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Valentin R, Niérat M, Wattiez N, Jacq O, Decavèle M, Arnulf I, Similowski T, Attali V. Neurophysiological basis of respiratory discomfort improvement by mandibular advancement in awake OSA patients. Physiol Rep 2024; 12:e15951. [PMID: 38373738 PMCID: PMC10984610 DOI: 10.14814/phy2.15951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/23/2024] [Accepted: 01/31/2024] [Indexed: 02/21/2024] Open
Abstract
Patients with obstructive sleep apneas (OSA) do not complain from dyspnea during resting breathing. Placement of a mandibular advancement device (MAD) can lead to a sense of improved respiratory comfort ("pseudo-relief") ascribed to a habituation phenomenon. To substantiate this conjecture, we hypothesized that, in non-dyspneic awake OSA patients, respiratory-related electroencephalographic figures, abnormally present during awake resting breathing, would disappear or change in parallel with MAD-associated pseudo-relief. In 20 patients, we compared natural breathing and breathing with MAD on: breathing discomfort (transitional visual analog scale, VAS-2); upper airway mechanics, assessed in terms of pressure peak/time to peak (TTP) ratio respiratory-related electroencephalography (EEG) signatures, including slow event-related preinspiratory potentials; and a between-state discrimination based on continuous connectivity evaluation. MAD improved breathing and upper airway mechanics. The 8 patients in whom the EEG between-state discrimination was considered effective exhibited higher Peak/TTP improvement and transitional VAS ratings while wearing MAD than the 12 patients where it was not. These results support the notion of habituation to abnormal respiratory-related afferents in OSA patients and fuel the causative nature of the relationship between dyspnea, respiratory-related motor cortical activity and impaired upper airway mechanics in this setting.
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Affiliation(s)
- Rémi Valentin
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et CliniqueSorbonne UniversitéParisFrance
- Hôpital Pitié‐Salpêtrière, Département R3S, Service des Pathologies du Sommeil (Département R3S)AP‐HP, Groupe Hospitalier Universitaire APHP‐Sorbonne UniversitéParisFrance
- Institut de Biomécanique Humaine Georges CharpakÉcole Nationale Supérieure des Arts et MétiersParisFrance
| | - Marie‐Cécile Niérat
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et CliniqueSorbonne UniversitéParisFrance
| | - Nicolas Wattiez
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et CliniqueSorbonne UniversitéParisFrance
| | - Olivier Jacq
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et CliniqueSorbonne UniversitéParisFrance
| | - Maxens Decavèle
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et CliniqueSorbonne UniversitéParisFrance
- Service de Médecine Intensive et Réanimation (Département R3S)Groupe Hospitalier Universitaire APHP‐Sorbonne UniversitéParisFrance
| | - Isabelle Arnulf
- Hôpital Pitié‐Salpêtrière, Département R3S, Service des Pathologies du Sommeil (Département R3S)AP‐HP, Groupe Hospitalier Universitaire APHP‐Sorbonne UniversitéParisFrance
- Paris Brain Institute (ICM)Sorbonne UniversitéParisFrance
| | - Thomas Similowski
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et CliniqueSorbonne UniversitéParisFrance
- Hôpital, Pitié‐Salpêtrière, Département R3SAP‐HP, Groupe Hospitalier APHP‐Sorbonne UniversitéParisFrance
| | - Valérie Attali
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et CliniqueSorbonne UniversitéParisFrance
- Hôpital Pitié‐Salpêtrière, Département R3S, Service des Pathologies du Sommeil (Département R3S)AP‐HP, Groupe Hospitalier Universitaire APHP‐Sorbonne UniversitéParisFrance
- Institut de Biomécanique Humaine Georges CharpakÉcole Nationale Supérieure des Arts et MétiersParisFrance
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Lespert Y, Rivals I, Ing RK, Clavel L, Similowski T, Sandoz B, Attali V. Coupling Between Posture and Respiration Among the Postural Chain: Toward a Screening Tool for Respiratory-Related Balance Disorders. IEEE Trans Neural Syst Rehabil Eng 2023; 31:4338-4346. [PMID: 37906488 DOI: 10.1109/tnsre.2023.3328860] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Alteration of posturo-respiratory coupling (PRC) may precede postural imbalance in patients with chronic respiratory disease. PRC assessment would be appropriate for early detection of respiratory-related postural dysfunction. PRC may be evaluated by respiratory emergence (REm), the proportion of postural oscillations attributed to breathing activity; assessed by motion analysis) as measured from the displacement of the center of pressure (CoP) (measured with a force platform). To propose a simplified method of PRC assessment (using motion capture only), we hypothesized that the REm can appropriately be measured derived from single body segment the postural oscillations of a single body segment rather than whole body postural oscillations. An optoelectronic system recorded the breathing pattern and the postural oscillations of six body segments in 50 healthy participants (22 women), 34 years [26; 48]. The CoP displacements were assessed using a force platform. One-minute recordings were made in standing position in four conditions by varying vision (eyes opened/closed) and jaw position (rest position/dental contact). The Sway Path and Mean Velocity of the CoP and of the representative point of each body segment were recorded. The REm was measured along the major and the minor axis of the 95% confidence ellipse of the CoP position (REm_MajorAxisCoP; REm_MinorAxisCoP) and of that of each body segment. SwayPathCoP and MVCoP varied widely across the four conditions (par< 0.000001). These changes were related to the visual condition ( [Formula: see text]) while the jaw position had no effect. The REm_MajorAxisCoP and the REm_MinorAxisCoP changed across conditions ( [Formula: see text]); this was related to vision while jaw induced changes only for the REm_MinorAxisCoP. The SwayPath, the Mean Velocity and the REm of all body segments were significantly correlated to the CoP, but the highest correlations were observed for the thorax, the pelvis and the shoulder. PRC may be assessed from the postural oscillations of thorax, pelvis and shoulder. This should simplify the evaluation of respiratory-related postural interactions in the clinical environment, by using a single device to simultaneously assess postural oscillations on body segments, and breathing pattern. In addition, this study provides reference data for PRC and its sensory-related modulations on body segments along the postural chain.
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Patout M, Razakamanantsoa L, D'Cruz R, Arbane G, Similowski T, Hart N, Murphy PB. Cognitive Function in Patients with Chronic Respiratory Failure: Effect of Treatment with Home Noninvasive Ventilation. Am J Respir Crit Care Med 2023; 208:900-903. [PMID: 37499242 DOI: 10.1164/rccm.202212-2323le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 07/27/2023] [Indexed: 07/29/2023] Open
Affiliation(s)
- Maxime Patout
- Lane Fox Clinical Respiratory Physiology Research Centre, Centre for Human and Applied Physiological Science, School of Basic and Biomedical Science, King's College, London, United Kingdom
- Service des Pathologies du Sommeil (Département R3S)
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche en Santé 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; and
| | - Léa Razakamanantsoa
- Service de Pneumologie (Département R3S), and
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche en Santé 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; and
| | - Rebecca D'Cruz
- Lane Fox Clinical Respiratory Physiology Research Centre, Centre for Human and Applied Physiological Science, School of Basic and Biomedical Science, King's College, London, United Kingdom
- Lane Fox Respiratory Service, Guy's & St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Gill Arbane
- Lane Fox Clinical Respiratory Physiology Research Centre, Centre for Human and Applied Physiological Science, School of Basic and Biomedical Science, King's College, London, United Kingdom
| | - Thomas Similowski
- Département R3S, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Universitaire Assistance Publique-Hôpitaux de Paris Sorbonne Université, site Pitié-Salpêtrière, Paris, France
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche en Santé 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; and
| | - Nicholas Hart
- Lane Fox Clinical Respiratory Physiology Research Centre, Centre for Human and Applied Physiological Science, School of Basic and Biomedical Science, King's College, London, United Kingdom
- Lane Fox Respiratory Service, Guy's & St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Patrick B Murphy
- Lane Fox Clinical Respiratory Physiology Research Centre, Centre for Human and Applied Physiological Science, School of Basic and Biomedical Science, King's College, London, United Kingdom
- Lane Fox Respiratory Service, Guy's & St Thomas' National Health Service Foundation Trust, London, United Kingdom
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Attali V, Weber M, Rivals I, Similowski T, Arnulf I, Gatignol P. Moderate-to-severe obstructive sleep apnea syndrome is associated with altered tongue motion during wakefulness. Eur Arch Otorhinolaryngol 2023; 280:2551-2560. [PMID: 36707431 DOI: 10.1007/s00405-023-07854-9] [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: 12/11/2022] [Accepted: 01/18/2023] [Indexed: 01/29/2023]
Abstract
PURPOSE Impairment of genioglossus control is a frequent "non-anatomical" cause of obstructive sleep apnea syndrome (OSAS) in non- or mildly obese patients. Although wake-related compensatory mechanisms prevent the occurrence of obstructive events, the genioglossus control is often impaired during wakefulness. We hypothesized that the lingual motion would be altered during wakefulness in this population in patients with moderate-to-severe OSAS. METHODS We included non- or mildly obese participants with suspected OSAS. They underwent a Bucco-Linguo-Facial Motor Skills assessment using the MBLF ("Motricité Bucco-Linguo-Faciale"), which includes an evaluation of 13 movements of the tongue. This was followed by a night-attended polysomnography. We compared patients with moderate-to-severe OSAS (apnea-hypopnea index (AHI) ≥ 15/h; n = 15) to patients without or with mild OSAS (AHI < 15/h; n = 24). RESULTS MBLF total and "tongue" sub-scores were lower in patients with moderate-to-severe OSAS: total z-score - 0.78 [- 1.31; 0.103] versus 0.20 [- 0.26; 0.31], p = 0.0011; "tongue" z-sub-score (- 0.63 [- 1.83; 0.41] versus 0.35 [0.26; 0.48], p = 0.014). There was a significant age-adjusted correlation between the "tongue" sub-score and AHI. The logistic regression model for the prediction of moderate-to-severe OSAS gave area under the curve ratio of 88.2% for MBLF score plus age. CONCLUSIONS Myofunctional activity of the tongue is impaired during wakefulness in non- or mildly obese patients with moderate-to-severe OSAS. This study supports the lingual myofunctional assessment using the MBLF in screening of moderate-to-severe OSAS. This simple tool could help clinicians to select patients with suspected moderate-to-severe OSAS for polysomnography.
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Affiliation(s)
- Valérie Attali
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, 75005, Paris, France. .,Département R3S, Service des Pathologies du Sommeil, AP-HP, Sorbonne Université, Hôpital Pitié-Salpêtrière, 75013, Paris, France.
| | - Mathilde Weber
- Département d'Orthophonie, Faculté de Médecine UFR 967, Sorbonne Université, 75013, Paris, France
| | - Isabelle Rivals
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, 75005, Paris, France.,Equipe de Statistique Appliquée, ESPCI Paris, PSL Research University, Paris, France
| | - Thomas Similowski
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, 75005, Paris, France.,Département R3S, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, 75013, Paris, France
| | - Isabelle Arnulf
- Département R3S, Service des Pathologies du Sommeil, AP-HP, Sorbonne Université, Hôpital Pitié-Salpêtrière, 75013, Paris, France.,Institut du Cerveau, Paris Brain Institute-ICM, INSERM, CNRS, Sorbonne Université, 75013, Paris, France
| | - Peggy Gatignol
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, 75005, Paris, France.,Département d'Orthophonie, Faculté de Médecine UFR 967, Sorbonne Université, 75013, Paris, France.,Service d'Oto-Rhino-Laryngologie, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, 75013, Paris, France
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5
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Hudson AL, Wattiez N, Navarro‐Sune X, Chavez M, Similowski T. Combined head accelerometry and EEG improves the detection of respiratory-related cortical activity during inspiratory loading in healthy participants. Physiol Rep 2022; 10:e15383. [PMID: 35818313 PMCID: PMC9273870 DOI: 10.14814/phy2.15383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 06/15/2022] [Accepted: 06/21/2022] [Indexed: 12/01/2022] Open
Abstract
Mechanical ventilation is a highly utilized life-saving tool, particularly in the current era. The use of EEG in a brain-ventilator interface (BVI) to detect respiratory discomfort (due to sub-optimal ventilator settings) would improve treatment in mechanically ventilated patients. This concept has been realized via development of an EEG covariance-based classifier that detects respiratory-related cortical activity associated with respiratory discomfort. The aim of this study was to determine if head movement, detected by an accelerometer, can detect and/or improve the detection of respiratory-related cortical activity compared to EEG alone. In 25 healthy participants, EEG and acceleration of the head were recorded during loaded and quiet breathing in the seated and lying postures. Detection of respiratory-related cortical activity using an EEG covariance-based classifier was improved by inclusion of data from an Accelerometer-based classifier, i.e. classifier 'Fusion'. In addition, 'smoothed' data over 50s, rather than one 5 s window of EEG/Accelerometer signals, improved detection. Waveform averages of EEG and head acceleration showed the incidence of pre-inspiratory potentials did not differ between loaded and quiet breathing, but head movement was greater in loaded breathing. This study confirms that compared to event-related analysis with >5 min of signal acquisition, an EEG-based classifier is a clinically valuable tool with rapid processing, detection times, and accuracy. Data smoothing would introduce a small delay (<1 min) but improves detection results. As head acceleration improved detection compared to EEG alone, the number of EEG signals required to detect respiratory discomfort with future BVIs could be reduced if head acceleration is included.
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Affiliation(s)
- Anna L. Hudson
- College of Medicine and Public HealthFlinders UniversityAdelaideAustralia
- Neuroscience Research Australia andUniversity of New South WalesSydneyAustralia
- Sorbonne UniversitéINSERM UMRS1158 Neurophysiologie Respiratoire Expérimentale et CliniqueParisFrance
| | - Nicolas Wattiez
- Sorbonne UniversitéINSERM UMRS1158 Neurophysiologie Respiratoire Expérimentale et CliniqueParisFrance
| | - Xavier Navarro‐Sune
- Sorbonne UniversitéINSERM UMR 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle ÉpinièreParisFrance
- myBrain TechnologiesParisFrance
| | - Mario Chavez
- Sorbonne UniversitéINSERM UMR 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle ÉpinièreParisFrance
| | - Thomas Similowski
- Sorbonne UniversitéINSERM UMRS1158 Neurophysiologie Respiratoire Expérimentale et CliniqueParisFrance
- AP‐HP, Groupe Hospitalier APHP‐Sorbonne Université, Hôpital Pitié‐SalpêtrièreDépartement R3SParisFrance
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Gouveris H, Koirala N, Anwar AR, Ding H, Ludwig K, Huppertz T, Matthias C, Groppa S, Muthuraman M. Reduced Cross-Frequency Coupling and Daytime Sleepiness in Obstructive Sleep Apnea Patients. BIOLOGY 2022; 11:biology11050700. [PMID: 35625429 PMCID: PMC9138271 DOI: 10.3390/biology11050700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/10/2022] [Accepted: 04/25/2022] [Indexed: 11/30/2022]
Abstract
Obstructive sleep apnea (OSA) is associated with sleep-stage- and respiratory-event-specific sensorimotor cortico-muscular disconnection. The modulation of phase−amplitude cross-frequency coupling (PACFC) may influence information processing throughout the brain. We investigated whether sleep-stage-specific PACFC is impaired at the sensorimotor areas in OSA patients. C3 and C4 electrode EEG polysomnography recordings of 170 participants were evaluated. Different frequency band combinations were used to compute CFC modulation index (MI) to assess if MI differs between OSA and non-significant OSA patients in distinct sleep stages. We tested if the CFC-MI could predict daytime sleepiness in OSA. Theta−gamma CFC-MI at cortical sensorimotor areas was significantly reduced during all sleep stages; the delta−alpha CFC-MI was significantly reduced during REM and N1 while increasing during N2 in patients with respiratory disturbance index (RDI) > 15/h compared to those with RDI ≤ 15/h. A sleep stage classification using MI values was achieved in both patient groups. Theta−gamma MI during N2 and N3 could predict RDI and Epworth Sleepiness Scale, while delta−alpha MI during REM predicted RDI. This increase in disconnection at the cortical sensorimotor areas with increasing respiratory distress during sleep supports a cortical motor dysfunction in OSA patients. The MI provides an objective marker to quantify subjective sleepiness and respiratory distress in OSA.
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Affiliation(s)
- Haralampos Gouveris
- Sleep Medicine Center, Department of Otolaryngology, University Medical Center, Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (K.L.); (T.H.); (C.M.)
- Correspondence: ; Tel.: +49-6131-177361
| | - Nabin Koirala
- Haskins Laboratories, Yale University, New Haven, CT 06511, USA;
| | - Abdul Rauf Anwar
- Department of Biomedical Engineering, University of Engineering and Technology (New Campus), Lahore 54890, Pakistan;
| | - Hao Ding
- Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, University Medical Center of Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (H.D.); (S.G.); (M.M.)
| | - Katharina Ludwig
- Sleep Medicine Center, Department of Otolaryngology, University Medical Center, Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (K.L.); (T.H.); (C.M.)
| | - Tilman Huppertz
- Sleep Medicine Center, Department of Otolaryngology, University Medical Center, Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (K.L.); (T.H.); (C.M.)
| | - Christoph Matthias
- Sleep Medicine Center, Department of Otolaryngology, University Medical Center, Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (K.L.); (T.H.); (C.M.)
| | - Sergiu Groppa
- Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, University Medical Center of Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (H.D.); (S.G.); (M.M.)
| | - Muthuraman Muthuraman
- Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, University Medical Center of Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (H.D.); (S.G.); (M.M.)
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Betka S, Adler D, Similowski T, Blanke O. Breathing control, brain, and bodily self-consciousness: Toward immersive digiceuticals to alleviate respiratory suffering. Biol Psychol 2022; 171:108329. [PMID: 35452780 DOI: 10.1016/j.biopsycho.2022.108329] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 04/11/2022] [Accepted: 04/11/2022] [Indexed: 01/19/2023]
Abstract
Breathing is peculiar among autonomic functions through several characteristics. It generates a very rich afferent traffic from an array of structures belonging to the respiratory system to various areas of the brain. It is intimately associated with bodily movements. It bears particular relationships with consciousness as its efferent motor control can be automatic or voluntary. In this review within the scope of "respiratory neurophysiology" or "respiratory neuroscience", we describe the physiological organisation of breathing control. We then review findings linking breathing and bodily self-consciousness through respiratory manipulations using virtual reality (VR). After discussing the currently admitted neurophysiological model for dyspnea, as well as a new Bayesian model applied to breathing control, we propose that visuo-respiratory paradigms -as developed in cognitive neuroscience- will foster insights into some of the basic mechanisms of the human respiratory system and will also lead to the development of immersive VR-based digital health tools (i.e. digiceuticals).
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Affiliation(s)
- Sophie Betka
- Laboratory of Cognitive Neuroscience, Brain Mind Institute and Center for Neuroprosthetics, Faculty of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, (EPFL), Geneva 1202, Switzerland.
| | - Dan Adler
- Division of Lung Diseases, University Hospital and Geneva Medical School, University of Geneva, Switzerland
| | - Thomas Similowski
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005 Paris, France; AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département R3S (Respiration, Réanimation, Réhabilitation respiratoire, Sommeil), F-75013 Paris, France
| | - Olaf Blanke
- Laboratory of Cognitive Neuroscience, Brain Mind Institute and Center for Neuroprosthetics, Faculty of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, (EPFL), Geneva 1202, Switzerland; Department of Clinical Neurosciences, University Hospital and Geneva Medical School, University of Geneva, Switzerland
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8
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Domnik NJ, Phillips DB, James MD, Ayoo GA, Taylor SM, Scheeren RE, Di Luch AT, Milne KM, Vincent SG, Elbehairy AF, Crinion SJ, Driver HS, Neder JA, O'Donnell DE. Compensatory responses to increased mechanical abnormalities in COPD during sleep. Eur J Appl Physiol 2022; 122:663-676. [PMID: 35034195 DOI: 10.1007/s00421-021-04869-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 12/06/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess whether night-time increases in mechanical loading negatively impact respiratory muscle function in COPD and whether compensatory increases in inspiratory neural drive (IND) are adequate to stabilize ventilatory output and arterial oxygen saturation, especially during sleep when wakefulness drive is withdrawn. METHODS 21 patients with moderate-to-severe COPD and 20 age-/sex-matched healthy controls (CTRL) participated in a prospective, cross-sectional, one-night study to assess the impact of COPD on serial awake, supine inspiratory capacity (IC) measurements and continuous dynamic respiratory muscle function (esophageal manometry) and IND (diaphragm electromyography, EMGdi) in supine sleep. RESULTS Supine inspiratory effort and EMGdi were consistently twice as high in COPD versus CTRL (p < 0.05). Despite overnight increases in awake total airways resistance and dynamic lung hyperinflation in COPD (p < 0.05; not in CTRL), elevated awake EMGdi and respiratory effort were unaltered in COPD overnight. At sleep onset (non-rapid eye movement sleep, N2), EMGdi was decreased versus wakefulness in COPD (- 43 ± 36%; p < 0.05) while unaffected in CTRL (p = 0.11); however, respiratory effort and arterial oxygen saturation (SpO2) were unchanged. Similarly, in rapid eye movement (stage R), sleep EMGdi was decreased (- 38 ± 32%, p < 0.05) versus wakefulness in COPD, with preserved respiratory effort and minor (2%) reduction in SpO2. CONCLUSIONS Despite progressive mechanical loading overnight and marked decreases in wakefulness drive, inspiratory effort and SpO2 were well maintained during sleep in COPD. Preserved high inspiratory effort during sleep, despite reduced EMGdi, suggests continued (or increased) efferent activation of extra-diaphragmatic muscles, even in stage R sleep. CLINICAL TRIAL INFORMATION The COPD data reported herein were secondary data (Placebo arm only) obtained through the following Clinical Trial: "Effect of Aclidinium/Formoterol on Nighttime Lung Function and Morning Symptoms in Chronic Obstructive Pulmonary Disease" ( https://clinicaltrials.gov/ct2/show/NCT02429765 ; NCT02429765).
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Affiliation(s)
- Nicolle J Domnik
- Department of Medicine, Queen's University, Kingston, Canada.,Department of Physiology and Pharmacology, Western University, London, Canada
| | | | - Matthew D James
- Department of Medicine, Queen's University, Kingston, Canada
| | - Grace A Ayoo
- Department of Medicine, Queen's University, Kingston, Canada
| | - Sarah M Taylor
- Department of Medicine, Queen's University, Kingston, Canada
| | | | | | - Kathryn M Milne
- Department of Medicine, Queen's University, Kingston, Canada
| | | | - Amany F Elbehairy
- Department of Medicine, Queen's University, Kingston, Canada.,Manchester University NHS Foundation Trust, Manchester, UK.,Department of Chest Diseases, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Sophie J Crinion
- Department of Medicine, Queen's University, Kingston, Canada.,Sleep Disorders Laboratory, Kingston Health Sciences Centre, Kingston, Canada.,Division of Respiratory Medicine, Queen's University, Kingston, Canada
| | - Helen S Driver
- Department of Medicine, Queen's University, Kingston, Canada.,Sleep Disorders Laboratory, Kingston Health Sciences Centre, Kingston, Canada.,Division of Respiratory Medicine, Queen's University, Kingston, Canada
| | - J Alberto Neder
- Department of Medicine, Queen's University, Kingston, Canada.,Division of Respiratory Medicine, Queen's University, Kingston, Canada
| | - Denis E O'Donnell
- Department of Medicine, Queen's University, Kingston, Canada. .,Division of Respiratory Medicine, Queen's University, Kingston, Canada. .,Respiratory Investigation Unit, Kingston Health Sciences Centre, 102 Stuart St, Kingston, ON, K7L 2V7, Canada.
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9
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Osteopathic Manipulation of the Sphenopalatine Ganglia Versus Sham Manipulation, in Obstructive Sleep Apnoea Syndrom: A Randomised Controlled Trial. J Clin Med 2021; 11:jcm11010099. [PMID: 35011840 PMCID: PMC8745154 DOI: 10.3390/jcm11010099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/06/2021] [Accepted: 12/21/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: osteopathic manipulation of the sphenopalatine ganglia (SPG) blocks the action of postganglionic sensory fibres. This neuromodulation can reduce nasal obstruction and enhance upper airway stability. We investigated the manipulation of the SPG in 31 patients with obstructive sleep apnoea syndrome (OSAS); (2) Methods: Randomised, controlled, double-blind, crossover study. Participants received active (AM), then sham manipulation (SM), or vice versa. The primary endpoint was apnoea-hypopnoea index (AHI). Secondary endpoints were variation of nasal obstruction evaluated by peak nasal inspiratory flow (PNIF) and upper airways stability evaluated by awake critical closing pressure [awake Pcrit]), at 30 min and 24 h. Schirmer’s test and pain were assessed immediately post-manipulation. Tactile/gustatory/olfactory/auditory/nociceptive/visual sensations were recorded. Adverse events were collected throughout. (3) Results: SPG manipulation did not reduce AHI (p = 0.670). PNIF increased post-AM but not post-SM at 30 min (AM-SM: 18 [10; 38] L/min, p = 0.0001) and 24 h (23 [10; 30] L/min, p = 0.001). There was no significant difference on awake Pcrit (AM-SM) at 30 min or 24 h). Sensations were more commonly reported post-AM (100% of patients) than post-SM (37%). Few adverse events and no serious adverse events were reported. (4) Conclusions: SPG manipulation is not supported as a treatment for OSAS but reduced nasal obstruction. This effect remains to be confirmed in a larger sample before using this approach to reduce nasal congestion in CPAP-treated patients or in mild OSAS.
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Laghi F, Shaikh H, Littleton SW, Morales D, Jubran A, Tobin MJ. Inhibition of central activation of the diaphragm: a mechanism of weaning failure. J Appl Physiol (1985) 2020; 129:366-376. [PMID: 32673161 PMCID: PMC7473953 DOI: 10.1152/japplphysiol.00856.2019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
During a T-tube trial following disconnection of mechanical ventilation, patients failing the trial do not develop contractile diaphragmatic fatigue despite increases in inspiratory pressure output. Studies in volunteers, patients, and animals raise the possibility of spinal and supraspinal reflex mechanisms that inhibit central-neural output under loaded conditions. We hypothesized that diaphragmatic recruitment is submaximal at the end of a failed weaning trial despite concurrent respiratory distress. Tidal transdiaphragmatic pressure (ΔPdi) and electrical activity (ΔEAdi) were recorded with esophago-gastric catheters during a T-tube trial in 20 critically ill patients. During the T-tube trial, ∆EAdi was greater in weaning failure patients than in weaning success patients (P = 0.049). Despite increases in ΔPdi, from 18.1 ± 2.5 to 25.9 ± 3.7 cm H2O (P < 0.001), rate of transdiaphragmatic pressure development (from 22.6 ± 3.1 to 37.8 ± 6.7 cm H2O/s; P < 0.0004), and concurrent respiratory distress, ∆EAdi at the end of a failed T-tube trial was half of maximum, signifying inhibition of central neural output to the diaphragm. The increase in ΔPdi in the weaning failure group, while ∆EAdi remained constant, indicates unexpected improvement in diaphragmatic neuromuscular coupling (from 46.7 ± 6.5 to 57.8 ± 8.4 cm H2O/%; P = 0.006). Redistribution of neural output to the respiratory muscles characterized by a progressive increase in rib cage and accessory muscle contribution to tidal breathing and expiratory muscle recruitment contributed to enhanced coupling. In conclusion, diaphragmatic recruitment is submaximal at the end of a failed weaning trial despite concurrent respiratory distress. This finding signifies that reflex inhibition of central neural output to the diaphragm contributes to weaning failure. NEW & NOTEWORTHY Research into pathophysiology of failure to wean from mechanical ventilation has excluded several factors, including contractile fatigue, but the precise mechanism remains unknown. We recorded transdiaphragmatic pressure and diaphragmatic electrical activity in patients undergoing a T-tube trial. Diaphragmatic recruitment was submaximal at the end of a failed trial despite concurrent respiratory distress, signifying that inhibition of central neural output to the diaphragm is an important mechanism of weaning failure.
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Affiliation(s)
- Franco Laghi
- Division of Pulmonary and Critical Care Medicine, Hines Veterans Affairs Hospital, Hines, Illinois.,Division of Pulmonary and Critical Care Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
| | - Hameeda Shaikh
- Division of Pulmonary and Critical Care Medicine, Hines Veterans Affairs Hospital, Hines, Illinois.,Division of Pulmonary and Critical Care Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
| | - Stephen W Littleton
- Division of Pulmonary and Critical Care Medicine, Hines Veterans Affairs Hospital, Hines, Illinois.,Division of Pulmonary and Critical Care Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
| | - Daniel Morales
- Division of Pulmonary and Critical Care Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
| | - Amal Jubran
- Division of Pulmonary and Critical Care Medicine, Hines Veterans Affairs Hospital, Hines, Illinois.,Division of Pulmonary and Critical Care Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
| | - Martin J Tobin
- Division of Pulmonary and Critical Care Medicine, Hines Veterans Affairs Hospital, Hines, Illinois.,Division of Pulmonary and Critical Care Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
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11
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Clavel L, Attali V, Rivals I, Niérat MC, Laveneziana P, Rouch P, Similowski T, Sandoz B. Decreased respiratory-related postural perturbations at the cervical level under cognitive load. Eur J Appl Physiol 2020; 120:1063-1074. [PMID: 32185476 DOI: 10.1007/s00421-020-04345-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 03/10/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE In healthy humans, postural and respiratory dynamics are intimately linked and a breathing-related postural perturbation is evident in joint kinematics. A cognitive dual-task paradigm that is known to induce both postural and ventilatory disturbances can be used to modulate this multijoint posturo-ventilatory (PV) interaction, particularly in the cervical spine, which supports the head. The objective of this study was to assess this modulation. METHODS With the use of optoelectronic sensors, the breathing profile, articular joint motions of the cervical spine, hip, knees and ankles, and centre of pressure (CoP) displacement were measured in 20 healthy subjects (37 years old [29; 49], 10 females) during natural breathing (NB), a cognitive dual task (COG), and eyes-closed and increased-tidal-volume conditions. The PV interaction in the CoP and joint motions were evaluated by calculating the respiratory emergence (REm). RESULTS Only the COG condition induced a decrease in the cervical REm (NB: 17.2% [7.8; 37.2]; COG: 4.2% [1.8; 10.0] p = 0.0020) concurrent with no changes in the cervical motion. The CoP REm (NB: 6.2% [3.8; 10.3]; COG: 12.9% [5.8; 20.7] p = 0.0696) and breathing frequency (NB: 16.6 min-1 [13.3; 18.7]; COG: 18.6 min-1 [16.3; 19.4] p = 0.0731) tended to increase, while the CoP (p = 0.0072) and lower joint motion displacements (p < 0.05) increased. CONCLUSION This study shows stable cervical spine motion during a cognitive dual task, as well as increased postural perturbations globally and in other joints. The concurrent reduction in the PV interaction at the cervical spine suggests that this "stabilization strategy" is centrally controlled and is achieved by a reduction in the breathing-related postural perturbations at this level. Whether this strategy is a goal for maintaining balance remains to be studied.
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Affiliation(s)
- Louis Clavel
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, 75005, Paris, France. .,Arts et Metiers Institute of Technology, IBHGC, 151 bd de l'Hopital, 75013, Paris, France.
| | - Valérie Attali
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, 75005, Paris, France.,Arts et Metiers Institute of Technology, IBHGC, 151 bd de l'Hopital, 75013, Paris, France.,Service des Pathologies du Sommeil (Département R3S), AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, 75013, Paris, France
| | - Isabelle Rivals
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, 75005, Paris, France.,Equipe de Statistique Appliquée, ESPCI Paris, PSL Research University, 75005, Paris, France
| | - Marie-Cécile Niérat
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, 75005, Paris, France
| | - Pierantonio Laveneziana
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, 75005, Paris, France.,Service des Explorations Fonctionnelles de la Respiration, de l'Exercice et de la Dyspnée, Département "R3S", Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, 75013, Paris, France
| | - Philippe Rouch
- Arts et Metiers Institute of Technology, IBHGC, 151 bd de l'Hopital, 75013, Paris, France
| | - Thomas Similowski
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, 75005, Paris, France.,Service de Pneumologie, Médecine Intensive et Réanimation (Département R3S), AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, 75013, Paris, France
| | - Baptiste Sandoz
- Arts et Metiers Institute of Technology, IBHGC, 151 bd de l'Hopital, 75013, Paris, France
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12
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Nguyen DAT, Boswell-Ruys CL, McCaughey EJ, Gandevia SC, Hudson AL, Butler JE. Absence of inspiratory premotor potentials during quiet breathing in cervical spinal cord injury. J Appl Physiol (1985) 2020; 128:660-666. [PMID: 32078470 DOI: 10.1152/japplphysiol.00831.2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
A premotor potential, or Bereitschaftspotential (BP), is a low-amplitude negativity in the electroencephalographic activity (EEG) of the sensorimotor cortex. It begins ~1 s prior to the onset of inspiration in the averaged EEG. Although normally absent during quiet breathing in healthy, younger people, inspiration-related BPs are present in people with respiratory disease and healthy, older people, indicating a cortical contribution to quiet breathing. People with tetraplegia have weak respiratory muscles and increased neural drive during quiet breathing, indicated by increased inspiratory muscle activity. Therefore, we hypothesized that BPs would be present during quiet breathing in people with tetraplegia. EEG was recorded in 17 people with chronic tetraplegia (14M, 3 female; 22-51 yr; C3-C7, American Spinal Injury Association Impairment Scale A-D; >1 yr postinjury). They had reduced lung function and respiratory muscle weakness [FEV1: 54 ± 19% predicted, FVC: 59 ± 22% predicted and MIP: 56 ± 24% predicted (mean ± SD)]. Participants performed quiet breathing and voluntary self-paced sniffs (positive control condition). A minimum of 250 EEG epochs during quiet breathing and 60 epochs during sniffs, time-locked to the onset of inspiration, were averaged to determine the presence of BPs at Cz, FCz, C3, and C4. Fifteen participants (88%) had a BP for the sniffs. Of these 15 participants, only one (7%) had a BP in quiet breathing, a rate similar to that reported during quiet breathing in young able-bodied participants (12%). The findings suggest that, as in young able-bodied people, a cortical contribution to quiet breathing is absent in people with tetraplegia despite higher neural drive.NEW & NOTEWORTHY People with tetraplegia have weak respiratory muscles, increased neural drive during quiet breathing, and a high incidence of sleep-disordered breathing. Using electroencephalographic recordings, we show that inspiratory premotor potentials are absent in people with chronic tetraplegia during quiet breathing. This suggests that cortical activity is not present during resting ventilation in people with tetraplegia who are awake and breathing independently.
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Affiliation(s)
- David A T Nguyen
- Neuroscience Research Australia, New South Wales, Australia.,University of New South Wales, New South Wales, Australia
| | - Claire L Boswell-Ruys
- Neuroscience Research Australia, New South Wales, Australia.,University of New South Wales, New South Wales, Australia.,Prince of Wales Hospital, New South Wales, Australia
| | - Euan James McCaughey
- Neuroscience Research Australia, New South Wales, Australia.,University of New South Wales, New South Wales, Australia
| | - Simon C Gandevia
- Neuroscience Research Australia, New South Wales, Australia.,University of New South Wales, New South Wales, Australia.,Prince of Wales Hospital, New South Wales, Australia
| | - Anna L Hudson
- Neuroscience Research Australia, New South Wales, Australia.,University of New South Wales, New South Wales, Australia
| | - Jane E Butler
- Neuroscience Research Australia, New South Wales, Australia.,University of New South Wales, New South Wales, Australia.,Prince of Wales Hospital, New South Wales, Australia
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13
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Clavel L, Rémy-Neris S, Skalli W, Rouch P, Lespert Y, Similowski T, Sandoz B, Attali V. Cervical Spine Hyperextension and Altered Posturo-Respiratory Coupling in Patients With Obstructive Sleep Apnea Syndrome. Front Med (Lausanne) 2020; 7:30. [PMID: 32118015 PMCID: PMC7020015 DOI: 10.3389/fmed.2020.00030] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 01/21/2020] [Indexed: 12/26/2022] Open
Abstract
Obstructive sleep apnea syndrome (OSAS) is associated with postural dysfunction characterized by abnormal spinal curvature and disturbance of balance and walking, whose pathophysiology is poorly understood. We hypothesized that it may be the result of a pathological interaction between postural and ventilatory functions. Twelve patients with OSAS (4 women, age 53 years [51–63] (median [quartiles]), apnea hypopnea index 31/h [24–41]) were compared with 12 healthy matched controls. Low dose biplanar X-rays (EOS® system) were acquired and personalized three-dimensional models of the spine and pelvis were reconstructed. We also estimated posturo-respiratory coupling by measurement of respiratory emergence, obtaining synchronized center of pressure data from a stabilometric platform and ventilation data recorded by an optico-electronic system of movement analysis. Compared with controls, OSAS patients, had cervical hyperextension with anterior projection of the head (angle OD-C7 12° [8; 14] vs. 5° [4; 8]; p = 0.002), and thoracic hyperkyphosis (angle T1–T12 65° [51; 71] vs. 49° [42; 59]; p = 0.039). Along the mediolateral axis: (1) center of pressure displacement was greater in OSAS patients, whose balance was poorer (19.2 mm [14.2; 31.5] vs. 8.5 [1.4; 17.8]; p = 0.008); (2) respiratory emergence was greater in OSAS patients, who showed increased postural disturbance of respiratory origin (19.2% [9.9; 24.0] vs. 8.1% [6.4; 10.4]; p = 0.028). These results are evidence for the centrally-mediated and primarily respiratory origin of the postural dysfunction in OSAS. It is characterized by an hyperextension of the cervical spine with a compensatory hyperkyphosis, and an alteration in posturo-respiratory coupling, apparently secondary to upper airway instability.
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Affiliation(s)
- Louis Clavel
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,Arts et Métiers, Institut de Biomécanique Humaine Georges Charpak (IBHGC), Paris, France
| | - Ségolène Rémy-Neris
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Wafa Skalli
- Arts et Métiers, Institut de Biomécanique Humaine Georges Charpak (IBHGC), Paris, France
| | - Philippe Rouch
- Arts et Métiers, Institut de Biomécanique Humaine Georges Charpak (IBHGC), Paris, France
| | - Yoann Lespert
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,Arts et Métiers, Institut de Biomécanique Humaine Georges Charpak (IBHGC), Paris, France
| | - Thomas Similowski
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service de Pneumologie, Médecine Intensive et Réanimation (Département R3S), Paris, France
| | - Baptiste Sandoz
- Arts et Métiers, Institut de Biomécanique Humaine Georges Charpak (IBHGC), Paris, France
| | - Valérie Attali
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,Arts et Métiers, Institut de Biomécanique Humaine Georges Charpak (IBHGC), Paris, France.,AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service des Pathologies du Sommeil (Département R3S), Paris, France
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14
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Leacy JK, O'Halloran KD. Corticomotor control of airway calibre in obstructive sleep apnoea syndrome. Exp Physiol 2020; 105:234-235. [DOI: 10.1113/ep088336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 12/09/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Jack K. Leacy
- Department of PhysiologySchool of MedicineCollege of Medicine & HealthUniversity College Cork Cork Ireland
| | - Ken D. O'Halloran
- Department of PhysiologySchool of MedicineCollege of Medicine & HealthUniversity College Cork Cork Ireland
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15
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Launois C, Nierat M, Attali V, Raux M, Arnulf I, Similowski T, Redolfi S. Postural preinspiratory cortical activity, genioglossus activity and fluid shift in awake obstructive sleep apnoea patients. Exp Physiol 2019; 105:370-378. [DOI: 10.1113/ep087804] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 11/12/2019] [Indexed: 01/06/2023]
Affiliation(s)
- Claire Launois
- Sorbonne UniversitéINSERM, UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France
| | - Marie‐Cécile Nierat
- Sorbonne UniversitéINSERM, UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France
| | - Valérie Attali
- Sorbonne UniversitéINSERM, UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France
- AP‐HPGroupe Hospitalier Pitié‐Salpêtrière Charles FoixService de Pathologies du Sommeil Département R3S Paris France
| | - Mathieu Raux
- Sorbonne UniversitéINSERM, UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France
- AP‐HPGroupe Hospitalier Pitié‐Salpêtrière Charles FoixDépartement d'Anesthésie Réanimation Paris France
| | - Isabelle Arnulf
- AP‐HPGroupe Hospitalier Pitié‐Salpêtrière Charles FoixService de Pathologies du Sommeil Département R3S Paris France
| | - Thomas Similowski
- Sorbonne UniversitéINSERM, UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France
- AP‐HPGroupe Hospitalier Pitié‐Salpêtrière Charles FoixService de PneumologieMédecine Intensive et Réanimation Département R3S Paris France
| | - Stefania Redolfi
- Sorbonne UniversitéINSERM, UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France
- AP‐HPGroupe Hospitalier Pitié‐Salpêtrière Charles FoixService de Pathologies du Sommeil Département R3S Paris France
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16
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Leacy JK, O'Halloran KD. Cortical control of upper airway calibre: It's the thought that counts! Exp Physiol 2019; 104:789-790. [DOI: 10.1113/ep087681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 04/01/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Jack K. Leacy
- Department of PhysiologySchool of MedicineCollege of Medicine & HealthUniversity College Cork Cork Ireland
| | - Ken D. O'Halloran
- Department of PhysiologySchool of MedicineCollege of Medicine & HealthUniversity College Cork Cork Ireland
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17
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Laveneziana P, Albuquerque A, Aliverti A, Babb T, Barreiro E, Dres M, Dubé BP, Fauroux B, Gea J, Guenette JA, Hudson AL, Kabitz HJ, Laghi F, Langer D, Luo YM, Neder JA, O'Donnell D, Polkey MI, Rabinovich R, Rossi A, Series F, Similowski T, Spengler C, Vogiatzis I, Verges S. ERS statement on respiratory muscle testing at rest and during exercise. Eur Respir J 2019; 53:13993003.01214-2018. [DOI: 10.1183/13993003.01214-2018] [Citation(s) in RCA: 227] [Impact Index Per Article: 45.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 02/18/2019] [Indexed: 12/12/2022]
Abstract
Assessing respiratory mechanics and muscle function is critical for both clinical practice and research purposes. Several methodological developments over the past two decades have enhanced our understanding of respiratory muscle function and responses to interventions across the spectrum of health and disease. They are especially useful in diagnosing, phenotyping and assessing treatment efficacy in patients with respiratory symptoms and neuromuscular diseases. Considerable research has been undertaken over the past 17 years, since the publication of the previous American Thoracic Society (ATS)/European Respiratory Society (ERS) statement on respiratory muscle testing in 2002. Key advances have been made in the field of mechanics of breathing, respiratory muscle neurophysiology (electromyography, electroencephalography and transcranial magnetic stimulation) and on respiratory muscle imaging (ultrasound, optoelectronic plethysmography and structured light plethysmography). Accordingly, this ERS task force reviewed the field of respiratory muscle testing in health and disease, with particular reference to data obtained since the previous ATS/ERS statement. It summarises the most recent scientific and methodological developments regarding respiratory mechanics and respiratory muscle assessment by addressing the validity, precision, reproducibility, prognostic value and responsiveness to interventions of various methods. A particular emphasis is placed on assessment during exercise, which is a useful condition to stress the respiratory system.
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18
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Launois C, Perger E, Attali V, Nierat M, Raux M, Arnulf I, Similowski T, Redolfi S. Postural respiratory‐related cortical activation and rostral fluid shift in awake healthy humans. Exp Physiol 2019; 104:887-895. [DOI: 10.1113/ep087468] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 02/27/2019] [Indexed: 12/29/2022]
Affiliation(s)
- Claire Launois
- Sorbonne UniversitéINSERM UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France
| | - Elisa Perger
- AP‐HPGroupe Hospitalier Pitié‐Salpêtrière Charles FoixService de Pathologies du SommeilDépartement R3S Paris France
| | - Valérie Attali
- Sorbonne UniversitéINSERM UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France
- AP‐HPGroupe Hospitalier Pitié‐Salpêtrière Charles FoixService de Pathologies du SommeilDépartement R3S Paris France
| | - Marie‐Cécile Nierat
- Sorbonne UniversitéINSERM UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France
| | - Mathieu Raux
- Sorbonne UniversitéINSERM UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France
- AP‐HPGroupe Hospitalier Pitié‐Salpêtrière Charles FoixDépartement d'Anesthésie Réanimation Paris France
| | - Isabelle Arnulf
- AP‐HPGroupe Hospitalier Pitié‐Salpêtrière Charles FoixService de Pathologies du SommeilDépartement R3S Paris France
| | - Thomas Similowski
- Sorbonne UniversitéINSERM UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France
- AP‐HPGroupe Hospitalier Pitié‐Salpêtrière Charles FoixService de PneumologieMédecine Intensive et RéanimationDépartement R3S Paris France
| | - Stefania Redolfi
- Sorbonne UniversitéINSERM UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France
- AP‐HPGroupe Hospitalier Pitié‐Salpêtrière Charles FoixService de Pathologies du SommeilDépartement R3S Paris France
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19
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Attali V, Collet JM, Jacq O, Souchet S, Arnulf I, Rivals I, Kerbrat JB, Goudot P, Morelot-Panzini C, Similowski T. Mandibular advancement reveals long-term suppression of breathing discomfort in patients with obstructive sleep apnea syndrome. Respir Physiol Neurobiol 2019; 263:47-54. [PMID: 30872167 DOI: 10.1016/j.resp.2019.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/08/2019] [Accepted: 03/10/2019] [Indexed: 02/07/2023]
Abstract
Obstructive sleep apnoea syndrome (OSAS) patients do not report breathing discomfort in spite of abnormal upper airway mechanics. We studied respiratory sensations in OSAS patients without and with mandibular advancement device (MAD). Fifty-seven moderate to severe non obese OSAS patients were asked about breathing discomfort using visual analogue scales (VAS) in the sitting position (VAS-1), after lying down (VAS-2), then with MAD (VAS-3). Awake critical closing pressure (awake Pcrit) was measured in 15 patients without then with MAD. None of the patients reported breathing discomfort when sitting but 19 patients (33%) did when lying (VAS-2: -20% or less). A feeling of "easier breathing" with MAD was observed and was more marked in patients reporting breathing discomfort when supine (VAS-3: +66.0% [49.0; 89.0]) than in those not doing so (VAS-3: +28.5% [1.0; 56.5], p = 0.007). MAD-induced change in awake Pcrit was correlated to VAS-3. In conclusion, MAD revealed "latent dyspnea" related to the severity of upper airways mechanics abnormalities in OSAS patients.
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Affiliation(s)
- Valérie Attali
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Pathologies du Sommeil (Département "R3S"), F-75013, Paris, France.
| | - Jean-Marc Collet
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Pathologies du Sommeil (Département "R3S"), F-75013, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Stomatologie et Chirurgie Maxillo-faciale, F-75013, Paris, France.
| | - Olivier Jacq
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Pathologies du Sommeil (Département "R3S"), F-75013, Paris, France.
| | - Sandie Souchet
- Université Paris I - Panthéon-Sorbonne, laboratoire SAMM (Statistique, Analyse, Modélisation Multidisciplinaire -EA4543), F-75005, Paris, France.
| | - Isabelle Arnulf
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Pathologies du Sommeil (Département "R3S"), F-75013, Paris, France.
| | - Isabelle Rivals
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005, Paris, France; Equipe de Statistique Appliquée, ESPCI Paris, PSL Research University F-75005, Paris, France.
| | - Jean-Baptiste Kerbrat
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Stomatologie et Chirurgie Maxillo-faciale, F-75013, Paris, France; Sorbonne Université, UMR, 8256 B2A, F-75005, Paris, France.
| | - Patrick Goudot
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Stomatologie et Chirurgie Maxillo-faciale, F-75013, Paris, France; Sorbonne Université, UMR, 8256 B2A, F-75005, Paris, France.
| | - Capucine Morelot-Panzini
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie, Médecine Intensive et Réanimation (Département "R3S"), F-75013, Paris, France.
| | - Thomas Similowski
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie, Médecine Intensive et Réanimation (Département "R3S"), F-75013, Paris, France.
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Morélot‐Panzini C. Respiratory‐related cortical activity in patients with COPD and aged normal individuals: towards a different vision of dyspnoea? J Physiol 2018; 596:6137-6138. [DOI: 10.1113/jp276761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Capucine Morélot‐Panzini
- AP‐HPGroupe Hospitalier Pitié‐Salpêtrière Charles FoixService de PneumologieMédecine Intensive et Réanimation, (Département “R3S”) F‐75013 Paris France
- Sorbonne UniversitéINSERM UMRS1158 Neurophysiologie respiratoire expérimentale et clinique F‐75005 Paris France
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Adler D, Janssens JP. The Pathophysiology of Respiratory Failure: Control of Breathing, Respiratory Load, and Muscle Capacity. Respiration 2018; 97:93-104. [PMID: 30423557 DOI: 10.1159/000494063] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 09/24/2018] [Indexed: 11/19/2022] Open
Abstract
The purpose of this review is to provide an overview on how interactions between control of breathing, respiratory load, and muscle function may lead to respiratory failure. The mechanisms involved vary according to the underlying pathology, but respiratory failure is most often the result of an imbalance between the muscular pump and the mechanical load placed upon it. Changes in respiratory drive and response to CO2 seem to be important contributors to the pathophysiology of respiratory failure. Inspiratory muscle dysfunction is also frequent but is not a mandatory prerequisite to respiratory failure since increased load may also be sufficient to precipitate it. It is crucial to recognize these interactions to be able to timeously establish patients on mechanical ventilation and adapt the ventilator settings to their respiratory system physiology.
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Affiliation(s)
- Dan Adler
- Division of Lung Diseases, University Hospitals of Geneva and Geneva Medical School, Geneva, Switzerland,
| | - Jean-Paul Janssens
- Division of Lung Diseases, University Hospitals of Geneva and Geneva Medical School, Geneva, Switzerland
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22
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Kalashnikova TP, Anisimov GV, Yastrebova AV, Starikova NL. [Etiopathogenesis of obstructive sleep apnoea and its consequences in the children]. Vestn Otorinolaringol 2018; 83:79-83. [PMID: 30412183 DOI: 10.17116/otorino20188305179] [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: 11/18/2022]
Abstract
The article presents the modern view of etiology of the obstructive sleep apnoea/hypopnoea syndrome (OAHSS) in the children taking into consideration the ontogenetic stage and the principal mechanisms of its formation including the short-term and long-term consequences of sleep apnoea with special reference to the pathogenetic commonness of OAHSS with endothelial dysfunction, metabolic syndrome, cardiac disorders, and systemic chronic inflammation. The role of ENT diseases in the children with obstructive sleep apnoea is discussed. The results of genetic studies of the processes influencing the formation of the risk of development of sleep apnoea/hypopnoea syndrome and its outcomes in the children are discussed.
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Affiliation(s)
- T P Kalashnikova
- V.P. Pervushin Department of Neurology, Academician E.A. Vagner Perm State Medical University, Ministry of Health of the Russian Federation, Perm, Russia
| | - G V Anisimov
- The First Medico-Pedagogical Centre 'Lingva Bona', Perm, Russia
| | - A V Yastrebova
- V.P. Pervushin Department of Neurology, Academician E.A. Vagner Perm State Medical University, Ministry of Health of the Russian Federation, Perm, Russia
| | - N L Starikova
- Department of Neurology, Faculty of Advanced Training and Professional Retraining of Specialists with the course of neurorehabitology, Academician E.A. Vagner Perm State Medical University, Ministry of Health of the Russian Federation, Perm, Russia
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23
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Pouget P, Allard E, Poitou T, Raux M, Wattiez N, Similowski T. Slower Is Higher: Threshold Modulation of Cortical Activity in Voluntary Control of Breathing Initiation. Front Neurosci 2018; 12:663. [PMID: 30364283 PMCID: PMC6193114 DOI: 10.3389/fnins.2018.00663] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 09/04/2018] [Indexed: 12/14/2022] Open
Abstract
Speech or programmed sentences must often be interrupted in order to listen to and interact with interlocutors. Among many processes that produce such complex acts, the brain must precisely adjust breathing to produce adequate phonation. The mechanism of these adjustments is multifactorial and still poorly understood. In order to selectively examine the adjustment in breath control, we recorded respiratory-related premotor cortical potentials from the scalp of human subjects while they performed a single breathing initiation or inhibition task. We found that voluntary breathing is initiated if, and only if, the cortical premotor potential activity reaches a threshold activation level. The stochastic variability in the threshold correlates to the distribution of initiation times of breathing. The data also fitted a computerized interactive race model. Modeling results confirm that this model is also as effective in respiratory modality, as it has been found to be for eye and hand movements. No modifications were required to account for respiratory cycle inhibition processes. In this overly simplified task, we showed a link between voluntary initiation and control of breathing and activity in a fronto-median region of the cerebral cortex. These results shed light on some of the physiological constraints involved in the complex mechanisms of respiration, phonation, and language.
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Affiliation(s)
- Pierre Pouget
- UMRS 975, INSERM, CNRS 7225, Institute of Brain and Spinal Cord, UPMC - University Pierre and Marie Curie, Paris, France
| | - Etienne Allard
- UMRS1158, INSERM, Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Universités, UPMC - University Pierre and Marie Curie, Paris, France
| | - Tymothée Poitou
- UMRS1158, INSERM, Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Universités, UPMC - University Pierre and Marie Curie, Paris, France
| | - Mathieu Raux
- UMRS 975, INSERM, CNRS 7225, Institute of Brain and Spinal Cord, UPMC - University Pierre and Marie Curie, Paris, France.,Service de Pneumologie et Réanimation Médicale (Département "R3S"), AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
| | - Nicolas Wattiez
- UMRS 975, INSERM, CNRS 7225, Institute of Brain and Spinal Cord, UPMC - University Pierre and Marie Curie, Paris, France
| | - Thomas Similowski
- UMRS 975, INSERM, CNRS 7225, Institute of Brain and Spinal Cord, UPMC - University Pierre and Marie Curie, Paris, France.,Service de Pneumologie et Réanimation Médicale (Département "R3S"), AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
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24
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Nguyen DAT, Boswell-Ruys CL, McBain RA, Eckert DJ, Gandevia SC, Butler JE, Hudson AL. Inspiratory pre-motor potentials during quiet breathing in ageing and chronic obstructive pulmonary disease. J Physiol 2018; 596:6173-6189. [PMID: 29971827 DOI: 10.1113/jp275764] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 06/27/2018] [Indexed: 12/14/2022] Open
Abstract
KEY POINTS A cortical contribution to breathing, as indicated by a Bereitschaftspotential (BP) in averaged electroencephalographic signals, occurs in healthy individuals when external inspiratory loads are applied. Chronic obstructive pulmonary disease (COPD) is a condition where changes in the lung, chest wall and respiratory muscles produce an internal inspiratory load. These changes also occur in normal ageing, although to a lesser extent. In the present study, we determined whether BPs are present during quiet breathing and breathing with an external inspiratory load in COPD compared to age-matched and young healthy controls. We demonstrated that increased age, rather than COPD, is associated with a cortical contribution to quiet breathing. A cortical contribution to inspiratory loading is associated with more severe dyspnoea (i.e. the sensation of breathlessness). We propose that cortical mechanisms may be engaged to defend ventilation in ageing with dyspnoea as a consequence. ABSTRACT A cortical contribution to breathing is determined by the presence of a Bereitschaftspotential, a low amplitude negativity in the averaged electroencephalographic (EEG) signal, which begins ∼1 s before inspiration. It occurs in healthy individuals when external inspiratory loads to breathing are applied. In chronic obstructive pulmonary disease (COPD), changes in the lung, chest wall and respiratory muscles produce an internal inspiratory load. We hypothesized that there would be a cortical contribution to quiet breathing in COPD and that a cortical contribution to breathing with an inspiratory load would be linked to dyspnoea, a major symptom of COPD. EEG activity was analysed in 14 participants with COPD (aged 57-84 years), 16 healthy age-matched (57-87 years) and 15 young (18-26 years) controls during quiet breathing and inspiratory loading. The presence of Bereitschaftspotentials, from ensemble averages of EEG epochs at Cz and FCz, were assessed by blinded assessors. Dyspnoea was rated using the Borg scale. The incidence of a cortical contribution to quiet breathing was significantly greater in participants with COPD (6/14) compared to the young (0/15) (P = 0.004) but not the age-matched controls (6/16) (P = 0.765). A cortical contribution to inspiratory loading was associated with higher Borg ratings (P = 0.007), with no effect of group (P = 0.242). The data show that increased age, rather than COPD, is associated with a cortical contribution to quiet breathing. A cortical contribution to inspiratory loading is associated with more severe dyspnoea. We propose that cortical mechanisms may be engaged to defend ventilation with dyspnoea as a consequence.
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Affiliation(s)
- David A T Nguyen
- Neuroscience Research Australia, Randwick, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia
| | - Claire L Boswell-Ruys
- Neuroscience Research Australia, Randwick, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia.,Prince of Wales Hospital, Sydney, NSW, Australia
| | - Rachel A McBain
- Neuroscience Research Australia, Randwick, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia.,Prince of Wales Hospital, Sydney, NSW, Australia
| | - Danny J Eckert
- Neuroscience Research Australia, Randwick, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia
| | - Simon C Gandevia
- Neuroscience Research Australia, Randwick, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia.,Prince of Wales Hospital, Sydney, NSW, Australia
| | - Jane E Butler
- Neuroscience Research Australia, Randwick, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia
| | - Anna L Hudson
- Neuroscience Research Australia, Randwick, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia
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Hudson AL, Niérat MC, Raux M, Similowski T. The Relationship Between Respiratory-Related Premotor Potentials and Small Perturbations in Ventilation. Front Physiol 2018; 9:621. [PMID: 29899704 PMCID: PMC5988848 DOI: 10.3389/fphys.2018.00621] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 05/08/2018] [Indexed: 12/12/2022] Open
Abstract
Respiratory-related premotor potentials from averaged electroencephalography (EEG) over the motor areas indicate cortical activation in healthy participants to maintain ventilation in the face of moderate inspiratory or expiratory loads. These experimental conditions are associated with respiratory discomfort, i.e., dyspnea. Premotor potentials are also observed in resting breathing in patients with reduced automatic respiratory drive or respiratory muscle strength due to respiratory or neurological disease, presumably in an attempt to maintain ventilation. The aim of this study was to determine if small voluntary increases in ventilation or smaller load-capacity imbalances, that generate an awareness of breathing but aren’t necessarily dyspneic, give rise to respiratory premotor potentials in healthy participants. In 15 healthy subjects, EEG was recorded during voluntary large breaths (∼3× tidal volume, that were interspersed with smaller non-voluntary breaths in the same trial; in 10 subjects) and breathing with a ‘low’ inspiratory threshold load (∼7 cmH2O; in 8 subjects). Averaged EEG signals at Cz and FCz were assessed for premotor potentials prior to inspiration. Premotor potential incidence in large breaths was 40%, similar to that in the smaller non-voluntary breaths in the same trial (20%; p > 0.05) and to that in a separate trial of resting breathing (0%; p > 0.05). The incidence of premotor potentials was 25% in the low load condition, similar to that in resting breathing (0%; p > 0.05). In contrast, voluntary sniffs were always associated with a higher incidence of premotor potentials (100%; p < 0.05). We have demonstrated that in contrast to respiratory and neurological disease, there is no significant cortical contribution to increase tidal volume or to maintain the load-capacity balance with a small inspiratory threshold load in healthy participants as detected using event-related potential methodology. A lack of cortical contribution during loading was associated with low ratings of respiratory discomfort and minimal changes in ventilation. These findings advance our understanding of the neural control of breathing in health and disease and how respiratory-related EEG may be used for medical technologies such as brain-computer interfaces.
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Affiliation(s)
- Anna L Hudson
- Neuroscience Research Australia and University of New South Wales, Sydney, NSW, Australia.,Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Marie-Cécile Niérat
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Mathieu Raux
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Département d'Anesthésie Réanimation, Paris, France
| | - Thomas Similowski
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale, Paris, France
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26
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Jacq O, Arnulf I, Similowski T, Attali V. Upper airway stabilization by osteopathic manipulation of the sphenopalatine ganglion versus sham manipulation in OSAS patients: a proof-of-concept, randomized, crossover, double-blind, controlled study. Altern Ther Health Med 2017; 17:546. [PMID: 29262824 PMCID: PMC5738827 DOI: 10.1186/s12906-017-2053-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 12/07/2017] [Indexed: 11/10/2022]
Abstract
Background Osteopathic manipulative treatment (OMT) of the sphenopalatine ganglion (SPG) is used empirically for the treatment of rhinitis and snoring and is thought to increase pharyngeal stability. This trial was designed to study the effects of this treatment on pharyngeal stability evaluated by critical closing pressure in obstructive sleep apnoea syndrome. Methods This single-centre, randomized, crossover, double-blind study compared active manipulation and sham manipulation of the SPG. Randomization was computer-generated. Patients each received one active manipulation and one sham manipulation at an interval of 21 days and were evaluated 30 min and 48 h after each session administered by a qualified osteopath. Neither the patients, nor the investigator performing the evaluations were informed about the order of the two techniques (double-blind). The primary endpoint was the percentage of responding patients presenting increased pharyngeal stability defined by a variation of critical closing pressure (Pcrit) of at least −4 cmH2O at 30 min. Secondary endpoints were the variation of Pcrit in absolute values, sleepiness and snoring. Others endpoints were lacrimation (Schirmer’s test), induced pain, sensations experienced during OMT. Results Ten patients were included and nine (57 [50; 58] years, comprising 7 men, with an apnoea-hypopnoea index of 31.0 [25.5; 33.2]/h; (values are median [quartiles])) were analysed. Seven patients were analysed for the primary endpoint and nine patients were analysed for secondary endpoints. Five patients responded after active manipulation versus no patients after sham manipulation (p = 0.0209). Active manipulation induced more intense pain (p = 0.0089), increased lacrimation (ns) and more tactile, nociceptive and gustatory sensations (13 versus 1) compared to sham manipulation. No significant difference was observed for the other endpoints. Conclusions Osteopathic manipulative treatment of the SPG may improve pharyngeal stability in obstructive sleep apnoea syndrome. This trial validates the feasibility of the randomized, controlled, double-blind methodology for evaluation of this osteopathic treatment. Studies on a larger sample size must specify the efficacy on the apnoea-hypopnoea index. Trial registration The study was retrospectively registered in the clinicaltrial.gov registry under reference NCT01193738 on 1st September 2010 (first inclusion May 19, 2010). Electronic supplementary material The online version of this article (doi: 10.1186/s12906-017-2053-0) contains supplementary material, which is available to authorized users.
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Neurophysiological Evidence for a Cortical Contribution to the Wakefulness-Related Drive to Breathe Explaining Hypocapnia-Resistant Ventilation in Humans. J Neurosci 2017; 36:10673-10682. [PMID: 27733617 DOI: 10.1523/jneurosci.2376-16.2016] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 08/29/2016] [Indexed: 12/14/2022] Open
Abstract
Spontaneous ventilation in mammals is driven by automatic brainstem networks that generate the respiratory rhythm and increase ventilation in the presence of increased carbon dioxide production. Hypocapnia decreases the drive to breathe and induces apnea. In humans, this occurs during sleep but not during wakefulness. We hypothesized that hypocapnic breathing would be associated with respiratory-related cortical activity similar to that observed during volitional breathing, inspiratory constraints, or in patients with defective automatic breathing (preinspiratory potentials). Nineteen healthy subjects were studied under passive (mechanical ventilation, n = 10) or active (voluntary hyperventilation, n = 9) profound hypocapnia. Ventilatory and electroencephalographic recordings were performed during voluntary sniff maneuvers, normocapnic breathing, hypocapnia, and after return to normocapnia. EEG recordings were analyzed with respect to the ventilatory flow signal to detect preinspiratory potentials in frontocentral electrodes and to construct time-frequency maps. After passive hyperventilation, hypocapnia was associated with apnea in 3 cases and ventilation persisted in 7 cases (3 and 6 after active hyperventilation, respectively). No respiratory-related EEG activity was observed in subjects with hypocapnia-related apneas. In contrast, preinspiratory potentials were present at vertex recording sites in 12 of the remaining 13 subjects (p < 0.001). This was corroborated by time-frequency maps. This study provides direct evidence of a cortical substrate to hypocapnic breathing in awake humans and fuels the notion of corticosubcortical cooperation to preserve human ventilation in a variety of situations. Of note, maintaining ventilatory activity at low carbon dioxide levels is among the prerequisites to speech production insofar as speech often induces hypocapnia. SIGNIFICANCE STATEMENT Human ventilatory activity persists, during wakefulness, even when hypocapnia makes it unnecessary. This peculiarity of human breathing control is important to speech and speech-breathing insofar as speech induces hypocapnia. This study evidences a specific respiratory-related cortical activity. This suggests that human hypocapnic breathing is driven, at least in part, by cortical mechanisms similar to those involved in volitional breathing, in breathing against mechanical constraints or with weak inspiratory muscle, and in patients with defective medullary breathing pattern generators. This fuels the notion that the human ventilatory drive during wakefulness often results from a corticosubcortical cooperation, and opens new avenues to study certain ventilatory and speech disorders.
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28
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Georges M, Attali V, Golmard JL, Morélot-Panzini C, Crevier-Buchman L, Collet JM, Tintignac A, Morawiec E, Trosini-Desert V, Salachas F, Similowski T, Gonzalez-Bermejo J. Reduced survival in patients with ALS with upper airway obstructive events on non-invasive ventilation. J Neurol Neurosurg Psychiatry 2016; 87:1045-50. [PMID: 27090433 DOI: 10.1136/jnnp-2015-312606] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 03/23/2016] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Non-invasive ventilation (NIV) is part of standard care in amyotrophic lateral sclerosis (ALS). Intolerance or unavailability of NIV, as well as the quality of correction of nocturnal hypoventilation, has a direct impact on prognosis. OBJECTIVES We describe the importance of NIV failure due to upper airway obstructive events, the clinical characteristics, as well as their impact on the prognosis of ALS. METHODS Retrospective analysis of the data of 190 patients with ALS and NIV in a single centre for the period 2011-2014. 179 patients tolerating NIV for more than 4 h per night without leaks were analysed. RESULTS Among the 179 patients, after correction of leaks, 73 remained inadequately ventilated at night (defined as more than 5% of the night spent at <90% of SpO2), as a result of obstructive events in 67% of cases (n=48). Patients who remained inadequately ventilated after optimal adjustment of ventilator settings presented with shorter survival than adequately ventilated patients. Unexpectedly, patients with upper airway obstructive events without nocturnal desaturation and in whom no adjustment of treatment was therefore performed also presented with shorter survival. On initiation of NIV, no difference was demonstrated between patients with and without upper airway obstructive events. In all patients, upper airway obstruction was concomitant with reduction of ventilatory drive. CONCLUSIONS This study shows that upper airway obstruction during NIV occurs in patients with ALS and is associated with poorer prognosis. Such events should be identified as they can be corrected by adjusting ventilator settings.
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Affiliation(s)
- Marjolaine Georges
- Département "R3S", Service de Pneumologie et Réanimation Médicale, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France
| | - Valérie Attali
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France Département "R3S", Service des Pathologies du Sommeil AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
| | - Jean Louis Golmard
- Département de biostatistiques, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
| | - Capucine Morélot-Panzini
- Département "R3S", Service de Pneumologie et Réanimation Médicale, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France
| | - Lise Crevier-Buchman
- Unité de la Voix, Service ORL et Chirurgie Cervico-Faciale, AP-HP, Hôpital Européen Georges Pompidou, Paris, France Université Paris Descartes, CNRS UMR 7018, Paris, France
| | - Jean-Marc Collet
- Département "R3S", Service des Pathologies du Sommeil AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
| | - Anne Tintignac
- Département "R3S", Service de Pneumologie et Réanimation Médicale, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
| | - Elise Morawiec
- Département "R3S", Service de Pneumologie et Réanimation Médicale, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
| | - Valery Trosini-Desert
- Département "R3S", Service de Pneumologie et Réanimation Médicale, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
| | - François Salachas
- Département de Neurologie et Centre de Référence pour la SLA, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
| | - Thomas Similowski
- Département "R3S", Service de Pneumologie et Réanimation Médicale, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France
| | - Jesus Gonzalez-Bermejo
- Département "R3S", Service de Pneumologie et Réanimation Médicale, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France
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Kubin L. Neural Control of the Upper Airway: Respiratory and State-Dependent Mechanisms. Compr Physiol 2016; 6:1801-1850. [PMID: 27783860 DOI: 10.1002/cphy.c160002] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Upper airway muscles subserve many essential for survival orofacial behaviors, including their important role as accessory respiratory muscles. In the face of certain predisposition of craniofacial anatomy, both tonic and phasic inspiratory activation of upper airway muscles is necessary to protect the upper airway against collapse. This protective action is adequate during wakefulness, but fails during sleep which results in recurrent episodes of hypopneas and apneas, a condition known as the obstructive sleep apnea syndrome (OSA). Although OSA is almost exclusively a human disorder, animal models help unveil the basic principles governing the impact of sleep on breathing and upper airway muscle activity. This article discusses the neuroanatomy, neurochemistry, and neurophysiology of the different neuronal systems whose activity changes with sleep-wake states, such as the noradrenergic, serotonergic, cholinergic, orexinergic, histaminergic, GABAergic and glycinergic, and their impact on central respiratory neurons and upper airway motoneurons. Observations of the interactions between sleep-wake states and upper airway muscles in healthy humans and OSA patients are related to findings from animal models with normal upper airway, and various animal models of OSA, including the chronic-intermittent hypoxia model. Using a framework of upper airway motoneurons being under concurrent influence of central respiratory, reflex and state-dependent inputs, different neurotransmitters, and neuropeptides are considered as either causing a sleep-dependent withdrawal of excitation from motoneurons or mediating an active, sleep-related inhibition of motoneurons. Information about the neurochemistry of state-dependent control of upper airway muscles accumulated to date reveals fundamental principles and may help understand and treat OSA. © 2016 American Physiological Society. Compr Physiol 6:1801-1850, 2016.
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Affiliation(s)
- Leszek Kubin
- Department of Biomedical Sciences, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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30
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Georges M, Morawiec E, Raux M, Gonzalez-Bermejo J, Pradat PF, Similowski T, Morélot-Panzini C. Cortical drive to breathe in amyotrophic lateral sclerosis: a dyspnoea-worsening defence? Eur Respir J 2016; 47:1818-28. [DOI: 10.1183/13993003.01686-2015] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 01/19/2016] [Indexed: 11/05/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease causing diaphragm weakness that can be partially compensated by inspiratory neck muscle recruitment. This disappears during sleep, which is compatible with a cortical contribution to the drive to breathe. We hypothesised that ALS patients with respiratory failure exhibit respiratory-related cortical activity, relieved by noninvasive ventilation (NIV) and related to dyspnoea.We studied 14 ALS patients with respiratory failure. Electroencephalographic recordings (EEGs) and electromyographic recordings of inspiratory neck muscles were performed during spontaneous breathing and NIV. Dyspnoea was evaluated using the Multidimensional Dyspnea Profile.Eight patients exhibited slow EEG negativities preceding inspiration (pre-inspiratory potentials) during spontaneous breathing. Pre-inspiratory potentials were attenuated during NIV (p=0.04). Patients without pre-inspiratory potentials presented more advanced forms of ALS and more severe respiratory impairment, but less severe dyspnoea. Patients with pre-inspiratory potentials had stronger inspiratory neck muscle activation and more severe dyspnoea during spontaneous breathing.ALS-related diaphragm weakness can engage cortical resources to augment the neural drive to breathe. This might reflect a compensatory mechanism, with the intensity of dyspnoea a negative consequence. Disease progression and the corresponding neural loss could abolish this phenomenon. A putative cognitive cost should be investigated.
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Nierat MC, Demiri S, Dupuis-Lozeron E, Allali G, Morélot-Panzini C, Similowski T, Adler D. When Breathing Interferes with Cognition: Experimental Inspiratory Loading Alters Timed Up-and-Go Test in Normal Humans. PLoS One 2016; 11:e0151625. [PMID: 26978782 PMCID: PMC4792478 DOI: 10.1371/journal.pone.0151625] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 02/29/2016] [Indexed: 12/14/2022] Open
Abstract
Human breathing stems from automatic brainstem neural processes. It can also be operated by cortico-subcortical networks, especially when breathing becomes uncomfortable because of external or internal inspiratory loads. How the “irruption of breathing into consciousness” interacts with cognition remains unclear, but a case report in a patient with defective automatic breathing (Ondine's curse syndrome) has shown that there was a cognitive cost of breathing when the respiratory cortical networks were engaged. In a pilot study of putative breathing-cognition interactions, the present study relied on a randomized design to test the hypothesis that experimentally loaded breathing in 28 young healthy subjects would have a negative impact on cognition as tested by “timed up-and-go” test (TUG) and its imagery version (iTUG). Progressive inspiratory threshold loading resulted in slower TUG and iTUG performance. Participants consistently imagined themselves faster than they actually were. However, progressive inspiratory loading slowed iTUG more than TUG, a finding that is unexpected with regard to the known effects of dual tasking on TUG and iTUG (slower TUG but stable iTUG). Insofar as the cortical networks engaged in response to inspiratory loading are also activated during complex locomotor tasks requiring cognitive inputs, we infer that competition for cortical resources may account for the breathing-cognition interference that is evidenced here.
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Affiliation(s)
- Marie-Cécile Nierat
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France
| | - Suela Demiri
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France
| | - Elise Dupuis-Lozeron
- Division of Pulmonary Diseases, Geneva University Hospital and University of Geneva, Geneva, Switzerland
- Research Center for Statistics, Geneva School of Economics and Management, University of Geneva, Geneva, Switzerland
| | - Gilles Allali
- Department of Neurology, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
- Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Capucine Morélot-Panzini
- Sorbonne Universités, UPMC Univ 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"), F-75013, Paris, France
| | - Thomas Similowski
- Sorbonne Universités, UPMC Univ 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"), F-75013, Paris, France
- * E-mail:
| | - Dan Adler
- Division of Pulmonary Diseases, Geneva University Hospital and University of Geneva, Geneva, Switzerland
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Hudson AL, Navarro-Sune X, Martinerie J, Pouget P, Raux M, Chavez M, Similowski T. Electroencephalographic detection of respiratory-related cortical activity in humans: from event-related approaches to continuous connectivity evaluation. J Neurophysiol 2016; 115:2214-23. [PMID: 26864771 DOI: 10.1152/jn.01058.2015] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 02/03/2016] [Indexed: 11/22/2022] Open
Abstract
The presence of a respiratory-related cortical activity during tidal breathing is abnormal and a hallmark of respiratory difficulties, but its detection requires superior discrimination and temporal resolution. The aim of this study was to validate a computational method using EEG covariance (or connectivity) matrices to detect a change in brain activity related to breathing. In 17 healthy subjects, EEG was recorded during resting unloaded breathing (RB), voluntary sniffs, and breathing against an inspiratory threshold load (ITL). EEG were analyzed by the specially developed covariance-based classifier, event-related potentials, and time-frequency (T-F) distributions. Nine subjects repeated the protocol. The classifier could accurately detect ITL and sniffs compared with the reference period of RB. For ITL, EEG-based detection was superior to airflow-based detection (P < 0.05). A coincident improvement in EEG-airflow correlation in ITL compared with RB (P < 0.05) confirmed that EEG detection relates to breathing. Premotor potential incidence was significantly higher before inspiration in sniffs and ITL compared with RB (P < 0.05), but T-F distributions revealed a significant difference between sniffs and RB only (P < 0.05). Intraclass correlation values ranged from poor (-0.2) to excellent (1.0). Thus, as for conventional event-related potential analysis, the covariance-based classifier can accurately predict a change in brain state related to a change in respiratory state, and given its capacity for near "real-time" detection, it is suitable to monitor the respiratory state in respiratory and critically ill patients in the development of a brain-ventilator interface.
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Affiliation(s)
- Anna L Hudson
- Neuroscience Research Australia and University of New South Wales, Sydney, Australia;
| | - Xavier Navarro-Sune
- Sorbonne Universités, Université Pierre et Marie Curie, University of Paris 06, Institut National de la Santé et de la Recherche Médicale, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Jacques Martinerie
- Centre National de la Recherche Scientifique UMR7225 at the Institut du Cerveau et de la Moelle Épinière, Paris, France
| | - Pierre Pouget
- Centre National de la Recherche Scientifique UMR7225 at the Institut du Cerveau et de la Moelle Épinière, Paris, France
| | - Mathieu Raux
- Sorbonne Universités, Université Pierre et Marie Curie, University of Paris 06, Institut National de la Santé et de la Recherche Médicale, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; Assistance Publique-Hopitaux de Paris (AP-HP), Groupe Hospitalier Pitie-Salpêtrière-Charles Foix, Département d'Anesthésie-Réanimation, Paris, France; and
| | - Mario Chavez
- Centre National de la Recherche Scientifique UMR7225 at the Institut du Cerveau et de la Moelle Épinière, Paris, France
| | - Thomas Similowski
- Sorbonne Universités, Université Pierre et Marie Curie, University of Paris 06, Institut National de la Santé et de la Recherche Médicale, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; AP-HP, Groupe Hospitalier Pitie-Salpêtrière-Charles Foix, Service de Pneumologie et Réanimation Medicale, Paris, France
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