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Xinliang Z, Achkasov EE, Gavrikov LK, Yuchen L, Zhang C, Dudnik EN, Rumyantseva O, Beeraka NM, Glazachev OS. Assessing the importance and safety of hypoxia conditioning for patients with occupational pulmonary diseases: A recent clinical perspective. Biomed Pharmacother 2024; 178:117275. [PMID: 39126774 DOI: 10.1016/j.biopha.2024.117275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 07/25/2024] [Accepted: 08/05/2024] [Indexed: 08/12/2024] Open
Abstract
Occupational pulmonary diseases (OPDs) pose a significant global health challenge, contributing to high mortality rates. This review delves into the pathophysiology of hypoxia and the safety of intermittent hypoxic conditioning (IHC) in OPD patients. By examining sources such as PubMed, Relemed, NLM, Scopus, and Google Scholar, the review evaluates the efficacy of IHC in clinical outcomes for OPD patients. It highlights the complexities of cardiovascular and respiratory regulation dysfunctions in OPDs, focusing on respiratory control abnormalities and the impact of intermittent hypoxic exposures. Key areas include the physiological effects of hypoxia, the role of hypoxia-inducible factor-1 alpha (HIF-1α) in occupational lung diseases, and the links between brain ischemia, stroke, and OPDs. The review also explores the interaction between intermittent hypoxic exposures, mitochondrial energetics, and lung physiology. The potential of IHE to improve clinical manifestations and underlying pathophysiology in OPD patients is thoroughly examined. This comprehensive analysis aims to benefit molecular pathologists, pulmonologists, clinicians, and physicians by enhancing understanding of IHE's clinical benefits, from research to patient care, and improving clinical outcomes for OPD patients.
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Affiliation(s)
- Zhang Xinliang
- Chair of Sports Medicine and Rehabilitation, Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), 8/2 Trubetskaya Str., Moscow 119991, Russia; Co-Chair of Normal Physiology, Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), 8/2 Trubetskaya Str., Moscow 119991, Russia.
| | - Eugeny E Achkasov
- Chair of Sports Medicine and Rehabilitation, Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), 8/2 Trubetskaya Str., Moscow 119991, Russia.
| | - Leonid K Gavrikov
- Volgograd State Medical University, 1, Pavshikh Bortsov Sq., Volgograd 400131, Russia.
| | - Li Yuchen
- Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), 8/2 Trubetskaya Str., Moscow 119991, Russia.
| | - Chen Zhang
- Chair of Epidemiology and Modern Technologies of Vaccination, Institute of Professional Education, I.M. Sechenov First Moscow State Medical University (Sechenov University), 8/2 Trubetskaya Str., Moscow 119991, Russia
| | - Elena N Dudnik
- Co-Chair of Normal Physiology, Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), 8/2 Trubetskaya Str., Moscow 119991, Russia.
| | - Olga Rumyantseva
- Izmerov Research Institute of Occupational Health, 31 Budeynniy Avenye, Moscow 105275, Russia.
| | - Narasimha M Beeraka
- Herman B. Wells Center for Pediatric Research, Department of Pediatrics, Indiana University School of Medicine, 1044 W. Walnut Street, R4-168, Indianapolis, IN 46202, USA; Department of Human Anatomy and Histology, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), 8/2 Trubetskaya Str., Moscow 119991, Russia; Raghavendra Institute of Pharmaceutical Education and Research (RIPER), Chiyyedu, Anantapuramu, Andhra Pradesh 515721, India.
| | - Oleg S Glazachev
- Co-Chair of Normal Physiology, Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), 8/2 Trubetskaya Str., Moscow 119991, Russia.
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2
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Chen SY, Huang CK, Wu CL, Peng HC, Yu CJ, Chien JY. Prognostic value of the post-exercise heart rate recovery and BHDE-index in chronic obstructive pulmonary disease. BMC Pulm Med 2023; 23:263. [PMID: 37461073 DOI: 10.1186/s12890-023-02557-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 07/08/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND The BODE index, consisting of body mass index (B), airflow obstruction (O), dyspnea score (D), and exercise capacity (E), can predict outcomes in COPD. However, when spirometry was restricted to prevent cross-infection such as COVID-19 pandemic, a modified index would be needed. Because cardiovascular dysfunction is associated with poor clinical outcomes in COPD, we conducted a novel BHDE-index by replacing spirometry with post-exercise heart rate recovery (HRR, H) and evaluated its predictive performance in this observational study. METHODS From January 2019 to December 2019, enrolled patients were analyzed as a derivation cohort for the setup of the model. This model was verified in another group of patients generated between January 2020 and December 2020, as the validation cohort. The post exercise HRR was defined as the difference of heart rate immediately after and 1 min after test cessation. RESULTS A total of 447 patients with COPD were enrolled. Patients with abnormal HRR were older, with more severe airway obstruction, severe airway symptoms, faster resting heart rate, shorter 6-min walk distance and higher frequency of severe acute exacerbation in previous one year. The prediction performance of the BHDE-index for one-year severe COPD exacerbation was similar to that of the BODE-index in both the derivation and validation groups [area under the receiver operating characteristic curve (AUROC) 0.76 vs. 0.75, p = 0.369; AUROC 0.74 vs. 0.79, p = 0.05]. The prediction performance for 1 year mortality was also similar between BHDE-index and BODE-index in both cohorts [AUROC 0.80 vs. 0.77, p = 0.564; 0.76 vs. 0.70, p = 0.234]. Univariate and multivariate analyses also showed that the BHDE-index was an independent and important predictor of annual severe COPD exacerbation in the derivation and validation cohorts. CONCLUSIONS The BHDE-index is a good and easy-to-perform prediction model for the risk of severe acute exacerbation and 1-year mortality in COPD wherever spirometry results are unavailable.
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Affiliation(s)
- Shih-Yu Chen
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chun-Kai Huang
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chia-Ling Wu
- Department of Integrated Diagnostic & Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Hui-Chuan Peng
- Department of Nursing, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chong-Jen Yu
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jung-Yien Chien
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
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3
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Raju S, Woo H, Koehler K, Fawzy A, Liu C, Putcha N, Balasubramanian A, Peng RD, Lin CT, Lemoine C, Wineke J, Berger RD, Hansel NN, McCormack MC. Indoor Air Pollution and Impaired Cardiac Autonomic Function in Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2023; 207:721-730. [PMID: 36288428 PMCID: PMC10037475 DOI: 10.1164/rccm.202203-0523oc] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2022] Open
Abstract
Rationale: Indoor air pollution represents a modifiable risk factor for respiratory morbidity in chronic obstructive pulmonary disease (COPD). The effects of indoor air pollution, as well as the impact of interventions to improve indoor air quality, on cardiovascular morbidity in COPD remain unknown. Objectives: To determine the association between indoor particulate matter (PM) and heart rate variability (HRV), a measure of cardiac autonomic function tied to cardiovascular morbidity and mortality, as well as the impact of household air purifiers on HRV. Methods: Former smokers with moderate-severe COPD were recruited from a 6-month randomized controlled trial of a portable air cleaner intervention to undergo paired assessment of both in-home PM and HRV using 24-hour Holter monitoring at up to five time points. Primary outcomes were HRV measures tied to cardiovascular morbidity (standard deviation of normal-to-normal intervals [SDNN] and root mean square of successive differences between normal-to-normal intervals [RMSSD]). Measurements and Results: Eighty-five participants contributed 317 HRV measurements. A twofold increase in household PM ⩽2.5 µm in aerodynamic diameter was associated with decreases in SDNN (β, -2.98% [95% confidence interval (CI), -5.12 to -0.78]) and RMSSD (β, -4.57% [95% CI, -10.1 to -1.60]). The greatest effects were observed with ultrafine particles (<100 nm) (RMSSD; β, -16.4% [95% CI, -22.3 to -10.1]) and among obese participants. Participants randomized to the active air cleaner saw improvements in RMSSD (β, 25.2% [95% CI, 2.99 to 52.1]), but not SDNN (β, 2.65% [95% CI, -10.8 to 18.1]), compared with the placebo group. Conclusions: This is the first U.S. study to describe the association between household PM and cardiac autonomic function among individuals with COPD, as well as the potential cardiovascular health benefits of household air cleaners.
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Affiliation(s)
| | | | - Kirsten Koehler
- Department of Environmental Health Sciences and Engineering and
| | | | | | | | | | - Roger D. Peng
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Cheng Ting Lin
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Chantal Lemoine
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; and
| | - Jennifer Wineke
- Department of Psychiatry, University of Maryland Medical Center, Baltimore, Maryland
| | | | - Nadia N. Hansel
- Department of Medicine and
- Department of Environmental Health Sciences and Engineering and
| | - Meredith C. McCormack
- Department of Medicine and
- Department of Environmental Health Sciences and Engineering and
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4
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Dourado IM, Santos PB, Goulart CL, Marinho RS, Santos-De-Araújo AD, Roscani MG, Mendes RG, Borghi-Silva A. Is the six-minute step test able to reflect the severity and symptoms based on cat score? Heart Lung 2023; 58:28-33. [PMID: 36372060 DOI: 10.1016/j.hrtlng.2022.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 10/19/2022] [Accepted: 10/19/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND This is the first study to investigate the performance of 6MST in COPD patients divided into different symptom severity groups based on the CAT questionnaire score. OBJECTIVES To evaluate the relationship between the degree symptomatology using the chronic obstructive pulmonary disease (COPD) Assessment Test (CAT) with the six- minute step test (6MST) in COPD patients. METHODS This is a cross-sectional study in which 59 patients with COPD were evaluated. The groups were stratified according to the subsequent cutoff points: CAT <10 (little impact) n= 22; CAT 11-20 (moderate impact) n=20; CAT <20 (large impact) n=17. During 6MST the individuals were instructed to go up and down a single step with a height of 20 centimeters (cm). RESULTS Comparing the groups in relation to performance on the 6MST, the number of climbs on the step were significantly higher in the CAT group <10 when compared to the CAT group >20, the variation in HR between rest and peak exercise (∆ HRpeak- rest) was lower in the CAT>20 group compared to the CAT<10 group and the CAT 11- 20 group. We found direct relationships between the number of ascents and descents in the 6MST vs the CAT score (r=0.35, p=0.007); and 6MST vs degree of obstruction of %FEV1 (r-0.46, p=0.002) We verified a linear regression model in which the FEV1 (L) and the CAT score influenced 29% in the performance of the 6MST. CONCLUSION The COPD severity represented by the FEV1 and the CAT score are associated and influenced by 29% the performance of 6-minute step test. Our findings may have important implications for the clinical evaluation of these patients as well as for rehabilitation.
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Affiliation(s)
- Izadora M Dourado
- Cardiopulmonary Physical Therapy Laboratory, Federal University of Sao Carlos, Sao Carlos, São Paulo, Brazil
| | - Polliana B Santos
- Cardiopulmonary Physical Therapy Laboratory, Federal University of Sao Carlos, Sao Carlos, São Paulo, Brazil
| | - Cássia L Goulart
- Cardiopulmonary Physical Therapy Laboratory, Federal University of Sao Carlos, Sao Carlos, São Paulo, Brazil
| | - Renan S Marinho
- Cardiopulmonary Physical Therapy Laboratory, Federal University of Sao Carlos, Sao Carlos, São Paulo, Brazil
| | | | - Meliza G Roscani
- Department of Medicine, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Renata G Mendes
- Cardiopulmonary Physical Therapy Laboratory, Federal University of Sao Carlos, Sao Carlos, São Paulo, Brazil
| | - Audrey Borghi-Silva
- Cardiopulmonary Physical Therapy Laboratory, Federal University of Sao Carlos, Sao Carlos, São Paulo, Brazil.
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5
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Promsrisuk T, Boonla O, Kongsui R, Sriraksa N, Thongrong S, Srithawong A. Oxidative stress associated with impaired autonomic control and severity of lung function in chronic obstructive pulmonary disease patients. J Exerc Rehabil 2023; 19:75-84. [PMID: 36910680 PMCID: PMC9993008 DOI: 10.12965/jer.2244586.293] [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: 12/26/2022] [Accepted: 01/15/2023] [Indexed: 02/25/2023] Open
Abstract
Oxidative stress has been suggested to play a role in the pathogenesis of chronic obstructive pulmonary disease (COPD). This study aimed to investigate a link between malondialdehyde (MDA) levels, pulmonary function, and cardiac autonomic control in patients with COPD. Plasma levels of MDA, heart rate variability, and pulmonary function were measured in 50 clinically stable COPD patients and 50 normal male controls. COPD patients exhibited lower means of the standard deviations of all normal to normal (NN) intervals (SDNN), the square root of the mean of the sum of the squares of differences between adjacent NN intervals (RMSSD), and high frequency (HF). Nevertheless, they presented greater low frequency (LF) and low frequency/high frequency ratio (LF/HF ratio) in supine and head-up tilt positions than controls (P<0.001). More-over, a negative correlation between MDA levels with SDNN (P<0.001) and a positive correlation with LF (P<0.01) and LF/HF ratio (P<0.05) were observed in both positions. In COPD patients, plasma MDA levels were 2.3 times greater than controls (4.33±2.03 μM vs. 1.89±0.39 μM, P<0.001), and they were inversely correlated with forced vital capacity, forced expiratory volume in 1 sec, midexpiratory flow, and peak expiratory flow (P<0.001). Our findings suggest a potential role for oxidative stress in impaired cardiac autonomic control and clinical relevance of plasma MDA levels as a predictor of severity of COPD in COPD patients.
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Affiliation(s)
- Tichanon Promsrisuk
- Division of Physiology, School of Medical Sciences, University of Phayao, Phayao, Thailand.,Unit of Excellence in the Pulmonary and Cardiovascular Health Care, University of Phayao, Phayao, Thailand
| | - Orachorn Boonla
- Faculty of Allied Health Sciences, Burapha University, Chonburi, Thailand.,Exercise and Nutrition Innovation and Sciences Research Unit, Burapha University, Chonburi, Thailand
| | - Ratchaniporn Kongsui
- Division of Physiology, School of Medical Sciences, University of Phayao, Phayao, Thailand
| | - Napatr Sriraksa
- Division of Physiology, School of Medical Sciences, University of Phayao, Phayao, Thailand.,Unit of Excellence in the Pulmonary and Cardiovascular Health Care, University of Phayao, Phayao, Thailand
| | - Sitthisak Thongrong
- Division of Anatomy, School of Medical Sciences, University of Phayao, Phayao, Thailand
| | - Arunrat Srithawong
- Department of Physical Therapy, School of Allied Health Sciences, University of Phayao, Phayao, Thailand
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6
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Hirayama Y, Takata M, Yamasaki A, Kato M, Burioka N. Assessing Autonomic Nervous System Function by Pulse Rate Variability in Patients with Chronic Obstructive Pulmonary Disease. Yonago Acta Med 2023; 66:180-188. [PMID: 36820291 PMCID: PMC9937960 DOI: 10.33160/yam.2023.02.010] [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: 01/21/2022] [Accepted: 12/19/2022] [Indexed: 01/22/2023]
Abstract
Heart rate variability (HRV) is measured to analyze autonomic nervous system function in humans, and pulse rate variability (PRV) assessed using the photoplethysmography method with a pulse oximeter has been proposed as a surrogate for HRV. To examine whether PRV is compatible with HRV in patients with chronic obstructive pulmonary disease (COPD), we simultaneously measured HRV with an electrocardiogram and PRV with a pulse oximeter in patients with COPD, and compared low-frequency and high-frequency components computed from HRV and PRV as indicators of autonomic nervous system function. In a Bland-Altman analysis, the low-frequency component computed from HRV exhibited good consistency with that computed from PRV. The high-frequency component showed a significant fixed error but relatively good consistency. Our results indicate that autonomic nervous system function may be estimated with the low-frequency component by measuring PRV with a pulse oximeter in patients with COPD.
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Affiliation(s)
- Yuki Hirayama
- Division of Respiratory Medicine and Rheumatology, Graduate
School of Medical Sciences, Major in Medicine, Faculty of Medicine, Tottori University,
Yonago 683-8504, Japan
| | - Miyako Takata
- Department of Pathobiological Science and Technology,
Graduate School of Medical Sciences, Major in Integrated Medical Sciences, Faculty of
Medicine, Tottori University, Yonago 683-8503, Japan
| | - Akira Yamasaki
- Division of Respiratory Medicine and Rheumatology, Graduate
School of Medical Sciences, Major in Medicine, Faculty of Medicine, Tottori University,
Yonago 683-8504, Japan
| | - Masahiko Kato
- Department of Pathobiological Science and Technology,
Graduate School of Medical Sciences, Major in Integrated Medical Sciences, Faculty of
Medicine, Tottori University, Yonago 683-8503, Japan
| | - Naoto Burioka
- Department of Pathobiological Science and Technology,
Graduate School of Medical Sciences, Major in Integrated Medical Sciences, Faculty of
Medicine, Tottori University, Yonago 683-8503, Japan
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7
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Alqahtani JS, Aldhahir AM, Alghamdi SM, Al Ghamdi SS, AlDraiwiesh IA, Alsulayyim AS, Alqahtani AS, Alobaidi NY, Al Saikhan L, AlRabeeah SM, Alzahrani EM, Heubel AD, Mendes RG, Alqarni AA, Alanazi AM, Oyelade T. A systematic review and meta-analysis of heart rate variability in COPD. Front Cardiovasc Med 2023; 10:1070327. [PMID: 36873414 PMCID: PMC9981678 DOI: 10.3389/fcvm.2023.1070327] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/24/2023] [Indexed: 02/19/2023] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is associated with disruption in autonomic nervous control of the heart rhythm. We present here quantitative evidence of the reduction in HRV measures as well as the challenges to clinical application of HRV in COPD clinics. Method Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we search in June 2022 Medline and Embase databases for studies reporting HRV in COPD patients using relevant medical subject headings (MeSH) terms. The quality of included studies was assessed using the modified version of the Newcastle-Ottawa Scale (NOS). Descriptive data were extracted, while standardized mean difference was computed for changes in HRV due to COPD. Leave-one-out sensitivity test was performed to assess exaggerated effect size and funnel plots to assess publication bias. Results The databases search yielded 512 studies, of which we included 27 that met the inclusion criteria. The majority of the studies (73%) had a low risk of bias and included a total of 839 COPD patients. Although there were high between-studies heterogeneity, HRV time and frequency domains were significantly reduced in COPD patients compared with controls. Sensitivity test showed no exaggerated effect sizes and the funnel plot showed general low publication bias. Conclusion COPD is associated with autonomic nervous dysfunction as measured by HRV. Both sympathetic and parasympathetic cardiac modulation were decreased, but there is still a predominance of sympathetic activity. There is high variability in the HRV measurement methodology, which affects clinical applicability.
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Affiliation(s)
- Jaber S Alqahtani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Abdulelah M Aldhahir
- Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Saeed M Alghamdi
- Respiratory Care Program, Clinical Technology Department, College of Applied Health Science, Umm Al Qura University, Makkah, Saudi Arabia
| | - Shouq S Al Ghamdi
- Anesthesia Technology Department, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Ibrahim A AlDraiwiesh
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Abdullah S Alsulayyim
- Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia.,National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Abdullah S Alqahtani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Nowaf Y Alobaidi
- Respiratory Therapy Department, King Saud bin Abdulaziz University for Health Sciences, Alahsa, Saudi Arabia
| | - Lamia Al Saikhan
- Department of Cardiac Technology, College of Applied Medial Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Saad M AlRabeeah
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Eidan M Alzahrani
- Physical Therapy Department, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Alessandro D Heubel
- Cardiopulmonary Physiotherapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, SP, Brazil
| | - Renata G Mendes
- Cardiopulmonary Physiotherapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, SP, Brazil
| | - Abdullah A Alqarni
- Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdullah M Alanazi
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Tope Oyelade
- UCL Institute for Liver and Digestive Health, London, United Kingdom
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8
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Stapelberg NJC, Branjerdporn G, Adhikary S, Johnson S, Ashton K, Headrick J. Environmental Stressors and the PINE Network: Can Physical Environmental Stressors Drive Long-Term Physical and Mental Health Risks? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13226. [PMID: 36293807 PMCID: PMC9603079 DOI: 10.3390/ijerph192013226] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/10/2022] [Accepted: 10/13/2022] [Indexed: 06/16/2023]
Abstract
Both psychosocial and physical environmental stressors have been linked to chronic mental health and chronic medical conditions. The psycho-immune-neuroendocrine (PINE) network details metabolomic pathways which are responsive to varied stressors and link chronic medical conditions with mental disorders, such as major depressive disorder via a network of pathophysiological pathways. The primary objective of this review is to explore evidence of relationships between airborne particulate matter (PM, as a concrete example of a physical environmental stressor), the PINE network and chronic non-communicable diseases (NCDs), including mental health sequelae, with a view to supporting the assertion that physical environmental stressors (not only psychosocial stressors) disrupt the PINE network, leading to NCDs. Biological links have been established between PM exposure, key sub-networks of the PINE model and mental health sequelae, suggesting that in theory, long-term mental health impacts of PM exposure may exist, driven by the disruption of these biological networks. This disruption could trans-generationally influence health; however, long-term studies and information on chronic outcomes following acute exposure event are still lacking, limiting what is currently known beyond the acute exposure and all-cause mortality. More empirical evidence is needed, especially to link long-term mental health sequelae to PM exposure, arising from PINE pathophysiology. Relationships between physical and psychosocial stressors, and especially the concept of such stressors acting together to impact on PINE network function, leading to linked NCDs, evokes the concept of syndemics, and these are discussed in the context of the PINE network.
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Affiliation(s)
- Nicolas J. C. Stapelberg
- Gold Coast Hospital and Health Service, Gold Coast, QLD 4215, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD 4226, Australia
| | - Grace Branjerdporn
- Gold Coast Hospital and Health Service, Gold Coast, QLD 4215, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD 4226, Australia
| | - Sam Adhikary
- Mater Young Adult Health Centre, Mater Hospital, Brisbane, QID 4101, Australia
| | - Susannah Johnson
- Gold Coast Hospital and Health Service, Gold Coast, QLD 4215, Australia
| | - Kevin Ashton
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD 4226, Australia
| | - John Headrick
- School of Medical Science, Griffith University, Gold Coast, QID 4215, Australia
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9
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Fantin A, Patruno V, Sartori G, Crisafulli E. Autonomic nervous system alterations in patients with mild-to-moderate asthma: do not forget airflow obstruction! A lesson from COPD. J Asthma 2022; 60:1054-1055. [PMID: 35972058 DOI: 10.1080/02770903.2022.2114085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Affiliation(s)
- Alberto Fantin
- Department of Pulmonology, S. Maria della Misericordia University Hospital, Udine, Italy
| | - Vincenzo Patruno
- Department of Pulmonology, S. Maria della Misericordia University Hospital, Udine, Italy
| | - Giulia Sartori
- Department of Medicine, Respiratory Medicine Unit, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Ernesto Crisafulli
- Department of Medicine, Respiratory Medicine Unit, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
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10
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Suri JS, Paul S, Maindarkar MA, Puvvula A, Saxena S, Saba L, Turk M, Laird JR, Khanna NN, Viskovic K, Singh IM, Kalra M, Krishnan PR, Johri A, Paraskevas KI. Cardiovascular/Stroke Risk Stratification in Parkinson's Disease Patients Using Atherosclerosis Pathway and Artificial Intelligence Paradigm: A Systematic Review. Metabolites 2022; 12:metabo12040312. [PMID: 35448500 PMCID: PMC9033076 DOI: 10.3390/metabo12040312] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 12/20/2022] Open
Abstract
Parkinson’s disease (PD) is a severe, incurable, and costly condition leading to heart failure. The link between PD and cardiovascular disease (CVD) is not available, leading to controversies and poor prognosis. Artificial Intelligence (AI) has already shown promise for CVD/stroke risk stratification. However, due to a lack of sample size, comorbidity, insufficient validation, clinical examination, and a lack of big data configuration, there have been no well-explained bias-free AI investigations to establish the CVD/Stroke risk stratification in the PD framework. The study has two objectives: (i) to establish a solid link between PD and CVD/stroke; and (ii) to use the AI paradigm to examine a well-defined CVD/stroke risk stratification in the PD framework. The PRISMA search strategy selected 223 studies for CVD/stroke risk, of which 54 and 44 studies were related to the link between PD-CVD, and PD-stroke, respectively, 59 studies for joint PD-CVD-Stroke framework, and 66 studies were only for the early PD diagnosis without CVD/stroke link. Sequential biological links were used for establishing the hypothesis. For AI design, PD risk factors as covariates along with CVD/stroke as the gold standard were used for predicting the CVD/stroke risk. The most fundamental cause of CVD/stroke damage due to PD is cardiac autonomic dysfunction due to neurodegeneration that leads to heart failure and its edema, and this validated our hypothesis. Finally, we present the novel AI solutions for CVD/stroke risk prediction in the PD framework. The study also recommends strategies for removing the bias in AI for CVD/stroke risk prediction using the PD framework.
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Affiliation(s)
- Jasjit S. Suri
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA 95661, USA; (A.P.); (I.M.S.)
- Correspondence: ; Tel.: +1-(916)-749-5628
| | - Sudip Paul
- Department of Biomedical Engineering, North Eastern Hill University, Shillong 793022, India; (S.P.); (M.A.M.)
| | - Maheshrao A. Maindarkar
- Department of Biomedical Engineering, North Eastern Hill University, Shillong 793022, India; (S.P.); (M.A.M.)
| | - Anudeep Puvvula
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA 95661, USA; (A.P.); (I.M.S.)
- Annu’s Hospitals for Skin & Diabetes, Gudur 524101, India
| | - Sanjay Saxena
- Department of CSE, International Institute of Information Technology, Bhuneshwar 751003, India;
| | - Luca Saba
- Department of Radiology, University of Cagliari, 09121 Cagliari, Italy;
| | - Monika Turk
- Deparment of Neurology, University Medical Centre Maribor, 1262 Maribor, Slovenia;
| | - John R. Laird
- Heart and Vascular Institute, Adventist Health St. Helena, St. Helena, CA 94574, USA;
| | - Narendra N. Khanna
- Department of Cardiology, Indraprastha APOLLO Hospitals, New Delhi 110001, India;
| | - Klaudija Viskovic
- Department of Radiology and Ultrasound, University Hospital for Infectious Diseases, 10000 Zagreb, Croatia;
| | - Inder M. Singh
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA 95661, USA; (A.P.); (I.M.S.)
| | - Mannudeep Kalra
- Department of Radiology, Harvard Medical School, Boston, MA 02115, USA;
| | | | - Amer Johri
- Department of Medicine, Division of Cardiology, Queen’s University, Kingston, ON K7L 3N6, Canada;
| | - Kosmas I. Paraskevas
- Department of Vascular Surgery, Central Clinic of Athens, 106 80 Athens, Greece;
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11
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Use of a Wearable Biosensor to Study Heart Rate Variability in Chronic Obstructive Pulmonary Disease and Its Relationship to Disease Severity. SENSORS 2022; 22:s22062264. [PMID: 35336436 PMCID: PMC8952191 DOI: 10.3390/s22062264] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/05/2022] [Accepted: 03/10/2022] [Indexed: 12/19/2022]
Abstract
The purpose of this study was to explore the relationships between heart rate variability (HRV) and various phenotypic measures that relate to health and functional status in chronic obstructive pulmonary disease (COPD), and secondly, to demonstrate the feasibility of ascertaining HRV via a chest-worn wearable biosensor in COPD patients. HRV analysis was performed using SDNN (standard deviation of the mean of all normal R-R intervals), low frequency (LF), high frequency (HF), and LF/HF ratio. We evaluated the associations between HRV and COPD severity, class of bronchodilator therapy prescribed, and patient reported outcomes. Seventy-nine participants with COPD were enrolled. There were no differences in SDNN, HF, and LF/HF ratio according to COPD severity. The SDNN in participants treated with concurrent beta-agonists and muscarinic antagonists was lower than that in other participants after adjusting heart rate (beta coefficient −3.980, p = 0.019). The SDNN was positively correlated with Veterans Specific Activity Questionnaire (VSAQ) score (r = 0.308, p = 0.006) and handgrip strength (r = 0.285, p = 0.011), and negatively correlated with dyspnea by modified Medical Research Council (mMRC) questionnaire (r = −0.234, p = 0.039), health status by Saint George’s Respiratory Questionnaire (SGRQ) (r = −0.298, p = 0.008), symptoms by COPD Assessment Test (CAT) (r = −0.280, p = 0.012), and BODE index (r = −0.269, p = 0.020). When measured by a chest-worn wearable device, reduced HRV was observed in COPD participants receiving inhaled beta-sympathomimetic agonist and muscarinic antagonists. HRV was also correlated with various health status and performance measures.
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12
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Huang PH, Luo YF, Hsiao TC. The Indices of Instantaneous Pulse Rate Variability Are Indicators for Daily Life Quality Assessment in Patients with COPD. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:6103305. [PMID: 35186234 PMCID: PMC8853820 DOI: 10.1155/2022/6103305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/25/2022] [Indexed: 11/18/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a progressive respiratory illness. Questionnaires such as modified Medical Research Council (mMRC) dyspnea scale and COPD assessment test (CAT) are useful for COPD condition and life quality assessment. These questionnaires reflect how respiratory disorder affects daily life. Breathing and autonomic nervous system (ANS) usually regulate each other. Few studies discussed the ANS activity and daily life quality in patients with COPD. Therefore, this study aimed to find the relationship between daily life quality assessed by mMRC or CAT and ANS assessed by a novel method, instantaneous pulse rate variability (iPRV), a method indicating not only the ANS activity but also the peripheral response. The result showed that the change in mMRC and the change in low frequency power to high frequency power ratio, which usually represents the sympathetic activity in conventional heart rate variability analysis, had significant correlation (r = 0.63; p < 0.05). The change in CAT and the change in high frequency power (regulated by vagal nervous and respiratory system) or very high frequency power (new frequency band can be indicated in iPRV spectrum) had significant negative correlation (r = -0.64 and -0.55, respectively; p < 0.05 for both). This study showed the change in iPRV indices when the condition of COPD was improvement or exacerbation. This study presents a possible way to show how cardiovascular activity affects daily life quality in patients with COPD. Increase in LF or decrease in HF and VHF would cause poorer quality of daily life in patients with COPD. The result can also be a reference for patients with COPD to choose the breathing type to adjust rehabilitation and therapy program for ANS regulation to indicate or improve their daily life quality.
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Affiliation(s)
- Po-Hsun Huang
- Institute of Computer Science and Engineering, College of Computer Science, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Yi-Fei Luo
- Service Systems Technology Center, Industrial Technology Research Institute, Hsinchu, Taiwan
| | - Tzu-Chien Hsiao
- Institute of Computer Science and Engineering, College of Computer Science, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Department of Computer Science, College of Computer Science, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Institute of Biomedical Engineering, College of Electrical and Computer Engineering, National Chiao Tung University, Hsinchu, Taiwan
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13
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Meszaros M, Latshang TD, Aeschbacher SS, Huber F, Flueck D, Lichtblau M, Ulrich S, Hasler ED, Scheiwiller PM, Reinhard L, Ulrich S, Bloch KE, Furian M, Schwarz EI. Effect of Nocturnal Oxygen on Blood Pressure Response to Altitude Exposure in COPD - Data from a Randomized Placebo-Controlled Cross-Over Trial. Int J Chron Obstruct Pulmon Dis 2022; 16:3503-3512. [PMID: 34992358 PMCID: PMC8713709 DOI: 10.2147/copd.s331658] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/12/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Patients with chronic obstructive pulmonary disease (COPD) are particularly vulnerable to hypoxia-induced autonomic dysregulation. Hypoxemia is marked during sleep. In COPD, altitude exposure is associated with an increase in blood pressure (BP) and a decrease in baroreflex-sensitivity (BRS). Whether nocturnal oxygen therapy (NOT) may mitigate these cardiovascular autonomic changes in COPD at altitude is unknown. Materials and Methods In a randomized placebo-controlled cross-over trial, 32 patients with moderate-to-severe COPD living <800 m were subsequently allocated to NOT and placebo during acute exposure to altitude. Measurements were done at low altitude at 490 m and during two stays at 2048 m on NOT (3 L/min) and placebo (3 L/min, ambient air) via nasal cannula. Allocation and intervention sequences were randomized. Outcomes of interest were BP, BRS (from beat-to-beat BP measurement), BP variability (BPV), and heart rate. Results About 23/32 patients finished the trial per protocol (mean (SD) age 66 (5) y, FEV1 62 (14) % predicted) and 9/32 experienced altitude-related illnesses (8 vs 1, p < 0.05 placebo vs NOT). NOT significantly mitigated the altitude-induced increase in systolic BP compared to placebo (Δ median −5.8 [95% CI −22.2 to −1.4] mmHg, p = 0.05) but not diastolic BP (−3.5 [95% CI −12.6 to 3.0] mmHg; p = 0.21) or BPV. BRS at altitude was significantly higher in NOT than in placebo (1.7 [95% CI 0.3 to 3.4] ms/mmHg, p = 0.02). Conclusion NOT may protect from hypoxia-induced autonomic dysregulation upon altitude exposure in COPD and thus protect from a relevant increase in BP and decrease in BRS. NOT may provide cardiovascular benefits in COPD during conditions of increased hypoxemia and may be considered in COPD travelling to altitude.
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Affiliation(s)
- Martina Meszaros
- Department of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, Zurich, Switzerland
| | - Tsogyal D Latshang
- Department of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, Zurich, Switzerland
| | - Sayaka S Aeschbacher
- Department of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, Zurich, Switzerland
| | - Fabienne Huber
- Department of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, Zurich, Switzerland
| | - Deborah Flueck
- Department of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, Zurich, Switzerland
| | - Mona Lichtblau
- Department of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, Zurich, Switzerland
| | - Stefanie Ulrich
- Department of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, Zurich, Switzerland
| | - Elisabeth D Hasler
- Department of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, Zurich, Switzerland
| | - Philipp M Scheiwiller
- Department of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, Zurich, Switzerland
| | - Lukas Reinhard
- Department of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, Zurich, Switzerland
| | - Silvia Ulrich
- Department of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, Zurich, Switzerland.,Zurich Center for Integrative Human Physiology (ZIHP), University of Zurich, Zurich, Switzerland
| | - Konrad E Bloch
- Department of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, Zurich, Switzerland.,Zurich Center for Integrative Human Physiology (ZIHP), University of Zurich, Zurich, Switzerland.,Centre of Competence Sleep & Health, University of Zurich, Zurich, Switzerland
| | - Michael Furian
- Department of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, Zurich, Switzerland
| | - Esther I Schwarz
- Department of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, Zurich, Switzerland.,Centre of Competence Sleep & Health, University of Zurich, Zurich, Switzerland
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14
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Naz İ, Şahin H, Aktaş B. Predictors of improvement in resting heart rate after exercise training in patients with chronic obstructive pulmonary disease. Ir J Med Sci 2021; 191:1613-1619. [PMID: 34510377 DOI: 10.1007/s11845-021-02771-4] [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: 07/29/2021] [Accepted: 09/02/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND High resting heart rate (RHR) is associated with multiple morbidity in chronic obstructive pulmonary disease (COPD) patients. Factors regarding the effectiveness of exercise training (ET) on RHR in COPD patients are unclear. AIMS The main objective of the current study is to determine the predictors of the eventual change in RHR after ET. METHODS One hundred and ten COPD patients (mean age: 63.1 ± 8.1 years, FEV1%: 43.6 ± 16.6) who participated in the ET program that consisted of supervised breathing, aerobic, strengthening, and stretching exercises for 8 weeks, 2 days a week, were included in the study. RHR, pulmonary functions, 6-min walk distance (6-MWD), Modified Medical Research Council Dyspnea Scale, St. George Respiratory Questionnaire, and Hospital Anxiety and Depression scores were compared before and after ET. Multivariate regression analysis was performed to correlate factors related to changes in RHR before and after exercise. RESULTS There was a significant improvement in RHR after the ET program (p < 0.001). Improvement in RHR was correlated with baseline RHR, 6-MWD, partial arterial oxygen pressure, dyspnea sensation, forced expiratory volume in the first second (r = 0.516, -0.388, -0.489, 0.369, -0.360, p < 0.05, respectively), and change in 6-MWD, partial arterial oxygen pressure, and symptom score (r = 0.523, 0.451, -0.325, p < 0.05, respectively) after ET. Baseline RHR, 6-MWD, and the change in 6-MWD were the independent factors that predicted the change in RHR after ET. CONCLUSIONS Patients with a high RHR and low functional capacity and whose functional capacity improves more have a greater decrease in RHR after the ET program. By considering these related factors, clinicians can focus on improving the cardiovascular system in COPD patients. CLINICAL TRIAL NUMBER NCT04890080 (retrospectively registered-date of registration: 05.17.2021).
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Affiliation(s)
- İlknur Naz
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Kâtip Celebi University, 35620, Çiğli, İzmir, Turkey.
| | - Hülya Şahin
- Chest Diseases Clinic, Dr. Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Büşra Aktaş
- Institute of Health Sciences, Izmir Kâtip Celebi University, Izmir, Turkey
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15
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Boutou AK, Dipla K, Theodorakopoulou MP, Markopoulou K, Pitsiou G, Papadopoulos S, Kritikou S, Stanopoulos I, Zafeiridis A. Effects of oxygen supplementation in autonomic nervous system function during exercise in patients with idiopathic pulmonary fibrosis and exertional desaturation. CLINICAL RESPIRATORY JOURNAL 2021; 15:1088-1096. [PMID: 34143559 DOI: 10.1111/crj.13412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 06/05/2021] [Accepted: 06/08/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Patients with idiopathic pulmonary fibrosis (IPF) have reduced exercise capacity and often present exertional dyspnea and desaturation. The role of autonomic nervous system (ANS) as a pathogenetic contributor to this dysfunction has not been evaluated. OBJECTIVE To evaluate whether improvement of arterial oxygen saturation (SpO2 ) via oxygen supplementation results to ANS function improvement, during steady state submaximal exercise. METHODS This is a secondary analysis of a single-blind, randomized, placebo-controlled, cross-over trial, including 12 IPF patients, with isolated exertional desaturation. Following a maximal cardiopulmonary test, participants underwent two submaximal steady state tests during which they received either supplementary oxygen or medical air. Continuous beat-to-beat blood pressure measurements were recorded (Finapres Medical Systems, Amsterdam, The Netherlands). Autonomic function was assessed non-invasively by heart rate variability (HRV); root mean square of successive differences (RMSSD) and standard-deviation-Poincare-plot (SD1) were used as indices of parasympathetic output. Entropy and detrended fluctuation analysis (DFA) were also used. RESULTS During rest, oxygen supplementation did not significantly alter RMSSD and SD1. During exercise, subjects presented no significant alterations compared with baseline, in most HRV indices examined. There was no improvement of this behavior with O2 -supplementation. Approximate-entropy increased during exercise, with no differences between protocols. CONCLUSIONS IPF patients presented an inadequate adaptive response of their ANS to exercise and recovery. Although oxygen supplementation significantly prolonged exercise duration and prevented the substantial exertional desaturation, the blunted vagal response to steady-state exercise in these patients was not improved, suggesting that acute oxygen supplementation does not sufficiently improve ANS dysfunction in these patients.
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Affiliation(s)
- Afroditi K Boutou
- Department of Respiratory Medicine, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - Konstantina Dipla
- Exercise Physiology & Biochemistry Laboratory, Department of Sport Sciences at Serres, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Katerina Markopoulou
- Department of Respiratory Medicine, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - Georgia Pitsiou
- Department of Respiratory Failure, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stavros Papadopoulos
- Exercise Physiology & Biochemistry Laboratory, Department of Sport Sciences at Serres, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stella Kritikou
- Exercise Physiology & Biochemistry Laboratory, Department of Sport Sciences at Serres, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Stanopoulos
- Department of Respiratory Failure, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andreas Zafeiridis
- Exercise Physiology & Biochemistry Laboratory, Department of Sport Sciences at Serres, Aristotle University of Thessaloniki, Thessaloniki, Greece
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16
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Castello-Simões V, Kabbach EZ, Schafauser NS, Camargo PF, Simões RP, Heubel AD, Alqahtani JS, da Cunha Martino Pereira MB, Sgarbosa NM, Borghi-Silva A, Mendes RG. Brain-heart autonomic axis across different clinical status and severity of chronic obstructive pulmonary disease. Respir Med 2021; 185:106511. [PMID: 34175805 DOI: 10.1016/j.rmed.2021.106511] [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: 03/11/2021] [Accepted: 06/14/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Impairment of cardiac autonomic integrity is common in chronic obstructive pulmonary disease (COPD) patients. The influence of the interaction between clinical and severity status on brain-heart autonomic axis (BHAA) is not well known. We aimed to investigate the BHAA function across different clinical status and severity of COPD. METHODS Cross-sectional study involving 77 COPD patients allocated into four groups according to clinical status [acute exacerbation (GAE) or stable (GST)] and severity [less (-) or more (+)]: 1) GAE-, n = 13; 2) GAE+, n = 20; 3) GST-, n = 23; and 4) GST+, n = 21. Heart rate variability (HRV) at rest and heart rate recovery (HRR) after 6-min walk test were markers of BHAA. Mean R-R, STDRR, RMSSD, RRtri, HF, LF, SD1, SD2, ApEn and SampEn were the HRV indexes and, HRR was obtained as: HR at 1st min of recovery minus peak HR. RESULTS A main effect of clinical status (p < 0.001) was found to vagal modulation in GAE-vs. GST- (RMSSD: 25.0 ± 14.8 vs. 12.6 ± 5.5 ms; SD1: 18.0 ± 10.6 vs. 8.9 ± 3.9 ms) and to GAE + vs. GST+ (RMSSD: 26.4 ± 15.2 vs. 15.4 ± 6.3 ms; SD1: 18.3 ± 11.2 vs. 10.9 ± 4.5 ms). An effect of clinical status (p = 0.032) and severity (p = 0.030) were found to HF (vagal) in GAE + compared to GAE- and GST+ (264.7 ± 239.0 vs. 134.7 ± 169.7 and 135.8 ± 139.7 ms2). Lower HRR was found in GAE-compared to GST- (8.0 ± 2.4 vs. 19.6 ± 2.4 bpm), p = 0.002. CONCLUSION In COPD patients, clinical status (AECOPD or stable) was more dominant than the severity on BHAA function. A more pronounced parasympathetic modulation was found in AECOPD patients with a lower HRR to exercise.
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Affiliation(s)
- Viviane Castello-Simões
- Cardiopulmonary Physiotherapy Laboratory, Department of Physiotherapy, Federal University of Sao Carlos - UFSCar, Rodovia Washington Luis, KM 235, Jardim Guanabara, 13565-905, Sao Carlos, SP, Brazil.
| | - Erika Zavaglia Kabbach
- Cardiopulmonary Physiotherapy Laboratory, Department of Physiotherapy, Federal University of Sao Carlos - UFSCar, Rodovia Washington Luis, KM 235, Jardim Guanabara, 13565-905, Sao Carlos, SP, Brazil.
| | - Nathany Souza Schafauser
- Cardiopulmonary Physiotherapy Laboratory, Department of Physiotherapy, Federal University of Sao Carlos - UFSCar, Rodovia Washington Luis, KM 235, Jardim Guanabara, 13565-905, Sao Carlos, SP, Brazil.
| | - Patrícia Faria Camargo
- Cardiopulmonary Physiotherapy Laboratory, Department of Physiotherapy, Federal University of Sao Carlos - UFSCar, Rodovia Washington Luis, KM 235, Jardim Guanabara, 13565-905, Sao Carlos, SP, Brazil.
| | - Rodrigo Polaquini Simões
- Cardiopulmonary Physiotherapy Laboratory, Department of Physiotherapy, Federal University of Sao Carlos - UFSCar, Rodovia Washington Luis, KM 235, Jardim Guanabara, 13565-905, Sao Carlos, SP, Brazil; Postgraduate Program in Rehabilitation Sciences, Federal University of Alfenas, UNIFAL, Rua Gabriel Monteiro da Silva, 700, Centro, Postal Code: 37130-001, Alfenas, MG, Brazil.
| | - Alessandro Domingues Heubel
- Cardiopulmonary Physiotherapy Laboratory, Department of Physiotherapy, Federal University of Sao Carlos - UFSCar, Rodovia Washington Luis, KM 235, Jardim Guanabara, 13565-905, Sao Carlos, SP, Brazil.
| | - Jaber Saud Alqahtani
- UCL Respiratory, University College London, Rowland Hill Street, London NW3 2PF, London, EN, United Kingdom; Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Al Amal Dhahran, 34313, Dammam, Saudi Arabia.
| | - Mariana Brasil da Cunha Martino Pereira
- Cardiopulmonary Physiotherapy Laboratory, Department of Physiotherapy, Federal University of Sao Carlos - UFSCar, Rodovia Washington Luis, KM 235, Jardim Guanabara, 13565-905, Sao Carlos, SP, Brazil.
| | - Nicole Marques Sgarbosa
- Cardiopulmonary Physiotherapy Laboratory, Department of Physiotherapy, Federal University of Sao Carlos - UFSCar, Rodovia Washington Luis, KM 235, Jardim Guanabara, 13565-905, Sao Carlos, SP, Brazil.
| | - Audrey Borghi-Silva
- Cardiopulmonary Physiotherapy Laboratory, Department of Physiotherapy, Federal University of Sao Carlos - UFSCar, Rodovia Washington Luis, KM 235, Jardim Guanabara, 13565-905, Sao Carlos, SP, Brazil.
| | - Renata Gonçalves Mendes
- Cardiopulmonary Physiotherapy Laboratory, Department of Physiotherapy, Federal University of Sao Carlos - UFSCar, Rodovia Washington Luis, KM 235, Jardim Guanabara, 13565-905, Sao Carlos, SP, Brazil.
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17
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Simons SO, Elliott A, Sastry M, Hendriks JM, Arzt M, Rienstra M, Kalman JM, Heidbuchel H, Nattel S, Wesseling G, Schotten U, van Gelder IC, Franssen FME, Sanders P, Crijns HJGM, Linz D. Chronic obstructive pulmonary disease and atrial fibrillation: an interdisciplinary perspective. Eur Heart J 2021; 42:532-540. [PMID: 33206945 DOI: 10.1093/eurheartj/ehaa822] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 06/12/2020] [Accepted: 09/11/2020] [Indexed: 02/06/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is highly prevalent among patients with atrial fibrillation (AF), shares common risk factors, and adds to the overall morbidity and mortality in this population. Additionally, it may promote AF and impair treatment efficacy. The prevalence of COPD in AF patients is high and is estimated to be ∼25%. Diagnosis and treatment of COPD in AF patients requires a close interdisciplinary collaboration between the electrophysiologist/cardiologist and pulmonologist. Differential diagnosis may be challenging, especially in elderly and smoking patients complaining of unspecific symptoms such as dyspnoea and fatigue. Routine evaluation of lung function and determination of natriuretic peptides and echocardiography may be reasonable to detect COPD and heart failure as contributing causes of dyspnoea. Acute exacerbation of COPD transiently increases AF risk due to hypoxia-mediated mechanisms, inflammation, increased use of beta-2 agonists, and autonomic changes. Observational data suggest that COPD promotes AF progression, increases AF recurrence after cardioversion, and reduces the efficacy of catheter-based antiarrhythmic therapy. However, it remains unclear whether treatment of COPD improves AF outcomes and which metric should be used to determine COPD severity and guide treatment in AF patients. Data from non-randomized studies suggest that COPD is associated with increased AF recurrence after electrical cardioversion and catheter ablation. Future prospective cohort studies in AF patients are needed to confirm the relationship between COPD and AF, the benefits of treatment of either COPD or AF in this population, and to clarify the need and cost-effectiveness of routine COPD screening.
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Affiliation(s)
- Sami O Simons
- Department of Respiratory Medicine, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands.,Division of Respiratory & Age-related Health, Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands
| | - Adrian Elliott
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, 1 Port Road, SA 5000 Adelaide, Australia
| | - Manuel Sastry
- Academic Sleep Centre CIRO, Hornerheide 1, 6085 NM Horn, the Netherlands
| | - Jeroen M Hendriks
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, 1 Port Road, SA 5000 Adelaide, Australia.,Institute of Health, Medicine and Caring Sciences, Linköping University, Campus US, SE 581 83 Linköping, Sweden.,Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, SA 5001 Adelaide, Australia
| | - Michael Arzt
- Department of Internal Medicine II, Centre of Sleep Medicine, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Michiel Rienstra
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, the Netherlands
| | - Jonathan M Kalman
- Department of Cardiology, Royal Melbourne Hospital and Department of Medicine, University of Melbourne, Grattan St Parkville, 3050 Melbourne, Australia
| | - Hein Heidbuchel
- University of Antwerp and Antwerp University Hospital, Drie Eikenstraat 655, 2650 Antwerp, Belgium.,Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium
| | - Stanley Nattel
- Department of Medicine, Montreal Heart Institute and Université de Montréal, 5000 Rue Bélanger, QC H1T 1C8, Montréal, Canada.,Department of Pharmacology and Therapeutics, McGill University, 3649 Promenade Sir-William-Osler, QC H3A 1A3, Canada.,Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Geertjan Wesseling
- Department of Respiratory Medicine, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Ulrich Schotten
- University Maastricht, Cardiovascular Research Institute Maastricht (CARIM), Universiteitssingel 50, 6229 ER Maastricht, the Netherlands
| | - Isabelle C van Gelder
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, the Netherlands
| | - Frits M E Franssen
- Department of Respiratory Medicine, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands.,Division of Respiratory & Age-related Health, Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands.,Academic Sleep Centre CIRO, Hornerheide 1, 6085 NM Horn, the Netherlands
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, 1 Port Road, SA 5000 Adelaide, Australia
| | - Harry J G M Crijns
- University Maastricht, Cardiovascular Research Institute Maastricht (CARIM), Universiteitssingel 50, 6229 ER Maastricht, the Netherlands.,Department of Cardiology, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Dominik Linz
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, 1 Port Road, SA 5000 Adelaide, Australia.,University Maastricht, Cardiovascular Research Institute Maastricht (CARIM), Universiteitssingel 50, 6229 ER Maastricht, the Netherlands.,Department of Cardiology, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands.,Department of Cardiology, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands.,Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 København N, Denmark
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18
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Direct measurement of vagal tone in rats does not show correlation to HRV. Sci Rep 2021; 11:1210. [PMID: 33441733 PMCID: PMC7807082 DOI: 10.1038/s41598-020-79808-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/07/2020] [Indexed: 02/07/2023] Open
Abstract
The vagus nerve is the largest autonomic nerve, innervating nearly every organ in the body. “Vagal tone” is a clinical measure believed to indicate overall levels of vagal activity, but is measured indirectly through the heart rate variability (HRV). Abnormal HRV has been associated with many severe conditions such as diabetes, heart failure, and hypertension. However, vagal tone has never been directly measured, leading to disagreements in its interpretation and influencing the effectiveness of vagal therapies. Using custom carbon nanotube yarn electrodes, we were able to chronically record neural activity from the left cervical vagus in both anesthetized and non-anesthetized rats. Here we show that tonic vagal activity does not correlate with common HRV metrics with or without anesthesia. Although we found that average vagal activity is increased during inspiration compared to expiration, this respiratory-linked signal was not correlated with HRV either. These results represent a clear advance in neural recording technology but also point to the need for a re-interpretation of the link between HRV and “vagal tone”.
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19
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Teixeira de Carvalho EF, Aletti F, Costa IP, Gomes ELFD, da Silva NP, Damasceno N, Muramatu LH, Dos Santos Alves VL, Ferrario M, Cahalin LP, Sampaio LMM. Evaluation of autonomic modulation of lung function and heart rate in children with cystic fibrosis. Pediatr Pulmonol 2021; 56:120-128. [PMID: 33124743 DOI: 10.1002/ppul.25147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 10/08/2020] [Accepted: 10/22/2020] [Indexed: 11/11/2022]
Abstract
The autonomic nervous system (ANS) plays an important role in modulating bronchial smooth muscle contractility, which is altered in cystic fibrosis (CF). A convenient approach to probe ANS regulation is the quantitative analysis of heart rate variability (HRV). The purpose of this study was to evaluate ANS regulation in children with CF and to investigate the influence of colonization by Pseudonomas aeruginosa via assessment of HRV in colonized CF (CCF) children and noncolonized CF (NCCF) children. Sixteen children with CF (7 CCF and 9 NCCF) and seven healthy age-matched control children were enrolled in the study. Heart rate was recorded for 10 min at rest in the supine and standing positions and HRV analysis was carried out using autoregressive spectral analysis. The CCF group was characterized by lower forced expiratory volume than NCCF, indicating an impairment of respiratory function. The HRV parameters further confirmed the possible sympathetic overactivity in CCF. Children with CF exhibited hyperactivity of the sympathetic nervous system. In particular, the CCF group presented a greater impairment of ANS modulation. Both CCF and NCCF children showed lower supine vagal activation in the HRV indices related to sympathetic activation and reduction of indices indicating vagal activity with the postural change from supine to standing when compared to the NCCF group.
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Affiliation(s)
- Etiene F Teixeira de Carvalho
- Departament of Master's and Doctoral Programs in Rehabilitation Sciences, Nove de Julho University, São Paulo, São Paulo, Brazil
| | - Federico Aletti
- Department of Bioengineering, University of California San Diego, La Jolla, California, USA.,Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Ivan P Costa
- Departament of Master's and Doctoral Programs in Rehabilitation Sciences, Nove de Julho University, São Paulo, São Paulo, Brazil
| | - Evelim L F D Gomes
- Department of Bioengineering, University of California San Diego, La Jolla, California, USA
| | - Natalia P da Silva
- Departament of Master's and Doctoral Programs in Rehabilitation Sciences, Nove de Julho University, São Paulo, São Paulo, Brazil
| | - Neiva Damasceno
- Departament Pediatric Pulmonology - Faculdade de Ciências Médicas da Santa Casa de Misericórdia de São Paulo, São Paulo, São Paulo, Brazil
| | - Lucia H Muramatu
- Departament Pediatric Pulmonology - Faculdade de Ciências Médicas da Santa Casa de Misericórdia de São Paulo, São Paulo, São Paulo, Brazil
| | - Vera L Dos Santos Alves
- Departament Pediatric Pulmonology - Faculdade de Ciências Médicas da Santa Casa de Misericórdia de São Paulo, São Paulo, São Paulo, Brazil
| | - Manuela Ferrario
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Lawrence P Cahalin
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Ponce de Leon Boulevard, 5th Floor - Coral Gable, Miami, FL, 5915, USA
| | - Luciana M M Sampaio
- Departament of Master's and Doctoral Programs in Rehabilitation Sciences, Nove de Julho University, São Paulo, São Paulo, Brazil
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20
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Rocha HM, Muniz de Souza HC, Viana R, Neves VR, Dornelas de Andrade A. Immediate Effects of Rib Mobilization and Diaphragm Release Techniques on Cardiac Autonomic Control in Patients With Chronic Obstructive Pulmonary Disease: A Pilot Study. J Chiropr Med 2020; 19:167-174. [PMID: 33362439 DOI: 10.1016/j.jcm.2020.06.001] [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: 10/07/2018] [Revised: 03/16/2020] [Accepted: 06/03/2020] [Indexed: 10/23/2022] Open
Abstract
Objective The purpose of this pilot study was to evaluate the feasibility of testing an intervention protocol and measuring the immediate effects of a rib mobilization technique (RMT) and a diaphragm release technique (DRT) on the autonomic nervous system of patients with chronic obstructive pulmonary disease (COPD). Methods This was a pilot study of a randomized controlled trial. Fourteen individuals were evaluated. Eligibility criteria were being a sedentary person with a diagnosis of COPD, age between 50 and 72 years, and being clinically stable. Exclusion criteria were heart disease, other respiratory comorbidities, and body mass index above 30kg/m2. Participants first underwent cardiorespiratory evaluation and were then allocated into 2 groups: the RMT + DRT group and the DRT group. Clinical assessments were performed immediately before and after the intervention. Statistical analysis was carried out through a paired-sample Wilcoxon test, and the comparison between groups was performed using the Mann-Whitney test. Results All randomized participants completed the assessment and intervention protocol. Sample size was estimated at 24 individuals per group. The DRT group decreased resting heart rate by 5 bpm (P = .03) and increased variance (P = .04) and mean R-R interval (P = .03). The RMT + DRT group decreased mean R-R interval (P = .02). Conclusion The design for this study appears to be feasible for evaluating manual-therapy intervention in the nonmusculoskeletal function of patients with COPD. It was possible to determine the sample size for future studies. Preliminary data show that the diaphragm release technique may reduce mean resting heart rate and increase heart-rate variability immediately after the intervention.
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Affiliation(s)
| | | | - Rodrigo Viana
- Department of Physical Therapy, Federal University of Pernambuco, Recife, Brazil
| | - Victor Ribeiro Neves
- Department of Physiotherapy, University of Pernambuco Campus Petrolina, Petrolina, Brazil
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21
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Wade C, Wells JM. Practical recommendations for the use of beta-blockers in chronic obstructive pulmonary disease. Expert Rev Respir Med 2020; 14:671-678. [PMID: 32250198 DOI: 10.1080/17476348.2020.1752671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Controversies regarding the use of beta-blocker in chronic obstructive pulmonary disease (COPD) have been longstanding and based on inconsistent data. COPD and cardiovascular disease have many shared risk factors and potentially overlapping pathophysiologic mechanisms. Beta-blockers, a mainstay of treatment in ischemic heart disease, congestive heart failure, and cardiac arrhythmia, remain underutilized in COPD patients despite considerable evidence of safety. Furthermore, observational studies indicated the potential benefits of beta-blockers in COPD via a variety of possible mechanisms. Recently, a randomized controlled trial of metoprolol versus placebo failed to show a reduction in COPD exacerbation risk in subjects with moderate to severe COPD and no absolute indication for beta-blocker use. AREAS COVERED Physiology of beta-adrenergic receptors, links between COPD and cardiovascular disease, and the role of beta-blockers in COPD management are discussed. EXPERT COMMENTARY Beta-blockers should not be used to treat COPD patients who do not have conditions with clear guideline-directed recommendations for their use. Vigilance is recommended in prescribing these medications for indications where another drug class could be utilized.
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Affiliation(s)
- Chad Wade
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham , Birmingham, AL, USA.,Lung Health Center , Birmingham, AL, USA
| | - J Michael Wells
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham , Birmingham, AL, USA.,Lung Health Center , Birmingham, AL, USA.,Acute Care Service, Birmingham VA Medical Center , Birmingham, AL, USA
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22
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Byers BW, Fuhr DP, Moore LE, Bhutani M, Wong EYL, Stickland MK. The effect of pulmonary rehabilitation on carotid chemoreceptor activity and sensitivity in chronic obstructive pulmonary disease. J Appl Physiol (1985) 2019; 127:1278-1287. [PMID: 31295067 DOI: 10.1152/japplphysiol.00799.2018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Recent work demonstrates that carotid chemoreceptor (CC) activity/sensitivity is elevated in patients with chronic obstructive pulmonary disease (COPD) compared with healthy controls, and this elevated chemoreception appears to contribute to increased cardiovascular risk. Exercise training has been shown to normalize CC activity/sensitivity in other populations, and therefore, the purpose of this study was to determine whether pulmonary rehabilitation (PR) can reduce CC activity/sensitivity in COPD. Forty-five COPD patients [mean FEV1 (forced expiratory volume in 1 s) = 56.6% predicted] completed PR, while 15 COPD patients (mean FEV1 = 74.6% predicted) served as non-PR controls. CC activity was determined by the reduction in ventilation while breathing transient hyperoxia ([Formula: see text] = 1.0); CC sensitivity was evaluated by the increase in ventilation relative to the drop in arterial saturation while breathing hypoxia. Dyspnea, six-minute walk and autonomic function data were also obtained. PR improved 6-minute walk distance (P < 0.001) and dyspnea (P = 0.04); however, there was no effect on CC activity (P = 0.60), sensitivity (P = 0.69), or autonomic function (P > 0.05 for all). Subgroup analyses indicated that PR reduced CC activity in those with elevated baseline CC activity, independent of changes in autonomic function. No change in dyspnea (P = 0.24), CC activity (P = 0.19), sensitivity (P = 0.80), or autonomic function (P > 0.05 for all) was observed in the control group. Despite improvements in exercise tolerance and dyspnea, PR appears to be generally ineffective at reducing CC sensitivity in stable COPD patients; while PR reduced CC activity in those with elevated basal CC activity, the physiological significance of this is unclear. Further investigations aimed at improving CC function in COPD are needed.NEW & NOTEWORTHY While work in other chronic diseases has shown that exercise training may help normalize carotid chemoreceptor (CC) activity/sensitivity, the current study found that exercise training through pulmonary rehabilitation did not consistently reduce CC activity/sensitivity in patients with chronic obstructive pulmonary disease (COPD). These results suggest that other interventions are needed to normalize CC activity/sensitivity in COPD.
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Affiliation(s)
- Bradley W Byers
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Desi P Fuhr
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Linn E Moore
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Mohit Bhutani
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Eric Y L Wong
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Michael K Stickland
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.,G. F. MacDonald Centre for Lung Health, Covenant Health, Edmonton, Alberta, Canada
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23
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Sarkar S, Bhattacharyya P, Mitra M, Pal S. A novel approach towards non-obstructive detection and classification of COPD using ECG derived respiration. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2019; 42:1011-1024. [PMID: 31602592 DOI: 10.1007/s13246-019-00800-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 08/29/2019] [Accepted: 09/07/2019] [Indexed: 10/25/2022]
Abstract
The alarming rate of mortality and disability due to Chronic Obstructive Pulmonary Disease (COPD) has become a serious health concern worldwide. The progressive nature of this disease makes it inevitable to detect this disease in its early stages, leads to a greater demand for developing non-obstructive and reliable technology for COPD detection. The use of highly patient-effort dependent, time-consuming, and expensive methods are some major inherent limitations of previous techniques. Lack of knowledge about the disease and inadequacy of proper diagnostic tool for early detection of COPD is another reason behind the 3rd leading cause of death worldwide. For this reason, this study aims to explore the utility of ECG Derived Respiration (EDR) for classification between COPD patients and normal healthy subjects as EDR can be easily extracted from ECG. ECG and respiration signals collected from 30 normal and 30 COPD subjects were analysed. Error calculation and statistical analysis were performed to observe the similarity between original respiration and EDR signal. The morphological pattern changes of respiration and EDR signals were analysed and three different features were extracted from those. Classification was performed by different classifiers employing Decision Tree, Linear Discriminant Analysis (LDA), Support Vector Machine (SVM) and K-Nearest Neighbor (KNN). Apart from obtaining comparable classification performance it was seen that EDR has better potential than the original respiration signal for classification of COPD from normal population.
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Affiliation(s)
- Surita Sarkar
- Department of Applied Physics, University of Calcutta, Kolkata, 700009, India
| | | | - Madhuchhanda Mitra
- Department of Applied Physics, University of Calcutta, Kolkata, 700009, India
| | - Saurabh Pal
- Department of Applied Physics, University of Calcutta, Kolkata, 700009, India.
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24
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Martelli V, Mathur S, Wickerson L, Gottesman C, Helm D, Singer LG, Rozenberg D. Impaired cardiac autonomic response in lung transplant patients: A retrospective cohort study. Clin Transplant 2019; 33:e13612. [PMID: 31132178 DOI: 10.1111/ctr.13612] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 05/07/2019] [Accepted: 05/15/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cardiac autonomic dysfunction (AD) is associated with adverse prognosis in lung disease; however, its implications in lung transplantation have not been previously described. This study evaluated the prevalence of AD in lung transplant (LTx) candidates, its determinants, prognostic implications, and prevalence post-transplant. METHODS Retrospective one-year study of 103 LTx candidates with AD assessed using heart rate (HR) from the six-minute walk test (6MWT). Impaired chronotropic response index (CRI) was defined as <80% age-adjusted HR during 6MWT. Abnormal HR recovery (HRR) was categorized as reduction in HR ≤ 12 beats/minute after the first minute of 6MWT cessation. RESULTS Abnormal CRI and HRR were observed in 94% and 76% of patients, respectively. A lower CRI was associated with obstructive lung disease and lower estimated aerobic capacity. CRI was independently associated with 6MW distance [12 m per 10% CRI, P = 0.03], but not with post-transplant cardiovascular events, hospital stay, or one-year mortality. At 3 months post-transplant, no improvement was observed in CRI (99%, n = 66/67, P = 0.25) or HRR (88%, n = 36/41, P = 0.12). CONCLUSION Cardiac AD was prevalent in LTx candidates and recipients, with chronotropic incompetence a modest contributor to exercise intolerance pretransplant. Further study may help determine whether direct autonomic measures such as HR variability may be more prognostic of LTx outcomes.
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Affiliation(s)
- Vanessa Martelli
- Department of Medicine, Respirology, University of Toronto, Toronto, Ontario, Canada
| | - Sunita Mathur
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Lisa Wickerson
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.,Lung Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Chaya Gottesman
- Lung Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Denise Helm
- Lung Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Lianne G Singer
- Department of Medicine, Respirology, University of Toronto, Toronto, Ontario, Canada.,Lung Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Dmitry Rozenberg
- Department of Medicine, Respirology, University of Toronto, Toronto, Ontario, Canada.,Lung Transplant Program, University Health Network, Toronto, Ontario, Canada.,Toronto General Hospital Research Institute, Toronto, Ontario, Canada
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25
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Vidotto LS, Carvalho CRFD, Harvey A, Jones M. Dysfunctional breathing: what do we know? ACTA ACUST UNITED AC 2019; 45:e20170347. [PMID: 30758427 PMCID: PMC6534396 DOI: 10.1590/1806-3713/e20170347] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 02/17/2018] [Indexed: 11/26/2022]
Abstract
Dysfunctional breathing (DB) is a respiratory condition characterized by irregular breathing patterns that occur either in the absence of concurrent diseases or secondary to cardiopulmonary diseases. Although the primary symptom is often dyspnea or “air hunger”, DB is also associated with nonrespiratory symptoms such as dizziness and palpitations. DB has been identified across all ages. Its prevalence among adults in primary care in the United Kingdom is approximately 9.5%. In addition, among individuals with asthma, a positive diagnosis of DB is found in a third of women and a fifth of men. Although DB has been investigated for decades, it remains poorly understood because of a paucity of high-quality clinical trials and validated outcome measures specific to this population. Accordingly, DB is often underdiagnosed or misdiagnosed, given the similarity of its associated symptoms (dyspnea, tachycardia, and dizziness) to those of other common cardiopulmonary diseases such as COPD and asthma. The high rates of misdiagnosis of DB suggest that health care professionals do not fully understand this condition and may therefore fail to provide patients with an appropriate treatment. Given the multifarious, psychophysiological nature of DB, a holistic, multidimensional assessment would seem the most appropriate way to enhance understanding and diagnostic accuracy. The present narrative review was developed as a means of summarizing the available evidence about DB, as well as improving understanding of the condition by researchers and practitioners.
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Affiliation(s)
- Laís Silva Vidotto
- . Department of Clinical Sciences, Brunel University London, United Kingdom
| | | | - Alex Harvey
- . Department of Clinical Sciences, Brunel University London, United Kingdom
| | - Mandy Jones
- . Department of Clinical Sciences, Brunel University London, United Kingdom
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26
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Effects of Water-Based Aerobic Interval Training in Patients With COPD: A RANDOMIZED CONTROLLED TRIAL. J Cardiopulm Rehabil Prev 2019; 39:105-111. [PMID: 30720640 DOI: 10.1097/hcr.0000000000000352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE Chronic obstructive pulmonary disease promotes systemic repercussions, which can be minimized with physical exercise. This study investigated the effects of a water-based aerobic interval training program on the autonomic modulation of heart rate (HR), quality of life (QoL), and functional capacity (FC) of patients with chronic obstructive pulmonary disease. METHODS Nineteen patients with chronic obstructive pulmonary disease were enrolled in this randomized clinical trial and allocated to either the usual care group (n = 9) or training group (n = 10). Before and after 24 sessions of water-based physical training, the patients underwent evaluation of autonomic modulation of HR by analyzing the HR variability, QoL using the St George's Respiratory Questionnaire, and FC using 6-min walk test distance. RESULTS The results showed significant improvement when comparing the variables of HR variability, QoL, and FC in the training group in the pre- and post-training conditions (P < .05). In the usual care group, there was no significant difference for any of the variables. Negative correlations were found between HR variability and QoL (r =-0. 55; P = .01) and 6-min walk test distance and QoL (r =-0.49; P = .02). CONCLUSION Water-based physical training promoted beneficial adaptations in the autonomic modulation of HR, QoL, and FC of patients with chronic obstructive pulmonary disease.
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27
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Leite MR, Ramos EMC, Freire APCF, de Alencar Silva BS, Nicolino J, Vanderlei LCM, Ramos D. Analysis of Autonomic Modulation in Response to a Session of Aerobic Exercise at Different Intensities in Patients With Moderate and Severe COPD. COPD 2018; 15:245-253. [PMID: 30375894 DOI: 10.1080/15412555.2018.1529744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Despite the many benefits of performing physical exercise in patients with chronic obstructive pulmonary disease (COPD), information on the response of acute cardiac autonomic modulation in subjects with moderate and severe COPD during and after an aerobic exercise session at different intensities is unknown. The aim of this study was to evaluate the response of cardiac autonomic modulation in patients with moderate and severe COPD during and after an aerobic exercise session at different intensities. Twenty-seven patients with COPD, divided into: Moderate Group and Severe Group, underwent an aerobic exercise sessions with intensities equivalent to 60% and 90% of velocity corresponding to peak oxygen consumption. The heart rate variability (HRV) indices were analyzed in the time and frequency domains at the following times: at rest, during exercise, immediately after, and 5, 10, and 15 minutes after exercise. In the comparison analysis between the two groups, no differences were observed in any of the HRV indices at different intensities applied. However, it was observed that the exercise caused autonomic changes when the groups were analyzed separately. Sessions of aerobic exercise influence the autonomic modulation in patients with COPD. However, COPD severity did not influence the autonomic nervous system response to exercise and recovery moments; and there was no difference between the exercise intensities.
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Affiliation(s)
- Marceli Rocha Leite
- a Department of Physiotherapy , Universidade Estadual Paulista (UNESP) , São Paulo , Brazil
| | - Ercy Mara Cipulo Ramos
- a Department of Physiotherapy , Universidade Estadual Paulista (UNESP) , São Paulo , Brazil
| | | | | | - Juliana Nicolino
- a Department of Physiotherapy , Universidade Estadual Paulista (UNESP) , São Paulo , Brazil
| | | | - Dionei Ramos
- a Department of Physiotherapy , Universidade Estadual Paulista (UNESP) , São Paulo , Brazil
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28
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Crisafulli E, Vigna M, Ielpo A, Tzani P, Mangia A, Teopompi E, Aiello M, Alfieri V, Bertorelli G, Palange P, Chetta A. Heart rate recovery is associated with ventilatory constraints and excess ventilation during exercise in patients with chronic obstructive pulmonary disease. Eur J Prev Cardiol 2018; 25:1667-1674. [PMID: 30033754 DOI: 10.1177/2047487318789756] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Heart rate recovery delay is a marker of cardiac autonomic dysfunction. In chronic obstructive pulmonary disease patients, the ventilatory response to exercise during incremental cardiopulmonary exercise test may add information about dynamic hyperinflation by low values of inspiratory capacity/total lung capacity ratio (at peak) and excess ventilation by the slope of minute ventilation to carbon dioxide output ratio (VE/VCO2 slope). We aimed to assess if the ventilatory response to exercise might be a determinant for heart rate recovery delay. Design An observational, prospective study. Methods Anthropometric characteristics, lung function and cardiopulmonary exercise test data were recorded in chronic obstructive pulmonary disease outpatients. A cut-off of heart rate recovery of 12 or more beats was used to define heart rate recovery delay. Results Of 254 patients enrolled, 156 (61%) showed heart rate recovery delay. As compared to patients with normal heart rate recovery, patients with delay were older, with a worse lung function and with lower values of peak oxygen uptake, maximal workload, oxygen pulse at rest and at peak, and inspiratory capacity/total lung capacity at peak. Conversely, VE/VCO2 slope and dyspnoea and leg fatigue perception at peak were higher in patients with heart rate recovery delay. In the multivariate regression model adjusted for age, sex, fat-free mass, heart rate at rest and use of β-blockers, we found that inspiratory capacity/total lung capacity at peak (<0.25) (odds ratio 2.61; P = 0.007) and VE/VCO2 slope (>32) (odds ratio 2.26; P = 0.018) predict the risk of heart rate recovery delay. Conclusions In chronic obstructive pulmonary disease outpatients, heart rate recovery is associated with dynamic hyperinflation and excess ventilation during exercise.
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Affiliation(s)
| | - Matteo Vigna
- 1 Department of Medicine and Surgery, University of Parma, Italy
| | - Antonella Ielpo
- 1 Department of Medicine and Surgery, University of Parma, Italy
| | - Panagiota Tzani
- 1 Department of Medicine and Surgery, University of Parma, Italy
| | - Angelo Mangia
- 1 Department of Medicine and Surgery, University of Parma, Italy
| | | | - Marina Aiello
- 1 Department of Medicine and Surgery, University of Parma, Italy
| | - Veronica Alfieri
- 1 Department of Medicine and Surgery, University of Parma, Italy
| | | | - Paolo Palange
- 2 Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
| | - Alfredo Chetta
- 1 Department of Medicine and Surgery, University of Parma, Italy
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29
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Ricci-Vitor AL, Vanderlei LCM, Pastre CM, Ramos D, Ramos EMC, Ferreira Filho C, Ferreira C. Elastic Tubing Resistance Training and Autonomic Modulation in Subjects with Chronic Obstructive Pulmonary Disease. BIOMED RESEARCH INTERNATIONAL 2018; 2018:9573630. [PMID: 30003108 PMCID: PMC5996473 DOI: 10.1155/2018/9573630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 03/22/2018] [Accepted: 04/05/2018] [Indexed: 11/30/2022]
Abstract
This study addresses evidence concerning elastic tubing resistance training (ET) on autonomic modulation in patients with chronic obstructive pulmonary disease (COPD). Autonomic dysfunction is common in COPD and contributes to the development of arrhythmias and sudden death. Along with autonomic dysfunction, muscle dysfunction is related to functional limitations and prognosis of the disease. This study investigated the effects of ET on autonomic modulation, muscle strength, and walking distance in COPD. Subjects were divided into two groups, ET (n = 20; 66,5 ± 8,9 y; 25,5 ± 3,5 kg/m2; FEV1/FVC: 50,3 ± 11,0) and conventional training (n = 19; 66,0 ± 6,9; 27,1 ± 4,3; FEV1/FVC: 55,05 ± 9,56). Both groups undertook 24 sessions for 60 minutes, 3 times in a week. The significance level was p ≤ 0,05. Autonomic modulation was evaluated using heart rate variability in the time (rMSSD, ms) and frequency domain (HF, ms). Strength for upper and lower limbs was measured using dynamometry and walking distance was measured using a 6-minute walking test. There were no significant differences in the outcomes between groups. There was an increment to rMSSD [(16,7 ± 11,0 versus 20,8 ± 14,9) versus (14,2 ± 10,0 versus 17,4 ± 12,1)], HF [(141,9 ± 191,3 versus 234,9 ± 335,7) versus (94,1 ± 123,5 versus 177,6 ± 275,5)], shoulder abduction [(50,1 ± 19,6 versus 56,9 ± 20,4) versus (50,5 ± 19,0 versus 56,9 ± 19,3)], knee flexion [(101,9 ± 34,0 versus 116,8 ± 43,3) versus (98,6 ± 21,5 versus 115,1 ± 30,8)], and walking test [(433,0 ± 84,8 versus 468,9 ± 90,8) versus (397,4 ± 99,8 versus 426,3 ± 101,6)] after training for ET and conventional training, respectively. In conclusion, ET improves autonomic modulation in COPD with additional benefits for strength and cardiorespiratory capacity similar to conventional training.
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Affiliation(s)
- Ana Laura Ricci-Vitor
- Department of Medicine, Federal University of São Paulo, São Paulo, SP, Brazil
- Department of Physical Therapy, São Paulo State University, Presidente Prudente, SP, Brazil
| | | | - Carlos Marcelo Pastre
- Department of Physical Therapy, São Paulo State University, Presidente Prudente, SP, Brazil
| | - Dionei Ramos
- Department of Physical Therapy, São Paulo State University, Presidente Prudente, SP, Brazil
| | - Ercy Mara C. Ramos
- Department of Physical Therapy, São Paulo State University, Presidente Prudente, SP, Brazil
| | - Celso Ferreira Filho
- Department of Clinical Medicine, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Celso Ferreira
- Department of Medicine, Federal University of São Paulo, São Paulo, SP, Brazil
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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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Zangrando KTL, Trimer R, de Carvalho LCS, Arêas GPT, Caruso FCR, Cabiddu R, Roscani MG, Rizzatti FPG, Borghi-Silva A. Chronic obstructive pulmonary disease severity and its association with obstructive sleep apnea syndrome: impact on cardiac autonomic modulation and functional capacity. Int J Chron Obstruct Pulmon Dis 2018; 13:1343-1351. [PMID: 29731622 PMCID: PMC5927062 DOI: 10.2147/copd.s156168] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background The study was conducted to determine the impact of chronic obstructive pulmonary disease (COPD) in association with obstructive sleep apnea syndrome (OSAS) on cardiac autonomic control and functional capacity. Subjects and methods The study was a cross-sectional prospective controlled clinical study. Heart rate variability indices of 24 COPD (n = 12) and COPD+OSAS (n = 12) patients were evaluated and compared by electrocardiographic recordings acquired during rest, active postural maneuver (APM), respiratory sinus arrhythmia maneuver (RSA-m), and the 6-minute walk test (6MWT). Results The COPD group presented higher parasympathetic modulation during APM when compared to the COPD+OSAS group (P = 0.02). The COPD+OSAS group presented higher sympathetic modulation during RSA-m when compared to the COPD group (P = 0.00). The performance during 6MWT was similarly impaired in both groups, despite the greater severity of the COPD group. Conclusion Subjects with COPD+OSAS present marked sympathetic modulation, and the presence of OSAS in COPD subjects has a negative impact on functional capacity regardless of the severity of lung disease.
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Affiliation(s)
- Katiany Thays Lopes Zangrando
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Renata Trimer
- Physical Education and Health Department, University of Santa Cruz do Sul, Santa Cruz do Sul, Rio Grande do Sul, Brazil
| | - Luiz Carlos Soares de Carvalho
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Guilherme Peixoto Tinoco Arêas
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Flávia Cristina Rossi Caruso
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Ramona Cabiddu
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Meliza Goi Roscani
- Medicine Department, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | | | - Audrey Borghi-Silva
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of São Carlos, São Carlos, São Paulo, Brazil
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da L Goulart C, San Martin EA, Mansour KMK, Schneiders PB, da Silva ALG. Influence of expiratory positive airway pressure on cardiac autonomic modulation at rest and in submaximal exercise in COPD patients. ACTA ACUST UNITED AC 2018; 51:e7180. [PMID: 29694504 PMCID: PMC5937727 DOI: 10.1590/1414-431x20187180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 01/16/2018] [Indexed: 11/29/2022]
Abstract
The aim of this study was to evaluate the effect of expiratory positive airway pressure (EPAP) on heart rate variability (HRV) indices at rest and during 6-min walk test (6MWT) in chronic obstructive pulmonary disease (COPD) patients. Fifteen moderate to severe COPD patients were randomized and evaluated with and without (Non-EPAP) a 5 cmH2O EPAP device. Respiratory rate (RR) was collected at rest (5 min), during the 6MWT (5 min), and at recovery (5 min). Indices of HRV were computed in the time domain, in the frequency domain, and nonlinear analysis. For EPAP and Non-EPAP during the 6MWT, we found an increased mean heart rate (HR) (P=0.001; P=0.001) while mean RR (P=0.001; P=0.015) and RR tri index decreased (P=0.006; P=0.028). Peripheral oxygen saturation (P=0.019) increased at rest only in the EPAP group. In EPAP, correlations were found between forced expiratory volume in 1 s (FEV1) and low frequency (LF) sympathetic tonus (P=0.05; r=-0.49), FEV1 and high frequency (HF) parasympathetic tonus at rest (P=0.05; r=0.49), lactate at rest and LF during the 6MWT (P=0.02; r=-0.57), and lactate at rest and HF during 6MWT (P=0.02; r=0.56). Through a linear regression model, we found that lactate at rest explained 27% of the alterations of LF during 6MWT. The use of 5 cmH2O EPAP improved autonomic cardiac modulation and its complexity at rest in COPD patients. Although it did not influence the performance of the 6MWT, the EPAP device caused alterations in resting lactate concentration with an effect on sympatho-vagal control during the test.
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Affiliation(s)
- C da L Goulart
- Iniciação Científica, Curso de Fisioterapia, Universidade de Santa Cruz do Sul, Santa Cruz do Sul, RS, Brasil
| | - E A San Martin
- Iniciação Científica, Curso de Fisioterapia, Universidade de Santa Cruz do Sul, Santa Cruz do Sul, RS, Brasil
| | - K M K Mansour
- Iniciação Científica, Curso de Fisioterapia, Universidade de Santa Cruz do Sul, Santa Cruz do Sul, RS, Brasil
| | - P B Schneiders
- Iniciação Científica, Curso de Fisioterapia, Universidade de Santa Cruz do Sul, Santa Cruz do Sul, RS, Brasil
| | - A L G da Silva
- Curso de Fisioterapia, Departamento de Educação Física e Saúde, Universidade de Santa Cruz do Sul, Santa Cruz do Sul, RS, Brasil
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Pan L, Wu S, Li H, Xu J, Dong W, Shan J, Yang X, Chen Y, Shima M, Deng F, Guo X. The short-term effects of indoor size-fractioned particulate matter and black carbon on cardiac autonomic function in COPD patients. ENVIRONMENT INTERNATIONAL 2018; 112:261-268. [PMID: 29306794 DOI: 10.1016/j.envint.2017.12.037] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 11/25/2017] [Accepted: 12/27/2017] [Indexed: 05/06/2023]
Abstract
BACKGROUND Previous studies have reported adverse health effects of indoor air pollutants especially particulate matter (PM) and black carbon (BC). Patients with chronic obstructive pulmonary disease (COPD) have been shown to be more likely with cardiovascular comorbidities in which cardiac autonomic dysfunction plays an important role. However, there is little evidence for the effect of indoor PM and BC exposures on cardiac autonomic function in COPD patients. OBJECTIVES To evaluate the association between exposure to indoor size-fractioned PM and BC and changes in HRV and HR in COPD patients. METHODS Forty-three doctor diagnosed, stable COPD patients were recruited and measured for 24-h HRV and HR. Real-time indoor size-fractioned PM and BC were monitored on the day before and the day of performing health measurements. Mixed-effects models were used to estimate the associations between indoor PM and BC and HRV indices and HR after controlling for potential confounders. RESULTS Increasing levels of size-fractioned PM and BC were associated with decreased HRV indices and increased HR. An IQR (3.14μg/m3) increase in 8-h BC moving average and an IQR (20.72μg/m3) increase in 5-min PM0.5 moving average concentrations were associated with declines of 7.45% (95% CI: -10.89%, -3.88%) and 16.40% (95% CI: -21.06%, -11.41%) in LF, respectively. The smaller the particles size, the greater effects on HRV indices and HR. Patients' BMI modified the associations between size-fractioned PM and BC and their HRV and HR. For an IQR increase in PM0.5, there was decline in HF of 34.85% (95% CI: -39.08%, -30.33%) in overweight patients, compared to a 2.01% (95% CI: -6.44%, 11.19%) increase in normal-weight patients. CONCLUSIONS Exposures to indoor PM and BC were associated with altered cardiac autonomic function in COPD patients, and the associations for HRV measures of parasympathetic activity (e.g., HF) were more apparent in overweight patients.
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Affiliation(s)
- Lu Pan
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, China
| | - Shaowei Wu
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, China
| | - Hongyu Li
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, China
| | - Junhui Xu
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, China
| | - Wei Dong
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, China
| | - Jiao Shan
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, China
| | - Xuan Yang
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, China
| | - Yahong Chen
- Respiratory Department, Peking University Third Hospital, Beijing, China
| | - Masayuki Shima
- Department of Public Health, Hyogo College of Medicine, Hyogo, Japan
| | - Furong Deng
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, China.
| | - Xinbiao Guo
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, China.
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Mohammed J, Derom E, De Backer T, De Wandele I, Calders P. Cardiac Autonomic Function and Reactivity Tests in Physically Active Subjects with Moderately Severe COPD. COPD 2018; 15:51-59. [DOI: 10.1080/15412555.2017.1412414] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Jibril Mohammed
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
- Department of Physiotherapy, Bayero University Kano, Kano, Nigeria
| | - Eric Derom
- Department of Internal Medicine, Ghent University – Ghent University Hospital, Ghent, Belgium
| | - Tine De Backer
- Department of Internal Medicine, Ghent University – Ghent University Hospital, Ghent, Belgium
| | - Inge De Wandele
- Center for Medical Genetics, Ghent University – Ghent University Hospital, Ghent, Belgium
| | - Patrick Calders
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
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Vanzella LM, Bernardo AFB, de Carvalho TD, Vanderlei FM, da Silva AKF, Vanderlei LCM. Complexity of autonomic nervous system function in individuals with COPD. J Bras Pneumol 2018; 44:24-30. [PMID: 29538539 PMCID: PMC6104537 DOI: 10.1590/s1806-37562017000000086] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 07/21/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate autonomic modulation in individuals with COPD, compared with healthy controls, via recurrence plots (RPs) and linear heart rate variability (HRV) indices. METHODS We analyzed data on 74 volunteers, who were divided into two groups: COPD (n = 43) and control (n = 31). For calculation of HRV indices, heart rate was measured beat-by-beat during 30 min of supine rest using a heart-rate meter. We analyzed linear indices in the time and frequency domains, as well as indices derived from the RPs. RESULTS In comparison with the control group, the COPD group showed significant increases in the indices derived from the RPs, as well as significant reductions in the linear indices in the time and frequency domains. No significant differences were observed in the linear indices in the frequency domains expressed in normalized units or in the low frequency/high frequency ratio. CONCLUSIONS Individuals with COPD show a reduction in both sympathetic and parasympathetic activity, associated with decreased complexity of autonomic nervous system function, as identified by RPs, which provide important complementary information in the detection of autonomic changes in this population.
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Affiliation(s)
- Laís Manata Vanzella
- . Programa de Pós-Graduação, Curso de Fisioterapia. Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista - FCT/UNESP - Presidente Prudente (SP) Brasil
| | - Aline Fernanda Barbosa Bernardo
- . Programa de Pós-Graduação, Curso de Fisioterapia. Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista - FCT/UNESP - Presidente Prudente (SP) Brasil
| | - Tatiana Dias de Carvalho
- . Departamento de Ciencias de la Salud, Kinesiología, Universidad Nacional de La Matanza - UNLaM - San Justo (BA) Argentina
| | - Franciele Marques Vanderlei
- . Departamento de Fisioterapia. Faculdade de Ciências e Tecnologia Universidade Estadual Paulista - FCT/UNESP - Presidente Prudente (SP) Brasil
| | - Anne Kastelianne França da Silva
- . Programa de Pós-Graduação, Curso de Fisioterapia. Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista - FCT/UNESP - Presidente Prudente (SP) Brasil
| | - Luiz Carlos Marques Vanderlei
- . Departamento de Fisioterapia. Faculdade de Ciências e Tecnologia Universidade Estadual Paulista - FCT/UNESP - Presidente Prudente (SP) Brasil
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Sima CA, Inskip JA, Sheel AW, van Eeden SF, Reid WD, Camp PG. The reliability of short-term measurement of heart rate variability during spontaneous breathing in people with chronic obstructive pulmonary disease. REVISTA PORTUGUESA DE PNEUMOLOGIA 2017; 23:338-342. [PMID: 28689709 DOI: 10.1016/j.rppnen.2017.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 05/08/2017] [Accepted: 06/04/2017] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Reduced heart rate variability (HRV), a marker of autonomic system dysfunction, has been reported in patients with chronic obstructive pulmonary disease (COPD). Yet, limited data exists on the reliability of HRV measurement in this population. Here we investigated the reliability of short-term HRV measurement performed during spontaneous breathing in patients with COPD. METHODS Thirteen individuals (8 males) with moderate-to-severe COPD (FEV1 46±16% predicted; FEV1/FVC 49±13) underwent standard time and frequency domain HRV measurements derived from 5-minute electrocardiograms collected on two separate days using a SphygmoCor device. Absolute and relative reliability was assessed by a number of coefficients including within-subject random variation, systematic change in the mean, and retest correlations. RESULTS Within-subject coefficients of variation (CV) ranged from 4.3% to 193.4%. The intraclass correlation coefficients (ICCs) ranged from 0.72 to 0.93 for parameters related to overall HRV, and from 0.57 to 0.59 for those related to parasympathetic tone in both time and frequency domains. Mean heart rate was the only parameter that showed excellent absolute and relative reliability (CV=4.3%, ICC=0.93). CONCLUSION The HRV measurements showed overall moderate-to-substantial reliability during spontaneous breathing in COPD population. Our findings support the use of HRV parameters for diagnosis and cardiac risk assessment, but only mean heart rate can be used reliably for monitoring changes in autonomic status following rehabilitation intervention in this population.
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Affiliation(s)
- C A Sima
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
| | - J A Inskip
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - A W Sheel
- School of Kinesiology, University of British Columbia, Vancouver, Canada
| | - S F van Eeden
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada; Department of Internal Medicine, University of British Columbia, Vancouver, Canada
| | - W D Reid
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - P G Camp
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, Canada.
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Herzratenvariabilitäts-Biofeedback in der klinischen Praxis. PSYCHOTHERAPEUT 2017. [DOI: 10.1007/s00278-017-0236-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Jin Y, Chen C, Cao Z, Sun B, Lo IL, Liu TM, Zheng J, Sun S, Shi Y, Zhang XD. Entropy change of biological dynamics in COPD. Int J Chron Obstruct Pulmon Dis 2017; 12:2997-3005. [PMID: 29066881 PMCID: PMC5644543 DOI: 10.2147/copd.s140636] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
In this century, the rapid development of large data storage technologies, mobile network technology, and portable medical devices makes it possible to measure, record, store, and track analysis of large amount of data in human physiological signals. Entropy is a key metric for quantifying the irregularity contained in physiological signals. In this review, we focus on how entropy changes in various physiological signals in COPD. Our review concludes that the entropy change relies on the types of physiological signals under investigation. For major physiological signals related to respiratory diseases, such as airflow, heart rate variability, and gait variability, the entropy of a patient with COPD is lower than that of a healthy person. However, in case of hormone secretion and respiratory sound, the entropy of a patient is higher than that of a healthy person. For mechanomyogram signal, the entropy increases with the increased severity of COPD. This result should give valuable guidance for the use of entropy for physiological signals measured by wearable medical device as well as for further research on entropy in COPD.
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Affiliation(s)
- Yu Jin
- Faculty of Health Sciences, University of Macau, Taipa, Macau
| | - Chang Chen
- Faculty of Health Sciences, University of Macau, Taipa, Macau
| | - Zhixin Cao
- Beijing Engineering Research Center of Diagnosis and Treatment of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Beijing
| | - Baoqing Sun
- State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou
| | - Iek Long Lo
- Department of Geriatrics, Centro Hospital Conde de Sao Januario, Macau
| | - Tzu-Ming Liu
- Faculty of Health Sciences, University of Macau, Taipa, Macau
| | - Jun Zheng
- Faculty of Health Sciences, University of Macau, Taipa, Macau
| | - Shixue Sun
- Faculty of Health Sciences, University of Macau, Taipa, Macau
| | - Yan Shi
- School of Automation Science and Electrical Engineering, Beihang University, Beijing, China
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Kabbach EZ, Mazzuco A, Borghi-Silva A, Cabiddu R, Agnoleto AG, Barbosa JF, de Carvalho Junior LCS, Mendes RG. Increased parasympathetic cardiac modulation in patients with acute exacerbation of COPD: how should we interpret it? Int J Chron Obstruct Pulmon Dis 2017; 12:2221-2230. [PMID: 28814850 PMCID: PMC5546179 DOI: 10.2147/copd.s134498] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Cardiac autonomic modulation (CAM) is impaired in patients with stable COPD. Exacerbation aggravates the patients’ health status and functional capacity. While the clinical and functional effects of exacerbation are known, no studies investigated CAM during exacerbation and whether there is a relationship between CAM and functional capacity and dyspnea. Methods Thirty-two patients with moderate to severe COPD were enrolled into two groups: stable COPD (GSta, n=16) and acute exacerbation of COPD (GAE, n=16). The GAE patients were evaluated 24–48 hours after starting standard therapy for COPD exacerbation during hospitalization; the GSta patients were evaluated in an outpatient clinic and included in the study if no decompensation episodes had occurred during the previous month. The heart rate (HR) and R-wave peak detection intervals in ms (RRi) were registered using a heart rate monitor (Polar® system) at rest in seated position during 10 minutes. CAM was assessed by heart rate variability (HRV) linear and non-linear analysis. Functional capacity was evaluated by handgrip strength test, performed by Jamar® dynamometer, and dyspnea was scored using the modified scale of the Medical Research Council. Results GAE presented higher parasympathetic CAM values compared with GSta for square root of the mean squared differences of successive RRi (RMSSD; 17.8±5.6 ms vs 11.7±9.5 ms); high frequency (HF; 111.3±74.9 ms2 vs 45.6±80.7 ms2) and standard deviation measuring the dispersion of points in the plot perpendicular to the line of identity (SD1; 12.7±3.9 ms vs 8.3±6.7 ms) and higher CAM values for standard deviation of the mean of all of RRi (STD RRi; 19.3±6.5 ms vs 14.3±12.5 ms); RRi tri (5.2±1.7 ms vs 4.0±3.0 ms); triangular interpolation of NN interval histogram (TINN; 88.7±26.9 ms vs 70.6±62.2 ms); low frequency (LF; 203±210.7 ms2 vs 101.8±169.7 ms2) and standard deviation measuring the dispersion of points along the line of identity (SD2; 30.4±14.8 ms vs 16.2±12.54 ms). Lower values were observed for the complexity indices: approximate entropy (ApEn; 0.9±0.07 vs 1.06±0.06) and sample entropy (SampEn; 1.4±0.3 vs 1.7±0.3). Significant and moderate associations were observed between HF (nu) and handgrip strength (r=−0.58; P=0.01) and between LF (ms2) and subjective perception of dyspnea (r=−0.53; P=0.03). Conclusion COPD exacerbated patients have higher parasympathetic CAM than stable patients. This should be interpreted with caution since vagal influence on the airways determines a narrowing and not a better clinical condition. Additionally, functional capacity was negatively associated with parasympathetic CAM in COPD exacerbation.
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Affiliation(s)
- Erika Zavaglia Kabbach
- Department of Physical Therapy, Cardiopulmonary Physiotherapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Sao Paulo, Brazil
| | - Adriana Mazzuco
- Department of Physical Therapy, Cardiopulmonary Physiotherapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Sao Paulo, Brazil
| | - Audrey Borghi-Silva
- Department of Physical Therapy, Cardiopulmonary Physiotherapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Sao Paulo, Brazil
| | - Ramona Cabiddu
- Department of Physical Therapy, Cardiopulmonary Physiotherapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Sao Paulo, Brazil
| | - Aline Galvão Agnoleto
- Department of Physical Therapy, Cardiopulmonary Physiotherapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Sao Paulo, Brazil
| | - Jessica Fernanda Barbosa
- Department of Physical Therapy, Cardiopulmonary Physiotherapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Sao Paulo, Brazil
| | | | - Renata Gonçalves Mendes
- Department of Physical Therapy, Cardiopulmonary Physiotherapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Sao Paulo, Brazil
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Niérat MC, Laviolette L, Hudson A, Similowski T, Sévoz-Couche C. Experimental dyspnea as a stressor: differential cardiovegetative responses to inspiratory threshold loading in healthy men and women. J Appl Physiol (1985) 2017; 123:205-212. [DOI: 10.1152/japplphysiol.00078.2017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 04/18/2017] [Accepted: 04/27/2017] [Indexed: 01/21/2023] Open
Abstract
Dyspnea is associated with an emotional reaction that involves limbic activation. The inspiratory threshold load (ITL) is known to elicit a dyspneic response in healthy subjects. Laboratory-induced stress conditions have been shown to elicit sex-related differences in cardiovascular responses. The aim of this study was to evaluate how healthy men ( n = 8) and women ( n = 9) react and adapt to 5-min periods of ITL at three levels (low, medium, and high) in terms of heart rate (HR), temporal (RMSSD) and spectral (LF, HF, LF/HF ratio) HRV indexes, and rating of breathing discomfort. HR increased with low, medium, and high ITL in men, whereas it increased only with high ITL in women. LF/HF ratio increased at low ITL in both men and women. Modifications appear to depend essentially on increased LF in men and on reduced HF in women. In addition, HRV modifications differ between men and women, following the order of presentation of ITLs. Our results show a continuous and sustained stress in men (increased HR, LF, and LF/HF ratio across ITL presentation) and a stress adaptation in women. Subjective responses of breathing discomfort were not correlated with sympatho-vagal balance modifications for a subgroup of subjects ( n = 10). Breathing against the ITL induced autonomic modifications that are different between men and women, i.e., driven by sympathetic mediated responses in men, whereas women showed a greater parasympathetic modulation of cardiovascular activity. These results highlight the role of the mechanical inspiratory load in the heart rate variability seen in chronic obstructive pulmonary disease. NEW & NOTEWORTHY Breathing against the ITL induced autonomic modifications driven by sympathetic mediated responses in men, whereas women showed a greater parasympathetic modulation of cardiovascular activity, even for low load. A stress circuit could be at the origin of autonomic modifications induced by ITL. Our results would underline the role of the mechanic inspiratory load in the abnormalities in heart rate variability seen in COPD patients.
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Affiliation(s)
- Marie-Cécile Niérat
- Sorbonne Universités, UPMC Universite Paris 06, INSERM, UMRS1158 “Neurophysiologie respiratoire expérimentale et clinique”, Paris, France
| | - Louis Laviolette
- Sorbonne Universités, UPMC Universite Paris 06, INSERM, UMRS1158 “Neurophysiologie respiratoire expérimentale et clinique”, Paris, France
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, Canada; and
| | - Anna Hudson
- Sorbonne Universités, UPMC Universite Paris 06, INSERM, UMRS1158 “Neurophysiologie respiratoire expérimentale et clinique”, Paris, France
- Neuroscience Research Australia and University of New South Wales, Sydney, New South Wales, Australia
| | - Thomas Similowski
- Sorbonne Universités, UPMC Universite Paris 06, INSERM, UMRS1158 “Neurophysiologie respiratoire expérimentale et clinique”, Paris, France
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (“Département R3S”), Paris, France
| | - Caroline Sévoz-Couche
- Sorbonne Universités, UPMC Universite Paris 06, INSERM, UMRS1158 “Neurophysiologie respiratoire expérimentale et clinique”, Paris, France
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Goulart CDL, Cabiddu R, Schneiders PDB, Antunes San Martin E, Trimer R, Borghi-Silva A, da Silva ALG. Is cardiac autonomic modulation during upper limb isometric contraction and Valsalva maneuver impaired in COPD patients? Int J Chron Obstruct Pulmon Dis 2017; 12:849-857. [PMID: 28331306 PMCID: PMC5357074 DOI: 10.2147/copd.s130428] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate the heart rate variability (HRV) indices and heart rate (HR) responses during isometric contraction (IC) and Valsalva maneuver (VM) in COPD patients. METHODS Twenty-two stable moderate to severe COPD patients were evaluated. R-R intervals were recorded (monitor Polar® S810i) during dominant upper limb IC (2 minutes). Stable signals were analyzed by Kubios HRV® software. Indices of HRV were computed in the time domain (mean HR; square root of the mean squared differences of successive RR intervals [RMSSD] and HRV triangular index [RR tri index]) and in the frequency domain (high frequency [HF]; low frequency [LF] and LF/HF ratio). The HR responses were evaluated at rest, at the peak and at the nadir of the VM (15 seconds). The Valsalva index was also calculated. RESULTS During IC: time domain indices (mean HR increased [P=0.001], RMSSD, and RR tri index decreased [P=0.005 and P=0.005, respectively]); frequency domain indices (LF increased [P=0.033] and HF decreased [P=0.002]); associations were found between forced expiratory volume in 1 second (FEV1) vs RMSSD (P=0.04; r=-0.55), FEV1 vs HR (P=0.04; r=-0.48), forced vital capacity (FVC) vs RMSSD (P=0.05; r=-0.62), maximum inspiratory pressure (MIP) vs HF (P=0.02; r=0.68). FEV1 and FVC justified 30% of mean HR. During VM: HR increased (P=0.01); the nadir showed normal bradycardic response; the Valsalva index was =0.7. CONCLUSION COPD patients responded properly to the upper limb IC and to the VM; however, HR recovery during VM was impaired in these patients. The severity of the disease and MIP were associated with increased parasympathetic modulation and higher chronotropic response.
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Affiliation(s)
| | - Ramona Cabiddu
- Cardiopulmonary Physiotherapy Laboratory, Nucleus of Research in Physical Exercise, Federal University of São Carlos, São Carlos, Brazil
| | | | | | - Renata Trimer
- Department of Physiotherapy, Federal University of Amazonas, Manaus, AM, Brazil
| | - Audrey Borghi-Silva
- Cardiopulmonary Physiotherapy Laboratory, Nucleus of Research in Physical Exercise, Federal University of São Carlos, São Carlos, Brazil
| | - Andréa Lúcia Gonçalves da Silva
- Course of Physiotherapy, Department of Health and Physical Education, University of Santa Cruz do Sul, Rio Grande do Sul, Brazil; Pulmonary Rehabilitation Program, Santa Cruz Hospital, Santa Cruz do Sul, Rio Grande do Sul, Brazil
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Crisafulli E, Scelfo C, Tzani P, Aiello M, Bertorelli G, Chetta A. Asymptomatic peripheral artery disease can limit maximal exercise capacity in chronic obstructive pulmonary disease patients regardless of airflow obstruction and lung hyperinflation. Eur J Prev Cardiol 2017; 24:990-999. [PMID: 28436723 DOI: 10.1177/2047487317695629] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Silent/asymptomatic peripheral artery disease may occur in patients with chronic obstructive pulmonary disease, but it is poorly investigated. The primary aim of this study was to evaluate in chronic obstructive pulmonary disease patients the impact of asymptomatic/silent peripheral artery disease on maximal exercise capacity; the secondary aim was to search for predictors of peripheral artery disease. Methods We prospectively enrolled chronic obstructive pulmonary disease outpatients. Data on anthropometric characteristics, lung function, cardiopulmonary exercise test and ankle-brachial index were recorded. The cut-off of ankle-brachial index used to define patients with peripheral artery disease was ≤0.90. Results We studied 47 patients and found 24 patients (51%) who showed peripheral artery disease. As compared to patients without peripheral artery disease, patients with peripheral artery disease had lower values of peak oxygen uptake, peak workload, energy expenditure (metabolic equivalents) and heart rate recovery, but showed the same degree of airflow obstruction and static and dynamic hyperinflation. In a multivariate linear regression model performed to identify variables predicting metabolic equivalents, ankle-brachial index (β 2.59; 95% confidence interval 0.51-4.67; p = 0.016) was an independent variable. In the search for predictors of peripheral artery disease, heart rate recovery (odds ratio 8.80; 95% confidence interval 1.30-59.35; p = 0.026) increased the risk of peripheral artery disease, whereas metabolic equivalents (odds ratio 0.50; 95% confidence interval 0.26-0.94, p = 0.033) and inhaled corticosteroids+long-acting β2 agonists (odds ratio 0.13; 95% confidence interval 0.02-0.83; p = 0.030) reduced this risk. Conclusions In chronic obstructive pulmonary disease outpatients, asymptomatic/silent peripheral artery disease affects the maximal exercise capacity regardless of airflow obstruction and lung hyperinflation. A delay of heart rate recovery increase the risk of peripheral artery disease, whereas high values of metabolic equivalents and the use of inhaled corticosteroids+long-acting β2 agonists reduces this risk.
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Affiliation(s)
| | - Chiara Scelfo
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Panagiota Tzani
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Marina Aiello
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Alfredo Chetta
- Department of Medicine and Surgery, University of Parma, Parma, Italy
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van den Berg ME, Stricker BH, Brusselle GG, Lahousse L. Chronic obstructive pulmonary disease and sudden cardiac death: A systematic review. Trends Cardiovasc Med 2016; 26:606-13. [DOI: 10.1016/j.tcm.2016.04.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 03/22/2016] [Accepted: 04/04/2016] [Indexed: 12/26/2022]
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Lu WA, Kuo J, Wang YM, Lien TC, Liu YB, Tsai JZ, Kuo CD. Reduced enhancement of high-frequency component in the cross spectrum of ECG and nostril airflow signals in patients with chronic obstructive pulmonary disease. Physiol Rep 2016; 4:4/7/e12763. [PMID: 27053296 PMCID: PMC4831331 DOI: 10.14814/phy2.12763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 03/19/2016] [Indexed: 11/24/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a chronic airway disease with increased airway resistance. This study investigated the common characteristics of electrocardiographic (ECG) and nostril airflow signals in COPD patients using cross-spectral analysis. Heart rate variability (HRV) measures and cross-spectral (cs) measures of ECG and nostril airflow were compared in COPD patients and normal subjects, and correlated with their clinical characteristics. We found that cross-spectral analysis can lead to a significant increase in normalized high-frequency power (nHFPcs) and a significant decrease in normalized very low-frequency power (nVLFPcs), normalized low-frequency power (nLFPcs), and low-/high-frequency power ratio (LHRcs) in both normal subjects and COPD patients, as compared with their corresponding HRV measures. Further analysis showed that the percentage increase in nHFP (%nHFP) and the percentage decrease in LHR (%LHR) due to cross-spectral analysis in COPD patients were significantly smaller than those of normal subjects. All cross-spectral measures of ECG and nostril airflow in COPD patients did not significantly correlate with their pulmonary function characteristics. However, the nHFPcs correlated significantly and negatively with body mass index (BMI) in both normal subjects and COPD patients, and the %nHFP correlated significantly and negatively with BMI in COPD patients. We conclude that cross-spectral analysis of ECG and nostril airflow signals could lead to reduced enhancement in the high-frequency component in the cross spectrum of COPD patients. The magnitude of reduced enhancement in the high-frequency component in the cross-spectrum was related to the BMI of the patients. Cross-spectral analysis of ECG and nostril airflow might be used to assess the cardiovascular-related functions of COPD patients.
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Affiliation(s)
- Wan-An Lu
- Laboratory of Biophysics, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan Institute of Cultural Asset and Reinvention, Fo-Guang University, Yilan, Taiwan
| | - Jane Kuo
- Laboratory of Biophysics, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yan-Min Wang
- Laboratory of Biophysics, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Te-Cheng Lien
- Division of Respiratory Therapy, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yen-Bin Liu
- Medical Department, National Taiwan University Hospital, Taipei, Taiwan
| | - Jang-Zern Tsai
- Department of Electrical Engineering, National Central University, Jung-Li City, Taiwan
| | - Cheng-Deng Kuo
- Laboratory of Biophysics, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan Division of Respiratory Therapy, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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Long-term noninvasive ventilation in patients with chronic hypercapnic respiratory failure. Curr Opin Pulm Med 2016; 22:130-7. [DOI: 10.1097/mcp.0000000000000239] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Mazzuco A, Medeiros WM, Sperling MPR, de Souza AS, Alencar MCN, Arbex FF, Neder JA, Arena R, Borghi-Silva A. Relationship between linear and nonlinear dynamics of heart rate and impairment of lung function in COPD patients. Int J Chron Obstruct Pulmon Dis 2015; 10:1651-61. [PMID: 26316739 PMCID: PMC4544724 DOI: 10.2147/copd.s81736] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND In chronic obstructive pulmonary disease (COPD), functional and structural impairment of lung function can negatively impact heart rate variability (HRV); however, it is unknown if static lung volumes and lung diffusion capacity negatively impacts HRV responses. We investigated whether impairment of static lung volumes and lung diffusion capacity could be related to HRV indices in patients with moderate to severe COPD. METHODS Sixteen sedentary males with COPD were enrolled in this study. Resting blood gases, static lung volumes, and lung diffusion capacity for carbon monoxide (DLCO) were measured. The RR interval (RRi) was registered in the supine, standing, and seated positions (10 minutes each) and during 4 minutes of a respiratory sinus arrhythmia maneuver (M-RSA). Delta changes (Δsupine-standing and Δsupine-M-RSA) of the standard deviation of normal RRi, low frequency (LF, normalized units [nu]) and high frequency (HF [nu]), SD1, SD2, alpha1, alpha2, and approximate entropy (ApEn) indices were calculated. RESULTS HF, LF, SD1, SD2, and alpha1 deltas significantly correlated with forced expiratory volume in 1 second, DLCO, airway resistance, residual volume, inspiratory capacity/total lung capacity ratio, and residual volume/total lung capacity ratio. Significant and moderate associations were also observed between LF/HF ratio versus total gas volume (%), r=0.53; LF/HF ratio versus residual volume, %, r=0.52; and HF versus total gas volume (%), r=-0.53 (P<0.05). Linear regression analysis revealed that ΔRRi supine-M-RSA was independently related to DLCO (r=-0.77, r (2)=0.43, P<0.05). CONCLUSION Responses of HRV indices were more prominent during M-RSA in moderate to severe COPD. Moreover, greater lung function impairment was related to poorer heart rate dynamics. Finally, impaired lung diffusion capacity was related to an altered parasympathetic response in these patients.
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Affiliation(s)
- Adriana Mazzuco
- Cardiopulmonary Physiotherapy Laboratory, Federal University of São Carlos, São Carlos, Brazil
| | - Wladimir Musetti Medeiros
- Pulmonary Function and Clinical Exercise Physiology Unit, Respiratory Division, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | | | - Aline Soares de Souza
- Pulmonary Function and Clinical Exercise Physiology Unit, Respiratory Division, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Maria Clara Noman Alencar
- Pulmonary Function and Clinical Exercise Physiology Unit, Respiratory Division, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Flávio Ferlin Arbex
- Pulmonary Function and Clinical Exercise Physiology Unit, Respiratory Division, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - José Alberto Neder
- Pulmonary Function and Clinical Exercise Physiology Unit, Respiratory Division, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
- Laboratory of Clinical Exercise Physiology, Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen’s University, Kingston, ON, Canada
| | - Ross Arena
- Department of Physical Therapy and Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, USA
| | - Audrey Borghi-Silva
- Cardiopulmonary Physiotherapy Laboratory, Federal University of São Carlos, São Carlos, Brazil
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Autonomic nervous system activity as risk predictor in the medical emergency department: a prospective cohort study. Crit Care Med 2015; 43:1079-86. [PMID: 25738854 DOI: 10.1097/ccm.0000000000000922] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To evaluate heart rate deceleration capacity, an electrocardiogram-based marker of autonomic nervous system activity, as risk predictor in a medical emergency department and to test its incremental predictive value to the modified early warning score. DESIGN Prospective cohort study. SETTING Medical emergency department of a large university hospital. PATIENTS Five thousand seven hundred thirty consecutive patients of either sex in sinus rhythm, who were admitted to the medical emergency department of the University of Tübingen, Germany, between November 2010 and March 2012. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Deceleration capacity of heart rate was calculated within the first minutes after emergency department admission. The modified early warning score was assessed from respiratory rate, heart rate, systolic blood pressure, body temperature, and level of consciousness as previously described. Primary endpoint was intrahospital mortality; secondary endpoints included transfer to the ICU as well as 30-day and 180-day mortality. One hundred forty-two patients (2.5%) reached the primary endpoint. Deceleration capacity was highly significantly lower in nonsurvivors than survivors (2.9 ± 2.1 ms vs 5.6 ± 2.9 ms; p < 0.001) and yielded an area under the receiver-operator characteristic curve of 0.780 (95% CI, 0.745-0.813). The modified early warning score model yielded an area under the receiver-operator characteristic curve of 0.706 (0.667-0.750). Implementing deceleration capacity into the modified early warning score model led to a highly significant increase of the area under the receiver-operator characteristic curve to 0.804 (0.770-0.835; p < 0.001 for difference). Deceleration capacity was also a highly significant predictor of 30-day and 180-day mortality as well as transfer to the ICU. CONCLUSIONS Deceleration capacity is a strong and independent predictor of short-term mortality among patients admitted to a medical emergency department.
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Rasheedy D, Taha HM. Cardiac autonomic neuropathy: The hidden cardiovascular comorbidity in elderly patients with chronic obstructive pulmonary disease attending primary care settings. Geriatr Gerontol Int 2015; 16:329-35. [DOI: 10.1111/ggi.12473] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Doha Rasheedy
- Geriatric Medicine and Gerontology; Faculty of Medicine; Ain Shams University; Cairo Egypt
| | - Hend M Taha
- Geriatric Medicine and Gerontology; Faculty of Medicine; Ain Shams University; Cairo Egypt
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Nicolino J, Ramos D, Leite MR, Rodrigues FMM, de Alencar Silva BS, Tacao GY, de Toledo AC, Vanderlei LCM, Ramos EMC. Analysis of autonomic modulation after an acute session of resistance exercise at different intensities in chronic obstructive pulmonary disease patients. Int J Chron Obstruct Pulmon Dis 2015; 10:223-9. [PMID: 25673982 PMCID: PMC4321648 DOI: 10.2147/copd.s64345] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Physical exercises are employed as part of the treatment of patients with chronic obstructive pulmonary disease (COPD); however information regarding cardiac autonomic modulation after an acute session of resistance exercise (RE) is unknown. The aim of this study was to evaluate the cardiac autonomic modulation, via heart rate variability after an acute session of RE applied at different intensities in COPD patients. Patients and methods Twelve COPD patients underwent an acute session of RE with an intensity of 60% and another of 90% of the one repetition maximum test. For analysis of autonomic modulation, heart rate was recorded beat-by-beat for 20 minutes at rest and after the training session. Heart rate variability indexes were obtained in the time and frequency domains for the assessment of autonomic modulation. Results Regardless of exercise intensity, RE acute sessions influenced the autonomic modulation when the recovery period was compared with the baseline. An increase in standard deviation of normal to normal RR intervals was observed throughout recovery time after the RE, as compared to baseline in both protocols: 60% and 90% of the one repetition maximum test. The spectral component of low frequency index (ms) was higher throughout recovery when compared to baseline in both protocols. The same was also observed in the spectral component of high frequency index (ms) for the protocols of 60% and 90%. Conclusion RE sessions impact on the autonomic modulation of COPD patients by promoting differences in the recovery period compared to baseline, regardless of the intensity of the exercise performed.
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Affiliation(s)
- Juliana Nicolino
- Department of Physiotherapy, Paulista State University (UNESP), Presidente Prudente, São Paulo, Brazil
| | - Dionei Ramos
- Department of Physiotherapy, Paulista State University (UNESP), Presidente Prudente, São Paulo, Brazil
| | - Marceli Rocha Leite
- Department of Physiotherapy, Paulista State University (UNESP), Presidente Prudente, São Paulo, Brazil
| | | | | | - Guilherme Yassuyuki Tacao
- Department of Physiotherapy, Paulista State University (UNESP), Presidente Prudente, São Paulo, Brazil
| | | | | | - Ercy Mara Cipulo Ramos
- Department of Physiotherapy, Paulista State University (UNESP), Presidente Prudente, São Paulo, Brazil
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Chhabra SK, Gupta M, Ramaswamy S, Dash DJ, Bansal V, Deepak KK. Cardiac Sympathetic Dominance and Systemic Inflammation in COPD. COPD 2014; 12:552-9. [DOI: 10.3109/15412555.2014.974743] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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