Breathing In
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Multiple mechanisms likely explain the associations of excess body mass and SDB, including increased upper airway collapsibility and impaired neuromuscular control of upper airway patency due to local fat deposition (35). Excess fat deposited outside of the upper airway may also contribute to breathing events via several mechanisms, including reduced lung volume, greater whole-body metabolic demand, and increased effort of breathing (24, 36). Studies have demonstrated that weight loss has the potential to reduce and sometimes eliminate SDB in overweight patients (11). However, intentional weight loss with long-term weight maintenance is typically not sustained (37), and overweight persons with SDB in whom sufficient weight loss cannot be attained may require direct treatments of SDB (e.g., positive airway pressure therapy) to mitigate SDB-related outcomes. Unfortunately, like weight loss, high rates of long-term adherence to positive pressure therapy have been difficult to achieve (38).
Background: Sleep-disordered breathing (SDB) is common, but largely undiagnosed in the general population. Information on demographic patterns of SDB occurrence and its predictive factors in the general population is needed to target high-risk groups that may benefit from diagnosis.
Methods: The sample comprised 5615 community-dwelling men and women aged between 40 and 98 years who were enrolled in the Sleep Heart Health Study. Data were collected by questionnaire, clinical examinations, and in-home polysomnography. Sleep-disordered breathing status was based on the average number of apnea and hypopnea episodes per hour of sleep (apnea-hypopnea index [AHI]). We used multiple logistic regression modeling to estimate cross-sectional associations of selected participant characteristics with SDB defined by an AHI of 15 or greater.
Results: Male sex, age, body mass index, neck girth, snoring, and repeated breathing pause frequency were independent, significant correlates of an AHI of 15 or greater. People reporting habitual snoring, loud snoring, and frequent breathing pauses were 3 to 4 times more likely to have an AHI of 15 or greater vs an AHI less than 15, but there were weaker associations for other factors with an AHI of 15 or greater. The odds ratios (95% confidence interval) for an AHI of 15 or greater vs an AHI less than 15 were 1.6 and 1.5, respectively, for 1-SD increments in body mass index and neck girth. As age increased, the magnitude of associations for SDB and body habitus, snoring, and breathing pauses decreased.
These are the final results of a survey of sleep-disordered breathing, which examined objective and subjective information from a large randomly selected elderly sample. We randomly selected 427 elderly people aged 65 yr and over in the city of San Diego, California. Twenty-four percent had an apnea index, AI, greater than or equal to 5 and 62% had a respiratory disturbance index, RDI, greater than or equal to 10. Correlates of sleep-disordered breathing included high relative weight and reports of snoring, breathing cessation at night, nocturnal wandering or confusion, daytime sleepiness and depression. Body mass index, falling asleep at inappropriate times, male gender, no alcohol within 2 hr of bedtime and napping were the best predictors of sleep-disordered breathing. Despite statistical significance, all of the associations between interview variables and apnea indices were small. No combination of demographic variables and symptoms allowed highly reliable prediction of AI or RDI.
Background: Sleep-disordered breathing is associated with major morbidity and mortality. However, its prevalence has mainly been selectively studied in populations at risk for sleep-disordered breathing or cardiovascular diseases. Taking into account improvements in recording techniques and new criteria used to define respiratory events, we aimed to assess the prevalence of sleep-disordered breathing and associated clinical features in a large population-based sample.
Methods: Between Sept 1, 2009, and June 30, 2013, we did a population-based study (HypnoLaus) in Lausanne, Switzerland. We invited a cohort of 3043 consecutive participants of the CoLaus/PsyCoLaus study to take part. Polysomnography data from 2121 people were included in the final analysis. 1024 (48%) participants were men, with a median age of 57 years (IQR 49-68, range 40-85) and mean body-mass index (BMI) of 256 kg/m(2) (SD 41). Participants underwent complete polysomnographic recordings at home and had extensive phenotyping for diabetes, hypertension, metabolic syndrome, and depression. The primary outcome was prevalence of sleep-disordered breathing, assessed by the apnoea-hypopnoea index.
Interpretation: The high prevalence of sleep-disordered breathing recorded in our population-based sample might be attributable to the increased sensitivity of current recording techniques and scoring criteria. These results suggest that sleep-disordered breathing is highly prevalent, with important public health outcomes, and that the definition of the disorder should be revised.
Pursed lip breathing is one of the simplest ways to control shortness of breath. It provides a quick and easy way to slow your breathing pace, making each breath more effective. It also helps you get more oxygen into your lungs.
Anyone can benefit from learning how to control their breath. However, pursed lip breathing is very beneficial if you have a pulmonary (lung) condition that affects how well you breathe. These conditions include:
Pursed lip breathing helps bring more oxygen into your lungs and take more carbon dioxide out of your lungs. Your airways stay open longer, which helps clear out stale air from your lungs and airways. Your breath rate should slow down as you start to relax.
If you have a lung condition that affects your breathing, your muscles may constrict (tighten), your airways may become swollen, mucus may clog your airways and you may have shortness of breath or wheezing.
Pursed lip breathing may feel awkward or uncomfortable at first. However, with regular practice, the technique will become easier. The following tips will help pursed lip breathing become more natural for you:
As the sub-specialty of sports cardiology continues to expand with increasing numbers of practicing clinicians and formal programs/centers, combined with the increasing awareness of sudden cardiac death in athletes, there has been a rapid influx of athlete referrals. While one of the primary roles of a sports cardiologist is evaluating a symptomatic athlete for concerning cardiac pathologies, the sports cardiologist should also be aware of other etiologies of breathlessness and exercise intolerance as well as a wider differential for atypical presentations of chest pain, palpitations, and dizziness. Dysfunctional breathing is relatively common in athletes (particularly younger athletes) with a broad range of presentations. The sports cardiologist should know when to consider dysfunctional breathing in athletes as well as where to refer them for further evaluation and management to avoid potentially unnecessary cardiac workups.
Asthma and exercise-induced bronchoconstriction (EIB) have a high prevalence in athletes.1 However, the majority of these athletes are primarily referred to pulmonary specialists with the predominant symptoms of pure shortness of breath or wheezing. Dysfunctional breathing is an umbrella term describing an abnormal biomechanical pattern of respiration, which can be caused from functional or structural factors and results in intermittent or chronic symptoms.2 Exercise-induced laryngeal obstruction (EILO), also known as vocal cord dysfunction (VCD), is an extrathoracic cause of dysfunctional breathing that is also relatively common in athletes.3 Breathing pattern disorder (BPD) reflects a poor or inefficient breathing pattern resulting in breathlessness and has become an increasingly recognized etiology for a diverse group of symptoms in young athletes.4,5 With dysfunctional breathing, common concerns include difficulty breathing, difficulty \"catching my breath\", or an inability to take deep breaths in. These symptoms should be included in a detailed history as a primary inability to inhale may help differentiate these disorders from pulmonary related disease. Figure 1 highlights symptom intensity, quality, and localization between EILO, EIB and BPD.
EILO is the current preferred nomenclature that is inclusive of disorders affecting the glottic and supraglottic structures causing breathing problems precipitated by exercise (Video 1).
Beyond dyspnea, additional symptoms can include cough, stridor/wheezing, throat tightness, chest tightness/pain, anxiety and dysphonia.7 EILO affects 5-10% of all adolescents and is particularly more common in females.8 EILO has been reported to be relatively common in athletes, affecting nearly one-third of athletes with respiratory symptoms.3,9 It can mimic and even co-exist with EIB, but it often does not respond to inhaled bronchodilators. Symptoms most often develop during intense exercise and resolve rapidly on exercise cessation with the athlete commonly reporting difficulty breathing in and/or an inability to get a complete breath in. A high level of suspicion from a careful history should prompt referral to a specialist with laryngeal examination during exercise and often be required to confirm a diagnosis.10
A cardiopulmonary exercise test (CPET) may be helpful in identifying the irregular and unpredictable nature of BPD (Figure 2) which can also help distinguish it from the more characteristic rhythmic nature of periodic breathing associated with heart failure.12
Both EILO and BPD are treatable, but identification and management often require a multidisciplinary approach with a high-level of suspicion. Barker et al.13 have proposed an algorithm (Figure 3) to assist clinicians through diagnostic testing in which the sports cardiologist may play a potential role. As non-pharmaceutical therapy is the mainstay of treatment, subsequent referral to a specialized speech pathologist with expertise in the diagnosis and treatment of these disorders is pivotal in improving the athlete's overall clinical status. Treatment should include having the athlete not only improve their breathing control and pattern(s) at rest, but also transition therapies into higher levels of exertion consistent with their athletic performance. 59ce067264