1
|
Herth J, Schmidt F, Basler S, Sievi NA, Kohler M. Exhaled breath analysis in patients with potentially curative lung cancer undergoing surgery: a longitudinal study. J Breath Res 2024; 18:036003. [PMID: 38718786 DOI: 10.1088/1752-7163/ad48a9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 05/08/2024] [Indexed: 05/18/2024]
Abstract
Exhaled breath analysis has emerged as a non-invasive and promising method for early detection of lung cancer, offering a novel approach for diagnosis through the identification of specific biomarkers present in a patient's breath. For this longitudinal study, 29 treatment-naive patients with lung cancer were evaluated before and after surgery. Secondary electrospray ionization high-resolution mass spectrometry was used for exhaled breath analysis. Volatile organic compounds with absolute log2fold change ⩾1 andq-values ⩾ 0.71 were selected as potentially relevant. Exhaled breath analysis resulted in a total of 3482 features. 515 features showed a substantial difference before and after surgery. The small sample size generated a false positive rate of 0.71, therefore, around 154 of these 515 features were expected to be true changes. Biological identification of the features with the highest consistency (m/z-242.18428 andm/z-117.0539) revealed to potentially be 3-Oxotetradecanoic acid and Indole, respectively. Principal component analysis revealed a primary cluster of patients with a recurrent lung cancer, which remained undetected in the initial diagnostic and surgical procedures. The change of exhaled breath patterns after surgery in lung cancer emphasizes the potential for lung cancer screening and detection.
Collapse
Affiliation(s)
- Jonas Herth
- Department of Pulmonology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Felix Schmidt
- Faculty of Medicine, University of Zurich, 8032 Zurich, Switzerland
- Department of Pulmonology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Sarah Basler
- Faculty of Medicine, University of Zurich, 8032 Zurich, Switzerland
- Department of Pulmonology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Noriane A Sievi
- Department of Pulmonology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Malcolm Kohler
- Faculty of Medicine, University of Zurich, 8032 Zurich, Switzerland
- Department of Pulmonology, University Hospital Zurich, 8091 Zurich, Switzerland
| |
Collapse
|
2
|
Roeder M, Sievi NA, Frei N, Schwarz EI, Steinack C, Gaisl T, Kohler M. The effect of longitudinal sleep monitoring on clinician agreement in obstructive sleep apnea diagnosis: The ELSA study. J Sleep Res 2024; 33:e13943. [PMID: 37197997 DOI: 10.1111/jsr.13943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/08/2023] [Accepted: 05/03/2023] [Indexed: 05/19/2023]
Abstract
There is strong evidence for clinically relevant night-to-night variability of respiratory events in patients with suspected obstructive sleep apnea. Sleep experts retrospectively evaluated diagnostic data in 56 patients with suspected obstructive sleep apnea. Experts were blinded to the fact that they were diagnosing the same case twice, once based on a short report of a single in-laboratory respiratory polygraphy and once with the additional information of 14 nights of pulse oximetry at home. All experts (n = 22) were highly qualified, 13 experts (59.1%) treated > 100 patients with suspected obstructive sleep apnea per year. In 12 patients, the apnea-hypopnea index in the respiratory polygraphy was < 5 per hr, but the mean oxygen desaturation index of 14 nights of pulse oximetry was ≥ 5 per hr. The additional information of 14 nights of pulse oximetry helped to diagnose obstructive sleep apnea with a 70% consensus in two of those patients (16.7% [95% confidence interval: 4.7/44.8]). In eight patients, experts could not agree to a 70% consensus regarding continuous positive airway pressure therapy recommendation after respiratory polygraphy. The additional information of multiple-night testing led to a consensus in three of those cases (37.5% [95% confidence interval: 14/69]). Change of obstructive sleep apnea diagnosis and continuous positive airway pressure recommendation was significantly negatively associated with the number of treated obstructive sleep apnea patients > 100 per year compared with 0-29 patients per year (Coef. [95% confidence interval] -0.63 [-1.22/-0.04] and -0.61 [-1.07/-0.15], respectively). Experts found already a high level of consensus regarding obstructive sleep apnea diagnosis, severity and continuous positive airway pressure recommendation after a single respiratory polygraphy. However, longitudinal sleep monitoring could help increase consensus in selected patients with diagnostic uncertainty.
Collapse
Affiliation(s)
- Maurice Roeder
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Noriane A Sievi
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Nina Frei
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Esther I Schwarz
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Carolin Steinack
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Gaisl
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Malcolm Kohler
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
3
|
Kohlbrenner D, Kuhn M, Manettas A, Aregger C, Peterer M, Greco N, Sievi NA, Clarenbach C. Low-load blood flow restriction strength training in patients with COPD: a randomised single-blind pilot study. Thorax 2024; 79:340-348. [PMID: 38129116 PMCID: PMC10958309 DOI: 10.1136/thorax-2023-220546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 11/18/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE The objective of this study is to compare the effectiveness of lower limb low-load blood flow restriction training (LL-BFRT) with high-load strength training (HL-ST) as part of an outpatient pulmonary rehabilitation programme on leg strength in patients with chronic obstructive pulmonary disease (COPD). METHODS Participants were randomised to LL-BFRT or HL-ST (24 sessions). LL-BFRT was done at 30% 1-repetition maximum (1-RM) with 70% arterial occlusion pressure. HL-ST was done at 70% 1-RM. Primary outcome was isometric strength of knee extensors and flexors. Secondary outcomes were 1-RM, functional exercise capacity, physical activity, symptom burden and health-related quality of life. Perceptions of dyspnoea and leg fatigue were recorded after every exercise. We compared groups with t-tests. RESULTS We included 30 participants (13 women, 17 men, 64 (9) years, forced expiratory volume in 1 s 47 (18)% pred.), 24 completed the study. Isometric knee extensor strength improved to a clinically relevant degree in both legs in both groups (LL-BFRT: right leg 9 (20) Nm, left leg 10 (18) Nm; HL-ST: right leg 15 (26) Nm, left leg 16 (30) Nm, data are mean (SD)), without statistically significant or clinically relevant between-group differences (right leg mean difference= -6.4, 95% CI= -13.20 to 25.92 Nm, left leg mean difference= -5.6, 95% CI= -15.44 to 26.55 Nm). 1 min sit-to-stand test performance improved to a clinically relevant degree only in the LL-BFRT group (4 (4) vs 1 (5) repetitions). Interestingly, physical activity improved to a clinically relevant degree only in the LL-BFRT group (1506 (2441) vs -182 (1971) steps/day). LL-BFRT lowered perceived in-exercise dyspnoea and increased leg fatigue compared with HL-ST in the initial 12 trainings. CONCLUSION In patients with stable COPD undergoing outpatient pulmonary rehabilitation, LL-BFRT was not superior to HL-ST in improving leg strength. LL-BFRT led to similar strength gains as HL-ST while reducing perceptions of dyspnoea in the initial training phase. TRIAL REGISTRATION NUMBER NCT04151771.
Collapse
Affiliation(s)
- Dario Kohlbrenner
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Manuel Kuhn
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Anastasios Manettas
- Physiotherapy Occupational Therapy, University Hospital Zurich, Zurich, Switzerland
- Biomechanics and Ergonomics, ErgoMech Laboratory, Department of Physical Education and Sport Science, University of Thessaly, Trikala, Greece
| | - Céline Aregger
- Physiotherapy Occupational Therapy, University Hospital Zurich, Zurich, Switzerland
| | - Matthias Peterer
- Physiotherapy Occupational Therapy, University Hospital Zurich, Zurich, Switzerland
| | - Nicola Greco
- Physiotherapy Occupational Therapy, University Hospital Zurich, Zurich, Switzerland
| | - Noriane A Sievi
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Christian Clarenbach
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
4
|
Fraughen DD, Ghosh AJ, Hobbs BD, Funk GC, Meischl T, Clarenbach CF, Sievi NA, Schmid-Scherzer K, McElvaney OJ, Murphy MP, Roche AD, Clarke L, Strand M, Vafai-Tabrizi F, Kelly G, Gunaratnam C, Carroll TP, McElvaney NG. Augmentation Therapy for Severe Alpha-1 Antitrypsin Deficiency Improves Survival and Is Decoupled from Spirometric Decline-A Multinational Registry Analysis. Am J Respir Crit Care Med 2023; 208:964-974. [PMID: 37624745 PMCID: PMC10870866 DOI: 10.1164/rccm.202305-0863oc] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/24/2023] [Indexed: 08/27/2023] Open
Abstract
Rationale: Intravenous plasma-purified alpha-1 antitrypsin (IV-AAT) has been used as therapy for alpha-1 antitrypsin deficiency (AATD) since 1987. Previous trials (RAPID and RAPID-OLE) demonstrated efficacy in preserving computed tomography of lung density but no effect on FEV1. This observational study evaluated 615 people with severe AATD from three countries with socialized health care (Ireland, Switzerland, and Austria), where access to standard medical care was equal but access to IV-AAT was not. Objectives: To assess the real-world longitudinal effects of IV-AAT. Methods: Pulmonary function and mortality data were utilized to perform longitudinal analyses on registry participants with severe AATD. Measurements and Main Results: IV-AAT confers a survival benefit in severe AATD (P < 0.001). We uncovered two distinct AATD phenotypes based on an initial respiratory diagnosis: lung index and non-lung index. Lung indexes demonstrated a more rapid FEV1 decline between the ages of 20 and 50 and subsequently entered a plateau phase of minimal decline from 50 onward. Consequentially, IV-AAT had no effect on FEV1 decline, except in patients with a Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 2 lung index. Conclusions: This real-world study demonstrates a survival advantage from IV-AAT. This improved survival is largely decoupled from FEV1 decline. The observation that patients with severe AATD fall into two major phenotypes has implications for clinical trial design where FEV1 is a primary endpoint. Recruits into trials are typically older lung indexes entering the plateau phase and, therefore, unlikely to show spirometric benefits. IV-AAT attenuates spirometric decline in lung indexes in GOLD stage 2, a spirometric group commonly outside current IV-AAT commencement recommendations.
Collapse
Affiliation(s)
- Daniel D. Fraughen
- Department of Medicine, Irish Center for Genetic Lung Disease, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Auyon J. Ghosh
- Division of Pulmonary, Critical Care, and Sleep Medicine, SUNY Upstate University Hospital, Syracuse, New York
| | - Brian D. Hobbs
- Channing Division of Network Medicine and Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Georg-Christian Funk
- Karl Landsteiner Institute for Lung Research and Pulmonary Oncology and Department of Medicine II with Pneumology, Klinik Ottakring, Vienna, Austria
| | - Tobias Meischl
- Karl Landsteiner Institute for Lung Research and Pulmonary Oncology and Department of Medicine II with Pneumology, Klinik Ottakring, Vienna, Austria
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | | | - Noriane A. Sievi
- Department of Pneumology, University Hospital Zurich, Zurich, Switzerland
| | - Karin Schmid-Scherzer
- Karl Landsteiner Institute for Lung Research and Pulmonary Oncology and Department of Medicine II with Pneumology, Klinik Ottakring, Vienna, Austria
| | - Oliver J. McElvaney
- Department of Medicine, Irish Center for Genetic Lung Disease, Royal College of Surgeons in Ireland, Dublin, Ireland
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington
| | - Mark P. Murphy
- Department of Medicine, Irish Center for Genetic Lung Disease, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Adam D. Roche
- Department of Medicine, Irish Center for Genetic Lung Disease, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Louise Clarke
- Department of Respiratory Physiology, Beaumont Hospital, Dublin, Ireland; and
| | - Matthew Strand
- Division of Biostatistics and Bioinformatics, National Jewish Health, Denver, Colorado
| | - Florian Vafai-Tabrizi
- Karl Landsteiner Institute for Lung Research and Pulmonary Oncology and Department of Medicine II with Pneumology, Klinik Ottakring, Vienna, Austria
| | - Geraldine Kelly
- Department of Medicine, Irish Center for Genetic Lung Disease, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Cedric Gunaratnam
- Department of Respiratory Physiology, Beaumont Hospital, Dublin, Ireland; and
| | - Tomás P. Carroll
- Department of Medicine, Irish Center for Genetic Lung Disease, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Noel G. McElvaney
- Department of Medicine, Irish Center for Genetic Lung Disease, Royal College of Surgeons in Ireland, Dublin, Ireland
| |
Collapse
|
5
|
Malesevic S, Sievi NA, Schmidt D, Vallelian F, Jelcic I, Kohler M, Clarenbach CF. Physical Health-Related Quality of Life Improves over Time in Post-COVID-19 Patients: An Exploratory Prospective Study. J Clin Med 2023; 12:4077. [PMID: 37373770 DOI: 10.3390/jcm12124077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
(1) Background: Ongoing symptoms after mild or moderate acute coronavirus disease 19 (COVID-19) substantially affect health-related quality of life (HRQoL). However, follow-up data on HRQoL are scarce. We characterized the change in HRQoL over time in post-COVID-19 patients who initially suffered from mild or moderate acute COVID-19 without hospitalization. (2) Methods: Outpatients who visited an interdisciplinary post-COVID-19 consultation at the University Hospital Zurich and suffered from ongoing symptoms after acute COVID-19 were included in this observational study. HRQoL was assessed using established questionnaires. Six months after baseline, the same questionnaires and a self-constructed questionnaire about the COVID-19 vaccination were distributed. (3) Results: In total, 69 patients completed the follow-up, of whom 55 (80%) were female. The mean (SD) age was 44 (12) years and the median (IQR) time from symptom onset to completing the follow-up was 326 (300, 391) days. The majority of patients significantly improved in EQ-5D-5L health dimensions of mobility, usual activities, pain and anxiety. Furthermore, according to the SF-36, patients showed clinically relevant improvements in physical health, whereas no significant change was found regarding mental health. (4) Conclusions: Physical aspects of HRQoL in post-COVID-19 patients relevantly improved over 6 months. Future studies are needed to focus on potential predictors that allow for establishing individual care and early interventions.
Collapse
Affiliation(s)
- Stefan Malesevic
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland
- Department of Pulmonology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Noriane A Sievi
- Department of Pulmonology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Dörthe Schmidt
- Department of Cardiology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Florence Vallelian
- Department of Internal Medicine, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Ilijas Jelcic
- Department of Neurology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Malcolm Kohler
- Department of Pulmonology, University Hospital Zurich, 8091 Zurich, Switzerland
| | | |
Collapse
|
6
|
Malesevic S, Sievi NA, Baumgartner P, Roser K, Sommer G, Schmidt D, Vallelian F, Jelcic I, Clarenbach CF, Kohler M. Impaired health-related quality of life in long-COVID syndrome after mild to moderate COVID-19. Sci Rep 2023; 13:7717. [PMID: 37173355 PMCID: PMC10175927 DOI: 10.1038/s41598-023-34678-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 05/05/2023] [Indexed: 05/15/2023] Open
Abstract
A growing number of patients with SARS-CoV-2 infections experience long-lasting symptoms. Even patients who suffered from a mild acute infection show a variety of persisting and debilitating neurocognitive, respiratory, or cardiac symptoms (Long-Covid syndrome), consequently leading to limitations in everyday life. Because data on health-related quality of life (HRQoL) is scarce, we aimed to characterize the impact of Long-Covid symptoms after a mild or moderate acute infection on HRQoL. In this observational study, outpatients seeking counseling in the interdisciplinary Post-Covid consultation of the University Hospital Zurich with symptoms persisting for more than 4 weeks were included. Patients who received an alternative diagnosis or suffered from a severe acute Covid-19 infection were excluded. St. George's Respiratory Questionnaire (SGRQ), Euroquol-5D-5L (EQ-5D-5L), and the Short form 36 (SF-36) were distributed to assess HRQoL. 112 patients were included, 86 (76.8%) were female, median (IQR) age was 43 (32.0, 52.5) years with 126 (91, 180) days of symptoms. Patients suffered frequently from fatigue (81%), concentration difficulties (60%), and dyspnea (60%). Patients mostly stated impairment in performing usual activities and having pain/discomfort or anxiety out of the EQ-5D-5L. EQ index value and SGRQ activity score component were significantly lower in females. SF-36 scores showed remarkably lower scores in the physical health domain compared to the Swiss general population before and during the COVID-19 pandemic. Long-Covid syndrome has a substantial impact on HRQoL. Long-term surveillance of patients must provide clarity on the duration of impairments in physical and mental health.Trial registration: The study is registered on www.ClinicalTrials.gov , NCT04793269.
Collapse
Affiliation(s)
- Stefan Malesevic
- Faculty of Medicine, University of Zurich, Zurich, Switzerland.
- Department of Pulmonology, University Hospital Zurich, 8091, Zurich, Switzerland.
| | - Noriane A Sievi
- Department of Pulmonology, University Hospital Zurich, 8091, Zurich, Switzerland
| | - Patrick Baumgartner
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Department of Pulmonology, University Hospital Zurich, 8091, Zurich, Switzerland
| | - Katharina Roser
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Grit Sommer
- Division of Pediatric Endocrinology, Diabetology and Metabolism, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Biomedical Research, University of Bern, Bern, Switzerland
| | - Dörthe Schmidt
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Florence Vallelian
- Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Ilijas Jelcic
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Christian F Clarenbach
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Department of Pulmonology, University Hospital Zurich, 8091, Zurich, Switzerland
| | - Malcolm Kohler
- Department of Pulmonology, University Hospital Zurich, 8091, Zurich, Switzerland
| |
Collapse
|
7
|
Malesevic S, Sievi NA, Herth J, Schmidt F, Schmidt D, Vallelian F, Jelcic I, Jungblut L, Frauenfelder T, Kohler M, Martini K, Clarenbach CF. Chest CT Findings after Mild COVID-19 Do Not Explain Persisting Respiratory Symptoms: An Explanatory Study. Diagnostics (Basel) 2023; 13:diagnostics13091616. [PMID: 37175007 PMCID: PMC10178158 DOI: 10.3390/diagnostics13091616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/24/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023] Open
Abstract
(1) Background: Lung tissue involvement is frequently observed in acute COVID-19. However, it is unclear whether CT findings at follow-up are associated with persisting respiratory symptoms after initial mild or moderate infection. (2) Methods: Chest CTs of patients with persisting respiratory symptoms referred to the post-COVID-19 outpatient clinic were reassessed for parenchymal changes, and their potential association was evaluated. (3) Results: A total of 53 patients (31 female) with a mean (SD) age of 46 (13) years were included, of whom 89% had mild COVID-19. Median (quartiles) time from infection to CT was 139 (86, 189) days. Respiratory symptoms were dyspnea (79%), cough (42%), and thoracic pain (64%). Furthermore, 30 of 53 CTs showed very discrete and two CTs showed medium parenchymal abnormalities. No severe findings were observed. Mosaic attenuation (40%), ground glass opacity (2%), and fibrotic-like changes (25%) were recorded. No evidence for an association between persisting respiratory symptoms and chest CT findings was found. (4) Conclusions: More than half of the patients with initially mild or moderate infection showed findings on chest CT at follow-up. Respiratory symptoms, however, were not related to any chest CT finding. We, therefore, do not suggest routine chest CT follow-up in this patient group if no other indications are given.
Collapse
Affiliation(s)
- Stefan Malesevic
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland
- Department of Pulmonology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Noriane A Sievi
- Department of Pulmonology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Jonas Herth
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland
- Department of Pulmonology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Felix Schmidt
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland
- Department of Pulmonology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Dörthe Schmidt
- Department of Cardiology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Florence Vallelian
- Department of Internal Medicine, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Ilijas Jelcic
- Department of Neurology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Lisa Jungblut
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Thomas Frauenfelder
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Malcolm Kohler
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland
- Department of Pulmonology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Katharina Martini
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Christian F Clarenbach
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland
- Department of Pulmonology, University Hospital Zurich, 8091 Zurich, Switzerland
| |
Collapse
|
8
|
Kuhn M, Nalbant E, Kohlbrenner D, Alge M, Kuett L, Arvaji A, Sievi NA, Russi EW, Clarenbach CF. Validation of a small cough detector. ERJ Open Res 2023; 9:00279-2022. [PMID: 36699651 PMCID: PMC9868968 DOI: 10.1183/23120541.00279-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/23/2022] [Indexed: 01/28/2023] Open
Abstract
Research question The assessment of cough frequency in clinical practice relies predominantly on the patient's history. Currently, objective evaluation of cough is feasible with bulky equipment during a brief time (i.e. hours up to 1 day). Thus, monitoring of cough has been rarely performed outside clinical studies. We developed a small wearable cough detector (SIVA-P3) that uses deep neural networks for the automatic counting of coughs. This study examined the performance of the SIVA-P3 in an outpatient setting. Methods We recorded cough epochs with SIVA-P3 over eight consecutive days in patients suffering from chronic cough. During the first 24 h, the detector was validated against cough events counted by trained human listeners. The wearing comfort and the device usage were assessed using a questionnaire. Results In total, 27 participants (mean±sd age 50±14 years) with either chronic unexplained cough (n=12), COPD (n=4), asthma (n=5) or interstitial lung disease (n=6) were studied. During the daytime, the sensitivity of SIVA-P3 cough detection was 88.5±2.49% and the specificity was 99.97±0.01%. During the night-time, the sensitivity was 84.15±5.04% and the specificity was 99.97±0.02%. The wearing comfort and usage of the device was rated as very high by most participants. Conclusion SIVA-P3 enables automatic continuous cough monitoring in an outpatient setting for objective assessment of cough over days and weeks. It shows comparable sensitivity or higher sensitivity than other devices with fully automatic cough counting. Thanks to its wearing comfort and the high performance for cough detection, it has the potential for being used in routine clinical practice.
Collapse
Affiliation(s)
- Manuel Kuhn
- Faculty of Medicine, University of Zurich, Zurich, Switzerland,Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland,Corresponding author: Manuel Kuhn ()
| | | | - Dario Kohlbrenner
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | | | | | - Alexandra Arvaji
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Noriane A. Sievi
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Erich W. Russi
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Christian F. Clarenbach
- Faculty of Medicine, University of Zurich, Zurich, Switzerland,Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
9
|
Schmidt F, Nowak N, Baumgartner P, Gaisl T, Malesevic S, Streckenbach B, Sievi NA, Schwarz EI, Zenobi R, Brown SA, Kohler M. Severe Obstructive Sleep Apnea Disrupts Vigilance-State-Dependent Metabolism. Int J Mol Sci 2022; 23:14052. [PMID: 36430527 PMCID: PMC9694615 DOI: 10.3390/ijms232214052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/08/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022] Open
Abstract
The direct pathophysiological effects of obstructive sleep apnea (OSA) have been well described. However, the systemic and metabolic consequences of OSA are less well understood. The aim of this secondary analysis was to translate recent findings in healthy subjects on vigilance-state-dependent metabolism into the context of OSA patients and answer the question of how symptomatic OSA influences metabolism and whether these changes might explain metabolic and cardiovascular consequences of OSA. Patients with suspected OSA were assigned according to their oxygen desaturation index (ODI) and Epworth Sleepiness Scale (ESS) score into symptomatic OSA and controls. Vigilance-state-dependent breath metabolites assessed by high-resolution mass spectrometry were used to test for a difference in both groups. In total, 44 patients were eligible, of whom 18 (40.9%) were assigned to the symptomatic OSA group. Symptomatic OSA patients with a median [25%, 75% quartiles] ODI of 40.5 [35.0, 58.8] events/h and an ESS of 14.0 [11.2, 15.8] showed moderate to strong evidence for differences in 18 vigilance-state-dependent breath compounds compared to controls. These identified metabolites are part of major metabolic pathways in carbohydrate, amino acid, and lipid metabolism. Thus, beyond hypoxia per se, we hypothesize that disturbed sleep in OSA patients persists as disturbed sleep-dependent metabolite levels during daytime.
Collapse
Affiliation(s)
- Felix Schmidt
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland
- Department of Pulmonology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Nora Nowak
- Department of Chemistry and Applied Biosciences, ETH Zurich, 8093 Zurich, Switzerland
| | - Patrick Baumgartner
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland
- Department of Pulmonology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Thomas Gaisl
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland
- Department of Pulmonology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Stefan Malesevic
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland
- Department of Pulmonology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Bettina Streckenbach
- Department of Chemistry and Applied Biosciences, ETH Zurich, 8093 Zurich, Switzerland
| | - Noriane A. Sievi
- Department of Pulmonology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Esther I. Schwarz
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland
- Department of Pulmonology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Renato Zenobi
- Department of Chemistry and Applied Biosciences, ETH Zurich, 8093 Zurich, Switzerland
| | - Steven A. Brown
- Institute of Pharmacology and Toxicology, University of Zurich, 8006 Zurich, Switzerland
| | - Malcolm Kohler
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland
- Department of Pulmonology, University Hospital Zurich, 8091 Zurich, Switzerland
- Zurich Centre for Integrative Human Physiology, University of Zurich, 8006 Zurich, Switzerland
| |
Collapse
|
10
|
Roeder M, Sievi NA, Schneider A, Osswald M, Malesevic S, Kolios A, Nilsson J, Kohler M, Franzen D. The prevalence of obstructive sleep apnea in sarcoidosis and its impact on sleepiness, fatigue, and sleep-associated quality of life: a cross-sectional study with matched controls (the OSASA study). J Clin Sleep Med 2022; 18:2415-2422. [PMID: 35855534 PMCID: PMC9516590 DOI: 10.5664/jcsm.10140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/30/2022] [Accepted: 06/02/2022] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Patients with sarcoidosis experience fatigue and excessive daytime sleepiness (EDS). However, the underlying pathomechanism is unclear. Studies suggested undiagnosed obstructive sleep apnea (OSA) to be an important contributor, but reliable data on prevalence and impact of OSA in sarcoidosis are scarce. METHODS 71 adult patients with sarcoidosis, 1-to-1 matched to 71 adult controls according to sex, age, and body mass index were included. Participants underwent structured interviews (including Epworth Sleepiness Scale [ESS], Fatigue Assessment Scale [FAS], and Functional Outcome of Sleep Questionnaire [FOSQ-30]) and level-3 respiratory polygraphy. OSA was defined as apnea-hypopnea index ≥ 5 events/h. Prevalence of OSA was assessed and possible risk factors for OSA in sarcoidosis were investigated. RESULTS Mild OSA (AHI ≥ 5 events/h) was prevalent in 32 (45%) sarcoidosis patients vs 22 (31%) controls (P = .040). Sarcoidosis patients presented higher ESS compared with matched controls (P = .037). FAS scores (median [quartile] of 21.5 [16, 27.5]) indicated fatigue in sarcoidosis patients. Patients with EDS (ESS ≥ 11) presented reduced FOSQ-30 results (median [quartile] of 16.7 [15.2, 17.8]). ESS, FAS, and FOSQ were not associated with AHI in sarcoidosis patients. Body mass index, sex, neck circumference, and NoSAS score were predictors for OSA in sarcoidosis. CONCLUSIONS The risk for mild OSA is 2.5-fold higher in sarcoidosis patients compared with matched controls. OSA seems not to be the reason for increased sleepiness or fatigue in sarcoidosis. Risk factors such as body mass index, sex, neck circumference, and NoSAS score can be used to screen for OSA in sarcoidosis patients. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Obstructive Sleep Apnoea in Sarcoidosis (OSASA); URL: https://clinicaltrials.gov/ct2/history/NCT04156789?V_2=View; Identifier: NCT04156789. CITATION Roeder M, Sievi NA, Schneider A, et al. The prevalence of obstructive sleep apnea in sarcoidosis and its impact on sleepiness, fatigue, and sleep-associated quality of life: a cross-sectional study with matched controls (the OSASA study). J Clin Sleep Med. 2022;18(10):2415-2422.
Collapse
Affiliation(s)
- Maurice Roeder
- Department of Pulmonology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Noriane A. Sievi
- Department of Pulmonology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Alexandra Schneider
- Department of Pulmonology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Martin Osswald
- Department of Pulmonology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Stefan Malesevic
- Department of Pulmonology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Antonios Kolios
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Jakob Nilsson
- Department of Clinical Immunology, University Hospital Zurich, Zurich, Switzerland
| | - Malcolm Kohler
- Department of Pulmonology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Zurich Centre for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Daniel Franzen
- Department of Pulmonology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| |
Collapse
|
11
|
Kuhn M, Kohlbrenner D, Sievi NA, Clarenbach CF. Increasing Daily Physical Activity and Its Effects on QTc Time in Severe to Very Severe COPD: A Secondary Analysis of a Randomised Controlled Trial. COPD 2022; 19:339-344. [PMID: 36166273 DOI: 10.1080/15412555.2022.2101992] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Approximately, half of COPD patients die from cardiovascular diseases. A prolongation of cardiac repolarization (measured as QTc interval) is associated with cardiovascular events or cardiovascular deaths in populations of older adults and COPD. One way to reduce the QTc could be to increase physical activity (PA). We investigated whether QTc can be reduced by an increase in PA in patients with severe COPD. This is a secondary outcome analysis from a randomized controlled trial investigating the effects of a 3 months pedometer based program to improve PA. 12-lead ECG was assessed at baseline and after 3 months. We measured PA using a validated triaxial accelerometer. Data were analyzed from 59 participants. Multiple regression modeling, including adjustment for baseline QTc, sex, QT prolonging medications, BMI, smoking status and FEV1%, showed no evidence for an association between an improvement of ≥15% PA and QTc reduction. A 15% improvement in PA according to step counts over 3 months seems not to reduce QTc interval by its MCID of 20 ms in patients with severe to very severe COPD.
Collapse
Affiliation(s)
- Manuel Kuhn
- Faculty of Medicine, University of Zurich, Zurich, Switzerland.,Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Dario Kohlbrenner
- Faculty of Medicine, University of Zurich, Zurich, Switzerland.,Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Noriane A Sievi
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | | |
Collapse
|
12
|
Rausch Osthoff AK, Beyer S, Gisi D, Rezek S, Schwank A, Meichtry A, Sievi NA, Hess T, Wirz M. Effect of counselling during pulmonary rehabilitation on self-determined motivation to be physically active for people with chronic obstructive pulmonary disease: a pragmatic RCT. BMC Pulm Med 2021; 21:317. [PMID: 34641819 PMCID: PMC8506471 DOI: 10.1186/s12890-021-01685-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 09/23/2021] [Indexed: 11/16/2022] Open
Abstract
Background Counselling is considered to be a promising approach to increasing physical activity (PA) in people with chronic obstructive pulmonary disease (COPD). The aim of the current study was to investigate whether a PA counselling program for people with COPD, when embedded in a comprehensive outpatient pulmonary rehabilitation (PR) program, increased their daily PA. Methods A two-armed, single blind randomized controlled trial was conducted as a component of a 12-week outpatient pulmonary rehabilitation program. The participants randomized into the intervention group received five counselling sessions, based on the principles of motivational interviewing (MI), with a physiotherapist. The participants’ steps per day and other proxies of PA were measured using an accelerometer (SenseWear Pro®) at baseline, at the end of the PR program, and three months later. The group-by-time interaction effect was analyzed. Results Of the 43 participants,17 were allocated to the intervention group and 26 to the usual-care control group (mean age 67.9 ± 7.9; 21 (49%) males; mean FEV1 predicted 47.1 ± 18.6). No difference between groups was found for any measure of PA at any point in time. Conclusions In this study, counselling, based on MI, when embedded in a comprehensive PR program for people with COPD, showed no short-term or long-term effects on PA behavior. To investigate this potentially effective counselling intervention and to analyze the best method, timing and tailoring of an intervention embedded in a comprehensive outpatient PR program, further adequately powered research is needed. Trial registration: Clinical Trials.gov NCT02455206 (05/21/2015), Swiss National Trails Portal SNCTP000001426 (05/21/2015).
Collapse
Affiliation(s)
- Anne-Kathrin Rausch Osthoff
- Institute of Physiotherapy, School of Health Professions, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8400, Winterthur, Switzerland.
| | - Swantje Beyer
- Pneumology, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland
| | - David Gisi
- Institute of Physiotherapy, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland
| | - Spencer Rezek
- Institute of Physiotherapy, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland
| | - Ariane Schwank
- Institute of Physiotherapy, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland
| | - André Meichtry
- Institute of Physiotherapy, School of Health Professions, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8400, Winterthur, Switzerland
| | - Noriane A Sievi
- Department of Pulmonology, University Hospital of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Thomas Hess
- Pneumology, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland
| | - Markus Wirz
- Institute of Physiotherapy, School of Health Professions, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8400, Winterthur, Switzerland
| |
Collapse
|
13
|
Kohlbrenner D, Aregger C, Osswald M, Sievi NA, Clarenbach CF. Blood-Flow-Restricted Strength Training Combined With High-Load Strength and Endurance Training in Pulmonary Rehabilitation for COPD: A Case Report. Phys Ther 2021; 101:6134603. [PMID: 33580965 DOI: 10.1093/ptj/pzab063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/03/2020] [Accepted: 12/31/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The purpose of this report is to describe the case of a patient with chronic obstructive pulmonary disease (COPD) who was load compromised and being referred for outpatient pulmonary rehabilitation. Low-load blood flow restriction strength training (LL-BFRT) was applied to prepare for and increase tolerability of subsequently applied high-load strength training. METHODS (CASE DESCRIPTION) A 62-year-old woman with COPD GOLD 2 B presented with severe breathlessness. Lower limb strength was severely reduced while functional exercise capacity was preserved. The patient was severely load compromised and had high risk to be intolerant of the high training loads required to trigger the desired adaptations. LL-BFRT was applied during the first 12 training sessions and high-load strength training in the subsequent 12 training sessions of the rehabilitation program. Endurance training on a cycle ergometer was performed throughout the program. RESULTS Symptom burden in the COPD assessment test was reduced by 6 points (40%). Lower limb strength improved by 95.3 Nm (521%) and 88.4 Nm (433%) for the knee extensors and by 33.8 Nm (95%) and 56 Nm (184%) for the knee flexors, respectively. Functional exercise capacity improved by 44 m (11%) in the 6-minute walk test and 14 repetitions (108%) in the 1-minute sit-to stand test. The patient did not experience any adverse events related to the exercise training. CONCLUSION Clinically relevant changes were observed in both strength-related functional and self-reported outcomes. The achievements translated well into daily living and enabled functioning according to the patients' desires. LL-BFRT was reported to be well tolerated and implementable into an outpatient pulmonary rehabilitation program. IMPACT The description of this case encourages the systematic investigation of LL-BFRT in COPD. LL-BFRT has the potential to increase benefits as well as tolerability of strength training in pulmonary rehabilitation. Consideration of the physiological changes achieved through LL-BFRT highlights potential in targeting peripheral muscle dysfunction in COPD.
Collapse
Affiliation(s)
- Dario Kohlbrenner
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Céline Aregger
- Department of Physiotherapy and Occupational Therapy, University Hospital Zurich, Zurich, Switzerland
| | - Martin Osswald
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Noriane A Sievi
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | | |
Collapse
|
14
|
Rassouli F, Germann A, Baty F, Kohler M, Stolz D, Thurnheer R, Brack T, Kähler C, Widmer S, Tschirren U, Sievi NA, Tamm M, Brutsche MH. Telehealth mitigates COPD disease progression compared to standard of care: a randomized controlled crossover trial. J Intern Med 2021; 289:404-410. [PMID: 33428219 PMCID: PMC7986739 DOI: 10.1111/joim.13230] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/08/2020] [Accepted: 12/11/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND We showed excellent adherence and satisfaction with our telehealth care (TC) approach for COPD. Here, the results of a consecutive randomized controlled trial are presented. METHODS Patients were randomly assigned to TC or standard care (SC). During TC, patients answered six daily questions online, and focused on the early recognition of exacerbations, in addition to SC. RESULTS The mean increase in COPD assessment test (CAT) was 1.8 vs. 3.6 points/year in the TC and SC groups, respectively (P = 0.0015). Satisfaction with care (VAS) at baseline was 8.2; at the end of SC, 8.5 (P = 0.062); and after TC, 8.8 (P < 0.001). We detected significantly more moderate exacerbations during TC. CONCLUSION Whilst receiving TC, the slope of the CAT increase - an indicator of the naturally progressive course of COPD - was reduced by 50%. Satisfaction with care increased with TC. The higher number of detected moderate exacerbations probably indicates a higher diagnostic sensitivity than without TC.
Collapse
Affiliation(s)
- F Rassouli
- From the, Lung Center, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - A Germann
- From the, Lung Center, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - F Baty
- From the, Lung Center, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - M Kohler
- Clinic for Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - D Stolz
- Clinic for Pulmonology, University Hospital Basel, Basel, Switzerland
| | - R Thurnheer
- Clinic for Internal Medicine, Cantonal Hospital Münsterlingen, Münsterlingen, Switzerland
| | - T Brack
- Clinic for Internal Medicine, Cantonal Hospital Glarus, Glarus, Switzerland
| | - C Kähler
- Clinic for Pulmonology, Waldburg-Zeil-Kliniken, Wangen, Germany
| | - S Widmer
- From the, Lung Center, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - U Tschirren
- From the, Lung Center, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - N A Sievi
- Clinic for Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - M Tamm
- Clinic for Pulmonology, University Hospital Basel, Basel, Switzerland
| | - M H Brutsche
- From the, Lung Center, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| |
Collapse
|
15
|
Gaisl T, Rejmer P, Roeder M, Baumgartner P, Sievi NA, Siegfried S, Stämpfli SF, Thurnheer R, Stradling JR, Tanner FC, Kohler M. Obstructive sleep apnoea and the progression of thoracic aortic aneurysm: a prospective cohort study. Eur Respir J 2020; 57:13993003.03322-2020. [PMID: 33214207 DOI: 10.1183/13993003.03322-2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 10/26/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) is associated with an increased prevalence of aortic aneurysms and it has also been suggested that severe OSA furthers aneurysm expansion in the abdomen. We evaluated whether OSA is a risk factor for the progression of ascending thoracic aortic aneurysm (TAA). METHODS Patients with TAA underwent yearly standardised echocardiographic measurements of the ascending aorta over 3 years and two level III sleep studies. The primary outcome was the expansion rate of TAA in relation to the apnoea-hypopnoea index (AHI). Secondary outcomes included surveillance for aortic events (composite end-points of rupture/dissection, elective surgery or death). RESULTS Between July 2014 and March 2020, 230 patients (median age 70 years, 83.5% male) participated in the cohort. At baseline, 34.8% of patients had AHI ≥15 events·h-1. There was no association between TAA diameter and AHI at baseline. After 3 years, mean±sd expansion rates were 0.55±1.25 mm at the aortic sinus and 0.60±1.12 mm at the ascending aorta. In the regression analysis, after controlling for baseline diameter and cardiovascular risk factors, there was strong evidence for a positive association of TAA expansion with AHI (aortic sinus estimate 0.025 mm, 95% CI 0.009-0.040 mm; p<0.001 and ascending aorta estimate 0.026 mm, 95% CI 0.011-0.041 mm; p=0.001). 20 participants (8%) experienced an aortic event; however, there was no association with OSA severity. CONCLUSION OSA may be a modest but independent risk factor for faster TAA expansion and thus potentially contributes to life-threatening complications in aortic disease.
Collapse
Affiliation(s)
- Thomas Gaisl
- Dept of Pulmonology, University Hospital Zurich, Zurich, Switzerland.,Dept of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Protazy Rejmer
- Dept of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Maurice Roeder
- Dept of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | | | - Noriane A Sievi
- Dept of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Sandra Siegfried
- Dept of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Simon F Stämpfli
- Dept of Cardiology, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Robert Thurnheer
- Pulmonary Division, Münsterlingen Cantonal Hospital, Münsterlingen, Switzerland
| | - John R Stradling
- National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust and University of Oxford, Oxford, UK
| | - Felix C Tanner
- Dept of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Malcolm Kohler
- Dept of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
16
|
Kohlbrenner D, Clarenbach CF, Thiel S, Roeder M, Kohler M, Sievi NA. A few more steps lead to improvements in endothelial function in severe and very severe COPD. Respir Med 2020; 176:106246. [PMID: 33248361 DOI: 10.1016/j.rmed.2020.106246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/13/2020] [Accepted: 11/17/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Cardiovascular disease is among the most prevalent concomitant chronic diseases in COPD. Physical activity (PA) modifies endothelial function and is commonly impaired in COPD. However, studies directly investigating the effects of increased PA on endothelial function in COPD are lacking. We investigated the effect of changes in PA on endothelial function in patients with severe to very severe COPD. Furthermore, we determined which variables modify this effect. MATERIALS AND METHODS This is a secondary outcome analysis from a randomised controlled trial investigating the effects of combined PA counselling and pedometer-based feedback in COPD. We analysed the change in PA based on three visits during one year. We measured PA using a validated triaxial accelerometer, and endothelial function using flow-mediated dilation. RESULTS Data was analysed from 54 patients, which provided 101 change scores. Multiple regression modelling, including adjustment for baseline step count, showed strong evidence for an association between changes in flow-mediated dilation and changes in PA (p < 0.001). The analysis of several effect modificators showed no evidence of any influence on the interaction between PA and endothelial function: smoking status (p = 0.766), severity of airflow obstruction (p = 0.838), exacerbation frequency (p = 0.227), lung diffusion capacity of carbon monoxide % pred. (p = 0.735). CONCLUSION We found strong evidence that increasing steps per day ameliorates the heavily impaired endothelial function in patients with severe and very severe COPD. Further studies should examine which factors influence this relationship in a positive or negative manner.
Collapse
Affiliation(s)
- Dario Kohlbrenner
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | | | - Sira Thiel
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Maurice Roeder
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Malcolm Kohler
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Noriane A Sievi
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland.
| |
Collapse
|
17
|
Kohlbrenner D, Sievi NA, Senn O, Kohler M, Clarenbach CF. Long-Term Effects of Pedometer-Based Physical Activity Coaching in Severe COPD: A Randomized Controlled Trial. Int J Chron Obstruct Pulmon Dis 2020; 15:2837-2846. [PMID: 33192057 PMCID: PMC7655791 DOI: 10.2147/copd.s279293] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/14/2020] [Indexed: 02/04/2023] Open
Abstract
Background and Objective Limited evidence on long-term effects of physical activity programs in COPD is available. The aim of the study was to investigate the effects of a three-month program combining physical activity counselling and pedometer-based feedback in addition to usual care, followed by a nine-month unsupervised observation period as compared to usual care in participants with severe to very severe COPD. Methods Participants were randomized to either a control group receiving usual care or an intervention group receiving motivational support, an activity diary with an individual step count goal (ie, an increase of ≥15% from baseline) and a pedometer in addition to usual care. The intervention ended after three months and an unsupervised observational period followed until twelve months. Primary outcome was daily step count after one year. Results Seventy-four participants were included, 61 (82%) completed the study. Linear regression modelling, adjusted for baseline step count, showed no significant difference in change in step count after 12 months between the groups (Β = 547.33, 95% CI = −243.55/1338.20). Conclusion A three-month program combining physical activity counselling and pedometer-based feedback in addition to usual care does not attenuate the declining course of physical activity in participants with severe and very severe COPD during a long term follow-up of one year as compared to usual care. This result was primarily determined by the low intervention response rates to the combined program. Clinical Trial Registration www.ClinicalTrials.gov, NCT03114241.
Collapse
Affiliation(s)
- Dario Kohlbrenner
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Noriane A Sievi
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Oliver Senn
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Malcolm Kohler
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | | |
Collapse
|
18
|
Bradicich M, Sievi NA, Grewe FA, Gasperetti A, Kohler M, Schwarz EI. Nocturnal heart rate variability in obstructive sleep apnoea: a cross-sectional analysis of the Sleep Heart Health Study. J Thorac Dis 2020; 12:S129-S138. [PMID: 33214918 PMCID: PMC7642633 DOI: 10.21037/jtd-cus-2020-005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background Obstructive sleep apnoea (OSA) results in sympathetic overdrive. Increased nocturnal heart rate variability (HRV) is a surrogate marker of autonomic disturbance. The aim was to study the association of the apnoea-hypopnea index (AHI), nocturnal hypoxaemia, and sleep fragmentation with nocturnal HRV to address the pathophysiological mechanisms underlying autonomic disturbance in OSA. Methods Participants of the Sleep Hearth Health Study with available data on nocturnal HRV and an AHI ≥10/h have been included in this cross-sectional analysis. The main outcome of interest was the association of sleep fragmentation, nocturnal hypoxaemia, and the AHI with nocturnal HRV. Multivariate regression modelling with the mean of the standard deviations of normal-sinus-to-normal-sinus-interbeat intervals in all 5-minute segments (SDNNIDX) and with low to high frequency power-ratio (LF/HF) as dependent variables controlling for prespecified confounders (age, sex, cups of coffee, beta blocker, nocturnal heart rate) was used to assess the contribution of the arousal index, total sleep time with an oxygen saturation <90% (TST90) and the AHI not due to arousals to HRV. The significance level was set at P<0.01. Results In 258 patients with OSA (mean ± SD age 62±10 years, BMI 29±4 kg/m2, median (IQR) AHI 18.6/h (14.0-25.6), the arousal index (coef =0.42, P=0.002) was independently positively associated with SDNNIDX also after having controlled for potential confounders, whereas the AHI (coef =0.22, P=0.030) and TST90 (coef =0.36, P=0.054) were not. The arousal index-but not TST and AHI-was also independently associated with LF/HF. Conclusions In OSA, pronounced sleep fragmentation is associated with higher nocturnal HRV and a sympatho-vagal imbalance with sympathetic dominance. OSA severity and nocturnal hypoxaemia did not independently predict nocturnal HRV.
Collapse
Affiliation(s)
- Matteo Bradicich
- Department of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, Zurich, Switzerland
| | - Noriane A Sievi
- Department of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, Zurich, Switzerland
| | - Fabian A Grewe
- Department of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, Zurich, Switzerland
| | - Alessio Gasperetti
- University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Malcolm Kohler
- Department of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, Zurich, Switzerland.,Center of Competence Sleep and Health, University of Zurich, Zurich, Switzerland
| | - Esther I Schwarz
- Department of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, Zurich, Switzerland.,Center of Competence Sleep and Health, University of Zurich, Zurich, Switzerland
| |
Collapse
|
19
|
Roeder M, Thiel S, Baumann F, Sievi NA, Rohrbach M, Kohler M, Gaisl T. Increased augmentation index in patients with Ehlers-Danlos syndrome. BMC Cardiovasc Disord 2020; 20:417. [PMID: 32933483 PMCID: PMC7493396 DOI: 10.1186/s12872-020-01684-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 08/25/2020] [Indexed: 01/06/2023] Open
Abstract
Background Ehlers-Danlos Syndrome (EDS) comprises a heterogeneous group of diseases characterized by joint hypermobility, connective tissue friability, and vascular fragility. Reliable prognostic factors predicting vascular disease progression (e.g. arterial aneurysms, dissections, and ruptures) in EDS patients are still missing. Recently, applanation tonometry derived augmentation index (AIx), an indirect marker of arterial stiffness, has shown to be positively associated with progression of aortic disease in Marfan syndrome. In this study, we assessed aortic AIx in patients with EDS and matched healthy controls. Methods We performed noninvasive applanation tonometry in 61 adults with EDS (43 women and 18 men aged 39.3 ± 14.6 years) and 61 age-, gender-, height-, and weight-matched healthy controls. Radial artery pulse waveforms were recorded and analyzed using the SphygmoCor System (AtCor Medical, Sydney, NSW, Australia). Calculated AIx was adjusted to a heart rate of 75/min. Groups were compared and association between AIx and EDS was determined by univariate and multivariate regression analysis. Results EDS patients were categorized in classical type EDS (34%), hypermobile type EDS (43%), vascular type EDS (5%), or remained unassignable (18%) due to overlapping features. EDS patients showed a significantly increased aortic AIx compared to healthy controls (22.8% ± 10.1 vs 14.8% ± 14.0, p < 0.001). EDS showed a positive association with AIx; independent of age, sex, height, blood pressure, medication, and pack years of smoking. Conclusions Patients with EDS showed elevated AIx, indicating increased arterial stiffness when compared to healthy controls. Further investigations are needed in order to assess the prognostic value of increased AIx for cardiovascular outcomes in patients with EDS.
Collapse
Affiliation(s)
- Maurice Roeder
- Department of Pulmonology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Sira Thiel
- Department of Pulmonology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Frederic Baumann
- Clinical and Interventional Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Noriane A Sievi
- Department of Pulmonology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Marianne Rohrbach
- Division of Metabolism and Children's Research Center University Children's Hospital Zurich, Zurich, Switzerland
| | - Malcolm Kohler
- Department of Pulmonology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland. .,Centre for Interdisciplinary Sleep Research, University of Zurich, Zurich, Switzerland.
| | - Thomas Gaisl
- Department of Pulmonology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| |
Collapse
|
20
|
Grewe FA, Bradicich M, Gaisl T, Roeder M, Thiel S, Sievi NA, Kohler M. Patterns of nightly CPAP usage in OSA patients with suboptimal treatment adherence. Sleep Med 2020; 74:109-115. [PMID: 32841842 DOI: 10.1016/j.sleep.2020.05.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 05/28/2020] [Accepted: 05/31/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Low adherence impairs the effectiveness of continuous positive airway pressure (CPAP) therapy in patients with obstructive sleep apnoea (OSA), but knowledge on CPAP usage micro-patterns is mostly lacking. Thus, the aim of this study was to analyse usage micro-patterns among patients with suboptimal CPAP adherence. METHODS We analysed CPAP usage datasets comprising the initial 31 nights of therapy. By employing a threshold of 4 h usage in at least 70% of nights, we subdivided the patients into suboptimal and optimal users. We investigated single CPAP start- and stop-points, and introduced the parameter "interruption-rate", by dividing the amount of therapy interruptions per night by the usage duration per night. This parameter represents the amount of interruptions per 1 h of CPAP usage. Group comparison analysis was performed via t-test, Wilcoxon rank sum-test, and via Chi2-test. RESULTS We included datasets of 48 suboptimal and 48 optimal users (55.9 ± 11.3 years, 83.3% men) in the analysis. Interruption-rate was significantly higher among suboptimal users, when compared with optimal users (median (quartiles) 0.24 (0.14/0.45) versus 0.15 (0.05/0.28), p < 0.001∗). Suboptimal users were more likely to report that CPAP reduced their sleep quality, waked them up at night, and that CPAP side effects or problems with the device impaired their adherence. CONCLUSIONS CPAP usage micro-patterns are more fragmented among OSA patients with lower overall adherence. These patterns might result from impaired sleep quality, due to CPAP side effects, and device-associated problems.
Collapse
Affiliation(s)
- Fabian A Grewe
- Department of Pulmonology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Matteo Bradicich
- Department of Pulmonology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Thomas Gaisl
- Department of Pulmonology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Maurice Roeder
- Department of Pulmonology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sira Thiel
- Department of Pulmonology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Noriane A Sievi
- Department of Pulmonology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Malcolm Kohler
- Department of Pulmonology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Centre for Interdisciplinary Sleep Research, University of Zurich, Zurich, Switzerland.
| |
Collapse
|
21
|
Roeder M, Sievi NA, Kohler M, Schwarz EI. Predictors of changes in subjective daytime sleepiness in response to CPAP therapy withdrawal in OSA: A post-hoc analysis. J Sleep Res 2020; 30:e13078. [PMID: 32441873 DOI: 10.1111/jsr.13078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 04/25/2020] [Accepted: 04/27/2020] [Indexed: 11/28/2022]
Abstract
Subjective sleepiness is the hallmark symptom of untreated obstructive sleep apnea (OSA) and leads to an increased risk of motor vehicle accidents and impaired quality of life. Continuous positive airway pressure (CPAP) is the standard therapy for OSA and improves sleepiness. The aim was to identify factors that might predict recurrence of sleepiness in times off CPAP and to define OSA patient types with a likely effect of CPAP on sleepiness. A post-hoc analysis of six clinical trials, including 132 patients with OSA effectively treated with CPAP prior to study inclusion, who were allocated to 2 weeks of CPAP withdrawal, was conducted to assess predictors of a change in subjective sleepiness. A multivariate regression model was used to assess predictors of a change in the Epworth Sleepiness Scale (ESS) score. In response to CPAP withdrawal, the median apnea-hypopnea index (AHI) and the ESS score significantly increased compared to baseline on CPAP by 32.6/hr (95% CI, 28.8, 36.4)/hr and 2.5 (95% CI, 1.8,3.2), respectively (p < .001), in the included 132 patients. There was an independent positive association of AHI (Coef. [95% CI] 0.04 [0.01, 0.08]) with an increase in ESS score upon CPAP withdrawal, and an independent negative association of age (coef. [95% CI], -0.10 [-0.18, -0.2]), ESS on CPAP (coef. [95% CI], -0.21 [-0.40, -0.015]) and active smoking status (coef. [95% CI], -1.22 [-2.26, -0.17]). These findings suggest that younger patients with a low residual sleepiness on CPAP and a recurrence of more severe OSA during CPAP withdrawal are at highest risk of suffering from a clinically relevant return of daytime sleepiness in times off CPAP.
Collapse
Affiliation(s)
- Maurice Roeder
- Department of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, Zurich, Switzerland
| | - Noriane A Sievi
- Department of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, Zurich, Switzerland
| | - Malcolm Kohler
- Department of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, Zurich, Switzerland.,Centre of Competence Sleep and Health Zurich, University of Zurich, Zurich, Switzerland
| | - Esther I Schwarz
- Department of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, Zurich, Switzerland.,Centre of Competence Sleep and Health Zurich, University of Zurich, Zurich, Switzerland
| |
Collapse
|
22
|
Sievi NA, Kohler M, Clarenbach CF. Respond to the letter to the editor by Van't Hul et al. regarding the published manuscript "can do, don't do" are not the lazy ones: a longitudinal study on physical functioning in patients with COPD" by Sievi et al.(1). Respir Res 2020; 21:114. [PMID: 32404164 PMCID: PMC7218539 DOI: 10.1186/s12931-020-01376-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 04/27/2020] [Indexed: 11/24/2022] Open
|
23
|
Grewe FA, Sievi NA, Bradicich M, Roeder M, Brack T, Brutsche MH, Frey M, Irani S, Leuppi JD, Thurnheer R, Clarenbach CF, Kohler M. Compliance of Pharmacotherapy with GOLD Guidelines: A Longitudinal Study in Patients with COPD. Int J Chron Obstruct Pulmon Dis 2020; 15:627-635. [PMID: 32273691 PMCID: PMC7105357 DOI: 10.2147/copd.s240444] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 03/10/2020] [Indexed: 12/01/2022] Open
Abstract
Objective To evaluate the clinical implementation of pharmacotherapy recommendations for chronic obstructive pulmonary disease (COPD) based on the Global Initiative for chronic obstructive lung disease (GOLD) guidelines, in a longitudinal setting. Methods This is a sub-analysis of a prospective, non-interventional cohort study including patients with confirmed mild-to-very-severe COPD from seven pulmonary outpatient clinics in Switzerland. Follow-up visits took place annually for up to 7 years, from October 2010 until December 2016. For each visit, we evaluated the compliance of the prescribed pharmacotherapy with the concurrently valid GOLD guideline. We investigated whether step-ups or step-downs in GOLD stage or risk-group were accompanied by concordant changes in prescribed medication. Groups were compared via ANOVA. Results Data of 305 patients (62±7 years, 66% men) were analysed. In 59.1% of visits, the prescribed medication conformed to the respective valid GOLD-guideline. Patients with very severe COPD were most likely to receive pharmacotherapy in compliance with guidelines. Step-ups and step-downs in risk group, requiring escalation, or de-escalation of pharmacotherapy, were noticed in 24 and 43 follow-up visits, respectively. Step-ups were adequately implemented in 4 (16.7%) and step-downs in six cases (14.0%). Conclusion The compliance of COPD-pharmacotherapy with GOLD-guidelines is suboptimal, especially in lower risk groups. The high rates of missed out treatment-adjustments suggest that the familiarity of physicians with guidelines leaves room for improvement.
Collapse
Affiliation(s)
- Fabian A Grewe
- Pulmonary Division, University Hospital Zurich, Zurich, Switzerland
| | - Noriane A Sievi
- Pulmonary Division, University Hospital Zurich, Zurich, Switzerland
| | - Matteo Bradicich
- Pulmonary Division, University Hospital Zurich, Zurich, Switzerland
| | - Maurice Roeder
- Pulmonary Division, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Brack
- Pulmonary Division, Cantonal Hospital of Glarus, Glarus, Switzerland
| | - Martin H Brutsche
- Pulmonary Division, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
| | - Martin Frey
- Pulmonary Division, Clinic Barmelweid, Erlinsbach, Switzerland
| | - Sarosh Irani
- Pulmonary Division, Cantonal Hospital of Aarau, Aarau, Switzerland
| | - Jörg D Leuppi
- University Department of Medicine, Cantonal Hospital Baselland and University of Basel, Basel, Switzerland
| | - Robert Thurnheer
- Pulmonary Division, Cantonal Hospital of Münsterlingen, Münsterlingen, Switzerland
| | | | - Malcolm Kohler
- Pulmonary Division, University Hospital Zurich, Zurich, Switzerland.,Zurich Centre for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| |
Collapse
|
24
|
Kohlbrenner D, Sievi NA, Roeder M, Thurnheer R, Leuppi JD, Irani S, Frey M, Brutsche M, Brack T, Kohler M, Clarenbach CF. Handgrip Strength Seems Not to Be Affected by COPD Disease Progression: A Longitudinal Cohort Study. COPD 2020; 17:150-155. [DOI: 10.1080/15412555.2020.1727428] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Dario Kohlbrenner
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Noriane A. Sievi
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Maurice Roeder
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Robert Thurnheer
- Pulmonary Division, Cantonal Hospital of Muensterlingen, Muensterlingen, Switzerland
| | - Joerg D. Leuppi
- University Clinic of Medicine, Cantonal Hospital Baselland and University of Basel, Liestal, Switzerland
| | - Sarosh Irani
- Pulmonary Division, Cantonal Hospital of Aarau, Aarau, Switzerland
| | - Martin Frey
- Pulmonary Division, Clinic Barmelweid, Barmelweid, Switzerland
| | - Martin Brutsche
- Pulmonary Division, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
| | - Thomas Brack
- Pulmonary Division, Cantonal Hospital of Glarus, Glarus, Switzerland
| | - Malcolm Kohler
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | | |
Collapse
|
25
|
Grewe FA, Roeder M, Bradicich M, Schwarz EI, Held U, Thiel S, Gaisl T, Sievi NA, Kohler M. Low repeatability of Epworth Sleepiness Scale after short intervals in a sleep clinic population. J Clin Sleep Med 2020; 16:757-764. [PMID: 32039756 DOI: 10.5664/jcsm.8350] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The purpose of this study was to evaluate the short-term repeatability of the Epworth Sleepiness Scale (ESS) in patients with suspected obstructive sleep apnea and to determine whether transitory sleepiness of the patient influenced ESS results. METHODS Adult participants with suspected obstructive sleep apnea taking part in a study on the diagnostic accuracy of repeated sleep studies were eligible. For assessment of repeatability, the agreement between 2 sequential ESS scores obtained within 1 day (same-day group) or on different days within 1 week (same-week group) was evaluated. By analyzing the within-day repeatability, a possible influence of situational sleepiness on ESS results was assessed. By comparing correlations of sequential scores between both groups, a potential influence of test day-specific sleepiness on ESS results was evaluated. Data were analyzed using Bland-Altman plots, intraclass correlation coefficients, standard error of measurement analysis, and relative amounts of ESS discrepancies beyond 2, 3, 5, and 7 points. RESULTS Forty participants (mean age, 47.7 ± 15.4 years; 67.5% men) were included in this study, with 20 in each group. Bland-Altman analysis demonstrated considerable variability of repeated scores (mean ± 1.96 × SD = 1.93 [-3.81 to 7.66]). Discrepancies of at least 3 points between sequential ESS scores were found in 48% of all participants. Comparison of ESS repeatability between both groups showed no evidence for a difference. CONCLUSIONS A clinically relevant variability in ESS scores was found, even when repeated on the same day, possibly because of situational sleepiness influencing ESS results. Changes in ESS in response to interventions should be interpreted with caution because of its low test-retest reliability.
Collapse
Affiliation(s)
- Fabian A Grewe
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Maurice Roeder
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Matteo Bradicich
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Esther I Schwarz
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland.,Centre of Competence Sleep and Health Zurich, University of Zurich, Zurich, Switzerland
| | - Ulrike Held
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Sira Thiel
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Gaisl
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Noriane A Sievi
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Malcolm Kohler
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland.,Centre of Competence Sleep and Health Zurich, University of Zurich, Zurich, Switzerland
| |
Collapse
|
26
|
Roeder M, Sievi NA, Kohlbrenner D, Clarenbach CF, Kohler M. Arterial Stiffness Increases Over Time in Relation to Lung Diffusion Capacity: A Longitudinal Observation Study in COPD. Int J Chron Obstruct Pulmon Dis 2020; 15:177-187. [PMID: 32158204 PMCID: PMC6986246 DOI: 10.2147/copd.s234882] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 12/17/2019] [Indexed: 12/24/2022] Open
Abstract
Background Cardiovascular events are, after cancer, the most common cause of death in COPD patients. Arterial stiffness is an independent predictor of all-cause mortality and cardiovascular events. Several cross-sectional studies have confirmed increased arterial stiffness in patients with COPD. Various mechanisms in the development of arterial stiffness in COPD such as reduced lung function or systemic inflammation have been proposed. However, clinical predictors of arterial stiffness that had been reported in cross-sectional studies have not yet been confirmed in a longitudinal setting. We have assessed the course of augmentation index (AIx) - a measure of systemic arterial stiffness - and possible predictors in a cohort of COPD patients over a period of up to 7 years. Methods COPD patients underwent annual AIx measurement by applanation tonometry for a maximum duration of 7 years. Additionally, we performed annual assessments of lung function, blood gases, systemic inflammation, serum lipids and blood pressure. Associations between the course of AIx and potential predictors were investigated through a mixed effect model. Results Seventy-six patients (mean (SD) age 62.4 (7.1), male 67%) were included. The AIx showed a significant annual increase of 0.91% (95% CI 0.21/1.60) adjusted for baseline. The change in diffusion capacity (DLco), low-density lipoprotein (LDL), and high-sensitivity c-reactive protein (hsCRP) was independently associated with the increasing evolution of AIx (Coef. - 0.10, p<0.001, Coef. 1.37, p=0.003, and Coef. 0.07, p=0.033, respectively). Conclusion This study demonstrated a meaningful increase in arterial stiffness in COPD over time. A greater annual increase in arterial stiffness was associated with the severity of emphysema (measured by DLco), systemic inflammation, and dyslipidaemia. Clinical Trial Registration www.ClinicalTrials.gov, NCT01527773.
Collapse
Affiliation(s)
- Maurice Roeder
- Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland
| | - Noriane A Sievi
- Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland
| | - Dario Kohlbrenner
- Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland
| | | | - Malcolm Kohler
- Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland.,Centre for Interdisciplinary Sleep Research, University of Zurich, Zurich, Switzerland
| |
Collapse
|
27
|
Sievi NA, Brack T, Brutsche MH, Frey M, Irani S, Leuppi JD, Thurnheer R, Kohler M, Clarenbach CF. "Can do, don't do" are not the lazy ones: a longitudinal study on physical functioning in patients with COPD. Respir Res 2020; 21:27. [PMID: 31959169 PMCID: PMC6972031 DOI: 10.1186/s12931-020-1290-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 01/08/2020] [Indexed: 01/28/2023] Open
Abstract
Background and objective Reduced physical capacity (PC) and physical activity (PA) are common in COPD patients and associated with poor outcome. However, they represent different aspects of physical functioning and interventions do not affect them in the same manner. To address this, a new PC-PA quadrant concept was recently generated to identify clinical characteristics of sub-groups of physical functioning. The objective of this study was to I) proof the new concept and to verify their differentiating clinical characteristics, II) evaluate the consistency of the concept over time, III) assess whether patients changed their quadrant affiliation over time, IV) and to test if changes in quadrant affiliations are associated with changes in clinical characteristics. Methods In a longitudinal, prospective, non-interventional cohort with mild to very severe COPD patients, PC and PA as well as respiratory variables, COPD-specific health status, comorbidities, survival, and exacerbations were yearly assessed. Results Data from 283 patients were analysed at baseline. Mean (min/max) follow-up time was 2.4 (0.5/6.8) years. The PC-PA quadrants could be characterized as follows: I) “can’t do, don’t do”: most severe and symptomatic, several comorbidities II) “can do, don’t do”: severe but less symptomatic, several comorbidities III) “can’t do, do do”: few patients, severe and symptomatic, less comorbidities IV) “can do, do do”: mildest and less symptomatic, less comorbidities, lowest exacerbation frequency. Of the 172 patients with at least one follow-up, 58% patients never changed their quadrant affiliation, while 17% declined either PC, PA or both, 11% improved their PC, PA or both, and 14% showed improvement and decline in PC, PA or both during study period. None of the clinical characteristics or their annual changes showed consistent significant and relevant differences between all individual sub-groups. Conclusion Our findings suggest that there are no clinical characteristics allowing to distinguish between the PC-PA quadrants and the concept seems not able to illustrate disease process. However, the already low PA but preserved PC in the “can do, don’t do” quadrant raises the question if regularly assessment of PA in clinical practice would be more sensitive to detect progressive deterioration of COPD compared to the commonly used PC. Clinical trial registration www.ClinicalTrials.gov, NCT01527773.
Collapse
Affiliation(s)
- Noriane A Sievi
- Pulmonary Division, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Thomas Brack
- Pulmonary Division, Cantonal Hospital of Glarus, Glarus, Switzerland
| | - Martin H Brutsche
- Pulmonary Division, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
| | - Martin Frey
- Pulmonary Division, Clinic Barmelweid, Erlinsbach, Switzerland
| | - Sarosh Irani
- Pulmonary Division, Cantonal Hospital of Aarau, Aarau, Switzerland
| | - Jörg D Leuppi
- University Department of Medicine, Cantonal Hospital Baselland and University of Basel, Basel, Switzerland
| | - Robert Thurnheer
- Pulmonary Division, Cantonal Hospital of Münsterlingen, Münsterlingen, Switzerland
| | - Malcolm Kohler
- Pulmonary Division, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.,Zurich Centre for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Christian F Clarenbach
- Pulmonary Division, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
| |
Collapse
|
28
|
Thiel S, Haile SR, Peitzsch M, Schwarz EI, Sievi NA, Kurth S, Beuschlein F, Kohler M, Gaisl T. Endocrine responses during CPAP withdrawal in obstructive sleep apnoea: data from two randomised controlled trials. Thorax 2019; 74:1102-1105. [PMID: 31467191 DOI: 10.1136/thoraxjnl-2019-213522] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 08/09/2019] [Accepted: 08/13/2019] [Indexed: 11/03/2022]
Abstract
The aim of this investigation was to elucidate the effect of CPAP withdrawal on neurometabolic and cardiometabolic markers in patients with obstructive sleep apnoea. We evaluated 70 patients (mean age 61±10 years, 82% men) treated with CPAP in two 2-week, parallel, randomised controlled trials. CPAP withdrawal resulted in elevated 3,4-dihydroxyphenylglycol, norepinephrine and cortisol after 2 weeks of CPAP withdrawal; however, no statistically significant changes of the renin-angiotensin-aldosterone system (RAAS) determinants were documented. In summary, CPAP withdrawal may be more prominently linked to short-term increases in sympathetic activation than hypothalamic-pituitary-adrenal axis or RAAS activation. ClinicalTrials.gov Identifier: NCT02493673 and NCT02050425.
Collapse
Affiliation(s)
- Sira Thiel
- Department of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, Zurich, Switzerland
| | - Sarah R Haile
- Department of Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Mirko Peitzsch
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Esther I Schwarz
- Department of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, Zurich, Switzerland
| | - Noriane A Sievi
- Department of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, Zurich, Switzerland
| | - Salome Kurth
- Department of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, Zurich, Switzerland
| | - Felix Beuschlein
- Department of Endocrinology, Diabetology and Nutrition, University Hospital Zurich, Zurich, Switzerland.,Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
| | - Malcolm Kohler
- Department of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, Zurich, Switzerland.,Centre for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Thomas Gaisl
- Department of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
29
|
Gaisl T, Nowak A, Sievi NA, Gerard N, Clarenbach CF, Kohler M, Franzen D. Obstructive sleep apnea and quality of life in Fabry disease: a prospective parallel cohort study. Sleep Breath 2019; 24:95-101. [PMID: 30937718 DOI: 10.1007/s11325-019-01832-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 03/15/2019] [Accepted: 03/21/2019] [Indexed: 12/19/2022]
Abstract
STUDY OBJECTIVES Patients with Fabry disease (FD) report impaired quality of life and excessive daytime sleepiness. Obstructive sleep apnea (OSA) is frequently reported among patients with FD; however, its prevalence and its influence on quality of life and daytime sleepiness in this population are unclear. METHODS Patients with FD in a cohort from the University Hospital Zurich (n = 52) were one-to-two matched to healthy adult controls (n = 104) according to age, sex, and body mass index. Participants underwent structured interviews (including Short Form-36) and level-3 respiratory polygraphy. An apnea-hypopnea index of ≥ 5/h was defined as OSA and the severity of FD was quantified with the Mainz Severity Score Index (MSSI). Conditional logistic regression was used to compare the outcomes. RESULTS In patients with FD the mean MSSI was 13.3 ± 10.5 points and OSA prevalence was 19.2% vs. 9.0% in the matched control group (p = 0.09). The apnea-hypopnea index was significantly higher in patients with FD than in the control group (0.5/h [0.2-3.0] vs. 0.2/h [0.1-1.8], p = 0.026). OSA severity was associated with impaired quality of life in four dimensions for the whole study population. Furthermore, patients with FD did report significantly higher daytime sleepiness (Epworth Sleepiness Scale 7.6 points vs. 6.3 points; p = 0.01) than healthy controls. CONCLUSION Patients with mild FD do not have a higher OSA prevalence than matched control subjects. Differences in OSA severity did not reach clinical significance. Further studies are warranted to determine the impact of OSA in patients with moderate-to-severe FD.
Collapse
Affiliation(s)
- Thomas Gaisl
- Division of Pulmonology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
| | - Albina Nowak
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich, Zurich, Switzerland.,Division of Internal Medicine, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Noriane A Sievi
- Division of Pulmonology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Nicolas Gerard
- Division of Pulmonology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Christian F Clarenbach
- Division of Pulmonology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Malcolm Kohler
- Division of Pulmonology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Daniel Franzen
- Division of Pulmonology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| |
Collapse
|
30
|
Thiel S, Lettau F, Rejmer P, Rossi C, Haile S, Schwarz EI, Stöberl AS, Sievi NA, Boss A, Becker AS, Winklhofer S, Stradling JR, Kohler M. Effects of short-term continuous positive airway pressure withdrawal on cerebral vascular reactivity measured by blood oxygen level-dependent magnetic resonance imaging in obstructive sleep apnoea: a randomised controlled trial. Eur Respir J 2019; 53:13993003.01854-2018. [DOI: 10.1183/13993003.01854-2018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 11/20/2018] [Indexed: 12/20/2022]
Abstract
Impaired cerebral vascular reactivity (CVR) increases long-term stroke risk. Obstructive sleep apnoea (OSA) is associated with peripheral vascular dysfunction and vascular events. The aim of this trial was to evaluate the effect of continuous positive airway pressure (CPAP) withdrawal on CVR.41 OSA patients (88% male, mean age 57±10 years) were randomised to either subtherapeutic or continuation of therapeutic CPAP. At baseline and after 2 weeks, patients underwent a sleep study and magnetic resonance imaging (MRI). CVR was estimated by quantifying the blood oxygen level-dependent (BOLD) MRI response to breathing stimuli.OSA did recur in the subtherapeutic CPAP group (mean treatment effect apnoea–hypopnoea index +38.0 events·h−1, 95% CI 24.2–52.0; p<0.001) but remained controlled in the therapeutic group. Although there was a significant increase in blood pressure upon CPAP withdrawal (mean treatment effect +9.37 mmHg, 95% CI 1.36–17.39; p=0.023), there was no significant effect of CPAP withdrawal on CVR assessedviaBOLD MRI under either hyperoxic or hypercapnic conditions.Short-term CPAP withdrawal did not result in statistically significant changes in CVR as assessed by functional MRI, despite the recurrence of OSA. We thus conclude that, unlike peripheral endothelial function, CVR is not affected by short-term CPAP withdrawal.
Collapse
|
31
|
Sievi NA, Kohler M, Thurnheer R, Leuppi JD, Irani S, Frey M, Brutsche M, Brack T, Clarenbach CF. No impact of exacerbation frequency and severity on the physical activity decline in COPD: a long-term observation. Int J Chron Obstruct Pulmon Dis 2019; 14:431-437. [PMID: 30863043 PMCID: PMC6388775 DOI: 10.2147/copd.s188710] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction COPD exacerbations are associated with a concomitant profound reduction in daily physical activity (PA). Thereby, exacerbation frequency and severity may have an amplifying effect. Whether the reduced level of PA returns to the level prior to exacerbation or has a sustained negative impact on activity behavior over time is unclear. Methods The number of steps per day over 1 week, as a measure of daily PA, was assessed annually in a cohort of patients with COPD. Exacerbation frequency and severity were documented. Uni- and multivariate mixed effect models were used to investigate associations between change in number of steps per day (dependent variable) and exacerbations. Stratification by possible confounders was performed. Results One hundred and eighty one COPD patients (median [quartile] age 64 [59/69] years, 65% male, median [quartiles] FEV1 % pred. 46 [33/65]) suffered a total of 273 exacerbations during the observation period (median [quartiles] follow-up time of 2.1 [1.6/3.1] years). Neither the frequency nor the severity of exacerbations was significantly related to the overall decline in PA over time. Stratification by different possible confounders such as age, sex and disease severity did not yield a subgroup in which exacerbations enhance the decrease in PA over time. Conclusion The drop in PA during the phase of an acute exacerbation seems not to be a lasting phenomenon leading to a fundamental change in activity behavior. Trial registration www.ClinicalTrials.gov, NCT01527773
Collapse
Affiliation(s)
- Noriane A Sievi
- Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland,
| | - Malcolm Kohler
- Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland,
| | - Robert Thurnheer
- Pulmonary Division, Cantonal Hospital of Münsterlingen, Münsterlingen, Switzerland
| | - Joerg D Leuppi
- University Clinic of Medicine, Cantonal Hospital Baselland and University of Basel, Basel, Switzerland
| | - Sarosh Irani
- Pulmonary Division, Cantonal Hospital of Aarau, Aarau, Switzerland
| | - Martin Frey
- Pulmonary Division, Clinic Barmelweid, Barmelweid, Switzerland
| | - Martin Brutsche
- Pulmonary Division, Cantonal Hospital of St Gallen, St Gallen, Switzerland
| | - Thomas Brack
- Pulmonary Division, Cantonal Hospital of Glarus, Glarus, Switzerland
| | | |
Collapse
|
32
|
Stöberl AS, Gaisl T, Giunta C, Sievi NA, Singer F, Möller A, Rohrbach M, Kohler M. Obstructive Sleep Apnoea in Children and Adolescents with Ehlers-Danlos Syndrome. Respiration 2018; 97:284-291. [PMID: 30485858 DOI: 10.1159/000494328] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 10/05/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND In Ehlers-Danlos syndrome (EDS), a group of monogenic disorders affecting connective tissues, obstructive sleep apnoea (OSA) is highly prevalent in adults. The prevalence of OSA in children with EDS is unknown. OBJECTIVES This prospective cross-sectional study aimed at determining the prevalence of OSA in paediatric EDS patients. METHODS Children with EDS (n = 24) were recruited from the Children's Hospital Zurich and matched to healthy controls. Participants completed home respiratory polygraphy and questionnaires (Sleep-Related Breathing Disorder Scale [SRBD], Epworth Sleepiness Scale [ESS], and Child Health Questionnaire [CHQ]). The American Academy of Sleep Medicine criteria were applied for OSA diagnosis (obstructive apnoea-hypopnoea index [oAHI] ≥1/h). Conditional logistic regression was used to compare the prevalence of OSA and to adjust for possible confounding. RESULTS OSA was found in 42% of paediatric EDS patients and in 13% of matched controls (OR = 4.5, 95% CI = 0.97-20.83, p = 0.054). The median oAHI was higher in EDS patients than in controls (0.77/h, IQR = 0.19-1.76, vs. 0.24/h, IQR = 0.0-0.60, p < 0.001 adjusted for age, sex, and BMI z-score). EDS patients had lower scores in most CHQ scales and higher SRBD and ESS scores than controls (0.26, IQR = 0.1-0.35, vs. 0.07, IQR = 0-0.19, p = 0.004); 7 ± 4 vs. 5 ± 4, p = 0.033, respectively). CONCLUSION OSA is a previously underestimated EDS-related complication increasing disease burden.
Collapse
Affiliation(s)
- Anna S Stöberl
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Gaisl
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Cecilia Giunta
- Connective Tissue Unit, Division of Metabolism and Children's Research Centre, University Children's Hospital, Zurich, Switzerland
| | - Noriane A Sievi
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Florian Singer
- Division of Respiratory Medicine, University Children's Hospital Zurich, Zurich, Switzerland
| | - Alexander Möller
- Division of Respiratory Medicine, University Children's Hospital Zurich, Zurich, Switzerland.,Centre for Interdisciplinary Sleep Research, University of Zurich, Zurich, Switzerland
| | - Marianne Rohrbach
- Connective Tissue Unit, Division of Metabolism and Children's Research Centre, University Children's Hospital, Zurich, Switzerland
| | - Malcolm Kohler
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland, .,Centre for Interdisciplinary Sleep Research, University of Zurich, Zurich, Switzerland,
| |
Collapse
|
33
|
Güntner AT, Kompalla JF, Landis H, Theodore SJ, Geidl B, Sievi NA, Kohler M, Pratsinis SE, Gerber PA. Guiding Ketogenic Diet with Breath Acetone Sensors. Sensors (Basel) 2018; 18:E3655. [PMID: 30373291 PMCID: PMC6264102 DOI: 10.3390/s18113655] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 10/22/2018] [Accepted: 10/22/2018] [Indexed: 12/12/2022]
Abstract
Ketogenic diet (KD; high fat, low carb) is a standard treatment for obesity, neurological diseases (e.g., refractory epilepsy) and a promising method for athletes to improve their endurance performance. Therein, the level of ketosis must be regulated tightly to ensure an effective therapy. Here, we introduce a compact and inexpensive breath sensor to monitor ketosis online and non-invasively. The sensor consists of Si-doped WO₃ nanoparticles that detect breath acetone selectively with non-linear response characteristics in the relevant range of 1 to 66 ppm, as identified by mass spectrometry. When tested on eleven subjects (five women and six men) undergoing a 36-h KD based on the Johns Hopkins protocol, this sensor clearly recognizes the onset and progression of ketosis. This is in good agreement to capillary blood β-hydroxybutyrate (BOHB) measurements. Despite similar dieting conditions, strong inter-subject differences in ketosis dynamics were observed and correctly identified by the sensor. These even included breath acetone patterns that could be linked to low tolerance to that diet. As a result, this portable breath sensor represents an easily applicable and reliable technology to monitor KD, possibly during medical treatment of epilepsy and weight loss.
Collapse
Affiliation(s)
- Andreas T Güntner
- Particle Technology Laboratory, Department of Mechanical and Process Engineering, ETH Zurich, CH-8092 Zurich, Switzerland.
| | - Julia F Kompalla
- Particle Technology Laboratory, Department of Mechanical and Process Engineering, ETH Zurich, CH-8092 Zurich, Switzerland.
| | - Henning Landis
- Particle Technology Laboratory, Department of Mechanical and Process Engineering, ETH Zurich, CH-8092 Zurich, Switzerland.
| | - S Jonathan Theodore
- Particle Technology Laboratory, Department of Mechanical and Process Engineering, ETH Zurich, CH-8092 Zurich, Switzerland.
| | - Bettina Geidl
- Department of Endocrinology, Diabetes, and Clinical Nutrition, University Hospital Zurich, CH-8091 Zurich, Switzerland.
| | - Noriane A Sievi
- Department of Pulmonology, University Hospital Zurich, CH-8091 Zurich, Switzerland.
| | - Malcolm Kohler
- Department of Pulmonology, University Hospital Zurich, CH-8091 Zurich, Switzerland.
| | - Sotiris E Pratsinis
- Particle Technology Laboratory, Department of Mechanical and Process Engineering, ETH Zurich, CH-8092 Zurich, Switzerland.
| | - Philipp A Gerber
- Department of Endocrinology, Diabetes, and Clinical Nutrition, University Hospital Zurich, CH-8091 Zurich, Switzerland.
| |
Collapse
|
34
|
Crook S, Sievi NA, Bloch KE, Stradling JR, Frei A, Puhan MA, Kohler M. Minimum important difference of the Epworth Sleepiness Scale in obstructive sleep apnoea: estimation from three randomised controlled trials. Thorax 2018; 74:390-396. [PMID: 30100576 DOI: 10.1136/thoraxjnl-2018-211959] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 06/21/2018] [Accepted: 07/23/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND The Epworth Sleepiness Scale (ESS) is a widely used tool for assessing sleepiness in patients with obstructive sleep apnoea (OSA). We aimed to estimate the minimal important difference (MID) in patients with OSA. METHODS We used individual data from three randomised controlled trials (RCTs) in patients with OSA where the preintervention to postintervention change in ESS was used as a primary outcome. We used anchor-based linear regression and responder analysis approaches to estimate the MID. For anchors, we used the change in domains of the Functional Outcomes of Sleep Questionnaire and 36-Item Short Form Health Survey. We also used the distribution-based approaches Cohen's effect size, SE of measurement and empirical rule effect size to support the anchor-based estimates. The final MID was determined by triangulating all estimates to a single MID. FINDINGS A total of 639 patients with OSA were included in our analyses across the three RCTs with a median (IQR) baseline ESS score of 10 (6-13). The median (IQR) ESS change score overall was -2 (-5 to 1). The anchor-based estimates of the MID were between -1.74 and -4.21 points and estimates from the responder analysis were between -1 and -3 points. Distribution-based estimates were smaller, ranging from -1.46 to -2.36. INTERPRETATION We propose an MID for the ESS of 2 points in patients with OSA with a disease severity from mild to severe. This estimate provides the means to plan trials and interpret the clinical relevance of changes in ESS. TRIAL REGISTRATION NUMBER Provent, NCT01332175; autoCPAP trial, NCT00280800; MOSAIC,ISRCTN (3416388).
Collapse
Affiliation(s)
- Sarah Crook
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Noriane A Sievi
- Department of Pneumology, University Hospital of Zurich, Zurich, Switzerland
| | - Konrad E Bloch
- Department of Pneumology, University Hospital of Zurich, Zurich, Switzerland.,Center of Interdisciplinary Sleep Research, University of Zurich, Zurich, Switzerland
| | - John R Stradling
- Oxford Centre for Respiratory Medicine and Oxford NIHR Biomedical Research Centre, Churchill Campus, Oxford University, Oxford, UK
| | - Anja Frei
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Milo A Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Malcolm Kohler
- Department of Pneumology, University Hospital of Zurich, Zurich, Switzerland.,Center of Interdisciplinary Sleep Research, University of Zurich, Zurich, Switzerland
| |
Collapse
|
35
|
Sievi NA, Brack T, Brutsche MH, Frey M, Irani S, Leuppi JD, Thurnheer R, Kohler M, Clarenbach CF. Physical activity declines in COPD while exercise capacity remains stable: A longitudinal study over 5 years. Respir Med 2018; 141:1-6. [DOI: 10.1016/j.rmed.2018.06.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 06/13/2018] [Accepted: 06/14/2018] [Indexed: 10/14/2022]
|
36
|
Sievi NA, Franzen D, Kohler M, Clarenbach CF. Lung volume reduction surgery does not increase daily physical activity in patients with severe chronic obstructive pulmonary disease. J Thorac Dis 2018; 10:2722-2730. [PMID: 29997934 DOI: 10.21037/jtd.2018.05.18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Lung volume reduction surgery (LVRS) is a treatment option for selected patients with severe chronic obstructive pulmonary disease (COPD) and emphysema. The positive effects of LVRS on exercise capacity are well known. In contrast, the effect of LVRS on daily physical activity (PA) is less clear. Methods In a prospective case-control study we evaluated selected patients with severe COPD and emphysema who underwent LVRS and COPD patients following usual care. Controls were matched for age, severity of airflow obstruction (FEV1) and hyperinflation [residual volume to total lung capacity (RV/TLC)]. Treatment effect of LVRS on activity parameters was analysed using univariable regression model adjusting for treatment group. Results A total of 19 patients underwent LVRS and 16 COPD patients without a surgical intervention during the study period were included. The median (quartile) FEV1%pred was 28% (range, 21-33%), RV/TLC was 69% (range, 64-73%) in cases while controls had a median (quartile) FEV1%pred of 33% (range, 28.5-49.5%) and a RV/TLC of 58% (range, 49-61%). Age and body mass index (BMI) were comparable between both groups. Number of steps per day following LVRS was comparable to before the intervention (mean change: -115, 95% CI: -994.6 to 764.3, P=0.779) and was not significantly different to the change in control subjects (mean treatment effect: 931.4, 95% CI: -252.4 to 2,115.1, P=0.117). Conclusions The results from this study reveal that patients undergoing LVRS did not increase their daily level of PA despite improvement of exercise capacity and symptoms.
Collapse
Affiliation(s)
- Noriane A Sievi
- Division of Pulmonary, University Hospital of Zurich, Zurich, Switzerland
| | - Daniel Franzen
- Division of Pulmonary, University Hospital of Zurich, Zurich, Switzerland
| | - Malcolm Kohler
- Division of Pulmonary, University Hospital of Zurich, Zurich, Switzerland.,Zurich Centre for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | | |
Collapse
|
37
|
Güntner AT, Sievi NA, Theodore SJ, Gulich T, Kohler M, Pratsinis SE. Noninvasive Body Fat Burn Monitoring from Exhaled Acetone with Si-doped WO 3-sensing Nanoparticles. Anal Chem 2017; 89:10578-10584. [PMID: 28891296 DOI: 10.1021/acs.analchem.7b02843] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Obesity is a global health threat on the rise, and its prevalence continues to grow. Yet suitable biomedical sensors to monitor body fat burn rates in situ, to guide physical activity or dietary interventions toward efficient weight loss, are missing. Here, we introduce a compact and inexpensive breath acetone sensor based on Si-doped WO3 nanoparticles that can accurately follow body fat burn rates in real time. We tested this sensor on 20 volunteers during exercise and rest and measured their individual breath acetone concentrations in good agreement with benchtop proton transfer reaction time-of-flight mass spectrometry (PTR-TOF-MS). During exercise, this sensor reveals clearly the onset and progression of increasing breath acetone levels that indicate intensified body fat metabolism, as validated by parallel venous blood β-hydroxybutyrate (BOHB) measurements. Most importantly, we found that the body fat metabolism was especially pronounced for most volunteers during fasting for 3 h after exercise, with strong variation between subjects, and this was displayed correctly by the sensor in real-time. As a result, this simple breath acetone sensor enables easily applicable and hand-held body fat burn monitoring for personalized and immediate feedback on workout effectiveness that can guide dieting as well.
Collapse
Affiliation(s)
- A T Güntner
- Particle Technology Laboratory, Department of Mechanical and Process Engineering, Eidgenössische Technische Hochschule Zürich , CH-8092 Zürich, Switzerland
| | - N A Sievi
- Department of Pulmonology, University Hospital Zürich , CH-8091 Zürich, Switzerland
| | - S J Theodore
- Particle Technology Laboratory, Department of Mechanical and Process Engineering, Eidgenössische Technische Hochschule Zürich , CH-8092 Zürich, Switzerland
| | - T Gulich
- Particle Technology Laboratory, Department of Mechanical and Process Engineering, Eidgenössische Technische Hochschule Zürich , CH-8092 Zürich, Switzerland
| | - M Kohler
- Department of Pulmonology, University Hospital Zürich , CH-8091 Zürich, Switzerland
| | - S E Pratsinis
- Particle Technology Laboratory, Department of Mechanical and Process Engineering, Eidgenössische Technische Hochschule Zürich , CH-8092 Zürich, Switzerland
| |
Collapse
|
38
|
Clarenbach CF, Sievi NA, Kohler M. Annual progression of endothelial dysfunction in patients with COPD. Respir Med 2017; 132:15-20. [PMID: 29229089 DOI: 10.1016/j.rmed.2017.09.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 08/16/2017] [Accepted: 09/15/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND The risk to die from cardiovascular disease is particularly high in patients with COPD. This longitudinal study aims to evaluate changes of endothelial function over time and identify underlying mechanisms in COPD patients. METHODS In stable COPD patients we performed annual assessments of endothelial function by flow-mediated dilatation (FMD), lung function, systemic inflammation and cholesterol, sympathetic activation, oxygenation, physical activity and exercise capacity. Associations between annual changes of potential predictors and FMD were investigated in mixed analysis. RESULTS 76 patients (41% GOLD stage 1/2, 30% 3, 29% 4) were included. Endothelial function significantly decreased annually by -0.14% (95%CI -0.25/-0.04), equal to a relative decrease of -5.6%. Yearly change in 6-min walking distance was significantly associated with FMD in univariable analysis (Coef. -0.00, p = 0.045). Progressive airway obstruction and increase in level of total cholesterol were borderline significant with a greater decrease in FMD (Coeff. -0.02, p = 0.097 and Coeff. -0.16, p = 0.080, respectively). In multivariable analysis a greater annual decline in FEV1 tends to be independently associated with a decrease in FMD (p = 0.085). CONCLUSION The findings of this study demonstrated that COPD patients experience a significant decrease in endothelial function over time. A greater annual decline in lung function tends to be associated with greater decrease in FMD. However, no other independent predictors for endothelial dysfunction could be identified. CLINICAL TRIAL REGISTRATION www.ClinicalTrials.gov, NCT01527773.
Collapse
Affiliation(s)
| | - Noriane A Sievi
- Pulmonary Division, University Hospital Zurich, Zurich, Switzerland
| | - Malcolm Kohler
- Pulmonary Division, University Hospital Zurich, Zurich, Switzerland; Center for Integrative Human Physiology, University of Zurich, Switzerland
| |
Collapse
|
39
|
Sievi NA, Brack T, Brutsche MH, Frey M, Irani S, Leuppi JD, Thurnheer R, Kohler M, Clarenbach CF. Accelerometer- versus questionnaire-based assessment of physical activity and their changes over time in patients with COPD. Int J Chron Obstruct Pulmon Dis 2017; 12:1113-1118. [PMID: 28435244 PMCID: PMC5391993 DOI: 10.2147/copd.s130195] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background and objective Physical activity (PA) is an important outcome parameter in patients with COPD regarding hospitalizations and mortality. Both objective assessment by accelerometers and self-evaluation by questionnaires were used in studies investigating PA in COPD. Whether self-reported questionnaires can adequately reflect PA and its changes over time compared to objective assessments has not been thoroughly investigated in COPD. In this COPD cohort study, we evaluated whether PA measured by accelerometer and its annual changes can also be assessed by self-reported questionnaires. Methods In 178 COPD patients with at least two assessments of PA, the agreement between objectively measured and self-reported activity was analyzed by Bland–Altman plots. Daily PA was assessed by a triaxial activity monitor over 1 week and by the self-reported German PA questionnaire 50+. Results Comparison between the two methods of measurement revealed no convincing agreement with a mean difference and limits of agreement (±1.96 standard deviation [SD]) of time spent in at least moderate PA (>3 metabolic equivalent of task [MET]) of −77.6 (−340.3/185.2) min/day, indicating a self-reported overestimation of PA by the questionnaire. The mean difference and limits of agreement (±1.96SD) in the annual change of PA was 1.2 min/day (−208.2/282.6 min/day), showing also a poor agreement on an individual level. Conclusion Evaluation of objectively measured and self-reported PA and their annual changes revealed no agreement in patients with COPD. Therefore, the evaluated questionnaire seems not helpful for measurement of PA and its changes over time.
Collapse
Affiliation(s)
| | - Thomas Brack
- Pulmonary Division, Cantonal Hospital of Glarus, Glarus
| | | | | | - Sarosh Irani
- Pulmonary Division, Cantonal Hospital of Aarau, Aarau
| | - Jörg D Leuppi
- University Clinic of Internal Medicine, Cantonal Hospital Baselland
| | - Robert Thurnheer
- Pulmonary Division, Cantonal Hospital of Münsterlingen, Münsterlingen
| | - Malcolm Kohler
- Pulmonary Division, University Hospital of Zurich, Zurich.,Zurich Centre for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | | |
Collapse
|
40
|
Clarenbach CF, Sievi NA, Haile SR, Brack T, Brutsche MH, Frey M, Irani S, Leuppi JD, Thurnheer R, Kohler M. Determinants of annual change in physical activity in COPD. Respirology 2017; 22:1133-1139. [DOI: 10.1111/resp.13035] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 01/13/2017] [Accepted: 01/13/2017] [Indexed: 12/01/2022]
Affiliation(s)
| | - Noriane A. Sievi
- Pulmonary Division; University Hospital of Zurich; Zurich Switzerland
| | - Sarah R. Haile
- Epidemiology, Biostatistics and Prevention Institute; University of Zurich; Zurich Switzerland
| | - Thomas Brack
- Pulmonary Division; Cantonal Hospital of Glarus; Glarus Switzerland
| | - Martin H. Brutsche
- Pulmonary Division; Cantonal Hospital of St. Gallen; St. Gallen Switzerland
| | - Martin Frey
- Pulmonary Division; Clinic Barmelweid; Barmelweid Switzerland
| | - Sarosh Irani
- Pulmonary Division; Cantonal Hospital of Aarau; Aarau Switzerland
| | - Jörg D. Leuppi
- University Clinic of Internal Medicine; Cantonal Hospital Baselland and University of Basel; Basel Switzerland
| | - Robert Thurnheer
- Pulmonary Division; Cantonal Hospital of Münsterlingen; Münsterlingen Switzerland
| | - Malcolm Kohler
- Pulmonary Division; University Hospital of Zurich; Zurich Switzerland
- Zurich Centre for Integrative Human Physiology; University of Zurich; Zurich Switzerland
| |
Collapse
|
41
|
Sievi NA, Clarenbach CF, Kohler M. Chronic Obstructive Pulmonary Disease and Cardiac Repolarization: Data from a Randomized Controlled Trial. Respiration 2016; 91:288-95. [DOI: 10.1159/000445030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 02/29/2016] [Indexed: 11/19/2022] Open
|
42
|
Franzen D, Gerard N, Bratton DJ, Wons A, Gaisl T, Sievi NA, Clarenbach CF, Kohler M, Krayenbühl PA. Prevalence and Risk Factors of Sleep Disordered Breathing in Fabry disease: A Prospective Cohort Study. Medicine (Baltimore) 2015; 94:e2413. [PMID: 26717401 PMCID: PMC5291642 DOI: 10.1097/md.0000000000002413] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Excessive daytime sleepiness (EDS) is a frequently reported and not well-understood symptom in patients with Fabry disease (FD). Sleep-disordered breathing (SDB) is a possible factor. As deposition of glycosphingolipids in the upper airway muscles is likely, we hypothesized that obstructive sleep apnoea (OSA) is highly prevalent in FD and positively associated with its severity.All patients with FD who are followed in the Fabry cohort of the University Hospital Zurich (n = 62) were asked to participate in this prospective cohort study. Eligible patients were prospectively investigated by assessing their daytime sleepiness using the Epworth Sleepiness Scale (ESS), the severity of FD using the Mainz Severity Score Index (MSSI), and by an ambulatory overnight respiratory polygraphy between November 1, 2013, and January 31, 2015. SDB was defined as an apnea/hypopnea index (AHI) of > 5/h.Fifty-two patients (mean ± SD age 42.8 ± 14.7 years, 33% men, mean ± SD BMI 23.4 ± 3.6 kg/m) with a median (IQR) MSSI of 12 (5-19) were included. Median (IQR) ESS was 6 (2-10) and 7 patients (14%) had an ESS > 10. Thirteen patients (25%) had SDB (78% obstructive sleep apnea, 22% central sleep apnea). In the multivariable analysis, the age was the only statistically significant predictor of SDB (OR 1.11, 95% CI 1.04-1.18, P = 0.001). ESS was associated with depression (P < 0.001) but not AHI nor age.This study shows that SDB, especially obstructive sleep apnea is highly prevalent in patients with Fabry disease. However, EDS in FD seems to be related with depression rather than SDB.ClinicalTrials.gov (identifier: NCT01947634).
Collapse
Affiliation(s)
- Daniel Franzen
- From the Division of Pulmonology, University Hospital Zurich, Raemistrasse, Zurich (DF, NG, DJB, AW, TG, NAS, CFC, MK); and Department of Internal Medicine, Regional Hospital Linth, Gasterstrasse, Uznach, Switzerland (PAK)
| | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Clarenbach CF, Sievi NA, Brock M, Schneiter D, Weder W, Kohler M. Lung Volume Reduction Surgery and Improvement of Endothelial Function and Blood Pressure in Patients with Chronic Obstructive Pulmonary Disease. A Randomized Controlled Trial. Am J Respir Crit Care Med 2015; 192:307-14. [PMID: 26016823 DOI: 10.1164/rccm.201503-0453oc] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Cardiovascular disease is a major cause of morbidity and mortality in patients with chronic obstructive pulmonary disease (COPD). Preliminary studies have shown that both airflow obstruction and systemic inflammation may contribute to endothelial dysfunction in COPD. Lung volume reduction surgery (LVRS) is a treatment option in selected patients with COPD with emphysema that improves breathing mechanics and lung function. OBJECTIVES To determine the effect of LVRS on endothelial function and systemic inflammation. METHODS We conducted a randomized controlled trial in 30 patients scheduled for LVRS. In the intervention group, immediate LVRS was performed after baseline evaluation followed by reassessment 3 months later. In the control group, reassessment followed 3 months after baseline evaluation, and thereafter LVRS was performed. MEASUREMENTS AND MAIN RESULTS The primary outcome measures were the treatment effect on endothelial function and systemic inflammation. In the LVRS group 14 patients completed the trial and 13 in the control group. LVRS led to a relative reduction in mean (SD) residual volume/total lung capacity of -12% (12%) and an increase in FEV1 of 29% (27%). Flow-mediated dilatation of the brachial artery increased in the intervention group as compared with the control group (+2.9%; 95% confidence interval, +2.1 to +3.6%; P < 0.001), whereas there was no significant change in systemic inflammation. A significant treatment effect on mean blood pressure was observed (-9.0 mm Hg; 95% confidence interval, -17.5 to -0.5; P = 0.039). CONCLUSIONS Endothelial function and blood pressure are improved 3 months after LVRS in patients with severe COPD and emphysema. LVRS may therefore have beneficial effects on cardiovascular outcomes. Clinical trial registered with www.clinicaltrials.gov (NCT 01020344).
Collapse
Affiliation(s)
| | | | | | - Didier Schneiter
- 2 Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland; and
| | - Walter Weder
- 2 Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland; and
| | - Malcolm Kohler
- 1 Department of Pulmonology and.,3 Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| |
Collapse
|
44
|
Abstract
BACKGROUND Arterial stiffness is an important predictor of cardiovascular risk besides classic cardiovascular risk factors. Previous studies showed that arterial stiffness is increased in patients with COPD compared to healthy controls and exercise training may reduce arterial stiffness. Since physical inactivity is frequently observed in patients with COPD and exercise training may improve arterial stiffness, we hypothesized that low daily physical activity may be associated with increased arterial stiffness. METHODS In 123 patients with COPD (72% men; mean [standard deviation] age: 62 [7.5] years; median [quartile] forced expiratory volume in 1 second 35 [27/65] %predicted), arterial stiffness was assessed by augmentation index (AI). Daily physical activity level (PAL) was measured by an activity monitor (SenseWear Pro™) >1 week. The association between AI and PAL was investigated by univariate and multivariate regression analysis, taking into account disease-specific characteristics and comorbidities. RESULTS Patients suffered from moderate (35%), severe (32%), and very severe (33%) COPD, and 22% were active smokers. Median (quartile) PAL was 1.4 (1.3/1.5) and mean (standard deviation) AI 26% (9.2%). PAL showed a negative association with AI (B=-9.32, P=0.017) independent of age, sex, blood pressure, and airflow limitation. CONCLUSION In COPD patients, a higher PAL seems to favorably influence arterial stiffness and therefore may reduce cardiovascular risk. CLINICAL TRIAL REGISTRATION http://www.ClinicalTrials.gov, NCT01527773.
Collapse
Affiliation(s)
- Noriane A Sievi
- Division of Pulmonology, University Hospital of Zurich, Zurich, Switzerland
| | - Daniel Franzen
- Division of Pulmonology, University Hospital of Zurich, Zurich, Switzerland
| | - Malcolm Kohler
- Division of Pulmonology, University Hospital of Zurich, Zurich, Switzerland ; Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | | |
Collapse
|
45
|
Gaisl T, Schlatzer C, Schwarz EI, Possner M, Stehli J, Sievi NA, Clarenbach CF, Dey D, Slomka PJ, Kaufmann PA, Kohler M. Coronary artery calcification, epicardial fat burden, and cardiovascular events in chronic obstructive pulmonary disease. PLoS One 2015; 10:e0126613. [PMID: 26011039 PMCID: PMC4444203 DOI: 10.1371/journal.pone.0126613] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 04/04/2015] [Indexed: 01/23/2023] Open
Abstract
RATIONALE Patients with chronic obstructive pulmonary disease (COPD) suffer from significantly more cardiovascular comorbidity and mortality than would be anticipated from conventional risk factors. The aim of this study was to determine whether COPD patients have a higher coronary artery calcium score (CACS) and epicardial fat burden, compared to control subjects, and their association with cardiovascular events. METHODS From a registry of 1906 patients 81 patients with clinically diagnosed COPD were one-to-one matched to 81 non-COPD control subjects with a smoking history, according to their age, sex, and the number of classic cardiovascular risk factors (arterial hypertension, diabetes mellitus, dyslipidemia, family history of premature coronary artery disease). CACS, epicardial fat, and subsequent major adverse cardiovascular events (MACE) during follow-up were compared between groups. RESULTS Patients with COPD (Global Initiative for Chronic Obstructive Lung Disease-classification I: 5%, II: 23%, III: 16% and IV: 56%) showed no difference in CACS (median difference 68 Agatston Units [95% confidence interval -176.5 to 192.5], p=0.899) or epicardial fat volume (mean difference -0.5 cm3 [95% confidence interval -20.9 to 21.9], p=0.961) compared with controls. After a median follow-up of 42.6 months a higher incidence of MACE was observed in COPD patients (RR=2.80, p=0.016) compared with controls. Cox proportional hazard regression identified cardiac ischemias and CACS as independent predictors for MACE. CONCLUSION COPD patients experienced a higher MACE incidence compared to controls despite no baseline differences in coronary calcification and epicardial fat burden. Other mechanisms such as undersupply of medication seem to account for an excess cardiovascular comorbidity in COPD patients.
Collapse
Affiliation(s)
- Thomas Gaisl
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | | | - Esther I. Schwarz
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Mathias Possner
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Julia Stehli
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Noriane A. Sievi
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | | | - Damini Dey
- Departments of Medicine and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Piotr J. Slomka
- Departments of Medicine and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Philipp A. Kaufmann
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Malcolm Kohler
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
- Zurich Centre for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
- Centre for Interdisciplinary Sleep Research, University of Zurich, Zurich, Switzerland
- * E-mail:
| |
Collapse
|
46
|
Schlatzer C, Schwarz EI, Sievi NA, Clarenbach CF, Gaisl T, Haegeli LM, Duru F, Stradling JR, Kohler M. Intrathoracic pressure swings induced by simulated obstructive sleep apnoea promote arrhythmias in paroxysmal atrial fibrillation. Europace 2015; 18:64-70. [DOI: 10.1093/europace/euv122] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 04/02/2015] [Indexed: 02/03/2023] Open
|
47
|
Sievi NA, Senn O, Brack T, Brutsche MH, Frey M, Irani S, Leuppi JD, Thurnheer R, Franzen D, Kohler M, Clarenbach CF. Impact of comorbidities on physical activity in COPD. Respirology 2015; 20:413-8. [PMID: 25565363 DOI: 10.1111/resp.12456] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 09/15/2014] [Accepted: 11/09/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Both comorbidities and physical inactivity have been shown to impair quality of life and contribute to hospital admissions and mortality in chronic obstructive pulmonary disease (COPD) patients. We hypothesized that the comorbid status predicts the level of daily physical activity (PA) in COPD. METHODS In 228 patients with COPD (76% men; median (quartiles) age: 64 (59/69) years; percentage of predicted forced expiratory volume in 1 s (FEV1 % pred): 44 (31/63)), comorbidities were assessed by medical history, clinical interviews, examination and blood analysis. PA level (PAL) was measured by an activity monitor (SenseWear Pro, Bodymedia Inc., Pittsburgh, PA, USA). The association between PAL and comorbidities was investigated by univariate and multivariate regression analysis. RESULTS Seventy-nine percent of the COPD patients had at least one additional chronic comorbidity, 56% had two or more comorbidities and 35% had three or more comorbidities. In univariate analysis body mass index, the number of pack years and having at least one additional comorbidity was negatively associated with PAL while there was a positive nonlinear association between FEV1 and PAL. The presence of at least one additional comorbidity was independently associated with PAL irrespective of airflow limitation. CONCLUSIONS In this cohort, almost 80% of COPD patients had at least one additional chronic comorbidity. The level of daily PA seems to be significantly impaired by the presence of comorbidities irrespective of the type of comorbidity and independent of the degree of airflow limitation. CLINICAL TRIAL REGISTRATION NCT01527773 at http://www.clinicalTrials.gov.
Collapse
Affiliation(s)
- Noriane A Sievi
- Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Rausch-Osthoff AK, Kohler M, Sievi NA, Clarenbach CF, Van Gestel AJ. Association between peripheral muscle strength, exercise performance, and physical activity in daily life in patients with Chronic Obstructive Pulmonary Disease. Multidiscip Respir Med 2014. [DOI: 10.4081/mrm.2014.372] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Resistance training of peripheral muscles has been recommended in order to increase muscle strength in patients with Chronic Obstructive Pulmonary Disease (COPD). However, whether peripheral muscle strength is associated with exercise performance (EP) and physical activity in daily life (PADL) in these patients needs to be investigated. The aim of this study is to evaluate whether strength of the quadriceps muscle (QS) is associated with EP and daily PADL in patients with COPD.
Methods: We studied patients with COPD (GOLD A-D) and measured maximal isometric strength of the left QS. PADL was measured for 7 days with a SenseWear-Pro® accelerometer. EP was quantified by the 6-minute walk distance (6MWD), the number of stands in the Sit-to-Stand Test (STST), and the handgrip-strength. Univariate and multivariate analyses were used to examine possible associations between QS, PADL and EP.
Results: In 27 patients with COPD with a mean (SD) FEV1 of 37.6 (17.6)% predicted, QS was associated with 6MWD, STST, and handgrip-strength but not with PADL. Multiple linear regression analyses showed that QS was independently associated with the 6MWD (β = 0.42, 95% CI 0.09 to 0.84, p = 0.019), STST (β = 0.50, 95% CI 0.11 to 0.86, p = 0.014) and with handgrip-strength (β = 0.45, 95% CI 0.05 to 0.84, p = 0.038).
Conclusions: Peripheral muscle strength may be associated with exercise performance but not with physical activity in daily life. This may be due to the fact that EP tests evaluate patients’ true abilities while PADL accelerometers may not.
Collapse
|
49
|
Rausch-Osthoff AK, Kohler M, Sievi NA, Clarenbach CF, van Gestel AJ. Association between peripheral muscle strength, exercise performance, and physical activity in daily life in patients with Chronic Obstructive Pulmonary Disease. Multidiscip Respir Med 2014; 9:37. [PMID: 25013723 PMCID: PMC4091091 DOI: 10.1186/2049-6958-9-37] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 06/18/2014] [Indexed: 04/10/2023] Open
Abstract
BACKGROUND Resistance training of peripheral muscles has been recommended in order to increase muscle strength in patients with Chronic Obstructive Pulmonary Disease (COPD). However, whether peripheral muscle strength is associated with exercise performance (EP) and physical activity in daily life (PADL) in these patients needs to be investigated. The aim of this study is to evaluate whether strength of the quadriceps muscle (QS) is associated with EP and daily PADL in patients with COPD. METHODS We studied patients with COPD (GOLD A-D) and measured maximal isometric strength of the left QS. PADL was measured for 7 days with a SenseWear-Pro® accelerometer. EP was quantified by the 6-minute walk distance (6MWD), the number of stands in the Sit-to-Stand Test (STST), and the handgrip-strength. Univariate and multivariate analyses were used to examine possible associations between QS, PADL and EP. RESULTS In 27 patients with COPD with a mean (SD) FEV1 of 37.6 (17.6)% predicted, QS was associated with 6MWD, STST, and handgrip-strength but not with PADL. Multiple linear regression analyses showed that QS was independently associated with the 6MWD (β = 0.42, 95% CI 0.09 to 0.84, p = 0.019), STST (β = 0.50, 95% CI 0.11 to 0.86, p = 0.014) and with handgrip-strength (β = 0.45, 95% CI 0.05 to 0.84, p = 0.038). CONCLUSIONS Peripheral muscle strength may be associated with exercise performance but not with physical activity in daily life. This may be due to the fact that EP tests evaluate patients' true abilities while PADL accelerometers may not.
Collapse
Affiliation(s)
- Anne-Kathrin Rausch-Osthoff
- Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland ; Department of Physiotherapy, Zurich University of Applied Sciences, Winterthur, Switzerland ; Zurich University of Applied Sciences, School of Health Professions, Department of Physiotherapy, Technikumstrasse 71, 8401 Winterthur, Switzerland
| | - Malcolm Kohler
- Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland ; Centre for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Noriane A Sievi
- Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland
| | | | - Arnoldus Jr van Gestel
- Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland ; Department of Physiotherapy, Zurich University of Applied Sciences, Winterthur, Switzerland
| |
Collapse
|
50
|
Sievi NA, Clarenbach CF, Camen G, Rossi VA, van Gestel AJR, Kohler M. High prevalence of altered cardiac repolarization in patients with COPD. BMC Pulm Med 2014; 14:55. [PMID: 24690123 PMCID: PMC3976227 DOI: 10.1186/1471-2466-14-55] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 03/25/2014] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Altered cardiac repolarization and increased dispersion of repolarization have been identified as risk factors for sudden cardiac death (SCD). The prevalence of and the mechanisms contributing to altered cardiac repolarization are currently unknown in COPD. METHODS In 91 COPD patients, 32 controls matched for age, cardiovascular risk and medication, and 41 healthy subjects, measures of cardiac repolarization and dispersion of repolarization (QTc interval, QT dispersion) were derived from 12-lead electrocardiography (ECG). Prevalence rates of heart rate corrected QT (QTc) >450ms and QT dispersion >60ms were determined to assess the number of subjects at risk for SCD. Univariate and multivariate analyses were used to identify possible factors contributing to altered cardiac repolarization. RESULTS QTc was found to be prolonged in 31.9% and QT dispersion in 24.2% of the COPD patients compared to 12.5% in matched controls and 0% in healthy subjects. The QTc interval was longer in COPD patients compared to matched and healthy controls respectively (437.9 ± 29.5 vs. 420.1 ± 25.3 ms, p = 0.001 and vs. 413.4 ± 18.2 ms, p < 0.001). QT dispersion was significantly increased in COPD patients compared to healthy subjects (45.4 (34.8 , 59.5) vs. 39.7 (29.3 , 54.8) ms, p = 0.049). Only oxygen saturation was independently associated with QTc duration in multivariate analysis (β = -0.29, p = 0.015). CONCLUSION One third of a typical COPD population has altered cardiac repolarization and increased dispersion of repolarization, which may be related to hypoxia. Altered cardiac repolarization may expose these patients to an increased risk for malignant ventricular arrhythmias and SCD.
Collapse
Affiliation(s)
- Noriane A Sievi
- Pulmonary Division, University Hospital Zurich, Zurich, Switzerland
- Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
| | | | - Giovanni Camen
- Pulmonary Division, University Hospital Zurich, Zurich, Switzerland
| | | | | | - Malcolm Kohler
- Pulmonary Division, University Hospital Zurich, Zurich, Switzerland
- Zurich Centre for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
- Chair Respiratory Medicine, Clinical Director Division of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|