Respiratory muscle weakness after stroke: An exploratory mediation analysis of associated factors - 19/05/26
Abstract |
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 (TF di ), transversus abdominis thickening fraction, and echo intensity (EI). Pulmonary function (forced vital capacity [FVC], forced expiratory volume in 1 s [FEV 1 ], 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 TF di and transversus abdominis thickening fraction, along with higher echo intensity. Mediation analyses indicated that PEF (% predicted) and TF di were significant mediators in the association between stroke status and lower %MIP. TF di 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.
Le texte complet de cet article est disponible en PDF.Graphical abstract |
Highlights |
• | Stroke reduces lung function and respiratory muscle strength. |
• | Peak expiratory flow was associated with indirect effects consistent with mediation of 48.4% of inspiratory weakness. |
• | Diaphragm thickening fraction explains 14% of MIP reduction. |
• | Abdominal muscle parameters show limited mechanistic role. |
• | Combined spirometry and ultrasound improve clinical assessment. |
Keywords : Cerebrovascular disease, Skeletal muscle, Muscle strength, Ultrasound imaging, Echo intensity
Plan
Vol 257
Article 108842- juin 2026 Retour au numéro
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