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Acute effects of air stacking manuever and posture on cardiac autonomic function in patients with spinal muscular atrophy types II and III

Efeitos agudos da manobra de empilhamento de ar e postura na função autonômica cardíaca em pacientes com atrofia muscular espinhal tipos II e III

Débora Pedroza Guedes Silva, Míriam Raquel Meira Mainenti, Carla Peixoto Vinha Souza, Alexandra Prufer Queiroz Campos Araújo, Arthur Sá Ferreira, Cristina Marcia Dias

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Resumo

Background: Respiratory dysfunction is the major cause of morbidity and mortality in patients with spinal muscular atrophy. Air stacking is a clearance airway technique frequently used but its effects on cardiac autonomic function in patients with spinal muscle atrophy is not clear. Objective: To evaluate the acute effect of air stacking and posture on cardiac autonomic function in patients with spinal muscular atrophy types II and III. Methods: Nine patients with spinal muscle atrophy type II and III were recruited. Electrocardiogram signals were recorded for analyses of heart rate variability during air stacking in supine and sitting position. Data were collected before, during and after air stacking and were compared using Anova Repeated Measures or Kruskal-Wallis Anova on Ranks, followed by Tukey test. The relationship between heart rate variability indexes and age was evaluated by Pearson correlation. Significant level was set at 5%. Results: During air stacking, STDRR, LF and SD2 significantly increased in supine and sitting positions. In supine, air stacking significantly reduced LF and increased both LF/HF and SD2. In sitting position, RMSSD and SD1 were significantly lower reduced in pre period and air stacking led to significant increase in STDHR and RMSSD. MeanRR and Mean HR correlated with age in sitting position. MeanRR was significantly lower and MeanHR was significantly higher in both positions in all moments. Conclusion: Patients with spinal muscle atrophy types II and III present alterations on heart rate variability during postural change and air stacking maneuver is suggestive of cardiac autonomic control integrity.

Palavras-chave

Spinal muscular atrophy; Physical therapy modalities; Air stacking; Autonomic nervous system.

Abstract

Introdução: A disfunção respiratória é a maior causa de morbidade e mortalidade em pacientes com atrofia muscular espinhal. O empilhamento de ar (air stacking) é uma técnica de higiene brônquica frequentemente utilizada, no entanto, seus efeitos na função autonômica cardíaca de pacientes com atrofia muscular espinhal não são claros. Objetivo: Avaliar o efeito agudo da manobra de empilhamento de ar e de posturas na função autonômica cardíaca em pacientes com atrofia muscular espinhal tipos II e III. Métodos: Nove pacientes com atrofia muscular espinhal tipos II e III foram recrutados. Sinais de eletrocardiograma foram registrados para as análises da variabilidade da frequência cardíaca durante a manobra de empilhamento de ar nas posições supina e sentado. Os dados foram coletados antes, durante e após a manobra de empilhamento de ar e foram comparados utilizando o teste de Anova de Medidas Repetidas ou Kruskal-Wallis Anova on Ranks, com o respectivo teste de Tukey. A relação entre os índices da variabilidade da frequência cardíaca e idade foram analisados por meio do coeficiente de correlação de Pearson. A significância estatística foi determinada em 5%. Resultados: Durante a manobra de empilhamento de ar, STDRR, LF e SD2 aumentaram significativamente na posição supina e sentada. Na posição supina, a manobra de empilhamento de ar reduziu significantemente LF e aumentou o LF/HF e o SD2. Na posição sentada, RMSSD e SD1 foram significativamente menores no período pré, e a manobra de empilhamento de ar aumentou significativamente o STDHR e o RMSSD. MeanRR e MeanHR correlacionaram com a idade na posição sentada. MeanRR foi significativamente menor e MeanHR foi significativamente maior nas duas posições em todos os momentos. Conclusão: Pacientes com atrofia muscular espinhal tipos II e III apresentam alterações na variabilidade da frequência cardíaca durante as mudanças de postura e a manobra de empilhamento de ar, o que é sugestivo de integridade do controle autonômico cardíaco.

Keywords

Atrofia muscular espinhal; Modalidades de fisioterapia; Empilhamento de ar; sistema nervoso autônomo.

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