Respiratory medicine最新文献_第4页

Characterizing pulmonary rehabilitation referrals from primary care 从基层医疗机构转诊的肺康复患者的特点。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2024-09-28 DOI: 10.1016/j.rmed.2024.107822

Background

Supporting referral to pulmonary rehabilitation (PR) from primary care for people with chronic lung disease could improve equity of access. Understanding who is referred to PR from primary care, and by whom, could inform development of strategies to increase awareness of and referral to PR for people with chronic respiratory disease. We aimed to quantify the proportion of patients referred to PR from primary care in an Australian metropolitan setting; and to identify characteristic features of patients and referrers.

Methods

A retrospective, single-site, audit of referrals was undertaken. Corresponding patient medical records were reviewed for referral details, patient demographics and baseline PR assessment measures.

Results

Between January 2020 and December 2023 658 referrals to PR were received of which 6.2 % (n = 41) originated from a primary care source (98 % general practice; 2 % allied health). People referred to PR from primary care were typically diagnosed with COPD (71 %), were female (59 %), had moderate disease severity (mean(SD) forced expiratory volume in 1 s 70(26) %predicted) and had mild symptoms (53 % modified Medical Research Council dyspnoea score 0 or 1) and modest functional impairment (6-min walk distance 410(121) meters). Just 4 of 36 primary care practitioners referred more than one patient.

Conclusion

In this audit the proportion of people referred to PR from primary care was very low. Processes to support the referral of more patients from primary care to PR, across the spectrum of chronic respiratory disease, remain a priority for improving access to this well-established treatment.

背景：支持慢性肺病患者从初级保健转诊至肺康复（PR）可提高就诊的公平性。了解哪些人以及由哪些人从初级保健转诊到肺康复，可以为制定提高慢性呼吸系统疾病患者对肺康复的认识和转诊的策略提供参考。我们的目标是量化澳大利亚大都市中由初级医疗转诊至 PR 的患者比例，并确定患者和转诊者的特征：方法：我们对转诊患者进行了一次单一地点的回顾性审计。结果：在 2020 年 1 月至 2020 年 12 月期间，转诊病人和转诊人的特征发生了变化：2020 年 1 月至 2023 年 12 月期间，共收到 658 例转诊到 PR 的患者，其中 6.2% (n=41) 来自初级医疗机构（98% 为全科医生；2% 为联合医疗机构）。从初级医疗机构转介到 PR 的患者通常被诊断为慢性阻塞性肺病（71%），女性（59%），疾病严重程度中等（平均（标度）一秒钟用力呼气量为 70(26) % 预测值），症状轻微（53% 经修改的医学研究委员会呼吸困难评分为 0 或 1），功能受损程度适中（6 分钟步行距离为 410(121) 米）。在 36 名初级保健医生中，仅有 4 名医生转介了一名以上的患者：在本次审核中，从初级医疗机构转诊到 PR 的患者比例非常低。在各种慢性呼吸道疾病中，支持将更多患者从初级保健转诊至 PR 的流程仍是改善这一成熟治疗方法的优先事项。

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引用次数: 0

Identifying disparities in pediatric cystic fibrosis care between low-middle and middle-high income countries in the Middle East 确定中东中低收入国家和中高收入国家在小儿囊性纤维化护理方面的差距。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2024-09-27 DOI: 10.1016/j.rmed.2024.107821

Cystic Fibrosis (CF) care has advanced tremendously in the United States (US), North America, Australasia, and Europe in recent decades. Given the concern for global disparities in pediatric medical care in other parts of the world, we wanted to assess the availability of key aspects of current pediatric CF care in the Middle East as-compared to the US. We collected electronic surveys from pediatric CF providers in the Middle East and surrounding countries assessing whether treatments known to be widely available in the US were also available in surveyed countries. Many countries in the Middle East, as-compared to the US, do have less overall availability of many key CF diagnostic and treatment modalities. Within the Middle East, 80 % of higher-income countries had inhaled tobramycin available compared to none in lower-income countries. This study highlights the additional global collaboration needed to ensure all children with CF receive optimal care globally.

近几十年来，囊性纤维化（CF）治疗在美国、北美、澳大拉西亚和欧洲取得了巨大进步。鉴于全球其他地区在儿科医疗护理方面存在的差距，我们希望评估中东地区与美国相比目前儿科 CF 护理的主要方面的可用性。我们从中东及周边国家的儿科 CF 医疗机构收集了电子调查问卷，以评估在美国广泛使用的治疗方法是否也能在被调查国家使用。与美国相比，中东许多国家的许多主要 CF 诊断和治疗方法的总体可用性确实较低。在中东地区，80% 的高收入国家有吸入妥布霉素，而低收入国家则没有。这项研究强调，要确保全球所有CF患儿都能得到最佳治疗，还需要更多的全球合作。

引用次数: 0

Clinical and radiological characteristics of mediastinal melioidosis: A four-year retrospective cohort from Sabah, Malaysia 纵隔髓样病的临床和放射学特征：马来西亚沙巴州一项为期四年的回顾性队列研究。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2024-09-26 DOI: 10.1016/j.rmed.2024.107818

Background

Melioidosis is a potentially fatal tropical infection. Little is known about mediastinal involvement in melioidosis. This study aimed to (a) describe the prevalence and demographics of various morphologies of mediastinal melioidosis, (b) propose a classification for radiological morphologies of mediastinal melioidosis.

Methods

A retrospective cohort study was performed. Case records of consecutive patients with culture-positive melioidosis who underwent computed tomography (CT) thorax from January 1, 2018–February 28, 2022, were reviewed.

Results

486 culture-positive melioidosis patients were identified, of which 70 underwent CT thorax. 41 patients demonstrating mediastinal involvement were included in the final analysis, of which four were mediastinal collections, while the rest were classified into those with necrotic or matted appearances, and subcentimeter and larger than 1 cm. Culture-positivity was proven from blood in 83 % of patients (n = 34), with the remaining from chest wall pus, neck abscess pus, sputum, liver abscess, seminal vesicle, pleural, pericardial and peritoneal fluid. The most commonly associated pulmonary manifestations were consolidation and pleural effusion. Half had diabetes; a quarter had chronic kidney disease, while one had syphilis. Exposure to soil was present in six patients: quarry (n = 1), construction (n = 2), farmer (n = 1), living environment (n = 2). Seven patients succumbed before the end of 6-week intensive phase antibiotic treatment.

Conclusion

Mediastinal melioidosis is a spectrum with multiple overlapping features consisting of necrosis, matted lymph nodes, multiseptated and non-septated collections. Further studies will elucidate the prognostic implications of mediastinal melioidosis.

背景：瓜虫病是一种可能致命的热带传染病。人们对美拉德氏病纵隔受累情况知之甚少。本研究旨在(a)描述纵隔瓜虫病各种形态的发病率和人口统计学特征，(b)提出纵隔瓜虫病放射学形态的分类：方法：进行了一项回顾性队列研究。回顾性分析了2018年1月1日至2022年2月28日期间接受胸部计算机断层扫描（CT）的培养阳性瓜虫病连续患者的病例记录：确定了486名培养阳性的瓜虫病患者，其中70人接受了胸部CT检查。41例显示纵隔受累的患者被纳入最终分析，其中4例为纵隔集合，其余分为坏死或垫状外观、亚厘米和大于1厘米。83%的患者（34 人）血液中的培养物呈阳性，其余患者的培养物为胸壁脓液、颈部脓肿脓液、痰液、肝脓肿、精囊液、胸腔液、心包液和腹腔液。最常见的肺部表现是合并症和胸腔积液。半数患者患有糖尿病，四分之一患有慢性肾病，一人患有梅毒。六名患者接触过土壤：采石场（1 人）、建筑工地（2 人）、农民（1 人）、生活环境（2 人）。7名患者在为期6周的强化阶段抗生素治疗结束前死亡：纵隔髓样病是一种具有多种重叠特征的疾病，包括坏死、淋巴结萎缩、多囊性和无囊性集合。进一步的研究将阐明纵隔梅里埃病对预后的影响。

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引用次数: 0

Deciphering loop gain complexity: a primer for understanding a pathophysiological trait of obstructive sleep apnea patients 解读环路增益的复杂性：了解阻塞性睡眠呼吸暂停患者病理生理特征的入门指南

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2024-09-25 DOI: 10.1016/j.rmed.2024.107820

Loop Gain (LG), a concept borrowed from engineering used to describe the stability of electrical circuits under negative feedback, has emerged as a crucial pathophysiological trait in sleep respiratory disorders. In simple terms, LG measures how the respiratory control system reacts to changes in breathing. A high LG suggests that minor disturbances in breathing prompt exaggerated responses, potentially leading to instability and oscillations in respiratory patterns. Conversely, a low LG implies that the system responds more gently to disturbances, resulting in stable and well-regulated breathing. However, understanding the concept of loop gain presents challenges due to its dynamic nature across various sleep respiratory disorders, sleep stages, positions, and interactions with other pathophysiological traits. Recent efforts have aimed to identify a non-invasive method for assessing LG, with some evidence suggesting that information regarding pathophysiological traits can be extracted from polysomnography. There exists a clinical imperative for physician to unravel the intricacies of LG when managing Obstructive Sleep Apnea (OSA) patients, because LG abnormalities delineate a distinct pathophysiological phenotype of OSA. Specifically, certain patients exhibit a high LG as the primary factor driving sleep apnea, influencing treatment outcomes. For instance, individuals with high LG may respond differently to therapies such as continuous positive airway pressure (CPAP) or oral appliances compared to those with normal LG, or they can be treated with specific drugs or combination therapies. Thus, understanding LG becomes paramount for precise assessment of OSA patients and is fundamental for optimizing a personalized and effective treatment approach.

环路增益（LG）是从工程学中借用的概念，用于描述负反馈下电路的稳定性。简单地说，LG 衡量呼吸控制系统对呼吸变化的反应。LG 值越高，表明呼吸中的微小干扰都会引起夸张的反应，从而可能导致呼吸模式的不稳定和振荡。相反，低 LG 则意味着系统对干扰的反应较为平缓，从而导致呼吸稳定和调节良好。然而，由于环路增益在各种睡眠呼吸障碍、睡眠阶段、体位以及与其他病理生理特征的相互作用中具有动态性质，因此理解环路增益的概念面临挑战。最近，人们努力寻找一种无创方法来评估 LG，一些证据表明，可以从多导睡眠图中提取有关病理生理特征的信息。在临床上，医生在管理阻塞性睡眠呼吸暂停（OSA）患者时，有必要了解 LG 的复杂性，因为 LG 异常是 OSA 的一种独特病理生理表型。具体来说，某些患者的高 LG 是导致睡眠呼吸暂停的主要因素，从而影响治疗效果。例如，与 LG 正常的患者相比，LG 偏高的患者对持续气道正压（CPAP）或口腔矫治器等疗法的反应可能不同，或者他们可以接受特定药物或联合疗法的治疗。因此，了解 LG 对于精确评估 OSA 患者至关重要，也是优化个性化有效治疗方法的基础。

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引用次数: 0

Use of Sodium-glucose cotransporter 2 (SGLT 2) inhibitor is associated with reduced emergency room visits and hospitalizations in patients with Chronic obstructive pulmonary disease (COPD) and type 2 Diabetes Mellitus 使用钠-葡萄糖共转运体 2 (SGLT 2) 抑制剂可减少慢性阻塞性肺病 (COPD) 和 2 型糖尿病患者的急诊就诊率和住院率

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2024-09-24 DOI: 10.1016/j.rmed.2024.107819

Background

The Sodium-Glucose Cotransporter 2 inhibitors (SGLT2i) are a class of anti-diabetic medications that confer cardio-renal-metabolic (CRM) benefits. Emerging evidence also suggests that these agents provide better benefits for chronic pulmonary conditions, especially chronic obstructive pulmonary disease (COPD).

Research question

We aimed to assess the association between SGLT2i use and outcomes in patients with COPD and concomitant Type 2 Diabetes Mellitus (T2DM).

Study design and methods

We conducted a retrospective cohort study on adults with T2DM and COPD in a primary care clinic from January 01, 2019 to 01/01//2023. Patients were categorized into two groups based on SGLT2i use. We collected demographic information and outcomes such as emergency room (ER) visits, hospitalizations secondary to COPD exacerbation over the period of four years and time to hospitalization and ER visits. Chi-square analysis was used for categorical variables, whereas an unpaired t-test was used for continuous variables. Cox regression was performed to identify significant prognostic factors of hospitalization and ER visits. A Kaplan-Meir analysis was used to visualize the probability of non-hospitalization and the probability of not visiting the ER. Statistical significance was set at p-value <0.05.

Results

Of the 220 patients screened, 94 met the inclusion criteria, of which 20 patients (21.3 %) had SGLT2i use at admission, and 74 (78.7 %) did not. Baseline demographic information were well-matched between the two groups. SGLT2i use was associated with a significant reduction in ER visits (70 % vs. 97.3 %, p-0.001) and the number of hospitalizations (55 % vs 87.8 %, p-0.001). Further multivariate analysis showed lower hazards of hospitalization (adjusted HR-0.156; CI:0.073 to 0.331) and ER visits (HR)-0.232; CI:0.118 to 0.453) in patients on SGLT2i.

Interpretation

In patients with T2DM with COPD, SGLT2i use was associated with reduced ER visits and hospitalizations related to COPD. This protective effect of SGLT2i could be explained by reduced systemic proinflammatory markers and increased anti-inflammatory markers via inhibition of Node like receptor protein 3(NLRP3) inflammasome activation in multiple tissues, including the lungs.

背景钠葡萄糖转运体 2 抑制剂（SGLT2i）是一类抗糖尿病药物，具有心肾代谢（CRM）方面的益处。研究问题我们旨在评估SGLT2i的使用与慢性阻塞性肺疾病（COPD）和并发2型糖尿病（T2DM）患者的预后之间的关联。研究设计和方法我们对2019年1月1日至2023年1月1日在初级保健诊所就诊的T2DM和COPD成人患者进行了一项回顾性队列研究。根据 SGLT2i 的使用情况将患者分为两组。我们收集了人口统计学信息以及四年内急诊室（ER）就诊、因慢性阻塞性肺病加重而住院以及住院和急诊室就诊时间等结果。对分类变量采用卡方分析，对连续变量采用非配对t检验。为确定住院和急诊就诊的重要预后因素，进行了 Cox 回归分析。Kaplan-Meir 分析用于显示不住院的概率和不去急诊室的概率。结果在筛选出的 220 名患者中，94 人符合纳入标准，其中 20 人（21.3%）入院时使用了 SGLT2i，74 人（78.7%）未使用。两组患者的基线人口统计学信息完全匹配。使用 SGLT2i 可显著减少急诊就诊率（70% 对 97.3%，P-0.001）和住院次数（55% 对 87.8%，P-0.001）。进一步的多变量分析显示，服用 SGLT2i 的患者住院的危险性较低（调整后 HR-0.156; CI:0.073 to 0.331），急诊就诊的危险性也较低（HR)-0.232; CI:0.118 to 0.453）。SGLT2i的这种保护作用可解释为，通过抑制包括肺部在内的多个组织中的类节点受体蛋白3（NLRP3）炎性体的激活，降低了全身促炎性标志物，增加了抗炎性标志物。

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引用次数: 0

High burden of respiratory allergy in children warrants early identification and treatment with allergen immunotherapy 儿童呼吸道过敏症发病率高，需要及早发现并使用过敏原免疫疗法进行治疗。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2024-09-24 DOI: 10.1016/j.rmed.2024.107812

Respiratory allergy often begins in childhood and most commonly manifests as allergic rhinitis (upper airways) and/or asthma (lower airways). Children with upper respiratory allergy often suffer from coexisting asthma, and other comorbidities ranging from gastrointestinal disorders to emotional/mental health disorders. Consequently, the disease burden is considerable and profoundly impacts a child's daily life.

Early identification and appropriate management are important to reduce disease burden, lower the risk of disease progression and additional comorbidities, and protect the child's future well-being. A window of opportunity for halting disease progression may open in the early stages of allergic disease and underlines the importance of early diagnosis and treatment of children at risk. This review offers advice on identifying children with a high disease burden who would benefit from early intervention.

Allergen immunotherapy (AIT) modifies the cause of respiratory allergy and prevents disease progression. In clinical practice, AIT could be considered as an early treatment for eligible children, to achieve long-term symptom control and disease modification.

呼吸道过敏通常始于儿童时期，最常见的表现为过敏性鼻炎（上呼吸道）和/或哮喘（下呼吸道）。患有上呼吸道过敏症的儿童往往同时患有哮喘和其他并发症，包括胃肠道疾病和情绪/精神疾病。因此，疾病负担相当沉重，并对儿童的日常生活产生深远影响。早期识别和适当管理对于减轻疾病负担、降低疾病进展和其他并发症的风险以及保护儿童未来的福祉非常重要。在过敏性疾病的早期阶段，可能会出现阻止疾病发展的机会之窗，这也凸显了对高危儿童进行早期诊断和治疗的重要性。本综述就如何识别疾病负担较重并可从早期干预中受益的儿童提出了建议。过敏原免疫疗法（AIT）可改变呼吸道过敏的病因，防止疾病恶化。在临床实践中，可以考虑将过敏原免疫疗法作为符合条件的儿童的早期治疗方法，以实现长期的症状控制和疾病改善。

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引用次数: 0

Prevalence and significance of pulmonary hypertension among hospitalized patients with left heart disease 左心疾病住院患者肺动脉高压的发病率和意义

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2024-09-23 DOI: 10.1016/j.rmed.2024.107817

Background

Pulmonary hypertension associated with left heart disease (PH-LHD) prevalence ranges significantly across studies with limited real-world evidence.

Objectives

To investigate the prevalence and prognostic influence of PH-LHD in a nationwide sample.

Methods

Using the 2018 US Nationwide Inpatient Sample we calculated the prevalence of PH across heart failure (HF), cardiomyopathies, aortic, and mitral valve disease. We used logistic regression to assess the impact of PH on LHD and to find significant contributors to in-hospital mortality in the PH-LHD population.

Results

Among 6,270,625 hospitalizations with LHD, 801,535 (12.8 %) had a secondary PH diagnosis. PH-LHD prevalence was 17.2 % in HF with preserved ejection fraction (HFpEF), 11.8 % in HF with reduced ejection fraction (HFrEF), 16.8 % in dilated cardiomyopathy, 12.6 % in hypertrophic cardiomyopathy, 18.7 % in mitral regurgitation, 28.5 % in mitral stenosis, 13.5 % in aortic stenosis, and 13.9 % in aortic regurgitation. PH was associated with increased in-hospital mortality in HFpEF (OR 1.23; 95%CI 1.17–1.28), hypertrophic cardiomyopathy (1.42; 1.06–1.89), mitral regurgitation (1.17; 1.07–1.28), and aortic stenosis (1.14; 1.04–1.26), but not in HFrEF (1.04; 0.99–1.10), or dilated cardiomyopathy (1.13; 0.99–1.29). Among PH-LHD, in-hospital mortality was associated with age, atrial fibrillation/flutter, cancer, and acute cardiac (acute right HF, myocardial infarction, ventricular arrhythmia), or extra-cardiac (stroke, sepsis, pneumonia, acute renal failure, venous thromboembolism) diagnoses.

Conclusion

In a nationwide inpatient analysis the prevalence of PH-LHD was lower than previously reported indicating reduced recognition of this disease in real world clinical practice. The diagnosis of PH-LHD was associated with worse fatality rates across all forms of LHD, except for HFrEF.

背景与左心疾病相关的肺动脉高压（PH-LHD）患病率在不同研究中差异显著，而现实世界中的证据却很有限.目的调查全国样本中PH-LHD的患病率和对预后的影响.方法利用2018年美国全国住院患者样本，我们计算了心力衰竭（HF）、心肌病、主动脉瓣和二尖瓣疾病中PH的患病率。我们使用逻辑回归评估 PH 对 LHD 的影响，并在 PH-LHD 患者中寻找导致院内死亡率的重要因素。结果在 6,270,625 例因 LHD 住院的患者中，有 801,535 例（12.8%）继发 PH 诊断。PH-LHD发病率在射血分数保留型心房颤动（HFpEF）中占17.2%，在射血分数降低型心房颤动（HFrEF）中占11.8%，在扩张型心肌病中占16.8%，在肥厚型心肌病中占12.6%，在二尖瓣反流中占18.7%，在二尖瓣狭窄中占28.5%，在主动脉狭窄中占13.5%，在主动脉反流中占13.9%。PH与HFpEF（OR 1.23；95%CI 1.17-1.28）、肥厚型心肌病（1.42；1.06-1.89）、二尖瓣反流（1.17；1.07-1.28）和主动脉瓣狭窄（1.14；1.04-1.26）的院内死亡率增加有关，但与HFrEF（1.04；0.99-1.10）或扩张型心肌病（1.13；0.99-1.29）无关。在 PH-LHD 患者中，院内死亡率与年龄、心房颤动/扑动、癌症、急性心脏病（急性右侧高频、心肌梗死、室性心律失常）或心脏病外诊断（中风、败血症、肺炎、急性肾功能衰竭、静脉血栓栓塞）有关。在所有形式的 LHD 中，除 HFrEF 外，PH-LHD 诊断与更低的死亡率相关。

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引用次数: 0

Evaluation of continuous positive airway pressure adherence and its contributing factors 评估持续正压通气的依从性及其诱因

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2024-09-23 DOI: 10.1016/j.rmed.2024.107815

Background

Continuous positive airway pressure (CPAP) adherence may vary based on the study design and country.

Objectives

To investigate long-term CPAP adherence and elucidate associated factors.

Methods

A multicenter retrospective observational cohort study was conducted over two years. The study included patients diagnosed with obstructive sleep apnea who were prescribed CPAP (n = 1261). Adherence was assessed for 90 days and 365 days. Centers for Medicare and Medicaid Services (CMS) criteria (≥4 h/night on ≥70 % of nights) and research adherence criteria (≥4 h/night during the observational period) were used. Factors influencing CPAP adherence (CMS criteria) during 90 and 365 days were also evaluated. Continuous variables were categorized into low, middle, and high classes, and logistic regression analysis with interaction was performed.

Results

CPAP adherence to CMS criteria for 90 and 365 days was 45.6 % and 44.7 %, respectively, whereas adherence to research criteria was 57.0 % and 54.1 %, respectively. Middle age, high age, and high apnea ratio independently increased CPAP adherence. Conversely, a high rapid eye movement apnea-hypopnea index ratio decreased CPAP adherence. Although high body mass index (BMI) had no independent effect on adherence, its interaction with high 3 % oxygen desaturation index increased 90-day CPAP adherence. However, high BMI decreased 90-day CPAP adherence in males. The interaction between middle age and high BMI was associated with decreased CPAP adherence over 365 days.

Conclusions

Adherence to CPAP in real-world settings is modest. Various factors influence CPAP adherence. BMI may exert varied effects on CPAP adherence depending on the accompanying factors.

背景持续气道正压（CPAP）的依从性可能因研究设计和国家而异。目的调查 CPAP 的长期依从性并阐明相关因素。研究对象包括确诊为阻塞性睡眠呼吸暂停并获得 CPAP 处方的患者（n = 1261）。对患者的依从性进行了 90 天和 365 天的评估。采用美国医疗保险和医疗补助服务中心（CMS）标准（≥70% 的夜晚每晚≥4 小时）和研究坚持标准（观察期间每晚≥4 小时）。此外，还评估了影响 90 天和 365 天内坚持使用 CPAP 的因素（CMS 标准）。将连续变量分为低、中、高三个等级，并进行交互式逻辑回归分析。结果 CPAP 在 90 天和 365 天内符合 CMS 标准的比例分别为 45.6% 和 44.7%，而符合研究标准的比例分别为 57.0% 和 54.1%。中年、高龄和高呼吸暂停比率可独立提高 CPAP 的依从性。相反，眼球快速运动呼吸暂停-低通气指数比值高会降低 CPAP 的依从性。虽然高体重指数（BMI）对坚持使用 CPAP 没有独立影响，但它与高 3% 氧饱和度指数的交互作用会提高 90 天 CPAP 的坚持率。然而，高体重指数会降低男性 90 天的 CPAP 依从性。中年和高体重指数之间的交互作用与 CPAP 365 天的依从性降低有关。结论：在现实环境中，坚持使用 CPAP 的程度并不高。BMI 可能会对 CPAP 的依从性产生不同的影响，这取决于伴随因素。

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引用次数: 0

Pulmonary rehabilitation in lung transplant candidates with pulmonary arterial hypertension 肺动脉高压肺移植候选者的肺康复治疗。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2024-09-23 DOI: 10.1016/j.rmed.2024.107816

Background

Pulmonary rehabilitation (PR) guidelines support the efficacy and safety of supervised exercise training in mild-moderate pulmonary arterial hypertension (PAH). However, the exercise training response and safety of PR in PAH lung transplant (LTx) candidates has not been described. Objectives: (1) characterize the clinical characteristics and illness trajectory of adult patients with severe PAH listed for LTx and participating in PR; (2) evaluate the change in exercise capacity, aerobic and resistance training volumes; (3) assess PR safety.

Methods

Single-centre retrospective cohort study of PAH LTx candidates listed January 2014–December 2018 attending a supervised, facility-based outpatient program three times per week. Functional capacity was evaluated using 6-min walk distance (6MWD). Aerobic and muscle training volumes were evaluated with paired comparisons.

Results

40 PAH LTx candidates (age 50 ± 12 years, 73% females, mean pulmonary artery pressure 53 ± 16 mmHg) were included. The median listing duration was 91 [IQR 43–232] days. Sixteen patients (40%) had ≥1 admission pre-transplant. Nine patients (56%) were discharged home and resumed outpatient PR. Baseline 6MWD was 330 ± 119 metres (n = 40) with the final 6MWD pre-LTx increasing by 18 metres 95% CI (−18 to 56), p-value = 0.31, n = 25) over a median duration of 225 [IQR 70–311] days. Modest gains were observed in aerobic and resistance training volumes in PR with no adverse safety events.

Conclusion

Despite progressive and severe disease in PAH LTx candidates, patients safely participated in PR and maintained exercise capacity. Given frequent admissions, physiotherapy during hospitalization should focus on preserving functional capacity and facilitating re-integration into outpatient PR post-discharge.

背景：肺康复（PR）指南支持轻中度肺动脉高压（PAH）患者在指导下进行运动训练的有效性和安全性。目的：(1) 描述被列入肺移植名单并参与肺康复的重度 PAH 成年患者的临床特征和疾病轨迹；(2) 评估运动能力、有氧和阻力训练量的变化；(3) 评估肺康复的安全性：单中心回顾性队列研究，对象为2014年1月至2018年12月列入LTx候选名单的PAH患者，他们参加了一项有监督的、基于设施的门诊项目，每周三次。使用六分钟步行距离（6MWD）评估功能能力。有氧运动量和肌肉训练量通过配对比较进行评估：共纳入 40 名 PAH LTx 候选者（年龄为 50±12 岁，73% 为女性，平均肺动脉压为 53±16 mmHg）。上市时间中位数为 91 [IQR 43-232]天。16名患者（40%）在移植前入院≥1次。九名患者（56%）出院回家并恢复了门诊 PR。基线 6MWD 为 330±119 米（n=40），在中位 225 [IQR 70-311] 天的持续时间内，移植前的最终 6MWD 增加了 18 米（95% CI (-18 to 56)，p 值= 0.31，n=25）。在 PR 中观察到有氧和阻力训练量有适度增加，且无不良安全事件：结论：尽管 PAH LTx 候选者的病情进行性加重，但患者仍能安全地参与 PR 并保持运动能力。鉴于入院频繁，住院期间的物理治疗应侧重于保持功能能力，并促进出院后重新融入门诊 PR。

{"title":"Pulmonary rehabilitation in lung transplant candidates with pulmonary arterial hypertension","authors":"","doi":"10.1016/j.rmed.2024.107816","DOIUrl":"10.1016/j.rmed.2024.107816","url":null,"abstract":"<div><h3>Background</h3><div>Pulmonary rehabilitation (PR) guidelines support the efficacy and safety of supervised exercise training in mild-moderate pulmonary arterial hypertension (PAH). However, the exercise training response and safety of PR in PAH lung transplant (LTx) candidates has not been described. Objectives: (1) characterize the clinical characteristics and illness trajectory of adult patients with severe PAH listed for LTx and participating in PR; (2) evaluate the change in exercise capacity, aerobic and resistance training volumes; (3) assess PR safety.</div></div><div><h3>Methods</h3><div>Single-centre retrospective cohort study of PAH LTx candidates listed January 2014–December 2018 attending a supervised, facility-based outpatient program three times per week. Functional capacity was evaluated using 6-min walk distance (6MWD). Aerobic and muscle training volumes were evaluated with paired comparisons.</div></div><div><h3>Results</h3><div>40 PAH LTx candidates (age 50 ± 12 years, 73% females, mean pulmonary artery pressure 53 ± 16 mmHg) were included. The median listing duration was 91 [IQR 43–232] days. Sixteen patients (40%) had ≥1 admission pre-transplant. Nine patients (56%) were discharged home and resumed outpatient PR. Baseline 6MWD was 330 ± 119 metres (n = 40) with the final 6MWD pre-LTx increasing by 18 metres 95% CI (−18 to 56), <em>p</em>-value = 0.31, n = 25) over a median duration of 225 [IQR 70–311] days. Modest gains were observed in aerobic and resistance training volumes in PR with no adverse safety events.</div></div><div><h3>Conclusion</h3><div>Despite progressive and severe disease in PAH LTx candidates, patients safely participated in PR and maintained exercise capacity. Given frequent admissions, physiotherapy during hospitalization should focus on preserving functional capacity and facilitating re-integration into outpatient PR post-discharge.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142352841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Prognostic effect of obstructive sleep apnea in acute coronary syndrome patients with heart failure 急性冠状动脉综合征合并心衰患者阻塞性睡眠呼吸暂停的预后影响

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2024-09-21 DOI: 10.1016/j.rmed.2024.107814

Background and objective

Acute coronary syndrome (ACS), heart failure (HF) and obstructive sleep apnea (OSA) often overlap and interact, the impact of OSA on ACS patients with HF remains unclear. The study sought to comprehensively evaluate the effects of the interaction between OSA and HF on long-term cardiovascular outcomes in ACS patients.

Methods

Between June 2015 and January 2020, patients hospitalized for ACS were prospectively enrolled and underwent portable sleep monitoring after clinically stabilization. OSA was defined as an apnea hypopnea index ≥15 events/h. HF was defined using medical records. The primary endpoint was major adverse cardiovascular and cerebrovascular event (MACCE), including death, myocardial infarction, stroke, ischemia-driven revascularization, and hospitalization for unstable angina.

Results

Among all 1927 included patients, 214 (11.1 %) had HF, and 1014 (52.6 %) had OSA. For 2.9 years (1.5, 3.6 years) follow-up, OSA was independently associated with the risk of MACCE in HF patients (adjusted hazard ratio [HR], 2.11; 95%CI, 1.16–3.84; P = 0.014), but not in those without HF (adjusted HR, 1.15; 95%CI, 0.92–1.45; P = 0.228). Further analysis showed OSA exerted more prognostic effect in HF patients with preserved eject fraction (adjusted HR, 2.45; 95 % CI, 1.11–5.41; P = 0.027) than those with reduced eject fraction (adjusted HR, 1.62; 95 % CI, 0.63–4.20; P = 0.319).

Conclusions

In the settings of ACS, OSA was independently associated with poor prognosis in patients with concomitant HF especially those with persevered ejection fraction. Screening and treatment for OSA are highly recommended in ACS patients with HF.

Clinical trial registration

URL: www.clinicaltrails.gov; Unique Identifier: NCT03362385.

背景和目的：急性冠状动脉综合征（ACS）、心力衰竭（HF）和阻塞性睡眠呼吸暂停（OSA）常常相互重叠和影响，OSA对患有HF的ACS患者的影响仍不清楚。该研究旨在全面评估OSA和HF之间的相互作用对ACS患者长期心血管预后的影响：方法：2015 年 6 月至 2020 年 1 月期间，对因 ACS 住院的患者进行了前瞻性登记，并在临床病情稳定后接受了便携式睡眠监测。呼吸暂停低通气指数≥15次/小时定义为OSA。心房颤动是根据医疗记录定义的。主要终点是主要不良心脑血管事件（MACCE），包括死亡、心肌梗死、中风、缺血导致的血管再通和因不稳定型心绞痛住院：在所有 1927 名纳入患者中，214 人（11.1%）患有高血压，1,014 人（52.6%）患有 OSA。在2.9年（1.5-3.6年）的随访中，OSA与心房颤动患者的MACCE风险独立相关（调整后危险比[HR]，2.11；95%CI，1.16-3.84；P=0.014），但与非心房颤动患者的MACCE风险无关（调整后危险比，1.15；95%CI，0.92-1.45；P=0.228）。进一步分析显示，OSA对射血分数保留的HF患者（调整后HR，2.45；95%CI，1.11-5.41；P=0.027）的预后影响大于射血分数降低的患者（调整后HR，1.62；95%CI，0.63-4.20；P=0.319）：结论：在急性心肌梗死的情况下，伴有高血压的患者，尤其是射血分数持续降低的患者，OSA与预后不良密切相关。强烈建议对合并高血压的 ACS 患者进行 OSA 筛查和治疗：URL: www.clinicaltrails.gov; Unique Identifier：NCT03362385。

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引用次数: 0