Actigraphy informs distinct patient-centered outcomes in Pre-COPD

Jianhong Chen; Lemlem Weldemichael; Siyang Zeng; Brian Giang; Jeroen Geerts; Wendy Czerina Ching; Melissa Nishihama; Warren M Gold; Mehrdad Arjomandi

doi:10.1016/j.rmed.2021.106543

Actigraphy informs distinct patient-centered outcomes in Pre-COPD

Respir Med. 2021 Oct:187:106543. doi: 10.1016/j.rmed.2021.106543. Epub 2021 Jul 30.

Authors

Jianhong Chen¹, Lemlem Weldemichael², Siyang Zeng³, Brian Giang⁴, Jeroen Geerts⁵, Wendy Czerina Ching⁶, Melissa Nishihama⁷, Warren M Gold⁸, Mehrdad Arjomandi⁹

Affiliations

¹ Division of Pulmonary, Critical Care, Allergy and Immunology, and Sleep Medicine, Department of Medicine, University of California, San Francisco, CA, USA; Division of Occupational and Environmental Medicine, Department of Medicine, University of California, San Francisco, CA, USA; San Francisco Veterans Affairs Medical Center, San Francisco, California, USA. Electronic address: jianhong.chen@ucsf.edu.
² Division of Pulmonary, Critical Care, Allergy and Immunology, and Sleep Medicine, Department of Medicine, University of California, San Francisco, CA, USA; Division of Occupational and Environmental Medicine, Department of Medicine, University of California, San Francisco, CA, USA; San Francisco Veterans Affairs Medical Center, San Francisco, California, USA. Electronic address: weldemichael.lemlem@gmail.com.
³ San Francisco Veterans Affairs Medical Center, San Francisco, California, USA; Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, USA. Electronic address: Siyang.zeng@ucsf.edu.
⁴ George Washington University, School of Medicine, Washington, DC, USA. Electronic address: briangiang@gwmail.gwu.edu.
⁵ Radboud University Medical Center, Nijmegen, the Netherlands. Electronic address: jeroengeerts@msn.com.
⁶ Division of Pulmonary, Critical Care, Allergy and Immunology, and Sleep Medicine, Department of Medicine, University of California, San Francisco, CA, USA; Division of Occupational and Environmental Medicine, Department of Medicine, University of California, San Francisco, CA, USA; San Francisco Veterans Affairs Medical Center, San Francisco, California, USA. Electronic address: Wendy.Ching@ucsf.edu.
⁷ Division of Pulmonary, Critical Care, Allergy and Immunology, and Sleep Medicine, Department of Medicine, University of California, San Francisco, CA, USA; Division of Occupational and Environmental Medicine, Department of Medicine, University of California, San Francisco, CA, USA; San Francisco Veterans Affairs Medical Center, San Francisco, California, USA.
⁸ Division of Pulmonary, Critical Care, Allergy and Immunology, and Sleep Medicine, Department of Medicine, University of California, San Francisco, CA, USA; San Francisco Veterans Affairs Medical Center, San Francisco, California, USA. Electronic address: mynishihama@gmail.com.
⁹ Division of Pulmonary, Critical Care, Allergy and Immunology, and Sleep Medicine, Department of Medicine, University of California, San Francisco, CA, USA; Division of Occupational and Environmental Medicine, Department of Medicine, University of California, San Francisco, CA, USA; San Francisco Veterans Affairs Medical Center, San Francisco, California, USA. Electronic address: mehrdad.arjomandi@ucsf.edu.

PMID: 34496341
DOI: 10.1016/j.rmed.2021.106543

Abstract

Background: Actigraphy can provide useful patient-centered outcomes for quantification of physical activity in the "real-world" setting.

Methods: To characterize the relationship of actigraphy outputs with "in-laboratory" measures of cardiopulmonary function and respiratory symptoms in pre-COPD, we obtained actigraphy data for 8 h/day for 5 consecutive days a week before in-laboratory administration of respiratory questionnaires, PFT, and CPET to a subgroup of subjects participating in the larger study of the health effects of exposure to secondhand tobacco smoke who had air trapping but no spirometric obstruction (pre-COPD). Using machine learning approaches, we identified the most relevant actigraphy predictors and examined their associations with symptoms, lung function, and exercise outcomes.

Results: Sixty-one subjects (age = 66±7 years; BMI = 24±3 kg/m²; FEV₁/FVC = 0.75 ± 0.05; FEV₁ = 103 ± 17 %predicted) completed the nested study. In the hierarchical cluster analysis, the activity, distance, and energy domains of actigraphy, including moderate to vigorous physical activity, were closely correlated with each other, but were only loosely associated with spirometric and peak exercise measures of oxygen consumption, ventilation, oxygen-pulse, and anaerobic threshold (VO_2AT), and were divergent from symptom measures. Conversely, the sedentary domain clustered with respiratory symptoms, air trapping, airflow indices, and ventilatory efficiency. In Regression modeling, sedentary domain was inversely associated with baseline lung volumes and tidal breathing at peak exercise, while the activity domains were associated with VO_2AT. Respiratory symptoms and PFT data were not associated with actigraphy outcomes.

Discussion: Outpatient actigraphy can provide information for "real-world" patient-centered outcomes that are not captured by standardized respiratory questionnaires, lung function, or exercise testing. Actigraphy activity and sedentary domains inform of distinct outcomes.

Keywords: Actigraphy; Air trapping; COPD; Cardiopulmonary exercise; Machine learning; Pre-COPD; Pulmonary function testing; Secondhand tobacco smoke.

Published by Elsevier Ltd.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Actigraphy*
Aged
Anaerobiosis
Exercise / physiology*
Exercise Test
Female
Humans
Lung / physiopathology
Machine Learning
Male
Middle Aged
Oxygen Consumption
Patient Reported Outcome Measures*
Pulmonary Disease, Chronic Obstructive / diagnosis*
Pulmonary Disease, Chronic Obstructive / metabolism
Pulmonary Disease, Chronic Obstructive / physiopathology*
Spirometry
Surveys and Questionnaires

Grants and funding

T15 LM007442/LM/NLM NIH HHS/United States