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Pereira LDN, Pegorari MS, Patrizzi LJ, de Walsh IAP, Silva CDFR, da Silva JDS, Matos AP, Pinto ACPN, Ohara DG. Cross-Sectional Study on the Association Between Respiratory Muscle Strength and Dynapenic Abdominal Obesity in Community-Dwelling Older Adults. Clin Interv Aging 2023; 18:1351-1359. [PMID: 37605751 PMCID: PMC10440087 DOI: 10.2147/cia.s411170] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 08/07/2023] [Indexed: 08/23/2023] Open
Abstract
Purpose Impaired respiratory muscle strength has been associated with some geriatric syndromes. However, no studies have previously evaluated the relationship between respiratory muscle strength and dynapenic abdominal obesity. This study aimed to analyze whether there is an association between respiratory muscle strength and abdominal obesity, dynapenia and dynapenic abdominal obesity (DAO) in community-dwelling older adults. Patients and Methods Cross-sectional study conducted with community-dwelling older adults (n=382 / 70.03 ± 7.3 years) from Macapá, Amapá, Brazil. Respiratory muscle strength was assessed by measuring maximal inspiratory and expiratory pressures (MIP and MEP, respectively), using an analog manovacuometry. DAO was defined as the combination of dynapenia (grip strength < 26 kgf for men and < 16 kgf for women) and abdominal obesity (abdominal circumference > 102 cm for men and > 88 cm for women). We performed descriptive and inferential statistical analyses using the student's t-test for independent and related samples and linear regression model. Results Older adults with abdominal obesity, dynapenia, and DAO presented lower mean values (obtained and obtained versus predicted; except abdominal obesity versus MIP) for maximal respiratory pressures compared to individuals without these conditions. However, the adjusted analysis only indicated an association between MIP and the following conditions: dynapenia (MIP - β =-0.171; p<0.001), abdominal obesity (MIP - β=0.102; p=0.042), and DAO (MIP - β=-0.101; p=0.028). Conclusion Older adults with abdominal obesity, dynapenia, and DAO showed impaired maximal respiratory pressures. The results of the adjusted analysis indicate that inspiratory muscle strength may require greater attention by health professionals aiming at preventing respiratory complications and improving respiratory health care in older people with these conditions.
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Affiliation(s)
| | - Maycon Sousa Pegorari
- Department of Applied Physiotherapy, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
- Postgraduate Program in Physical Therapy, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
- Postgraduate Program in Health Sciences, Federal University of Amapá, Macapá, AP, Brazil
| | - Lislei Jorge Patrizzi
- Department of Applied Physiotherapy, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
- Postgraduate Program in Physical Therapy, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Isabel Aparecida Porcatti de Walsh
- Department of Applied Physiotherapy, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
- Postgraduate Program in Physical Therapy, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | | | | | - Areolino Pena Matos
- Department of Biological and Health Sciences, Federal University of Amapá, Macapá, AP, Brazil
- Postgraduate Program in Health Sciences, Federal University of Amapá, Macapá, AP, Brazil
| | - Ana Carolina Pereira Nunes Pinto
- Department of Biological and Health Sciences, Federal University of Amapá, Macapá, AP, Brazil
- Iberoamerican Cochrane Centre - Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- Cochrane Brazil, Center for Evidence-Based Health Studies and Health Technology Assessment, Sao Paulo, Brazil
- Department of Medicine, Evidence-Based Health Post-Graduation Program, Federal University of São Paulo, Sao Paulo, Brazil
| | - Daniela Gonçalves Ohara
- Department of Applied Physiotherapy, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
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Molani Gol R, Rafraf M. Association between abdominal obesity and pulmonary function in apparently healthy adults: A systematic review. Obes Res Clin Pract 2021; 15:415-424. [PMID: 34261619 DOI: 10.1016/j.orcp.2021.06.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 06/06/2021] [Accepted: 06/27/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Obesity, especially abdominal obesity as a chronic disorder is associated with a high risk of developing non-communicable diseases such as respiratory diseases. Impaired lung function is a sign of early respiratory injury. This review summarizes the current knowledge of the effects of abdominal obesity on pulmonary function in apparently healthy adults. METHODS Google Scholar, PubMed, Science Direct, and Scopus databases were searched from 2014 up to August 2020 using relevant keywords. All original articles written in English evaluating the effects of abdominal obesity on pulmonary function in apparently healthy adults were eligible for this review. RESULTS A total of 26 studies (23 cross-sectional and three cohort) involving 68,024 participants were included in this review. More than 88% of the included studies reported that abdominal obesity significantly inversely was associated with pulmonary function. CONCLUSION The findings indicate that in subjects with abdominal obesity respiratory function decline possibly due to mechanical compression and obesity-induced airway inflammation. Therefore, nutrition and lifestyle interventions are required for the reduction of abdominal obesity that leads to improving pulmonary function and metabolic disease.
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Affiliation(s)
- Roghayeh Molani Gol
- Student Research Committee, Tabriz university of Medical Sciences, Tabriz, Iran; Nutrition Research Center, Department of Community Nutrition, Faculty of Nutrition and Food Science, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Maryam Rafraf
- Nutrition Research Center, Department of Community Nutrition, Faculty of Nutrition and Food Science, Tabriz University of Medical Sciences, Tabriz, Iran.
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Todorčević M, Manuel AR, Austen L, Michailidou Z, Hazlehurst JM, Neville M, Stradling JR, Karpe F. Markers of adipose tissue hypoxia are elevated in subcutaneous adipose tissue of severely obese patients with obesity hypoventilation syndrome but not in the moderately obese. Int J Obes (Lond) 2021; 45:1618-1622. [PMID: 33758342 PMCID: PMC8236405 DOI: 10.1038/s41366-021-00793-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 02/01/2021] [Accepted: 02/11/2021] [Indexed: 01/15/2023]
Abstract
It has been suggested that metabolic dysfunction in obesity is at least in part driven by adipose tissue (AT) hypoxia. However, studies on AT hypoxia in humans have shown conflicting data. Therefore we aimed to investigate if markers of AT hypoxia were present in the subcutaneous AT of severly obese individuals (class III obesity) with and without hypoventilation syndrome (OHS) in comparison to moderately obese (class I obesity) and lean controls. To provide a proof-of-concept study, we quantified AT hypoxia by hypoxia inducible factor 1 A (HIF1A) protein abundance in human participants ranging from lean to severly obese (class III obesity). On top of that nightly arterial O2 saturation in individuals with obesity OHS was assessed. Subjects with class III obesity (BMI > 40 kg/m2) and OHS exhibited significantly higher adipose HIF1A protein levels versus those with class I obesity (BMI 30-34.9 kg/m2) and lean controls whereas those with class III obesity without OHS showed an intermediate response. HIF1A gene expression was not well correlated with protein abundance. Although these data demonstrate genuine AT hypoxia in the expected pathophysiological context of OHS, we did not observe a hypoxia signal in lesser degrees of obesity suggesting that adipose dysfunction may not be driven by hypoxia in moderate obesity.
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Affiliation(s)
- Marijana Todorčević
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Ari R Manuel
- Oxford Respiratory Trials Unit, Churchill Hospital, University of Oxford, Oxford, UK
- Liverpool Centre for Respiratory Science, University of Liverpool, Liverpool, UK
| | - Luke Austen
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Zoi Michailidou
- Queen's Medical Research, Institute Centre for Cardiovascular Research, University of Edinburgh, Edinburgh, UK
| | - Jonathan M Hazlehurst
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Matt Neville
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - John R Stradling
- Oxford Respiratory Trials Unit, Churchill Hospital, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, OUH Trust, Churchill Hospital, Oxford, UK
| | - Fredrik Karpe
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
- NIHR Oxford Biomedical Research Centre, OUH Trust, Churchill Hospital, Oxford, UK.
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4
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Luchesa CA, Mafort TT, Silva RR, Paro IC, Souza FM, Lopes AJ. Contribution of lung function in predicting distance covered in the 6-min walk test in obese Brazilian women. ACTA ACUST UNITED AC 2020; 53:e10279. [PMID: 33111741 PMCID: PMC7584155 DOI: 10.1590/1414-431x202010279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 08/18/2020] [Indexed: 01/08/2023]
Abstract
Obesity affects the respiratory system through various mechanisms, including systemic inflammation and direct mechanical hindrance due to fat deposition in the chest and abdomen. In addition, changes in the neural control of respiration and increases in thoracic blood volume can promote abnormalities in lung function. Thus, determining relationships between the distance covered in the 6-min walk test (6MWT) and demographic and lung function variables may help us better understand the mechanisms involved in reduced functional exercise capacity in obesity. To explore the determinants of the 6-min walking distance (6MWD) and evaluate the influence of lung function on the distance covered, 263 obese Brazilian women performed the 6MWT and underwent spirometry and respiratory muscle strength measurement. The mean age was 41.8±11.1 years. The mean body mass index (BMI) was 45±8 kg/m2. The 6MWD showed correlations with height (r=0.319), age (r=-0.281), weight (r=-0.370), BMI (r=-0.561), forced vital capacity (FVC, r=0.443), expiratory peak flow (r=0.278), maximal inspiratory pressure (MIP, r=0.326), and maximal expiratory pressure (r=0.259), all with P<0.0001. In the stepwise forward regression analysis, BMI, FVC, age, and MIP were the independent predictive variables for 6MWD, explaining 41% of its variability. The reference equation including lung function was as follows: 6MWD (m) = 513.6 - (4.439 × BMIkg/m2) + (1.136 × FVC%predicted) - (1.048 × ageyrs) + (0.544 × MIP%predicted). Thus, the inclusion of lung function in a reference equation for 6MWD contributes to a better prediction of the distance covered in this population.
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Affiliation(s)
- C A Luchesa
- Programa de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta, Rio de Janeiro, RJ, Brasil.,Centro de Reabilitações, Centro Universitário Fundação Assis Gurgacz, Cascavel, PR, Brasil
| | - T T Mafort
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - R R Silva
- Centro de Reabilitações, Centro Universitário Fundação Assis Gurgacz, Cascavel, PR, Brasil
| | - I C Paro
- Centro de Reabilitações, Centro Universitário Fundação Assis Gurgacz, Cascavel, PR, Brasil
| | - F M Souza
- Centro de Reabilitações, Centro Universitário Fundação Assis Gurgacz, Cascavel, PR, Brasil
| | - A J Lopes
- Programa de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta, Rio de Janeiro, RJ, Brasil.,Programa de Pós-Graduação em Ciências Médicas, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
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5
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Fontana AD, Lopes AD, Lunardi AC. Bariatric Surgery Associated with Practice of Moderate to Intense Physical Activity Related to Weight Loss, Activity Level in Daily Life, Dyspnea, and Quality of Life of Sedentary Individuals with Morbid Obesity: a Prospective Longitudinal Study. Obes Surg 2019; 29:2442-2448. [DOI: 10.1007/s11695-019-03859-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Sivam S, Yee B, Wong K, Wang D, Grunstein R, Piper A. Obesity Hypoventilation Syndrome: Early Detection of Nocturnal-Only Hypercapnia in an Obese Population. J Clin Sleep Med 2018; 14:1477-1484. [PMID: 30176974 DOI: 10.5664/jcsm.7318] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 05/09/2018] [Indexed: 01/19/2023]
Abstract
STUDY OBJECTIVES Hypoventilation in obesity is now divided into five stages; stage 0 (pure obstructive sleep apnea; OSA), stages I/II (obesity-related sleep hypoventilation; ORSH) and stages III/IV (awake hypercapnia, obesity hypoventilation syndrome; OHS). Hypercapnia during the day may be preceded by hypoventilation during sleep. The goal of this study was to determine the prevalence and to identify simple clinical measures that predict stages I/II ORSH. The effect of supine positioning on selected clinical measures was also evaluated. METHODS Ninety-four patients with a body mass index > 40 kg/m2 and a spirometric ratio > 0.7 were randomized to begin testing either in the supine or upright seated position on the day of their diagnostic sleep study. Arterialized capillary blood gases were measured in both positions. Oxygen saturation measured by pulse oximetry was also obtained while awake. Transcutaneous CO2 monitoring was performed during overnight polysomnography. RESULTS Stages I/II ORSH had a prevalence of 19% in an outpatient tertiary hospital setting compared with 61%, 17%, and 3% for stages 0, III/IV, and no sleep-disordered breathing respectively. Predictors for sleep hypoventilation in this group were an awake oxygen saturation of ≤ 93% (sensitivity 39%, specificity 98%, positive likelihood ratio of 22) and a partial pressure of carbon dioxide ≥ 45 mmHg (sensitivity 44%, specificity 98%, positive likelihood ratio of 24) measured in the supine position. CONCLUSIONS ORSH has a similar prevalence to OHS. Awake oxygen saturation and partial pressure of carbon dioxide performed in the supine position may help predict obese patients with sleep hypoventilation without awake hypercapnia. COMMENTARY A commentary on this article appears in this issue on page 1455. CLINICAL TRIAL REGISTRATION Registry: Australian New Zealand Clinical Trials Registry, Identifier: ACTRN 12615000135516, URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367493&isReview=true, Title: A cross-sectional study to identify obese patients who are at risk for developing obesity hypoventilation syndrome (OHS) by investigating the relationship between daytime measures (including supine hypercapnia, distribution of body fat and lung volumes) with the presence of hypoventilation during sleep.
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Affiliation(s)
- Sheila Sivam
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia; School of Medicine, University of Sydney, Sydney, Australia; Woolcock Institute of Medical Research, Sleep and Circadian Research Group, Sydney, Australia
| | - Brendon Yee
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia; School of Medicine, University of Sydney, Sydney, Australia; Woolcock Institute of Medical Research, Sleep and Circadian Research Group, Sydney, Australia
| | - Keith Wong
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia; School of Medicine, University of Sydney, Sydney, Australia; Woolcock Institute of Medical Research, Sleep and Circadian Research Group, Sydney, Australia
| | - David Wang
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia; School of Medicine, University of Sydney, Sydney, Australia; Woolcock Institute of Medical Research, Sleep and Circadian Research Group, Sydney, Australia
| | - Ronald Grunstein
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia; School of Medicine, University of Sydney, Sydney, Australia; Woolcock Institute of Medical Research, Sleep and Circadian Research Group, Sydney, Australia
| | - Amanda Piper
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia; School of Medicine, University of Sydney, Sydney, Australia; Woolcock Institute of Medical Research, Sleep and Circadian Research Group, Sydney, Australia
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7
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Rowsell L, Wong KKH, Yee BJ, Eckert DJ, Somogyi AA, Duffin J, Grunstein RR, Wang D. The effect of acute morphine on obstructive sleep apnoea: a randomised double-blind placebo-controlled crossover trial. Thorax 2018; 74:177-184. [DOI: 10.1136/thoraxjnl-2018-211675] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 06/26/2018] [Accepted: 07/23/2018] [Indexed: 01/18/2023]
Abstract
ObjectiveAnaesthesiology guidelines suggest that opioids worsen obstructive sleep apnoea (OSA) despite no randomised controlled trial evidence. We therefore conducted a randomised controlled trial to evaluate the effects of a common clinical dose of morphine on OSA, and to identify clinical phenotype and genotype vulnerability to opioid-respiratory depression.MethodsUnder a double-blind, randomised, crossover design, 60 male patients with OSA attended two visits to the hospital sleep laboratory, at least 1 week apart. Either 40 mg controlled-release oral morphine or placebo was administered. Awake ventilatory chemoreflex tests were performed post dose and prior to overnight polysomnography monitoring. Blood was sampled before sleep and the next morning for toxicology and genotype analyses. Sleep time with oxygen saturation (SpO2) <90% (T90) was the primary outcome.ResultsDespite a large inter-individual variability, 40 mg morphine did not worsen T90 and apnoea–hypopnoea index, and only decreased the SpO2 nadir by 1.3%. In patients with severe OSA, a lower baseline CO2ventilatory response threshold correlated with the worsening of T90, apnoea–hypopnoea index and oxygen desaturation index with morphine use. Patients with OSA and the A118G OPRM1 polymorphism of A/A and A/G had a significantly different morphine effect on awake ventilatory chemosensitivity and T90 during sleep.Conclusions40 mg oral controlled-release morphine did not worsen OSA in men, challenging traditional thinking that OSA will be worsened by opioids. Individual opioid response in patients with OSA may relate to baseline CO2 response threshold and OPRM1 genotype. Our study findings may pave the way for a precision medicine approach to avoid opioid-related risks.Trial registration numberThe Australian and New Zealand Clinical Trial Registry, ACTRN12613000858796.
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Chung Y, Garden FL, Jee AS, Srikantha S, Gupta S, Buchanan PR, Collett PW, Marks GB, Vedam H. Supine awake oximetry as a screening tool for daytime hypercapnia in super-obese patients. Intern Med J 2018; 47:1136-1141. [PMID: 28557364 DOI: 10.1111/imj.13496] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 05/20/2017] [Accepted: 05/22/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Evidence-based screening tools are required for detection of daytime hypercapnia in high-risk patient populations. AIMS To determine the validity of supine awake oximetry as a test for daytime hypercapnia and severe sleep disordered breathing (SDB) in super-obese patients. METHODS This was a cross-sectional diagnostic test evaluation of super-obese adults (body mass index >50 kg/m2 ) presenting to Liverpool Hospital, Australia, between 2009 and 2015 for diagnostic polysomnography (PSG) and arterial blood gas measurement. Supine awake oxygen saturation (SpO2 ) was determined using oximetry measurements from the first three awake epochs of raw PSG data. Sensitivity and specificity of SpO2 for detecting patients with daytime hypercapnia (PaCO2 >45 mmHg) and severe SDB (respiratory disturbance index (RDI) >30 events/h) were assessed at various cut-off points and displayed using a receiver operating characteristic (ROC) curve. Area under the ROC curve and positive and negative predictive values (PPV and NPV) in the present patient population were derived. RESULTS Of 52 patients, 23 (44%) had daytime hypercapnia. SpO2 measured awake in the supine position was associated with the presence of daytime hypercapnia but not with the presence of severe SDB. Overall, awake supine SpO2 <91.2% had 34.8% sensitivity, 96.6% specificity and 88.8% PPV, and SpO2 <96.7% had 87.0% sensitivity, 20.7% specificity and 66.7% NPV for the presence of daytime hypercapnia. CONCLUSION Awake supine oximetry is an easily performed test that may have novel use in identifying patients at high risk of respiratory failure. Future studies are required to evaluate prospectively its role in screening patients at risk of daytime hypercapnia.
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Affiliation(s)
- Yewon Chung
- Department of Respiratory and Sleep Medicine, Liverpool Hospital, Sydney, New South Wales, Australia.,Respiratory, Sleep and Environmental Health Research Group, University of New South Wales, Sydney, New South Wales, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia
| | - Frances L Garden
- Respiratory, Sleep and Environmental Health Research Group, University of New South Wales, Sydney, New South Wales, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia
| | - Adelle S Jee
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Central Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Subash Srikantha
- Department of Respiratory and Sleep Medicine, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Saurabh Gupta
- Department of Respiratory and Sleep Medicine, Liverpool Hospital, Sydney, New South Wales, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Peter R Buchanan
- Department of Respiratory and Sleep Medicine, Liverpool Hospital, Sydney, New South Wales, Australia.,Respiratory, Sleep and Environmental Health Research Group, University of New South Wales, Sydney, New South Wales, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Peter W Collett
- Department of Respiratory and Sleep Medicine, Liverpool Hospital, Sydney, New South Wales, Australia.,Respiratory, Sleep and Environmental Health Research Group, University of New South Wales, Sydney, New South Wales, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Guy B Marks
- Department of Respiratory and Sleep Medicine, Liverpool Hospital, Sydney, New South Wales, Australia.,Respiratory, Sleep and Environmental Health Research Group, University of New South Wales, Sydney, New South Wales, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia
| | - Hima Vedam
- Department of Respiratory and Sleep Medicine, Liverpool Hospital, Sydney, New South Wales, Australia.,Respiratory, Sleep and Environmental Health Research Group, University of New South Wales, Sydney, New South Wales, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia
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10
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Sonoda N, Morimoto A, Tatsumi Y, Asayama K, Ohkubo T, Izawa S, Ohno Y. A prospective study of the impact of diabetes mellitus on restrictive and obstructive lung function impairment: The Saku study. Metabolism 2018; 82:58-64. [PMID: 29288691 DOI: 10.1016/j.metabol.2017.12.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 12/14/2017] [Accepted: 12/23/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND To assess the impact of diabetes on restrictive and obstructive lung function impairment. METHODS This 5-year prospective study included 7524 participants aged 40-69years without lung function impairment at baseline who underwent a comprehensive medical check-up between April 2008 and March 2009 at Saku Central Hospital. Diabetes was defined by fasting plasma glucose ≥7.0mmol/l (126mg/dl), HbA1c≥6.5% (48mmol/mol), or a history of diabetes, as determined by interviews conducted by the physicians. Restrictive and obstructive lung function impairment were defined as forced vital capacity (FVC) <80% predicted and forced expiratory volume in 1s (FEV1) to FVC ratio (FEV1/FVC) <0.70, respectively. Participants were screened until they developed restrictive or obstructive lung function impairment or until March 2014. RESULTS During the follow-up period, 171 and 639 individuals developed restrictive and obstructive lung function impairment, respectively. Individuals with diabetes had a 1.6-fold higher risk of restrictive lung function impairment than those without diabetes after adjusting for sex, age, height, abdominal obesity, smoking status, exercise habits, systolic blood pressure, HDL-cholesterol, log-transformed high-sensitivity C-reactive protein, and baseline lung function [multivariable-adjusted HR and 95% CI; 1.57 (1.04-2.36)]. In contrast, individuals with diabetes did not have a significantly higher risk of obstructive lung function impairment [multivariable-adjusted HR and 95% CI; 0.93 (0.72-1.21)]. CONCLUSION Diabetes was associated with restrictive lung function impairment but not obstructive lung function impairment.
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Affiliation(s)
- Nao Sonoda
- Department of Mathematical Health Science, Graduate School of Medicine, Osaka University, Suita, Japan.
| | - Akiko Morimoto
- Department of Fundamental Nursing, Graduate School of Nursing, Osaka Prefecture University, Habikino, Japan
| | - Yukako Tatsumi
- Department of Hygiene and Public Health, Teikyo University, Itabashi-ku, Japan
| | - Kei Asayama
- Department of Hygiene and Public Health, Teikyo University, Itabashi-ku, Japan
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University, Itabashi-ku, Japan
| | | | - Yuko Ohno
- Department of Mathematical Health Science, Graduate School of Medicine, Osaka University, Suita, Japan
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Maia LDA, Silva PL, Pelosi P, Rocco PRM. Controlled invasive mechanical ventilation strategies in obese patients undergoing surgery. Expert Rev Respir Med 2017; 11:443-452. [PMID: 28436715 DOI: 10.1080/17476348.2017.1322510] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The obesity prevalence is increasing in surgical population. As the number of obese surgical patients increases, so does the demand for mechanical ventilation. Nevertheless, ventilatory strategies in this population are challenging, since obesity results in pathophysiological changes in respiratory function. Areas covered: We reviewed the impact of obesity on respiratory system and the effects of controlled invasive mechanical ventilation strategies in obese patients undergoing surgery. To date, there is no consensus regarding the optimal invasive mechanical ventilation strategy for obese surgical patients, and no evidence that possible intraoperative beneficial effects on oxygenation and mechanics translate into better postoperative pulmonary function or improved outcomes. Expert commentary: Before determining the ideal intraoperative ventilation strategy, it is important to analyze the pathophysiology and comorbidities of each obese patient. Protective ventilation with low tidal volume, driving pressure, energy, and mechanical power should be employed during surgery; however, further studies are required to clarify the most effective ventilation strategies, such as the optimal positive end-expiratory pressure and whether recruitment maneuvers minimize lung injury. In this context, an ongoing trial of intraoperative ventilation in obese patients (PROBESE) should help determine the mechanical ventilation strategy that best improves clinical outcome in patients with body mass index≥35kg/m2.
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Affiliation(s)
- Lígia de Albuquerque Maia
- a Laboratory of Pulmonary Investigation, Carlos Chagas Filho Biophysics Institute , Federal University of Rio de Janeiro , Rio de Janeiro , Brazil
| | - Pedro Leme Silva
- a Laboratory of Pulmonary Investigation, Carlos Chagas Filho Biophysics Institute , Federal University of Rio de Janeiro , Rio de Janeiro , Brazil.,b National Institute of Science and Technology for Regenerative Medicine , Rio de Janeiro , Brazil
| | - Paolo Pelosi
- c Department of Surgical Sciences and Integrated Diagnostics, IRCCS AOU San Martino-IST , University of Genoa , Genoa , Italy
| | - Patricia Rieken Macedo Rocco
- a Laboratory of Pulmonary Investigation, Carlos Chagas Filho Biophysics Institute , Federal University of Rio de Janeiro , Rio de Janeiro , Brazil.,b National Institute of Science and Technology for Regenerative Medicine , Rio de Janeiro , Brazil
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Mafort TT, Rufino R, Costa CH, Lopes AJ. Obesity: systemic and pulmonary complications, biochemical abnormalities, and impairment of lung function. Multidiscip Respir Med 2016; 11:28. [PMID: 27408717 PMCID: PMC4940831 DOI: 10.1186/s40248-016-0066-z] [Citation(s) in RCA: 139] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 05/10/2016] [Indexed: 12/11/2022] Open
Abstract
Obesity is currently one of the major epidemics of this millennium and affects individuals throughout the world. It causes multiple systemic complications, some of which result in severe impairment of organs and tissues. These complications involve mechanical changes caused by the accumulation of adipose tissue and the numerous cytokines produced by adipocytes. Obesity also significantly interferes with respiratory function by decreasing lung volume, particularly the expiratory reserve volume and functional residual capacity. Because of the ineffectiveness of the respiratory muscles, strength and resistance may be reduced. All these factors lead to inspiratory overload, which increases respiratory effort, oxygen consumption, and respiratory energy expenditure. It is noteworthy that patterns of body fat distribution significantly influence the function of the respiratory system, likely via the direct mechanical effect of fat accumulation in the chest and abdominal regions. Weight loss caused by various types of treatment, including low-calorie diet, intragastric balloon, and bariatric surgery, significantly improves lung function and metabolic syndrome and reduces body mass index. Despite advances in the knowledge of pulmonary and systemic complications associated with obesity, longitudinal randomized studies are needed to assess the impact of weight loss on metabolic syndrome and lung function.
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Affiliation(s)
- Thiago Thomaz Mafort
- Laboratory of Respiration Physiology, Pulmonary Medicine Department, Pedro Ernesto University Hospital, State University of Rio de Janeiro, Boulevard 28 de Setembro, 77, Vila Isabel, 20551-030 Rio de Janeiro Brazil
| | - Rogério Rufino
- Laboratory of Respiration Physiology, Pulmonary Medicine Department, Pedro Ernesto University Hospital, State University of Rio de Janeiro, Boulevard 28 de Setembro, 77, Vila Isabel, 20551-030 Rio de Janeiro Brazil ; Postgraduate Programme in Medical Sciences, State University of Rio de Janeiro, Av. Prof. Manoel de Abreu, 444, Vila Isabel, 20550-170 Rio de Janeiro Brazil
| | - Cláudia Henrique Costa
- Laboratory of Respiration Physiology, Pulmonary Medicine Department, Pedro Ernesto University Hospital, State University of Rio de Janeiro, Boulevard 28 de Setembro, 77, Vila Isabel, 20551-030 Rio de Janeiro Brazil ; Postgraduate Programme in Medical Sciences, State University of Rio de Janeiro, Av. Prof. Manoel de Abreu, 444, Vila Isabel, 20550-170 Rio de Janeiro Brazil
| | - Agnaldo José Lopes
- Laboratory of Respiration Physiology, Pulmonary Medicine Department, Pedro Ernesto University Hospital, State University of Rio de Janeiro, Boulevard 28 de Setembro, 77, Vila Isabel, 20551-030 Rio de Janeiro Brazil ; Postgraduate Programme in Medical Sciences, State University of Rio de Janeiro, Av. Prof. Manoel de Abreu, 444, Vila Isabel, 20550-170 Rio de Janeiro Brazil
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Dattani RS, Swerner CB, Stradling JR, Manuel AR. Exploratory study into the effect of abdominal mass loading on airways resistance and ventilatory failure. BMJ Open Respir Res 2016; 3:e000138. [PMID: 27335651 PMCID: PMC4908953 DOI: 10.1136/bmjresp-2016-000138] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 05/04/2016] [Accepted: 05/13/2016] [Indexed: 11/27/2022] Open
Abstract
Objective We hypothesised that the airway resistance during tidal breathing would correlate with a particular pattern of increasing obesity, particularly when supine, and would differ between participants with and without ventilatory failure. Methods In our cross-sectional cohort study, 72 morbidly obese patients (40 males, 32 females, mean body mass index (BMI) 47.2) had measurements of both airways resistance (by impulse oscillometry (IOS)) and adiposity (by dual-energy X-ray absorptiometry (DXA)). Results All measures of airways resistance increased in the supine position: total airways resistance (R5) +37% (p<0.0005); large airways resistance (R20) +29% (p<0.0005); and small airways resistance (R5–R20) +52% (p<0.0005). BMI was correlated with seated R5, seated R5–R20, supine R5 and supine R5–R20 (r=0.33 p<0.006, r=0.32 p<0.004, r=0.30 p<0.02 and r=0.36 p<0.04, respectively). Visceral adipose tissue mass was correlated with supine R5–20 (r=0.46 p<0.05). Supine measures of total airways resistance (R5) and large airways resistance (R20) differed between those with and without ventilatory failure, as did mean weight and BMI. Conclusions Our study identifies a potentially detrimental effect of the supine posture on tidal breathing airways resistance in obese patients. This change is correlated most with visceral adipose tissue mass and the small airways. We were able to demonstrate that supine increases in airways resistance during tidal breathing, within obese patients, are different between those with and without ventilatory failure. Trial registration number NCT01380418; pre-results.
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Affiliation(s)
- Raj S Dattani
- Oxford Respiratory Trials Unit, Experimental Medicine Division, Nuffield Department of Medicine, University of Oxford, Oxford, UK; St Peter's College, New Inn Hall Street, Oxford, UK; Centre for Altitude, Space and Extreme Environment Medicine (CASE Medicine), Institute of Sport Exercise and Health, University College London, London, UK
| | | | - John R Stradling
- Oxford Respiratory Trials Unit, Experimental Medicine Division, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Oxford Centre for Respiratory Medicine, NIHR Oxford Biomedical Research Centre, The Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Ari Rg Manuel
- Oxford Respiratory Trials Unit, Experimental Medicine Division, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Oxford Centre for Respiratory Medicine, NIHR Oxford Biomedical Research Centre, The Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
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Harrington MG, McGeorge AP, Ballantyne JP, Beastall G. A prospective survey for insulinomas in a neurology department. Sleep Breath 1983; 22:673-681. [PMID: 29197986 PMCID: PMC6133118 DOI: 10.1007/s11325-017-1599-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 11/07/2017] [Accepted: 11/23/2017] [Indexed: 12/28/2022]
Abstract
Purpose Obesity is associated with both obstructive sleep apnea (OSA) and obesity hypoventilation. Differences in adipose tissue distribution are thought to underlie the development of both OSA and hypoventilation. We explored the relationships between the distribution of upper airway, neck, chest, abdominal and muscle fat in very obese individuals. Methods We conducted a cross-sectional cohort study of individuals presenting to a tertiary sleep clinic or for assessment for bariatric surgery. Individuals underwent magnetic resonance (MR) imaging of their upper airway, neck, chest, abdomen and thighs; respiratory polygraphy; 1 week of autotitrating CPAP; and morning arterial blood gas to determine carbon dioxide partial pressure and base excess. Results Fifty-three individuals were included, with mean age of 51.6 ± 8.4 years and mean BMI of 44.3 ± 7.9 kg/m2; there were 27 males (51%). Soft palate, tongue and lateral wall volumes were significantly associated with the AHI in univariable analyses (p < 0.001). Gender was a significant confounder in these associations. No significant associations were found between MRI measures of adiposity and hypoventilation. Conclusions In very obese individuals, our results indicate that increased volumes of upper airway structures are associated with increased severity of OSA, as previously reported in less obese individuals. Increasingly large upper airway structures that reduce pharyngeal lumen size are likely to lead to OSA by increasing the collapsibility of the upper airway. However, we did not show any significant association between regional fat distribution and propensity for hypoventilation, in this population. Electronic supplementary material The online version of this article (10.1007/s11325-017-1599-x) contains supplementary material, which is available to authorized users.
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