Open
Abstract
Background More advanced knowledge is needed on how COPD alters the clinical presentation of obstructive sleep apnea (OSA) and how the association of both diseases, known as ‘overlap syndrome’ (OVS), impacts on cardiovascular health. Objective To investigate differences between patients with OVS and those with moderate-to-severe OSA alone. Methods A cross-sectional study conducted in the French National Sleep Apnea Registry between January 1997 and January 2017. Univariable and multivariable logistic regression models were used to compare OVS versus OSA alone on symptoms and cardiovascular health. Results 46,786 patients had moderate-to-severe OSA. Valid spirometry was available for 16,466 patients: 14,368 (87%) had moderate-to-severe OSA alone and 2098 (13%) had OVS. A lower proportion of OVS patients complained of snoring, morning headaches and excessive daytime sleepiness compared to OSA alone (median Epworth Sleepiness Scale score: 9 [interquartile range (IQR) 6–13] versus 10 (IQR 6–13), respectively; P <0.02). Similarly, a lower proportion of OVS patients (35.6% versus 39.4%, respectively; P <0.01) experienced sleepiness while driving. In contrast, 63.5% of the OVS population experienced nocturia compared to 58.0% of the OSA population (P<0.01). Apnea hypopnea index (36 [25; 52] vs 33.1 [23.3; 50]), oxygen desaturation index (28 [15; 48] vs 25.2 [14; 45]) and mean nocturnal SaO2 (92 [90; 93.8] vs 93 [91.3; 94]) were significantly more altered in the OVS group. Associated COPD had no effect on the prevalence of hypertension and stroke. After controlling for main confounders, COPD severity was associated in a dose-response relationship with a higher prevalence of coronary heart disease, heart failure and peripheral arteriopathy. Conclusions In adults with moderate-to-severe OSA, OVS was minimally symptomatic, but exhibited higher odds for prevalent coronary heart disease, heart failure and peripheral arteriopathy.
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Affiliation(s)
- Dan Adler
- Division of Pneumology, Geneva University Hospitals, Geneva, Switzerland.,University of Geneva Faculty of Medicine, Geneva, Switzerland
| | - Sébastien Bailly
- HP2 Laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France.,EFCR Laboratory, Pole Thorax et Vaisseaux, Grenoble Alpes University Hospital, Grenoble, France
| | - Meriem Benmerad
- HP2 Laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France.,EFCR Laboratory, Pole Thorax et Vaisseaux, Grenoble Alpes University Hospital, Grenoble, France
| | - Marie Joyeux-Faure
- HP2 Laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France.,EFCR Laboratory, Pole Thorax et Vaisseaux, Grenoble Alpes University Hospital, Grenoble, France
| | - Ingrid Jullian-Desayes
- HP2 Laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France.,EFCR Laboratory, Pole Thorax et Vaisseaux, Grenoble Alpes University Hospital, Grenoble, France
| | - Paola Marina Soccal
- Division of Pneumology, Geneva University Hospitals, Geneva, Switzerland.,University of Geneva Faculty of Medicine, Geneva, Switzerland
| | - Jean Paul Janssens
- Division of Pneumology, Geneva University Hospitals, Geneva, Switzerland.,University of Geneva Faculty of Medicine, Geneva, Switzerland
| | - Marc Sapène
- Private Practice Sleep and Respiratory Disease Centre, Nouvelle Clinique Bel Air, Bordeaux, France
| | - Yves Grillet
- Private Practice Sleep and Respiratory Disease Centre, Valence, France
| | - Bruno Stach
- Private Practice Sleep and Respiratory Disease Centre, Valenciennes, France
| | - Renaud Tamisier
- HP2 Laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France.,EFCR Laboratory, Pole Thorax et Vaisseaux, Grenoble Alpes University Hospital, Grenoble, France
| | - Jean-Louis Pépin
- Division of Pneumology, Geneva University Hospitals, Geneva, Switzerland.,HP2 Laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France.,EFCR Laboratory, Pole Thorax et Vaisseaux, Grenoble Alpes University Hospital, Grenoble, France
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Lima TRL, Almeida VP, Ferreira AS, Guimarães FS, Lopes AJ. Handgrip Strength and Pulmonary Disease in the Elderly: What is the Link? Aging Dis 2019; 10:1109-1129. [PMID: 31595206 PMCID: PMC6764733 DOI: 10.14336/ad.2018.1226] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 12/26/2018] [Indexed: 12/15/2022] Open
Abstract
Societies in developed countries are aging at an unprecedented rate. Considering that aging is the most significant risk factor for many chronic lung diseases (CLDs), understanding this process may facilitate the development of new interventionist approaches. Skeletal muscle dysfunction is a serious problem in older adults with CLDs, reducing their quality of life and survival. In this study, we reviewed the possible links between handgrip strength (HGS)—a simple, noninvasive, low-cost measure of muscle function—and CLDs in the elderly. Different mechanisms appear to be involved in this association, including systemic inflammation, chronic hypoxemia, physical inactivity, malnutrition, and corticosteroid use. Respiratory and peripheral myopathy, associated with muscle atrophy and a shift in muscle fiber type, also seem to be major etiological contributors to CLDs. Moreover, sarcopenic obesity, which occurs in older adults with CLDs, impairs common inflammatory pathways that can potentiate each other and further accelerate the functional decline of HGS. Our findings support the concept that the systemic effects of CLDs may be determined by HGS, and HGS is a relevant measurement that should be considered in the clinical assessment of the elderly with CLDs. These reasons make HGS a useful practical tool for indirectly evaluating functional status in the elderly. At present, early muscle reconditioning and optimal nutrition appear to be the most effective approaches to reduce the impact of CLDs and low muscle strength on the quality of life of these individuals. Nonetheless, larger in-depth studies are needed to evaluate the link between HGS and CLDs.
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Affiliation(s)
- Tatiana Rafaela Lemos Lima
- 1Rehabilitation Sciences Post-Graduate Program, Augusto Motta University Center (UNISUAM), Bonsucesso, 21041-010, Rio de Janeiro, Brazil
| | - Vívian Pinto Almeida
- 1Rehabilitation Sciences Post-Graduate Program, Augusto Motta University Center (UNISUAM), Bonsucesso, 21041-010, Rio de Janeiro, Brazil
| | - Arthur Sá Ferreira
- 1Rehabilitation Sciences Post-Graduate Program, Augusto Motta University Center (UNISUAM), Bonsucesso, 21041-010, Rio de Janeiro, Brazil
| | - Fernando Silva Guimarães
- 1Rehabilitation Sciences Post-Graduate Program, Augusto Motta University Center (UNISUAM), Bonsucesso, 21041-010, Rio de Janeiro, Brazil
| | - Agnaldo José Lopes
- 1Rehabilitation Sciences Post-Graduate Program, Augusto Motta University Center (UNISUAM), Bonsucesso, 21041-010, Rio de Janeiro, Brazil.,2Post-graduate Program in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro (UERJ), Vila Isabel, 20550-170, Rio de Janeiro, Brazil
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Vitacca M, Ambrosino N. Non-Invasive Ventilation as an Adjunct to Exercise Training in Chronic Ventilatory Failure: A Narrative Review. Respiration 2018; 97:3-11. [PMID: 30380534 DOI: 10.1159/000493691] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 09/12/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Chronic ventilatory failure (CVF) may be associated with reduced exercise capacity. Long-term non-invasive ventilation (NIV) may reduce patients' symptoms, improve health-related quality of life and reduce mortality and hospitalisations. There is an increasing use of NIV during exercise training with the purpose to train patients at intensity levels higher than allowed by their pathophysiological conditions. OBJECTIVE This narrative review describes the possibility to train patients with CVF and NIV use as a tool to increase the benefits of exercise training. METHODS We searched papers published between 1985 and 2018 in (or with the summary in) English language in PubMed and Scopus databases using the keywords "chronic respiratory failure AND exercise," "non invasive ventilation AND exercise," "pulmonary rehabilitation" and "exercise training." RESULTS Exercise training is feasible and effective also in patients with CVF. Assisted ventilation can improve exercise tolerance in different clinical conditions. In patients under long-term home ventilatory support, NIV administered also during walking results in improved oxygenation, decreased dyspnoea and increased walking distance. Continuous positive airway pressure and different modalities of assisted ventilation have been delivered through different interfaces during exercise training programmes. Patients with CVF on long-term NIV may benefit from exercising with the same ventilators, interfaces and settings as used at home. CONCLUSION We need more randomised clinical trials to investigate the effects of NIV on exercise training in patients with CVF and define organisation and setting.
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Affiliation(s)
- Michele Vitacca
- Istituti Clinici Scientifici Maugeri IRCCS, Department of Pulmonary Rehabilitation, Institute of Lumezzane (BS), Lumezzane,
| | - Nicolino Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Institute of Montescano (PV), Montescano, Italy
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Pan L, Dong W, Li H, Miller MR, Chen Y, Loh M, Wu S, Xu J, Yang X, Shima M, Deng F, Guo X. Association patterns for size-fractioned indoor particulate matter and black carbon and autonomic function differ between patients with chronic obstructive pulmonary disease and their healthy spouses. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2018; 236:40-48. [PMID: 29414364 DOI: 10.1016/j.envpol.2018.01.064] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 01/18/2018] [Accepted: 01/18/2018] [Indexed: 05/09/2023]
Abstract
BACKGROUND The effect of health status on the relationship between particulate matter (PM) and black carbon (BC) and cardiac autonomic function has not been examined sufficiently directly comparing patients with healthy participants. OBJECTIVES To evaluate the association patterns between size-fractioned indoor PM and BC and cardiac autonomic function in chronic obstructive pulmonary disease (COPD) patients and their healthy spouses. METHODS Twenty-four-hour heart rate variability (HRV) and heart rate (HR) was measured in eight pairs of stable COPD patients and their healthy spouses. Real-time size-fractioned indoor PM and BC levels were monitored on the same, and preceding, days. Mixed-effects models were used to estimate the changes in health indices and pollutants after controlling for potential confounding variables. RESULTS Increases in size-fractioned PM and BC were associated with alterations in cardiac autonomic function in both COPD patients and their healthy spouses. However, the association patterns differed between the two groups. In COPD group, an IQR (13.65 μg/m3) increase in PM0.5 at 12-h moving average was associated with reductions of 14.62% (95% CI: -21.74%, -6.86%) in total power (TP) and 10.14% (95% CI: -16.11%, -3.76%) in high frequency (HF) power. In healthy volunteers, however, TP and HF declined immediately upon exposure to PM and then returned to normal levels gradually. In this group, an IQR increase in PM0.5 at 5 min moving average was associated a 20.30% (95% CI: -25.49%, -14.73%) reduction in TP and a 31.79% (95% CI: -36.48%, -26.72%) reduction in HF. CONCLUSIONS Exposure to indoor PM and BC was associated with cardiac autonomic dysfunction in COPD patients and their healthy spouses. Exposure had a greater lagged effect on HRV in COPD patients than in healthy participants. These findings will aid the formulation of targeted measures to prevent the adverse effects of indoor air pollution for individuals with different health statuses.
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Affiliation(s)
- Lu Pan
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, No. 38 Xueyuan Road, Beijing 100191, China
| | - Wei Dong
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, No. 38 Xueyuan Road, Beijing 100191, China
| | - Hongyu Li
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, No. 38 Xueyuan Road, Beijing 100191, China
| | - Mark R Miller
- University/BHF Centre for Cardiovascular Science, Queens Medical Research Institute, The University of Edinburgh, 47 Little France Crescent Edinburgh, EH16 4TJ, UK
| | - Yahong Chen
- Respiratory Department, Peking University Third Hospital, No. 49 North Garden Road, Beijing 100191, China
| | - Miranda Loh
- Institute of Occupational Medicine, Research Avenue North Riccarton, Edinburgh, EH14 4AP, UK
| | - Shaowei Wu
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, No. 38 Xueyuan Road, Beijing 100191, China
| | - Junhui Xu
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, No. 38 Xueyuan Road, Beijing 100191, China
| | - Xuan Yang
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, No. 38 Xueyuan Road, Beijing 100191, China
| | - Masayuki Shima
- Department of Public Health, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Furong Deng
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, No. 38 Xueyuan Road, Beijing 100191, China.
| | - Xinbiao Guo
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, No. 38 Xueyuan Road, Beijing 100191, China
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Ichinose M, Matsumoto M, Fujii N, Yoshitake N, Nishiyasu T. Voluntary apnea during dynamic exercise activates the muscle metaboreflex in humans. Am J Physiol Heart Circ Physiol 2017; 314:H434-H442. [PMID: 29101169 DOI: 10.1152/ajpheart.00367.2017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Voluntary apnea during dynamic exercise evokes marked bradycardia, peripheral vasoconstriction, and pressor responses. However, the mechanism(s) underlying the cardiovascular responses seen during apnea in exercising humans is unknown. We therefore tested the hypothesis that the muscle metaboreflex contributes to the apnea-induced pressor response during dynamic exercise. Thirteen healthy subjects participated in apnea and control trials. In both trials, subjects performed a two-legged dynamic knee extension exercise at a workload that elicited heart rates at ~100 beats/min. In the apnea trial, after reaching a steady state, subjects began voluntary apnea. Immediately after cessation of the apnea, arterial occlusion was initiated at both thighs and the subjects stopped exercising. The occlusion was sustained for 3 min in the postexercise period. In the control trial, the occlusion was started without subjects performing the apnea. The apnea induced marked bradycardia, pressor responses, and decreases in arterial O2 saturation, cardiac output, and total vascular conductance. In addition, arterial blood pressure was significantly higher and total vascular conductance was significantly lower in the apnea trials than the control trials throughout the occlusion period. In separate sessions, we measured apnea-induced changes in exercising leg blood flow in the same subjects. Leg blood flow was significantly reduced by apnea and reached the resting level at the peak of the apnea response. We conclude that the muscle metaboreflex is activated by the decrease in O2 delivery to the working muscle during apnea in exercising humans and contributes to the large pressor response. NEW & NOTEWORTHY We demonstrated that apnea during dynamic exercise activates the muscle metaboreflex in humans. This result indicates that a reduction in O2 delivery to working muscle triggers the muscle metaboreflex during apnea. Activation of the muscle metaboreflex is one of the mechanisms underlying the marked apnea-induced pressor response.
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Affiliation(s)
- Masashi Ichinose
- Human Integrative Physiology Laboratory, School of Business Administration, Meiji University , Tokyo , Japan
| | - Mayumi Matsumoto
- Institute of Health and Sport Sciences, University of Tsukuba , Ibaraki , Japan
| | - Naoto Fujii
- Institute of Health and Sport Sciences, University of Tsukuba , Ibaraki , Japan
| | - Narumi Yoshitake
- Institute of Health and Sport Sciences, University of Tsukuba , Ibaraki , Japan
| | - Takeshi Nishiyasu
- Institute of Health and Sport Sciences, University of Tsukuba , Ibaraki , Japan
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Abstract
Non-invasive ventilation (NIV) is increasingly used in addition to exercise training in patients with chronic obstructive pulmonary disease with the purpose to allow them to train at higher intensities. Different modalities of assisted ventilation have been used with benefits for relief of dyspnoea and increase in exercise capacity. Nevertheless there are some potential problems with the use of NIV in pulmonary rehabilitation programmes. Despite promising results, a generalised use of NIV during exercise training programmes is unlikely to have a role in routine settings. The use of NIV during exercise training as a component of pulmonary rehabilitation should be reserved to individual cases.
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Affiliation(s)
| | - Lixin Xie
- b Department of Pulmonary and Critical Care Medicine , Chinese PLA General Hospital , Beijing , China
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