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Zhang T, Dong X, Wang D, Huang C, Zhang XD. RespirAnalyzer: an R package for analyzing data from continuous monitoring of respiratory signals. BIOINFORMATICS ADVANCES 2024; 4:vbae003. [PMID: 38269257 PMCID: PMC10807906 DOI: 10.1093/bioadv/vbae003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 11/30/2023] [Accepted: 01/11/2024] [Indexed: 01/26/2024]
Abstract
Motivation The analysis of data obtained from continuous monitoring of respiratory signals (CMRS) holds significant importance in improving patient care, optimizing sports performance, and advancing scientific understanding in the field of respiratory health. Results The R package RespirAnalyzer provides an analytic tool specifically for feature extraction, fractal and complexity analysis for CMRS data. The package covers a wide and comprehensive range of data analysis methods including obtaining inter-breath intervals (IBI) series, plotting time series, obtaining summary statistics of IBI series, conducting power spectral density, multifractal detrended fluctuation analysis (MFDFA) and multiscale sample entropy analysis, fitting the MFDFA results with the extended binomial multifractal model, displaying results using various plots, etc. This package has been developed from our work in directly analyzing CMRS data and is anticipated to assist fellow researchers in computing the related features of their CMRS data, enabling them to delve into the clinical significance inherent in these features. Availability and implementation The package for Windows is available from both Comprehensive R Archive Network (CRAN): https://cran.r-project.org/web/packages/RespirAnalyzer/index.html and GitHub: https://github.com/dongxinzheng/RespirAnalyzer.
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Affiliation(s)
- Teng Zhang
- Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Taipa, Macau 999078, China
| | - Xinzheng Dong
- Zhuhai Laboratory of Key Laboratory of Symbolic Computation and Knowledge Engineering of Ministry of Education, Zhuhai College of Science and Technology, Zhuhai 519041, China
| | - Dandan Wang
- Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Taipa, Macau 999078, China
| | - Chen Huang
- Dr. Neher's Biophysics Laboratory for Innovative Drug Discovery, Macau University of Science and Technology, Taipa, Macau 999078, China
| | - Xiaohua Douglas Zhang
- Department of Biostatistics, University of Kentucky, Lexington, KY 40536, United States
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2
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Enayati P, Dehdar K, Javan M, Raoufy MR. The protective effect of inhaled corticosteroid on lung inflammation and breathing pattern complexity in a rat model of asthma. Respir Physiol Neurobiol 2023; 314:104072. [PMID: 37182593 DOI: 10.1016/j.resp.2023.104072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/05/2023] [Accepted: 05/07/2023] [Indexed: 05/16/2023]
Abstract
Asthma is a heterogeneous disease in which the complexity of the breathing pattern reduces as the severity of the disease increases. Since the pathophysiological basis of reduced breathing pattern complexity in asthma is unclear, in this study, we investigated the effect of reducing inflammation using an inhaled corticosteroid (fluticasone propionate) on the breathing pattern of a rat model of asthma. Detrended fluctuation analysis, sample entropy, and cross-sample entropy analysis of both inter-breath interval and respiratory volume time series showed that early treatment with inhaled corticosteroids not only diminishes lung inflammation and airway hyper-responsiveness, but also has a protective effect against the reduction of breathing pattern complexity due to asthma. However, late treatment had a partial effect on asthma-induced respiratory pattern changes. Since inflammation is a key factor in shifting breathing dynamics away from normal fluctuations, these findings further emphasize the importance of early treatment of asthma with corticosteroids.
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Affiliation(s)
- Parisa Enayati
- Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Kolsum Dehdar
- Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mohammad Javan
- Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mohammad Reza Raoufy
- Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
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3
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Clark NC, Pethick J, Falla D. Measuring complexity of muscle force control: Theoretical principles and clinical relevance in musculoskeletal research and practice. Musculoskelet Sci Pract 2023; 64:102725. [PMID: 36773547 DOI: 10.1016/j.msksp.2023.102725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/18/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023]
Abstract
Musculoskeletal conditions affect bones, joints, and muscles of the locomotor system and are a leading cause of disability worldwide. This suggests that current musculoskeletal rehabilitation techniques fail to target the characteristics (e.g., physiological/physical/psychological) most influential for long-term musculoskeletal health. To identify whether a physiological characteristic is impaired, it must be measured. In neuromuscular control, traditional research approaches use magnitude-based measurements (e.g., peak force/standard deviation of force/coefficient of variation of force). However, magnitude-based measurements miss 'hidden information' regarding a physiological system's status across time. To better identify physiological characteristics that are clinically-important for long-term musculoskeletal health, other measurement approaches currently less applied in musculoskeletal research may be helpful. The purpose of this article is to present an introduction to technical and measurement principles for quantifying the 'complexity' of muscle force control as one representation of peripheral joint neuromuscular control. Complexity measurements are time-based and consider the irregular temporal structure of physiological signals. We review theoretical principles underlying measuring complexity of muscle force control and explain its clinical relevance for musculoskeletal scientists and clinicians. The principles include sensorimotor control of peripheral joints, muscle force signal construction and features, muscle force control measurement procedures, and variability and complexity variables. We propose the potential utility of measuring the complexity of muscle force control for diagnosing sensorimotor system impairment and prognosis following musculoskeletal disease or injury. This article will serve as an educational asset and a scientific resource that will inform future research directions to optimise rehabilitation for people with peripheral joint disease and injury.
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Affiliation(s)
- Nicholas C Clark
- School of Sport, Rehabilitation, and Exercise Sciences, University of Essex, Wivenhoe Park, Colchester, Essex, CO4 3SQ, United Kingdom.
| | - Jamie Pethick
- School of Sport, Rehabilitation, and Exercise Sciences, University of Essex, Wivenhoe Park, Colchester, Essex, CO4 3SQ, United Kingdom.
| | - Deborah Falla
- School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom.
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4
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Oku Y. Temporal variations in the pattern of breathing: techniques, sources, and applications to translational sciences. J Physiol Sci 2022; 72:22. [PMID: 36038825 DOI: 10.1186/s12576-022-00847-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 08/12/2022] [Indexed: 11/10/2022]
Abstract
The breathing process possesses a complex variability caused in part by the respiratory central pattern generator in the brainstem; however, it also arises from chemical and mechanical feedback control loops, network reorganization and network sharing with nonrespiratory motor acts, as well as inputs from cortical and subcortical systems. The notion that respiratory fluctuations contain hidden information has prompted scientists to decipher respiratory signals to better understand the fundamental mechanisms of respiratory pattern generation, interactions with emotion, influences on the cortical neuronal networks associated with cognition, and changes in variability in healthy and disease-carrying individuals. Respiration can be used to express and control emotion. Furthermore, respiration appears to organize brain-wide network oscillations via cross-frequency coupling, optimizing cognitive performance. With the aid of information theory-based techniques and machine learning, the hidden information can be translated into a form usable in clinical practice for diagnosis, emotion recognition, and mental conditioning.
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Affiliation(s)
- Yoshitaka Oku
- Division of Physiome, Department of Physiology, Hyogo Medical University, Nishinomiya, Hyogo, 663-8501, Japan.
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5
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Seppä VP, Gracia-Tabuenca J, Kotaniemi-Syrjänen A, Malmström K, Hult A, Pelkonen AS, Mäkelä MJ, Viik J, Malmberg LP. Expiratory variability index is associated with asthma risk, wheeze and lung function in infants with recurrent respiratory symptoms. ERJ Open Res 2020; 6:00167-2020. [PMID: 33123560 PMCID: PMC7569165 DOI: 10.1183/23120541.00167-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 08/05/2020] [Indexed: 11/30/2022] Open
Abstract
Analysis of tidal breathing flow–volume (TBFV) curves is a convenient method to assess lung function in infants. We have shown that impedance pneumography (IP) is a valid method to assess overnight TBFV profiles in young children [1] and infants [2] and that certain specific curve shapes are related to symptom presentation and asthma risk [3]. We have also shown that the reduced variability of TBFV curves may be an indicator of airway obstruction in children [4–6]. However, in infants, it is unknown whether overnight TBFV variability is associated with respiratory symptoms or asthma risk. Impedance pneumography enables the measurement of the expiratory variability index (EVI) at home during a night's sleep in infants with recurrent respiratory symptoms. EVI is associated with asthma risk, symptoms and lung function.https://bit.ly/2PF2cx8
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Affiliation(s)
| | | | | | | | | | - Anna S Pelkonen
- Helsinki University Central Hospital, Dept of Allergy, Helsinki, Finland
| | - Mika J Mäkelä
- Helsinki University Central Hospital, Dept of Allergy, Helsinki, Finland
| | - Jari Viik
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
| | - L Pekka Malmberg
- Helsinki University Central Hospital, Dept of Allergy, Helsinki, Finland
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6
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Klimeš F, Voskrebenzev A, Gutberlet M, Kern AL, Behrendt L, Grimm R, Suhling H, Crisosto CG, Kaireit TF, Pöhler GH, Glandorf J, Wacker F, Vogel-Claussen J. 3D phase-resolved functional lung ventilation MR imaging in healthy volunteers and patients with chronic pulmonary disease. Magn Reson Med 2020; 85:912-925. [PMID: 32926451 DOI: 10.1002/mrm.28482] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/04/2020] [Accepted: 07/27/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE To test the feasibility of 3D phase-resolved functional lung (PREFUL) MRI in healthy volunteers and patients with chronic pulmonary disease, to compare 3D to 2D PREFUL, and to investigate the required temporal resolution to obtain stable 3D PREFUL measurement. METHODS Sixteen participants underwent MRI using 2D and 3D PREFUL. Retrospectively, the spatial resolution of 3D PREFUL (4 × 4 × 4 mm3 ) was decreased to match the spatial resolution of 2D PREFUL (4 × 4 × 15 mm3 ), abbreviated as 3Dlowres . In addition to regional ventilation (RVent), flow-volume loops were computed and rated by a cross-correlation (CC). Ventilation defect percentage (VDP) maps were obtained. RVent, CC, VDPRVent , and VDPCC were compared for systematic differences between 2D, 3Dlowres , and 3D PREFUL. Dividing the 3D PREFUL data into 4- (≈ 20 phases), 8- (≈ 40 phases), and 12-min (≈ 60 phases) acquisition pieces, the ventilation parameter maps, including the heterogeneity of ventilation time to peak, were tested regarding the required temporal resolution. RESULTS RVent, CC, VDPRVent , and VDPCC presented significant correlations between 2D and 3D PREFUL (r = 0.64-0.94). CC and VDPCC of 2D and 3Dlowres PREFUL were significantly different (P < .0113). Comparing 3Dlowres and 3D PREFUL, all parameters were found to be statistically different (P < .0045). CONCLUSION 3D PREFUL MRI depicts the whole lung volume and breathing cycle with superior image resolution and with likely more precision compared to 2D PREFUL. Furthermore, 3D PREFUL is more sensitive to detect regions of hypoventilation and ventilation heterogeneity compared to 3Dlowres PREFUL, which is important for early detection and improved monitoring of patients with chronic lung disease.
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Affiliation(s)
- Filip Klimeš
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research (DZL), Hannover, Germany
| | - Andreas Voskrebenzev
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research (DZL), Hannover, Germany
| | - Marcel Gutberlet
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research (DZL), Hannover, Germany
| | - Agilo Luitger Kern
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research (DZL), Hannover, Germany
| | - Lea Behrendt
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research (DZL), Hannover, Germany
| | | | - Hendrik Suhling
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research (DZL), Hannover, Germany.,Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Cristian Gonzales Crisosto
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research (DZL), Hannover, Germany
| | - Till Frederick Kaireit
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research (DZL), Hannover, Germany
| | - Gesa Helen Pöhler
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research (DZL), Hannover, Germany
| | - Julian Glandorf
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research (DZL), Hannover, Germany
| | - Frank Wacker
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research (DZL), Hannover, Germany
| | - Jens Vogel-Claussen
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research (DZL), Hannover, Germany
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7
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Frima ES, Theodorakopoulos I, Gidaris D, Karantaglis N, Chatziparasidis G, Plotas P, Anthracopoulos M, Fouzas S. Lung Function Variability in Children and Adolescents With and Without Asthma (LUV Study): Protocol for a Prospective, Nonrandomized, Clinical Trial. JMIR Res Protoc 2020; 9:e20350. [PMID: 32763874 PMCID: PMC7442949 DOI: 10.2196/20350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/21/2020] [Accepted: 06/23/2020] [Indexed: 01/09/2023] Open
Abstract
Background Variability analysis of peak expiratory flow (PEF) and forced expiratory volume at 1 second (FEV1) has been used in research to predict exacerbations in adults with asthma. However, there is a paucity of data regarding PEF and FEV1 variability in healthy children and adolescents and those with asthma. Objective The objective of this study is the assessment of PEF and FEV1 variability in (1) healthy children and adolescents, to define the normal daily fluctuation of PEF and FEV1 and the parameters that may influence it, and (2) children and adolescents with asthma, to explore the differences from healthy subjects and reveal any specific variability changes prior to exacerbation. Methods The study will include 100 healthy children and adolescents aged 6-18 years (assessment of normal PEF and FEV1 variability) and 100 children and adolescents of the same age with diagnosed asthma (assessment of PEF and FEV1 variability in subjects with asthma). PEF and FEV1 measurements will be performed using an ultraportable spirometer (Spirobank Smart; MIR Medical International Research) capable of smartphone connection. Measurements will be performed twice a day between 7 AM and 9 AM and between 7 PM and 9 PM and will be dispatched via email to a central database for a period of 3 months. PEF and FEV1 variability will be assessed by detrended fluctuation and sample entropy analysis, aiming to define the normal pattern (healthy controls) and to detect and quantify any deviations among individuals with asthma. The anticipated duration of the study is 24 months. Results The study is funded by the “C. Caratheodory” Programme of the University of Patras, Greece (PN 47014/24.9.2018). It was approved by the Ethics Committee (decision 218/19-03-2019) and the Scientific Board (decision 329/02-04-2019) of the University Hospital of Patras, Greece. Patient recruitment started in January 2020, and as of June 2020, 100 healthy children have been enrolled (74 of them have completed the measurements). The anticipated duration of the study is 24 months. The first part of the study (assessment of lung function variability in healthy children and adolescents) will be completed in August 2020, and the results will be available for publication by October 2020. Conclusions Healthy children and adolescents may present normal short- and long-term fluctuations in lung function; the pattern of this variability may be influenced by age, sex, and environmental conditions. Significant lung function variability may also be present in children and adolescents with asthma, but the patterns may differ from those observed in healthy children and adolescents. Such data would improve our understanding regarding the chronobiology of asthma and permit the development of integrated tools for assessing the level of control and risk of future exacerbations. Trial Registration ClinicalTrials.gov NCT04163146; https://clinicaltrials.gov/ct2/show/NCT04163146 International Registered Report Identifier (IRRID) DERR1-10.2196/20350
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Affiliation(s)
- Eirini-Sofia Frima
- Pediatric Respiratory Unit, University Hospital of Patras, Patras, Greece.,Pediatric Respiratory Research Group, University of Patras, Patras, Greece
| | - Ilias Theodorakopoulos
- Pediatric Respiratory Research Group, University of Patras, Patras, Greece.,Electronics Laboratory, Department of Physics, University of Patras, Patras, Greece
| | | | - Nikolaos Karantaglis
- Pediatric Pulmonology Unit, 3rd Pediatric Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Grigorios Chatziparasidis
- Department of Primary Ciliary Dyskinesia, School of Medicine, University of Thessaly, Larissa, Greece
| | - Panagiotis Plotas
- Department of Public Health, School of Medicine, University of Patras, Patras, Greece
| | - Michael Anthracopoulos
- Pediatric Respiratory Unit, University Hospital of Patras, Patras, Greece.,Pediatric Respiratory Research Group, University of Patras, Patras, Greece
| | - Sotirios Fouzas
- Pediatric Respiratory Unit, University Hospital of Patras, Patras, Greece.,Pediatric Respiratory Research Group, University of Patras, Patras, Greece
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8
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Seppä VP, Turkalj M, Hult A, Maloča Vuljanko I, Plavec D, Erceg D, Petković G. Expiratory variability index (EVI) is associated with the severity of acute bronchial obstruction in small children: A proof-of-concept study. Pediatr Allergy Immunol 2020; 31:636-642. [PMID: 32307738 PMCID: PMC7496816 DOI: 10.1111/pai.13257] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 12/02/2022]
Abstract
BACKGROUND Lung function testing in small children is cumbersome. However, reduced variability of tidal breathing recorded using impedance pneumography (IP) during sleep was recently found to be a potential objective marker of wheeze in children aged 1-5 years. We aimed to investigate how an acute bronchial obstruction (BO) and its severity, and recovery thereof reflect in expiratory variability index (EVI). METHODS EVI was measured using a wearable IP system (Ventica®) during sleep in 40 healthy controls (aged 1.5-5.9 years) and 30 patients hospitalized due to acute BO (aged 1.3-5.3 years). In healthy controls, EVI was measured for 1-3 nights at their homes. Patients were measured for several nights during hospitalization, as practically feasible, and at home 2 and 4 weeks post-discharge. RESULTS We received 79 EVI results from 39 controls and 139 from 30 patients. 90% had previous BO episodes, 30% used asthma controller medication before and 100% after hospitalization. Compared to controls, EVI was significantly lower during hospitalization (P < .0001) having significant correlation with number of days to discharge (r = -.38, P = .004). At 2 or 4 weeks post-discharge, EVI was not significantly different from the controls (P = .14, P = .49, respectively). EVI was significantly associated with chest auscultation findings (P = .0001) being 17.5 (4.9) (median, IQR) with normal auscultation, 15.6 (7.4) in those with prolonged expiration and 11.4 (6.8) in those with wheeze and/or rales and crackles. CONCLUSIONS EVI was found to be a sensitive, objective marker of acute BO, showing strong association with changes in clinical status in wheezy children aged 1-5 years.
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Affiliation(s)
| | - Mirjana Turkalj
- Department of Pulmonology and Allergology for Preschool and Schoolchildren, Srebrnjak Children's Hospital, Zagreb, Croatia.,Catholic University of Croatia, Zagreb, Croatia.,Medical Faculty Osijek, JJ Strossmayer University, Osijek, Croatia
| | | | - Ivana Maloča Vuljanko
- Department of Pulmonology and Allergology for Infants and Young Children, Srebrnjak Children's Hospital, Zagreb, Croatia
| | - Davor Plavec
- Medical Faculty Osijek, JJ Strossmayer University, Osijek, Croatia.,Research Department, Srebrnjak Children's Hospital, Zagreb, Croatia
| | | | - Damir Erceg
- Department of Pulmonology and Allergology for Preschool and Schoolchildren, Srebrnjak Children's Hospital, Zagreb, Croatia.,Catholic University of Croatia, Zagreb, Croatia.,Medical Faculty Osijek, JJ Strossmayer University, Osijek, Croatia
| | - Giorgie Petković
- Department of Pulmonology and Allergology for Infants and Young Children, Srebrnjak Children's Hospital, Zagreb, Croatia
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9
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Seppä VP, Paassilta M, Kivistö J, Hult A, Viik J, Gracia-Tabuenca J, Karjalainen J. Reduced expiratory variability index (EVI) is associated with controller medication withdrawal and symptoms in wheezy children aged 1-5 years. Pediatr Allergy Immunol 2020; 31:489-495. [PMID: 32068911 PMCID: PMC7497189 DOI: 10.1111/pai.13234] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 02/12/2020] [Accepted: 02/13/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Lung function testing is an essential part of diagnostic workup and monitoring of asthma, but young children are lacking easy, routine testing methods. However, recent discoveries show reduced tidal breathing variability measured using impedance pneumography (IP) at home during sleep as a sign of airway obstruction. In this study, we assessed (a) the discriminative capacity of expiratory variability index (EVI) between healthy controls and young children with recurrent wheeze on-and-off controller medication, (b) association between EVI and parentally perceived obstructive symptoms (need for bronchodilator) and (c) measurement success rate. METHODS We included 68 patients (aged 1.0-5.6) and 40 healthy controls (aged 1.0-5.9 years). The patients were prescribed a three-month inhaled corticosteroid (ICS) treatment due to recurrent obstructive bronchitis. We measured EVI using IP at home at the end of the treatment (0W) and 2 (2W) and 4 (4W) weeks after ICS withdrawal. RESULTS EVI was higher in controls than in patients, and significant within-patient reduction occurred at 4W as compared to 2W or 0W. Area under curve of the ROC curve (controls vs all patients) at 4W was 0.78 (95% CI 0.70-0.85). Children who were administered bronchodilator by parental decision had lower EVI than those without bronchodilator need at 4W, but not at 0W or 2W. Patients with parent-reported airway infection, but no bronchodilator need, had normal EVI. Measurement success rate was 94%. CONCLUSION EVI was lower in patients than in controls and it reduced further after controller medication withdrawal, especially in the presence of parentally perceived wheeze symptoms. This technique shows a significant potential for routine lung function testing of wheezy young children.
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Affiliation(s)
| | - Marita Paassilta
- Allergy Centre, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Juho Kivistö
- Allergy Centre, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | | | - Jari Viik
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | | | - Jussi Karjalainen
- Allergy Centre, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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10
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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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11
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Hult A, Gjergja Juraški R, Gracia-Tabuenca J, Partinen M, Plavec D, Seppä VP. Sources of variability in expiratory flow profiles during sleep in healthy young children. Respir Physiol Neurobiol 2019; 274:103352. [PMID: 31790764 DOI: 10.1016/j.resp.2019.103352] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 10/21/2019] [Accepted: 11/18/2019] [Indexed: 11/29/2022]
Abstract
Standard lung function tests are not feasible in young children, but recent studies show that the variability of expiratory tidal breathing flow-volume (TBFV) curves during sleep is a potential indirect marker of lower airway obstruction. However, the neurophysiological sources of the TBFV variability in normal subjects has not been established. We investigated sleep stages and body position changes as potential sources for the TBFV curve variability. Simultaneous impedance pneumography (IP), polysomnography (PSG) and video recordings were done in 20 children aged 1.4-6.9 years without significant respiratory disorders during sleep. The early part of expiratory TBFV curves are less variable between cycles of REM than NREM sleep. However, within individual sleep cycles, TBFV curves during N3 are the least variable. The differences in TBFV curve shapes between sleep stages are the main source of overnight variability in TBFV curves and the changes in body position have a lesser impact.
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Affiliation(s)
| | - Romana Gjergja Juraški
- Sleep Laboratory, Srebrnjak Children's Hospital, Zagreb, Croatia; Medical Faculty, University JJ Strossmayer, Osijek, Croatia
| | | | - Markku Partinen
- Helsinki Sleep Clinic, Vitalmed Research Center, Helsinki, Finland; Department of Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | - Davor Plavec
- Medical Faculty, University JJ Strossmayer, Osijek, Croatia; Research Department, Srebrnjak Children's Hospital, Zagreb, Croatia
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12
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Lima TRL, Almeida VP, Ferreira AS, Guimarães FS, Lopes AJ. Handgrip Strength and Pulmonary Disease in the Elderly: What is the Link? Aging Dis 2019; 10:1109-1129. [PMID: 31595206 PMCID: PMC6764733 DOI: 10.14336/ad.2018.1226] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 12/26/2018] [Indexed: 12/15/2022] Open
Abstract
Societies in developed countries are aging at an unprecedented rate. Considering that aging is the most significant risk factor for many chronic lung diseases (CLDs), understanding this process may facilitate the development of new interventionist approaches. Skeletal muscle dysfunction is a serious problem in older adults with CLDs, reducing their quality of life and survival. In this study, we reviewed the possible links between handgrip strength (HGS)—a simple, noninvasive, low-cost measure of muscle function—and CLDs in the elderly. Different mechanisms appear to be involved in this association, including systemic inflammation, chronic hypoxemia, physical inactivity, malnutrition, and corticosteroid use. Respiratory and peripheral myopathy, associated with muscle atrophy and a shift in muscle fiber type, also seem to be major etiological contributors to CLDs. Moreover, sarcopenic obesity, which occurs in older adults with CLDs, impairs common inflammatory pathways that can potentiate each other and further accelerate the functional decline of HGS. Our findings support the concept that the systemic effects of CLDs may be determined by HGS, and HGS is a relevant measurement that should be considered in the clinical assessment of the elderly with CLDs. These reasons make HGS a useful practical tool for indirectly evaluating functional status in the elderly. At present, early muscle reconditioning and optimal nutrition appear to be the most effective approaches to reduce the impact of CLDs and low muscle strength on the quality of life of these individuals. Nonetheless, larger in-depth studies are needed to evaluate the link between HGS and CLDs.
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Affiliation(s)
- Tatiana Rafaela Lemos Lima
- 1Rehabilitation Sciences Post-Graduate Program, Augusto Motta University Center (UNISUAM), Bonsucesso, 21041-010, Rio de Janeiro, Brazil
| | - Vívian Pinto Almeida
- 1Rehabilitation Sciences Post-Graduate Program, Augusto Motta University Center (UNISUAM), Bonsucesso, 21041-010, Rio de Janeiro, Brazil
| | - Arthur Sá Ferreira
- 1Rehabilitation Sciences Post-Graduate Program, Augusto Motta University Center (UNISUAM), Bonsucesso, 21041-010, Rio de Janeiro, Brazil
| | - Fernando Silva Guimarães
- 1Rehabilitation Sciences Post-Graduate Program, Augusto Motta University Center (UNISUAM), Bonsucesso, 21041-010, Rio de Janeiro, Brazil
| | - Agnaldo José Lopes
- 1Rehabilitation Sciences Post-Graduate Program, Augusto Motta University Center (UNISUAM), Bonsucesso, 21041-010, Rio de Janeiro, Brazil.,2Post-graduate Program in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro (UERJ), Vila Isabel, 20550-170, Rio de Janeiro, Brazil
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13
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Malmberg LP. Shedding light on the breathing difficulties of children. Acta Paediatr 2019; 108:1380-1381. [PMID: 30916830 DOI: 10.1111/apa.14784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Leo Pekka Malmberg
- Allergology, University of Helsinki, Helsinki University Central Hospital, Helsinki, Finland
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14
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Seppä VP, Hult A, Gracia-Tabuenca J, Paassilta M, Viik J, Plavec D, Karjalainen J. Airway obstruction is associated with reduced variability in specific parts of the tidal breathing flow-volume curve in young children. ERJ Open Res 2019; 5:00028-2019. [PMID: 31218218 PMCID: PMC6571449 DOI: 10.1183/23120541.00028-2019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 04/27/2019] [Indexed: 11/13/2022] Open
Abstract
Lung function testing in subjects with limited cooperation, such as young children, the elderly or the disabled, is often extremely challenging even when using methods that need a low level of cooperation like impulse oscillometry (IOS). Hence, measurement and analysis of tidal breathing have been studied as an alternative option for conventional lung function methods in detecting airway obstruction. However, attempts to determine clinically useful obstruction-related tidal breathing indices, such as peak points or line fits from the tidal breathing flow–volume (TBFV) curves, have produced very limited outcomes. A more recent approach has focused on looking at the tidal breathing curve variability over time. The tidal breathing indices and the mathematical methods for their quantification analysed in early studies have been diverse; for instance, approximate entropy [1, 2] and noise limit of the flow signal [3], interquartile range of various tidal breathing indices [4, 5], and coefficient of variability of tidal volume [6]. A common finding has been that lower airway obstruction is associated with reduced variability in the tidal breathing pattern. Impedance pneumography recordings during sleep at night show reduced variability in specific parts of the expiratory flow–volume curve in children with recurrent wheezehttp://bit.ly/2Wkfap0
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Affiliation(s)
| | | | | | | | - Jari Viik
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Davor Plavec
- Research Dept, Srebrnjak Children's Hospital, Zagreb, Croatia.,Medical Faculty, University J.J. Strossmayer, Osijek, Croatia
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15
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Marinho CDL, Maioli MCP, do Amaral JLM, Lopes AJ, de Melo PL. Respiratory resistance and reactance in adults with sickle cell anemia: Part 2-Fractional-order modeling and a clinical decision support system for the diagnosis of respiratory disorders. PLoS One 2019; 14:e0213257. [PMID: 30845242 PMCID: PMC6405112 DOI: 10.1371/journal.pone.0213257] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 02/19/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND A better understanding of sickle cell anemia (SCA) and improvements in drug therapy and health policy have contributed to the emergence of a large population of adults living with this disease. The mechanisms by which SCA produces adverse effects on the respiratory system of these patients are largely unknown. Fractional-order (FrOr) models have a high potential to improve pulmonary clinical science and could be useful for diagnostic purposes, offering accurate models with an improved ability to mimic nature. Part 2 of this two-part study examines the changes in respiratory mechanics in patients with SCA using the new perspective of the FrOr models. These results are compared with those obtained in traditional forced oscillation (FOT) parameters, investigated in Part 1 of the present study, complementing this first analysis. METHODOLOGY/PRINCIPAL FINDINGS The data consisted of three categories of subjects: controls (n = 23), patients with a normal spirometric exam (n = 21) and those presenting restriction (n = 24). The diagnostic accuracy was evaluated by investigating the area under the receiver operating characteristic curve (AUC). Initially, it was observed that biomechanical changes in SCA included increased values of fractional inertance, as well as damping and hysteresivity (p<0.001). The correlation analysis showed that FrOr parameters are associated with functional exercise capacity (R = -0.57), pulmonary diffusion (R = -0.71), respiratory muscle performance (R = 0.50), pulmonary flows (R = -0.62) and airway obstruction (R = 0.60). Fractional-order modeling showed high diagnostic accuracy in the detection of early respiratory abnormalities (AUC = 0.93), outperforming spirometry (p<0.03) and standard FOT analysis (p<0.01) used in Part 1 of this study. A combination of machine learning methods with fractional-order modeling further improved diagnostic accuracy (AUC = 0.97). CONCLUSIONS FrOr modeling improved our knowledge about the biomechanical abnormalities in adults with SCA. Changes in FrOr parameters are associated with functional exercise capacity decline, abnormal pulmonary mechanics and diffusion. FrOr modeling outperformed spirometric and traditional forced oscillation analyses, showing a high diagnostic accuracy in the diagnosis of early respiratory abnormalities that was further improved by an automatic clinical decision support system. This finding suggested the potential utility of this combination to help identify early respiratory changes in patients with SCA.
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Affiliation(s)
- Cirlene de Lima Marinho
- Biomedical Instrumentation Laboratory—Institute of Biology and Faculty of Engineering, and BioVasc Research Laboratory—Institute of Biology, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Jorge Luis Machado do Amaral
- Department of Electronics and Telecommunications Engineering, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Agnaldo José Lopes
- School of Medical Sciences, Pulmonary Function Testing Laboratory, Rio de Janeiro/RJ, State University of Rio de Janeiro, Rio de Janeiro, Brazil
- Rehabilitation Sciences Post-Graduation Program, Augusto Motta University Centre, Rio de Janeiro, Brazil
| | - Pedro Lopes de Melo
- Biomedical Instrumentation Laboratory—Institute of Biology and Faculty of Engineering, and BioVasc Research Laboratory—Institute of Biology, State University of Rio de Janeiro, Rio de Janeiro, Brazil
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16
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Entropy Analysis for the Evaluation of Respiratory Changes Due to Asbestos Exposure and Associated Smoking. ENTROPY 2019; 21:e21030225. [PMID: 33266939 PMCID: PMC7514706 DOI: 10.3390/e21030225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/21/2019] [Accepted: 02/22/2019] [Indexed: 11/16/2022]
Abstract
Breathing is a complex rhythmic motor act, which is created by integrating different inputs to the respiratory centres. Analysing nonlinear fluctuations in breathing may provide clinically relevant information in patients with complex illnesses, such as asbestosis. We evaluated the effect of exposition to asbestos on the complexity of the respiratory system by investigating the respiratory impedance sample entropy (SampEnZrs) and recurrence period density entropy (RPDEnZrs). Similar analyses were performed by evaluating the airflow pattern sample entropy (SampEnV') and recurrence period density entropy (RPDEnV'). Groups of 34 controls and 34 asbestos-exposed patients were evaluated in the respiratory impedance entropy analysis, while groups of 34 controls and 30 asbestos-exposed patients were investigated in the analysis of airflow entropy. Asbestos exposition introduced a significant reduction of RPDEnV' in non-smoker patients (p < 0.0004), which suggests that the airflow pattern becomes less complex in these patients. Smoker patients also presented a reduction in RPDEnV' (p < 0.05). These finding are consistent with the reduction in respiratory system adaptability to daily life activities observed in these patients. It was observed a significant reduction in SampEnV' in smoker patients in comparison with non-smokers (p < 0.02). Diagnostic accuracy evaluations in the whole group of patients (including non-smokers and smokers) indicated that RPDEnV' might be useful in the diagnosis of respiratory abnormalities in asbestos-exposed patients, showing an accuracy of 72.0%. In specific groups of non-smokers, RPDEnV' also presented adequate accuracy (79.0%), while in smoker patients, SampEnV' and RPDEnV' presented adequate accuracy (70.7% and 70.2%, respectively). Taken together, these results suggest that entropy analysis may provide an early and sensitive functional indicator of interstitial asbestosis.
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17
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Sun S, Jin Y, Chen C, Sun B, Cao Z, Lo IL, Zhao Q, Zheng J, Shi Y, Zhang XD. Entropy Change of Biological Dynamics in Asthmatic Patients and Its Diagnostic Value in Individualized Treatment: A Systematic Review. ENTROPY (BASEL, SWITZERLAND) 2018; 20:E402. [PMID: 33265493 PMCID: PMC7512921 DOI: 10.3390/e20060402] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 04/12/2018] [Accepted: 04/23/2018] [Indexed: 12/21/2022]
Abstract
Asthma is a chronic respiratory disease featured with unpredictable flare-ups, for which continuous lung function monitoring is the key for symptoms control. To find new indices to individually classify severity and predict disease prognosis, continuous physiological data collected from monitoring devices is being studied from different perspectives. Entropy, as an analysis method for quantifying the inner irregularity of data, has been widely applied in physiological signals. However, based on our knowledge, there is no such study to summarize the complexity differences of various physiological signals in asthmatic patients. Therefore, we organized a systematic review to summarize the complexity differences of important signals in patients with asthma. We searched several medical databases and systematically reviewed existing asthma clinical trials in which entropy changes in physiological signals were studied. As a conclusion, we find that, for airflow, heart rate variability, center of pressure and respiratory impedance, their entropy values decrease significantly in asthma patients compared to those of healthy people, while, for respiratory sound and airway resistance, their entropy values increase along with the progression of asthma. Entropy of some signals, such as respiratory inter-breath interval, shows strong potential as novel indices of asthma severity. These results will give valuable guidance for the utilization of entropy in physiological signals. Furthermore, these results should promote the development of management and diagnosis of asthma using continuous monitoring data in the future.
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Affiliation(s)
- Shixue Sun
- Faculty of Health Sciences, University of Macau, Taipa, Macau, China
| | - Yu Jin
- Faculty of Health Sciences, University of Macau, Taipa, Macau, China
| | - Chang Chen
- Faculty of Health Sciences, University of Macau, Taipa, Macau, China
| | - Baoqing Sun
- State Key Laboratory of Respiratory Disease, the 1st Affiliated Hospital of Guangzhou Medical University, Guangzhou 510230, China
| | - Zhixin Cao
- Beijing Engineering Research Center of Diagnosis and Treatment of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Beijing 100043, China
| | - Iek Long Lo
- Department of Geriatrics, Centro Hospital Conde de Sao Januario, Macau, China
| | - Qi Zhao
- Faculty of Health Sciences, University of Macau, Taipa, Macau, China
| | - Jun Zheng
- Faculty of Health Sciences, University of Macau, Taipa, Macau, China
| | - Yan Shi
- Department of Mechanical and Electronic Engineering, Beihang University, Beijing 100191, China
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18
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Bansal T, Haji GS, Rossiter HB, Polkey MI, Hull JH. Exercise ventilatory irregularity can be quantified by approximate entropy to detect breathing pattern disorder. Respir Physiol Neurobiol 2018; 255:1-6. [PMID: 29730423 DOI: 10.1016/j.resp.2018.05.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 04/25/2018] [Accepted: 05/02/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Breathing pattern disorder (BPD) is a prevalent cause of exertional dyspnea and yet there is currently no reliable objective measure for its diagnosis. We propose that statistical analysis of ventilatory irregularity, quantified by approximate entropy (ApEn), could be used to detect BPD when applied to cardiopulmonary exercise test (CPET) data. We hypothesised that ApEn of ventilatory variables (tidal volume (VT), breathing frequency (Bf), minute ventilation (VE)) would be greater, i.e. more irregular, in patients with BPD than healthy controls. METHODS We evaluated ventilatory ApEn in 20 adults (14 female) with exertional dyspnoea, undergoing CPET and independently diagnosed with BPD by a specialist respiratory physiotherapist. Data were compared with 15 age- gender- and BMI-matched controls. ApEn for VT, Bf and VE were calculated for an incremental cycle exercise test. RESULTS Patients with BPD more frequently rated breathlessness as the reason for exercise limitation and had a lower mean (SD) peak oxygen uptake compared with controls: 80 (18) vs. 124 (27) % predicted (P < 0.001). ApEn was significantly greater for VT (p = .006) and VE (p = .002) in BPD than controls. ApEn VE was inversely related (r2 = 0.24, p = .03) to peak oxygen uptake in BPD but not controls. ROC analysis revealed that ApEn VE > 0.88, conferred a sensitivity and specificity of 70% and 87% respectively, for detection of BPD. CONCLUSIONS Non-linear statistical interrogation of CPET-acquired ventilatory data has utility in the detection of BPD. A simple calculation of approximate entropy of ventilation, during an incremental cardiopulmonary exercise test, provides a quantitative method to detect BPD.
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Affiliation(s)
- Taranpal Bansal
- NIHR Respiratory Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust & Imperial College, London UK
| | - Gulam S Haji
- NIHR Respiratory Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust & Imperial College, London UK
| | - Harry B Rossiter
- Rehabilitation Clinical Trials Center, Division of Pulmonary and Critical Care Physiology and Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, USA; Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | - Mike I Polkey
- NIHR Respiratory Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust & Imperial College, London UK
| | - James H Hull
- NIHR Respiratory Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust & Imperial College, London UK.
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19
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Pazhoohan S, Raoufy MR, Javan M, Hajizadeh S. Effect of Rho-kinase inhibition on complexity of breathing pattern in a guinea pig model of asthma. PLoS One 2017; 12:e0187249. [PMID: 29088265 PMCID: PMC5663484 DOI: 10.1371/journal.pone.0187249] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 10/17/2017] [Indexed: 12/26/2022] Open
Abstract
Asthma represents an episodic and fluctuating behavior characterized with decreased complexity of respiratory dynamics. Several evidence indicate that asthma severity or control is associated with alteration in variability of lung function. The pathophysiological basis of alteration in complexity of breathing pattern in asthma has remained poorly understood. Regarding the point that Rho-kinase is involved in pathophysiology of asthma, in present study we investigated the effect of Rho-kinase inhibition on complexity of respiratory dynamics in a guinea pig model of asthma. Male Dunkin Hartley guinea pigs were exposed to 12 series of inhalations with ovalbumin or saline. Animals were treated by the Rho-kinase inhibitor Y-27632 (1mM aerosols) prior to each allergen challenge. We recorded respiration of conscious animals using whole-body plethysmography. Exposure to ovalbumin induced lung inflammation, airway hyperresponsiveness and remodeling including goblet cell hyperplasia, increase in the thickness of airways smooth muscles and subepithelial collagen deposition. Complexity analysis of respiratory dynamics revealed a dramatic decrease in irregularity of respiratory rhythm representing less complexity in asthmatic guinea pigs. Inhibition of Rho-kinase reduced the airway remodeling and hyperreponsiveness, but had no significant effect on lung inflammation and complexity of respiratory dynamics in asthmatic animals. It seems that airway hyperresponsiveness and remodeling do not significantly affect the complexity of respiratory dynamics. Our results suggest that inflammation might be the probable cause of shift in the respiratory dynamics away from the normal fluctuation in asthma.
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Affiliation(s)
- Saeed Pazhoohan
- Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mohammad Reza Raoufy
- Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
- * E-mail: (MRR); (SH)
| | - Mohammad Javan
- Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Sohrab Hajizadeh
- Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
- * E-mail: (MRR); (SH)
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20
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Eslami-Behroozi M, Javan M, Raoufy MR. Effect of airway remodeling and hyperresponsiveness on complexity of breathing pattern in rat. Respir Physiol Neurobiol 2017; 247:65-70. [PMID: 28919369 DOI: 10.1016/j.resp.2017.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 07/29/2017] [Accepted: 09/13/2017] [Indexed: 11/18/2022]
Abstract
The complexity of respiratory dynamics is decreased, in association with disease severity, in patients with asthma. However, the pathophysiological basis of decreased complexity of breathing pattern in asthma is not clear. In the present study, we investigated the effect of airway remodeling and hyperresponsiveness induced by repeated bronchoconstriction (using methacholine) on breathing pattern in rats with or without allergen-induced sensitization. Entropy analysis of respiratory variability showed decreased irregularity (less complexity) of respiratory rhythm in this rat model of asthma. Airway remodeling and hyperresponsiveness induced by repeated bronchoconstriction also led to increased regularity of respiratory dynamics in sensitized rats. However, these airway alterations had no significant effect on the complexity of breathing pattern in non-sensitized rats. Our results indicate that mechanical respiratory alterations cannot per se attenuate the complexity of respiratory dynamics, unless there is an underlying inflammation. We suggest further studies on underlying mechanisms of breathing variability with focus on respiratory control alterations due to airway inflammation.
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Affiliation(s)
- Mehdi Eslami-Behroozi
- Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mohammad Javan
- Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mohammad Reza Raoufy
- Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
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21
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Malmberg LP, Seppä VP, Kotaniemi-Syrjänen A, Malmström K, Kajosaari M, Pelkonen AS, Viik J, Mäkelä MJ. Measurement of tidal breathing flows in infants using impedance pneumography. Eur Respir J 2016; 49:13993003.00926-2016. [DOI: 10.1183/13993003.00926-2016] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 10/29/2016] [Indexed: 11/05/2022]
Abstract
Tidal breathing flow volume (TBFV) profiles have been used to characterise altered lung function. Impedance pneumography (IP) is a novel option for assessing TBFV curves noninvasively. The aim of this study was to extend the application of IP for infants and to estimate the agreement between IP and direct pneumotachograph (PNT) measurements in assessing tidal airflow and flow-derived indices.Tidal flow profiles were recorded for 1 min simultaneously with PNT and uncalibrated IP at baseline in 44 symptomatic infants, and after methacholine-induced bronchoconstriction in a subgroup (n=20).The agreement expressed as the mean deviation from linearity ranged between 3.9 and 4.3% of tidal peak inspiratory flow, but was associated with specific airway conductance (p=0.002) and maximal flow at functional residual capacity (V′maxFRC) (p=0.004) at baseline. Acute bronchoconstriction induced by methacholine did not significantly affect the agreement of IP with PNT. TBFV indices derived from IP were slightly underestimated compared to PNT, but were equally well repeatable and associated with baseline V′maxFRC (p=0.012 and p=0.013, respectively).TBFV profiles were consistent between IP and PNT in most infants, but the agreement was affected by reduced lung function. TBFV parameters were not interchangeable between IP and PNT, but had a similar association with lung function in infants.
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22
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Seppä VP, Pelkonen AS, Kotaniemi-Syrjänen A, Viik J, Mäkelä MJ, Malmberg LP. Tidal flow variability measured by impedance pneumography relates to childhood asthma risk. Eur Respir J 2016; 47:1687-96. [PMID: 26989106 DOI: 10.1183/13993003.00989-2015] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 01/24/2016] [Indexed: 11/05/2022]
Abstract
Lung function variability is a fundamental feature of asthma but has been difficult to quantify in children due to methodological limitations. We assessed the feasibility and clinical implications of overnight flow variability measurement at home using impedance pneumography in young children.44 children aged 3-7 years with recurrent or persistent lower airway symptoms were recruited. Patients were divided into high- or lower-risk groups (HR and LR groups) based on their risk of asthma (modified Asthma Predictive Index), and a third group was formed of children who had a history of wheeze and who were treated with inhaled corticosteroids (ICS group). Tidal volume and the derived flow were recorded through skin electrodes using impedance pneumography at home during sleep. Quantities describing overnight change in expiratory flow-volume minimum curve shape correlation (CSRmin) and respiratory chaoticity (minimum noise limit (NLmin)) were derived.Recordings were successful in 34 children. CSRmin differed between the HR and LR groups (p=0.002) and between the HR and ICS groups (p=0.003), indicating a stronger change in flow profile shape in the HR group. NLmin differed between the HR and LR groups (p=0.014), indicating momentarily lowered chaoticity in the HR group.Impedance pneumography was found feasible for quantifying nocturnal lung function variability and the measured variability was associated with risk of asthma in young children.
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Affiliation(s)
- Ville-Pekka Seppä
- Dept of Electronics and Communications Engineering, Tampere University of Technology, BioMediTech, Tampere, Finland
| | - Anna S Pelkonen
- Dept of Allergology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anne Kotaniemi-Syrjänen
- Dept of Allergology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jari Viik
- Dept of Electronics and Communications Engineering, Tampere University of Technology, BioMediTech, Tampere, Finland
| | - Mika J Mäkelä
- Dept of Allergology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - L Pekka Malmberg
- Dept of Allergology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Raoufy MR, Ghafari T, Darooei R, Nazari M, Mahdaviani SA, Eslaminejad AR, Almasnia M, Gharibzadeh S, Mani AR, Hajizadeh S. Classification of Asthma Based on Nonlinear Analysis of Breathing Pattern. PLoS One 2016; 11:e0147976. [PMID: 26824900 PMCID: PMC4732950 DOI: 10.1371/journal.pone.0147976] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 01/10/2016] [Indexed: 11/30/2022] Open
Abstract
Normal human breathing exhibits complex variability in both respiratory rhythm and volume. Analyzing such nonlinear fluctuations may provide clinically relevant information in patients with complex illnesses such as asthma. We compared the cycle-by-cycle fluctuations of inter-breath interval (IBI) and lung volume (LV) among healthy volunteers and patients with various types of asthma. Continuous respiratory datasets were collected from forty age-matched men including 10 healthy volunteers, 10 patients with controlled atopic asthma, 10 patients with uncontrolled atopic asthma, and 10 patients with uncontrolled non-atopic asthma during 60 min spontaneous breathing. Complexity of breathing pattern was quantified by calculating detrended fluctuation analysis, largest Lyapunov exponents, sample entropy, and cross-sample entropy. The IBI as well as LV fluctuations showed decreased long-range correlation, increased regularity and reduced sensitivity to initial conditions in patients with asthma, particularly in uncontrolled state. Our results also showed a strong synchronization between the IBI and LV in patients with uncontrolled asthma. Receiver operating characteristic (ROC) curve analysis showed that nonlinear analysis of breathing pattern has a diagnostic value in asthma and can be used in differentiating uncontrolled from controlled and non-atopic from atopic asthma. We suggest that complexity analysis of breathing dynamics may represent a novel physiologic marker to facilitate diagnosis and management of patients with asthma. However, future studies are needed to increase the validity of the study and to improve these novel methods for better patient management.
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Affiliation(s)
- Mohammad Reza Raoufy
- Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
- * E-mail: (MRR); (SH)
| | - Tara Ghafari
- Department of Physiology, Medical School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Darooei
- Department of Biomedical Engineering, Faculty of Electrical and Computer Engineering, Tarbiat Modares University, Tehran, Iran
| | - Milad Nazari
- Faculty of Electrical Engineering, Sharif University of Technology, Tehran, Iran
| | - Seyed Alireza Mahdaviani
- Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Reza Eslaminejad
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Almasnia
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahriar Gharibzadeh
- Department of Bioelectric, Faculty of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran
| | - Ali R. Mani
- Division of Medicine, UCL, London, United Kingdom
| | - Sohrab Hajizadeh
- Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
- * E-mail: (MRR); (SH)
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Seppä VP, Uitto M, Viik J. Tidal breathing flow-volume curves with impedance pneumography during expiratory loading. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2013:2437-40. [PMID: 24110219 DOI: 10.1109/embc.2013.6610032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Diagnosis of asthma in the preschoold children is difficult due to lack of objective lung function tests suitable for this age group. Impedance pneumography (IP) is a mode of measurement that may potentially enable ambulatory 24h recording of tidal breathing indices and respiratory dynamics that are known to relate to small airway obstruction. The aim of this research was to induce changes in breathing control and mechanics and study the ability of IP to reproduce TBFVC and track its changes under potentially difficult conditions. This was achieved by a comparison of direct mouth pneumotachograph (PNT) and IP tidal breathing flow-volume curves (TBFVC) during free breathing and expiratory loading obtained from 17 young lung-healthy subjects. The expiratory loading produced strong and significant changes in the respiratory pattern and mouth pressure. The agreement of PNT and IP normalized TBFVCs was found excellent having the highest distance between the normalized TBFVCs of (mean ± SD) 7.4 % ± 3.6 % and 6.2 % ± 3.0 % during free and loaded breathing, respectively. The agreement was not affected by the presence of the expiratory load despite it poses multiple potential hazards for the IP measurements. We conclude that by using correct electrode placement and cardiac filtering, IP was able to accurately reproduce and track changes in normalized TBFVCs under normal and abnormal respiratory conditions in healthy adult subjects.
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25
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26
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Dames KK, Lopes AJ, de Melo PL. Airflow pattern complexity during resting breathing in patients with COPD: effect of airway obstruction. Respir Physiol Neurobiol 2013; 192:39-47. [PMID: 24334010 DOI: 10.1016/j.resp.2013.12.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 11/29/2013] [Accepted: 12/03/2013] [Indexed: 12/01/2022]
Abstract
We investigated the influence of airway obstruction in the complexity of the airflow pattern in COPD and its use as a marker of disease activity. The sample entropy (SampEnV') and the variability (SDV') of the airflow pattern were measured in a group of 88 subjects with various levels of airway obstruction. Airway obstruction resulted in a reduction in the SampEnV' (p<0.0001) that was significantly correlated with spirometric indices of airway obstruction (R=0.50, p<0.001). The early adverse effects in mild airway obstruction were detected by the SampEnV' with an accuracy of 84%. SDV' increased with airway obstruction (p<0.002). We conclude that (1) the airflow patterns in COPD exhibit reduced complexity compared with healthy subjects; (2) this reduction in complexity is proportional to airway obstruction; and (3) the evaluation of SampEnV' may provide novel respiratory biomarkers suitable to facilitate the diagnosis of respiratory abnormalities in COPD.
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Affiliation(s)
- Karla Kristine Dames
- Biomedical Instrumentation Laboratory, Institute of Biology and Faculty of Engineering, State University of Rio de Janeiro, Brazil
| | - Agnaldo José Lopes
- Pulmonary Function Laboratory, Faculty of Medical Sciences, State University of Rio de Janeiro, Brazil
| | - Pedro Lopes de Melo
- Biomedical Instrumentation Laboratory, Institute of Biology and Faculty of Engineering, State University of Rio de Janeiro, Brazil; Clinical and Experimental Research Laboratory in Vascular Biology, Institute of Biology, State University of Rio de Janeiro, Brazil.
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27
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Seppä VP, Pelkonen AS, Kotaniemi-Syrjänen A, Mäkelä MJ, Viik J, Malmberg LP. Tidal breathing flow measurement in awake young children by using impedance pneumography. J Appl Physiol (1985) 2013; 115:1725-31. [PMID: 24092693 DOI: 10.1152/japplphysiol.00657.2013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Characteristics of tidal breathing (TB) relate to lung function and may be assessed even in young children. Thus far, the accuracy of impedance pneumography (IP) in recording TB flows in young children with or without bronchial obstruction has not been evaluated. The aim of this study was to evaluate the agreement between IP and direct flow measurement with pneumotachograph (PNT) in assessing TB flow and flow-derived indices relating to airway obstruction in young children. Tidal flow was recorded for 1 min simultaneously with IP and PNT during different phases of a bronchial challenge test with methacholine in 21 wheezy children aged 3 to 7 years. The agreement of IP with PNT was found to be excellent in direct flow signal comparison, the mean deviation from linearity ranging from 2.4 to 3.1% of tidal peak inspiratory flow. Methacholine-induced bronchoconstriction or consecutive bronchodilation induced only minor changes in the agreement. Between IP and PNT, the obstruction-related tidal flow indices were equally repeatable, and agreement was found to be high, with intraclass correlation coefficients for T PTEF/T E, V PTEF/V E, and parameter S being 0.94, 0.91, and 0.68, respectively. Methacholine-induced changes in tidal flow indices showed significant associations with changes in mechanical impedance of the respiratory system assessed by the oscillometric technique, with the highest correlation found in V PTEF/V E (r = -0.54; P < 0.005 and r = -0.55; P < 0.005 by using IP or PNT, respectively). The results indicate that IP can be considered as a valid method for recording tidal airflow profiles in young children with wheezing disorders.
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Affiliation(s)
- Ville-Pekka Seppä
- Department of Electronics and Communications Engineering, Tampere University of Technology, Tampere, Finland
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28
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Forecasting respiratory collapse: theory and practice for averting life-threatening infant apneas. Respir Physiol Neurobiol 2013; 189:223-31. [PMID: 23735485 DOI: 10.1016/j.resp.2013.05.034] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 05/28/2013] [Accepted: 05/28/2013] [Indexed: 11/22/2022]
Abstract
Apnea of prematurity is a common disorder of respiratory control among preterm infants, with potentially serious adverse consequences on infant development. We review the capability for automatically assessing apnea risk and predicting apnea episodes from multimodal physiological measurements, and for using this knowledge to provide timely therapeutic intervention. We also review other, similar clinical domains of respiratory distress assessment and prediction in the hope of gaining useful insights. We propose an algorithmic framework for constructing discriminative feature vectors from physiological measurements, and for building robust and effective statistical models for apnea assessment and prediction.
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29
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Held HE, Pendergast DR. Relative effects of submersion and increased pressure on respiratory mechanics, work, and energy cost of breathing. J Appl Physiol (1985) 2013; 114:578-91. [PMID: 23305982 DOI: 10.1152/japplphysiol.00584.2012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Submersion and increased pressure (depth) characterize the diving environment and may independently increase demand on the respiratory system. To quantify changes in respiratory mechanics, this study employed a unique protocol and techniques to measure, in a hyperbaric chamber, inspiratory and expiratory alveolar pressures (interrupter technique), inspiratory and expiratory resistance in the airways (RawI and RawE, esophageal balloon technique), nitric oxide elimination (thought to correlate with Raw), inspiratory and expiratory mechanical power of breathing, and the total energy cost of ventilation. Eight healthy adult men underwent experiments at 1, 2.7, and 4.6 atmospheres absolute (ATA) in dry and fully submersed conditions. Subjects rested, cycled on an ergometer at 100 W, and rested while voluntarily matching their ventilation to their own exercise hyperpnea (isocapnic simulated exercise ventilation). During isocapnic simulated exercise ventilation, increased O2 uptake (above rest values) resulted from increased expired ventilation. RawI decreased with submersion (mean 43% during rest and 20% during exercise) but increased from 1 to 4.6 ATA (19% during rest and 75% during exercise), as did RawE (53% decrease with submersion during rest and 10% during exercise; 9% increase from 1 to 4.6 ATA during rest and 66% during exercise). Nitric oxide elimination did not correlate with Raw. Depth increased inspiratory mechanical power of breathing during rest (40%) and exercise (20%). Expiratory mechanical power of breathing was largely unchanged. These results suggest that the diving environment affects ventilatory mechanics primarily by increasing Raw, secondary to increased gas density. This necessitates increased alveolar pressure and increases the work and energy cost of breathing as the diver descends. These findings can inform physician assessment of diver fitness and the pulmonary risks of hyperbaric O2 therapy.
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Affiliation(s)
- Heather E Held
- Center for Research and Education in Special Environments, Department of Physiology and Biophysics, State University of New York at Buffalo, Buffalo, New York, USA
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Veiga J, Lopes AJ, Jansen JM, Melo PL. Fluctuation analysis of respiratory impedance waveform in asthmatic patients: effect of airway obstruction. Med Biol Eng Comput 2012; 50:1249-59. [PMID: 23011080 DOI: 10.1007/s11517-012-0957-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Accepted: 09/18/2012] [Indexed: 12/21/2022]
Abstract
Fluctuation analysis has great potential to contribute to pulmonary clinical science and practice. We evaluated the relationship between asthma and the respiratory impedance recurrence period density entropy (RPDEnZrs) and the variability (SDZrs). A non-invasive and simple protocol for assessing respiratory mechanics during spontaneous breathing was used in a group of 74 subjects with various levels of airway obstruction. Airway obstruction resulted in a reduction in the RPDEnZrs that was significantly correlated with both spirometric indices of airway obstruction (R = 0.48, p < 0.0001) and mean respiratory impedance (R = -0.83, p < 0.0001). These results suggest that the impedance pattern becomes less complex in asthmatic patients, which may explain the reduction in respiratory systems' adaptability to daily life activities. Preliminary evaluations indicate that RPDEnZrs may contribute to the asthma diagnosis, presenting accuracies of 82 and 87 % in patients with moderate and severe airway obstruction, respectively. On the other hand, SDZrs increased with obstruction (p < 0.0001) and was inversely correlated with spirometric indices of obstruction (R = -0.42, p = 0.0003) and directly associated with mean impedance (R = 0.88, p < 0.0001). This analysis contributes to elucidate previous studies and identified respiratory changes in patients with moderate and severe obstruction with an adequate accuracy (85 and 87 %, respectively).
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Affiliation(s)
- J Veiga
- Biomedical Instrumentation Laboratory, Institute of Biology and Faculty of Engineering, State University of Rio de Janeiro, Rio de Janeiro, Brazil
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