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Cheyrou-Lagrèze O, Hullo E, Taytard J, Giovannini-Chami L, Franco P, Ioan IC, Coutier L. Persistent and symptomatic periodic breathing beyond the neonatal period in full-term infants: A case series. Arch Pediatr 2024:S0929-693X(24)00052-6. [PMID: 38637248 DOI: 10.1016/j.arcped.2024.01.007] [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: 08/17/2023] [Revised: 01/03/2024] [Accepted: 01/18/2024] [Indexed: 04/20/2024]
Abstract
INTRODUCTION Periodic breathing (PB) is considered physiological in the neonatal period and usually disappears in the first months of life. There are few data available on persistent PB after the neonatal period. The objective of this study was to characterize infants born at term with persistent PB after the age of 1 month through polysomnography (PSG) performed during symptoms. METHODS This retrospective case series included infants born at term between 2012 and 2021, without an underlying disease, who presented with symptoms of persistent PB during a PSG. Persistent PB was defined as more than 1 % of total sleep time (TST) of PB after 1 month of life, and PB was defined as a succession of at least three episodes of central apnea lasting more than 3 s and separated by less than 20 s of normal breathing. RESULTS A total of 10 infants born at term were included. They underwent PSG for brief resolved unexplained events, desaturation, pauses in breathing, cyanosis, and/or signs of respiratory distress. The percentage of TST spent with PB was 18.1 % before 3 months of age (n = 7), and 4.7 % between 3 and 6 months of age (n = 10). During the first PSG, ≥3 % of desaturation events were observed in 77-100 % of the PB episodes. At the first PSG, nine of the 10 infants had an obstructive apnea-hypopnea index of >10/h and five of 10 infants had a central apnea index of >5/h. Gastroesophageal reflux (GER) was suspected in eight infants. All infants showed improvement in the initial symptoms during the first year of life. CONCLUSION This study presents cases of persistent and symptomatic PB after 1 month of life in infants born at term. The interesting finding was the presence of obstructive sleep apnea syndrome and/or central apnea syndrome in the majority of children, along with GER.
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Affiliation(s)
- Océane Cheyrou-Lagrèze
- Service de Pneumologie pédiatrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France; Service de Pédiatrie générale, CHU de la Réunion, Site Sud, Saint-Pierre, France
| | - Eglantine Hullo
- Service de Pneumologie pédiatrique, Hôpital Couple-Enfant, CHU Grenoble, Grenoble, France
| | - Jessica Taytard
- Service de Pneumologie pédiatrique, Hôpital Trousseau, APHP - Sorbonne Université, Paris, France; Inserm UMR_S 1158, Paris, France
| | - Lisa Giovannini-Chami
- Service de Pneumologie pédiatrique, Hôpitaux Pédiatriques de Nice, CHU Lenval - Université Côtes d'Azur, Nice, France
| | - Patricia Franco
- Service d'Épileptologie Clinique, des Troubles du Sommeil et de Neurologie Fonctionnelle de l'Enfant, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France; U1028, CNRL, Université de Lyon 1, France
| | - Iulia-Cristina Ioan
- Service d'Explorations Fonctionnelles Pédiatriques, Hôpital d'Enfants, Centre Hospitalier Universitaire de Nancy, DevAH Université de Lorraine, Nancy, France
| | - Laurianne Coutier
- Service de Pneumologie pédiatrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France; Service d'Épileptologie Clinique, des Troubles du Sommeil et de Neurologie Fonctionnelle de l'Enfant, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France; U1028, CNRL, Université de Lyon 1, France.
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Dos Santos Ribeiro G, Beltrame T, Fernando Deresz L, Hansen D, Agostoni P, Karsten M. Software development to standardize the clinical diagnosis of exercise oscillatory ventilation in heart failure. J Clin Monit Comput 2023; 37:1247-1253. [PMID: 36735189 DOI: 10.1007/s10877-023-00976-9] [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: 06/25/2022] [Revised: 01/12/2023] [Accepted: 01/18/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Exercise oscillatory ventilation (EOV) is characterized by periodic oscillations of minute ventilation during cardiopulmonary exercise testing (CPET). Despite its prognostic value in chronic heart failure (HF), its diagnosis is complex due to technical limitations. An easier and more accurate way of EOV identification can contribute to a better approach and clinical diagnosis. This study aims to describe a software development to standardize the EOV diagnosis from CPET's raw data in heart failure patients and test its reliability (intra- and inter-rater). METHODS The software was developed in the "drag-and-drop" G-language using LabVIEW®. Five EOV definitions (Ben-Dov, Corrà, Kremser, Leite, and Sun definitions), two alternative approaches, one smoothing technique, and some basic statistics were incorporated into the interface to visualize four charts of the ventilatory response. EOV identification was based on a set of criteria verified from the interaction between amplitude, cycle length, and oscillation time. Two raters analyzed the datasets. In addition, repeated measurements were verified after six months using about 25% of the initial data. Cohen's kappa coefficient (κ) was used to investigate the reliability. RESULTS Overall, 391 tests were analyzed in duplicate (inter-rater reliability) and 100 tests were randomized for new analysis (intra-rater reliability). High inter-rater (κ > 0.80) and intra-rater (κ > 0.80) reliability of the five EOV diagnoses were observed. CONCLUSION The present study proposes novel semi-automated software to detect EOV in HF, with high inter and intra-rater agreements. The software project and its tutorial are freely available for download.
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Affiliation(s)
- Gustavo Dos Santos Ribeiro
- Programa de Pós-Graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Thomas Beltrame
- Samsung R&D Institute Brazil - SRBR, Universidade Federal de São Carlos (UFSCAR), Campinas, SP, Brazil
| | - Luís Fernando Deresz
- Departamento de Educação Física, Universidade Federal de Juiz de Fora (UFJF), Governador Valadares, MG, Brazil
| | - Dominique Hansen
- Faculty of Rehabilitation Sciences, Hasselt University (UHASSELT), BIOMED/REVAL, Hasselt, Belgium
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Clinical Sciences of Community Health, Cardiovascular Section, University of Milano, Milano, Italy
| | - Marlus Karsten
- Programa de Pós-Graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
- Departamento de Fisioterapia, Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC, Brazil
- Programa de Pós-Graduação em Fisioterapia, UDESC, Florianópolis, SC, Brazil
- Centro de Ciências da Saúde e do Esporte, UDESC, Rua Pascoal Simone 358, CEP 88080-350, Florianópolis, SC, Brazil
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Belli-Marin JFC, Bocchi EA, Ayub-Ferreira S, Junior NC, Guimarães GV. Effects of β-blocker therapy on exercise oscillatory ventilation in reduced ejection fraction heart failure patients: A case series study. Biomed Pharmacother 2022; 152:113106. [PMID: 35665667 DOI: 10.1016/j.biopha.2022.113106] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/03/2022] [Accepted: 05/10/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Exercise oscillatory ventilation (EOV) is an abnormal breathing pattern that occurs in ~20% of patients with heart failure (HF) and is associated with poor prognosis and exercise intolerance. β-blockers (βb) are prescribed for most HF patients; however, their effect on EOV remains unclear. We evaluated the effect of βb on EOV in HF patients with reduced ejection fraction (HFrEF). METHODS Fifteen patients diagnosed with HF, ejection fraction < 45%, aged from 18 to 65 years, were included before starting βb therapy. Patients underwent clinical evaluation, cardiopulmonary exercise testing, echocardiography, laboratory exams (norepinephrine levels, B type natriuretic peptide) at baseline and after βb therapy optimized for six months. Presence of exercise oscillatory breathing was determined by two experienced observers who were blinded to the moment of the test (pre or post). RESULTS Fifteen patients (1 female), aged 49.5 ± 2.5 years, with HFrEF, NYHA I-III enrolled in the study. The etiologies of the HFrEF were idiopathic (n = 8) and hypertensive (n = 7). LVEF increased after βb therapy from 25.9 ± 2.5% to 33 ± 2.6%, P = 0.02; peak VO2 did not significantly change (21.8 ± 1.7 vs 24.7 ± 1.9, P = 0.4); VE/VCO2 slope changed from 32.1 ± 10.6-27.5 ± 9.1, P = 0.03. Before βb initiation, nine patients (60%) had EOV, but only two (13%) did after optimized therapy. McNemar test was used to evaluate the significance of the association between the two moments (P = 0.02). CONCLUSION In patients with HF, medical therapy with βb can reverse EOV. This may explain why these patients experience symptom improvement after βb therapy.
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Affiliation(s)
| | - Edimar Alcides Bocchi
- Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Silvia Ayub-Ferreira
- Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Nelson Carvas Junior
- Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Guilherme Veiga Guimarães
- Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil.
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Ribeiro GDS, Deresz LF, Salvioni E, Hansen D, Agostoni P, Karsten M. Sensitivity and specificity of different exercise oscillatory ventilation definitions to predict 2-year major adverse cardiovascular outcomes in chronic heart failure patients. Int J Cardiol 2022; 360:39-43. [PMID: 35623479 DOI: 10.1016/j.ijcard.2022.05.041] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Exercise oscillatory ventilation (EOV) shows a four-fold greater risk of adverse events. This study aims to analyze the sensitivity and specificity of three EOV diagnostic definitions to predict adverse outcomes at a 2-year follow-up and to compare its EOV prevalence and relations with the patient's profile. METHODS Cardiopulmonary exercise tests from 233 heart failure patients were analyzed. Two blinded reviewers used a semiautomated software to identify EOV cases pattern according to the definitions of Ben-Dov, Corrà, and Leite. Data were grouped in EOV-positive or EOV-negative according to each definition. Baseline characteristics, EOV prevalence, relative risk, sensitivity, and specificity to predict 2-years of major adverse cardiovascular outcomes were analyzed. RESULTS The Corrà definition led to the best prediction of 2-year major cardiovascular adverse outcomes (HR 2.46 [1.16 to 5.25]; p = 0.019, AUC = 0.618; p = 0.007). EOV prevalence was 17.2%, 17.2%, and 9.4% applying Ben-Dov, Corrà, and Leite definition, respectively. The main clinical differences between EOV-positive and EOV-negative patients were: MECKI score and VE/VCO2 slope (all definitions), and BNP levels (Ben-Dov and Leite). BNP levels were correlated with amplitude (rho = 0.255; p = 0.033) and cycle length (rho = 0.388; p = 0.002). CONCLUSION Corrà definition was the only one that exhibited the capacity to predict major adverse cardiovascular outcomes at a 2-year follow-up. Regardless of its definition, EOV was more often prevalent in patients with a greater MECKI score and VE/VCO2 slope values.
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Affiliation(s)
- Gustavo Dos Santos Ribeiro
- Programa de Pós-Graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Luís Fernando Deresz
- Departamento de Educação Física, Universidade Federal de Juiz de Fora (UFJF), Governador Valadares, Brazil
| | | | - Dominique Hansen
- Hasselt University (UHASSELT), Faculty of Rehabilitation Sciences, BIOMED/REVAL, Hasselt, Belgium; Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Clinical Sciences of Community Health, Cardiovascular Section, University of Milano, Milano, Italy
| | - Marlus Karsten
- Programa de Pós-Graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil; Departamento de Fisioterapia, Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Brazil; Programa de Pós-Graduação em Fisioterapia, UDESC, Florianópolis, Brazil.
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Seppä-Moilanen M, Andersson S, Kirjavainen T. Supplemental Oxygen Treats Periodic Breathing without Effects on Sleep in Late-Preterm Infants. Neonatology 2022; 119:567-574. [PMID: 36088903 PMCID: PMC9677840 DOI: 10.1159/000525196] [Citation(s) in RCA: 1] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/18/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The effect of supplemental oxygen on sleep has not been studied in preterm infants. METHODS We studied 18 stable late-preterm infants with observed periodic breathing at a median gestational age of 36 weeks. Polysomnography was performed on room air and on 25% oxygen-enriched ambient air. RESULTS Supplemental oxygen did not affect sleep stage distribution, sleep efficiency, the frequency of sleep stage transitions, the appearance of rapid-eye movement (REM) sleep periods, or the high number of spontaneous arousals. The percentage in periodic breathing out of total sleep time decreased from 10% (interquartile range [IQR] 5-9%) on room air to 1% (IQR 0-3%) (p < 0.001) on supplemental oxygen. Also, the number of central apneas decreased from 48 (IQR 32-68) to 23 (IRQ 15-32) per hour (p < 0.001), and the number of oxygen desaturations of a minimum 3% from 38 (IQR 29-74) to 10 (IQR 5-24) per hour (p < 0.001). On room air in non-REM sleep, the median end-tidal carbon dioxide values were systematically lower during periodic breathing at 5.1 (IQR 4.6-6.4) kPa than during stable breathing at 5.5 (4.9-5.9) kPa (p < 0.0001). CONCLUSIONS In late-preterm infants, supplemental oxygen effectively reduces periodic breathing and the number of oxygen desaturations while having no significant effect on sleep. The results support the importance of carotid body over-reactivity on the genesis of periodic breathing in preterm infants.
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Affiliation(s)
- Maija Seppä-Moilanen
- Children's Hospital, and Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sture Andersson
- Children's Hospital, and Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Turkka Kirjavainen
- Children's Hospital, and Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Abstract
Brain PCO2 is sensed primarily via changes in [H+]. Small pH changes are detected in the medulla oblongata and trigger breathing adjustments that help maintain arterial PCO2 constant. Larger perturbations of brain CO2/H+, possibly also sensed elsewhere in the CNS, elicit arousal, dyspnea, and stress, and cause additional breathing modifications. The retrotrapezoid nucleus (RTN), a rostral medullary cluster of glutamatergic neurons identified by coexpression of Phoxb and Nmb transcripts, is the lynchpin of the central respiratory chemoreflex. RTN regulates breathing frequency, inspiratory amplitude, and active expiration. It is exquisitely responsive to acidosis in vivo and maintains breathing autorhythmicity during quiet waking, slow-wave sleep, and anesthesia. The RTN response to [H+] is partly an intrinsic neuronal property mediated by proton sensors TASK-2 and GPR4 and partly a paracrine effect mediated by astrocytes and the vasculature. The RTN also receives myriad excitatory or inhibitory synaptic inputs including from [H+]-responsive neurons (e.g., serotonergic). RTN is silenced by moderate hypoxia. RTN inactivity (periodic or sustained) contributes to periodic breathing and, likely, to central sleep apnea. RTN development relies on transcription factors Egr2, Phox2b, Lbx1, and Atoh1. PHOX2B mutations cause congenital central hypoventilation syndrome; they impair RTN development and consequently the central respiratory chemoreflex.
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Affiliation(s)
- Patrice G Guyenet
- Department of Pharmacology, University of Virginia, Charlottesville, VA, United States.
| | - Douglas A Bayliss
- Department of Pharmacology, University of Virginia, Charlottesville, VA, United States
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Javaheri S, Germany R. Sleep and breathing disorders in heart failure. Handb Clin Neurol 2022; 189:295-307. [PMID: 36031310 DOI: 10.1016/b978-0-323-91532-8.00009-4] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Sleep disorders are prevalent in heart failure and include insomnia, poor sleep architecture, periodic limb movements and periodic breathing, and encompass both obstructive (OSA) and central sleep apnea (CSA). Polysomnographic studies show excess light sleep and poor sleep efficiency particularly in those with heart failure. Multiple studies of consecutive patients with heart failure show that about 50% of patients suffer from either OSA or CSA. While asleep, acute pathological consequences of apneas and hypopneas include altered blood gases, sleep fragmentation, and large negative swings in intrathoracic pressure. These pathological consequences are qualitatively similar in both types of sleep apnea, though worse in OSA than CSA. Sleep apnea results in oxidative stress, inflammation, and endothelial dysfunction, best documented in OSA. Multiple studies show that both OSA and CSA are associated with excess hospital readmissions and premature mortality. However, no randomized controlled trial (RCT) has been reported for OSA, but sensitivity analysis of two randomized controlled trials has concluded that use of positive airway pressure devices is associated with excess mortality in patients with heart failure and CSA. Phrenic nerve stimulation has shown improvement in sleep apnea events and daytime sleepiness; however, no randomized controlled trials have demonstrated improvement in survival in patients with heart failure. The correct identification and treatment of heart failure patients with sleep and breathing disorders could affect the long-term outcomes of these patients.
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Affiliation(s)
- Shahrokh Javaheri
- Division of Pulmonary and Sleep Medicine, Bethesda North Hospital, Cincinnati, OH, United States; Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States; Division of Cardiology, Ohio State University, Columbus, OH, United States.
| | - Robin Germany
- Division of Cardiovascular Disease, University of Oklahoma College of Medicine, Oklahoma City, OK, United States
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Saito K, Takamatsu Y. Periodic breathing in patients with stable obstructive sleep apnea on long-term continuous positive airway pressure treatment: a retrospective study using CPAP remote monitoring data. Sleep Breath 2021; 26:1181-1191. [PMID: 34651259 PMCID: PMC9418282 DOI: 10.1007/s11325-021-02510-0] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/21/2021] [Accepted: 10/06/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to investigate the rate of periodic breathing (PB) and factors associated with the emergence or persistence of PB in patients with obstructive sleep apnea (OSA) by continuous positive airway pressure (CPAP) remote monitoring data. METHODS This was a retrospective cohort study on 775 patients who had used the same model CPAP machine for at least 1 year as of September 1, 2020. The data were analyzed online using the dedicated analysis system. Using exporter software, average apnea/hypopnea index (AHI), average central apnea index (CAI), and average the rate of PB time (PB%) were cited. RESULTS Among 618 patients analyzed (age 61.7 ± 12.2 years, male 89%, BMI 27.2 ± 4.9), the average duration of CPAP use was 7.5 ± 4.0 years. The median PB% in stable patients was low at 0.32%, and only 149 patients (24%) had a PB% above 1%. Multiple regression analysis of factors for the development of PB showed that the most important factor was atrial fibrillation (Af) with a coefficient of 0.693 (95% CI; 0.536 to 0.851), followed by QRS duration with a coefficient of 0.445 (95% CI; 0.304 to 0.586), followed by history of heart failure, male sex, comorbid hypertension, obesity, and age. The average PB% for paroxysmal Af was significantly lower than that for persistent and permanent Af. CONCLUSIONS The median PB% in stable patients on CPAP treatment was low at 0.32%, with only 24% of patients having PB% ≥ 1%. Persistent Af and an increase in QRS duration were found to be important predictors of increased PB%. CLINICAL TRIAL REGISTRATION UMIN000042555 2021/01/01.
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Affiliation(s)
- Kimimasa Saito
- Saito Naika Kokyukika, Mie Sleep Clinic, Ise-shi, 519-0502, Japan.
| | - Yoko Takamatsu
- Saito Naika Kokyukika, Mie Sleep Clinic, Ise-shi, 519-0502, Japan
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Jeklin AT, Sully F, Flannery D, Naughton MT, Macefield VG, Nilsen K, Ellis MJ, La Gerche A. Exercise oscillatory ventilation during autonomic blockade in young athletes and healthy controls. Eur J Appl Physiol 2021; 121:2499-507. [PMID: 34031723 DOI: 10.1007/s00421-021-04720-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 05/15/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Exercise oscillatory ventilation (EOV) is a form of periodic breathing that is associated with a poor prognosis in heart failure patients, but little is known about EOV in other populations. We sought to provide insights into the phenomenon of EOV after it was observed in young healthy subjects, including athletes, after the administration of dual autonomic blockade (DAB). METHODS From 29 participants who completed cardiopulmonary exercise testing (CPET) with and without DAB (0.04 mg/kg atropine and 0.2 mg/kg metoprolol), 5 subjects developed EOV (age = 29 ± 5 years; 3/5 were athletes) according to American Heart Association criteria. For each case, we identified 2 non-EOV healthy controls (age = 34.2 ± 8.3; 7/10 were athletes) that were subsequently age- and sex-matched. RESULTS No participants had EOV during exercise without DAB. The 5 participants (4 male, 1 female) who demonstrated EOV with DAB had lower mean tidal volume (1.7 ± 0.5 L/min vs. 1.8 ± 0.5 L/min; p = 0.04) compared to participants in the non-EOV group and a decrease in peak tidal volume (2.9 ± 0.6 L/min to 2.2 ± 0.7 L/min; p = 0.004) with DAB. There were few other differences in CPET measures between EOV and non-EOV participants, although the PETCO2 tended to be higher in the EOV group (p = 0.07). CONCLUSION EOV can be elucidated in young healthy subjects, including athletes, during cardiopulmonary exercise testing, suggesting that it may not be an ominous sign in all populations.
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Stieglitz S, Galetke W, Esquinas A. Treatment of Cheyne-Stokes respiration with adaptive servoventilation-analysis of patients with regard to therapy restriction. Somnologie (Berl) 2021; 25:226-31. [PMID: 33046962 DOI: 10.1007/s11818-020-00269-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/09/2020] [Indexed: 10/27/2022]
Abstract
Purpose The SERVE-HF study revealed no benefit of adaptive servoventilation (ASV) versus guideline-based medical treatment in patients with symptomatic heart failure, an ejection fraction (EF) ≤45% and a predominance of central events (apnoea-hypopnea Index [AHI] > 15/h). Because both all-cause and cardiovascular mortality were higher in the ASV group, an EF ≤ 45% in combination with AHI 15/h, central apnoea-hyponoea index [CAHI/AHI] > 50% and central apnoea index [CAI] > 10/h were subsequently listed as contraindications for ASV. The intention of our study was to analyse the clinical relevance of this limitation. Methods Data were analysed retrospectively for patients treated with ASV who received follow-up echocardiography to identify contraindications for ASV. Results Echocardiography was conducted in 23 patients. The echocardiogram was normal in 10 cases, a left ventricular hypertrophy with normal EF was found in 8 patients, there was an EF 45-50% in 2 cases and a valvular aortic stenosis (grade II) with normal EF was found in 1 case. EF <45% was present in just 2 cases, and only 1 of these patients also had more than 50% central events in the diagnostic night. Conclusion The population typically treated with ASV is entirely different from the study population in SERVE-HF, as nearly half of the patients treated with ASV showed a normal echocardiogram. Thus, the modified indication for ASV has little impact on the majority of treated patients. The current pathomechanistic hypothesis of central apnoea must be reviewed.
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Abstract
Periodic breathing (PB) during exercise is a slow, prominent, consistent fluctuation in ventilation and derived parameters that may be persistent for the entire exercise or present only in the early phases of exercise. It is associated with a negative prognosis, particularly if concomitant with PB during sleep. Little is known about exercise-induced PB physiology, but hyperventilation is likely due to an increased sympathetic activity combined with an enhanced stimulation of intrapulmonary, chemoreceptors and metaboreceptors, low cardiac output leading to increased circulatory delay, and cerebrovascular reactivity to CO2, all with have a definite role.
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Affiliation(s)
- Piergiuseppe Agostoni
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Via Parea 4, Milano 20138, Italy; Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milano 20138, Italy.
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Hermand E, Pichon A, Lhuissier FJ, Richalet JP. Low-frequency ventilatory oscillations in hypoxia are a major contributor to the low-frequency component of heart rate variability. Eur J Appl Physiol 2019; 119:1769-1777. [PMID: 31154522 DOI: 10.1007/s00421-019-04166-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 01/05/2019] [Revised: 04/19/2019] [Accepted: 05/23/2019] [Indexed: 12/23/2022]
Abstract
PURPOSE Heart rate variability (HRV) may be influenced by several factors, such as environment (hypoxia, hyperoxia, hypercapnia) or physiological demand (exercise). In this retrospective study, we tested the hypothesis that inter-beat (RR) intervals in healthy subjects exercising under various environmental stresses exhibit oscillations at the same frequency than ventilatory oscillations. METHODS Spectra from RR intervals and ventilation ([Formula: see text]E) were collected from 37 healthy young male subjects who participated in 5 previous studies focused on ventilatory oscillations (or periodic breathing) during exercise in hypoxia, hyperoxia and hypercapnia. Bland and Altman test and multivariate regressions were then performed to compare respective frequencies and changes in peak powers of the two signals. RESULTS Fast Fourier analysis of RR and [Formula: see text]E signals showed that RR was oscillating at the same frequency than periodic breathing, i.e., ~ 0.09 Hz (11 s). During exercise, in these various conditions, the difference between minimum and maximum HRV peak power was positively correlated to the same change in ventilation peak power (P < 0.05). Low-frequency (LF) peak power was correlated to tidal volume (P < 0.01) and breathing frequency (P < 0.001). CONCLUSIONS This study suggests that low-frequency ventilatory oscillations in hypoxia are a major contributor to the LF band power of heart rate variability. CLINICAL TRIAL REG. NO.: NCT02201875.
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Affiliation(s)
- Eric Hermand
- Laboratoire HAVAE 'Handicap, Activité, Vieillissement, Autonomie, Environnement', E6310, Université de Limoges, Faculté Des Sciences Et Techniques, 123 avenue Albert Thomas, 87060, Limoges Cedex, France.
- Sorbonne Paris Cité, Laboratoire "Hypoxie & Poumon", E2363, Université Paris 13, Bobigny, France.
| | - Aurélien Pichon
- Laboratoire MOVE, Université de Poitiers, E6314, Poitiers, France
| | - François J Lhuissier
- Sorbonne Paris Cité, Laboratoire "Hypoxie & Poumon", E2363, Université Paris 13, Bobigny, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Service de Physiologie, Explorations Fonctionnelles Et Médecine du Sport, 93009, Bobigny, France
| | - Jean-Paul Richalet
- Sorbonne Paris Cité, Laboratoire "Hypoxie & Poumon", E2363, Université Paris 13, Bobigny, France
- Département Médical, Institut National de L'Expertise Et de La Performance, 75012, Paris, France
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13
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Pramsohler S, Schilz R, Patzak A, Rausch L, Netzer NC. Periodic breathing in healthy young adults in normobaric hypoxia equivalent to 3500 m, 4500 m, and 5500 m altitude. Sleep Breath 2019; 23:703-709. [PMID: 30972693 PMCID: PMC6529391 DOI: 10.1007/s11325-019-01829-z] [Citation(s) in RCA: 10] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/18/2019] [Accepted: 03/21/2019] [Indexed: 01/01/2023]
Abstract
Purpose The occurrence of periodic breathing (PB) at high altitude during sleep and the quality of sleep are individually different and influenced by multiple factors including sex. Although poor sleep quality at high altitude might not be directly linked to oxygen desaturations, the PB upsurge at high altitude leads to significant oscillations in oxygen saturation. Methods Thirty-three students were recruited. Participants were randomly assigned to three groups (A, B, C) sleeping one full night in a dormitory with normobaric hypoxia at a FIO2 of 14.29% (A), a FIO2 of 12.47% (B), or a FIO2 of 10.82% (C). Full polysomnography was performed in each participant. Results Mean total sleeping time decreased significantly with increasing hypoxia (p < 0.001). Respiratory events changed from central hypopneas to central apneas (CA) with increasing hypoxia: CA = 17.8%, 50.0%, 92.2% of AHI (37.96 events per hour (n/h), 68.55 n/h, 93.44 n/h). AHI (p = 0.014) and time duration of respiratory events (p = 0.003) were significantly different between sexes, both greater in men. REM sleep was reduced. Conclusions Men tend to be more prone to PB in normobaric hypoxia. Further research should implicate a longer acclimatization period around simulated 4500 m in order to find out if the exponential increase in PB between 4500 m and 5500 m could be shifted to lower hypoxic levels, i.e., higher altitudes.
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Affiliation(s)
- Stephan Pramsohler
- Dept. of Psychology and Sports Science, Hermann Buhl Institute for Hypoxia and Sleep Medicine Research, University of Innsbruck, Ghersburgstr. 9, 83043, Bad Aibling, Germany.
| | - Robert Schilz
- University Hospitals of Cleveland and Case University School of Medicine, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Andreas Patzak
- Charité-Universitätsmedizin Berlin, Institute for Vegetative Physiology, Chariteplatz 1, 10117, Berlin, Germany
| | - Linda Rausch
- Dept. of Psychology and Sports Science, Hermann Buhl Institute for Hypoxia and Sleep Medicine Research, University of Innsbruck, Ghersburgstr. 9, 83043, Bad Aibling, Germany
- Dept. of Psychology and Sport Science, University Innsbruck, Fürstenweg 185, 6020, Innsbruck, Austria
| | - Nikolaus C Netzer
- Dept. of Psychology and Sports Science, Hermann Buhl Institute for Hypoxia and Sleep Medicine Research, University of Innsbruck, Ghersburgstr. 9, 83043, Bad Aibling, Germany
- Dept. of Psychology and Sport Science, University Innsbruck, Fürstenweg 185, 6020, Innsbruck, Austria
- Division of Sports Medicine and Rehabilitation, Department of Medicine, University Ulm, Leimgrubenweg 14, 89070, Ulm, Germany
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14
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Seppä‐Moilanen M, Andersson S, Rantakari K, Mikkola K, Kirjavainen T. Caffeine and supplemental oxygen effectively suppress periodic breathing with only minor effects during long episodes of apnoea in preterm infants. Acta Paediatr 2019; 108:443-451. [PMID: 30118174 DOI: 10.1111/apa.14541] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 04/06/2018] [Accepted: 08/13/2018] [Indexed: 12/29/2022]
Abstract
AIM We investigated the characteristics and effects of sleep stage, supplemental oxygen and caffeine on periodic breathing (PB) and apnoea of prematurity (AOP) in preterm infants. METHODS This 2013-2015 study recruited 21 preterm infants on neonatal wards in the Helsinki and Uusimaa Hospital District, Finland, at a median corrected gestational age of 35.7 weeks and performed polysomnography at baseline, during supplemental oxygen and during caffeine treatment. RESULTS All infants demonstrated PB, during a median of 11% of sleep time and 85% of PB occurred during non-rapid eye movement sleep (NREM). Apnoea episodes were brief during PB, but 66% were associated with oxygen desaturation. Supplemental oxygen substantially reduced PB time by 99% and caffeine by 91%. Oxygen desaturation decreased from 38 per hour at baseline to 8.5 with oxygen and 24 with caffeine (all p < 0.001). AOPs decreased from 1.4 per hour at baseline to 0.4 with oxygen (p = 0.03) and 0.3 with caffeine (p = 0.07). Most (84%) apnoea episodes over 15 seconds were mixed episodes during REM sleep. CONCLUSION PB occurred predominantly during NREM sleep, caused intermittent hypoxia, and was suppressed by supplemental oxygen and caffeine. In contrast, long apnoea episodes representing AOP were only modestly decreased.
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Affiliation(s)
- Maija Seppä‐Moilanen
- Children‘s Hospital Paediatric Research Center University of Helsinki Helsinki University Hospital Helsinki Finland
| | - Sture Andersson
- Children‘s Hospital Paediatric Research Center University of Helsinki Helsinki University Hospital Helsinki Finland
| | - Krista Rantakari
- Children‘s Hospital Paediatric Research Center University of Helsinki Helsinki University Hospital Helsinki Finland
| | - Kaija Mikkola
- Children‘s Hospital Paediatric Research Center University of Helsinki Helsinki University Hospital Helsinki Finland
| | - Turkka Kirjavainen
- Children‘s Hospital Paediatric Research Center University of Helsinki Helsinki University Hospital Helsinki Finland
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15
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Takagawa J, Asanoi H, Tobushi T, Kumagai N, Kadokami T, Dohi K, Joho S, Wada O, Koyama T, Haruki N, Ando SI, Momomura SI. Multicenter, Prospective Study on Respiratory Stability During Recovery From Deterioration of Chronic Heart Failure. Circ J 2018; 83:164-173. [PMID: 30429428 DOI: 10.1253/circj.cj-18-0519] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The respiratory instability frequently observed in advanced heart failure (HF) is likely to mirror the clinical status of worsening HF. The present multicenter study was conducted to examine whether the noble respiratory stability index (RSI), a quantitative measure of respiratory instability, reflects the recovery process from HF decompensation. Methods and Results: Thirty-six of 44 patients hospitalized for worsening HF completed all-night measurements of RSI both at deterioration and recovery phases. Based on the signs, symptoms, and laboratory data during hospitalization, the Central Adjudication Committee identified 22 convalescent patients and 14 patients with less extent of recovery in a blinded manner without any information on RSI or other respiratory variables. The all-night RSI in the convalescent patients was increased from 27.8±18.4 to 34.6±15.8 (P<0.05). There was no significant improvement of RSI, however, in the remaining patients with little clinical improvement. Of the clinical and laboratory variables, on stepwise linear regression modeling, body weight, peripheral edema, and lung congestion were closely related to the RSI of recovered patients and accounted for 56% of the changes in RSI (coefficient of determination, R2=0.56). CONCLUSIONS All-night RSI, a quantitative measure of respiratory instability, could faithfully reflect congestive signs and clinical status of HF during the recovery process from acute decompensation.
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Affiliation(s)
| | | | | | - Naoto Kumagai
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine
| | | | - Kaoru Dohi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine
| | - Shuji Joho
- Second Department of Internal Medicine, Toyama University Hospital
| | - Osamu Wada
- Cardiovascular Medicine, Japan Community Health Care Organization Takaoka Fushiki Hospital
| | | | - Nobuhiko Haruki
- Cardiovascular Medicine, Wakamatsu Hospital of the University of Occupational and Environmental Health
| | | | - Shin-Ichi Momomura
- Cardiovascular Medicine, Jichi Medical University Saitama Medical Center
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16
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Tarquinio DC, Hou W, Neul JL, Berkmen GK, Drummond J, Aronoff E, Harris J, Lane JB, Kaufmann WE, Motil KJ, Glaze DG, Skinner SA, Percy AK. The course of awake breathing disturbances across the lifespan in Rett syndrome. Brain Dev 2018; 40:515-529. [PMID: 29657083 PMCID: PMC6026556 DOI: 10.1016/j.braindev.2018.03.010] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [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: 10/12/2017] [Revised: 02/15/2018] [Accepted: 03/27/2018] [Indexed: 11/16/2022]
Abstract
Rett syndrome (RTT), an X-linked dominant neurodevelopmental disorder caused by mutations in MECP2, is associated with a peculiar breathing disturbance exclusively during wakefulness that is distressing, and can even prompt emergency resuscitation. Through the RTT Natural History Study, we characterized cross sectional and longitudinal characteristics of awake breathing abnormalities in RTT and identified associated clinical features. Participants were recruited from 2006 to 2015, and cumulative lifetime prevalence of breathing dysfunction was determined using the Kaplan-Meier estimator. Risk factors were assessed using logistic regression. Of 1205 participants, 1185 had sufficient data for analysis, including 922 females with classic RTT, 778 of whom were followed longitudinally for up to 9.0 years, for a total of 3944 person-years. Participants with classic or atypical severe RTT were more likely to have breathing dysfunction (nearly 100% over the lifespan) compared to those with atypical mild RTT (60-70%). Remission was common, lasting 1 year on average, with 15% ending the study in terminal remission. Factors associated with higher odds of severe breathing dysfunction included poor gross and fine motor function, frequency of stereotypical hand movements, seizure frequency, prolonged corrected QT interval on EKG, and two quality of life metrics: caregiver concern about physical health and contracting illness. Factors associated with lower prevalence of severe breathing dysfunction included higher body mass index and head circumference Z-scores, advanced age, and severe scoliosis or contractures. Awake breathing dysfunction is common in RTT, more so than seizures, and is associated with function, quality of life and risk for cardiac dysrhythmia.
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Affiliation(s)
- Daniel C. Tarquinio
- Emory University, Atlanta, GA,Center for Rare Neurological Diseases, Norcross, GA
| | - Wei Hou
- Statistical analysis, Stony Brook University Medical Center, Stony Brook, NY
| | | | - Gamze Kilic Berkmen
- Emory University, Atlanta, GA,Center for Rare Neurological Diseases, Norcross, GA
| | - Jana Drummond
- Emory University, Atlanta, GA,Center for Rare Neurological Diseases, Norcross, GA
| | - Elizabeth Aronoff
- Emory University, Atlanta, GA,Center for Rare Neurological Diseases, Norcross, GA
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Pal T, Dutta PK, Maka S. Modulation-demodulation hypothesis of periodic breathing in human respiration. Respir Physiol Neurobiol 2018. [PMID: 29526660 DOI: 10.1016/j.resp.2018.03.005] [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] [Indexed: 11/18/2022]
Abstract
Periodic breathing (PB) is a diseased condition of the cardiorespiratory system, and mathematically it is modelled as an oscillation. Modeling approaches replicate periodic oscillation in the minute ventilation due to a higher than normal gain of the feedback signals from the chemoreceptors coupled with a longer than normal latency in feedback, and do not consider the waxing-waning pattern of the oronasal airflow. In this work, a noted regulation model is extended by integrating respiratory mechanics and respiratory central pattern generator (rCPG) model, using modulation-demodulation1 hypothesis. This is a top-down modeling approach, and it is assumed that the sensory feedback signal from the chemoreceptors modulates the output of the rCPG model. It is also assumed that the brainstem network is responsible for the demodulation process. The respiratory mechanics is modeled as a multi-input multi-output (MIMO) system, where modulated and demodulated neural signals are applied as input and the minute ventilation and the oronasal airflow are specified as output. The minute ventilation signal drives the regulation model, completing the feedback loop. The proposed model is validated by comparing the model output with the clinical data. Using the modulation-demodulation hypothesis, a respiratory mechanics model is formulated in the form of a linear state-space model, which can be useful for providing assisted ventilation in clinical conditions.
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Affiliation(s)
- Tanmay Pal
- Department of Electrical Engineering, Indian Institute of Technology, Kharagpur 721302, India.
| | - Pranab Kumar Dutta
- Department of Electrical Engineering, Indian Institute of Technology, Kharagpur 721302, India.
| | - Srinivasu Maka
- Department of Electrical Engineering, Indian Institute of Technology, Kharagpur 721302, India.
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18
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Abstract
There is a range of breathing problems which occur and may persist in preterm infants, such as central apneas, obstructive apneas and periodic breathing. Preterm infants may also suffer from respiratory distress syndrome and chronic lung disease necessitating prolonged use of oxygen therapy after discharge from the hospital. Due to these persistent breathing pattern abnormalities in preterm infants, there is a higher risk of altered sleep and apparent life threatening events. Polysomnography can be a helpful tool to identify those infants who have abnormalities in their breathing pattern, to identify those infants who have an increased risk to get a sleep related breathing event at home and to decide about the discontinuation of oxygen therapy.
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Affiliation(s)
- Koen Joosten
- Erasmus MC, Sophia Children's Hospital, Pediatric Intensive Care, Rotterdam, The Netherlands.
| | - Robbin de Goederen
- Dutch Craniofacial Center, Department of Plastic, Reconstructive and Hand Surgery, Sophia Children's Hospital - Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Angelique Pijpers
- Kempenhaeghe Academic Center for Epileptology, Sleep Medicine and Neurocognition, Heeze, The Netherlands
| | - Karel Allegaert
- Department of Pediatric Surgery, Erasmus University Medical Center - Sophia, Rotterdam, The Netherlands; Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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19
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Kumagai N, Dohi K, Fujimoto N, Tanimura M, Sato Y, Miyahara S, Nakamori S, Fujii E, Yamada N, Ito M. A novel method for the quantitative evaluation of diurnal respiratory instability in patients with heart failure: A pilot study. J Cardiol 2017; 71:159-167. [PMID: 28958750 DOI: 10.1016/j.jjcc.2017.08.002] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 07/19/2017] [Accepted: 08/09/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is no established method to quantitatively measure the presence and the severity of respiratory instability (RI). The purpose of this pilot study was to propose a novel index of diurnal RI as a surrogate measure of clinical severity of heart failure (HF). METHODS AND RESULTS We prospectively enrolled 60 patients with symptomatic HF [70±14 years, 75% male, and New York Heart Association (NYHA) functional classes II-IV] who underwent right heart catheterization (RHC), and recorded diurnal respiration using a nasal pressure sensor during bed rest while awake within 2 days before or after RHC. Non-uniformity of the breath-by-breath respiratory slopes during 15min calculated as the ratio of peak expiratory amplitude to corresponding peak-to-peak interval was assessed by histogram-based frequency distribution measurement, and was defined as the "RI-index". The RI-index was significantly different among NYHA functional classes and was highest in NYHA class IV. The presence of atrial fibrillation (β coefficient: 0.300, p=0.01) and stroke volume index (β coefficient: -0.462, p<0.01) were independently associated with RI index among hemodynamic parameters. Furthermore, the high RI index above the median value was the independent predictor of the composite outcome of death from any cause, a life-threatening arrhythmia, and an unplanned hospitalization for worsening HF. CONCLUSIONS The RI index stratified functional severity of HF well, and was a significant independent predictor of poor outcomes.
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Affiliation(s)
- Naoto Kumagai
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Kaoru Dohi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan.
| | - Naoki Fujimoto
- Department of Molecular and Laboratory Medicine, Mie University Graduate School of Medicine, Tsu, Japan
| | - Muneyoshi Tanimura
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Yuichi Sato
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - So Miyahara
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Shiro Nakamori
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Eitaro Fujii
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Norikazu Yamada
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Masaaki Ito
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
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20
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Hermand E, Lhuissier FJ, Richalet JP. Effect of dead space on breathing stability at exercise in hypoxia. Respir Physiol Neurobiol 2017; 246:26-32. [PMID: 28760461 DOI: 10.1016/j.resp.2017.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 06/06/2017] [Revised: 07/17/2017] [Accepted: 07/20/2017] [Indexed: 01/08/2023]
Abstract
Recent studies have shown that normal subjects exhibit periodic breathing when submitted to concomitant environmental (hypoxia) and physiological (exercise) stresses. A mathematical model including mass balance equations confirmed the short period of ventilatory oscillations and pointed out an important role of dead space in the genesis of these phenomena. Ten healthy subjects performed mild exercise on a cycloergometer in different conditions: rest/exercise, normoxia/hypoxia and no added dead space/added dead space (aDS). Ventilatory oscillations (V˙E peak power) were augmented by exercise, hypoxia and aDS (P<0.001, P<0.001 and P<0.01, respectively) whereas V˙E period was only shortened by exercise (P<0.001), with an 11-s period. aDS also increased V˙E (P<0.001), tidal volume (VT, P<0.001), and slightly augmented PETCO2 (P<0.05) and the respiratory frequency (P<0.05). These results confirmed our previous model, showing an exacerbation of breathing instability by increasing dead space. This underlines opposite effects observed in heart failure patients and normal subjects, in which added dead space drastically reduced periodic breathing and sleep apneas. It also points out that alveolar ventilation remains very close to metabolic needs and is not affected by an added dead space. Clinical Trial reg. n°: NCT02201875.
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Affiliation(s)
- Eric Hermand
- Université Paris 13, Sorbonne Paris Cité, Laboratoire "Hypoxie et poumon", EA2363, Bobigny, France.
| | - François J Lhuissier
- Université Paris 13, Sorbonne Paris Cité, Laboratoire "Hypoxie et poumon", EA2363, Bobigny, France; Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Service de Physiologie, explorations fonctionnelles et médecine du sport, 93009 Bobigny, France
| | - Jean-Paul Richalet
- Université Paris 13, Sorbonne Paris Cité, Laboratoire "Hypoxie et poumon", EA2363, Bobigny, France.
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Panagopoulou N, Karatzanos E, Dimopoulos S, Tasoulis A, Tachliabouris I, Vakrou S, Sideris A, Gratziou C, Nanas S. Exercise training improves characteristics of exercise oscillatory ventilation in chronic heart failure. Eur J Prev Cardiol 2017; 24:825-832. [PMID: 28436722 DOI: 10.1177/2047487317695627] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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] [Indexed: 02/05/2023]
Abstract
Background Exercise oscillatory ventilation in chronic heart failure has been suggested as a factor related to adverse cardiac events, aggravated prognosis and higher mortality. Exercise training is well known to affect exercise capacity and mechanisms of pathophysiology beneficially in chronic heart failure. Little is known, however, about the exercise training effects on characteristics of exercise oscillatory ventilation in chronic heart failure patients. Design and methods Twenty (out of 38) stable chronic heart failure patients exhibited exercise oscillatory ventilation (age 54 ± 11 years, peak oxygen uptake 15.0 ± 5.0 ml/kg per minute). Patients attended 36 sessions of high intensity interval exercise. All patients underwent cardiopulmonary exercise testing before and after the programme. Assessment of exercise oscillatory ventilation was based on the amplitude of cyclic fluctuations in breathing during rest and exercise. All values are mean ± SD. Results Exercise training reduced ( P < 0.05) the percentage of exercise oscillatory ventilation duration (79.0 ± 13.0 to 50.0 ± 25.0%), while average amplitude (5.2 ± 2.0 to 4.9 ± 1.6 L/minute) and length (44.0 ± 10.9 to 41.0 ± 6.7 seconds) did not change ( P > 0.05). Exercise oscillatory ventilation patients also increased exercise capacity ( P < 0.05). Conclusions A rehabilitation programme based on high intensity interval training improved exercise oscillatory ventilation observed in chronic heart failure patients, as well as cardiopulmonary efficiency and functional capacity.
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Affiliation(s)
- Niki Panagopoulou
- 1 Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Eleftherios Karatzanos
- 1 Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Stavros Dimopoulos
- 1 Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Athanasios Tasoulis
- 1 Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Ioannis Tachliabouris
- 2 Third Cardiology Department, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Styliani Vakrou
- 2 Third Cardiology Department, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Antonios Sideris
- 3 Second Department of Cardiology, "Evaggelismos" General Hospital, Athens, Greece
| | - Christina Gratziou
- 4 Pulmonary and Critical Care University Department, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Serafim Nanas
- 1 Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, School of Medicine, National and Kapodistrian University of Athens, Greece
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Fu TC, Lin WC, Wang JS, Wang CH, Chang CT, Tsai CL, Lee YS, Lin KP. Detection of exercise periodic breathing using thermal flowmeter in patients with heart failure. Med Biol Eng Comput 2016; 55:1189-1198. [PMID: 27744563 DOI: 10.1007/s11517-016-1581-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 03/03/2016] [Accepted: 09/26/2016] [Indexed: 02/04/2023]
Abstract
Exercise periodic breathing (EPB) is associated with exercise intolerance and poor prognosis in patients with heart failure (HF). However, EPB detection during cardiopulmonary exercise test (CPET) is difficult. The present study investigated the use of a wireless monitoring device to record the EPB during CPET and proposed quantization parameter estimates for the EPB. A total of 445 patients with HF were enrolled and underwent exercise tests. The ventilation data from the wearable device were compared with the data obtained during the CPET and were analyzed based on professional opinion and on 2 automated programs (decision tree [DT] and oscillatory pattern methods). The measurement accuracy was greater with the DT method (89 %) than with the oscillatory pattern method (75 %). The cutoffs for EPB recognition using the DT method were (1) an intercept of the regression line passing through the minute ventilation rate vs. the time curve during the recovery phase ≥64.63, and (2) an oscillatory phase duration to total exercise time ratio ≥0.5828. The wearable device was suitable for the assessment of EPB in patients with HF, and our new automated analysis system using the DT method effectively identified the EPB pattern.
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Affiliation(s)
- Tieh-Cheng Fu
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Keelung, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Wen-Chen Lin
- Technology Translation Center for Medical Device, Chung Yuan Christian University, Tao-Yuan, Taiwan
| | - Jong-Shyan Wang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Keelung, Taiwan.,Healthy Aging Research Center, Graduate Institute of Rehabilitation Science, Medical College, Chang Gung University, Tao-Yuan, Taiwan
| | - Chao-Hung Wang
- Heart Failure Center, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chun-Tien Chang
- Computer and Communication Center, National Tsing Hua University, Hsinchu, Taiwan
| | - Cheng-Lun Tsai
- Technology Translation Center for Medical Device, Chung Yuan Christian University, Tao-Yuan, Taiwan.,Department of Biomedical Engineering, Chung Yuan Christian University, Tao-Yuan, Taiwan
| | - Yun-Shien Lee
- Department of Biotechnology, Ming-Chuan University, Kwei-Shan, Tao-Yuan, Taiwan
| | - Kang-Ping Lin
- Technology Translation Center for Medical Device, Chung Yuan Christian University, Tao-Yuan, Taiwan. .,Department of Electrical Engineering, Chung Yuan Christian University, 200 Chung Pei Road, Chung Li, Tao-Yuan, 32023, Taiwan.
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Hermand E, Lhuissier FJ, Voituron N, Richalet JP. Ventilatory oscillations at exercise in hypoxia: A mathematical model. J Theor Biol 2016; 411:92-101. [PMID: 27743839 DOI: 10.1016/j.jtbi.2016.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 03/22/2016] [Revised: 09/01/2016] [Accepted: 10/04/2016] [Indexed: 10/20/2022]
Abstract
We evaluated the mechanisms responsible for the instability of ventilation control system under simultaneous metabolic (exercise) and environmental (hypoxia) stresses, promoting the genesis of periodic breathing. A model following the main concepts of ventilatory control has been tested, including cardiovascular and respiratory parameters, characteristics of peripheral and central chemoreceptors, at mild exercise in hypoxia (FIO2=0.145). Interaction between O2 and CO2 sensing was introduced following three different modalities. A sensitivity and multivariate regression analyses closely matched with physiological data for magnitude and period of oscillations. Low FIO2 and long circulatory delay from lungs to peripheral chemoreceptors (DeltaTp) lengthen the period of oscillations, while high peripheral and central chemoresponses to O2 and CO2, low FIO2 and high DeltaTp increased their magnitude. Peripheral and central O2/CO2 interactions highlight the role of CO2 on peripheral gain to O2 and the contribution of peripheral afferences on central gain to CO2. Our model supports the key role of peripheral chemoreceptors in the genesis of ventilatory oscillations. Differences in the dynamics of central and peripheral components might be determinant for the system stability.
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Affiliation(s)
- Eric Hermand
- Université Paris 13, Sorbonne Paris Cité, Laboratoire "Hypoxie et poumons", EA2363, 74 rue Marcel Cachin, 93017 Bobigny Cedex, France.
| | - François J Lhuissier
- Université Paris 13, Sorbonne Paris Cité, Laboratoire "Hypoxie et poumons", EA2363, 74 rue Marcel Cachin, 93017 Bobigny Cedex, France
| | - Nicolas Voituron
- Université Paris 13, Sorbonne Paris Cité, Laboratoire "Hypoxie et poumons", EA2363, 74 rue Marcel Cachin, 93017 Bobigny Cedex, France
| | - Jean-Paul Richalet
- Université Paris 13, Sorbonne Paris Cité, Laboratoire "Hypoxie et poumons", EA2363, 74 rue Marcel Cachin, 93017 Bobigny Cedex, France.
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MacLean JE, Fitzgerald DA, Waters KA. Developmental changes in sleep and breathing across infancy and childhood. Paediatr Respir Rev 2015; 16:276-84. [PMID: 26364005 DOI: 10.1016/j.prrv.2015.08.002] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 08/06/2015] [Indexed: 11/24/2022]
Abstract
Sleep and breathing are physiological processes that begin in utero and undergo progressive change. While the major period of change for both sleep and breathing occurs during the months after birth, considered a period of vulnerability, more subtle changes continue to occur throughout childhood. The systems that control sleep and breathing develop separately, but sleep represents an activity state during which breathing and breathing control is significantly altered. Infants and young children may spend up to 12 hours a day sleeping; therefore, the effects of sleep on breathing are fundamental to understanding both processes in childhood. This review summarizes the current literature relevant to understanding the normal development of sleep and breathing across infancy and childhood.
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Affiliation(s)
- Joanna E MacLean
- Division of Respiratory Medicine, Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada; Discipline of Paediatrics & Child Health, Sydney Medical School, University of Sydney, Australia; Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia.
| | - Dominic A Fitzgerald
- Discipline of Paediatrics & Child Health, Sydney Medical School, University of Sydney, Australia; Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Karen A Waters
- Discipline of Paediatrics & Child Health, Sydney Medical School, University of Sydney, Australia; Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
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Insalaco G, Salvaggio A, Pomidori L, Cogo A, Romano S. Heart rate variability during sleep at high altitude: effect of periodic breathing. Sleep Breath 2016; 20:197-204. [PMID: 26041647 DOI: 10.1007/s11325-015-1205-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 04/28/2015] [Accepted: 05/25/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Heart rate variability (HRV) during sleep in normal subjects at high altitude shows a decrease in parasympathetic tone associated with an increase in the sympathetic one, which tends to be reversed with acclimatization. However, periodic breathing (PB) during sleep may influence this effect detected by HRV spectral analysis. PURPOSE The aim of our study was to investigate HRV during sleep periodic breathing (PB) at high altitude in normal subjects at two different times of acclimatization, i.e., two different levels of hypoxemia. METHODS Recordings of six healthy climbers (aged between 33 and 40 years), at sea level (SL) and at Everest North Base Camp (5180 m), during the first (BC1) and the tenth (BC2) overnight unattended polygraphy, were analyzed. PB was commonplace in all subjects at high altitude to a variable extent. At SL and at BC1 and BC2, HRV was evaluated overnight and separately during clear regular breathing (RB) and PB. RESULTS A mean overnight beat-by-beat series interval (RR) reduction at acute environmental hypoxic exposure that resumed to SL values after 10-day sojourn was observed. This reduction was mostly due to RR during RB, while during PB, RR values were not different from SL. Higher peaks of tidal volume were associated with higher HRV. CONCLUSIONS The present study shows that in healthy subjects, PB with central apneas increases the amplitude of RR oscillations, and these oscillations are tightly related to respiratory amplitude. Oxygenation does not influence this phenomenon. Therefore, oscillations in ventilation itself should be taken into account when investigating HRV.
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Kisaka T, Rossiter HB, Wasserman K, Kihara Y. Exercise oscillatory ventilation: ventilation-perfusion abnormality in heart failure. Int J Cardiol 2015; 185:55. [PMID: 25804348 DOI: 10.1016/j.ijcard.2015.03.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 03/07/2015] [Indexed: 11/23/2022]
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Van den Broecke S, Jobard O, Montalescot G, Bruyneel M, Ninane V, Arnulf I, Similowski T, Attali V. Very early screening for sleep-disordered breathing in acute coronary syndrome in patients without acute heart failure. Sleep Med 2014; 15:1539-46. [PMID: 25308397 DOI: 10.1016/j.sleep.2014.06.017] [Citation(s) in RCA: 13] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 06/16/2014] [Accepted: 06/20/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is frequently associated with acute coronary syndrome (ACS). Screening of sleep-disordered breathing (SDB) has not been previously evaluated in ACS within 72 h in intensive care settings and its management could potentially enhance patients' prognosis. This pilot study assessed the feasibility of SDB screening at the early phase of ACS. METHODS All consecutive patients admitted to the coronary care unit (CCU) for ACS without acute heart failure underwent one overnight-attended polysomnography (PSG) within 72 h after admission. A telemonitoring (TM) system was set up to remotely monitor the signals and repair faulty sensors. The 27 recordings were analyzed as respiratory polygraphy (RP) and as PSG, and the results were compared. RESULTS The TM system allowed successful intervention in 48% of recordings, resulting in excellent quality PSG for 89% of cases. The prevalence of SDB [apnea-hypopnea index (AHI) ≥ 15/h] was 82% and mainly consisted of central SDB and periodic breathing, except three patients with OSA. Compared with PSG, RP underestimated AHI, probably due to the poor sleep efficiency, reduction of slow-wave sleep, and alteration of rapid eye movement sleep. CONCLUSION An early SDB screening by remote-attended PSG is feasible in ACS patients shortly after admission to CCU. The TM enhanced the quality of PSG. A high prevalence of central SDB was noticed, for which the etiology remains unknown. Further large-scale studies are needed to determine whether central SDB is an incidental finding in early ACS and whether the presence and severity of SDB have a prognostic impact.
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Affiliation(s)
- Sandra Van den Broecke
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Pathologies du Sommeil, Paris, France; Service de Pneumologie, CHU St Pierre, Université Libre de Bruxelles, Brussels, Belgium.
| | - Olivier Jobard
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Institut de Cardiologie, ACTION Group, Université Paris-6, Paris, France
| | - Gilles Montalescot
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Institut de Cardiologie, ACTION Group, Université Paris-6, Paris, France
| | - Marie Bruyneel
- Service de Pneumologie, CHU St Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Vincent Ninane
- Service de Pneumologie, CHU St Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Isabelle Arnulf
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Pathologies du Sommeil, Paris, France; Sorbonne Universités, UPMC Université Paris 06, I5, CRICM, Paris, France; INSERM, UMR_S 975; CNRS UMR 7225, Paris, France
| | - Thomas Similowski
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale, Paris, France; Sorbonne Universités, UPMC Université Paris 06, UMR_S 1158, "Neurophysiologie Respiratoire Expérimentale et Clinique", F-75005, Paris, France; INSERM, UMR_S 1158, "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France
| | - Valérie Attali
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Pathologies du Sommeil, Paris, France; Sorbonne Universités, UPMC Université Paris 06, UMR_S 1158, "Neurophysiologie Respiratoire Expérimentale et Clinique", F-75005, Paris, France; INSERM, UMR_S 1158, "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France
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Gederi E, Nemati S, Edwards BA, Clifford GD, Malhotra A, Wellman A. Model-based estimation of loop gain using spontaneous breathing: a validation study. Respir Physiol Neurobiol 2014; 201:84-92. [PMID: 25038522 DOI: 10.1016/j.resp.2014.07.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [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: 11/07/2013] [Revised: 06/16/2014] [Accepted: 07/02/2014] [Indexed: 10/25/2022]
Abstract
Non-invasive assessment of ventilatory control stability or loop gain (which is a key contributor in a number of sleep-related breathing disorders) has proven to be cumbersome. We present a novel multivariate autoregressive model that we hypothesize will enable us to make time-varying measurements of loop gain using nothing more than spontaneous fluctuations in ventilation and CO2. The model is adaptive to changes in the feedback control loop and therefore can account for system non-stationarities (e.g. changes in sleep state) and it is resistant to artifacts by using a signal quality measure. We tested this method by assessing its ability to detect a known increase in loop gain induced by proportional assist ventilation (PAV). Subjects were studied during sleep while breathing on continuous positive airway pressure (CPAP) alone (to stabilize the airway) or on CPAP+PAV. We show that the method tracked the PAV-induced increase in loop gain, demonstrating its time-varying capabilities, and it remained accurate in the face of measurement related artifacts. The model was able to detect a statistically significant increase in loop gain from 0.14±10 on CPAP alone to 0.21±0.13 on CPAP+PAV (p<0.05). Furthermore, our method correctly detected that the PAV-induced increase in loop gain was predominantly driven by an increase in controller gain. Taken together, these data provide compelling evidence for the validity of this technique.
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Affiliation(s)
- Elnaz Gederi
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford OX1 3PJ, UK.
| | - Shamim Nemati
- Harvard School of Engineering and Applied Sciences, 33 Oxford Street, Cambridge, MA 02138, USA
| | - Bradley A Edwards
- Division of Sleep Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Gari D Clifford
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford OX1 3PJ, UK; Division of Sleep Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA; Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, GA 30322, USA; Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Atul Malhotra
- Division of Sleep Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA; Pulmonary and Critical Care Division, University of California, San Diego, CA 92037, USA
| | - Andrew Wellman
- Division of Sleep Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
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Olson TP, Johnson BD. Quantifying oscillatory ventilation during exercise in patients with heart failure. Respir Physiol Neurobiol 2014; 190:25-32. [PMID: 24121091 DOI: 10.1016/j.resp.2013.09.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 09/06/2013] [Accepted: 09/18/2013] [Indexed: 01/01/2023]
Abstract
BACKGROUND This study examined the validity of a novel software application to quantify measures of periodic breathing rest (PB) and oscillatory ventilation during exercise (EOV) in heart failure patients (HF). METHODS Eleven male HF patients (age=53±8yrs, ejection fraction=17±4, New York Heart Association Class=III(7)/IV(4)) were recruited. Ventilation and gas exchange were collected breath-by-breath. Amplitude and period of oscillations in ventilation (V˙E), tidal volume (VT), end-tidal carbon dioxide [Formula: see text] , and oxygen consumption [Formula: see text] were measured manually (MAN) and using novel software which included a peak detection algorithm (PK), sine wave fitting algorithm (SINE), and Fourier analysis (FOUR). RESULTS During PB, there were no differences between MAN and PK for amplitude of V˙E, VT, [Formula: see text] , or [Formula: see text] . Similarly, there were no differences between MAN and SINE for amplitude of V˙E or VT although [Formula: see text] and [Formula: see text] were lower with SINE (p<0.05). In contrast, the PK demonstrated significantly shorter periods for V˙E, VT, [Formula: see text] , and [Formula: see text] compared to MAN (p<0.05) whereas there were no differences in periods of oscillations between MAN and SINE or FOUR for all variables. During EOV, there were no differences between MAN and PK for amplitude of V˙E, VT, [Formula: see text] , and [Formula: see text] . SINE demonstrated significantly lower amplitudes for VT, [Formula: see text] , and [Formula: see text] (p<0.05) although V˙E was not different. PK demonstrated shorter periods for all variables (p<0.05) whereas there were no differences between MAN and SINE or FOUR for all variables. CONCLUSION These data suggest PK consistently captures amplitudes while underestimating period. In contrast, SINE and FOUR consistently capture period although SINE underestimates amplitude. Thus, an optimal algorithm for the quantification of PB and/or EOV in patients with HF might combine multiple analysis methods.
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Wang JS, Fu TC, Wang CH, Chou SL, Liu MH, Cherng WJ. Exertional periodic breathing potentiates erythrocyte rheological dysfunction by elevating pro-inflammatory status in patients with anemic heart failure. Int J Cardiol 2013; 167:1289-97. [PMID: 22521383 DOI: 10.1016/j.ijcard.2012.03.170] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Accepted: 03/30/2012] [Indexed: 01/27/2023]
Abstract
BACKGROUND Exertional periodic breathing (EPB) or anemia is associated with an adverse prognosis in advanced heart failure (HF). The disturbed rheological properties of erythrocytes may contribute to circulatory disorders. This study investigated whether EPB with/without anemia influences rheological/hemodynamic functions in patients with HF. METHODS According to the WHO criteria for anemia, 168 HF patients were divided into six groups: non (N)-anemic with (n=27)/without (n=56) EPB, light (L)-anemic with (n=17)/without (n=21) EPB, and moderate/several (M/S)-anemic with (n=21)/without (n=26) EPB groups. These HF patients and 30 healthy counterparts performed an incremental exercise test using a bicycle ergometer. Rheological and hemodynamic characteristics were determined by slit-flow ektacytometer and bioreactance-based device/near infrared spectrometer, respectively. RESULTS In the HF patients with EPB, both L- and M/S-anemic groups exhibited 1) higher plasma myeloperoxidase/interleukin-6 concentrations, 2) more blood senescent/spherical erythrocyte counts, 3) larger aggregability and smaller deformability of erythrocytes under shear flows, 4) higher systemic vascular resistance, which was accompanied by smaller amounts of blood distributed to cerebral/muscular tissues during exercise, 5) less VO(2peak) and ventilatory efficiency, and 6) lower Short Form-36 physical/mental component scores and higher Minnesota Living with HF questionnaire score than N-anemic group. Additionally, plasma myeloperoxidase/interleukin-6 levels were directly related to erythrocyte aggregability and inversely related to erythrocyte deformability. However, there were no significant differences in pro-inflammatory factors, rheological/hemodynamic properties, and aerobic capacity between L- and N-anemic groups in the HF patients without EPB. CONCLUSION EPB potentiates anemia-related rheological/hemodynamic dysfunctions by elevating pro-inflammatory status, reducing physical fitness in patients with HF.
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