2004 OPEN FORUM Abstracts
NEURORESPIRATORY SYNDROME IN COPD PATIENTS
Pavel N. Barlamov,
MD, PhD1, Vladimir V. Shchokotov, MD, PhD1,Anna
B. Edlebeck, MD, PhD1Perm
State Medical Academy, Perm, Russia
Background:
Chronic obstructive pulmonary disease (COPD) is an important public
health problem worldwide, and is currently one of the leading causes
of morbidity and mortality in both US and Russia. Many COPD
patients present with concurrent breathing disorders, e g sleep apnea
or hyperventilation syndrome (HVS). HVS is a widely known autonomic
nervous system (ANS) dysfunction which is frequently associated with
emotional disturbances, and can have a potential impact on the course
of COPD and quality of life as well. However, there is no sufficient
information regarding HVS in COPD patients.
Methods: 60
patients with COPD (47 males, 13 females, age 36-69, mean age 52.7
yrs) in steady state were included in the study. 12 (20%) of the
patients had mild COPD, 22 (36.7%) had moderate, and 26 (43.3%) –
severe disease (ETS criteria, 1995). The majority of the patients -
49 (81.7%) had the smoking history (1.25 to 60 pack-years). 17
healthy subjects with matching age and sex were included in the
control group. The complex investigation included the use of the
special questionnaires and algorithms for ANS dysfunction evaluation,
spirometry with bronchodilator (Berodual) test and hyperventilation
test, capnography with hyperventilation provocation test (HVPT),
heart rhythm variability (HRV) study with tests on ANS function
(tonicity, reactivity, support), Minnesota Multiple Personality
Inventory (MMPI) and Spilberger anxiety tests.
Purpose: To
evaluate the ANS dysfunction, presence of HVS, and emotional
disturbances in COPD patients.
Results: Symptoms of autonomic
dysfunction were present in 54 (90%) patients. The HRV study showed
an activation of sympathetic function at rest, inverted autonomic
reactivity and deficient support (p<0.05 when compared to control
subjects). 41(68.3%) of the patients had the chronic HVS (75% of the
patients with mild COPD, 73.3% with moderate, and 57,7% with advanced
COPD). Patients with mild and moderate COPD had prominent hypocapnia
during HVPT recovery period (PaCO2 4,49±
0,24 vol%, p<0,001 and 4,4±
0,23 vol%, p<0,01). Personal and situational anxiety traits were
more prominent in the group of patients with HVS (46,72±
1,14, p<0.01, 44,38±
1,64, p<0.05, respectively), and so were the MMPI profile changes
with peaks on axis 3, 4, 6, 8, characterizing presence of anxiety,
depression and somatization. Conclusion: HVS as a part of the
autonomic dysregulaton is a very common breathing disorder in the
patients with COPD. On this matter, we suggest a definition of the
neurorespiratory syndrome to combine the abovementioned disturbances.
It is recommended that this syndrome should be taken into
consideration at the time of discussing the options of treatment.