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Wang Z, Li J, Zhang Y, Chen R. Ultrasonographic changes and impact factors of diaphragmatic function in patients with obstructive sleep apnea-hypopnea syndrome. Sleep Breath 2024; 28:1319-1327. [PMID: 38413555 DOI: 10.1007/s11325-024-03010-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 01/22/2024] [Accepted: 02/19/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE Diaphragmatic impairment has been reported in obstructive sleep apnea-hypopnea syndrome (OSAHS) patients. However, the risk factors of diaphragmatic dysfunction are unclear. This study was conducted to evaluate the diaphragmatic function and to investigate impact factors of ultrasonographic changes of the diaphragm in OSAHS patients. METHODS This cross-sectional study recruited 150 snoring patients. All patients were divided into the control group (AHI < 5/h, n = 20), the mild-to-moderate OSAHS group (5/h ≤ AHI ≤ 30/h, n = 61), and the severe OSAHS group (AHI > 30/h, n = 69). Diaphragmatic thickness at function residual capacity (TFRC) and total lung capacity (TTLC) were measured by two-dimensional ultrasound, and the diaphragmatic excursion during tidal and deep breath was measured by M-mode ultrasound. The diaphragmatic thickening fraction (TF) was calculated. Spearman analysis and multiple linear stepwise regression analysis were conducted to analyze the impact factors of diaphragmatic function. RESULTS TFRC in the control group, mild-to-moderate OSAHS group, and severe OSAHS group was 1.23 (1.10, 1.39) mm, 1.60 (1.43, 1.85) mm, and 1.90 (1.70, 2.25) mm; TTLC was 2.75 (2.53, 2.93) mm, 3.25 (2.90, 3.55) mm, and 3.60 (3.33, 3.90) mm, and TF was 119.23% (102.94, 155.97), 96.55% (74.34, 119.11), and 85.29% (60.68,101.22). There were across-group significant differences in TFRC, TTLC, and TF (P < 0.05). The oxygen desaturation index was the influencing factor of TFRC, TTLC, and TF (P < 0.05). CONCLUSION The diaphragm is thickened and diaphragmatic contractility is decreased in OSAHS patients. Nocturnal intermittent hypoxia is a risk factor for diaphragmatic hypertrophy and impaired diaphragmatic contractility.
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Affiliation(s)
- Zhijun Wang
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, Jiangsu, China
| | - Jing Li
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, Jiangsu, China
| | - Yingchun Zhang
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, Jiangsu, China
| | - Rui Chen
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, Jiangsu, China.
- Department of Sleeping Center, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, Jiangsu, China.
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Raberin A, Burtscher J, Citherlet T, Manferdelli G, Krumm B, Bourdillon N, Antero J, Rasica L, Malatesta D, Brocherie F, Burtscher M, Millet GP. Women at Altitude: Sex-Related Physiological Responses to Exercise in Hypoxia. Sports Med 2024; 54:271-287. [PMID: 37902936 PMCID: PMC10933174 DOI: 10.1007/s40279-023-01954-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 11/01/2023]
Abstract
Sex differences in physiological responses to various stressors, including exercise, have been well documented. However, the specific impact of these differences on exposure to hypoxia, both at rest and during exercise, has remained underexplored. Many studies on the physiological responses to hypoxia have either excluded women or included only a limited number without analyzing sex-related differences. To address this gap, this comprehensive review conducted an extensive literature search to examine changes in physiological functions related to oxygen transport and consumption in hypoxic conditions. The review encompasses various aspects, including ventilatory responses, cardiovascular adjustments, hematological alterations, muscle metabolism shifts, and autonomic function modifications. Furthermore, it delves into the influence of sex hormones, which evolve throughout life, encompassing considerations related to the menstrual cycle and menopause. Among these physiological functions, the ventilatory response to exercise emerges as one of the most sex-sensitive factors that may modify reactions to hypoxia. While no significant sex-based differences were observed in cardiac hemodynamic changes during hypoxia, there is evidence of greater vascular reactivity in women, particularly at rest or when combined with exercise. Consequently, a diffusive mechanism appears to be implicated in sex-related variations in responses to hypoxia. Despite well-established sex disparities in hematological parameters, both acute and chronic hematological responses to hypoxia do not seem to differ significantly between sexes. However, it is important to note that these responses are sensitive to fluctuations in sex hormones, and further investigation is needed to elucidate the impact of the menstrual cycle and menopause on physiological responses to hypoxia.
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Affiliation(s)
- Antoine Raberin
- Institute of Sport Sciences, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Johannes Burtscher
- Institute of Sport Sciences, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Tom Citherlet
- Institute of Sport Sciences, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Giorgio Manferdelli
- Institute of Sport Sciences, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Bastien Krumm
- Institute of Sport Sciences, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Nicolas Bourdillon
- Institute of Sport Sciences, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Juliana Antero
- Institut de Recherche Bio-Médicale Et d'Épidémiologie du Sport (EA 7329), French Institute of Sport, Paris, France
| | - Letizia Rasica
- Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Davide Malatesta
- Institute of Sport Sciences, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Franck Brocherie
- Laboratory Sport, Expertise and Performance (EA 7370), French Institute of Sport, Paris, France
| | - Martin Burtscher
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | - Grégoire P Millet
- Institute of Sport Sciences, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.
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Angus SA, Chang JC, Mann LM, Thompson BP, Doherty CJ, Dominelli PB. Altering magnetic field strength impacts the assessment of diaphragmatic function using cervical magnetic stimulation. Respir Physiol Neurobiol 2023; 309:104012. [PMID: 36592844 DOI: 10.1016/j.resp.2022.104012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/20/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022]
Abstract
Quantifying diaphragm neuromuscular function using cervical magnetic stimulation (CMS) typically uses only a single stimulator (1-Stim) which may be inadequate to maximally stimulate the phrenic nerves. We questioned if using two stimulators (2-Stim) together alters diaphragm neuromuscular function at baseline and following inspiratory pressure threshold loading. Six (n = 3 female) healthy young participants were instrumented with esophageal and gastric balloon tipped catheters and electrodes over the 7-8th intercostal space. With either 1-Stim or 2-Stim an incremental protocol, where the stimulator intensity was progressively increased was completed prior to a series of potentiated twitches. The inspiratory threshold loading test consisted of loaded breathing to failure. Compared to 1-Stim, 2-Stim resulted in significantly greater unpotentiated Pditw and M-waves during the incremental protocol (both p < 0.01). Similarly, 2-Stim resulted in greater potentiated Pditw (31 ± 8 vs. 41 ± 9 cmH2O; p = 0.02) and M-waves (6.4 ± 2.9 vs. 8.6 ± 2.4 V; p = 0.02). Our findings suggest that CMS using 1-Stim is unlikely to generate a sufficient magnetic field to maximally stimulate the phrenic nerves and may underestimate diaphragm function.
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Affiliation(s)
- Sarah A Angus
- Department of Kinesiology and Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON, Canada
| | - Jou-Chung Chang
- Department of Kinesiology and Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON, Canada
| | - Leah M Mann
- Department of Kinesiology and Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON, Canada
| | - Benjamin P Thompson
- Department of Kinesiology and Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON, Canada
| | - Connor J Doherty
- Department of Kinesiology and Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON, Canada
| | - Paolo B Dominelli
- Department of Kinesiology and Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON, Canada.
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Ramsook AH, Schaeffer MR, Mitchell RA, Dhillon SS, Milne KM, Ferguson ON, Puyat JH, Koehle MS, Sheel AW, Guenette JA. Voluntary activation of the diaphragm after inspiratory pressure threshold loading. Physiol Rep 2023; 11:e15575. [PMID: 36695772 PMCID: PMC9875816 DOI: 10.14814/phy2.15575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 12/28/2022] [Accepted: 01/01/2023] [Indexed: 06/17/2023] Open
Abstract
After a bout of isolated inspiratory work, such as inspiratory pressure threshold loading (IPTL), the human diaphragm can exhibit a reversible loss in contractile function, as evidenced by a decrease in transdiaphragmatic twitch pressure (PDI,TW ). Whether or not diaphragm fatigability after IPTL is affected by neural mechanisms, measured through voluntary activation of the diaphragm (D-VA) in addition to contractile mechanisms, is unknown. It is also unknown if changes in D-VA are similar between sexes given observed differences in diaphragm fatigability between males and females. We sought to determine whether D-VA decreases after IPTL and whether this was different between sexes. Healthy females (n = 11) and males (n = 10) completed an IPTL task with an inspired duty cycle of 0.7 and targeting an intensity of 60% maximal transdiaphragmatic pressure until task failure. PDI,TW and D-VA were measured using cervical magnetic stimulation of the phrenic nerves in combination with maximal inspiratory pressure maneuvers. At task failure, PDI,TW decreased to a lesser degree in females vs. males (87 ± 15 vs. 73 ± 12% baseline, respectively, p = 0.016). D-VA decreased after IPTL but was not different between females and males (91 ± 8 vs. 88 ± 10% baseline, respectively, p = 0.432). When all participants were pooled together, the decrease in PDI,TW correlated with both the total cumulative diaphragm pressure generation (R2 = 0.43; p = 0.021) and the time to task failure (TTF, R2 = 0.40; p = 0.30) whereas the decrease in D-VA correlated only with TTF (R2 = 0.24; p = 0.041). Our results suggest that neural mechanisms can contribute to diaphragm fatigability, and this contribution is similar between females and males following IPTL.
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Affiliation(s)
- Andrew H. Ramsook
- Department of Physical Therapy, Faculty of MedicineThe University of British ColumbiaVancouverBritish ColumbiaCanada
- Centre for Heart Lung Innovation, Providence ResearchThe University of British Columbia and St. Paul's HospitalVancouverBritish ColumbiaCanada
| | - Michele R. Schaeffer
- Department of Physical Therapy, Faculty of MedicineThe University of British ColumbiaVancouverBritish ColumbiaCanada
- Centre for Heart Lung Innovation, Providence ResearchThe University of British Columbia and St. Paul's HospitalVancouverBritish ColumbiaCanada
| | - Reid A. Mitchell
- Department of Physical Therapy, Faculty of MedicineThe University of British ColumbiaVancouverBritish ColumbiaCanada
- Centre for Heart Lung Innovation, Providence ResearchThe University of British Columbia and St. Paul's HospitalVancouverBritish ColumbiaCanada
| | - Satvir S. Dhillon
- Centre for Heart Lung Innovation, Providence ResearchThe University of British Columbia and St. Paul's HospitalVancouverBritish ColumbiaCanada
| | - Kathryn M. Milne
- Centre for Heart Lung Innovation, Providence ResearchThe University of British Columbia and St. Paul's HospitalVancouverBritish ColumbiaCanada
- Division of Respiratory Medicine, Faculty of MedicineThe University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Olivia N. Ferguson
- Department of Physical Therapy, Faculty of MedicineThe University of British ColumbiaVancouverBritish ColumbiaCanada
- Centre for Heart Lung Innovation, Providence ResearchThe University of British Columbia and St. Paul's HospitalVancouverBritish ColumbiaCanada
| | - Joseph H. Puyat
- Centre for Health Evaluation and Outcome Services, Providence ResearchThe University of British Columbia and St. Paul's HospitalVancouverBritish ColumbiaCanada
| | - Michael S. Koehle
- School of Kinesiology, Faculty of EducationThe University of British ColumbiaVancouverBritish ColumbiaCanada
- Department of Family Practice, Faculty of MedicineThe University of British ColumbiaVancouverBritish ColumbiaCanada
| | - A. William Sheel
- Centre for Heart Lung Innovation, Providence ResearchThe University of British Columbia and St. Paul's HospitalVancouverBritish ColumbiaCanada
- School of Kinesiology, Faculty of EducationThe University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Jordan A. Guenette
- Department of Physical Therapy, Faculty of MedicineThe University of British ColumbiaVancouverBritish ColumbiaCanada
- Centre for Heart Lung Innovation, Providence ResearchThe University of British Columbia and St. Paul's HospitalVancouverBritish ColumbiaCanada
- Division of Respiratory Medicine, Faculty of MedicineThe University of British ColumbiaVancouverBritish ColumbiaCanada
- School of Kinesiology, Faculty of EducationThe University of British ColumbiaVancouverBritish ColumbiaCanada
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Wei S, Lu R, Zhang Z, Wang F, Tan H, Wang X, Ma J, Zhang Y, Deng N, Chen J. MRI-assessed diaphragmatic function can predict frequent acute exacerbation of COPD: a prospective observational study based on telehealth-based monitoring system. BMC Pulm Med 2022; 22:438. [PMID: 36424599 PMCID: PMC9685983 DOI: 10.1186/s12890-022-02254-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/18/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) have considerably high mortality and re-hospitalisation rate. Diaphragmatic dysfunction (DD) is common in COPD patients. However, whether diaphragmatic dysfunction is related to acute exacerbation is yet to be elucidated. This study aimed to evaluate the diaphragm function by magnetic resonance imaging (MRI) in COPD patients and assess whether the impact of DD may help predict AECOPD. METHODS 20 healthy adult volunteers and 80 COPD patients were enrolled. The diaphragms function parameters were accessed by MRI. Patients were guided to start self-management by the Telehealth-based monitoring system following the enrolment. Events of acute exacerbation of COPD were recorded by the system and confirmed by healthcare providers. Binary univariate and multivariate logistic regression analyses were performed to investigate the factors associated with the frequency of AECOPD. Receiver operating characteristic (ROC) curves were further used to assess the value of prediction indexes. RESULTS Fifty-nine COPD patients completed a one-year follow-up based on the Telehealth-based monitoring system. The clinical outcomes showed that the diaphragm function parameters at the end of maximal breathing were lower in the COPD group than in the healthy control group (P < 0.05). ANOVA showed significant differences among Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages for diaphragm function parameters, including chest wall motion, lung area, upper-lower diameter, and the diaphragm thickening fraction at the end of maximal breathing (P < 0.05). Moreover, significant differences in diaphragm function parameters were observed between patients with infrequent AECOPD (n = 28) and frequent AECOPD (n = 31) based on the frequency of AECOPD (P < 0.05). The diaphragm thickening fraction and the chest wall motion were associated with AECOPD after adjusting for age, sex, BMI, and lung functions, and the combination of predictions showed better accuracy in predicting the frequency of AECOPD. CONCLUSIONS In COPD patients, diaphragm function parameters correlate with the severity of airflow limitation. The diaphragm thickening fraction and the chest wall motion were associated with the frequency of AECOPD and can predict it.
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Affiliation(s)
- Shuoshuo Wei
- grid.413385.80000 0004 1799 1445Department of Pulmonary and Critical Care Medicine, General Hospital of Ningxia Medical University, Yongan Lane, Xingqing District, Yinchuan, 750004 Ningxia China ,grid.412194.b0000 0004 1761 9803Ningxia Medical University, Yinchuan, 750004 Ningxia China
| | - Rong Lu
- grid.413385.80000 0004 1799 1445Department of Pulmonary and Critical Care Medicine, General Hospital of Ningxia Medical University, Yongan Lane, Xingqing District, Yinchuan, 750004 Ningxia China ,Department of Pulmonary Medicine, People’s Hospital of Wuzhong, Wuzhong, 751100 Ningxia China
| | - Zhengping Zhang
- grid.413385.80000 0004 1799 1445Department of Radiology, General Hospital of Ningxia Medical University, Yinchuan, 750004 Ningxia China
| | - Faxuan Wang
- grid.412194.b0000 0004 1761 9803Ningxia Medical University, Yinchuan, 750004 Ningxia China ,grid.412194.b0000 0004 1761 9803School of Public Health and Management, Ningxia Medical University, Yinchuan, China
| | - Hai Tan
- grid.413385.80000 0004 1799 1445Department of Pulmonary and Critical Care Medicine, General Hospital of Ningxia Medical University, Yongan Lane, Xingqing District, Yinchuan, 750004 Ningxia China
| | - Xiaohong Wang
- grid.413385.80000 0004 1799 1445Department of Critical Care Medicine, General Hospital of Ningxia Medical University, Yinchuan, 750004 Ningxia China
| | - Jinlan Ma
- grid.413385.80000 0004 1799 1445Department of Critical Care Medicine, General Hospital of Ningxia Medical University, Yinchuan, 750004 Ningxia China
| | - Yating Zhang
- grid.413385.80000 0004 1799 1445Department of Pulmonary and Critical Care Medicine, General Hospital of Ningxia Medical University, Yongan Lane, Xingqing District, Yinchuan, 750004 Ningxia China
| | - Ning Deng
- grid.13402.340000 0004 1759 700XMinistry of Education Key Laboratory of Biomedical Engineering, College of Biomedical Engineering and Instrument Science, Zhejiang University, 38 Zheda Road, Hangzhou, 310027 Zhejiang China
| | - Juan Chen
- grid.413385.80000 0004 1799 1445Department of Pulmonary and Critical Care Medicine, General Hospital of Ningxia Medical University, Yongan Lane, Xingqing District, Yinchuan, 750004 Ningxia China
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Vento KA, Borden CK, Blacker KJ. Sex comparisons in physiological and cognitive performance during hypoxic challenge. Front Physiol 2022; 13:1062397. [PMID: 36505049 PMCID: PMC9727089 DOI: 10.3389/fphys.2022.1062397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 11/11/2022] [Indexed: 11/24/2022] Open
Abstract
Within the tactical aviation community, human performance research lags in considering potential psychophysiological differences between male and female aviators due to little inclusion of females during the design and development of aircraft systems. A poor understanding of how male and female aviators differ with respect to human performance results in unknown potential sex differences on aeromedically relevant environmental stressors, perchance leading to suboptimal performance, safety, and health guidelines. For example, previous hypoxia studies have excluded female participants or lacked a sizeable sample to examine sex comparisons. As such, progress toward sensor development and improving hypoxia familiarization training are stunted due to limited knowledge of how individual differences, including sex, may or may not underlie hypoxia symptoms and performance impairment. Investigating sex differences bridges the gap between aerospace medicine and operational health, and addressing hypoxia is one of many facets yet to be studied. In the current study, we retrospectively examined N = 6 hypoxia studies with male-female participant samples (total, N = 189; male, n = 118; female, n = 71). We explored sex as a predictor of physiological response, sensory deficits, the severity of cognitive performance declines, and symptom manifestation via linear and binary logistic regression models. We found that the female sex predicted lower peripheral oxygen saturation and the likelihood of headache reporting in response to hypoxic challenge, yet explained little variance when combined with age and body mass index. The sensory and cognitive performance models did not converge, suggesting high intra-individual variability. Together, sex, age, and body mass index were not the most robust predictors in responses to hypoxic challenge; we cannot infer this for sensory deficits and cognitive performance within an experimentally induced hypoxic environment. The findings have implications for improving hypoxia familiarization training, monitoring sensor development, and emergency response and recovery protocols in case of a hypoxia occurrence suitable for all aircrew. We recommend continuing to elucidate the impact of sex and intrapersonal differences in hypoxia and other aeromedically relevant stressors in tactical aviation.
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Affiliation(s)
- Kaila A. Vento
- Naval Medical Research Unit-Dayton Wright-Patterson Air Force Base, Dayton, OH, United States,Oak Ridge Institute for Science and Education, Oak Ridge, TN, United States
| | - Cammi K. Borden
- Naval Medical Research Unit-Dayton Wright-Patterson Air Force Base, Dayton, OH, United States,Oak Ridge Institute for Science and Education, Oak Ridge, TN, United States
| | - Kara J. Blacker
- Naval Medical Research Unit-Dayton Wright-Patterson Air Force Base, Dayton, OH, United States,*Correspondence: Kara J. Blacker,
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Ramsook AH, Schaeffer MR, Mitchell RA, Dhillon SS, Milne KM, Ferguson ON, Puyat JH, Koehle MS, Sheel AW, Guenette JA. Sex Differences in Diaphragm Voluntary Activation after Exercise. Med Sci Sports Exerc 2022; 54:1167-1175. [PMID: 35195102 DOI: 10.1249/mss.0000000000002897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
INTRODUCTION The female diaphragm develops less fatigue after high-intensity exercise compared with males. Diaphragm fatigability is typically defined as a decrease in transdiaphragmatic twitch pressure (Pdi,TW) and represents the contractile function of the muscle. However, it is unclear whether this sex difference persists when examining changes in voluntary activation, which represents a neural mechanism contributing to fatigability. PURPOSE This study aimed to determine if high-intensity cycling results in a decrease in diaphragm voluntary activation (D-VA) and to explore if the decrease in D-VA is different between sexes. METHODS Twenty-five participants (15 females) completed a single bout of high-intensity constant load cycling. D-VA and Pdi,TW were measured before and after exercise using cervical magnetic stimulation of the phrenic nerves to assess diaphragm fatigability. RESULTS Participants were of similar aerobic fitness when expressed relative to predicted values (females: 114% ± 25% predicted, males: 111% ± 11% predicted; P = 0.769). Pdi,TW decreased relative to baseline to 85.2% ± 16.7% and 70.3% ± 12.4% baseline (P = 0.012) in females and males, respectively, immediately after exercise. D-VA also decreased in both females and males immediately after exercise. The decrease in D-VA was less in females compared with males (95.4% ± 4.9% baseline vs 87.4% ± 10.8% baseline, respectively; P = 0.018). CONCLUSIONS D-VA decreases after whole-body exercise in both females and males, although the magnitude of the decrease is not as large in females compared with males. The findings of this study suggest that the female diaphragm is more resistant to both contractile and neural mechanisms of fatigability after whole-body exercise.
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Affiliation(s)
| | | | | | - Satvir S Dhillon
- Centre for Heart Lung Innovation, Providence Research, The University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, CANADA
| | | | | | - Joseph H Puyat
- Centre for Health Evaluation and Outcome Sciences, Providence Research, The University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, CANADA
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Cao Y, Li P, Wang Y, Liu X, Wu W. Diaphragm Dysfunction and Rehabilitation Strategy in Patients With Chronic Obstructive Pulmonary Disease. Front Physiol 2022; 13:872277. [PMID: 35586711 PMCID: PMC9108326 DOI: 10.3389/fphys.2022.872277] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/18/2022] [Indexed: 12/03/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) affects the whole body and causes many extrapulmonary adverse effects, amongst which diaphragm dysfunction is one of the prominent manifestations. Diaphragm dysfunction in patients with COPD is manifested as structural changes, such as diaphragm atrophy, single-fibre dysfunction, sarcomere injury and fibre type transformation, and functional changes such as muscle strength decline, endurance change, diaphragm fatigue, decreased diaphragm mobility, etc. Diaphragm dysfunction directly affects the respiratory efficiency of patients and is one of the important pathological mechanisms leading to progressive exacerbation of COPD and respiratory failure, which is closely related to disease mortality. At present, the possible mechanisms of diaphragm dysfunction in patients with COPD include systemic inflammation, oxidative stress, hyperinflation, chronic hypoxia and malnutrition. However, the specific mechanism of diaphragm dysfunction in COPD is still unclear, which, to some extent, increases the difficulty of treatment and rehabilitation. Therefore, on the basis of the review of changes in the structure and function of COPD diaphragm, the potential mechanism of diaphragm dysfunction in COPD was discussed, the current effective rehabilitation methods were also summarised in this paper. In order to provide direction reference and new ideas for the mechanism research and rehabilitation treatment of diaphragm dysfunction in COPD.
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Affiliation(s)
- Yuanyuan Cao
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Peijun Li
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Yingqi Wang
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Xiaodan Liu
- School of Rehabilitation Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Weibing Wu
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China
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LoMauro A, Aliverti A. Sex and gender in respiratory physiology. Eur Respir Rev 2021; 30:30/162/210038. [PMID: 34750114 DOI: 10.1183/16000617.0038-2021] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 06/08/2021] [Indexed: 11/05/2022] Open
Abstract
Sex is a biological concept determined at conception. Gender is a social concept. Medicine recognises sex as a biological variable and recommends including sex as a factor in clinical practice norms and as a topic of bench and clinical research. Sex plays a role in respiratory physiology according to two pathways: hormones and anatomy, with females characterised by smaller dimensions at every level of the respiratory system. Sex hormones also play specific roles in lung inflammatory processes, breathing control and in response to diseases. The literature is extremely controversial because many factors need to be considered to avoid erroneous comparisons. The main difficulty lies in creating homogeneous groups of subjects according to age, body weight, lung/airway size, fluctuations in circulating hormone levels, and exercise protocol. Because almost all of the knowledge available in physiology is based on research in males, medicine for women is therefore less evidence-based than that being applied to men. Finally, the number of transsexual people is increasing and they represent new challenges for clinicians, due to the anatomical and physiological changes that they undergo.
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Affiliation(s)
- Antonella LoMauro
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Andrea Aliverti
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
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Giersch GEW, Charkoudian N, McClung HL. The Rise of the Female Warfighter: Physiology, Performance, and Future Directions. Med Sci Sports Exerc 2021; 54:683-691. [PMID: 34939610 DOI: 10.1249/mss.0000000000002840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT Since 1948, the United States military has been open to both men and women as permanent party service members. However, in the majority of the time since, there have been a subset of military occupational specialties (MOS), or job descriptions, open only to men. In particular, jobs requiring more intense physical and/or environmental strain were considered to be beyond the physiological capabilities of women. In the present analysis, we review the literature regarding neuromuscular, physical performance, and environmental physiology in women, to highlight that women have no inherent limitation in their capacity to participate in relevant roles and jobs within the military, within accepted guidelines to promote risk mitigation across sexes. First, we discuss performance and injury risk: both neuromuscular function and physical capabilities. Second, physiological responses to environmental stress. Third, we discuss risk as it relates to reproductive health and nutritional considerations. We conclude with a summary of current physiological, performance and injury risk data in men and women that support our overarching purpose, as well as suggestions for future directions.
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Affiliation(s)
- Gabrielle E W Giersch
- Thermal and Mountain Medicine Division, United States Army Research Institute of Environmental Medicine, Natick, MA Biophysical and Biomedical Modeling Division, United States Army Research Institute of Environmental Medicine, Natick, MA Oak Ridge Institute for Science and Technology, Oak Ridge, TN
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Chambault J, Grand G, Kayser B. Sex-Specific Effects of Respiratory Muscle Endurance Training on Cycling Time Trial Performance in Normoxia and Hypoxia. Front Physiol 2021; 12:700620. [PMID: 34421638 PMCID: PMC8378271 DOI: 10.3389/fphys.2021.700620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/02/2021] [Indexed: 12/11/2022] Open
Abstract
Objectives: We tested the hypotheses that respiratory muscle endurance training (RMET) improves endurance cycling performance differently in women and men and more so in hypoxia than in normoxia. Design: A prospective pre-post cross-over study with two testing conditions. Methods: Healthy and active women (seven, 24 ± 4 years, mean ± standard deviation [SD]) and men (seven, 27 ± 5 years) performed incremental cycling to determine maximum oxygen consumption (VO2peak) and power output (Wpeak) and on different days two 10-km cycling time trials (TTs) in normoxia and normobaric hypoxia (FiO2, 0.135, ~3,500 m equivalent), in a balanced randomized order. Next they performed supervised RMET in normoxia (4 weeks, 5 days/week, 30 min/day eucapnic hyperpnea at ~60% predicted maximum voluntary ventilation) followed by identical post-tests. During TTs, heart rate, ear oximetry reading, and Wpeak were recorded. Results: The VO2peak and Wpeak values were unchanged after RMET. The TT was improved by 7 ± 6% (p < 0.001) in normoxia and 16 ± 6% (p < 0.001) in hypoxia. The difference between normoxic and hypoxic TT was smaller after RMET as compared with that before RMET (14% vs. 21%, respectively, p < 0.001). All effects were greater in women (p < 0.001). The RMET did not change the heart rate or ear oximetry reading during TTs. Conclusion: We found a greater effect of RMET on cycling TT performance in women than in men, an effect more pronounced in hypoxia. These findings are congruent with the contention of a more pronounced performance-limiting role of the respiratory system during endurance exercise in hypoxia compared with normoxia and more so in women whose respiratory system is undersized compared with that of men.
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Affiliation(s)
- Julie Chambault
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Grégorine Grand
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Bengt Kayser
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
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Archiza B, Leahy MG, Kipp S, Sheel AW. An integrative approach to the pulmonary physiology of exercise: when does biological sex matter? Eur J Appl Physiol 2021; 121:2377-2391. [PMID: 33903937 DOI: 10.1007/s00421-021-04690-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 04/12/2021] [Indexed: 11/30/2022]
Abstract
Historically, many studies investigating the pulmonary physiology of exercise (and biomedical research in general) were performed exclusively or predominantly with male research participants. This has led to an incomplete understanding of the pulmonary response to exercise. More recently, important sex-based differences with respect to the human respiratory system have been identified. The purpose of this review is to summarize current findings related to sex-based differences in the pulmonary physiology of exercise. To that end, we will discuss how morphological sex-based differences of the respiratory system affect the respiratory response to exercise. Moreover, we will discuss sex-based differences of the physiological integrative responses to exercise, and how all these differences can influence the regulation of breathing. We end with a brief discussion of pregnancy and menopause and the accompanying ventilatory changes observed during exercise.
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Affiliation(s)
- Bruno Archiza
- School of Kinesiology, University of British Columbia, 2553 Wesbrook Mall, Vancouver, BC, V6T 0B8, Canada.
| | - Michael G Leahy
- School of Kinesiology, University of British Columbia, 2553 Wesbrook Mall, Vancouver, BC, V6T 0B8, Canada
| | - Shalaya Kipp
- School of Kinesiology, University of British Columbia, 2553 Wesbrook Mall, Vancouver, BC, V6T 0B8, Canada
| | - A William Sheel
- School of Kinesiology, University of British Columbia, 2553 Wesbrook Mall, Vancouver, BC, V6T 0B8, Canada
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13
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O'Halloran KD. Muscling in on neurorehabilitative strategies to counter respiratory motor dysfunction in cervical spinal cord injury. J Physiol 2021; 599:1009-1010. [PMID: 33226628 DOI: 10.1113/jp281042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 11/20/2020] [Indexed: 01/07/2023] Open
Affiliation(s)
- Ken D O'Halloran
- Department of Physiology, School of Medicine, College of Medicine & Health, University College Cork, Cork, Ireland
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14
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O'Halloran KD. Diaphragm fatigue: Similarities and differences between sexes. J Physiol 2020; 599:1023-1024. [PMID: 33347624 DOI: 10.1113/jp281081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 12/08/2020] [Indexed: 11/08/2022] Open
Affiliation(s)
- Ken D O'Halloran
- Department of Physiology, School of Medicine, College of Medicine & Health, University College Cork, Cork, Ireland
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