Ludovico Messineo1,2, Elisa Perger3,4, Luciano Corda5,6, Simon A Joosten7,8,9, Francesco Fanfulla10, Leonardo Pedroni5, Philip I Terrill11, Carolina Lombardi3,4, Andrew Wellman12, Garun S Hamilton7,8,9, Atul Malhotra13, Guido Vailati5, Gianfranco Parati3,4, Scott A Sands12,14. 1. Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham & Women's Hospital & Harvard Medical School, Boston, MA, USA. ludovico.messineo@yahoo.it. 2. Adelaide Institute for Sleep Health (AISH), Flinders Health and Medical Research Institute (FHMRI), Flinders University, 5 Laffer Drive, Bedford Park, Adelaide, SA, 5043, Australia. ludovico.messineo@yahoo.it. 3. Istituto Auxologico Italiano IRCSS, Sleep Medicine Center, Department of Cardiology, San Luca Hospital, Milano, Italy. 4. Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy. 5. Respiratory Medicine and Sleep Laboratory, Department of Experimental and Clinical Sciences, University of Brescia and Spedali Civili, Brescia, Italy. 6. Department of Internal Medicine, Spedali Civili, Brescia, Italy. 7. Monash Lung and Sleep, Monash Medical Centre, Clayton, VIC, Australia. 8. School of Clinical Sciences, Monash University, Melbourne, VIC, Australia. 9. Monash Partners - Epworth, Victoria, Australia. 10. Maugeri Institute IRCCS, Sleep Medicine Center, Pavia, Italy. 11. School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia. 12. Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham & Women's Hospital & Harvard Medical School, Boston, MA, USA. 13. University of California San Diego, La Jolla, CA, USA. 14. Department of Allergy Immunology and Respiratory Medicine and Central Clinical School, The Alfred and Monash University, Melbourne, Australia.
Abstract
BACKGROUND: Despite considerable progress, it remains unclear why some patients admitted for COVID-19 develop adverse outcomes while others recover spontaneously. Clues may lie with the predisposition to hypoxemia or unexpected absence of dyspnea ('silent hypoxemia') in some patients who later develop respiratory failure. Using a recently-validated breath-holding technique, we sought to test the hypothesis that gas exchange and ventilatory control deficits observed at admission are associated with subsequent adverse COVID-19 outcomes (composite primary outcome: non-invasive ventilatory support, intensive care admission, or death). METHODS: Patients with COVID-19 (N = 50) performed breath-holds to obtain measurements reflecting the predisposition to oxygen desaturation (mean desaturation after 20-s) and reduced chemosensitivity to hypoxic-hypercapnia (including maximal breath-hold duration). Associations with the primary composite outcome were modeled adjusting for baseline oxygen saturation, obesity, sex, age, and prior cardiovascular disease. Healthy controls (N = 23) provided a normative comparison. RESULTS: The adverse composite outcome (observed in N = 11/50) was associated with breath-holding measures at admission (likelihood ratio test, p = 0.020); specifically, greater mean desaturation (12-fold greater odds of adverse composite outcome with 4% compared with 2% desaturation, p = 0.002) and greater maximal breath-holding duration (2.7-fold greater odds per 10-s increase, p = 0.036). COVID-19 patients who did not develop the adverse composite outcome had similar mean desaturation to healthy controls. CONCLUSIONS: Breath-holding offers a novel method to identify patients with high risk of respiratory failure in COVID-19. Greater breath-hold induced desaturation (gas exchange deficit) and greater breath-holding tolerance (ventilatory control deficit) may be independent harbingers of progression to severe disease.
BACKGROUND: Despite considerable progress, it remains unclear why some patients admitted for COVID-19 develop adverse outcomes while others recover spontaneously. Clues may lie with the predisposition to hypoxemia or unexpected absence of dyspnea ('silent hypoxemia') in some patients who later develop respiratory failure. Using a recently-validated breath-holding technique, we sought to test the hypothesis that gas exchange and ventilatory control deficits observed at admission are associated with subsequent adverse COVID-19 outcomes (composite primary outcome: non-invasive ventilatory support, intensive care admission, or death). METHODS:Patients with COVID-19 (N = 50) performed breath-holds to obtain measurements reflecting the predisposition to oxygen desaturation (mean desaturation after 20-s) and reduced chemosensitivity to hypoxic-hypercapnia (including maximal breath-hold duration). Associations with the primary composite outcome were modeled adjusting for baseline oxygen saturation, obesity, sex, age, and prior cardiovascular disease. Healthy controls (N = 23) provided a normative comparison. RESULTS: The adverse composite outcome (observed in N = 11/50) was associated with breath-holding measures at admission (likelihood ratio test, p = 0.020); specifically, greater mean desaturation (12-fold greater odds of adverse composite outcome with 4% compared with 2% desaturation, p = 0.002) and greater maximal breath-holding duration (2.7-fold greater odds per 10-s increase, p = 0.036). COVID-19patients who did not develop the adverse composite outcome had similar mean desaturation to healthy controls. CONCLUSIONS: Breath-holding offers a novel method to identify patients with high risk of respiratory failure in COVID-19. Greater breath-hold induced desaturation (gas exchange deficit) and greater breath-holding tolerance (ventilatory control deficit) may be independent harbingers of progression to severe disease.
Authors: Scott A Sands; Bradley A Edwards; Vanessa J Kelly; Malcolm R Davidson; Malcolm H Wilkinson; Philip J Berger Journal: J Theor Biol Date: 2010-04-01 Impact factor: 2.691
Authors: Gerardina Fratianni; Gabriella Malfatto; Elisa Perger; Luca Facchetti; Laura Pini; Miriam Bosco; Franco Cernigliaro; Giovanni B Perego; Mario Facchini; Luigi P Badano; Gianfranco Parati Journal: J Ultrasound Med Date: 2021-09-17 Impact factor: 2.754