Janssen Daalen Jules M, Straatsma Isabel R, van Hees Jeroen W H, Weevers Amber, van de Wetering-van Dongen Veerle A, Nijkrake Maarten J, Meinders Marjan J, Bosch Frank H, Kox Matthijs, Ainslie Philip N, Bloem Bastiaan R, Thijssen Dick H J
Radboud University Medical Center, Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands.
Department of Medical BioSciences, Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands.
Mov Disord Clin Pract. 2024 Dec;11(12):1550-1558. doi: 10.1002/mdc3.14249. Epub 2024 Nov 5.
Respiratory dysfunction is an important contributor to morbidity and mortality in advanced Parkinson's disease (PD), but it is unclear what parameters are sensitive to diagnose and monitor respiratory dysfunction across disease phases.
We aimed to characterize respiratory dysfunction in mild to moderate PD.
In 20 individuals without cardiopulmonary comorbidity, pulmonary and inspiratory muscle function testing were performed ON-medication. Subsequently, the acute ventilatory response to hypoxia (HVR) was assessed by gradually decreasing FO from 0.209 (room air) to 0.127, which was compared to eight age- and sex-matched healthy controls under arterial blood gas monitoring. Lastly, on different days, the same 20 individuals with PD underwent six blinded exposures to 45-min normobaric hypoxia at FiO2 0.163 and 0.127 or placebo OFF-medication to assess breathing responses.
At rest, individuals with greatest PD severity had a lower tidal volume (pairwise comparisons: 0.59 vs. 0.74, P = 0.038-0.050) and tended to have a higher breathing frequency (17.7 vs. 14.4, P = 0.076), despite normal pulmonary function. A 45-min exposure to hypoxia induced a significantly lower acute HVR in individuals with PD compared to controls (-0.0489 vs. 0.133 L.min/%, P = 0.0038). Acute HVR was reduced regardless of disease severity. Subacute HVR in individuals with milder disease tended to be higher compared to those with more advanced disease (P = 0.079).
Respiratory dysfunction is present in individuals with PD, including those with relatively mild disease severity, and is characterized by altered breathing patterns at rest, as well as a lower HVR, despite normal pulmonary and inspiratory muscle function testing.
呼吸功能障碍是晚期帕金森病（PD）发病和死亡的重要因素，但尚不清楚哪些参数对跨疾病阶段诊断和监测呼吸功能障碍敏感。
我们旨在描述轻度至中度PD患者的呼吸功能障碍特征。
对20名无心肺合并症的个体在服药状态下进行肺功能和吸气肌功能测试。随后，通过将吸氧分数（FO）从0.209（室内空气）逐渐降至0.127来评估急性低氧通气反应（HVR），并在动脉血气监测下与8名年龄和性别匹配的健康对照者进行比较。最后，在不同日期，这20名PD患者在未服药状态下接受6次盲法暴露，分别在吸氧分数为0.163和0.127的条件下进行45分钟的常压低氧暴露或安慰剂暴露，以评估呼吸反应。
在静息状态下，尽管肺功能正常，但PD严重程度最高的个体潮气量较低（两两比较：0.59 vs. 0.74，P = 0.038 - 0.050），且呼吸频率有升高趋势（17.7 vs. 14.4，P = 0.076）。与对照组相比，45分钟的低氧暴露使PD患者的急性HVR显著降低（-0.0489 vs. 0.133 L.min/%，P = 0.0038）。无论疾病严重程度如何，急性HVR均降低。疾病较轻的个体亚急性HVR往往高于疾病较严重的个体（P = 0.079）。
PD患者存在呼吸功能障碍，包括疾病严重程度相对较轻的患者，其特征为静息时呼吸模式改变以及HVR降低，尽管肺功能和吸气肌功能测试正常。
