Nasal high flow, but not supplemental O 2 , reduces peripheral vascular sympathetic activity during sleep in COPD patients.

Autor: Fricke K; Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA, hschnei3@jhmi.edu.; Department for Pulmonary, Sleep, and Intensive Care Medicine, Helios Klinikum, Wuppertal, Germany., Schneider H; Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA, hschnei3@jhmi.edu., Biselli P; Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA, hschnei3@jhmi.edu.; Intensive Care Unit, Medical Division, University Hospital, University of Sao Paolo, Sao Paolo, Brazil., Hansel NN; Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA, hschnei3@jhmi.edu., Zhang ZG; Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA, hschnei3@jhmi.edu.; Department for Geriatrics, Peking University First Hospital, Beijing, China., Sowho MO; Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA, hschnei3@jhmi.edu., Grote L; Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA, hschnei3@jhmi.edu.; Sleep Disorders Center, Department for Pulmonary Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.; Center for Sleep and Wake Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
Jazyk: angličtina
Zdroj: International journal of chronic obstructive pulmonary disease [Int J Chron Obstruct Pulmon Dis] 2018 Nov 02; Vol. 13, pp. 3635-3643. Date of Electronic Publication: 2018 Nov 02 (Print Publication: 2018).
DOI: 10.2147/COPD.S166093
Abstrakt: Introduction: Patients with COPD have increased respiratory loads and altered blood gases, both of which affect vascular function and sympathetic activity. Sleep, particularly rapid eye movement (REM) sleep, is known to exacerbate hypoxia and respiratory loads. Therefore, we hypothesize that nasal high flow (NHF), which lowers ventilatory loads, reduces sympathetic activity during sleep and that this effect depends on COPD severity.
Methods: We performed full polysomnography in COPD patients (n=17; FEV 1 , 1.6±0.6 L) and in matched controls (n=8). Participants received room air (RA) at baseline and single night treatment with O 2 (2 L/min) and NHF (20 L/min) in a random order. Finger pulse wave amplitude (PWA), a measure of vascular sympathetic tone, was assessed by photoplethysmography. Autonomic activation (AA) events were defined as PWA attenuation ≥30% and indexed per hour for sleep stages (AA index [AAI]) at RA, NHF, and O 2 ).
Results: In COPD, sleep apnea improved following O 2 (REM-apnea hypopnea index [AHI] with RA, O 2 , and NHF: 18.6±20.9, 12.7±18.1, and 14.4±19.8, respectively; P =0.04 for O 2 and P =0.06 for NHF). REM-AAI was reduced only following NHF in COPD patients (AAI-RA, 21.5±18.4 n/h and AAI-NHF, 9.9±6.8 n/h, P =0.02) without changes following O 2 (NHF-O 2 difference, P =0.01). REM-AAI reduction was associated with lung function expressed as FEV 1 and FVC (FEV 1 : r =-0.59, P =0.001; FEV 1 /FVC: r =-0.52 and P =0.007).
Conclusion: NHF but not elevated oxygenation reduces peripheral vascular sympathetic activity in COPD patients during REM sleep. Sympathetic off-loading by NHF, possibly related to improved breathing mechanics, showed a strong association with COPD severity.
Competing Interests: Disclosure The authors report no conflicts of interest in this work.
Databáze: MEDLINE
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