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Yuksel Kalyoncu M, Gokdemir Y, Yilmaz Yegit C, Yanaz M, Gulieva A, Selcuk M, Karabulut Ş, Metin Çakar N, Ergenekon P, Erdem Eralp E, Öztürk G, Unver O, Turkdogan D, Sahbat Y, Akgülle AH, Karakoç F, Karadag B. Unveiling the Respiratory Muscle Strength in Duchenne Muscular Dystrophy: The Impact of Nutrition and Thoracic Deformities, Beyond Spirometry. CHILDREN (BASEL, SWITZERLAND) 2024; 11:994. [PMID: 39201929 PMCID: PMC11352812 DOI: 10.3390/children11080994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 07/05/2024] [Accepted: 08/08/2024] [Indexed: 09/03/2024]
Abstract
BACKGROUND/OBJECTIVES Duchenne muscular dystrophy (DMD) is the most prevalent progressive muscular dystrophy, and the guidelines recommend the regular assessment of respiratory muscle function. This study aimed to assess the relationship between maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP) and sniff nasal inspiratory pressure (SNIP) measurements and upright-supine spirometry parameters in children with DMD, the predictability of upright-supine spirometry in terms of diaphragm involvement, and the impact of nutrition on muscle strength. METHODS This prospective cross-sectional study examined patients with DMD by comparing upright and supine FVC, MIP, MEP, and SNIP measurements. The effects of the ambulatory status, kyphoscoliosis, chest deformity, and low BMI on respiratory parameters were investigated. RESULTS Forty-four patients were included in the study. The mean patient age was 10.8 ± 2.9 years. Twenty-five patients were ambulatory. A significant decrease in FVC, FEV1, and FEF25-75 values was detected in the supine position in both ambulatory and non-ambulatory patients (p < 0.05). All patients had low MIP, MEP, and SNIP measurements (less than 60 cm H2O). MIP, MEP, and SNIP values were significantly lower in patients with a low BMI than in those without (p < 0.05). CONCLUSIONS To accurately assess respiratory muscle strength, supine FVC should be combined with upright FVC, MIP, MEP, and SNIP measurements. It is crucial to regularly screen patients for nutrition, as this can significantly affect respiratory muscle function during pulmonology follow-up.
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Affiliation(s)
- Mine Yuksel Kalyoncu
- Department of Pediatric Pulmonology, Dr. Lutfi Kirdar City Hospital, Istanbul 34865, Turkey
| | - Yasemin Gokdemir
- Department of Pediatric Pulmonology, School of Medicine, Marmara University, Istanbul 34899, Turkey; (Y.G.); (A.G.); (M.S.); (Ş.K.); (N.M.Ç.); (P.E.); (E.E.E.); (F.K.); (B.K.)
| | - Cansu Yilmaz Yegit
- Department of Pediatric Pulmonology, Çam and Sakura City Hospital, Istanbul 34480, Turkey;
| | - Muruvvet Yanaz
- Department of Pediatric Pulmonology, Diyarbakir Child Hospital, Diyarbakir 21100, Turkey;
| | - Aynur Gulieva
- Department of Pediatric Pulmonology, School of Medicine, Marmara University, Istanbul 34899, Turkey; (Y.G.); (A.G.); (M.S.); (Ş.K.); (N.M.Ç.); (P.E.); (E.E.E.); (F.K.); (B.K.)
| | - Merve Selcuk
- Department of Pediatric Pulmonology, School of Medicine, Marmara University, Istanbul 34899, Turkey; (Y.G.); (A.G.); (M.S.); (Ş.K.); (N.M.Ç.); (P.E.); (E.E.E.); (F.K.); (B.K.)
| | - Şeyda Karabulut
- Department of Pediatric Pulmonology, School of Medicine, Marmara University, Istanbul 34899, Turkey; (Y.G.); (A.G.); (M.S.); (Ş.K.); (N.M.Ç.); (P.E.); (E.E.E.); (F.K.); (B.K.)
| | - Neval Metin Çakar
- Department of Pediatric Pulmonology, School of Medicine, Marmara University, Istanbul 34899, Turkey; (Y.G.); (A.G.); (M.S.); (Ş.K.); (N.M.Ç.); (P.E.); (E.E.E.); (F.K.); (B.K.)
| | - Pinar Ergenekon
- Department of Pediatric Pulmonology, School of Medicine, Marmara University, Istanbul 34899, Turkey; (Y.G.); (A.G.); (M.S.); (Ş.K.); (N.M.Ç.); (P.E.); (E.E.E.); (F.K.); (B.K.)
| | - Ela Erdem Eralp
- Department of Pediatric Pulmonology, School of Medicine, Marmara University, Istanbul 34899, Turkey; (Y.G.); (A.G.); (M.S.); (Ş.K.); (N.M.Ç.); (P.E.); (E.E.E.); (F.K.); (B.K.)
| | - Gülten Öztürk
- Department of Pediatric Neurology, School of Medicine, Marmara University, Istanbul 34899, Turkey; (G.Ö.); (O.U.); (D.T.)
| | - Olcay Unver
- Department of Pediatric Neurology, School of Medicine, Marmara University, Istanbul 34899, Turkey; (G.Ö.); (O.U.); (D.T.)
| | - Dilsad Turkdogan
- Department of Pediatric Neurology, School of Medicine, Marmara University, Istanbul 34899, Turkey; (G.Ö.); (O.U.); (D.T.)
| | - Yavuz Sahbat
- Department of Orthopaedic Surgery and Traumatology, School of Medicine, Marmara University, Istanbul 34899, Turkey; (Y.S.); (A.H.A.)
| | - Ahmet Hamdi Akgülle
- Department of Orthopaedic Surgery and Traumatology, School of Medicine, Marmara University, Istanbul 34899, Turkey; (Y.S.); (A.H.A.)
| | - Fazilet Karakoç
- Department of Pediatric Pulmonology, School of Medicine, Marmara University, Istanbul 34899, Turkey; (Y.G.); (A.G.); (M.S.); (Ş.K.); (N.M.Ç.); (P.E.); (E.E.E.); (F.K.); (B.K.)
| | - Bulent Karadag
- Department of Pediatric Pulmonology, School of Medicine, Marmara University, Istanbul 34899, Turkey; (Y.G.); (A.G.); (M.S.); (Ş.K.); (N.M.Ç.); (P.E.); (E.E.E.); (F.K.); (B.K.)
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Marcelino AA, Fregonezi G, Marques L, Lista-Paz A, Torres-Castro R, Resqueti V. Reliability of SNIP test and optimal number of maneuvers in 6-11 years healthy children. PLoS One 2021; 16:e0252150. [PMID: 34038470 PMCID: PMC8153431 DOI: 10.1371/journal.pone.0252150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 05/10/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND PURPOSE Sniff nasal inspiratory pressure (SNIP) is a voluntary inspiratory maneuver measured through a plug occluding one nostril. The investigation of the number of maneuvers necessary to reach the highest peak of SNIP in pediatric populations has been inconsistent. Thus, this study aimed to assess the reliability of SNIP in healthy children aged 6 to 11 years according to sex and age group, and to determine the optimal number of SNIP maneuvers for this age group. METHODS This cross-sectional study included healthy children with normal pulmonary function. We performed 12 to 20 SNIP maneuvers, with a 30 s rest between each maneuver. The reliability was tested using the intraclass correlation coefficient (ICC), standard error of measurement (SEM), minimal detectable change (MDC), and Bland-Altman analysis for agreement. RESULTS A total of 121 healthy children (62 girls [51%]) were included in this study. The ICC and corresponding confidence interval (CI) between the highest measure and the first reproducible maneuver were 0.752 (0.656-0.824), SEM = 10.37 cmH2O, and MDC = 28.74 cmH2O. For children aged 6 to 7 years, the ICC was 0.669 (0.427-0.822), SEM = 10.76 cmH2O and MDC = 29.82 cmH2O; for children aged 8 to 11 years, the ICC was 0.774 (0.662-0.852), SEM = 9.74 cmH2O, and MDC = 26.05 cmH2O. For girls, the ICC was 0.817 (0.706-0.889), SEM = 9.40 cmH2O and MDC = 26.05 cmH2O; for boys, the ICC was 0.671 (0.487-0.798), SEM = 11.51 cmH2O, and MDC = 31.90 cmH2O. Approximately 80% of the total sample reached the highest SNIP before the 10th maneuver. CONCLUSIONS SNIP demonstrated moderate reliability between the maneuvers in children aged 6 to 11 years; older children and girls reached the SNIP peak faster. Finally, results indicated that 12 maneuvers were sufficient for healthy children aged 6 to 11 years to achieve the highest SNIP peak.
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Affiliation(s)
- Ana Aline Marcelino
- PneumoCardioVascular Lab/HUOL, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERH), Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil.,Departamento de Fisioterapia, Laboratório de Inovação Tecnológica em Reabilitação, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Guilherme Fregonezi
- PneumoCardioVascular Lab/HUOL, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERH), Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil.,Departamento de Fisioterapia, Laboratório de Inovação Tecnológica em Reabilitação, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil.,International Physiotherapy Research Network (PhysioEvidence)
| | - Layana Marques
- PneumoCardioVascular Lab/HUOL, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERH), Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil.,Departamento de Fisioterapia, Laboratório de Inovação Tecnológica em Reabilitação, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Ana Lista-Paz
- Facultad de Fisioterapia, Universidade da Coruña, A Coruña, España
| | - Rodrigo Torres-Castro
- International Physiotherapy Research Network (PhysioEvidence).,Departamento de Kinesiología, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Vanessa Resqueti
- PneumoCardioVascular Lab/HUOL, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERH), Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil.,Departamento de Fisioterapia, Laboratório de Inovação Tecnológica em Reabilitação, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil.,International Physiotherapy Research Network (PhysioEvidence)
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