Background

Dysfunctional breathing (DB) resulting in inappropriate breathlessness is common in individuals living with postural orthostatic tachycardia syndrome (POTS). DB in POTS is complex, multifactorial, and not routinely assessed clinically outside of specialist centres. To date DB in POTS has been identified and diagnosed predominately via cardiopulmonary exercise testing (CPEX), hyperventilation provocation testing and/or specialist respiratory physiotherapy assessment. The Breathing Pattern Assessment Tool (BPAT) is a clinically validated diagnostic tool for DB in Asthma. There are, however, no published data regarding the use of the BPAT in POTS. The aim of this study was therefore to assess the potential clinic utility of the BPAT in the diagnosis of DB in individuals with POTS.

Methods

A retrospective observational cohort study of individuals with POTS referred to respiratory physiotherapy for formal assessment of DB. DB was determined by specialist respiratory physiotherapist assessment which included physical assessment of chest wall movement/breathing pattern. The BPAT and Nijgmegen questionnaire were also completed. Receiver operating characteristics (ROC) analysis was used to compare the physiotherapy assessment based diagnosis of DB to the BPAT score.

Results

Seventy-seven individuals with POTS [mean (sd) age 32 (11) years, 71 (92 %) female] were assessed by a specialist respiratory physiotherapist, with 65 (84 %) being diagnosed with DB. Using the established BPAT cut off of four or more, receiver operating characteristics (ROC) analysis indicated a sensitivity of 87 % and specificity of 75 % for diagnosing DB in individuals with POTS with an area under the curve (AUC) of 0.901 (95 % CI 0.803–0.999), demonstrating excellent discriminatory ability.

Conclusion

BPAT has high sensitivity and moderate specificity for identifying DB in individuals living with POTS.

中文翻译：

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呼吸模式评估工具 (BPAT) 在识别体位性心动过速综合征 (POTS) 患者呼吸功能障碍 (DB) 方面的临床应用

背景

导致不适当呼吸困难的呼吸功能障碍 (DB) 在患有体位性心动过速综合征 (POTS) 的个体中很常见。POTS 中的 DB 是复杂的、多因素的，并且不会在专业中心之外进行常规临床评估。迄今为止，POTS 中的 DB 主要通过心肺运动试验 (CPEX)、过度通气激发试验和/或专业呼吸物理治疗评估来识别和诊断。呼吸模式评估工具 (BPAT) 是一种经过临床验证的哮喘 DB 诊断工具。然而，目前还没有关于在 POTS 中使用 BPAT 的公开数据。因此，本研究的目的是评估 BPAT 在 POTS 患者 DB 诊断中的潜在临床效用。

方法

一项针对 POTS 患者的回顾性观察队列研究提到呼吸物理治疗对 DB 进行正式评估。DB 由专业呼吸物理治疗师评估确定，其中包括胸壁运动/呼吸模式的物理评估。BPAT 和奈格梅亨问卷也已完成。接受者操作特征 (ROC) 分析用于将基于物理治疗评估的 DB 诊断与 BPAT 评分进行比较。

结果

专业呼吸物理治疗师对 77 名 POTS 患者[平均 (标准差) 年龄 32 (11) 岁，71 名 (92%) 女性] 进行了评估，其中 65 名 (84%) 被诊断为 DB。使用已确定的 BPAT 截断值 4 或更多，接受者操作特征 (ROC) 分析表明，诊断 POTS 个体 DB 的敏感性为 87%，特异性为 75%，曲线下面积 (AUC) 为 0.901（95%） CI 0.803–0.999），表现出出色的辨别能力。

结论

BPAT 对于识别 POTS 患者的 DB 具有高敏感性和中等特异性。