Introduction:Prior data suggest that higher nocturnal heart rate may represent a marker of cardiometabolic disease risk in nonpregnant adults. Data on nocturnal heart rate and pregnancy outcomes are limited. We sought to assess the association of maternal nocturnal heart rate with adverse pregnancy outcomes. Methods:This is a secondary analysis of nulliparas in a prospective cohort at eight US sites undergoing a home sleep study using the Embletta-Gold device with bipolar electrocardiogram at baseline (60-156 weeks) and follow-up (220-316 weeks) visits. Exposures were mean, minimum, and maximum nocturnal heart rate at baseline and follow-up (analyzed separately). Outcomes of interest were gestational diabetes, hypertensive disorders of pregnancy, preterm birth, small-for-gestational age, and stillbirth. Multivariable logistic regression models estimated the odds of each outcome, except for stillbirth due to low frequency, per each 5-beat higher nocturnal heart rate, adjusted for possible confounders. Results:Among 2952 eligible nulliparas, 30% experienced an adverse pregnancy outcome. We identified higher adjusted odds of gestational diabetes (minimum nocturnal heart rate mean ± standard deviation, gestational diabetes vs. no gestational diabetes: 49 ± 10 vs. 46 ± 11; adjusted odds ratio [aOR] 1.15, 95% confidence interval [CI] 1.03-1.29) and hypertensive disorders of pregnancy (48 ± 11 vs. 46 ± 11; aOR 1.05, 95% CI 1.01-1.10) for each 5-beat higher minimum nocturnal heart rate at baseline; adjusted odds of gestational diabetes were also higher at baseline and follow-up for mean and maximum nocturnal heart rate. At follow-up, we identified lower adjusted odds of small-for-gestational age for each 5-beat higher mean (76 ± 10 vs. 78 ± 9; aOR 0.83, 95% CI 0.78-0.88) and minimum nocturnal heart rate (48 ± 12 vs. 51 ± 13; aOR 0.90, 95% CI 0.86-0.94). Conclusion:Higher mean, minimum, and/or maximum nocturnal heart rate in pregnancy were associated with higher odds of hypertensive disorders of pregnancy and gestational diabetes. This may reflect higher sympathetic and/or decreased parasympathetic activity in affected gravidas. Conversely, lower mean and minimum nocturnal heart rate in late pregnancy were associated with higher odds of small-for-gestational age, which may be reflective of maladaptive hemodynamic changes in affected gravidas.

Objective Our objective was to determine whether objectively measured sleep-disordered breathing (SDB) during pregnancy is associated with an increased risk of adverse neonatal outcomes in a cohort of nulliparous individuals. Study Design Secondary analysis of the nuMom2b sleep disordered breathing substudy was performed. Individuals underwent in-home sleep studies for SDB assessment in early (6–15 weeks' gestation) and mid-pregnancy (22–31 weeks' gestation). SDB was defined as an apnea-hypopnea index ≥5 events/h at either time point. The primary outcome was a composite outcome of respiratory distress syndrome, transient tachypnea of the newborn, or receipt of respiratory support, treated hyperbilirubinemia or hypoglycemia, large-for-gestational age, seizures treated with medications or confirmed by electroencephalography, confirmed sepsis, or neonatal death. Individuals were categorized into (1) early pregnancy SDB (6–15 weeks' gestation), (2) new onset mid-pregnancy SDB (22–31 weeks' gestation), and (3) no SDB. Log-binomial regression was used to calculate adjusted risk ratios (RR) and 95% confidence intervals (CIs) representing the association. Results Among 2,106 participants, 3% (n = 75) had early pregnancy SDB and 5.7% (n = 119) developed new-onset mid-pregnancy SDB. The incidence of the primary outcome was higher in the offspring of individuals with early (29.3%) and new onset mid-pregnancy SDB (30.3%) compared with individuals with no SDB (17.8%). After adjustment for maternal age, chronic hypertension, pregestational diabetes, and body mass index, new onset mid-pregnancy SDB conferred increased risk (RR = 1.43, 95% CI: 1.05, 1.94), where there was no longer statistically significant association between early pregnancy SDB and the primary outcome. Conclusion New onset, mid-pregnancy SDB is independently associated with neonatal morbidity. Key Points

Prior data suggest nocturnal heart rate (NHR) may represent a marker of cardiometabolic disease risk in non-pregnant adults, but data on NHR and pregnancy outcomes are limited. We sought to assess the association of NHR with gestational diabetes (GDM) and hypertensive disorders of pregnancy (HDP). This is a secondary analysis of nulliparas enrolled in a prospective observational cohort at 8 clinical sites who completed a home sleep study using the Embletta-Gold device with bipolar electrocardiogram at baseline (60-136 weeks) and follow-up visits (220-296 weeks). We excluded those with chronic hypertension or pregestational diabetes. The primary exposure was the mean NHR at baseline and follow-up (analyzed separately). Secondary exposures were the minimum and maximum NHR at each visit. The outcomes were GDM and HDP. Independent samples t-tests compared each exposure among gravidas with and without the outcomes of interest. Multivariable logistic regression models estimated the odds of each outcome per 5-beat increase in NHR at baseline and follow-up. Among 2,952 eligible nulliparas, 4.1% (118/2911) developed GDM and 13.6% (392/2890) developed HDP. The mean (standard deviation) for the mean, minimum, and maximum NHR was 71 (8), 46 (11), and 102 (14) at baseline, and 78 (9), 51 (13), and 108 (15) at follow-up. Gravidas who developed GDM had higher mean, minimum, and maximum NHR at baseline and follow-up than unaffected gravidas (p ≤ 0.01, Table), with each exposure associated with higher adjusted odds of GDM. Gravidas who developed HDP also had higher mean NHR (baseline and follow-up), higher minimum NHR (baseline), and higher maximum NHR (follow-up) (p < 0.01) than those without HDP. For each 5-beat increase in mean NHR at the baseline visit, the adjusted odds of GDM and HDP were higher by 39% and 10%, respectively, with similar increased odds at follow-up. Higher mean, minimum, and maximum NHR in pregnancy appear to be associated with higher odds of GDM and HDP. This may reflect increased sympathetic and/or decreased parasympathetic activity in affected gravidas.

Purpose: To evaluate the association between risk of obstructive sleep apnea (OSA) and severity of thyroid eye disease (TED) using a validated OSA screening tool. Methods: A prospective, observational cohort study was performed. New adult TED patients were offered OSA screening with the Snoring Tired Observed Pressure (STOP)-Bang survey during their initial evaluation. Clinical examination and treatment for TED were standard of care and utilized the International Thyroid Eye Disease Society Vision Inflammation Strabismus Appearance system. At the conclusion of the study period, analysis was performed correlating maximum severity of TED signs and symptoms between high- and low-risk OSA groups. Multivariate logistic and linear regression analyses were also performed to analyze the association between the numerical STOP-Bang score and maximum severity of the potentially actionable clinical features of TED (compressive optic neuropathy, vertical prism deviation, horizontal prism deviation, exophthalmos, vertical fissure height). Results: Eighty-five patients met inclusion criteria. Twenty-eight percent were at high risk of OSA (STOP-Bang score of 3 or higher). When comparing the low- and high-risk cohorts, increased risk of OSA was significantly associated with the development of TED compressive optic neuropathy (p = 0.014), conjunctival injection (p = 0.027), chemosis (p = 0.013), upper eyelid edema (p = 0.024), lower eyelid edema (p = 0.003), eyelid erythema (p = 0.037), and vertical strabismus (p = 0.047). In the multivariate regression analyses, higher STOP-Bang scores correlated with increased risk of TED compressive optic neuropathy (p = 0.006), vertical strabismus (p = 0.019), and higher subjective diplopia scores (p = 0.045). Conclusions: Increased risk of OSA, as determined by the STOP-Bang survey, is associated with increased severity of multiple clinical features of TED, including TED compressive optic neuropathy and strabismus.

Abstract Introduction While psychological stress is adversely linked to sleep, the bidirectional and temporal relationships between sleep and psychological stress in the context of daily life are largely understudied, particularly among Latinxs. We examined the bidirectional relationships between daily sleep duration, sleep quality, perceived stress, and negative mood in Latinx adults. Methods Between 2016-2019, healthy Latinxs (N=42), defined as those without any major physical or psychiatric morbidities, and free from polysomnography-assessed sleep disorders, were recruited from a community sample in New York. Participants naïve to study hypotheses completed 40 consecutive days of actigraphy and ecological momentary assessment of psychological stress and negative mood (depressed, anxious mood) using a 0 (not at all) to 10 (extremely) scale, contributing 1713 observations. Daily sleep duration was measured via wrist-actigraphy, and perceived daily sleep quality (1[very bad] to 4[very good]) was assessed via morning self-report. Sources of daily stress, including sociocultural stress, were collected once each evening. Multi-level modeling was used to examine within-person effects and temporal associations with adjustment for day of the week. Results Mean age=37.2 (SD=11.8), 69.1% women, 36.6% unemployed, 64.3% immigrant, and 38.1% Spanish-speaking. Non-specific stress (43%), work (28%), and family/relationship (21%) stress were the most common sources of daily stress. Discrimination and immigration stress were rarely reported as daily sources of stress (1.2%). Mean nightly sleep duration was 403.9 minutes (±81.3). Preliminary lagged linear mixed models indicated that a 60-minute increase in sleep duration during the night predicted a -.12 change in stress ratings (SE=.001,p Conclusion Overall, these results imply distinct associations of sleep with both anxiety and depressed mood. Longer sleep duration and improved perceived sleep quality were associated with subsequent decreased stress and anxiety. Increased depressed mood predicted worse sleep quality that night. Future research should identify the mechanisms of action for these differential associations. Support (if any):

BACKGROUND:Sleep-disordered breathing (SDB) in pregnancy is associated with adverse maternal outcomes. The relationship between SDB and infant birthweight is unclear. This study's primary aim is to determine if objectively measured SDB in pregnancy is associated with infant birthweight. METHODS:We measured SDB objectively in early (6-15 weeks' gestation) and mid (22-31 weeks' gestation) pregnancy in a large cohort of nulliparous women. SDB was defined as an Apnea-Hypopnea Index ≥5 and in secondary analyses we also examined measures of nocturnal hypoxemia. We used a modified Poisson regression approach to estimate relative risks (RR) of large-for-gestational-age (LGA: >90th percentile for gestational age) and small-for-gestational-age (SGA: <10th percentile for gestational age) birthweights. RESULTS:The prevalence of early-pregnancy SDB was nearly 4%. The incidence of mid-pregnancy SDB was nearly 6.0%. The prevalence of LGA and SGA was 7.4% and 11.9%, respectively. Early-pregnancy SDB was associated with a higher risk of LGA in unadjusted models (RR 2.2, 95% CI 1.3-3.5) but not BMI-adjusted models (aRR 1.0, 95% CI 0.6-1.8). Mid-pregnancy SDB was not associated with SGA or LGA. Mid-pregnancy nocturnal hypoxemia (% of sleep time <90% oxygen saturation) and increasing nocturnal hypoxemia from early to mid-pregnancy were associated with a higher risk of LGA in BMI-adjusted models. SDB and nocturnal hypoxemia were not associated with SGA. CONCLUSIONS:SDB in pregnancy was not associated with an increased risk of LGA or SGA birthweight, independent of BMI. Some measures nocturnal hypoxemia were associated with an increase in LGA risk, independent of BMI. ClinicalTrials.gov Registration number NCT02231398.

Study ObjectivesSleep quality is poor among patients with chronic obstructive pulmonary disease (COPD), and studies show that sleep disturbance is associated with low overall quality of life in this population. We evaluated the impact of patient-reported sleep quality and sleep apnea risk on disease-specific and overall quality of life within patients with COPD enrolled in the SPIROMICS study, after accounting for demographics and COPD disease severity.MethodsBaseline data from 1341 participants [892 mild/moderate COPD (FEV1 ≥ 50% predicted); 449 severe COPD (FEV1 < 50%)] were used to perform three nested (blocks) regression models to predict quality of life (Short Form-12 mental and physical components and St. George's Respiratory Questionnaire). Dependent measures used for the nested regressions included the following: Block1: demographics and smoking history; Block 2: disease severity (forced expiratory volume 1 s; 6 min walk test); Block 3: risk for obstructive sleep apnea (OSA; Berlin questionnaire); and Block 4: sleep quality (Pittsburgh Sleep Quality Index [PSQI]).ResultsOver half of participants with COPD reported poor sleep quality (Mean PSQI 6.4 ± 3.9; 50% with high risk score on the Berlin questionnaire). In all three nested regression models, sleep quality (Block 4) was a significant predictor of poor quality of life, over and above variables included in blocks 1-3.ConclusionsPoor sleep quality represents a potentially modifiable risk factor for poor quality of life in patients with COPD, over and above demographics and smoking history, disease severity, and risk for OSA. Improving sleep quality may be an important target for clinical interventions.Clinical TrialSPIROMICS.Clinical Trial URLhttp://www2.cscc.unc.edu/spiromics/.Clinical Trial RegistrationClinicalTrials.gov NCT01969344.

Sleep-disordered breathing (SDB) refers to a group of disorders characterized by abnormal respiratory patterns or abnormal gas exchange during sleep. The most common type of SDB, especially among young obese women, is obstructive sleep apnea. SDB has clearly been linked to poor sleep and impaired daytime function, but there are also data linking SDB to other health outcomes, principally cardiovascular and metabolic disease. SDB symptoms are common in pregnancy, and pregnancy itself has been associated with an increase in the prevalence of SDB symptoms. Although a link between SDB and adverse pregnancy outcomes appears to be biologically plausible, data exploring this relationship are only now emerging, and large prospective studies in which the authors use objective measures of sleep are lacking. Until we know more about the epidemiology and the impact of SDB in pregnancy, screening efforts for SDB in pregnancy should be focused on identifying very symptomatic patients because treatment of these individuals often leads to improved sleep quality and daytime functioning.

Patients with Chronic Obstructive Pulmonary Disease (COPD) maintain the benefits of pulmonary rehabilitation (PR) longer than those with Interstitial Lung Disease (ILD). Whether this is due to physiologic differences or differences in home exercise adherence is unknown. Aims: To assess whether adherence to regular exercise after PR influences exercise performance in patients with COPD and with ILD. Methods: Data were analyzed in all patients referred for cardiopulmonary exercise testing (CPET) from 9/2016 to 1/2017. Patients with COPD or ILD who completed PR were categorized as exercise adherent (E) or non-adherent (NE) at referral. CPET performed by cycle ergometry and spirometry were measured. Multivariate regression assessed the interaction of diagnosis and exercise adherence, controlling for age and BMI, on CPET outcomes. Results: 40 patients were included (20 ILD, 20 COPD, 45% M). Exercise adherence was 55% in both groups. E had higher peak VO2 and workload than NE in both disorders. Peak ETCO2 was significantly higher in patients with NE COPD but lower in NE ILD; peak Ve/VO2 slope was significantly higher in NE ILD but lower in NE COPD. Conclusion: Alveolar hypoventilation with CPET is associated with exercise non-adherence in COPD; alveolar hyperventilation and ventilatory inefficiency with CPET are associated with exercise non-adherence in ILD. Adherence rates were the same in both disorders.

Study Objectives To characterize sleep duration, timing and continuity measures in pregnancy and their association with key demographic variables. Methods Multisite prospective cohort study. Women enrolled in the nuMoM2b study (nulliparous women with a singleton gestation) were recruited at the second study visit (16-21 weeks of gestation) to participate in the Sleep Duration and Continuity substudy. Women <18 years of age or with pregestational diabetes or chronic hypertension were excluded from participation. Women wore a wrist activity monitor and completed a sleep log for 7 consecutive days. Time in bed, sleep duration, fragmentation index, sleep efficiency, wake after sleep onset, and sleep midpoint were averaged across valid primary sleep periods for each participant. Results Valid data were available from 782 women with mean age of 27.3 (5.5) years. Median sleep duration was 7.4 hours. Approximately 27.9% of women had a sleep duration of <7 hours; 2.6% had a sleep duration of >9 hours. In multivariable models including age, race/ethnicity, body mass index, insurance status, and recent smoking history, sleep duration was significantly associated with race/ethnicity and insurance status, while time in bed was only associated with insurance status. Sleep continuity measures and sleep midpoint were significantly associated with all covariates in the model, with the exception of age for fragmentation index and smoking for wake after sleep onset. Conclusions Our results demonstrate the relationship between sleep and important demographic characteristics during pregnancy.

BACKGROUND: Experimental and epidemiologic data suggest that among nonpregnant adults, sleep duration may be an important risk factor for chronic disease. Although pregnant women commonly report poor sleep, few studies objectively evaluated the quality of sleep in pregnancy or explored the relationship between sleep disturbances and maternal and perinatal outcomes.OBJECTIVE: Our objective was to examine the relationship between objectively assessed sleep duration, timing, and continuity (measured via wrist actigraphy) and maternal cardiovascular and metabolic morbidity specific to pregnancy.STUDY DESIGN: This was a prospective cohort study of nulliparous women. Women were recruited between 16 0/7 and 21 6/7 weeks' gestation. They were asked to wear a wrist actigraphy monitor and complete a daily sleep log for a period of 7 consecutive days. The primary sleep exposure variables were the averages of the following over the total valid nights (minimum 5, maximum 7 nights): short sleep duration during the primary sleep period (< 7 h/night), late sleep midpoint (midpoint between sleep onset and sleep offset >5 AM), and top quartile of minutes of wake time after sleep onset and sleep fragmentation index. The primary outcomes of interest were a composite of hypertensive disorders of pregnancy (mild, severe, or superimposed preeclampsia; eclampsia; or antepartum gestational hypertension) and gestational diabetes mellitus. We used x(2) tests to assess associations between sleep variables and categorical baseline characteristics. Crude odds ratios and 95% confidence intervals were estimated from univariate logistic regression models to characterize the magnitude of the relationship between sleep characteristics and hypertensive disorders of pregnancy and gestational diabetes. For associations significant in univariate analysis, multiple logistic regression was used to explore further the association of sleep characteristics with pregnancy outcomes.RESULTS: In all, 901 eligible women consented to participate; 782 submitted valid actigraphy studies. Short sleep duration and a later sleep midpoint were associated with an increased risk of gestational diabetes (odds ratio, 2.24; 95% confidence interval, 1.11-4.53; and odds ratio, 2.58; 95% confidence interval, 1.24-5.36, respectively) but not of hypertensive disorders. A model with both sleep duration and sleep midpoint as well as their interaction term revealed that while there was no significant interaction between these exposures, the main effects of both short sleep duration and later sleep midpoint with gestational diabetes remained significant (adjusted odds ratio, 2.06; 95% confidence interval, 1.01-4.19; and adjusted odds ratio, 2.37; 95% confidence interval, 1.13-4.97, respectively). Additionally, after adjusting separately for age, body mass index, and race/ethnicity, both short sleep duration and later sleep midpoint remained associated with gestational diabetes. No associations were demonstrated between the sleep quality measures (wake after sleep onset, sleep fragmentation) and hypertensive disorders or gestational diabetes.CONCLUSION: Our results demonstrate a relationship between short sleep duration and later sleep midpoint with gestational diabetes. Our data suggest independent contributions of these 2 sleep characteristics to the risk for gestational diabetes in nulliparous women.

STUDY OBJECTIVES:To determine whether total sleep time (TST) and specific sleep stage duration are associated with bodily pain perception and whether sex, age, or subjective sleepiness modifies this relationship.METHODS:Data from adults ages 39-90 y (n = 5,199) who took part in the Sleep Heart Health Study Exam 1 were analyzed. TST, rapid eye movement (REM) sleep time, and slow wave sleep (SWS) time were measured by unattended, in-home nocturnal polysomnography. Bodily pain perception was measured via the Short Form-36 questionnaire bodily pain component. We used logistic regression to examine associations between total and individual sleep stage durations and bodily pain perception controlling for age, sex, race, body mass index, apnea-hypopnea index, antidepressant use, and important cardiovascular conditions (smoking [pack-years], history of diabetes, and history of percutaneous coronary intervention and/or coronary artery bypass graft).RESULTS:In the fully adjusted model, REM sleep time and SWS time were not associated with "moderate to severe pain," whereas TST was: Each 1-h decrement in TST was associated with a 7% increased odds of "moderate to severe pain" (odds ratio 1.07, 95% confidence interval 1.002, 1.14). Due to modification of the association between SWS time and "moderate to severe pain" by sex (P for interaction = 0.01), we performed analyses stratified by sex: Each 1-h decrement in SWS time was associated with a 20% higher odds of "moderate to severe pain" among men (odds ratio 1.20, 95% confidence interval 1.03-1.42) whereas an association was not observed among women.CONCLUSIONS:Shorter TST among all subjects and shorter SWS time in men was associated with "moderate to severe pain." REM sleep time was not associated with bodily pain perception in this cohort.

Evidence suggests that lung injury, inflammation and extracellular matrix remodelling precede lung fibrosis in interstitial lung disease (ILD). We examined whether a quantitative measure of increased lung attenuation on computed tomography (CT) detects lung injury, inflammation and extracellular matrix remodelling in community-dwelling adults sampled without regard to respiratory symptoms or smoking.We measured high attenuation areas (HAA; percentage of lung voxels between −600 and −250 Hounsfield Units) on cardiac CT scans of adults enrolled in the Multi-Ethnic Study of Atherosclerosis.HAA was associated with higher serum matrix metalloproteinase-7 (mean adjusted difference 6.3% per HAA doubling, 95% CI 1.3–11.5), higher interleukin-6 (mean adjusted difference 8.8%, 95% CI 4.8–13.0), lower forced vital capacity (FVC) (mean adjusted difference −82 mL, 95% CI −119–−44), lower 6-min walk distance (mean adjusted difference −40 m, 95% CI −1–−80), higher odds of interstitial lung abnormalities at 9.5 years (adjusted OR 1.95, 95% CI 1.43–2.65), and higher all cause-mortality rate over 12.2 years (HR 1.58, 95% CI 1.39–1.79).High attenuation areas are associated with biomarkers of inflammation and extracellular matrix remodelling, reduced lung function, interstitial lung abnormalities, and a higher risk of death among community-dwelling adults.

OBJECTIVE:The objective of the Sleep Disordered Breathing substudy of the Nulliparous Pregnancy Outcomes Study Monitoring Mothers-to-be (nuMoM2b) is to determine whether sleep disordered breathing during pregnancy is a risk factor for adverse pregnancy outcomes. STUDY DESIGN:NuMoM2b is a prospective cohort study of 10,037 nulliparous women with singleton gestations that was conducted across 8 sites with a central Data Coordinating and Analysis Center. The Sleep Disordered Breathing substudy recruited 3702 women from the cohort to undergo objective, overnight in-home assessments of sleep disordered breathing. A standardized level 3 home sleep test was performed between 6(0)-15(0) weeks' gestation (visit 1) and again between 22(0)-31(0) weeks' gestation (visit 3). Scoring of tests was conducted by a central Sleep Reading Center. Participants and their health care providers were notified if test results met "urgent referral" criteria that were based on threshold levels of apnea hypopnea indices, oxygen saturation levels, or electrocardiogram abnormalities but were not notified of test results otherwise. The primary pregnancy outcomes to be analyzed in relation to maternal sleep disordered breathing are preeclampsia, gestational hypertension, gestational diabetes mellitus, fetal growth restriction, and preterm birth. RESULTS:Objective data were obtained at visit 1 on 3261 women, which was 88.1% of the studies that were attempted and at visit 3 on 2511 women, which was 87.6% of the studies that were attempted. Basic characteristics of the substudy cohort are reported in this methods article. CONCLUSION:The substudy was designed to address important questions regarding the relationship of sleep-disordered breathing on the risk of preeclampsia and other outcomes of relevance to maternal and child health.

Rationale: This study quantitatively measured the effects of lung volume reduction surgery (LVRS) on spirometry, static and dynamic lung and chest wall volume subdivision mechanics, and cardiopulmonary exercise measures.Methods: Patients with severe COPD (mean FEV1 = 23 ± 6% predicted) undergoing LVRS evaluation were recruited.Spirometry, plethysmography and exercise capacity were obtained within 6 months pre-LVRS and again within 12 months post-LVRS.Ventilatory mechanics were quantified using stationary optoelectronic plethysmography (OEP) during spontaneous tidal breathing and during maximum voluntary ventilation (MVV).Statistical significance was set at P<0.05.Results: Ten consecutive patients met criteria for LVRS (5 females, 5 males, age: 62±6yrs).Post -LVRS (mean follow up 7 months ± 2 months), the group showed significant improvements in dyspnea scores (pre 4 ± 1 versus post 2 ± 2), peak exercise workload (pre 37 ± 21 watts versus post 50 ± 27 watts ), heart rate (pre 109 ± 19 beats per minutes [bpm] versus post 118 ± 19 bpm), duty cycle (pre 30.8 ± 3.8% versus post 38.0 ± 5.7%), and spirometric measurements (forced expiratory volume in 1 second [FEV1] pre 23 ± 6% versus post 32 ± 13%, total lung capacity / residual lung volume pre 50 ± 8 versus 50 ± 11) .Six to 12 month changes in OEP measurements were observed in an increased percent contribution of the abdomen compartment during tidal breathing (41.2 ± 6.2% versus 44.3 ± 8.9%, P=0.03) and in percent contribution of the pulmonary ribcage compartment during MVV (34.5 ± 10.3 versus 44.9 ± 11.1%, P=0.02).Significant improvements in dynamic hyperinflation during MVV occurred, demonstrated by decreases rather than increases in end expiratory volume (EEV) in the pulmonary ribcage (pre 207.0 ± 288.2 ml versus post -85.0 ± 255.9 ml) and abdominal ribcage compartments (pre 229.1 ± 182.4 ml versus post -17.0 ± 136.2 ml) during the maneuver.Conclusions: Post-LVRS, patients with severe COPD demonstrate significant favorable changes in ventilatory mechanics, during tidal and maximal voluntary breathing.Future work is necessary to determine if these findings are clinically relevant, and extend to other environments such as exercise.

Amyotrophic lateral sclerosis (ALS) is a lethal, progressive neurodegenerative disease characterized by loss of motor neurons.(1) Patients with ALS lose function in the limbs, speech, swallowing, and breathing muscles. The cause of the disease is still not known for most patients. Approximately 25,000 people in the United States have ALS, and 5,000 people are diagnosed with ALS annually in the United States.(1) Most patients die from respiratory failure 2 to 5 years after onset of symptoms. Cognitive dysfunction is seen in 20% to 50% of patients.(2) The disease burden for patients and caregivers is enormous. The average cost of care has been estimated at $50,000 per patient per year.(3.)