Respiratory medicine · 2026
Respiratory muscle weakness after stroke: An exploratory mediation analysis of associated factors.
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Domínguez-Sanz Natalia, Ramírez-Vélez Robinson
Аннотация
OBJECTIVE: This study had two aims: first, to compare pulmonary function and ultrasound-derived parameters between individuals with stroke and apparently healthy controls; and second, to examine whether selected pulmonary and ultrasound-derived variables mediated the association between stroke status and respiratory muscle strength.
METHODS: In this cross-sectional study, 49 individuals with chronic unilateral stroke (≥6 months) and 53 apparently healthy adults were evaluated. B-mode ultrasound assessed diaphragm and transversus abdominis thickness at functional residual capacity and total lung capacity, diaphragm thickening fraction (TFdi), transversus abdominis thickening fraction, and echo intensity (EI). Pulmonary function (forced vital capacity [FVC], forced expiratory volume in 1 s [FEV1], peak expiratory flow [PEF] % predicted and absolute values) and respiratory muscle strength (MIP and maximal expiratory pressure [MEP], % predicted) were measured according to ATS/ERS standards. Between-group differences were analyzed using t tests with Cohen d. Single-mediator models with bootstrap resampling evaluated mediation, adjusting for age and sex.
RESULTS: Pulmonary function was lower in the stroke group, including FVC (% predicted; d = 1.45), FEV1 (% predicted; d = 1.55), and PEF (% predicted; d = 1.53). %MIP and %MEP were reduced (both P < 0.001). Ultrasound measures showed reduced TFdi and transversus abdominis thickening fraction, along with higher echo intensity. Mediation analyses indicated that PEF (% predicted) and TFdi were significant mediators in the association between stroke status and lower %MIP. TFdi accounted for 14.2% of the total effect (β = -3.28; 95% CI, -7.45 to -0.60), whereas PEF accounted for 48.4% (β = -10.78; 95% CI, -17.57 to -5.50). For %MEP, TFdi and PEF also showed statistically significant indirect effects, whereas EITrA showed a smaller indirect effect and TrA thickness at TLC did not.
CONCLUSIONS: In this cross-sectional study, post-stroke inspiratory muscle weakness was associated with lower PEF and reduced diaphragmatic contractility in exploratory mediation analyses. These findings suggest that spirometric and ultrasound-derived measures capture complementary aspects of respiratory impairment.
METHODS: In this cross-sectional study, 49 individuals with chronic unilateral stroke (≥6 months) and 53 apparently healthy adults were evaluated. B-mode ultrasound assessed diaphragm and transversus abdominis thickness at functional residual capacity and total lung capacity, diaphragm thickening fraction (TFdi), transversus abdominis thickening fraction, and echo intensity (EI). Pulmonary function (forced vital capacity [FVC], forced expiratory volume in 1 s [FEV1], peak expiratory flow [PEF] % predicted and absolute values) and respiratory muscle strength (MIP and maximal expiratory pressure [MEP], % predicted) were measured according to ATS/ERS standards. Between-group differences were analyzed using t tests with Cohen d. Single-mediator models with bootstrap resampling evaluated mediation, adjusting for age and sex.
RESULTS: Pulmonary function was lower in the stroke group, including FVC (% predicted; d = 1.45), FEV1 (% predicted; d = 1.55), and PEF (% predicted; d = 1.53). %MIP and %MEP were reduced (both P < 0.001). Ultrasound measures showed reduced TFdi and transversus abdominis thickening fraction, along with higher echo intensity. Mediation analyses indicated that PEF (% predicted) and TFdi were significant mediators in the association between stroke status and lower %MIP. TFdi accounted for 14.2% of the total effect (β = -3.28; 95% CI, -7.45 to -0.60), whereas PEF accounted for 48.4% (β = -10.78; 95% CI, -17.57 to -5.50). For %MEP, TFdi and PEF also showed statistically significant indirect effects, whereas EITrA showed a smaller indirect effect and TrA thickness at TLC did not.
CONCLUSIONS: In this cross-sectional study, post-stroke inspiratory muscle weakness was associated with lower PEF and reduced diaphragmatic contractility in exploratory mediation analyses. These findings suggest that spirometric and ultrasound-derived measures capture complementary aspects of respiratory impairment.