Syfte: Apné/hypopné index (AHI), antalet apnéer/hypopnéer per sömntimma, är den vanligaste parametern som används för att beskriva graden av sömnapné. Syftet med studien är att undersöka effekten av olika hypopnékriterier för AHI, med desaturationsnivå 3% eller 4% d.v.s. om det finns en signifikant skillnad i AHI vid användning av hypopnékriterier 3% jämfört med 4 %. Metod och material: Polygrafiska registreringar från 40 patienter analyserades retrospektivt. Hypopnéer definierades först som 30–90% minskning av luftflödet under >10 sekunder förknippat med 3% desaturation. Därefter definierades hypopnéer med 4% desaturation. Patentregistreringarna tolkades manuellt på Fysiologkliniken vid Västmanlands sjukhus Västerås. Resultat och slutsats: En signifikant skillnad föreligger i AHI vid användning av de olika hypopnékriterierna, (p <0,001). AHI varierade från medianvärdet 8,5 (2,9–17,6) för vid användning av tolkningskriterium 4% desaturation till 15,7 (6,5–24) vid användning av tolkningskriterium 3%. Det är viktig att följa de nya uppdaterade kriterierna från American Academy of Sleep Medicine och Svenska sömnapnéregistret för att kunna ställa rätt diagnos och behandling för patienten. / Purpose: The apnea/hypopnea index (AHI) is the most common parameter used to describe the severity of sleep apnea. The purpose of this study was to examine the effect of different oxygen desaturation levels (3% and 4%) on AHI i.e. if there is a significant difference in the AHI when using different hypopnea-criteria. Method and material: Polygraphic recordings of 40 patients were analyzed retrospectively. Hypopneas were first defined as 30-90% drop in airflow for >10 s associated with 3% oxygen desaturation. Then hypopneas were defined as with 4% oxygen desaturation. Results and conclusion: There is a significant difference in AHI when using different hypopnea criteria, i.e. 4% or 3% desaturation. AHI varied from 8,5 (2,9–17,6) when using hypopnea criteria 4% to 15,7 (6,5–24) when using 3%. It is important to follow the new updated criteria from the American Academy of Sleep Medicine and the Swedish Sleep Apnea Register in order to provide the right diagnosis and treatment for the patient.

Ce travail de thèse s’est inséré dans la problématique du stockage de déchets radioactifs en formation argileuse profonde. Il porte en particulier sur l’étude de la fissuration hydrique induite par la désaturation et resaturation de la roche en paroi des galeries de la station expérimentale de Tournemire (Averyon, France). Cette étude a visé à identifier les déterminismes microstructuraux et minéralogiques de la fissuration hydrique des argilites de Tournemire, en couplant au laboratoire la Corrélation d’Images Numériques (CIN) et la Microscopie Electronique à Balayage (MEB). Deux échantillons d’argilite de Tournemire ont été soumis à des variations d’humidités différentes par chocs et par paliers progressifs. La CIN a permis de mettre en évidence l’influence de l’humidité et de la teneur en eau sur l’amplitude de l’ouverture des fissures et des déformations à différentes échelles. Cette étude a également permis de mettre en lumière l’influence du chargement hydrique sur l’organisation des réseaux de fractures. Une cartographie minéralogique sur un champ plurimillimétrique en haute résolution a été également mise en œuvre au MEB sur ces deux échantillons d’argilites. Cette cartographie a permis d’apporter des données qualitatives et quantitatives sur l’anisotropie microstructurale et minéralogique de la roche argileuse et de proposer une estimation de la surface élémentaire représentative du système grain/matrice pour des zones à tendance argileuse.Le couplage de la CIN avec le MEB a révélé l’importance des hétérogénéités microstructurales relatives à la proportion, taille, élongation et orientation moyennes des inclusions rigides présentes dans la matrice argileuse de la roche, sur la localisation des fissures hydriques. / This study is included in the issues of a nuclear waste storage in deep geological clay formations. It concerns the cracking phenomenon due to desaturation and saturation processes of the argillaceous medium on gallery walls of the Underground Laboratory of Tournemire (Aveyron, France). The work presented here aims to identify in laboratory the different mineralogical factors which control the cracking generated by humidity variations, coupling two methods: the Digital Image Correlation (DIC) and the Scanning Electron Microscopy (SEM).Two clay rock samples were submitted to swelling/shrinkage processes by fast bumps or gradual humidity variations. The DIC method enabled to reveal the influence of humidity and water content on crack widths and deformations intensity to different scales. This study highlighted the part of humidity variations on evolution and width of crack networks while comparing the results obtained by different conditions of humidity variations.A mineralogical map was investigated on a millimeter field with high resolution on two clay rock samples. It allowed to: quantify the microstructural anisotropy of the rock, and estimate the size of a representative elementary surface of a microstructural system composed of coarse grains and clay matrix, for argillaceous areas.The DIC-SEM approach has shown the closed relation between the location of microstructural heterogeneities such as local proportion of coarse grains and clay matrix, medium size, length ratio and orientation of coarse grains, with the position of the hydric cracks.

This study provides insight into the structure/function relationship between desaturases and acetylenases, and indicates amino acid residues within acetylenases which influence reaction outcome. <i>Oleate desaturases</i> belong to a family of enzymes capable of introducing cis double bonds between C12 - C13 in oleate esters. Acetylenases are a subset of oleate desaturase enzymes which introduce a triple bond in the C12 - C13 position of linoleate. To better understand which amino acids could be responsible for differentiating the activity of acetylenases from typical desaturases, a total of 50 protein sequences were used to compare the two classes of enzymes resulting in the identification of 11 amino acid residues which are conserved within either separate family but differ between the two groups of enzymes. These identified amino acid residues were then singularly altered by site-directed mutagenesis to test their role in fatty acid modification. Specifically, the wild type acetylenase, Crep1 from <i>Crepis alpina</i>, and a number of point mutants have been expressed in <i>Saccharomyces cerevisiae</i>, followed by fatty acid analysis of the resulting cultures. Results indicate the importance of 4 amino acid residues within Crep1 (Y150, F259, H266, and V304) with regards to desaturase and acetylenase chemoselectivity, stereoselectivity, and/or substrate recognition. The F259L mutation affected the acetylenase by converting it to an atypical FAD2 capable of producing both cis and trans isomers. The V304I mutation resulted in the conversion of Crep1 into a stereoselective FAD2, where only the cis isomers of 16:2 and 18:2 were produced. The Y150F mutation led to a loss of acetylenase activity without affecting the inherent desaturase activity of Crep1. The H266Q mutation appears to affect substrate selection causing an inability to bind substrate (16:1-9c and/or 18:1-9c) in a cisoid conformation, resulting in an increased accumulation of trans product. The changes in enzyme activity detected in cultures expressing Crep1 mutants demonstrate the profound effect that exchanging as little as one amino acid can have on an enzyme properties. Enzymes retain some conservation of amino acids necessary for activity, such as those involved in metal ion binding, whereas subtle changes can affect overall enzyme function and catalysis.

This study provides insight into the structure/function relationship between desaturases and acetylenases, and indicates amino acid residues within acetylenases which influence reaction outcome. <i>Oleate desaturases</i> belong to a family of enzymes capable of introducing cis double bonds between C12 - C13 in oleate esters. Acetylenases are a subset of oleate desaturase enzymes which introduce a triple bond in the C12 - C13 position of linoleate. To better understand which amino acids could be responsible for differentiating the activity of acetylenases from typical desaturases, a total of 50 protein sequences were used to compare the two classes of enzymes resulting in the identification of 11 amino acid residues which are conserved within either separate family but differ between the two groups of enzymes. These identified amino acid residues were then singularly altered by site-directed mutagenesis to test their role in fatty acid modification. Specifically, the wild type acetylenase, Crep1 from <i>Crepis alpina</i>, and a number of point mutants have been expressed in <i>Saccharomyces cerevisiae</i>, followed by fatty acid analysis of the resulting cultures. Results indicate the importance of 4 amino acid residues within Crep1 (Y150, F259, H266, and V304) with regards to desaturase and acetylenase chemoselectivity, stereoselectivity, and/or substrate recognition. The F259L mutation affected the acetylenase by converting it to an atypical FAD2 capable of producing both cis and trans isomers. The V304I mutation resulted in the conversion of Crep1 into a stereoselective FAD2, where only the cis isomers of 16:2 and 18:2 were produced. The Y150F mutation led to a loss of acetylenase activity without affecting the inherent desaturase activity of Crep1. The H266Q mutation appears to affect substrate selection causing an inability to bind substrate (16:1-9c and/or 18:1-9c) in a cisoid conformation, resulting in an increased accumulation of trans product. The changes in enzyme activity detected in cultures expressing Crep1 mutants demonstrate the profound effect that exchanging as little as one amino acid can have on an enzyme properties. Enzymes retain some conservation of amino acids necessary for activity, such as those involved in metal ion binding, whereas subtle changes can affect overall enzyme function and catalysis.

Study Objectives: Sleep bruxism (SB) is a repetitive jaw-muscle activity characterized by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible occurring during sleep. SB is scored, from electromyographic traces, as rhythmic masticatory muscle activity (RMMA). Most RMMA occurred during sleep in association with sleep arousal. Since not all RMMA episodes were associated with sleep arousal we hypothesized that some event could be observed in relation to small fluctuations of the oxygen level resulting in mild desaturation/hypoxia. Methods: Sleep laboratory or home recordings from 22 SB (teeth grinding) patients were analyzed from our data bank. A total of 143 RMMA/SB episodes were classified in 4 categories: (i) no arousal & no body movement; (ii) arousal + & no body movement; (iii) no arousal & body movement +; (iv) arousal + & body movement +. Minimum blood oxygen levels were assessed from finger oxymetry signal: 1) during the baseline period before RMMA, i.e., an average of 7 s before RMMA onset (-20 s to -14 s); 2) during RMMA, i.e. a window of 15 s corresponding to -5 s before the onset until +10 s after the episode. For all episodes, the minimum oximetry values were compared for each patient. Results: There was a significant variation of blood oxygen level over time (p=0.001) with a statistically significant transient hypoxia during RMMA at time (+7),(+8) and (+9) s. The variation over time was similar among the 4 groups (non significant group*time interaction p=0.10) and no overall difference was observed between groups (p=0.91). Of the 22 subjects, 6 subjects (27%) remained equal or had a slight increase in SaO2 (+8) s after the RMMA/SB onset compared to baseline (-20 s to -14) s, 10 subjects (45%) showed a small decrease in SaO2 (>0 to <1%) and 6 others (27%) had a decrease of 1-1.8%. Conclusions: These preliminary findings suggest that in some SB patients, RMMA episodes are potentially triggered by minor transient hypoxia. Key words: sleep bruxism, oximetry, desaturation, hypoxia, rhythmic masticatory muscle activity / Objectifs: Le bruxisme du sommeil (BRS) est une activité répétitive des muscles de la mâchoire caractérisée par le serrement et le grincement des dents et/ou par le bracing et le thrusting de la mandibule durant le sommeil. Les mouvements des muscles de la mâchoire que l’on appelle activité rythmique des muscles de la mastication (ARMM) sont des activités oromotrices qui constituent le modèle de base du BRS. La plupart des ARMM sont reliées à un micro-éveil de sommeil. Étant donné que ce ne sont pas tous les épisodes qui sont associés à un micro-éveil, notre hypothèse est qu'une légère désaturation/hypoxie en oxygène pourrait contribuer à l'apparition de certains épisodes d'activité rythmique des muscles de la mastication associé au bruxisme du sommeil-grincement des dents (ARMM/BRS). Méthodologie: Des enregistrements polysomnographiques en laboratoire ou ambulatoire de notre banque de données de 22 patients BRS ont été analysés. Leurs épisodes d'ARMM/BRS sont ensuite classifiés en 4 catégories : (i) sans micro-éveil & sans mouvement; (ii) micro-éveil + & sans mouvement; (iii) sans micro-éveil & mouvement +; (iv) micro-éveil + & mouvement +. Les valeurs minimales de saturation en oxygène sont évalués : 1) à la valeur de base avant le début de l'ARMM, correspondant à une moyenne de 7 sec avant le début de l'épisode, équivalent de (-20) sec à (-14) sec; 2) pendant l'ARMM dans une fenêtre temporale de 15 sec, correspondant de (-5) sec avant le début jusqu'à (+10) sec après l'épisode. Ensuite pour tous les épisodes, tous les points minimaux en oxymétrie sont comparés pour chaque patient. Résultats: Il y a une variation significative de la saturation en oxygène dans le temps (p=0.001) avec une hypoxie transitoire statistiquement significative durant l'ARMM à (+7), (+8) et (+9) sec. La variation dans le temps était semblable pour les 4 catégories (interaction non significative catérogie*temps p=0.1) et pas de différence globale n'est observé entre les catégories (p=0.91). Sur les 22 patients, 6 (27%) ont eu une légère augmentation ou sont restés stables dans la saturation en oxygène (+8) sec après le début de l'ARMM comparé à la valeur de base; 10 (45%) ont eu une légère diminution (>0 à <1%) et 6 autres (27%) ont eu une désaturation en oxygène de 1 à 1.8%. Conclusion: Ces résultats préliminaires suggèrent que chez certains patients BRS, les épisodes d'ARMM/BRS sont possiblement déclenchés par une légère hypoxie transitoire. Mots-clés : bruxisme du sommeil, oxymétrie, désaturation, hypoxie, activité rythmique des muscles de la mastication

INTRODUÇÃO: A doença pulmonar obstrutiva crônica (DPOC) apresenta obstrução crônica ao fluxo aéreo e evolui com perda da capacidade funcional. A intolerância ao exercício é um marcador prognóstico da doença. OBJETIVO: Investigar as respostas fisiológicas no teste incremental com cicloergômetro (TECP), teste do degrau de 6 minutos (TD6), teste da caminhada de 6 minutos (TC6) e teste senta e levanta de um minuto (TSL) em pacientes com DPOC. MÉTODOS: Foram incluídos 24 pacientes com DPOC (VEF1/CVF<70 e VEF1 pós bd <80%), clinicamente estáveis. Todos os pacientes realizaram provas de função pulmonar e os quatro protocolos de exercício. Durante os testes foram medidos: consumo de oxigênio (VO2), produção de CO2 (VCO2), ventilação (VE), frequência cardíaca (FC), frequência respiratória (FR), oximetria de pulso (SpO2), e sensação de dispneia e de desconforto nas pernas (escala de BORG modificada). RESULTADOS: Quinze pacientes eram homens, a média de idade foi de 63,7 ± 6,6 anos e do VEF1 foi de 1,20 ± 0,60 L, 42,5 ± 17,8 % do predito. O VO2pico observado no TD6 (1,01±0,40 L.min-1) não diferiu do VO2 medido no TECP (0,86±0,32 L.min-1) e no TC6 (0,99±0,46; L.min-1;p>0,05). Entretanto, o VO2 pico do TSL foi significativamente inferior (0,66±0,32 L.min-1, p<0,05). A VE foi comparável no TECP, TD6 e TC6. O estresse cardiovascular foi mais intenso no TECP, porém o pulso de oxigênio (VO2/FC) foi inferior no TECP e no TSL. Dessaturação (queda da SpO2 ³4% e SpO2 £88%) foi mais frequente no TC6 e no TD6. Dispneia e desconforto em pernas foram mais intensos no TECP. No TD6 14 pacientes interromperam o teste e no TC6 um paciente interrompeu. CONCLUSÕES: A dessaturação durante o exercício foi mais evidente no TD6 e no TC6 e estes testes reproduziram respostas fisiológicas equivalentes às do TECP. / BACKGROUND: Chronic obstructive pulmonary disease (COPD) has chronic obstruction of airflow and loss of functional capacity. Exercise intolerance is a prognostic marker of the disease. OBJECTIVE: To investigate the physiological responses to incremental cycle ergometry (CPET), six-minute step test (SMST), sixminute walk test (SMWT), and one-minute sit-to-stand test (STST) in patients with COPD. METHODS: We included 24 patients with COPD (FEV1/FVC ratio <70 and FEV1 post bd <80%), stable. All patients underwent pulmonary function tests and the four exercise protocols. Peak oxygen uptake (VO2peak), CO2 production (VCO2), ventilation (VE), heart rate (HR), respiratory rate (RR), pulse oximetry (SpO2), dyspnea and leg disconfort (modified Borg scale) were measured during the tests. RESULTS: Fifteen patients were men, mean age was 63.7 ± 6.6 years and FEV1 was 1.20 ± 0.60 L, 42.5 ± 17.8 % predicted. VO2 peak in SMST (1.01±0.40 L.min-1), measured during CPET (0.86±0.32 L.min-1) or SMWT (0.99±0.46; L.min-1) was not different (p>0.05). However, peak VO2 of STST was lower (0.66±0.32 L.min-1, p<0.05). VE was comparable among CPET, SMST and SMWT. The cardiovascular stress was more intense during CPET and oxygen pulse (VO2/HR) was lower during CPET and STST. Desaturation (decrease of SpO2 ³4% and SpO2 £88%) was more frequent during SMWT and STST. Dyspnea and leg disconfort were higher on CPET. The SMST was interrupted by 14 patients and the SMWT by one. CONCLUSIONS: Desaturation during exercise was more evident on SMWT and SMST and these tests elicited similar physiological responses as the CPET.

Ao considerar que os distúrbios respiratórios relacionados ao sono, apneia obstrutiva do sono (AOS) e dessaturação noturna de oxigênio (DNO), podem estar presentes em pacientes com doença pulmonar obstrutiva crônica (DPOC), este estudo teve como objetivos: (1) estimar a frequência de AOS e DNO na amostra e nos graus e categorias GOLD (Global Initiative for Chronic Obstructive Lung Disease); (2) avaliar a relação da presença de AOS e DNO no agravamento clínico de pacientes com DPOC. Estudo transversal em 56 pacientes com DPOC estável e pressão parcial arterial de oxigênio (PaO2) diurna > 60 mmHg, submetidos à coleta dos seguintes dados: demográficos, antropométricos e de hábito tabágico; relato de ronco e sonolência diurna; número de exacerbações e hospitalizações; escala de dispneia do Medical Reserch Council modificada; teste de avaliação da DPOC; escala de sonolência de Epworth; espirometria; gasometria arterial; hemograma; monitorização ambulatorial da pressão arterial e polissonografia. Os pacientes foram classificados em graus e categorias GOLD e divididos em 3 grupos de estudo: grupo DPOC pura, grupo síndrome de sobreposição (SS) e grupo dessaturador (D). Os resultados mostraram: 30 pacientes do sexo masculino (54%); idade: 63,7 (DP=7,3) anos; índice de massa corpórea (IMC): 25,2 (DP=4,3) Kg/m2; circunferência do pescoço: 38,4 (DP=3,2) cm; 46% tabagistas; carga tabágica: 50,0 (DP=20,7) anosmaço; volume expiratório forçado no primeiro segundo (VEF1): 56,4 (DP=19,8) % do previsto; PaO2: 78,3 (DP=8,0) mmHg; saturação arterial de oxigênio (SaO2): 95,5 (DP=1,4) %; 29 pacientes (52%) eram do grupo DPOC pura, 14 (25%) do grupo SS e 13 (23%) do grupo D; frequência de AOS e DNO na amostra: 25% e 23%, respectivamente; frequência de AOS nos GOLD 1234: 14%, 24%, 25%, 50% (p=0,34) e GOLD ABCD: 44%, 15%, 25%, 26% (p=0,31), respectivamente; frequência da DNO nos GOLD 1234: 29%, 24%, 19%, 25% (p=0,88) e GOLD ABCD: 11%, 20%, 25%, 30% (p=0,35), respectivamente. Evidências de diferença estatística entre os 3 grupos: sexo (DPOC pura: 48% de homens versus SS: 86% versus D: 31%; p<0,01); IMC (DPOC pura: 23,9 (DP=3,8) versus SS: 24,7 (DP=4,6) versus D: 28,6 (DP=3,5) Kg/m2; p<0,01); circunferência do pescoço (DPOC pura: 37,4 (DP=2,7) versus SS: 40,0 (DP=2,9) versus D: 38,9 (DP=3,9) cm; p=0,03); relato de sonolência diurna (DPOC pura: 17% versus SS: 0 versus D: 38%; p=0,03); SaO2 diurna (DPOC pura: 95,8 (DP=1,5) % versus SS: 95,8 (DP=1,1) % versus D: 94,7 (DP=1,3) %; p=0,04); descenso noturno diastólico (DPOC pura: 6,5 (DP=7,0) % versus SS: 2,3 (DP=7,3) % versus D: 5,6 (DP=7,0) %; p=0,04). Conclui-se que, em pacientes com DPOC, a frequência de AOS e DNO foi elevada na amostra e não sofreu influência dos graus ou categorias GOLD; encontrou-se associação entre a presença de AOS e o sexo masculino, maior circunferência do pescoço e menor descenso noturno diastólico; e a presença de DNO associou-se com o sexo feminino, maior IMC, maior relato de sonolência diurna e menor SaO2 diurna. Estas características podem contribuir para diferenciar clinicamente os grupos SS e D do grupo DPOC pura / While considering that the sleep-related breathing disorders, obstructive sleep apnea (OSA) and nocturnal oxygen desaturation (NOD) may be present in patients with chronic obstructive pulmonary disease (COPD), this study aimed to: (1) to estimate the frequency of OSA and NOD in the sample and in the GOLD degrees and categories (Global Initiative for Chronic Obstructive Lung Disease); (2) to assess the relationship of the presence of OSA and NOD in the clinical aggravation of patients with COPD. Transversal study in 56 patients suffering from stable COPD and daytime partial arterial oxygen tension (PaO2) > 60 mmHg, subjected to the collection of the following data: demographic and anthropometric data, and smoking habit; report of snoring and daytime sleepiness; number of exacerbations and hospitalizations; modified Medical Research Council dyspnea scale; COPD assessment test; Epworth Sleepiness Scale; spirometry; arterial gasometry; hemogram; ambulatory blood pressure monitoring and polysomnography. The patients were classified in GOLD degrees and categories and divided into 3 study groups: pure COPD group, overlap syndrome (OS) and desaturator group (D). The results showed: 30 male patients (54%); age 63,7 years old (DP=7,3); body mass index (BMI) 25,2 Kg/m2 (DP=4,3); neck circumference 38,4 cm (DP=3,2); 46% smokers; smoking load 50,0 pack years (DP=20,7); forced expiratory volume in the first second (FEV1) 56,4% of the expected (DP=19,8); PaO2 78,3 mmHg (DP=8,0); arterial oxygen saturation (SaO2) 95,5% (DP=1,4); 29 patients (52%) belonged to the pure COPD group, 14 (25%) to the OS group and 13 (23%) to the D group; frequency of OSA and NOD in the sample: 25% and 23%, respectively; frequency of OSA in the GOLD 1234: 14%, 24%, 25%, 50% (p=0,34) and GOLD ABCD: 44%, 15%, 25%, 26% (p=0,31), respectively; NOD frequency in the GOLD 1234: 29%, 24%, 19%, 25% (p=0,88) and GOLD ABCD: 11%, 20%, 25%, 30% (p=0,35), respectively. Evidences of statistical difference among the three groups: sex (pure COPD: 48% men versus OS: 86% versus D: 31%; p<0,01); BMI (pure COPD: 23,9 (DP=3,8) versus OS: 24,7 (DP=4,6) versus D: 28,6 (DP=3,5) Kg/m2; p<0,01); neck circumference (pure COPD: 37,4 (DP=2,7) versus OS: 40,0 (DP=2,9) versus D: 38,9 (DP=3,9) cm; p=0,03); report of daytime sleepiness (pure COPD: 17% versus OS: 0 versus D: 38%; p=0,03); daytime SaO2 (pure COPD: 95,8% (DP=1,5) versus OS: 95,8% (DP=1,1) versus D: 94,7% (DP=1,3); p=0,04); diastolic sleep dip (pure COPD: 6,5% (DP=7,0) versus OS: 2,3% (DP=7,3) versus D: 5,6% (DP=7,0); p=0,04). It was concluded that, in patients with COPD, the OSA and NOD frequency was high in the sample and was not influenced by GOLD grades or categories. An association between the presence of OSA and the male sex, a larger neck circumference and a smaller diastolic sleep dip was found; and the presence of the NOD was associated with the female sex, a larger BMI, a more significant report of daytime sleepiness and a smaller daytime SaO2. These characteristics may contribute to differentiate clinically the OS and D groups from the pure COPD group

INTRODUÇÃO: A doença pulmonar obstrutiva crônica (DPOC) apresenta obstrução crônica ao fluxo aéreo e evolui com perda da capacidade funcional. A intolerância ao exercício é um marcador prognóstico da doença. OBJETIVO: Investigar as respostas fisiológicas no teste incremental com cicloergômetro (TECP), teste do degrau de 6 minutos (TD6), teste da caminhada de 6 minutos (TC6) e teste senta e levanta de um minuto (TSL) em pacientes com DPOC. MÉTODOS: Foram incluídos 24 pacientes com DPOC (VEF1/CVF<70 e VEF1 pós bd <80%), clinicamente estáveis. Todos os pacientes realizaram provas de função pulmonar e os quatro protocolos de exercício. Durante os testes foram medidos: consumo de oxigênio (VO2), produção de CO2 (VCO2), ventilação (VE), frequência cardíaca (FC), frequência respiratória (FR), oximetria de pulso (SpO2), e sensação de dispneia e de desconforto nas pernas (escala de BORG modificada). RESULTADOS: Quinze pacientes eram homens, a média de idade foi de 63,7 ± 6,6 anos e do VEF1 foi de 1,20 ± 0,60 L, 42,5 ± 17,8 % do predito. O VO2pico observado no TD6 (1,01±0,40 L.min-1) não diferiu do VO2 medido no TECP (0,86±0,32 L.min-1) e no TC6 (0,99±0,46; L.min-1;p>0,05). Entretanto, o VO2 pico do TSL foi significativamente inferior (0,66±0,32 L.min-1, p<0,05). A VE foi comparável no TECP, TD6 e TC6. O estresse cardiovascular foi mais intenso no TECP, porém o pulso de oxigênio (VO2/FC) foi inferior no TECP e no TSL. Dessaturação (queda da SpO2 ³4% e SpO2 £88%) foi mais frequente no TC6 e no TD6. Dispneia e desconforto em pernas foram mais intensos no TECP. No TD6 14 pacientes interromperam o teste e no TC6 um paciente interrompeu. CONCLUSÕES: A dessaturação durante o exercício foi mais evidente no TD6 e no TC6 e estes testes reproduziram respostas fisiológicas equivalentes às do TECP. / BACKGROUND: Chronic obstructive pulmonary disease (COPD) has chronic obstruction of airflow and loss of functional capacity. Exercise intolerance is a prognostic marker of the disease. OBJECTIVE: To investigate the physiological responses to incremental cycle ergometry (CPET), six-minute step test (SMST), sixminute walk test (SMWT), and one-minute sit-to-stand test (STST) in patients with COPD. METHODS: We included 24 patients with COPD (FEV1/FVC ratio <70 and FEV1 post bd <80%), stable. All patients underwent pulmonary function tests and the four exercise protocols. Peak oxygen uptake (VO2peak), CO2 production (VCO2), ventilation (VE), heart rate (HR), respiratory rate (RR), pulse oximetry (SpO2), dyspnea and leg disconfort (modified Borg scale) were measured during the tests. RESULTS: Fifteen patients were men, mean age was 63.7 ± 6.6 years and FEV1 was 1.20 ± 0.60 L, 42.5 ± 17.8 % predicted. VO2 peak in SMST (1.01±0.40 L.min-1), measured during CPET (0.86±0.32 L.min-1) or SMWT (0.99±0.46; L.min-1) was not different (p>0.05). However, peak VO2 of STST was lower (0.66±0.32 L.min-1, p<0.05). VE was comparable among CPET, SMST and SMWT. The cardiovascular stress was more intense during CPET and oxygen pulse (VO2/HR) was lower during CPET and STST. Desaturation (decrease of SpO2 ³4% and SpO2 £88%) was more frequent during SMWT and STST. Dyspnea and leg disconfort were higher on CPET. The SMST was interrupted by 14 patients and the SMWT by one. CONCLUSIONS: Desaturation during exercise was more evident on SMWT and SMST and these tests elicited similar physiological responses as the CPET.

Made available in DSpace on 2016-06-02T20:19:24Z (GMT). No. of bitstreams: 1 5879.pdf: 1266280 bytes, checksum: 0c68967281d5bc570c239dd9afba662e (MD5) Previous issue date: 2014-02-21 / Universidade Federal de Sao Carlos / The Global Initiative for Chronic Obstructive Lung Disease (GOLD), in its 2011 update, began to recommend that the management and treatment of COPD were made to combine the impact of disease and future risk of exacerbations. These subjects have limitations in activities of daily living (ADL) performing, which may manifest as a decrease in oxygen saturation (SpO2) and progressive dyspnea. These limitations may be associated with worsening of quality of life. Thus, this study aims to verify whether the COPD combined classification, proposed by GOLD 2011, is able to differentiate subjects with ADL limitations, such as desaturation and dyspnea, and impaired quality of life. We intend to compare the quality of life, dyspnea and desaturation ADL among groups stratified by GOLD 2011. This is an observational, cross-sectional study. 44 subjects were evaluated and categorized in four groups proposed by the GOLD 2011. The mean age was 69 ± 8.8 years, with mean FEV1 = 1.33 ± 0.53 liters (49 ± 15.7% of predicted). Medical Research Council Dyspnea (mMRC) and London Chest Activity Daily Living (LCADL) Scales and the Saint George's Respiratory Questionnaire (SRGQ) were applied. The six-minute walk test (6MWT) and the ADL simulation in appropriate laboratory were also conducted. There was no association between the COPD combined evaluation groups and the presence of peripheral oxygen desaturation and dyspnea (X² test), however it was noted a higher prevalence of subjects who desaturate in GOLD D group. Regarding to dyspnea in all groups exist subjects with dyspnea when performing ADL. There was no correlation between the presence of dyspnea with the presence of desaturation. Most symptomatic subjects, GOLD B and D, had higher ADL dyspnea (LCADL% total = 28% and 30%) compared with subjects GOLD A. The GOLD D subjects had a poorer quality of life (SGRQtotal = 49%) when compared to less symptomatic groups. The COPD combined classification wasn t sensitive in determining the presence of desaturation and dyspnea while performing ADLs. The subjects of the symptomatic groups and with increased risk of exacerbation had a poorer quality of life and greater dyspnea. / A Global Initiative for Chronic Obstructive Lung Disease (GOLD), em sua atualização de 2011, passou a recomendar que o manejo e tratamento da DPOC fossem feitos de forma a combinar o impacto da doença e o risco futuro de exacerbações. Esses pacientes apresentam limitações na execução de suas atividades de vida diária (AVD), as quais podem se manifestar com a queda da saturação periférica de oxigênio (SpO2) e dispneia progressiva durante a execução dessas atividades. Essas limitações podem se associar com a piora da qualidade de vida. Com isso, esse trabalho objetiva verificar se a classificação combinada da DPOC, proposta pela GOLD 2011 é capaz de diferenciar os pacientes que apresentam limitações nas AVD, como dessaturação e dispneia, e prejuízos na qualidade de vida.. Trata-se de um estudo observacional e transversal, no qual foram avaliados 44 pacientes (69±8,8 anos e VEF1=1,33±0,53 litros (49±15,7% do previsto)) e categorizados nos quatros grupos propostos pela GOLD 2011. Foram aplicadas as escalas Modified Medical Research Council Dyspnea (mMRC) e London Chest Activity Daily Living (LCADL) e o questionário do Hospital Saint George na Doença Respiratória (SRGQ). Foram realizados também teste de caminhada de seis minutos (TC6) e a simulação de AVD em laboratório adaptado. Não foi constatada associação entre os grupos propostos pela avaliação combinada e a presença de dessaturação periférica de oxigênio e dispneia (teste X²), entretanto notou-se uma maior prevalência de pacientes que dessaturaram no grupo GOLD D. Em relação à dispneia verificou-se que existiram, em todos os grupos, pacientes que relataram dispneia ao executar as AVD. Não houve correlação entre a presença de dispneia com a presença de dessaturação. Os pacientes mais sintomáticos, GOLD B e D apresentaram maior dispneia nas AVD (LCADL%total=28% e 30%) quando comparados com os pacientes GOLD A. Os pacientes GOLD D apresentaram pior qualidade de vida (SGRQtotal=49%) quando comparados com os grupos menos sintomáticos. Conclui-se a partir dos resultados do presente estudo que a classificação combinada da DPOC não descriminou pacientes dessaturadores ou dispneicos durante a realização de AVD. Os pacientes dos grupos mais sintomático e com maior risco de exacerbação apresentaram pior qualidade de vida e maior dispneia nas AVD avaliada pela LCADL.

INTRODUÇÃO: A doença pulmonar obstrutiva crônica (DPOC) apresenta obstrução crônica ao fluxo aéreo e evolui com perda da capacidade funcional. A intolerância ao exercício é um marcador prognóstico da doença. OBJETIVO: Investigar as respostas fisiológicas no teste incremental com cicloergômetro (TECP), teste do degrau de 6 minutos (TD6), teste da caminhada de 6 minutos (TC6) e teste senta e levanta de um minuto (TSL) em pacientes com DPOC. MÉTODOS: Foram incluídos 24 pacientes com DPOC (VEF1/CVF<70 e VEF1 pós bd <80%), clinicamente estáveis. Todos os pacientes realizaram provas de função pulmonar e os quatro protocolos de exercício. Durante os testes foram medidos: consumo de oxigênio (VO2), produção de CO2 (VCO2), ventilação (VE), frequência cardíaca (FC), frequência respiratória (FR), oximetria de pulso (SpO2), e sensação de dispneia e de desconforto nas pernas (escala de BORG modificada). RESULTADOS: Quinze pacientes eram homens, a média de idade foi de 63,7 ± 6,6 anos e do VEF1 foi de 1,20 ± 0,60 L, 42,5 ± 17,8 % do predito. O VO2pico observado no TD6 (1,01±0,40 L.min-1) não diferiu do VO2 medido no TECP (0,86±0,32 L.min-1) e no TC6 (0,99±0,46; L.min-1;p>0,05). Entretanto, o VO2 pico do TSL foi significativamente inferior (0,66±0,32 L.min-1, p<0,05). A VE foi comparável no TECP, TD6 e TC6. O estresse cardiovascular foi mais intenso no TECP, porém o pulso de oxigênio (VO2/FC) foi inferior no TECP e no TSL. Dessaturação (queda da SpO2 ³4% e SpO2 £88%) foi mais frequente no TC6 e no TD6. Dispneia e desconforto em pernas foram mais intensos no TECP. No TD6 14 pacientes interromperam o teste e no TC6 um paciente interrompeu. CONCLUSÕES: A dessaturação durante o exercício foi mais evidente no TD6 e no TC6 e estes testes reproduziram respostas fisiológicas equivalentes às do TECP. / BACKGROUND: Chronic obstructive pulmonary disease (COPD) has chronic obstruction of airflow and loss of functional capacity. Exercise intolerance is a prognostic marker of the disease. OBJECTIVE: To investigate the physiological responses to incremental cycle ergometry (CPET), six-minute step test (SMST), sixminute walk test (SMWT), and one-minute sit-to-stand test (STST) in patients with COPD. METHODS: We included 24 patients with COPD (FEV1/FVC ratio <70 and FEV1 post bd <80%), stable. All patients underwent pulmonary function tests and the four exercise protocols. Peak oxygen uptake (VO2peak), CO2 production (VCO2), ventilation (VE), heart rate (HR), respiratory rate (RR), pulse oximetry (SpO2), dyspnea and leg disconfort (modified Borg scale) were measured during the tests. RESULTS: Fifteen patients were men, mean age was 63.7 ± 6.6 years and FEV1 was 1.20 ± 0.60 L, 42.5 ± 17.8 % predicted. VO2 peak in SMST (1.01±0.40 L.min-1), measured during CPET (0.86±0.32 L.min-1) or SMWT (0.99±0.46; L.min-1) was not different (p>0.05). However, peak VO2 of STST was lower (0.66±0.32 L.min-1, p<0.05). VE was comparable among CPET, SMST and SMWT. The cardiovascular stress was more intense during CPET and oxygen pulse (VO2/HR) was lower during CPET and STST. Desaturation (decrease of SpO2 ³4% and SpO2 £88%) was more frequent during SMWT and STST. Dyspnea and leg disconfort were higher on CPET. The SMST was interrupted by 14 patients and the SMWT by one. CONCLUSIONS: Desaturation during exercise was more evident on SMWT and SMST and these tests elicited similar physiological responses as the CPET.