Assessment of respiratory flow cycle morphology in patients with chronic heart failure

Breathing pattern as periodic breathing (PB) in chronic heart failure (CHF) is associated with poor prognosis and high mortality risk. This work investigates the significance of a number of time domain parameters for characterizing respiratory flow cycle morphology in patients with CHF. Thus, our primary goal is to detect PB pattern and identify patients at higher risk. In addition, differences in respiratory flow cycle morphology between CHF patients (with and without PB) and healthy subjects are studied. Differences between these parameters are assessed by investigating the following three classification issues: CHF patients with PB versus with non-periodic breathing (nPB), CHF patients (both PB and nPB) versus healthy subjects, and nPB patients versus healthy subjects. Twenty-six CHF patients (8/18 with PB/nPB) and 35 healthy subjects are studied. The results show that the maximal expiratory flow interval is shorter and with lower dispersion in CHF patients than in healthy subjects. The flow slopes are much steeper in CHF patients, especially for PB. Both inspiration and expiration durations are reduced in CHF patients, mostly for PB. Using the classification and regression tree technique, the most discriminant parameters are selected. For signals shorter than 1 min, the time domain parameters produce better results than the spectral parameters, with accuracies for each classification of 82/78, 89/85, and 91/89 %, respectively. It is concluded that morphologic analysis in the time domain is useful, especially when short signals are analyzed.Peer ReviewedPostprint (author's final draft

Using the heart rate variability for classifying patients with and without chronic heart failure and periodic breathing

Assessment of the dynamic interactions between cardiovascular signals can provide valuable information that improves the understanding of cardiovascular control. Heart rate variability (HRV) analysis is known to provide information about the autonomic heart rate modulation mechanism. Using the HRV signal, we aimed to obtain parameters for classifying patients with and without chronic heart failure (CHF), and with periodic breathing (PB), non-periodic breathing (nPB), and Cheyne-Stokes respiration (CSR) patterns. An electrocardiogram (ECG) and a respiratory flow signal were recorded in 36 elderly patients: 18 patients with CHF and 18 patients without CHF. According to the clinical criteria, the patients were classified into the follow groups: 19 patients with nPB pattern, 7 with PB pattern, 4 with Cheyne-Stokes respiration (CSR), and 6 non-classified patients (problems with respiratory signal). From the HRV signal, parameters in the time and frequency domain were calculated. Frequency domain parameters were the most discriminant in comparisons of patients with and without CHF: PTOT, PLF and fpHF. For the comparison of the nPB vs CSR patients groups, the best parameters were RMSSD and SDSD. Therefore, the parameters appear to be suitable for enhanced diagnosis of decompensated CHF patients and the possibility of developed periodic breathing and a CSR pattern

Effects of low dose morphine on perceived sleep quality in patients with refractory breathlessness : a hypothesis generating study

© 2015 Asian Pacific Society of Respirology. Background and objective The management of chronic refractory breathlessness is one of the indications for regular low-dose (≤30 mg/24 h) oral sustained release morphine. Morphine may disrupt sleep in some conditions and improve sleep quality in others. This study aimed to determine any signal of regular, low-dose morphine on perceived sleep disruption due to breathlessness and perceived sleep quality. Methods This is a secondary analysis of data from 38 participants with refractory breathlessness (30 male; 33 with COPD) aged 76 ± 0.9 years who completed a double-blind, randomized, placebo-controlled, cross-over study in which they received 20 mg oral sustained release morphine daily and placebo for 4 days each. Participant ratings of sleep disruption due to breathlessness and perceived sleep quality were obtained daily throughout the 8-day trial. Results Perceived sleep disruption due to breathlessness over the 4-day period ranged between 13% and 32% of participants for placebo and 13% and 26% for morphine, decreasing by each day of the study during the morphine arm. Most participants reported 'very good' or 'quite good' sleep throughout the trial and were less likely to perceive poor sleep quality during the morphine arm (odds ratio = 0.55, 95% confidence interval: 0.34-0.88, P = 0.01). Participants who reported decreased breathlessness during the 4 days on morphine were also likely to report improved sleep quality with morphine (P = 0.039). Conclusion Four days of low-dose morphine improved perceived sleep quality in elderly participants with refractory breathlessness. Regular low-dose morphine targeted to reduce refractory breathlessness may yield associated benefits by reducing sleep disruption and improving sleep quality

A medical information system for monitoring respiratory function and related nonlinear dynamics

In this paper the nonlinear effects in the respiratory systems at low frequencies are measured and evaluated in healthy children and healthy adults. To this aim forced oscillations technique (FOT) has been used to non-invasively measure the lung tissue mechanics. FOT does not require any special effort from the patient in contrast with standardized tests where maneuvers are necessary. Hence, FOT is an ideal lung function test for extreme ages, more specifically children and elderly, given the simpleness of measurement technique. Hitherto, measurements at low frequencies (i.e. close to the breathing frequency similar to 0.3 Hz) have been invasively performed in sacrificed animals and on anesthetized humans. Here we measure in the frequency interval 0.1-2 Hz a total number of 94 volunteers (37 adults with ages between 25-35 years and 57 children with ages between 8-11 years). To evaluate the nonlinear contributions of the respiratory tissue, a novel T-index has been introduced. We have tested the hypothesis whether the nonlinear distortions are changing with growth/development of the respiratory tree and aim to quantify its dependence to biometric values. The results obtained indicate that the proposed index can differentiate between the two analyzed groups and that there is a dependence to age, height and weight. A medical information system may use this information to update predictions of respiratory function and provide aid in decision-making process of drug therapy

Year in review 2006: Critical Care – respirology

The present article summarises and places in context original research articles from the respirology section published in Critical Care in 2006. Twenty papers were identified and were grouped by topic into those addressing acute lung injury and ventilator-induced lung injury, those examining high-frequency oscillation, those studying pulmonary physiology and mechanics, those assessing tracheostomy, and those exploring other topics

Bayesian Model Search for Nonstationary Periodic Time Series

We propose a novel Bayesian methodology for analyzing nonstationary time series that exhibit oscillatory behaviour. We approximate the time series using a piecewise oscillatory model with unknown periodicities, where our goal is to estimate the change-points while simultaneously identifying the potentially changing periodicities in the data. Our proposed methodology is based on a trans-dimensional Markov chain Monte Carlo (MCMC) algorithm that simultaneously updates the change-points and the periodicities relevant to any segment between them. We show that the proposed methodology successfully identifies time changing oscillatory behaviour in two applications which are relevant to e-Health and sleep research, namely the occurrence of ultradian oscillations in human skin temperature during the time of night rest, and the detection of instances of sleep apnea in plethysmographic respiratory traces.Comment: Received 23 Oct 2018, Accepted 12 May 201

Functional respiratory re-education interventions in people with respiratory disease: a systematic literature review

Objectives: to identify nursing interventions in rehabilitation, within the scope of functional respiratory reeducation, which allow a respiratory function improvement in people with respiratory disease. Methods: systematic literature review using the MEDLINE database search, adopting the PICO mnemonic and the Joanna Briggs Institute’s assessment of the level of evidence and methodological quality. The search for randomized controlled trials was carried out in June 2021 considering the period from 2015 to 2020, in English or Portuguese. Results: a sample of nine randomized controlled trials with methodological quality was obtained which highlighted the use of positive expiratory pressure devices as an importantcomponent and intervention for respiratory functional reeducation. Conclusions: nursing interventions in rehabilitation with an emphasis on functional respiratory reeducation are essential, showing improvements in people’s general health

The Appreciative Heart: The Psychophysiology of Positive Emotions and Optimal Functioning

This monograph is an overview of Institute of HeartMath's research on the physiological correlates of positive emotions and the science underlying two core HeartMath techniques which supports Heart-Based Living. The heart's connection with love and other positive emotions has survived throughout millennia and across many diverse cultures. New empirical research is providing scientific validation for this age-old association. This 21-page monograph offers a comprehensive understanding of the Institute of HeartMath's cutting-edge research exploring the heart's central role in emotional experience. Described in detail is physiological coherence, a distinct mode of physiological functioning, which is generated during sustained positive emotions and linked with beneficial health and performance-related outcomes. The monograph also provides steps and applications of two HeartMath techniques, Freeze-Frame(R) and Heart Lock-In(R), which engage the heart to help transform stress and produce sustained states of coherence. Data from outcome studies are presented, which suggest that these techniques facilitate a beneficial repatterning process at the mental, emotional and physiological levels

Physiological monitoring in the complex multi-morbid heart failure patient - Introduction.

Repeated physiological monitoring of comorbidities in heart failure (HF) is pivotal. This document introduces the main challenges related to physiological monitoring in the complex multimorbid HF patient, arising during an ESC consensus meeting on this topic

La insuficiencia cardíaca crónica en pacientes ancianos

Debido al creciente número de personas de edad avanzada y al extenso número de comorbilidades que les afectan, se requieren estudios para planificar los futuros incrementos en el número de ingresos en los servicios clínicos, y en particular en los de urgencias. Algunos de los problemas clínicos más comunes en pacientes ancianos están relacionados con enfermedades de los sistemas cardiovascular y respiratorio. Los pacientes ancianos a menudo presentan alteraciones en el patrón respiratorio, como son la respiración periódica (PB) y la respiración Cheyne-Stokes (CSR), que puede coincidir con una insuficiencia cardíaca crónica. El estudio de la envolvente de la señal respiratoria es un claro indicador de la modulación del patrón respiratorio