Journal Information
Vol. 16. Issue 6.
Pages 892-898 (November - December 2010)
Vol. 16. Issue 6.
Pages 892-898 (November - December 2010)
ARTIGO ORIGINAL
Open Access
Força muscular respiratória e qualidade de vida em pacientes com distrofia miotónica
Respiratory muscle strength and quality of life in myotonic dystrophy patients
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T. Lucena Araújoa, V. Regiane Resquetib, S. Brunoc, I. Guerra Azevedod, M.E. Dourado Júniore, G. Fregonezif
a Physiotherapy
b Physiotherapy, Fellow in PneumoCardioVascular Physical Therapy Laboratory, Department of Physical Therapy, Universidade Federal do Rio Grande do Norte, Natal, Brasil
c Physiotherapy, Master Degree Physical Therapy Program, PneumoCardioVascular Physical Therapy Laboratory, Department of Physical Therapy, Universidade Federal do Rio Grande do Norte, Natal, Brasil
d Physiotherapy
e Physician Neurology. Electroneuromyography Service and Neuromuscular Disease Ambulatory, Onofre Lopes University Hospital, Universidade Federal do Rio Grande do Norte, Natal, Brasil
f Physiotherapy, Master Degree Physical Therapy Program, PneumoCardioVascular Physical Therapy Laboratory, Department of Physical Therapy, Universidade Federal do Rio Grande do Norte, Natal, Brasil
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Resumo
Introdução

Na distrofia miotónica (DM) estudos sobre qualidade de vida relacionada à saúde (QVRS) ainda são escassos e a sua relação com a força muscular respiratória não foi determinada. Este estudo teve como objetivo a avaliação da força muscular respiratória e da QVRS, além de determinar as relações entre estas variáveis na DM.

Métodos

Foi avaliada a função pulmonar, as pressões respiratórias máximas inspiratórias e expiratórias (PImáx e PEmáx, respectivamente), pressão nasal inspiratória de sniff (SNIP), e a QVRS através do questionário genérico SF-36 em 23 pacientes (13 homens, idade 40 ± 16 anos) com DM.

Resultados

Os valores encontrados da força muscular respiratória foram de 71 ± 20 cmH2O (64% preditivo), 76 ± 32 cmH2O (70% preditivo), e 79 ± 28 cmH2O (80% preditivo) para PEmax, PImax e SNIP respectivamente. Encontramos diferenças significativas nos domínios de SF-36 de função física 58,7 ± 31,4 vs. 84,5 ± 23 (p < 0,01, 95% CI = 1,6-39,9) e problemas físicos 43,4 ± 35,2 vs. 81,2 ± 34 (p < 0,001, 95% CI = 19,4-6,1) comparado com os valores de referência. A análise de regressão linear demonstrou que a PImax explica 29% da variação da função física, 18% dos problemas físicos e 20% da vitalidade.

Conclusão

Indivíduos com DM têm uma redução da força muscular expiratória. A QVRS pode ser mais prejudicada em alguns domínios da atividade física, o que pode sofrer influência das variações da força muscular inspiratória.

PALAVRAS-CHAVE:
Pressões respiratórias máximas
Sniff teste
Doença neuromuscular
SF-36
Músculos respiratórios
Abstract
Introduction

Studies on quality of life in myotonic dystrophy (MD) are scarce and the relationship between respiratory muscle strength and health-related quality of life (HRQoL) has yet to be determined. The present study aims to investigate respiratory muscle strength and HRQoL and their relationship in MD patients.

Methods

Twenty-three patients (13 men, aged 40 ± 16 years) with MD were evaluated for pulmonary function, maximal inspiratory and expiratory pressure (MIP and MEP, respectively), sniff nasal inspiratory pressure (SNIP) and HRQoL using the Short Form (SF-36) quality of life questionnaire.

Results

Respiratory muscle strength values were 71 ± 20 cmH2O (64% predicted), 76 ± 32 cmH2O (70% predicted), and 79 ± 28 cmH2O (80% predicted) for MEP, MIP, and SNIP respectively. Signifi cant differences were found in the SF-36 domains of physical functioning 58.7 ± 31.4 vs. 84.5 ± 23 (p < 0.01, 95% CI = 1.6-39.9) and physical problems 43.4 ± 35.2 vs. 81.2 ± 34 (p < 0.001, 95% CI = 19.4-6.1) when compared with the reference values. According to single linear regression analysis, MIP explains 29% of the variance in physical functioning, 18% of physical problems and 20% of vitality.

Conclusions

Individuals with MD have reduced expiratory muscle strength. HRQoL may be more impaired in some physical domains, which might be influenced by variations in inspiratory muscle strength.

KEYWORDS:
Maximal respiratory pressures
Sniff test
Neuromuscular disease
SF-36
Respiratory muscles
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Bibliografia
[1.]
F. Bouhour, M. Bost, C. Vial.
Maladie de Steinert.
Presse Med., 36 (2007), pp. 965-971
[2.]
S.P. Kumar, D. Sword, R.K.H. Petty, S.W. Banham, K.R. Patel.
Assessment of sleep studies in myotonic dystrophy.
Chron Respir Dis., 4 (2007), pp. 15-18
[3.]
C.E.M. Die-Smulders, C.J. Höweler, C. Thijs, J.F. Mirandolle, H.B. Anten, H.J.M. Smeets, et al.
Age and causes of death in adult-onset myotonic dystrophy.
Brain., 121 (1998), pp. 1557-1563
[4.]
C. Perrin, J.N. Unterborn, C. D’Ambrosio, N.S. Hill.
Pulmonary complications of chronic neuromuscular diseases and their management.
Muscle Nerve., 29 (2004), pp. 5-27
[5.]
P. Bégin, J. Mathieu, J. Almirall, A. Grassino.
Relationship between chronic hypercapnia and inspiratory-muscle weakness in myotonic dystrophy.
Am J Respir Crit Care Med., 156 (1997), pp. 133-139
[6.]
R.K. Morgan, S. McNally, M. Alexander, R. Conroy, O. Hardiman, R.W. Costello.
Use of sniff nasal-inspiratory force to predict survival in amyotrophic lateral sclerosis.
Am J Respir Crit Care Med., 171 (2005), pp. 269-274
[7.]
M.J. Masdeu, A. Ferrer.
Series 4: respiratory muscles in neuromuscular diseases and the chest cavity. The function of respiratory muscles in neuromuscular diseases.
Arch Bronconeumol, 39 (2003), pp. 176-183
[8.]
J. Steier, S. Kaul, J. Seymour, C. Jolley, G. Rafferty, W. Man, et al.
The value of multiple tests of respiratory muscle force.
Thorax., 62 (2007), pp. 975-980
[9.]
S. Nava, N. Ambrosino, P. Crotti, C. Fracchia, C. Rampulla.
Recruitment of some respiratory muscles during three maximal inspiratory maneuvers.
Thorax., 48 (1993), pp. 702-707
[10.]
G. Antonini, F. Soscia, F. Giubilei, A. De Carolis, F. Gragnani, S. Morino, et al.
Health-related quality of life in myotonic dystrophy type 1 and its relationship with cognitive and emotional functioning.
J Rehabil Med., 38 (2006), pp. 181-185
[11.]
C. Ford, A. Kidd, G. Hammond-Tooke.
Myotonic dystrophy in Otago, New Zealand [resumo].
N Z Med J., 119 (2006), pp. U2145
[12.]
V. Ugalde, S. Walsh, R.T. Abresch, H.W. Bonekat, E. Breslin.
Respiratory abdominal muscle recruitment and chest wall motion in myotonic dystrophy.
J Appl Physiol., 91 (2001), pp. 395-407
[13.]
U.A. Zifko, A.F. Hahn, H. Remtulla, C.F.P. George, W. Wihlidal, C.F. Bolton, et al.
Central and peripheral respiratory electrophysiological studies in myotonic dystrophy.
Brain., 119 (1996), pp. 1911-1922
[14.]
J. Mathieu, H. Boivin, D. Meunier, M. Gaudreault, P. Bégin.
Assessment of a disease-specific muscular impairment rating scale in myotonic dystrophy.
Neurology., 56 (2001), pp. 336-340
[15.]
Sociedade Brasileira de Pneumologia e Tisiologia. Diretrizes para Testes de Função Pulmonar.
J Pneumol., 28 (2002), pp. S1-S238
[16.]
J.A. Neder, S. Andreoni, A. Castelo-Filho, L.E. Nery.
References values for lung fuction tests. Static volumes.
Braz J Med Biol Res, 32 (1999), pp. 703-717
[17.]
L.F. Black, R.E. Hyatt.
Maximal respiratory pressures: normal values and relationship to age and sex.
Am Rev Respir Dis., 99 (1969), pp. 696-702
[18.]
J.A. Neder, S. Andreoni, M.C. Lerario, L.E. Nery.
References values for lung fucntion tests. Maximal respiratory pressures and voluntary ventilation.
Braz J Med Biol Res, 32 (1999), pp. 719-727
[19.]
F. Lofaso, F. Nicot, M. Lejailie, L. Falaize, A. Louis, et al.
Sniff nasal inspiratory pressure: what is the optimal number of sniffs?.
Eur Respir J., 27 (2006), pp. 980-982
[20.]
C. Uldry, J.W. Fitting.
Maximal values of sniff nasal inspiratory pressure in healthy subjects.
Thorax., 50 (1995), pp. 371-375
[21.]
R.M. Ciconelli.
Tradução para o português e validação do questionário genérico de avaliação de qualidade de vida “Medical Outcomes Study 36-Item Short-Form ealth Survey (SF-36)” [tese].
Universidade Federal de São Paulo, (1997),
[22.]
T. Troosters, R. Gosselink, M. Decramer.
Respiratory muscle assessment.
Eur Respir Mon., 31 (2005), pp. 57-71
[23.]
W.K. Zung.
A self-rating depression scale.
Arch Gen Psychiatry., 12 (1965), pp. 63-70
[24.]
C.C. Pere.
Evaluación de la disnea y de la calidad de vida relacionada con la salud.
Arch Bronconeumol., 43 (2007), pp. 2-7
[25.]
M.A. Grootenhuis, J. Boone, A.J. van der Kooi.
Living with muscular dystrophy: health related quality of life consequences for children and adults.
Health Qual Life Outcomes., 5 (2007), pp. 31
[26.]
G.A. Fregonezi, V. Regiane-Resqueti, J. Pradas, L. Vigil, P. Casan.
The relationship between lung function and health-related quality of life in patients with generalized myasthenia gravis.
Arch Bronconeumol., 42 (2006), pp. 218-224
[27.]
G. Ahlström, L.G. Gunnarsson.
Disability and quality of life in individuals with muscular dystrophy.
Scand J Rehabil Med., 28 (1996), pp. 147-157
[28.]
G. Ahlström, L.G. Gunnarsson, A. Kihlgren, A. Arvill, P.O. Sjoden.
Respiratory function, electrocardiography and quality of life in individuals with muscular dystrophy.
Chest., 106 (1994), pp. 173-179
[29.]
D. Veale, B.G. Cooper, J.J. Gilmartin, T.J. Walls, C.J. Griffith, G.J. Gibson.
Breathing pattern awake and asleep in patients with myotonic dystrophy.
Eur Respir J., 8 (1995), pp. 815-818
[30.]
A.J. Finnimore, R.V. Jackson, A. Morton, E. Lynch.
Sleep hypoxia in myotonic dystrophy and its correlation with awake respiratory function.
Thorax., 49 (1994), pp. 66-70
[31.]
N. Terzi, D. Orlikowsk, C. Fermanian, M. Lejaille, L. Falaize, A. Louis, et al.
Measuring inspiratory muscle force in neuromuscular disease: one test or two?.
Eur Respir J., 31 (2008), pp. 93-98
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