Mouth and Nasal Inspiratory Pressure: Learning Effect and Reproducibility in Healthy Adults

Abstract

Background: Inspiratory muscle strength measurements have become a cornerstone in monitoring neuromuscular disorders. Usually, sniff nasal inspiratory pressure (SNIP) and maximal inspiratory pressure (MIP) are performed. To our knowledge the session-to-session learning effect has rarely been evaluated for MIP performance and has never been done for SNIP performance. Objectives: We hypothesized that the sniff manoeuvre was natural and did not need to be learned, whereas the Muller manoeuvre, used for MIP measurement, was an isometric contraction which needed to be learned because it is rarely performed in real life conditions. This hypothesis suggests that from the first session and continuing through a subsequent one, the maximal SNIP value and the number of sniff trials necessary to attain it are more reproducible than the maximal MIP value and the number of Muller manoeuvre trials necessary to attain it. Methods: Seventy-one healthy subjects were included. SNIP and MIP manoeuvres were repeated 12 and 6 times, respectively, per week during 2 sessions a week apart. Results: We observed a session effect on MIP but not on SNIP. Maximal value for MIP was higher during the second session, whereas SNIP maximal value did not increase during the second session. The number of trials needed to obtain the maximal value for MIP was lower during the second session whereas it was not different for SNIP. Conclusions: SNIP is less sensitive to a learning effect than is MIP. It requires only a routine warm-up. We suggest that SNIP is preferable to MIP for repeated measurement of inspiratory muscle performance.

Sniff nasal inspiratory pressure in the longitudinal assessment of young Duchenne muscular dystrophy children

“…We therefore adopted this approach in our study, in line with the recommendations of LOFASO et al [13] for the longitudinal monitoring of inspiratory muscle strength. As a result, the SNIP repeatability in our BMD/DMD children was better than that observed in healthy children (16-17%, 10 sniffs without visual feedback) [21] or in 5-50-year-old subjects with neuromuscular disorders (20%, 10 sniffs without visual feedback) [9] but close to that reported in healthy adults (6% and 10% with 10 and 12 sniffs, respectively, without visual feed-back) [22,23].…”

Evaluation of the effectiveness of a home-based inspiratory muscle training programme in patients with chronic obstructive pulmonary disease using multiple inspiratory muscle tests

“…The metal tube was connected to a differential pressure transducer and PImax tracings were recorded in real time. Nose clips were worn and patients performed a minimum of 10 efforts to minimise the learning effect [14] with rest intervals of 30-60 seconds between efforts [31,32]. Visual feedback and strong encouragement were given throughout.…”

Sniff Nasal Inspiratory Pressure in Patients with Moderate-to-Severe Chronic Obstructive Pulmonary Disease: Learning Effect and Short-Term Between-Session Repeatability

“…These tests are relatively easy to perform and the development of portable devices has allowed their assessment in a variety of clinical settings. SNIP is a more natural manoeuvre than the PI max or PE max manoeuvres [2] and is used as an outcome measure in clinical studies, such as in patients with degenerative neuromuscular disease [3,4] or chronic obstructive pulmonary disease (COPD) [5]. Due to its volitional nature, the SNIP, just like PI max and PE max , requires a period of familiarisation before baseline measurements are accepted.…”

“…The repeatability of SNIP has been studied in healthy subjects [4,7]. In a study by Maillard et al [7], SNIP values obtained after 1 day were maintained after a period of 1 month, and Terzi et al [4] showed that SNIP had good reproducibility over 2 sessions a few days apart.…”

“…In a study by Maillard et al [7], SNIP values obtained after 1 day were maintained after a period of 1 month, and Terzi et al [4] showed that SNIP had good reproducibility over 2 sessions a few days apart. The optimal number of sniffs per session has also been established in healthy subjects and a variety of patient groups [8] contributing to the standardisation of baseline assessments prior to clinical studies.…”