Optimal method for assessment of respiratory muscle strength in neuromuscular disorders using sniff nasal inspiratory pressure SNIPReport as inadecuate




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Background

The ability to accurately determine respiratory muscle strength is vitally important in patients with neuromuscular disorders NMD. Sniff nasal inspiratory pressure SNIP, a test of inspiratory muscle strength, is easier to perform for many NMD patients than the more commonly used determination of maximum inspiratory pressure measured at the mouth MIP. However, due to an inconsistent approach in the literature, the optimal technique to perform the SNIP maneuver is unclear. Therefore, we systematically evaluated the impact of performing the maneuver with nostril contralateral to the pressure-sensing probe open SNIPOP versus closed SNIPCL, on determination of inspiratory muscle strength in NMD patients as well as control subjects with normal respiratory muscle function.

Methods

NMD patients n = 52 and control subjects without respiratory dysfunction n = 52 were studied. SNIPOP, SNIPCL, and MIP were measured during the same session and compared using ANOVA. Agreement and bias were assessed with intraclass correlation coefficients ICC and Bland-Altman plots.

Results

Mean MIP values were 58.2 and 94.0 cmH2O in NMD and control subjects, respectively p<0.001. SNIPCL was greater than SNIPOP in NMD 51.9 ±31.0 vs. 36.9 ±25.4 cmH2O; p<0.001 as well as in controls 89.2 ±28.1 vs. 69.2 ±29.2 cmH2O; p<0.001. In both populations, the ICC between MIP and SNIPCL NMD = 0.78, controls = 0.35 was higher than for MIP and SNIPOP NMD = 0.53, controls = 0.06. In addition, SNIPCL was more often able to exclude inspiratory muscle weakness than SNIPOP.

Conclusions

SNIPCL values are systematically higher than SNIPOP in both normal subjects and NMD patients. Therefore, SNIPCL is a useful complementary test for ruling out inspiratory muscle weakness in individuals with low MIP values.



Author: Marta Kaminska , Francine Noel, Basil J. Petrof

Source: http://plos.srce.hr/



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