Neural Respiratory Drive and Ventilation in Patients with Chronic Obstructive Pulmonary Disease during Sleep

Luo, Yuan; He, Baiting; Wu, Yuping; Yuan, Hong; Xu, Jing; Moxham, John; Polkey, Michael I.

doi:10.1164/rccm.201402-0302le

Cited by 21 publications

(37 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Respiratory EMG has been used to assess respiratory muscle control in cardiorespiratory disease at rest (table S10) and during exercise (table S11). Briefly, diaphragm EMG is a surrogate of respiratory effort [102, [111][112][113], it can be used to distinguish between central and obstructive sleep apnoea events [111,112,114], to assess exertional breathlessness during exercise [64,97,115,116] and, when combined with VT recordings, it can be used to assess upper airway resistance [112,117]. Given increased respiratory motor output to the respiratory muscles in COPD [118,119] and the relationship between EMG and lung function, respiratory EMG has been taken as a marker for disease severity in stable COPD [103] and to predict COPD exacerbations [105], early hospital admission [107] and the effect of medical interventions [120][121][122].…”

Section: Electromyographymentioning

confidence: 99%

ERS statement on respiratory muscle testing at rest and during exercise

et al. 2019

Self Cite

View full text Add to dashboard Cite

Assessing respiratory mechanics and muscle function is critical for both clinical practice and research purposes. Several methodological developments over the past two decades have enhanced our understanding of respiratory muscle function and responses to interventions across the spectrum of health and disease. They are especially useful in diagnosing, phenotyping and assessing treatment efficacy in patients with respiratory symptoms and neuromuscular diseases. Considerable research has been undertaken over the past 17 years, since the publication of the previous American Thoracic Society (ATS)/European Respiratory Society (ERS) statement on respiratory muscle testing in 2002. Key advances have been made in the field of mechanics of breathing, respiratory muscle neurophysiology (electromyography, electroencephalography and transcranial magnetic stimulation) and on respiratory muscle imaging (ultrasound, optoelectronic plethysmography and structured light plethysmography). Accordingly, this ERS task force reviewed the field of respiratory muscle testing in health and disease, with particular reference to data obtained since the previous ATS/ERS statement. It summarises the most recent scientific and methodological developments regarding respiratory mechanics and respiratory muscle assessment by addressing the validity, precision, reproducibility, prognostic value and responsiveness to interventions of various methods. A particular emphasis is placed on assessment during exercise, which is a useful condition to stress the respiratory system.

show abstract

Section: Electromyographymentioning

confidence: 99%

ERS statement on respiratory muscle testing at rest and during exercise

et al. 2019

Self Cite

View full text Add to dashboard Cite

show abstract

“…2 Here we aimed to investigate the underlying mechanisms of hypoventilation during sleep in patients with COPD alone and patients with overlap syndrome by comparing neural respiratory drive and ventilation. The data from 10 of the patients with COPD alone and 10 healthy subjects has previously been reported; these were the participants with complete datasets from that report.…”

Section: Why Read On?mentioning

confidence: 99%

“…The EMG di recorded from a multipair oesophageal electrode can be used to assess neural respiratory drive, 2 …”

Section: Introductionmentioning

confidence: 99%

Coexistence of OSA may compensate for sleep related reduction in neural respiratory drive in patients with COPD

Gan

Xiao

et al. 2016

Thorax

Self Cite

View full text Add to dashboard Cite

BackgroundThe mechanisms underlying sleep-related hypoventilation in patients with coexisting COPD and obstructive sleep apnoea (OSA), an overlap syndrome, are incompletely understood. We compared neural respiratory drive expressed as diaphragm electromyogram (EMGdi) and ventilation during stage 2 sleep in patients with COPD alone and patients with overlap syndrome.MethodsEMGdi and airflow were recorded during full polysomnography in 14 healthy subjects, 14 patients with OSA and 39 consecutive patients with COPD. The ratio of tidal volume to EMGdi was measured to indirectly assess upper airway resistance.ResultsThirty-five patients with COPD, 12 healthy subjects and 14 patients with OSA completed the study. Of 35 patients with COPD, 19 had COPD alone (FEV1 38.5%±16.3%) whereas 16 had an overlap syndrome (FEV1 47.5±16.2%, AHI 20.5±14.1 events/hour). Ventilation (VE) was lower during stage 2 sleep than wakefulness in both patients with COPD alone (8.6±2.0 to 6.5±1.5 L/min, p<0.001) and those with overlap syndrome (8.3±2.0 to 6.1±1.8 L/min). Neural respiratory drive from wakefulness to sleep decreased significantly for patients with COPD alone (29.5±13.3% to 23.0±8.9% of maximal, p<0.01) but it changed little in those with overlap syndrome. The ratio of tidal volume to EMGdi was unchanged from wakefulness to sleep in patients with COPD alone and healthy subjects but was significantly reduced in patients with OSA or overlap syndrome (p<0.05).ConclusionsStage 2 sleep-related hypoventilation in COPD alone is due to reduction of neural respiratory drive, but in overlap syndrome it is due to increased upper airway resistance.

show abstract

“…In patients with COPD, neural drive decreases by 20%–30% during NREM sleep7 9 and by about 50% during REM sleep 9. Elevated drive during wakefulness9 10 along with sleep-related reduction in hypercapnic chemosensitivity11 underpin this decrease in drive during sleep in COPD 9 10.…”

mentioning

confidence: 99%

“…Elevated drive during wakefulness9 10 along with sleep-related reduction in hypercapnic chemosensitivity11 underpin this decrease in drive during sleep in COPD 9 10. In patients with OSA, increased drive during sleep is a physiological response to increased upper airway resistance 7 12.…”

mentioning

confidence: 99%