Brazilian Thoracic Association Consensus on Sleep-disordered Breathing.

Sleep is essential for the proper functioning of all individuals. Sleep-disordered breathing can occur at any age and is a common reason for medical visits. The objective of this consensus is to update knowledge about the main causes of sleep-disordered breathing in adult and pediatric populations, with an emphasis on obstructive sleep apnea. Obstructive sleep apnea is an extremely prevalent but often underdiagnosed disease. It is often accompanied by comorbidities, notably cardiovascular, metabolic, and neurocognitive disorders, which have a significant impact on quality of life and mortality rates. Therefore, to create this consensus, the Sleep-Disordered Breathing Department of the Brazilian Thoracic Association brought together 14 experts with recognized, proven experience in sleep-disordered breathing.

Incremental shuttle walk test: is it able to detect exercise-induced bronchospasm in young adult asthmatics?

OBJECTIVE: To determine the accuracy of incremental Shuttle Walking Test (ISWT) in detecting exercise-induced bronchospasm (EIB) in adults with asthma and to verify whether there is an association of the drop in FEV1 between ISWT and cardiopulmonary exercise testing with constant-load CPET-CL. METHODS: In this cross-sectional study 32 individuals with asthma performed two ISWTs, an incremental cardiopulmonary exercise test (CPET-I) and a constant-load cardiopulmonary exercise test (CPET-CL) with na interval of 48 h between tests. Spirometric measurements were obtained 5, 10, 15, 20 and 30 min after exercise; an FEV1 decline > 10% was considered EIB. RESULTS: Fifteen individuals had EIB in both tests [χ2 = 9.41; κ = 0.46 p < 0.002 (95% CI: 0.201-0.708)], with moderate agreement. There was a significant correlation between the greatest variation in the drop in FEV1 between the ISWT and the CPET-CL (r = 0.48; p < 0.01). There was a significant difference for ventilation maintenance time above 40% of Maximum Voluntary Ventilation between the groups of positive EIB (p = 0.001) and negative EIB (p = 0.001) and for ventilatory demand (positive EIB group) (p = 0.008) between ISWT vs CPET-CL. Moreover, assuming CPET-CL as the criterion test, ISWT presented a sensitivity of 62.5% and specificity was 100%. CONCLUSION: ISWT showed moderate accuracy in detecting EIB in adults with asthma and was able to show similar metabolic and ventilatory demand presented in CPET-CL.

Brazilian Thoracic Association Consensus on Sleep-disordered Breathing / Consenso em Distúrbios Respiratórios do Sono da Sociedade Brasileira de Pneumologia e Tisiologia

ABSTRACT Sleep is essential for the proper functioning of all individuals. Sleep-disordered breathing can occur at any age and is a common reason for medical visits. The objective of this consensus is to update knowledge about the main causes of sleep-disordered breathing in adult and pediatric populations, with an emphasis on obstructive sleep apnea. Obstructive sleep apnea is an extremely prevalent but often underdiagnosed disease. It is often accompanied by comorbidities, notably cardiovascular, metabolic, and neurocognitive disorders, which have a significant impact on quality of life and mortality rates. Therefore, to create this consensus, the Sleep-Disordered Breathing Department of the Brazilian Thoracic Association brought together 14 experts with recognized, proven experience in sleep-disordered breathing.

RESUMO O sono é essencial para o adequado funcionamento de todos os indivíduos. Os distúrbios respiratórios do sono ocorrem em todas as faixas etárias, constituindo motivo frequente de consulta médica. O objetivo deste consenso foi atualizar os conhecimentos sobre os principais distúrbios respiratórios do sono tanto na população adulta quanto na pediátrica, com ênfase na apneia obstrutiva do sono. A apneia obstrutiva do sono é uma doença extremamente prevalente, porém frequentemente subdiagnosticada. Associa-se frequentemente a uma série de comorbidades, notadamente cardiovasculares, metabólicas e neurocognitivas, que impactam significativamente na qualidade de vida e na mortalidade. Por conta disso, o Departamento de Distúrbios Respiratórios do Sono da Sociedade Brasileira de Pneumologia e Tisiologia reuniu 14 especialistas com reconhecida e comprovada experiência em distúrbios respiratórios do sono para a elaboração deste documento.

Reliability of Cardiorespiratory and Metabolic Responses During Incremental Shuttle Walk Test in Adult Subjects With Asthma.

BACKGROUND: The incremental shuttle walk test (ISWT) has been widely used to assess exercise capacity of subjects with COPD. However, to date, no studies have assessed its reliability in the asthmatic population. This study aimed to assess the test-retest reliability of ISWT for the distance walked (ISWD) and cardiorespiratory and metabolic responses in adult subjects with asthma. METHODS: This was a cross-sectional observational study. Thirty-four subjects of both genders, 18-45 y old, with a diagnosis of controlled asthma, were recruited from March 2012 to December 2015. The subjects performed 3 ISWTs on different days, with a minimum interval of 48 h and a maximum of 1 week between the second and third ISWT. For the reliability analysis, the values of the second and third ISWTs were used, eliminating the influence of any learning effect from the first test. RESULTS: The intraclass correlation coefficients were > 0.75 (P < .001) for ISWD (m), speed (km/h),oxygen uptake (V̇O2 ), ventilatory equivalent carbon dioxide (V̇E/V̇CO2 ), and minute ventilation (V̇E) at the ISWT peak. The Bland-Altman plot presented a mean error close to zero, and measurement distribution was within acceptable limits of variation. CONCLUSION: The ISWT presented excellent reliability for the ISWD and metabolic responses. The cardiorespiratory responses in the ISWTs presented good reliability. We concluded that the ISWT was reliable for young adult subjects with controlled asthma.

Chronic obstructive pulmonary disease severity and its association with obstructive sleep apnea syndrome: impact on cardiac autonomic modulation and functional capacity.

BACKGROUND: The study was conducted to determine the impact of chronic obstructive pulmonary disease (COPD) in association with obstructive sleep apnea syndrome (OSAS) on cardiac autonomic control and functional capacity. SUBJECTS AND METHODS: The study was a cross-sectional prospective controlled clinical study. Heart rate variability indices of 24 COPD (n = 12) and COPD+OSAS (n = 12) patients were evaluated and compared by electrocardiographic recordings acquired during rest, active postural maneuver (APM), respiratory sinus arrhythmia maneuver (RSA-m), and the 6-minute walk test (6MWT). RESULTS: The COPD group presented higher parasympathetic modulation during APM when compared to the COPD+OSAS group (P = 0.02). The COPD+OSAS group presented higher sympathetic modulation during RSA-m when compared to the COPD group (P = 0.00). The performance during 6MWT was similarly impaired in both groups, despite the greater severity of the COPD group. CONCLUSION: Subjects with COPD+OSAS present marked sympathetic modulation, and the presence of OSAS in COPD subjects has a negative impact on functional capacity regardless of the severity of lung disease.