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

Binaya Regmi; Chiara Borrelli; Alberto Giannoni; Florian Kahles; Vaughan G Macefield; Michael Dreher; Jens Spiesshoefer

doi:10.1007/s10286-024-01027-2

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

Clin Auton Res. 2024 Mar 19. doi: 10.1007/s10286-024-01027-2. Online ahead of print.

Authors

Binaya Regmi¹, Chiara Borrelli^{2

3}, Alberto Giannoni³, Florian Kahles⁴, Vaughan G Macefield^{5

6}, Michael Dreher¹, Jens Spiesshoefer^{7

8}

Affiliations

¹ Department of Pneumology and Intensive Care Medicine, University Hospital RWTH Aachen, 52074, Aachen, Germany.
² Department of Neurology, University of Iowa, Iowa City, IA, USA.
³ Interdisciplinary Health Science Centre, Scuola Superiore Sant'Anna, Pisa, Italy.
⁴ Department of Cardiology and Vascular Medicine, University Hospital RWTH Aachen, Aachen, Germany.
⁵ Human Autonomic Neurophysiology Laboratory, Department of Neuroscience, Monash University, Victoria, Australia.
⁶ Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, VIC, Australia.
⁷ Department of Pneumology and Intensive Care Medicine, University Hospital RWTH Aachen, 52074, Aachen, Germany. jspiesshoefer@ukaachen.de.
⁸ Interdisciplinary Health Science Centre, Scuola Superiore Sant'Anna, Pisa, Italy. jspiesshoefer@ukaachen.de.

PMID: 38502257
DOI: 10.1007/s10286-024-01027-2

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.

Publication types

Letter