J Clin Neurol.  2016 Jul;12(3):361-367. 10.3988/jcn.2016.12.3.361.

Reference Range of Respiratory Muscle Strength and Its Clinical Application in Amyotrophic Lateral Sclerosis: A Single-Center Study

Affiliations
  • 1Department of Neurology, Gyeongsang National University Hospital, Jinju, Korea.
  • 2Regional Cardiocerebrovascular Center, Gyeongsang National University Hospital, Jinju, Korea.
  • 3Department of Neurology, Gil Medical Center, Gachon University, Incheon, Korea.
  • 4Department of Neurology, Jeju National University School of Medicine, Jeju, Korea.
  • 5Department of Neurology, Korea Cancer Center Hospital, Seoul, Korea.
  • 6Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea.
  • 7Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. jjsaint@snu.ac.kr

Abstract

BACKGROUND AND PURPOSE
Evaluating respiratory function is important in neuromuscular diseases. This study explored the reference ranges of the maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and sniff nasal inspiratory pressure (SNIP) in healthy adults, and applied them to amyotrophic lateral sclerosis (ALS) patients.
METHODS
MIP, MEP, and SNIP were measured in 67 healthy volunteers aged from 21 to 82 years. Reference ranges were evaluated by multivariate regression analysis using the generalized additive modeling of location, scale, and shape method. Thirty-six ALS patients were reviewed retrospectively, and abnormal values of MIP, MEP, and SNIP were determined according to the reference ranges.
RESULTS
MIP, MEP, and SNIP were abnormal in 57.1%, 51.4%, and 25.7% of the ALS patients, respectively. MIP and SNIP were significantly correlated with the degree of restrictive pattern and respiratory symptoms. The ALS Functional Rating Scale-Revised score was correlated with SNIP.
CONCLUSIONS
This study has provided the reference range of respiratory muscle strength in healthy adults. This range is suitable for evaluating respiratory function in ALS patients.

Keyword

maximal inspiratory pressure; maximal expiratory pressure; sniff nasal inspiratory pressure; amyotrophic lateral sclerosis

MeSH Terms

Adult
Amyotrophic Lateral Sclerosis*
Healthy Volunteers
Humans
Methods
Neuromuscular Diseases
Reference Values*
Respiratory Muscles*
Retrospective Studies

Figure

  • Fig. 1 Test results with significant correlations in the healthy control group. A: Between MIP and MEP (r=0.597, p<0.001). B: Between MIP and SNIP (r=0.573, p<0.001). C: Between MEP and SNIP (r=0.437, p<0.001). MEP: maximal expiratory pressure, MIP: maximal inspiratory pressure, SNIP: sniff nasal inspiratory pressure.

  • Fig. 2 Test results with significant correlations in the ALS group. A: Between MIP and MEP (r=0.758, p<0.001). B: Between MIP and SNIP (r=0.646, p<0.001). C: Between MEP and SNIP (r=0.612, p<0.001). D: Between ALSFRS-R score and SNIP (r=0.473, p<0.007). ALS: amyotrophic lateral sclerosis, ALSFRS-R: amyotrophic lateral sclerosis functional rating scale-revised, MEP: maximal expiratory pressure, MIP: maximal inspiratory pressure, SNIP: sniff nasal inspiratory pressure.


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