von Leupoldt Andreas, Taube Karin, Schubert-Heukeshoven Stephan, Magnussen Helgo, Dahme Bernhard
Department of Psychology, University of Hamburg, Von-Melle-Park 5, 20146 Hamburg, Germany.
Chest. 2007 Nov;132(5):1506-12. doi: 10.1378/chest.07-1245. Epub 2007 Sep 21.
Dyspnea is the primary symptom limiting exercise in patients with COPD. Recent research has demonstrated that psychological factors can substantially influence the perception of dyspnea, but little is known about the modulation of perceived intensity or unpleasantness of dyspnea by attentional distraction. Therefore, we examined the impact of distractive auditory stimuli on the perception of exercise-induced dyspnea and the affective state in patients with COPD during 6-min walking tests (6MWTs).
Twenty patients with mild-to-severe COPD (mean FEV1, 55.9% predicted) underwent two 6MWTs. Under one exercise condition, distractive auditory stimuli were presented with headphones, while the other condition was performed without auditory distraction. Lung function (FEV1), heart rate (HR), pulse oximetric saturation (SpO2), perceived intensity of dyspnea (ie, visual analog scale for perceived intensity of dyspnea [VAS-I]), and perceived unpleasantness of dyspnea (visual analog scale for perceived unpleasantness of dyspnea [VAS-U]) were measured before and after exercise. In addition, the global level of dyspnea (Borg score), positive affectivity (PA), and negative affectivity were assessed after both conditions.
A similar exercise level during both conditions was confirmed by comparable results in FEV1, HR, SpO2, and distances walked. During auditory distraction, Borg scores and increases in VAS-U were smaller, while PA was higher compared to the nondistraction condition (p<0.05). VAS-I did not show differences across conditions.
Distractive auditory stimuli decrease the global level of exercise-induced dyspnea in patients with COPD by reducing the perceived unpleasantness of dyspnea and lead to an additional increase in PA. Auditory distraction might therefore serve as an intervention for the reduction of dyspnea during exercise in this patient group.
呼吸困难是限制慢性阻塞性肺疾病（COPD）患者运动的主要症状。最近的研究表明，心理因素可显著影响对呼吸困难的感知，但关于注意力分散对呼吸困难感知强度或不适感的调节作用知之甚少。因此，我们在6分钟步行试验（6MWT）期间，研究了分散性听觉刺激对COPD患者运动诱发呼吸困难感知及情感状态的影响。
20例轻至重度COPD患者（平均第一秒用力呼气容积[FEV1]为预测值的55.9%）进行了两次6MWT。在一种运动条件下，通过头戴式耳机呈现分散性听觉刺激，而另一种条件下则无听觉干扰。在运动前后测量肺功能（FEV1）、心率（HR）、脉搏血氧饱和度（SpO2）、呼吸困难感知强度（即呼吸困难感知强度视觉模拟量表[VAS-I]）和呼吸困难感知不适感（呼吸困难感知不适感视觉模拟量表[VAS-U]）。此外，在两种条件后均评估呼吸困难总体水平（Borg评分）、积极情感（PA）和消极情感。
通过FEV1、HR、SpO2及步行距离的可比结果证实了两种条件下的运动水平相似。在听觉干扰期间，与无干扰条件相比，Borg评分和VAS-U的增加较小，而PA较高（p<0.05）。VAS-I在不同条件下未显示差异。
分散性听觉刺激通过降低呼吸困难的感知不适感，降低了COPD患者运动诱发呼吸困难的总体水平，并导致PA额外增加。因此，听觉干扰可能作为该患者群体运动期间减轻呼吸困难的一种干预措施。
