Maximal Static Respiratory and Sniff Pressures in Healthy Children. A Systematic Review and Meta-Analysis

Verma, Ritu; Chiang, Jackie; Qian, Hong; Amin, Reshma

doi:10.1513/annalsats.201808-506oc

Cited by 34 publications

(50 citation statements)

References 29 publications

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“…Sniff nasal inspiratory pressure in the 7 patients completing this study was 73.6 + 11.1 cm H 2 O (4 of the patients were not able to complete the study because of lack of equipment access to measure the maximal inspiratory pressures and SNIPs). With these limitations and using proposed new normative values in children for maximal inspiratory pressure and sniff nasal inspiratory pressure, 19 we found that 6/11 patients had low maximal inspiratory pressure and 2/7 patients experienced abnormally low sniff nasal inspiratory pressure. There were no differences in myasthenia gravis extent or severity, onset of symptoms, presence of thymectomy, or steroid use in patients with abnormal respiratory tests compared to those without respiratory abnormality.…”

Section: Resultsmentioning

confidence: 95%

Respiratory Dysfunction and Sleep-Disordered Breathing in Children With Myasthenia Gravis

et al. 2020

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Objectives: The purpose of this study was to prospectively evaluate sleep patterns and the presence of sleep-disordered breathing in children with myasthenia gravis. We further aimed to examine the relationship between sleep and daytime respiratory function using spirometry tests including upright and supine forced vital capacity, sniff nasal inspiratory pressure, and maximal inspiratory pressure. Methods: Eleven children between 3 and 18 years old with confirmed myasthenia gravis were recruited from The Hospital for Sick Children Neuromuscular Clinic in this prospective observational study. After informed consent was obtained, patients underwent a comprehensive clinical assessment with collection of anthropometric data. Following this, all subjects performed pulmonary function tests, overnight polysomnography and completed the Epworth Sleepiness Scale questionnaire. Results: Two of eleven children who reported no symptoms of sleep disordered breathing were diagnosed with mild to moderate obstructive sleep apnea. Pulmonary function tests showed abnormal maximal inspiratory pressure in 6 of 11 patients, whereas seated forced vital capacity as well as seated to supine forced vital capacity ratios were normal in the entire group. Conclusions: In our small group of pediatric myasthenia gravis subjects, there was an unexpected finding of obstructive sleep apnea in 2 of the 11 patients studied. Maximal inspiratory pressure appears to be a more sensitive method of detecting abnormalities compared to upright or seated forced vital capacity. A larger multicenter study is needed to validate our findings and to determine the impact of obstructive sleep apnea in the pediatric myasthenia gravis population as well as risk factors associated with sleep disordered breathing.

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Section: Resultsmentioning

confidence: 95%

Respiratory Dysfunction and Sleep-Disordered Breathing in Children With Myasthenia Gravis

et al. 2020

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“…Categories were defined by the study physiotherapist (Grade 0: no contracture/hyperflexibility to Grade 4: most severe contracture). Reference values for pulmonary function testing were included for forced vital capacity (FVC) 25 , maximal inspiratory pressure (MIP) 26 , and peak cough flow (PCF) 27 . Participants were excluded from FVC% Predicted calculation if height and weight were not captured, or if they were unable to perform the assessment.…”

Section: Study Measuresmentioning

confidence: 99%

A Cross-Sectional Study of Nemaline Myopathy

et al. 2021

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Objective:Nemaline myopathy (NM) is a rare neuromuscular condition with clinical and genetic heterogeneity. To establish disease natural history, we performed a cross-sectional study of NM, complemented by longitudinal assessment and exploration of pilot outcome measures.Methods:Fifty-seven individuals with NM were recruited at two family workshops, including 16 examined at both time points. Subjects were evaluated by clinical history and physical examination. Functional outcome measures included the Motor Function Measure (MFM), pulmonary function tests (PFTs), myometry, goniometry, and bulbar assessments.Results:The most common clinical classification was “typical congenital” (54%), whereas 42% had more severe presentations. 58% of individuals needed mechanical support, with 26% requiring wheelchair, tracheostomy, and feeding tube. The MFM scale was performed in 44/57 participants and showed reduced scores in most with little floor/ceiling effect. Of the 27 individuals completing PFTs, abnormal values were observed in 65%. Lastly, bulbar function was abnormal in all patients examined, as determined using a novel outcome measure. Genotypes included mutations in ACTA1 (18), NEB (20), and TPM2 (2). Seventeen individuals were genetically unresolved. Patients with pathogenic ACTA1 and NEB variants were largely similar in clinical phenotype. Patients without genetic resolution had more severe disease.Conclusion:In all, we present a comprehensive cross-sectional study of NM. Our data identify significant disabilities and support a relatively stable disease course. We identify a need for further diagnostic investigation for the genetically unresolved group. Lastly, MFM, pulmonary function tests, and the slurp test were identified as promising outcome measures for future clinical trials.

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“…Maximal static inspiratory and expiratory pressures (PImax and PEmax, respectively), and sniff nasal inspiratory pressure (SNIP) are parameters commonly used to assess respiratory muscle strength in both adult and pediatric populations 1 . Although PImax is classically measured to assess global inspiratory muscle strength, this maneuver can be di cult, especially for children due to their reduced ability to understand and coordinate the effort with a hermetic seal placed around the mouthpiece 2 .…”

Section: Introductionmentioning

confidence: 99%

Reliability of SNIP test in healthy children from 6 to 11 years.

Marcelino

Fregonezi

Marques

et al. 2020

Preprint

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Background Sniff nasal inspiratory pressure (SNIP) is a voluntary inspiratory maneuver measured through a plug occluding one nostril. The investigation of the number of maneuvers necessary to reach the highest peak of SNIP in pediatric populations has been inconsistent. Thus, our goal was to assess the reliability SNIP in healthy children aged 6 to 11 years and compare with regard to sex and age group, as well as to determine the adequate number of maneuvers. Methods This cross-sectional study included healthy children with normal pulmonary function. Were performed 12 to 20 maneuvers SNIP near functional residual capacity, with a 30 s rest between each. Reliability was tested using intraclass correlation coefficient (ICC), standard error of measurement (SEM), minimal detectable change (MDC), and Bland-Altman analysis for agreement. Results A total of 121 children (62 girls [51%]) were included. The ICC and corresponding confidence interval (CI) between the highest measure and the first reproducible maneuver was 0.752 (0.656–0.824), SEM of 10.37 cmH2O and MDC of 28.74 cmH2O. For children aged 6–7 and 8–11 years, the ICC (CI) was 0.669 (0.427–0.822), SEM = 10.76 cmH2O and MDC = 29.82 cmH2O, and 0.774 (0.662–0.852), with SEM = 9.74 cmH2O and MDC = 26.05 cmH2O, respectively. For girls, the ICC (CI) was 0.817 (0.706–0.889), SEM = 9.40 cmH2O and MDC = 26.05 cmH2O; for boys, 0.671 (0.487–0.798), SEM = 11.51 cmH2O and MDC = 31.90 cmH2O. Approximately 80% of the total sample reached the highest SNIP before the 10th maneuver. Conclusions SNIP demonstrated moderate reliability between the maneuvers in children aged 6 to 11 years. Otherwise, older children and girls reached the SNIP peak faster. Finally, results suggested that 12 maneuvers were sufficient for healthy children aged 6 to 11 years to achieve the highest SNIP peak.

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Maximal Static Respiratory and Sniff Pressures in Healthy Children. A Systematic Review and Meta-Analysis

Cited by 34 publications

References 29 publications

Respiratory Dysfunction and Sleep-Disordered Breathing in Children With Myasthenia Gravis

Respiratory Dysfunction and Sleep-Disordered Breathing in Children With Myasthenia Gravis

A Cross-Sectional Study of Nemaline Myopathy

Reliability of SNIP test in healthy children from 6 to 11 years.

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