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PubMed1998

Effects of low-dose nifedipine on urinary protein excretion rate in patients with renal disease.

BACKGROUND: The observation that proteinuria is an important determinant of the progression of renal disease has prompted numerous studies on the effects of antihypertensive agents on protein excretion. Reports on the proteinuric effects of calcium-channel blockers are quite controversial. It has been suggested that the short-acting dihydropyridine calcium-channel blocker nifedipine increases protein excretion by interference with tubular protein reabsorption. METHODS: In a randomized controlled trial 10 patients with renal disease and proteinuria were treated with a dose of 10 mg nifedipine o.d. (slow release formulation) for 1 week. The acute effects on renal and systemic haemodynamics and on urinary albumin, IgG, and beta2-microglobulin excretion were investigated during a clearance study in the supine position after the first dose. After 1 week of treatment urinary protein excretion rates were measured in 24-h urine samples collected in the ambulatory patient in consecutive fractions of 4-8 h during normal daily activities. RESULTS: After the first dose nifedipine lowered mean arterial blood pressure in the supine position by 7+/-1 mmHg (<0.01), attenuated proximal tubular sodium reabsorption (fractional excretion of sodium 3.48+/-0.49 vs 2.62+/-0.35% during control, P<0.02), but did not affect proximal tubular protein reabsorption (fractional urinary excretion of beta2-microglobulin 0.97+/-0.30 vs 0.98+/-0.32% during control, NS). The decrease in blood pressure was not accompanied by decreases in urinary albumin or IgG excretion rates. The selectivity index as well as GFR, RPF, and FF did not change. Continued treatment for 1 week with nifedipine did not influence 24-h protein excretion. However, we observed a rise of proteinuria during daily activities in the first 4 h after drug intake compared to the start of the study with the patients in supine position. During control measurements there was a slight increase in proteinuria. During nifedipine the increase in proteinuria was more marked and correlated with the selectivity index. CONCLUSIONS: (1) Nifedipine 10 mg orally did not impair tubular protein reabsorption. (2) Nifedipine had no immediate antiproteinuric effect despite the observed blood pressure reduction. (3) Nifedipine increased proteinuria in ambulatory urine collections. This latter observation might explain the seemingly different effects of dihydropyridine calcium-channel blockers as reported in previous studies.

Adult↗

PubMedDate not supplied

Infant sleep positioning by nursery staff and mothers in newborn hospital nurseries.

BACKGROUND: Although advice from healthcare professionals may influence parental infant placement choice to reduce sudden infant death syndrome risk, literature on nursery staff infant placement behaviors and the degree to which they influence maternal infant sleep positioning is limited. OBJECTIVE: To assess newborn placement practices of the mother and nursery staff and their interrelationship in the hospital setting. METHODS: A cross-sectional survey-based study was conducted among hospital newborn nursery staff (n = 96) and mothers of newborns (n = 579) at eight perinatal hospitals in Orange County, California. RESULTS: Although a majority of sampled nursery staff (72%) identified the supine position as the placement that most lowers sudden infant death syndrome risk, only 30% reported most often placing infants to sleep in that position, with most staff (91%) citing fear of aspiration as the motivation for supine position avoidance. Only 34% of staff reported advising exclusive supine infant positioning to mothers. Approximately 36% of mothers reported using supine infant placement exclusively. Maternal infant placement choice varied by both the advice (p <.01) and the placement modeling (p <.01) provided by staff, with the highest proportion of usual supine infant placement found among mothers who reported receiving both. A mother's race/ethnicity also affected the reception of exclusive supine placement recommendations (p <.01). CONCLUSIONS: Exclusive supine infant placement appears to be underused by both nursery staff and mothers of newborn infants. Culturally grounded educational intervention with nursery staff regarding infant positioning and placement in the hospital setting is indicated.

Adult↗

PubMed2004

Carotid sinus syndrome in an unselected population of eight hundred consecutive patients with syncope. Prevalence and clinical profile.

Carotid sinus syndrome (CSS) is frequently underdiagnosed in patients with unexplained syncope or falls. The goal of our study was to assess the value of carotid sinus massage (CSM) in an unselected population with syncope, in the supine position and after prolonged orthostasis. We observed 824 consecutive patients with unexplained syncope referred to our Autonomic Laboratory between October and October 2000 (36 months). For the analysis we studied only patients aged over 42 years (the age of the youngest patient with CSS). One hundred and eight normal healthy subjects served as the control group. CSM was performed after beat-by-beat blood pressure and continuous electrocardiographic monitoring, during supine rest and after prolonged (45 min) orthostasis on a motor-driven tilt table (HTT). Three hundred and eighty-six patients were selected (all more than 42 years old and with unexplained syncope). Six of them were excluded because of contraindication to CSM. Seventy-five patients (20%) had CSS (28% cardioinhibitory type, 22% pure vasodepressor response and 50% mixed type). Forty patients had CSS diagnosed in the supine position and 35 only after HTT. The response type was similar in both positions. The control group had only one positive response after HTT. CSS was more prevalent in males (66/9). We concluded that in an elderly population CSS is a frequent cause of syncope or unexplained falls, particularly in men. CSM in the supine position is 100% specific but only 53% sensitive. Syncope centers should perform CSM with continuous blood pressure monitoring and after prolonged orthostasis.

Adult↗

PubMed1998

Tethered cord syndrome: ventral displacement of the spinal cord at the thoracolumbar junction in magnetic resonance imaging.

PURPOSE: To determine the route of the spinal cord at the thoracolumbar junction in a sagittal MRI taken in the supine position in tethered cord syndrome. PATIENTS AND METHODS: We retrospectively studied the MRIs of 11 cases with tethered cord syndrome and the MRIs of 33 individuals without spina bifida were used as a control. When the anteroposterior diameter of the low intensity area behind the spinal cord on the sagittal T1 weighted images taken in the supine position was more than one third the anteroposterior diameter of the cord at T12/L1, the spinal cord was defined as being displaced ventrally. RESULTS: Ventral displacement was found in 6 cases (VD group), but not in the rest (non-VD group). None of the control group showed ventral displacement. There was a tendency for motor weakness to be more severe in the VD group. CONCLUSION: In some cases with tethered cord syndrome, the spinal cord takes a ventral route at the thoracolumbar junction even on MRI taken in the supine position. This finding may be useful in predicting the severity of the motor weakness in the lower extremity.

Adolescent↗

PubMed1989

Clinical value of serum digoxin assays in outpatients: improvement by the standardization of blood sampling.

Everyday physical activity previously has been shown to affect serum digoxin concentrations. Standardized rest in the supine position increases outpatient serum digoxin levels 0% to 75%. The present study comprising 56 outpatients treated with digoxin was undertaken to elucidate the clinical importance of a standardized period of rest before collection of the blood sample. Blood samples were taken about 24 hours after the latest dose, before and after 2 hours of rest in the supine position. A careful clinical examination, including electrocardiogram (ECG) findings, systolic time intervals, and chest x-ray studies, was performed to identify adverse effects/intoxication or failure of digitalis treatment. Signs of failure of digitalis treatment occurred in 12% of the patients, with a serum digoxin concentration of 0.68 +/- 0.15 (mean +/- SD) nmol/L before rest and 0.85 +/- 0.22 nmol/L after rest. Eleven percent showed signs of adverse effects/intoxication, with serum digoxin concentrations of 1.70 +/- 0.70 nmol/L before rest and 2.08 +/- 0.80 nmol/L after rest. The serum digoxin concentrations of the adequately treated patients (77%) were 1.02 +/- 0.35 nmol/L before rest and 1.28 +/- 0.41 nmol/L after rest. The importance of standardized rest before blood sampling is illustrated by the fact that only one third of the patients without signs of adverse effects/intoxication or failure of digitalis treatment had serum digoxin concentrations within the therapeutic range most commonly used (1.2 to 2.6 nmol/L) without supine rest. If allowed to rest in the supine position before blood sampling, approximately 60% of the adequately treated patients had serum digoxin concentrations within this range.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1981

Effect of postural change on plasma renin and aldosterone concentrations in third-trimester pregnancy.

Plasma renin activity and aldosterone concentration were determined radioimmunologically after 30 minutes in the left lateral position and after an additional 30 minutes of supine recumbency in 26 normotensive nulliparous women between 28 and 32 weeks' gestation. Plasma renin activity decreased slightly but significantly in the supine position (P less than .05). A distinct increase of plasma aldosterone was observed in 14 of the 26 subjects. The following speculation has been drawn from these results: the fetal renin-angiotensin system is activated by decreased uteroplacental perfusion in the supine position, possibly followed by a diminution of blood flow to the fetal kidney, perhaps via hypoxia. Subsequently, aldosterone may also be secreted by the fetus at an increased rate. In contrast to the high molecular weight renin, aldosterone passes the placental barrier and appears in the maternal circulation.

Adult↗

PubMed1989

[Correlation between Selvester's QRS score and left ventricular function at rest and during effort in patients who survived myocardial infarction].

This study was carried out in order to determine if there is any correlation between QRS score and left ventricular function at rest and during exercise after single myocardial infarction. Selvester's QRS scoring system to determine infarct size by observing Q and R standard 12-lead ECG was independently applied by three cardiologists. Left ventricular function was determined using the resting angiographic LVEF, the pulmonary wedge pressure in supine position and during exercise. The total work performed and the heart rate and systolic blood pressure percentage increase (delta) were also considered. Forty-eight male pts (mean age 52.3 +/- 8.7) were studied within 2 months after acute myocardial infarction. The site of the myocardial infarction was anterior in 13, inferior in 20, inferior plus posterior in 15. There were poor correlations between QRS score and left ventricular ejection fraction (r = -0.44) and pulmonary wedge pressure in supine position and during exercise, total work performed, delta heart rate and delta systolic blood pressure. There was no significant difference in mean QRS score between pts with abnormal (greater than 12 mmHg) and normal resting pulmonary wedge pressure in supine position (10.8 +/- 8.4 vs 7.3 +/- 5.8) or between pts with abnormal (greater than 20 mmHg) and normal exertional pulmonary wedge pressure (10.5 +/- 8.4 vs 7.4 +/- 5.7). In conclusion, the QRS score, obtained up to 30 days following an acute myocardial infarction, is not useful in determining left ventricular function at rest or during exercise.

Blood Pressure↗

PubMed1992

Effects of the lithotomy position on arterial blood flow in the lower extremities.

The lithotomy position is known to decrease venous blood flow and predispose to lower extremity venous thrombosis. However, arterial thrombosis secondary to surgical positioning has rarely been discussed. One hundred patients underwent measurements of their ankle-arm index, the ratio of their ankle systolic pressure compared to their brachial blood pressure, preoperatively (AAI); immediately after being placed in the lithotomy position (AAII); and immediately prior to returning to the supine position (AAIII). Comparison of all the ankle-arm indexes revealed significant drops between preoperatively and immediately after being placed in the lithotomy position, and between preoperatively (p less than .01) and immediately prior to the supine position (p less than .05). When only preoperative ankle-arm indexes of 0.99 were examined, a very significant drop of p less than .005 was obtained. No significant drop was seen in the group with preoperative ankle-arm indexes less than 0.99. In view of this pressure drop, standard lithotomy stirrups, such as those usually utilized for OB procedures, should be used with caution for procedures requiring prolonged lithotomy position.

Aged↗

PubMed1997

The effects of endobronchial cuff inflation on double-lumen endobronchial tube movement after lateral decubitus positioning.

OBJECT: This study was designed to measure changes in tracheal and bronchial lumen distances from mainstem and secondary carina with lateral positioning, and to assess whether inflation of the endobronchial cuff before lateral positioning would further secure a double-lumen endobronchial tube (DLT) and reduce movement. DESIGN: Prospective study. SETTING: University-affiliated cancer center. PARTICIPANTS: Fifty adult patients scheduled for elective thoracic surgical procedures requiring the placement of a left DLT. INTERVENTIONS: Patients were sequentially assigned to either the endobronchial cuff-inflated group or the deflated group during lateral positioning. After induction of general anesthesia, a left polyvinylchloride (PVC) DLT was placed and the position confirmed. In the supine position, the distance from the tip of the tracheal lumen to main carina was measured using a fiberoptic bronchoscope (FOB) passed through the tracheal lumen, and the distance from the bronchial lumen to secondary carina was measured with the FOB passed through the bronchial lumen. The patients were then positioned laterally and a second set of measurements taken. Overall movement was determined by increases and decreases in tracheal and bronchial distances obtained by substracting supine values from lateral values. MEASUREMENTS AND MAIN RESULTS: There was significant tracheal movement in 40 of 50 patients, with a mean of 0.92 +/- 1.0 cm. This was predominantly in the upward direction, as seen in 35 of 50 patients. There was significant bronchial movement in 37 of 50 patients, with a mean of 0.92 +/- 1.15 cm. Also, predominance in the upward direction was seen in 34 of 50 patients. CONCLUSIONS: DLTs move with lateral positioning, regardless of endobronchial cuff inflation. The movement is predominantly in the upward direction. Therefore, fiberoptic visualization in the supine position should be used only to confirm that the endobronchial lumen is placed on the appropriate side and the cuff is at least 1 cm inside the left mainstem bronchus. Final positioning should always be verified in the lateral position.

Adult↗

PubMed1990

Complications in the emergency transport of pregnant women.

Emergency transport of pregnant women is increasing in frequency. The physiologic changes of pregnancy cause a gravid woman and her fetus to be particularly vulnerable during transport. As the uterus enlarges, it compresses the vena cava and the aorta of the mother when she is in the supine position. Aortocaval compression may lead to uteroplacental insufficiency, supine hypotension, and potentially cardiopulmonary arrest. In addition, aortocaval compression is associated with placental abruption. This report presents three cases that illustrate the tragic outcomes of transporting pregnant women in the supine position. Pregnant women should be transported in a position of lateral tilt.

Abruptio Placentae↗

PubMed2003

Definition of venous reflux in lower-extremity veins.

PURPOSE: This prospective study was designed to determine the upper limits of normal for duration and maximum velocity of retrograde flow (RF) in lower extremity veins. METHODS: Eighty limbs in 40 healthy subjects and 60 limbs in 45 patients with chronic venous disease were examined with duplex scanning in the standing and supine positions. Each limb was assessed for reflux at 16 venous sites, including the common femoral, deep femoral, and proximal and distal femoral veins; proximal and distal popliteal veins; gastrocnemial vein; anterior and posterior tibial veins; peroneal vein; greater saphenous vein, at the saphenofemoral junction, thigh, upper calf, and lower calf; and lesser saphenous vein, at the saphenopopliteal junction and mid-calf. Perforator veins along the course of these veins were also assessed. In the healthy volunteers, 1553 vein segments were assessed, including 480 superficial vein segments, 800 deep vein segments, and 273 perforator vein segments; and in the patients, 1272 vein segments were assessed, including 360 superficial vein segments, 600 deep vein segments, and 312 perforator vein segments. Detection and measurement of reflux were performed at duplex scanning. Standard pneumatic cuff compression pressure was used to elicit reflux. Duration of RF and peak vein velocity were measured immediately after release of compression. RESULTS: Duration of RF in the superficial veins ranged from 0 to 2400 ms (mean, 210 ms), and was less than 500 ms in 96.7% of these veins. In the perforator veins, regardless of location, outward flow ranged from 0 to 760 ms (mean, 170 ms), and was less than 350 ms in 97% of these veins. In the deep veins, RF ranged from 0 to 2600 ms. Mean RF in the deep femoral veins and calf veins was 190 ms, and was less than 500 ms in 97.6% of these veins. In the femoropopliteal veins, mean RF was 390 ms, and ranged from 510 to 2600 ms in 21 of 400 segments; however, RF was less than 990 ms in 99% of these veins. Duration of RF was significantly longer in all three veins systems in patients (P <.0001 for all comparisons). With a cutoff value of more than 1000 ms rather than more than 500 ms, prevalence of abnormal RF in the femoropopliteal veins was significantly reduced, from 29% to 18% (P =.002). Thirty-seven vein segments (2.4%) had RF greater than 500 ms in the supine position, compared with less than 500 ms in 22 of these vein segments (59%) in the standing position. Of the 48 vein segments (3.1%) with RF greater than 500 ms in the standing position, RF was less than 500 ms in 6 of these vein segments (13%) in the supine position. Similar observations were noted in patient veins. There was no association between RF and peak vein velocity. Peak vein velocity had no significance in determining reflux. CONCLUSIONS: The cutoff value for reflux in the superficial and deep calf veins is greater than 500 ms. However, the reflux cutoff value for the femoropopliteal veins should be greater than 1000 ms. Outward flow in the perforating veins should be considered abnormal at greater than 350 ms. Reflux testing should be performed with the patient standing.

Adult↗

PubMedDate not supplied

Pulmonary function and circulating adhesion molecules in patients with diabetes mellitus.

BACKGROUND: Lung function in diabetes has been reported in several studies with contradictory results. Diabetes mellitus increases expression of adhesion molecules through hyperglycemia. These molecules play an important role in the pathophysiological dysfunction of the vasculature. OBJECTIVE: To explore the possible relationship between lung function and circulating levels of adhesion molecules in diabetes. METHODS: Sixteen type 1 diabetic patients, 33 type 2 diabetic patients and 22 healthy subjects matched for age and sex were studied. Spirometry measurements were performed and pulmonary diffusion capacity for carbon monoxide (DLco) was measured in sitting and supine positions by the single-breath method corrected by alveolar volume (VA). Glycosylated hemoglobin, retinopathy and nephropathy were included as parameters of metabolic control and diabetic complications. Circulating levels of soluble E-selectin and vascular cell adhesion molecule-1 (VCAM-1) were determined in all subjects. RESULTS: Diabetic subjects showed lower variation in DLco and DLco/VA by changing posture from sitting to supine position (P=0.043 and P<0.001, respectively), and showed reduced total lung capacity (P<0.001) and forced expiratory volume in 1 s/forced vital capacity (P=0.009) compared with healthy control subjects. Serum concentrations of E-selectin were elevated in diabetic patients (P<0.001). There was no difference in serum VCAM-1 concentrations between diabetic and control subjects. On stepwise regression analysis, E-selectin concentrations were the most important contributing factor to the variation in DLco/VA. CONCLUSIONS: Diabetic patients show lower pulmonary volumes and variation in DLco by changing posture from sitting to supine position, and they also show increased levels of E-selectin. A possible explanation is impaired pulmonary microvasculature, because adhesion molecules seem to be sensitive markers of endothelial activation and damage seen in diabetes.

Aged↗

PubMed2001

Back to sleep: good advice for parents but not for hospitals?

BACKGROUND: In October 1998, when we surveyed nurses working in Iowa obstetric units about infant sleeping position in the hospital and recommendations for infant sleeping position at home, we learned that the side position was used frequently in the hospital and also was considered to be an acceptable alternative for sleeping position at home. OBJECTIVE: The purpose of our present study was to determine why nurses continued to use and endorse the side sleeping position rather than the supine position. DESIGN: We surveyed all Iowa hospitals that had an obstetric service as of July 1999 to learn why the side position was used. RESULTS: All 94 hospitals with obstetric services responded to the survey and revealed that 2 major factors were considered when an infant was put to sleep on his/her side. The most frequent response was fear of aspiration (57 responses or 51.4%) and the second was adherence to a federal brochure that lists side sleeping as a reasonable alternative (38 responses or 34.2%). CONCLUSION: We conclude that the reasons reported for use of the side position in Iowa maternity hospitals do not justify its continuing use. We believe that information about the importance of placing an infant on his/her back to sleep and its superiority over placing an infant on his/her side to sleep is sufficient to warrant its availability in every maternity hospital. We speculate that if the infant sleeping position used in the hospital is not different from that taught to parents, there will be less parental confusion and greater adherence to infant positioning shown to reduce sudden infant death syndrome.

Attitude of Health Personnel↗

PubMedDate not supplied

Risk factors for aspiration.

BACKGROUND: There are numerous risk factors for aspiration in tube-fed critically ill patients. However, there is confusion about the extent to which these factors actually contribute to aspiration. The purpose of this literature review was to summarize findings from selected research studies. METHODS: A nonexhaustive literature search was conducted to identify risk factors for aspiration in tube-fed, critically ill patients. The most commonly cited factors were decreased level of consciousness, supine position, presence of a nasogastric tube, tracheal intubation and mechanical ventilation, bolus or intermittent feeding delivery methods, high-risk disease and injury conditions, and advanced age. RESULTS: Many studies of aspiration risk factors have relatively small sample sizes and used equivocal definitions of aspiration. Although some addressed aspiration as an outcome, others considered gastroesophageal reflux or pneumonia as outcomes. Despite these variations, authors almost uniformly agree that a decreased level of consciousness and a sustained supine position are major risk factors for aspiration. There is less agreement regarding the effect of a nasogastric tube (or its size) on aspiration and on the effect of various formula delivery methods. CONCLUSIONS: A decreased level of consciousness is a major risk factor for aspiration, as is a sustained supine position. Although some authors favor using small-bore feeding tubes to prevent aspiration, there seems to be insufficient data to warrant this action. Although strong data are lacking regarding feeding delivery methods, there are more data to support continuous feedings than bolus/intermittent feedings in high-risk patients.

Enteral Nutrition↗

PubMed1996

Effect of positioning on pulmonary function of newborns: comparison of supine and prone position.

The effect of positioning on pulmonary function has been previously evaluated, and the prone position has been reported to be preferable for neonates with various respiratory diseases. Studies in healthy neonates have yielded conflicting results. Using a crying pulmonary function test, we examined the effect of positioning on pulmonary function in healthy full-term neonates. Thirty-nine infants with a mean birthweight (+/- SD) of 3,140 +/- 379 g and a mean gestational age (+/- SD) of 39.8 +/- 1.6 weeks were investigated during the first 6 hours of life. Measurements were obtained in both supine and prone positions using a computerized volume-flow system. There were statistically significant decreases in crying vital capacity (CVC) and peak expiratory flow rate (PEF) in the prone compared with the supine position. However, there were no significant differences in forced expiratory flow rate at 75% (V(75)), 50% (V(55)), and 25% (V(25)) of vital capacity between the two positions. These results suggest that prone positioning decreases lung volume and increases resistance of upper airways. We conclude that healthy neonates should be in the supine posture for optimal ventilation.

Humans↗

PubMed1998

Sudden infant death syndrome rates subsequent to the American Academy of Pediatrics supine sleep position.

OBJECTIVES: In April 1992, the American Academy of Pediatrics (AAP) recommended that healthy infants be positioned for sleep on their side or back to reduce the risk of Sudden Infant Death Syndrome (SIDS). The authors hypothesized three different forms of the intervention to examine the impact of the recommendation according to theory such as technology diffusion. Seasonality was included in the models to control its effect when testing. METHODS: Box and Tiao time-series intervention methodology was used to examine the effect of the AAP recommendation on SIDS rates. Sudden Infant Death Syndrome mortality data from Philadelphia and Chicago were examined separately for white and nonwhite populations over 32 quarters. RESULTS: Overall SIDS rates dropped significantly according to an abrupt effect from the intervention. However, the effect appeared to be gradually declining in Philadelphia but permanent in Chicago. In Philadelphia, a decline of 62.3% was estimated in whites in the first quarter after the intervention but decreased to only 5% in the last quarter of 1994. A decline of 35.8% was estimated in nonwhites in the first quarter after the intervention but decreased to only 9.4% in the last quarter of 1994. An abrupt and permanent decrease of 26.7% and 16.5% was found in Chicago for whites and nonwhites, respectively. CONCLUSIONS: Evidence of an abrupt adoption of the recommendation can be explained by the authority innovation decision made by the AAP. Some evidence was found that the effect is temporary, perhaps because physicians are reversing earlier decisions. The demonstrated methodology provides a powerful way to test naturally occurring interventions from quasiexperimental designs to test the impact of policy guidelines.

Chicago↗

PubMed2006

Upper airway dynamics during negative expiratory pressure in apneic and non-apneic awake snorers.

BACKGROUND: The ability of negative expiratory pressure (NEP) technique to differentiate between awake snorers with and without obstructive sleep apnea-hypopnea (OSAH) was investigated. METHODS: Forty-eight subjects with sleep disordered breathing (SDB) and 7 healthy subjects, as non-snorer controls, underwent the NEP application of -5 and -7 cmH2O in the seated and supine position during wakefulness, after performing a sleep study. The upper airway collapsibility was assessed by computing the volume exhaled during the first 0.5 sec. (V,NEP0.5) and 1 sec. (V,NEP1) following the NEP start. RESULTS: Patients with severe (AHI > or = 30) (n = 19) and mild-to-moderate (AHI <30 and >5) (n = 15) OSAH had lower V,NEP0.5 (340 +/- 88 ml) as compared to snorers (AHI < or = 5) (n = 14) (427 +/- 101 ml; p < 0.01) and controls (n = 7) (492 +/- 69 ml; p < 0.001) in the supine position with NEP -5 cmH2O. Less significant differences among the different groups were observed for V,NEP0.5 in the seated position with NEP -5 cmH2O and in both positions with NEP -7 cmH2O (only OSAH patients vs controls, p < 0.001). Similar results were obtained for V,NEP1 in either position by using both NEP -5 cmH2O and -7 cmH2O. In spite of this, a substantial overlapping of V,NEP0.5 and V,NEP1 between snorers and OSAH patients did not allow to identify a reliable diagnostic cut-off level. An inverse correlation with AHI was found for V,NEP0.5 in the supine position with NEP -5 cmH2O (rs = -0.46, p < 0.05) in severe OSAH patients. CONCLUSION: The awake OSAH patients exhibit values of V,NEP0.5 and V,NEP1 lesser than those of awake snorers. The NEP technique, however, appears to have a limited usefulness as clinical tool for routine screening of the OSAH patients during wakefulness.

Body Mass Index↗

PubMed2003

Electromyographic analysis of abdominal muscle activity using portable abdominal exercise devices and a traditional crunch.

The purpose of this study was to compare the abdominal muscle activity elicited while using 4 portable abdominal training devices vs. a traditional crunch. Thirty-three adults participated in this study. The exercise devices tested included the Ab Roller Plus, Torso Track 2, AB-DOer Pro, and the Perfect Abs. All subjects were tested on the Perfect Abs in both a seated and supine position using low-, medium-, and high-resistance bands. The Torso Track 2 was also tested at low- and high-resistance settings. Surface electromyography (EMG) was recorded from the upper and lower portions of the rectus abdominis, external oblique, and the rectus femoris during each repetition. Statistical analyses were performed on the mean EMG values using a repeated analysis of variance (ANOVA) procedure. There was no significant difference in abdominal muscle activity between the Ab Roller Plus, the Torso Track 2 (high resistance), and a traditional crunch. The mean abdominal muscle activity was significantly lower than a normal crunch, however, when using the AB-DOer, Torso Track (low resistance), and the Perfect Abs seated with the low-resistance band. In contrast, the Perfect Abs, when used in the supine position with the medium- and high-resistance bands, elicited significantly greater mean abdominal muscle activity than a crunch. Of the 4 devices tested, only the Perfect Abs when used in the supine position with the medium- and high-resistance bands, elicited more abdominal activity than a crunch. The results suggest that portable abdominal devices are most effective if they not only mimic the mechanics of a traditional crunch, but also provide external resistance to increase the involvement of the abdominal musculature.

Abdominal Muscles↗