Prehabilitation in Colorectal Cancer Surgery: A Narrative Review of Current Evidence and Clinical Perspectives.
Authors: Zierkiewicz D, Manulik S, Chudiak A, Krówczyńska D, Homola W, Pobrotyn P, Wioletta J, Głowacka M, Paprocka-Borowicz M, Chabowski M
Journal: Nutrients
depression treatment
mental health
open access
Abstract
Neuromuscular diseases (NMDs) encompass a group of disorders that affect upper and lower motor neurons, peripheral nerves (including hereditary and acquired neuropathies), the neuromuscular junction (such as myasthenia gravis and congenital myasthenia), and/or muscles (including myopathies and dystrophies).
They are characterized by progressive muscle weakness—often severe proximal weakness, muscle atrophy, and wasting—leading to loss of ambulation, major gait impairment, contractures, and progressive scoliosis; prominent bulbar impairment causes dysphagia, dysarthria, and recurrent aspiration, while respiratory muscle compromise manifests as nocturnal hypoventilation, orthopnea, and respiratory failure.
Most NMDs are considered rare, with a prevalence of less than 50 per 100,000. Restrictive respiratory impairment reflects diminished lung expansion from reduced respiratory system compliance or inspiratory capacity, with hallmark reductions in lung volumes—principally total lung capacity (TLC) and forced vital capacity (FVC). In NMDs, restriction is predominantly extrinsic, secondary to respiratory muscle weakness that limits diaphragmatic descent and chest wall excursion, producing proportional declines in TLC and FVC, reduced maximal inspiratory and expiratory pressures, diminished sniff nasal pressure and peak cough flow, and progressive nocturnal hypoventilation with hypercapnia.
Clinically significant sequelae include exertional dyspnea, orthopnea, ineffective cough with retained secretions, and recurrent atelectasis, which mandate periodic lung–volume and respiratory–muscle testing, nocturnal oximetry, and early consideration of noninvasive ventilatory support. Patients with NMDs also have a high incidence of sleep-related breathing disorders (SRBDs),
including obstructive sleep apnea (OSA), central sleep apnea (CSA), and nocturnal hypoventilation (NH). Due to the association of these disorders with typical restrictive respiratory impairment, both OSA and NH are frequent in these patients.
Additionally, studies suggest that OSA may be more prevalent in individuals with NMDs than in the general population.
They are characterized by progressive muscle weakness—often severe proximal weakness, muscle atrophy, and wasting—leading to loss of ambulation, major gait impairment, contractures, and progressive scoliosis; prominent bulbar impairment causes dysphagia, dysarthria, and recurrent aspiration, while respiratory muscle compromise manifests as nocturnal hypoventilation, orthopnea, and respiratory failure.
Most NMDs are considered rare, with a prevalence of less than 50 per 100,000. Restrictive respiratory impairment reflects diminished lung expansion from reduced respiratory system compliance or inspiratory capacity, with hallmark reductions in lung volumes—principally total lung capacity (TLC) and forced vital capacity (FVC). In NMDs, restriction is predominantly extrinsic, secondary to respiratory muscle weakness that limits diaphragmatic descent and chest wall excursion, producing proportional declines in TLC and FVC, reduced maximal inspiratory and expiratory pressures, diminished sniff nasal pressure and peak cough flow, and progressive nocturnal hypoventilation with hypercapnia.
Clinically significant sequelae include exertional dyspnea, orthopnea, ineffective cough with retained secretions, and recurrent atelectasis, which mandate periodic lung–volume and respiratory–muscle testing, nocturnal oximetry, and early consideration of noninvasive ventilatory support. Patients with NMDs also have a high incidence of sleep-related breathing disorders (SRBDs),
including obstructive sleep apnea (OSA), central sleep apnea (CSA), and nocturnal hypoventilation (NH). Due to the association of these disorders with typical restrictive respiratory impairment, both OSA and NH are frequent in these patients.
Additionally, studies suggest that OSA may be more prevalent in individuals with NMDs than in the general population.