Home respiratory muscle training in patients with chronic obstructive pulmonary disease

The benefits of inspiratory muscle strength training in decreasing symptoms, disability or handicap of patients affected by COPD are not well established. The objective of this study was to assess the efficacy of the constant use of a new flow-volumetric inspiratory exerciser, named Respivol™, in improving respiratory functional parameters in COPD patients. Twenty consecutive ambulatory patients affected by COPD were enrolled. Each patient was assessed, before and after 3 and 6 months inspiratory exercise with Respivol™, for the following clinical parameters: maximal inspiratory pressure, maximal expiratory pressure, dyspnoea grade, quality of life by a self-administered St George questionnaire and a 6-min walking test. After a brief progressive ambulatory training programme, inspiratory exercise with Respivol™ was performed at home for 6 months. All patients used Respivol™ together with medical treatment. Maximal inspiratory pressure and maximal expiratory pressure values were significantly increased after 3 and 6 months of exercise. Dyspnoea grade was significantly reduced and the 6-min walking test showed an increase in effort tolerance, after 6 months of home training. Quality of life assessment showed an improvement, associated with a decrease of respiratory disease symptoms. Inspiratory muscle strength training with Respivol™ seems to be efficient in reducing symptoms and improving quality of life in adults with COPD

Prevalence of sleep disruption and determinants of sleepiness in a cohort of Italian hospital physicians: The PRESOMO study

Nightshift work can cause daytime somnolence and decreased alertness, and can increase risk of medical errors, occupational injuries and car accidents. We used a structured questionnaire, including the Epworth Sleepiness Scale (ESS), to assess the prevalence and the determinants of sleep disruption in 268 Italian University hospital physicians from Cagliari (N = 57), Milan (N = 180) and Pisa (N = 31), who participated in the multicentre study on the prevalence of sleep disturbance among hospital physicians (PRESOMO); 198 of them (74%) were engaged in nightshift work. We explored the association between history of nightshift work and poor sleep quality and daytime somnolence with multivariate logistic regression, adjusting by personal and lifestyle covariates. Age, female gender, taking medication interfering with sleep and an elevated ESS score were significant predictors of poor sleep quality and daytime somnolence. Nightshift work was associated with a higher prevalence of unrestful sleep (84% versus 70%; odds ratio [OR] = 2.4, 95% confidence interval [CI] 1.18-5.05) and daytime dozing (57% versus 35%; OR = 1.9, 95% CI 1.03-3.64), with an upward trend by years of engagement in nightshift work for both conditions (p = .043 and 0.017, respectively), and by number of nightshifts/year for unrestful sleep (p = .024). Such an association was not detected with the ESS scale. Our results suggest that nightshift work significantly affects sleep quality and daytime somnolence in hospital physicians, who might underestimate their daytime dozing problem, when asked to subjectively scale it