Respiratory muscle strength effect on linear and nonlinear heart rate variability parameters in COPD patients

Abstract

Cássia Da Luz Goulart,1 Julio Cristiano Simon,1 Paloma De Borba Schneiders,1 Elisabete Antunes San Martin,1 Ramona Cabiddu,2 Audrey Borghi-Silva,2 Renata Trimer,2 Andréa Lúcia Gonçalves da Silva1 1Course of Physiotherapy, Department of Health and Physical Education, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Rio Grande do Sul, Brazil; 2Cardiopulmonary Physiotherapy Laboratory, Nucleus of Research in Physical Exercise, Federal University of São Carlos (UFSCar), São Carlos, São Paulo, Brazil Introduction: Chronic obstructive pulmonary disease (COPD) is recognized as a multisystemic inflammatory disease associated with extrapulmonary comorbidities, including respiratory muscle weakness and cardiovascular and cardiac autonomic regulation disorders. We investigated whether alterations in respiratory muscle strength (RMS) would affect cardiac autonomic modulation in COPD patients. Methods: This study was a cross-sectional study done in ten COPD patients affected by moderate to very severe disease. The heart rate variability (HRV) signal was recorded using a Polar cardiofrequencimeter at rest in the sitting position (10 minutes) and during a respiratory sinus arrhythmia maneuver (RSA-M; 4 minutes). Linear analysis in the time and frequency domains and nonlinear analysis were performed on the recorded signals. RMS was assessed using a digital manometer, which provided the maximum inspiratory pressure (Pimax) and the maximum expiratory pressure (Pemax). Results: During the RSA-M, patients presented an HRV power increase in the low-frequency band (LFnu) (46.9±23.7 vs 75.8±27.2; P=0.01) and a decrease in the high-frequency band (HFnu) (52.8±23.5 vs 24.0±27.0; P=0.01) when compared to the resting condition. Significant associations were found between RMS and HRV spectral indices: Pimax and LFnu (r=-0.74; P=0.01); Pimax and HFnu (r=0.74; P=0.01); Pemax and LFnu (r=-0.66; P=0.01); Pemax and HFnu (r=0.66; P=0.03); between Pemax and sample entropy (r=0.83; P<0.01) and between Pemax and approximate entropy (r=0.74; P=0.01). Using a linear regression model, we found that Pimax explained 44% of LFnu behavior during the RSA-M. Conclusion: COPD patients with impaired RMS presented altered cardiac autonomic control, characterized by marked sympathetic modulation and a reduced parasympathetic response; reduced HRV complexity was observed during the RSA-M. Keywords: COPD, heart rate, muscle strength, autonomic nervous system, sinus arrhythmia

Keywords

• COPD
• heart rate
• muscle strength
• autonomic nervous system
• sinus arrhythmia