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Cardiopulmonary Response to Exercise at High Altitude in Adolescents with Congenital Heart Disease

Congenital Heart Disease 2021年第6期16卷 597-608页

作者： Lukas Minder Markus Schwerzmann Thomas Radtke Hugo Saner Prisca Eser Matthias Wilhelm Jean-Paul Schmid Department of Cardiology Bern University Hospital and University of BernBernSwitzerland Center for Congenital Heart Disease Department of CardiologyBern University Hospital and University of BernBernSwitzerland Epidemiology Biostatistics and Prevention InstituteUniversity of ZurichZurichSwitzerland Department of Cardiology Clinic BarmelweidBarmelweidSwitzerland

Objective:To extend our knowledge on tolerance of acute high-altitude exposure and hemodynamic response to exercise in adolescents with congenital heart disease(AscCHD)without meaningful clinical or functional ***:A symptom limited cardiopulmonary exercise stress test and a non-invasive cardiac output measurement during steady state exercise were performed at 540 m and at 3454 m *** of acute mountain sickness were ***:We recruited 21 healthy controls and 16 AscCHD(59%male,mean age 14.7±1.1 years).Three subjects(2 controls,1 AscCHD)presented light symptoms of acute mountain sickness(dizziness and headache).During the symptom limited exercise test at lowland,control subjects showed a significantly higher power to weight index(3.5±0.6 W/kg vs.3.0±0.7 W/kg,p<0.001),heart rate(188.8±10.41/min vs.179.4±13.11/min,p<0.050)and ventilation(92.8±22.9 l/min vs.75.4±18.6 l/min,<0.050).At altitude,power to weight index only remained significantly higher in the control group(2.8±0.6 W/kg vs.2.6±0.6 W/kg,p<0.001).Pulmonary blood flow(PBF)at lowland showed no difference between the control and the AscCHD group,neither at rest(5.4±0.8 l/min vs.5.1±0.9 l/min,p=0.308),nor during the steady state test(10.6±2.4 l/min vs.10.5±2.0 l/min,p=0.825).At high altitude,PBF increased by 110%and 112%,respectively(12.8±2.32 l/min vs.12.5±3.0 l/min;intergroup difference:p=0.986).Conclusions:High altitude exposure was well tolerated in an unselected group of *** significant difference in the cardio-pulmonary adaptation to a control group was noted during a steady state *** of minor acute mountain sickness did occur,which should however not be misinterpreted as signs of hemodynamic maladaptation.

关键词： Adolescents with congenital heart disease high altitude non-invasive cardiac output measurement exercise

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The impact of central and obstructive respiratory events on cerebral oxygenation in adults with sleep disordered breathing

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Journal of Innovative Optical Health Sciences 2023年第6期16卷 43-52页

作者： Ramin Khatami Dominik Gnaiger Gordana Hügli Ming Qi Zhongxing Zhang Center for Sleep Medicine Sleep Research and Epileptology Clinic Barmelweid AGBarmelweidSwitzerland barmelweid academy Clinic Barmelweid AGBarmelweidSwitzerland Department of Neurology Inselspital Bern University Hospital and University of BernBernSwitzerland

Obstructive sleep apnea(OSA)and central sleep apnea(CSA)are two main types of sleep disordered breathing(SDB).While the changes in cerebral hemodynamics triggered by OSA events have been well studied using near-infrared spectroscopy(NIRS),they are essentially unknown in CSA in ***,in this study,we compared the changes in cerebral oxygenation between OSA and CSA events in adult patients using *** tissue oxygen saturation(StO_(2))in 13 severe SDB patients who had both CSA and OSA events was measured using frequency-domain *** changes in cerebral StO_(2)desaturation and blood volume(BV)in the¯rst hour of natural sleep were compared between different types of respiratory events(i.e.,277 sleep hypopneas,161 OSAs and 113 CSAs)with linear mixed-effect models controlling for *** respiratory events occurred during non-rapid eye movement(NREM)*** found that apnea events induced greater cerebral desaturations and BV°uctuations compared to hypopneas,but there was no difference between OSA and *** results suggest that cerebral autoregulation in our patients are still capable to counteract the pathomechanisms of apneas,in particularly the negative intrathoracic pressure(ITP)caused by OSA *** larger BV°uctuations in OSA compared to CSA should be observed due to the negative ITP that reduces cardiac stroke volume and leads to lower systematic blood *** study suggests that OSA and CSA may have similar impact on cerebral oxygenation during NREM sleep in adult patients with SDB.

关键词： Near-infrared spectroscopy cerebral autoregulation sleep apnea

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Near-infrared spectroscopy(NIRS)as a useful tool to evaluate the treatment efficacy of positive airways pressure therapy in patients with obstructive sleep apnea syndrome(OSAS):A pilot study

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Journal of Innovative Optical Health Sciences 2014年第2期7卷 143-152页

作者： Zhongxing Zhang Maja Schneider Ursula Fritschi Lsabela Lehner Ramin Khatami Sleep Center Clinic BarmelweidSwitzerland Department of Neurology Uniuersity Hospital Zurich University of ZurichSuitzerland

In obstructive sleep apnea syndrome(OSA)the periodic reduction or cessation of breathing dueto narrowing or occlusion of the upper airway during slep leads to an impaired cerebral vascularautoregulation that is associated with an increased cardiovascular risk,including ***-tinuous positive airways pressure(CPAP)therapy at night is the most effective treatment forOSA and has been shown to reduce the cardiovascular risk in OSA ***,there is nosuitable bedside monitoring method evaluating the recovery of cerebral hemodynamics duringCPAP ***-infrared spectroscopy(NiRS)is idelly suited for non-invasive monitoringthe cerebral hemodynamics during sleep due to its properties of local measurement,totally sa feapplication and good tolerance to *** this pilot study,we monitored cerebral hemody-namics during standard CPAP therapy at night in thre patients with severe OSA using *** found periodic oscllations in HbO2,HHb,tisue oxygenation index(TO1)and blood volume(BV)associa ted with periodic apnea events without CPAP in all OSA *** osillationswere eliminated under the optimal CPAP pressures in all *** results sugg ested thatthe recovery of cerebral hemodynamics impaired by apnea events can be evaluated by bedsideNIRS measurements in real time during ll night CPAP *** is a usefi bedsidemonitoring tool to evaluate the treatment elicacy of CPAP therapy in patients with OSA.

关键词： Sleep cerebral hemodynamics hemodynamic oscillations bedside monitoring.

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Infectious, atopic and inflammatory diseases, childhood adversities and familial aggregation are independently associated with the risk for mental disorders: Results from a large Swiss epidemiological study

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World Journal of Psychiatry 2016年第4期6卷 419-430页

作者： Vladeta Ajdacic-Gross Aleksandra Aleksandrowicz Stephanie Rodgers Margot Mutsch Anja Tesic Mario Müller Wolfram Kawohl Wulf R?ssler Erich Seifritz Enrique Castelao Marie-Pierre F Strippoli Caroline Vandeleur Roland von K?nel Rosa Paolicelli Markus A Landolt Cornelia Witthauer Roselind Lieb Martin Preisig Department of Psychiatry Psychotherapy and Psychosomatics Psychiatric Hospital University of Zurich Epidemiology Biostatistics and Prevention Institute University of Zurich Department of Psychiatry University Hospital of Lausanne Department of Neurology Bern University Hospital Clinic barmelweid Division of Psychiatry Research University of Zurich University Children’s Hospital Zurich and Children’s Research Center and Division of Child and Adolescent Health Psychology Department of Psychology University of Zurich Department of Psychology Division of Clinical Psychology and Epidemiology University of Basel

AIM To examine the associations between mental disorders and infectious, atopic, inflammatory diseases while adjusting for other risk *** We used data from PsyC oL aus, a large Swiss Population Cohort Study(n = 3720; age range 35-66). Lifetime diagnoses of mental disorders were grouped into the following categories: Neurodevelopmental, anxiety(early and late onset), mood and substance disorders. They were regressed on infectious, atopic and other inflammatory diseases adjusting for sex, educational level, familial aggregation, childhood adversities and traumatic experiences in childhood. A multivariate logistic regression was applied to each group of disorders. In a complementary analysis interactions with sex were introduced via nested effects. RESULTS Associations with infectious, atopic and other chronic inflammatory diseases were observable together with consistent effects of childhood adversities and familial aggregation, and less consistent effects of trauma in each group of mental disorders. Streptococcal infections were associated with neurodevelopmental disorders(men), and measles/mumps/rubella-infections with early and late anxiety disorders(women). Gastric inflammatory diseases took effect in mood disorders(both sexes) and in early disorders(men). Similarly, irritable bowel syndrome was prominent in a sex-specific way in mood disorders in women, and, moreover, was associated with early and late anxiety disorders. Atopic diseases were associated with late anxiety disorders. Acne(associations with mood disorders in men) and psoriasis(associations with early anxiety disorders in men and mood disorders in women) contributed sex-specific results. Urinary tract infections were associated with mood disorders and, in addition, in a sex-specific way with late anxiety disorders(men), and neurodevelopmental and early anxiety disorders(women).CONCLUSION Infectious, atopic and inflammatory diseases areimportant risk factors for all groups of mental disorde

关键词： Neurodevelopmental disorders Mental disorders Substance abuse Childhood diseases Infectious diseases Atopic diseases Chronic inflammatory diseases Risk factors

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