呼吸模式评估工具（BPAT）在识别体位性直立性心动过速综合征（POTS）患者呼吸功能障碍（DB）中的临床应用。

IF 3.2 4区医学 Q2 NEUROSCIENCES

Autonomic Neuroscience-Basic & Clinical Pub Date : 2023-09-01 DOI:10.1016/j.autneu.2023.103104

Charles C. Reilly , Sarah V. Floyd , Shehnaz Raniwalla , Nicholas Gall , Gerrard F. Rafferty

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引用次数: 0

摘要

背景：在体位性直立性心动过速综合征（POTS）患者中，导致呼吸困难的功能障碍（DB）很常见。POTS中的DB是复杂的、多因素的，并且没有在专家中心之外进行常规临床评估。迄今为止，POTS中的DB主要通过心肺运动测试（CPEX）、过度换气激发测试和/或专业呼吸物理治疗评估来识别和诊断。呼吸模式评估工具（BPAT）是一种经临床验证的哮喘DB诊断工具。然而，没有关于在POTS中使用BPAT的公开数据。因此，本研究的目的是评估BPAT在POTS患者DB诊断中的潜在临床效用。方法：对接受呼吸物理治疗的POTS患者进行回顾性观察性队列研究，以正式评估DB。DB由专业呼吸理疗师评估确定，其中包括对胸壁运动/呼吸模式的物理评估。BPAT和Nijgmegen问卷也已完成。受试者操作特征（ROC）分析用于比较基于物理治疗评估的DB诊断与BPAT评分。结果：77名POTS患者[平均（sd）年龄32（11）岁，71（92%）女性]由专业呼吸理疗师进行评估，其中65（84%）被诊断为DB。使用四个或更多的已建立的BPAT截断值，受试者操作特征（ROC）分析表明，在曲线下面积（AUC）为0.901（95%CI 0.803-0.999）的POTS患者中，诊断DB的敏感性为87%，特异性为75%，显示出优异的辨别能力。结论：BPAT对POTS患者的DB具有较高的敏感性和中等的特异性。

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The clinical utility of the Breathing Pattern Assessment Tool (BPAT) to identify dysfunctional breathing (DB) in individuals living with postural orthostatic tachycardia syndrome (POTS)

Background

Dysfunctional breathing (DB) resulting in inappropriate breathlessness is common in individuals living with postural orthostatic tachycardia syndrome (POTS). DB in POTS is complex, multifactorial, and not routinely assessed clinically outside of specialist centres. To date DB in POTS has been identified and diagnosed predominately via cardiopulmonary exercise testing (CPEX), hyperventilation provocation testing and/or specialist respiratory physiotherapy assessment. The Breathing Pattern Assessment Tool (BPAT) is a clinically validated diagnostic tool for DB in Asthma. There are, however, no published data regarding the use of the BPAT in POTS. The aim of this study was therefore to assess the potential clinic utility of the BPAT in the diagnosis of DB in individuals with POTS.

Methods

A retrospective observational cohort study of individuals with POTS referred to respiratory physiotherapy for formal assessment of DB. DB was determined by specialist respiratory physiotherapist assessment which included physical assessment of chest wall movement/breathing pattern. The BPAT and Nijgmegen questionnaire were also completed. Receiver operating characteristics (ROC) analysis was used to compare the physiotherapy assessment based diagnosis of DB to the BPAT score.

Results

Seventy-seven individuals with POTS [mean (sd) age 32 (11) years, 71 (92 %) female] were assessed by a specialist respiratory physiotherapist, with 65 (84 %) being diagnosed with DB. Using the established BPAT cut off of four or more, receiver operating characteristics (ROC) analysis indicated a sensitivity of 87 % and specificity of 75 % for diagnosing DB in individuals with POTS with an area under the curve (AUC) of 0.901 (95 % CI 0.803–0.999), demonstrating excellent discriminatory ability.

Conclusion

BPAT has high sensitivity and moderate specificity for identifying DB in individuals living with POTS.

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来源期刊

Autonomic Neuroscience-Basic & Clinical 医学-神经科学

CiteScore

5.80

自引率

7.40%

发文量

审稿时长

66 days

期刊介绍： This is an international journal with broad coverage of all aspects of the autonomic nervous system in man and animals. The main areas of interest include the innervation of blood vessels and viscera, autonomic ganglia, efferent and afferent autonomic pathways, and autonomic nuclei and pathways in the central nervous system. The Editors will consider papers that deal with any aspect of the autonomic nervous system, including structure, physiology, pharmacology, biochemistry, development, evolution, ageing, behavioural aspects, integrative role and influence on emotional and physical states of the body. Interdisciplinary studies will be encouraged. Studies dealing with human pathology will be also welcome.