Continuous characterisation of exacerbation pathophysiology using wearable technologies in free-living outpatients with COPD: a prospective observational cohort study.

IF 9.7 1区医学 Q1 MEDICINE, RESEARCH & EXPERIMENTAL

EBioMedicine Pub Date : 2024-11-22 DOI:10.1016/j.ebiom.2024.105472

Felix-Antoine Coutu, Olivia C Iorio, Seyedfakhreddin Nabavi, Amir Hadid, Dennis Jensen, Sushmita Pamidi, Jianguo Xia, Bryan A Ross

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引用次数: 0

Abstract

Background: The most recent exacerbation of COPD (ECOPD) classification criteria relies in part on changes in respiratory rate (RR), heart rate (HR) and oxygen saturation (SpO₂). Despite this paradigm shift, a thorough understanding of exacerbation patterns is still lacking, as is the identification of physiological exacerbation biomarkers.

Methods: Using a convenience sampling approach, this prospective observational cohort study was conducted between February 2023 and January 2024. Continuous measurements of daytime/overnight respiratory (primary outcome), cardiovascular, autonomic, activity and sleep-related parameters were collected by a wearable biometric wristband and ring over 21 consecutive days in free-living outpatients experiencing and receiving treatment (≤3 days) for a current exacerbation from the home environment. The EXACT-PRO questionnaire served as the validated reference for daily symptom burden and to identify 'recovered' versus 'persistent worsening' participants. Unadjusted and adjusted (for age, sex, FEV₁) linear mixed-effects models were fitted to estimate associations between each physiological parameter with daily EXACT-PRO score (points, pts), in all, 'recovered', and 'persistent worsening' participants. Results are presented as point estimates with 95% CIs.

Findings: In 21 participants with COPD (43% female, mean age 66.8, BMI 27.7 kg/m², FEV₁ 36.3% predicted; 85.7% with GOLD 3-4 disease), significant associations in unadjusted models with daily EXACT-PRO score included RR variability (-1.45 [-2.84, -0.073] pts/breath/min) but not RR, daily step count (-0.56 [-0.82, -0.31] pts/1000 steps), and sleep efficiency (-0.12 [-0.20, -0.037] pts/%asleep). In 'recovered' participants (n = 10), significant associations included nighttime HR, movement intensity and nightly SpO₂. In 'persistent worsening' participants (n = 11), significant associations included HR variability, nightly RR variability, nightly SpO₂, sleep efficiency, and skin temperature. Similar results were found in adjusted models.

Interpretation: This study provides a prospective continuous characterisation of exacerbations of COPD using remotely collected, ambulatory/free-living data. The physiological patterns presented may contribute to the understanding of exacerbations and may enhance the development of effective remote monitoring solutions.

Funding: University hospital (MUHC-CAS) grant.

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利用可穿戴技术持续描述自由生活的慢性阻塞性肺疾病门诊患者病情加重的病理生理学特征：一项前瞻性观察队列研究。

背景：最新的慢性阻塞性肺疾病加重（ECOPD）分类标准部分依赖于呼吸频率（RR）、心率（HR）和血氧饱和度（SpO2）的变化。尽管范式发生了转变，但对病情恶化模式仍缺乏透彻的了解，生理病情恶化生物标志物的鉴定也是如此：这项前瞻性观察性队列研究采用便利抽样方法，在 2023 年 2 月至 2024 年 1 月期间进行。在连续 21 天内，通过可穿戴生物识别腕带和戒指收集了自由生活的门诊患者的白天/夜间呼吸（主要结果）、心血管、自律神经、活动和睡眠相关参数，这些患者正在接受治疗（≤3 天），目前病情正在从家庭环境恶化。EXACT-PRO问卷作为日常症状负担的有效参考，并用于识别 "已康复 "和 "持续恶化 "的参与者。在所有参与者、"康复 "参与者和 "持续恶化 "参与者中，对每个生理参数与 EXACT-PRO 每日得分（点数，pts）之间的关系进行了未调整和调整（年龄、性别、FEV1）线性混合效应模型估计。结果以点估计值和 95% CIs 表示：在 21 名慢性阻塞性肺病患者（43% 为女性，平均年龄为 66.8 岁，体重指数为 27.7 kg/m2，FEV1 预测值为 36.3%；85.7% 患有 GOLD 3-4 疾病）中，未调整模型与每日 EXACT-PRO 评分的显著相关性包括 RR 变异性（-1.45 [-2.84, -0.073]分/呼吸/分钟），但与RR、每日步数（-0.56 [-0.82, -0.31]分/1000步）和睡眠效率（-0.12 [-0.20, -0.037]分/睡眠百分比）无关。在 "已康复 "的参与者（10 人）中，与夜间心率、运动强度和夜间 SpO2 有显著关联。在 "病情持续恶化 "的参与者（n = 11）中，有显著关联的包括心率变异性、夜间心率变异性、夜间 SpO2、睡眠效率和皮肤温度。在调整模型中也发现了类似的结果：这项研究利用远程收集的流动/自由生活数据，对慢性阻塞性肺疾病的加重情况进行了前瞻性的连续描述。所呈现的生理模式可能有助于对病情加重的理解，并有助于开发有效的远程监控解决方案：大学医院（MUHC-CAS）资助。

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来源期刊

EBioMedicine Biochemistry, Genetics and Molecular Biology-General Biochemistry,Genetics and Molecular Biology

CiteScore

17.70

自引率

0.90%

发文量

579

审稿时长

5 weeks

期刊介绍： eBioMedicine is a comprehensive biomedical research journal that covers a wide range of studies that are relevant to human health. Our focus is on original research that explores the fundamental factors influencing human health and disease, including the discovery of new therapeutic targets and treatments, the identification of biomarkers and diagnostic tools, and the investigation and modification of disease pathways and mechanisms. We welcome studies from any biomedical discipline that contribute to our understanding of disease and aim to improve human health.