Acute effects of expiratory positive pressure on autonomic cardiac modulation during spontaneous and slow deep breathing in COPD patients.

Andréa L.G Da Silva,Ramona Cabiddu,Guilherme D Back,Kamila M.K Mansour,Renata Trimer,Cássia L Goulart,Audrey Borghi-Silva

doi:10.1590/0001-3765202020190361

Abstract

to evaluate the acute effects of expiratory positive airway pressure on cardiac autonomic modulation in chronic obstructive pulmonary disease patients during spontaneous breathing and slow deep breathing. 17 patients were evaluated. The R-R intervals were collected (Polar® S810i) during spontaneous breathing (10 minutes) and slow deep breathing (4 minutes), with and without 5 cmH2O expiratory positive airway pressure. Stable signals were analyzed by Kubios®. Heart rate variability indices were computed in time domain and in frequency domain. Expiratory positive airway pressure application affected low frequency (spontaneous breathing: 62.5±4.1 vs slow deep breathing: 28.2±4.2, p<0.001) and high frequency (spontaneous breathing: 37.4±17.3 vs slow deep breathing: 58.9±18.1, p<0.001). Interactions were observed between expiratory positive airway pressure effect and slow deep breathing effect for low frequency (p<0.001), high frequency (p<0.001) and low frequency/high frequency ratio (p<0.001). When patients were stratified by disease's severity, we identified a significant low frequency reduction (p<0.001) and high frequency increase (p<0.001) for all stages when slow deep breathing was associated with expiratory positive airway pressure. A 5 cmH2O expiratory positive airway pressure during spontaneous and slow deep breathing can elicit an acute response, resulting in a cardiac autonomic control improvement in moderate-to-very severe patients.

Highlights

Sympathetic and parasympathetic control, peripheral oxygen saturation (SpO2), pulmonary stretch baroreceptors and cardiac and pulmonary reflexes control are altered in chronic obstructive pulmonary disease (COPD) patients (Pinsky 2005, Reis et al 2010a, Mazzuco et al 2015)
The aim of the present study was to evaluate by heart rate variability (HRV) analysis, the acute effects of expiratory positive airway pressure (EPAP) on cardiac autonomic modulation in COPD patients during spontaneous breathing (SB) and deep breathing (DB)
When stratifying patients by disease severity, we identified a significant LF reduction and a significant HF increase when DB was associated with EPAP, for all COPD stages, indicating

Summary

Introduction

Sympathetic and parasympathetic control, peripheral oxygen saturation (SpO2), pulmonary stretch baroreceptors and cardiac and pulmonary reflexes control are altered in chronic obstructive pulmonary disease (COPD) patients (Pinsky 2005, Reis et al 2010a, Mazzuco et al 2015). EFFECTS OF EPAP IN HRV IN COPD load and intrathoracic pressure during rest and physical exercise and improving physical and functional performance (Pinsky 2005, Reis et al 2010a, Chhabra et al 2015). Recent studies investigating bilevel positive airway pressure in COPD patients have shown that this method is effective to improve pulmonary ventilation, neural control of HR and sympatho-vagal balance, reducing blood pressure and illness exacerbation frequency (Skyba et al 2007, Borghi-Silva et al 2008). The major effect of the application of an expiratory positive airway pressure (EPAP) device consists in increasing the expiratory flow and decreasing pulmonary hyperinflation; it maintains upper airways patency, prevents atelectasis and improves mucociliary clearance (Nicolini et al 2013)

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