Cardiorespiratory coupling during sleep in difficult-to-control asthmatic patients

Heart rate variability (HRV) and respiration recorded during sleep from 8 patients suffering from difficult-to-control asthma were studied to investigate autonomic nervous system control of cardiac and respiratory activities, and of cardio-respiratory coupling during different sleep stages

Heart rate variability and cardiorespiratory coupling in obstructive sleep apnea: elderly compared with young

Introduction: Aging is known to be a major contributing factor to the increased risk of obstructive sleep apnea (OSA). With aging, breathing undergoes significant changes during sleep, increasing the prevalence of apnea events, which affects heart rate variability (HRV) and cardiorespiratory coupling (CRC).Objectives: To compare HRV and CRC during wakefulness and sleep between young and elderly patients with and without OSA; and to determine whether the presence of OSA in young and elderly patients has a different impact on HRV and CRC during sleep.Methods: One hundred subjects, 50 young (mean age, 27 +/- 9; 20 normal and 30 OSA) and 50 elderly (mean age, 65 +/- 7; 20 normal and 30 OSA), underwent polysomnography. Spectral, cross-spectrum, and HRV parameters were analyzed during wakefulness and sleep.Results: the spectral analysis indicated that age affected HRV, with higher values of low frequency (P < 0.05) in elderly subjects during wakefulness and an interaction between the presence of OSA and age. OSA influenced HRV during sleep with lower LF/HF ratios during stage 2 (S2) and rapid eye movement (REM) sleep (P < 0.05), with an interaction between the presence of OSA and age in REM sleep. Elderly patients had significantly lower percent tachogram power coherent with respiration (%TPCR) during wakefulness (P < 0.05), and OSA led to lower %TPCR during S2.Conclusions: Age and OSA have an unfavorable impact on HRV, with reduced autonomic modulation during wakefulness, S2, and REM sleep. Age affects CRC during wakefulness and the presence of OSA affects CRC during sleep. (C) 2014 Elsevier B.V. All rights reserved.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Univ Fed Sao Carlos, Physiotherapy Dept, Cardiopulm Physiotherapy Lab, BR-13560 Sao Carlos, SP, BrazilPolitecn Milan, Div Dipartimento Elettron Informaz & Bioingn, Milan, ItalyNove Julho Univ, São Paulo, BrazilUni Santa Casa Misericordia São Paulo, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychobiol, Sleep Med & Biol Discipline, São Paulo, BrazilUniversidade Federal de São Paulo, Phys Therapy Sch, Dept Human Mot Sci, São Paulo, BrazilSleep Inst Sao Carlos, Sao Carlos, BrazilUniv Illinois, Coll Appl Hlth Sci, Dept Phys Therapy, Chicago, IL USAUniv Illinois, Coll Appl Hlth Sci, Integrat Physiol Lab, Chicago, IL USAUniversidade Federal de São Paulo, Dept Psychobiol, Sleep Med & Biol Discipline, São Paulo, BrazilUniversidade Federal de São Paulo, Phys Therapy Sch, Dept Human Mot Sci, São Paulo, BrazilFAPESP: 2009/01842-0CAPES: 12883-12-3Web of Scienc

Outpatient vs. home-based pulmonary rehabilitation in COPD: a randomized controlled trial

Abstract Background Chronic obstructive pulmonary disease (COPD) is a common cause of morbidity and mortality affecting a large number of individuals in both developed and developing countries and it represents a significant financial burden for patients, families and society. Pulmonary rehabilitation (PR) is a multidisciplinary program that integrates components of exercise training, education, nutritional support, psychological support and self-care, resulting in an improvement in dyspnea, fatigue and quality of life. Despite its proven effectiveness and the strong scientific recommendations for its routine use in the care of COPD, PR is generally underutilized and strategies for increasing access to PR are needed. Home-based self-monitored pulmonary rehabilitation is an alternative to outpatient rehabilitation. In the present study, patients with mild, moderate and severe COPD submitted to either an outpatient or at-home PR program for 12 weeks were analyzed. Methods Patients who fulfilled the inclusion criteria were randomized into three distinct groups: an outpatient group who performed all activities at the clinic, a home-based group who performed the activities at home and a control group. PR consisted of a combination of aerobic exercises and strengthening of upper and lower limbs 3 times a week for 12 weeks. Results There was a significant difference in the distance covered on the six-minute walk test (p Conclusion A home-based self-monitoring pulmonary rehabilitation program is as effective as outpatient pulmonary rehabilitation and is a valid alternative for the management of patients with COPD.</p