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Yentes JM, Fallahtafti F, Denton W, Rennard SI. COPD Patients Have a Restricted Breathing Pattern That Persists with Increased Metabolic Demands. COPD 2020; 17:245-252. [PMID: 32301362 DOI: 10.1080/15412555.2020.1750578] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A healthy respiratory system has variability from breath-to-breath and patients with COPD (PwCOPD) have abnormal variability in breath cycles. The aim of this study was to determine if interbreath-interval and tidal-volume variability, and airflow regularity change as metabolic demands increase (seated, standing, and walking) in PwCOPD as compared to controls. Sixteen PwCOPD (64.3 ± 7.9 yr, 61.3 ± 44.1% FEV1%predicted) and 21 controls (60.2 ± 6.8 yr, 97.5 ± 16.8% FEV1%predicted) sat, stood, and walked at their preferred-pace for five-minutes each while breathing patterns were recorded. The mean, standard deviation, and coefficient of variation of interbreath-intervals and tidal-volume, and the regularity (sample entropy) of airflow were quantified. Results were subjected to ANOVA analysis. Interbreath-interval means were shorter in PwCOPD compared to controls (p = 0.04) and as metabolic demand increased (p < 0.0001), standard deviation was decreased in PwCOPD compared to controls during each condition (p's < 0.002). Mean tidal-volume did decrease as metabolic demand increased across groups (p < 0.0001). Coefficient of variation findings (p = 0.002) indicated PwCOPD decline in tidal-volume variability from sitting to standing to walking; whereas, controls do not. There was an interaction for airflow (p = 0.02) indicating that although, PwCOPD had a more regular airflow across all conditions, control's airflow became more irregular as metabolic demand increased. PwCOPD's airflow was always more regular compared to controls (p = 0.006); although, airflow became more irregular as metabolic demand increased (p < 0.0001). Healthy respiratory systems have variability and irregularity from breath-to-breath decreases with adaptation to demand. PwCOPD have more regular and restricted breathing pattern that may affect their ability to adjust in demanding situations.
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Affiliation(s)
- Jennifer M Yentes
- Department of Biomechanics, University of Nebraska, Omaha, Nebraska, USA.,Center for Research in Human Movement Variability, University of Nebraska, Omaha, Nebraska, USA
| | | | - William Denton
- Department of Biomechanics, University of Nebraska, Omaha, Nebraska, USA
| | - Stephen I Rennard
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Álvarez D, Sánchez-Fernández A, Andrés-Blanco AM, Gutiérrez-Tobal GC, Vaquerizo-Villar F, Barroso-García V, Hornero R, del Campo F. Influence of Chronic Obstructive Pulmonary Disease and Moderate-To-Severe Sleep Apnoea in Overnight Cardiac Autonomic Modulation: Time, Frequency and Non-Linear Analyses. ENTROPY 2019; 21:e21040381. [PMID: 33267095 PMCID: PMC7514865 DOI: 10.3390/e21040381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/02/2019] [Accepted: 04/05/2019] [Indexed: 11/25/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is one of the most prevalent lung diseases worldwide. COPD patients show major dysfunction in cardiac autonomic modulation due to sustained hypoxaemia, which has been significantly related to higher risk of cardiovascular disease. Obstructive sleep apnoea syndrome (OSAS) is a frequent comorbidity in COPD patients. It has been found that patients suffering from both COPD and OSAS simultaneously, the so-called overlap syndrome, have notably higher morbidity and mortality. Heart rate variability (HRV) has demonstrated to be useful to assess changes in autonomic functioning in different clinical conditions. However, there is still little scientific evidence on the magnitude of changes in cardiovascular dynamics elicited by the combined effect of both respiratory diseases, particularly during sleep, when apnoeic events occur. In this regard, we hypothesised that a non-linear analysis is able to provide further insight into long-term dynamics of overnight cardiovascular modulation. Accordingly, this study is aimed at assessing the usefulness of sample entropy (SampEn) to distinguish changes in overnight pulse rate variability (PRV) recordings among three patient groups while sleeping: COPD, moderate-to-severe OSAS, and overlap syndrome. In order to achieve this goal, a population composed of 297 patients were studied: 22 with COPD alone, 213 showing moderate-to-severe OSAS, and 62 with COPD and moderate-to-severe OSAS simultaneously (COPD+OSAS). Cardiovascular dynamics were analysed using pulse rate (PR) recordings from unattended pulse oximetry carried out at patients’ home. Conventional time- and frequency- domain analyses were performed to characterise sympathetic and parasympathetic activation of the nervous system, while SampEn was applied to quantify long-term changes in irregularity. Our analyses revealed that overnight PRV recordings from COPD+OSAS patients were significantly more irregular (higher SampEn) than those from patients with COPD alone (0.267 [0.210–0.407] vs. 0.212 [0.151–0.267]; p < 0.05) due to recurrent apnoeic events during the night. Similarly, COPD + OSAS patients also showed significantly higher irregularity in PRV during the night than subjects with OSAS alone (0.267 [0.210–0.407] vs. 0.241 [0.189–0.325]; p = 0.05), which suggests that the cumulative effect of both diseases increases disorganization of pulse rate while sleeping. On the other hand, no statistical significant differences were found between COPD and COPD + OSAS patients when traditional frequency bands (LF and HF) were analysed. We conclude that SampEn is able to properly quantify changes in overnight cardiovascular dynamics of patients with overlap syndrome, which could be useful to assess cardiovascular impairment in COPD patients due to the presence of concomitant OSAS.
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Affiliation(s)
- Daniel Álvarez
- Sleep-Ventilation Unit, Pneumology Service, Río Hortega University Hospital, c/ Dulzaina 2, 47012 Valladolid, Spain
- Biomedical Engineering Group, University of Valladolid, Paseo de Belén 15, 47011 Valladolid, Spain
- Correspondence: ; Tel.: +34-983-420400 (ext. 85776)
| | - Ana Sánchez-Fernández
- Sleep-Ventilation Unit, Pneumology Service, Río Hortega University Hospital, c/ Dulzaina 2, 47012 Valladolid, Spain
| | - Ana M. Andrés-Blanco
- Sleep-Ventilation Unit, Pneumology Service, Río Hortega University Hospital, c/ Dulzaina 2, 47012 Valladolid, Spain
| | | | | | - Verónica Barroso-García
- Biomedical Engineering Group, University of Valladolid, Paseo de Belén 15, 47011 Valladolid, Spain
| | - Roberto Hornero
- Biomedical Engineering Group, University of Valladolid, Paseo de Belén 15, 47011 Valladolid, Spain
| | - Félix del Campo
- Sleep-Ventilation Unit, Pneumology Service, Río Hortega University Hospital, c/ Dulzaina 2, 47012 Valladolid, Spain
- Biomedical Engineering Group, University of Valladolid, Paseo de Belén 15, 47011 Valladolid, Spain
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Jin Y, Chen C, Cao Z, Sun B, Lo IL, Liu TM, Zheng J, Sun S, Shi Y, Zhang XD. Entropy change of biological dynamics in COPD. Int J Chron Obstruct Pulmon Dis 2017; 12:2997-3005. [PMID: 29066881 PMCID: PMC5644543 DOI: 10.2147/copd.s140636] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
In this century, the rapid development of large data storage technologies, mobile network technology, and portable medical devices makes it possible to measure, record, store, and track analysis of large amount of data in human physiological signals. Entropy is a key metric for quantifying the irregularity contained in physiological signals. In this review, we focus on how entropy changes in various physiological signals in COPD. Our review concludes that the entropy change relies on the types of physiological signals under investigation. For major physiological signals related to respiratory diseases, such as airflow, heart rate variability, and gait variability, the entropy of a patient with COPD is lower than that of a healthy person. However, in case of hormone secretion and respiratory sound, the entropy of a patient is higher than that of a healthy person. For mechanomyogram signal, the entropy increases with the increased severity of COPD. This result should give valuable guidance for the use of entropy for physiological signals measured by wearable medical device as well as for further research on entropy in COPD.
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Affiliation(s)
- Yu Jin
- Faculty of Health Sciences, University of Macau, Taipa, Macau
| | - Chang Chen
- Faculty of Health Sciences, University of Macau, Taipa, Macau
| | - Zhixin Cao
- Beijing Engineering Research Center of Diagnosis and Treatment of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Beijing
| | - Baoqing Sun
- State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou
| | - Iek Long Lo
- Department of Geriatrics, Centro Hospital Conde de Sao Januario, Macau
| | - Tzu-Ming Liu
- Faculty of Health Sciences, University of Macau, Taipa, Macau
| | - Jun Zheng
- Faculty of Health Sciences, University of Macau, Taipa, Macau
| | - Shixue Sun
- Faculty of Health Sciences, University of Macau, Taipa, Macau
| | - Yan Shi
- School of Automation Science and Electrical Engineering, Beihang University, Beijing, China
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Baldi S, Pinna GD, Bruschi C, Caldara F, Maestri R, Dacosto E, Rezzani A, Popovich E, Bellinzona E, Crotti P, Montemartini S, Fracchia C. Medicinal clays improve the endurance of loaded inspiratory muscles in COPD: a randomized clinical trial of nonpharmacological treatment. Int J Chron Obstruct Pulmon Dis 2015; 10:2235-48. [PMID: 26604728 PMCID: PMC4629956 DOI: 10.2147/copd.s87999] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Inspiratory resistive breathing (IRB) challenges affect respiratory muscle endurance in healthy individuals, which is considered to be an interleukin 6 (IL-6)-dependent mechanism. Whether nonpharmacological thermal therapies promote the endurance of loaded inspiratory muscles in chronic obstructive pulmonary disease (COPD) is unclear. The objectives of this study were to compare the effects of two thermal interventions on endurance time (ET) and plasma IL-6 concentration following an IRB challenge. METHODS This study was a randomized, parallel-group, unblinded clinical trial in a single-center setting. Forty-two patients (aged 42-76 years) suffering from mild to severe COPD participated in this study. Both groups completed 12 sessions of the mud bath therapy (MBT) (n=22) or leisure thermal activity (LTA) (n=19) in a thermal spa center in Italy. Pre- and postintervention spirometry, maximum inspiratory pressure, and plasma mediators were obtained and ET and endurance oxygen expenditure (VO2Endur) were measured following IRB challenge at 40% of maximum inspiratory pressure. RESULTS There was no difference in ΔIL-6 between the intervention groups. But, IRB challenge increased cytokine IL-6 plasma levels systematically. The effect size was small. A statistically significant treatment by IRB challenge effect existed in ET, which significantly increased in the MBT group (P=0.003). In analysis of covariance treatment by IRB challenge analysis with LnVO2Endur as the dependent variable, ΔIL-6 after intervention predicted LnVO2Endur in the MBT group, but not in the LTA group. Adverse events occurred in two individuals in the MBT group, but they were mainly transient. One patient in the LTA group dropped out. CONCLUSION MBT model improves ET upon a moderate IRB challenge, indicating the occurrence of a training effect. The LnVO2Endur/ΔIL-6 suggests a physiologic adaptive mechanism in respiratory muscles of COPD patients allocated to treatment. Both thermal interventions are safe.
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Affiliation(s)
- Simonetta Baldi
- Department of Pneumology, Scientific Institute of Montescano, Salvatore Maugeri Foundation, Istituto Di Ricovero e Cura a Carattere Scientifico, Montescano (Pavia)
| | - Gian Domenico Pinna
- Department of Biomedical Engineering, Scientific Institute of Montescano, Salvatore Maugeri Foundation, Istituto Di Ricovero e Cura a Carattere Scientifico, Montescano (Pavia), AbanoTerme, Padua, Italy
| | - Claudio Bruschi
- Department of Pneumology, Scientific Institute of Montescano, Salvatore Maugeri Foundation, Istituto Di Ricovero e Cura a Carattere Scientifico, Montescano (Pavia)
| | - Fabrizio Caldara
- Center of Thermal Studies Pietro d’Abano, AbanoTerme, Padua, Italy
| | - Roberto Maestri
- Department of Biomedical Engineering, Scientific Institute of Montescano, Salvatore Maugeri Foundation, Istituto Di Ricovero e Cura a Carattere Scientifico, Montescano (Pavia), AbanoTerme, Padua, Italy
| | - Elena Dacosto
- Department of Pneumology, Scientific Institute of Montescano, Salvatore Maugeri Foundation, Istituto Di Ricovero e Cura a Carattere Scientifico, Montescano (Pavia)
| | - Antonella Rezzani
- Department of Pneumology, Scientific Institute of Montescano, Salvatore Maugeri Foundation, Istituto Di Ricovero e Cura a Carattere Scientifico, Montescano (Pavia)
| | - Ermanno Popovich
- Department of Pneumology, Scientific Institute of Montescano, Salvatore Maugeri Foundation, Istituto Di Ricovero e Cura a Carattere Scientifico, Montescano (Pavia)
| | - Ezio Bellinzona
- Department of Pneumology, Scientific Institute of Montescano, Salvatore Maugeri Foundation, Istituto Di Ricovero e Cura a Carattere Scientifico, Montescano (Pavia)
| | - Paola Crotti
- Department of Pneumology, Scientific Institute of Montescano, Salvatore Maugeri Foundation, Istituto Di Ricovero e Cura a Carattere Scientifico, Montescano (Pavia)
| | - Silvia Montemartini
- Department of Pneumology, Scientific Institute of Montescano, Salvatore Maugeri Foundation, Istituto Di Ricovero e Cura a Carattere Scientifico, Montescano (Pavia)
| | - Claudio Fracchia
- Department of Pneumology, Scientific Institute of Montescano, Salvatore Maugeri Foundation, Istituto Di Ricovero e Cura a Carattere Scientifico, Montescano (Pavia)
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