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Effective non-invasive ventilation reduces muscle sympathetic nerve activity in patients with stable hypercapnic COPD

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Abstract

Increased sympathetic drive is of prognostic significance in chronic obstructive pulmonary disease (COPD) but its determinants remain poorly understood. One potential mechanism may be chemoreflex-mediated adrenergic stimulation caused by sustained hypercapnia. This study determined the impact of non-invasive ventilation (NIV) on muscle sympathetic nerve activity (MSNA) in patients with stable hypercapnic COPD. Ten patients (age 70 ± 7 years, GOLD stage 3–4) receiving long-term NIV (mean inspiratory positive airway pressure 21 ± 7 cmH2O) underwent invasive MSNA measurement via the peroneal nerve during spontaneous breathing and NIV. Compared with spontaneous breathing, NIV significantly reduced hypercapnia (PaCO2 51.5 ± 6.9 vs 42.6 ± 6.1 mmHg, p < 0.0001) along with the burst rate (64.4 ± 20.9 vs 59.2 ± 19.9 bursts/min, p = 0.03) and burst incidence (81.7 ± 29.3 vs 74.1 ± 26.9 bursts/100 heartbeats, p = 0.04) of MSNA. This shows for the first time that correcting hypercapnia with NIV decreases MSNA in COPD.

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Fig. 1

Data availability

The data that support the findings of this study are not publicly available due to privacy reasons but are available from the corresponding author upon reasonable request and with the permission of University Hospital RWTH Aachen.

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Acknowledgements

The authors thank all the patients whose cooperation made this study possible. They also thank Ms. Faniry Ratsimba for analysing patient-related data. English language editing assistance was provided by Nicola Ryan, independent medical writer, funded by University Hospital RWTH Aachen.

Funding

This study funded by internal sources and was partially supported by Löwenstein Medical. Löwenstein Medical did not have any influence on study design, planning, enrolment, data acquisition, analysis and manuscript writing.

Author information

Authors and Affiliations

  1. Department of Pneumology and Intensive Care Medicine, University Hospital RWTH Aachen, 52074, Aachen, Germany

    Binaya Regmi, Michael Dreher & Jens Spiesshoefer

  2. Department of Neurology, University of Iowa, Iowa City, IA, USA

    Chiara Borrelli

  3. Interdisciplinary Health Science Centre, Scuola Superiore Sant’Anna, Pisa, Italy

    Chiara Borrelli, Alberto Giannoni & Jens Spiesshoefer

  4. Department of Cardiology and Vascular Medicine, University Hospital RWTH Aachen, Aachen, Germany

    Florian Kahles

  5. Human Autonomic Neurophysiology Laboratory, Department of Neuroscience, Monash University, Victoria, Australia

    Vaughan G. Macefield

  6. Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, VIC, Australia

    Vaughan G. Macefield

Authors
  1. Binaya Regmi
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  2. Chiara Borrelli
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  3. Alberto Giannoni
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  4. Florian Kahles
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  5. Vaughan G. Macefield
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  6. Michael Dreher
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  7. Jens Spiesshoefer
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Contributions

Concept and design of the study: BR, MD, JS. Acquisition of data: BR, JS. Analysis of data: BR, JS. Drafting of manuscript: BR, JS. Revision of manuscript critically for important intellectual content: CB, AG, FK, VM, MD. Approval of final manuscript: BR, CB, AG, FK, VM, MD, JS.

Corresponding author

Correspondence to Jens Spiesshoefer.

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Conflict of interest

J.S. declares to have no conflict of interest concerning this manuscript and has been supported by the Else-Kröner-Fresenius Stiftung, by Deutsche Herzstiftung, by a PhD curriculum (Scuola Superiore Sant’Anna), by the medical faculty of RWTH Aachen University and has received travel grants and/or speaking fees outside the submitted work from Sanofi-Genzyme, Boehringer Ingelheim, Chiesi, Astra Zeneca, Hormosan Pharma, Resmed and Löwenstein Medical.

Ethical approval

The present study (subset from ClinicalTrials.gov identifier NCT04854863) was conducted ethically in accordance with the World Medical Association Declaration of Helsinki and was approved by the local ethics committee (Ethikkommission an der medizinischen Fakultät der Rheinisch-Westfälischen Technischen Hochschule Aachen, CTC-A-Nr. 20-423, EK 426/20) and written informed consent was obtained in every subject.

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Not applicable.

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Regmi, B., Borrelli, C., Giannoni, A. et al. Effective non-invasive ventilation reduces muscle sympathetic nerve activity in patients with stable hypercapnic COPD. Clin Auton Res (2024). https://doi.org/10.1007/s10286-024-01027-2

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  • DOI: https://doi.org/10.1007/s10286-024-01027-2

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