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Poor indoor air quality slows down metabolic rate of office workers

Authors:
  • GT Advanced Ltd.

Abstract

A re-analysis of two independent laboratory studies was made in which a total of 60 female subjects had been exposed for several hours to 6 different air quality conditions in groups of 6 people at a time. The subjects performed typical office tasks at their own pace during exposures. Measured carbon dioxide (CO2) concentrations and outdoor air supply rates were used to calculate CO2 produced by subjects at each air quality level. The re-analysis showed that CO2 produced by subjects was affected by air quality (P<0.015). It decreased by ca. 13% when the percentage dissatisfied with the perceived air quality increased from 8% to 40%, indicating a dose-response relationship. A change in breathing pattern (shallow breathing) or a slow down of work rate in polluted air would both reduce metabolic rate and thus the CO2 production rate.
In: Proceedings of Indoor Air 2005, Beijing, China: in press
POOR INDOOR AIR QUALITY SLOWS DOWN METABOLIC RATE OF
OFFICE WORKERS
Zs Bakó-Biró *, P Wargocki, DP Wyon and PO Fanger
International Centre for Indoor Environment and Energy, Technical University of Denmark,
Nils Koppels Alle, Building 402, DK-2800 Kgs. Lyngby, Denmark (www.ie.dtu.dk)
ABSTRACT
A re-analysis of two independent laboratory studies was made in which a total of 60 female
subjects had been exposed for several hours to 6 different air quality conditions in groups of 6
people at a time. The subjects performed typical office tasks at their own pace during
exposures. Measured carbon dioxide (CO2) concentrations and outdoor air supply rates were
used to calculate CO2 produced by subjects at each air quality level. The re-analysis showed
that CO2 produced by subjects was affected by air quality (P<0.015). It decreased by ca. 13%
when the percentage dissatisfied with the perceived air quality increased from 8% to 40%,
indicating a dose-response relationship. A change in breathing pattern (shallow breathing) or
a slow down of work rate in polluted air would both reduce metabolic rate and thus the CO2
production rate.
INDEX TERMS
CO2 emission rate, perceived air quality, building materials, personal computers, metabolic
rate.
INTRODUCTION
The effects of a poor air quality on human comfort and performance of office work have been
investigated in a number of laboratory experiments (Wargocki et al., 1999, Lagercrantz, 2000;
Wargocki et al., 2002, Bakó-Biró et al., 2004). The air pollution level in these studies was
usually altered by placing typical building products, such as used carpets, linoleum floor
coverings, bookshelves with books and papers, sealant, and personal computers (PCs) with
cathode-ray tube (CRT) monitors, into a ventilated office. These interventions negatively
affected the perceived air quality (PAQ) and caused subjects to report an increased intensity
of such symptoms as headache and difficulty in concentrating, and to perform office tasks less
effectively. The carbon dioxide (CO2) concentration measured in the occupied space was
generally lower when the pollution sources were present compared to the unpolluted
conditions, although the outdoor air supply rate and all other environmental parameters were
kept unchanged, but no detailed analysis of this issue was undertaken. In another study,
Wargocki et al., (2000) reported that the metabolic rates, estimated from the CO2 levels and
actual ventilation rates, significantly increased when the outdoor air supply rate, and
consequently the PAQ, was improved in a polluted office. The higher metabolic rate was
attributed to an increased muscular tonus given by the higher work rate that was seen under
the conditions with improved PAQ. It was mentioned that breathing shallowly when air
quality is poor might be what lowered the metabolic rate. The objective of the current paper
was to analyze the CO2 production rates of subjects participating in two independent
* Corresponding author e-mail: zbb@mek.dtu.dk; from 18.04.2005: zbb@reading.ac.uk, School of Construction
Management and Engineering, The University of Reading, Whiteknights, PO Box 219, Reading RG6 6AW,
United Kingdom (www.cme.rdg.ac.uk)
experiments who had been exposed to various air quality conditions in a real office space and to
formulate an alternative hypothesis that may explain the alterations in CO2 levels that have
previously been reported.
METHODS
In two independent experiments, the same approach was used to establish different levels of
air quality: in an office with low-polluting floor, walls and furniture (CEN, 1998) common
building-related products were placed to increase the emission of indoor pollutants. With this
method two air quality conditions were created, one with sources present and one with
sources absent in the office, maintaining a given air change rate. This procedure was repeated
at outdoor air change rate of 1 h-1 and 3 h-1 (i.e. 5 and 15 L/s per person) in the first-, and of 2
h-1 air change rate (10 L/s per person) in the second experiment, obtaining thus 6 different air
quality conditions in the office. All other environmental parameters were kept unchanged.
The pollution sources consisted of linoleum, bookshelf with books and papers, and sealant in
the first experiment, and of PCs with CRT monitors in the second study. In each experiment
30 female subjects were recruited, i.e. a total of 60 subjects were exposed in groups of six
people at a time to the air quality conditions created in the office in 30 sessions (one session
per day, 5 sessions per week) using a balanced design for order of presentation. The exposure
period lasted for ca. 3 and ca. 5 hours in the first and second experiment respectively. During
each exposure the subjects performed simulated office work comprising text typing,
proofreading and arithmetical calculations. They remained thermally neutral by adjusting
their clothing. In each experiment the subjects had roughly the same average body size of 1.7
m2 (±0.1 SD). The office where the experiments were carried out was described in detail by
Wargocki et al. (1999). It was divided by a 2-m-high partition into a space for the equipment
used to supply and condition the outdoor air and for the pollution sources to be placed, and a
space where the subjects were exposed. The air was supplied directly from outdoors by an
axial fan mounted in the window and exhausted under the entrance door to an adjacent
corridor. Several desktop fans ensured good mixing of the pollutants released from the
sources in the office. The air was conditioned by oil-filled electric radiators and ultrasonic
humidifiers. If necessary a SPLIT-type air-conditioner was started to cool the air in the office.
The space used for exposure had six workstations, each consisting of a table, a chair, a desk-
lamp and a 6-year-old low-polluting PC with a sensory pollution strength of 0.3 olf/PC as
quantified by sensory evaluations carried out prior to the experiments.
The methodology of subjective and objective evaluation of air quality, indoor climate, sick
building syndrome (SBS) symptoms and performance were previously described in detail
(Wargocki et al., 2002, Bakó Biro et al., 2004). The perceived air quality was assessed on a
continuous acceptability scale upon entering, during exposure and upon re-entering as visitors
after they had left the office for a few minutes. The latter assessment is the most
representative in terms of air quality to which the subjects were exposed, as the office air
contained both pollution from the sources (when present), and human bioeffluents in what
was effectively a steady-state condition. Among the measured parameters the outdoor air
supply rate and indoor/outdoor concentration of CO2 were used in the present analysis. These
were continuously monitored each day before, during and after the exposures with a Inova
Multi-Gas monitor Type 1302 connected with a Inova Multipoint Sampler and Doser Type
1303. The constant concentration method with sulphur hexafluoride (SF6) as a tracer gas was
used to measure outdoor air supply rate. The sampling of CO2 and tracer gas was taken from
the breathing zone of each subject and from a central location in the occupied space at a
height of 1.1 m to ensure that the air was well mixed. The mean CO2 concentration in the
office was calculated as the average of CO2 concentrations measured at each of these 7
sampling points. Using this value, the outdoor CO2 concentration, and the outdoor air supply
rate, the CO2 production rate was calculated using a mass-balance model. As subjects were
exposed to different air quality conditions in groups of 6 subjects at a time on each exposure
day, the CO2 production rate was calculated separately for each group to take account for
small differences in outdoor air supply rate and CO2 concentration occurring between days for
the same exposure conditions. Dividing the group CO2 production rates by the number of
people in the group yielded an estimate of an average CO2 production rate per person. The
CO2 production rates per person calculated in this way were then used to calculate average
CO2 production rate per person in each of the exposure conditions for the whole group of 30
subjects participating in each of the two experiments. The data regarding air acceptability
were analysed using paired t-test. Wilcoxon matched-pairs test and chi-square statistics were
used to analyze the CO2 emission rates as function of the interventions established in the
office. All p-values are 1-tailed of an effect in the expected direction.
RESULTS
Table 1 shows that the acceptability of air quality was significantly lower (higher %
dissatisfied with air quality) in the presence of pollution sources
Table 1. Acceptability of air quality and % dissatisfied with air quality upon re-entering the
office in each condition (assessed as visitors)
Experiment 1 Experiment 2
air change rate = 1 h-1 air change rate = 3 h-1 air change rate = 2 h-1
Sources
present Sources
absent Sources
present Sources
absent Sources
present Sources
absent
Acceptability 0.03 0.15 0.04 0.42 0.11 0.29
p-value (t-test)* <0.016 <0.0003 <0.01
% dissatisfied 42 28 40 8.4 32 15
* difference between condition with sources present and absent
The average CO2 production rates were lower for almost every group of subjects when the
pollution sources were present compared to the conditions with sources absent, regardless
whether the outdoor air change rate was at 1, 2 or 3 h-1 (Figure 1 – left). The mean values for
30 subjects (Figure 1 – right) indicate a ca. 5% lower CO2 production rate in the office with
sources present compared to the condition with sources absent, at each air change rate. It may
be observed that the differences in the CO2 production rate were not always statistically
significant when applying the Wilcoxon test, as the sample size was relatively small – 5,
which is the number of groups exposed at a given air change rate to the polluted/unpolluted
conditions. The p values from each pair of conditions (sources present/absent, Fig. 1 right)
were combined to calculate an overall probability using the chi-square statistic, under the null
hypothesis that the sum of the Natural logarithms of the observed 1-tail probabilities are
distributed as –0.5·χ2. This analysis yielded a probability of p<0.015, indicating that an
overall hypothesis that CO2 production rates are lower in the presence of sources tested in this
analysis may be accepted.
10
12
14
16
18
20
10 12 14 16 18 20
CO
2
production rate (L/h per person)
Source absent (PD%=15±8)
CO
2
production rate (L/h per person)
Source present (PD%=39±6)
14
15
16
17
18
CO
2
production rate (L/h per person
)
Sources absent Sources present
p<0.06
p<0.03
p<0.15
p<0.015
1 h
-1
buiding mat. 2 h
-1
PCs 3 h
-1
buiding mat.
Figure 1. Left: Average CO2 production rate per person in conditions with sources absent
compared with average CO2 production rate per person in conditions when sources were
present. Each point represent data for the same group of 6 subjects exposed in the office with
sources present and absent ventilated with air change rates of 1, 2 or 3 h-1 (i.e 5, 10 and 15
L/s per person); Right: Average CO2 production rate per person at 6 different air quality
levels created in the office; each bar represents average CO2 production rate per person for
30 subjects exposed calculated from data for 5 groups of 6 subjects each
The average CO2 production rates per person (for 30 subjects exposed in each of the 6
experimental conditions, Fig. 1-right) were regressed against the assessments of acceptability
of air quality in these conditions made immediately upon re-entering the office after exposure
(Table 1) and yielded an approximately linear relationship (R2=0.6; p<0.07). This relationship
is plotted in Figure 2, after acceptability ratings were expressed in % dissatisfied with air
quality (Wargocki, 2004), and suggests that subjects start to produce less carbon dioxide as
the air quality decreases (increased % dissatisfied): a change by 13% when the percentage
dissatisfied with the quality of air changes from 8% to 40%.
14
15
16
17
18
0 102030405060
% Dissatisfied
CO
2
production rate (L/h per person *)
Figure 2: Carbon dioxide production rate per person as a function of the % dissatisfied with
air quality; * each point represents average CO2 production rate per person with an average
body size of 1.7 m2 (±0.1 SD) for 30 subjects; the bars represent standard errors.
DISCUSSION
This meta-analysis of the results of two independent experiments indicates that the pollution
level of inhaled air may significantly affect the CO2 production rate of occupants. This must
be assumed to be due to changes in metabolic rate. It may have a psychological origin,
reflecting people’s unwillingness to work in poor air quality conditions, or it may be due to
intensified SBS symptoms resulting from exposure to indoor pollutants (e.g., headache) that
reduce work rate. The question of how these symptoms are caused then arises. Changes in
breathing pattern may affect the CO2 content of exhaled air: if breathing does not correspond
to metabolic demand, i.e. if the rate at which CO2 is produced at the cellular level is greater
than the rate at which it is exhaled, due to shallow breathing or other dysfunction in the
respiratory system, CO2 concentration in the blood will increase, inducing physiological
effects such as symptoms similar to SBS (Martin, 1987; Paulev, 2000; Resta, 2000). If this
leads to a decrease in work rate, metabolic rate will be reduced and less CO2 will be exhaled.
This hypothesis is a feasible, simple and thus tempting explanation for the high frequency of
occurrence of complaints in so-called “sick buildings” that is commonly reported. Alteration
in the breathing pattern as a result of exposure to environmental chemicals has been reported
not only in mouse bioassays (Larsen et al., 2000) but also in human subjects (Danuser, 2001),
supporting the present hypothesis. Danuser (2001) reviewed a number of studies reporting
perceptual and breathing responses induced by exposure to environmental chemicals. She
pointed out that a decline in tidal volume (the amount of air inhaled per breath) may occur
even in response to stimuli that are not detected by anosmics and which elicit very little
olfactory response in normal individuals. Crucial experiments to investigate these
hypothesized mechanisms are required. CO2 levels in blood will differ depending on which
mechanism, i.e. psychological effects or changes in breathing pattern, is active. Measurements
of End-Tidal CO2 would reveal this difference non-invasively.
CONCLUSIONS AND IMPLICATIONS
The rate of CO2 production by occupants decreased significantly, by about 5%, when they
were exposed to emissions from typical indoor pollution sources, compared to conditions
in which these sources were not present. This effect can be caused by change in the
breathing pattern (shallow breathing) or by a slower work rate in polluted air. Both
changes would cause a reduction in metabolic rate, which may be either the cause or the
effect of reduced performance.
The effects of perceived air quality on the CO2 production rate are expected to be higher
than 5%, following a dose-response relationship. A change in the perceived air quality
level from 8% to 40% may decrease the CO2 production rate and consequently the
metabolic rate by ca. 13%.
The results of the present investigation imply that an adequate ventilation rate in buildings
is not only necessary to comply with human comfort requirements, but also to prevent a
direct negative effect of a mediocre indoor air quality manifested in an alteration of the
breathing pattern that may induce further physiological effects in humans, including
symptoms similar to SBS.
ACKNOWLEDGEMENTS
This work has been supported by the Danish Technical Research Council (STVF) as part of
the research programme of the International Centre for Indoor Environment and Energy
established at the Technical University of Denmark for the period 1998-2007.
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Humans emit carbon dioxide (CO2) as a product of their metabolism. No measurements of CO2 emission rates (CERs) of elderly sleeping people have yet been reported. This study performed such measurements and examined the possible mechanisms impacting CERs. Sixteen participants (8 males) aged ≥65 years old slept alone for a whole night under each of the four conditions in a 2 × 2 design: air temperatures of 27 °C and 30 °C and ventilation rates of 5 m³/h per person and 28 m³/h per person (resulting in an average indoor CO2 concentration of about 1200 ppm and 760 ppm, respectively). Physiological responses were recorded during sleep. Indoor parameters including CO2 concentration were continuously measured during and after sleep period. The CERs were calculated using a mass-balance model. The results show that the average CER was 9.0 ± 1.6 L/h per person. It was ca. 20% higher for males than for females, probably due to higher body mass, body surface area, and longer time awake during sleep. Compared with 27 °C, the CER was about 10% higher at 30 °C probably due to longer time awake and higher heart rate and skin temperature at this condition. No significant differences in CERs were observed between the two ventilation rates. The CERs measured in the present study for elderly are slightly lower than recently reported for young adults and 10–12 year old children. They all provide information required for estimating ventilation rates in bedrooms assuming that the ventilation is achieved with clean outdoor air.
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Accurate prediction of inhaled CO2 concentration and alveolar gas exchange efficiency would improve the prediction of CO2 concentrations around the human body, which is essential for advanced ventilation design in buildings. We therefore, developed a computer‐simulated person (CSP) that included a computational fluid dynamics approach. The CSP simulates metabolic heat production at the skin surface and carbon dioxide (CO2) gas exchange at the alveoli during the transient breathing cycle. This makes it possible to predict the CO2 distribution around the human body. The numerical model of the CO2 gas exchange mechanism includes both the upper and lower airways and makes it possible to calculate the alveolar CO2 partial pressure; this improves the prediction accuracy. We used the CSP to predict emission rates of metabolically generated CO2 exhaled by a person and assumed that the tidal volume will be unconsciously reduced as a result of exposure to poor indoor air quality. A reduction in tidal volume resulted in a decrease in CO2 emission rates of the same magnitude as was observed in our published experimental data. We also observed that the predicted inhaled CO2 concentration depended on the flow pattern around the human body, as would be expected.
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The effects of airborne R-(+)- and S-(-)- limonene were studied in conscious BALB/c mice by continuous monitoring respiratory rate (f), tidal volume (VT) and mid-expiratory flow rate (VD) during an exposure period of 30 min. Both enantiomers decreasedf from a trigeminal reflex, i.e., due to sensory irritation. The exposure concentration decreasing f by 50% (RD50) in the first 10 min of the exposure period was estimated to be 1,076 ppm for R-(+)-limonene and 1,467 ppm for S-(-)-limonene. Results for sensory irritation of R-(+)-limonene in BALB/c mice and humans are in close agreement. The reported sensory irritation threshold is above 80 ppm in humans while the no-observed-effect level was estimated to be 100 ppm in mice. The enantiomers were devoid of pulmonary irritation or general anesthetic effects with R-(+)-limonene < or =1,599 ppm and S-(-)-limonene < or =2,421 ppm. R-(+)-limonene did not influence VT below 629 ppm. S-(-)-limonene increased VT above 1,900 ppm. Both enantiomers induced a mild bronchoconstrictive effect above 1,000 ppm.
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Annoyance due to short-term exposure to airborne chemicals is a key factor in modern environmental research. Unpleasant odors or those that are believed harmful can annoy us. Since annoyance is modulated by the psychological and physiological states of the exposed persons, it is essential that we understand how these factors interact with environmental stimuli to yield a given level of this response. A potentially fruitful approach in this effort may be to treat annoyance as an emotion induced by the odor, and possibly irritation, resulting from chemical exposures. In this way, methods applied to assess induced emotions will likely be of value in elucidating annoyance. A rationale is presented for use of the startle reflex to elucidate the motor component of annoyance, which is manifest as a redirecting of attention towards the annoying odor (or irritant). Although evidence supporting the use of breathing changes to assess the vegetative component of annoyance is somewhat more scattered and indirect, this approach seems likely to be the most fruitful for future research. Experiments to enhance our understanding of annoyance using these two non-verbal end-points are outlined.
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Unlabelled: In groups of six, 30 female subjects were exposed for 4.8 h in a low-polluting office to each of two conditions--the presence or absence of 3-month-old personal computers (PCs). These PCs were placed behind a screen so that they were not visible to the subjects. Throughout the exposure the outdoor air supply was maintained at 10 l/s per person. Under each of the two conditions the subjects performed simulated office work using old low-polluting PCs. They also evaluated the air quality and reported Sick Building Syndrome (SBS) symptoms. The PCs were found to be strong indoor pollution sources, even after they had been in service for 3 months. The sensory pollution load of each PC was 3.4 olf, more than three times the pollution of a standard person. The presence of PCs increased the percentage of people dissatisfied with the perceived air quality from 13 to 41% and increased by 9% the time required for text processing. Chemical analyses were performed to determine the pollutants emitted by the PCs. The most significant chemicals detected included phenol, toluene, 2-ethylhexanol, formaldehyde, and styrene. The identified compounds were, however, insufficient in concentration and kind to explain the observed adverse effects. This suggests that chemicals other than those detected, so-called 'stealth chemicals', may contribute to the negative effects. Practical implications: PCs are an important, but hitherto overlooked, source of pollution indoors. They can decrease the perceived air quality, increase SBS symptoms and decrease office productivity. The ventilation rate in an office with a 3-month-old PC would need to be increased several times to achieve the same perceived air quality as in a low-polluting office with the PC absent. Pollution from PCs has an important negative impact on the air quality, not only in offices but also in many other spaces, including homes. PCs may have played a role in previously published studies on SBS and perceived air quality, where PCs were overlooked as a possible pollution source in the indoor environment. The fact that the chemicals identified in the office air and in the chamber experiments were insufficient to explain the adverse effects observed during human exposures illustrates the inadequacy of the analytical chemical methods commonly used in indoor air quality investigations. For certain chemicals the human senses are much more sensitive than the chemical methods routinely used in indoor air quality investigations. The adverse effects of PC-generated air pollutants could be reduced by modifications in the manufacturing process, increased ventilation, localized PC exhaust, or personalized ventilation systems.
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Unlabelled: Indoor air in non-industrial buildings is polluted by people, their activities, tobacco smoking, heating, ventilation and air-conditioning (HVAC) systems, building and furnishing materials, and electronic equipment. The sensory pollution loads on the air indoors quantified with an olf unit are summarized. They can be used to predict the impact of indoor pollution sources on the perceived air quality. Despite some limitations, they at present seem to be a suitable pragmatic tool for estimating the ventilation requirements for acceptable indoor air quality, based on perceived air quality. Control of pollution sources indoors and the avoidance of superfluous pollution sources is the most effective method to reduce sensory pollution loads in buildings. Practical implications: Data on sensory pollution loads can be used to predict ventilation requirements for acceptable perceived indoor air quality.
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Abstract Perceived air quality, Sick Building Syndrome (SBS) symptoms and productivity were studied in an existing office in which the air pollution level could be modified by introducing or removing a pollution source. This reversible intervention allowed the space to be classified as either non-low-polluting or low-polluting, as specified in the new European design criteria for the indoor environment CEN CR 1752 (1998). The pollution source was a 20-year-old used carpet which was introduced on a rack behind a screen so that it was invisible to the occupants. Five groups of six female subjects each were exposed to the conditions in the office twice, once with the pollution source present and once with the pollution source absent, each exposure being 265 min in the afternoon, one group at a time. They assessed the perceived air quality and SBS symptoms while performing simulated office work. The subject-rated acceptability of the perceived air quality in the office corresponded to 22% dissatisfied when the pollution source was present, and to 15% dissatisfied when the pollution source was absent. In the former condition there was a significantly increased prevalence of headaches (P= 0.04) and significantly lower levels of reported effort (P=0.02) during the text typing and calculation tasks, both of which required a sustained level of concentration. In the text typing task, subjects worked significantly more slowly when the pollution source was present in the office (P=0.003), typing 6.5% less text than when the pollution source was absent from the office. Reducing the pollution load on indoor air proved to be an effective means of improving the comfort, health and productivity of building occupants.
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Air quality was studied in an office space classified as low-polluting and ventilated with outdoor air at a rate of 1 h−1. The pollution load in the space was changed by introducing or removing common building-related indoor pollution sources (linoleum, sealant and wooden shelves with books and paper documents) so that the space could no longer be classified as low-polluting. The outdoor air supply rate in the office was altered from 1 to 3 h−1 (0.83 and 2.5 l/s per m2 floor, respectively) when sources were present and absent. Air temperature of 23 °C, relative humidity of 50% and noise level of 35 dB(A) remained unchanged. Under each of the four conditions of air quality in the office, concentrations of volatile organic compounds (VOCs) were measured and perceived air quality was assessed by a panel of 30 female subjects. Removing the sources reduced the chemical and sensory pollution load in the office, and increasing the outdoor air supply rate decreased concentrations of many VOCs, including those emitted by building materials and furnishing, and human bioeffluents. The perceived air quality in the office was consequently improved. The improvement in air quality obtained by removing the sources was similar to that obtained by increasing the outdoor air supply rate. The study, thus, confirmed that the systematic use of low-polluting building materials will lead to improved air quality.
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The reports on the prevalence of hypercapnia in Obstructive Sleep Apnoea Syndrome (OSAS) are conflicting. We studied the prevalence of hypercapnia in a population of OSAS patients referred to a Department of Respiratory Medicine and the mechanism of the respiratory failure in OSAS associated with Obesity Hypoventilation Syndrome (OHS) or with Chronic Obstructive Pulmonary Disease (COPD) (Overlap syndrome). We studied 219 consecutive OSAS patients during a period of 3 years. We recorded age and anthropomorphic data and performed polysomnography and pulmonary function tests. In relation to the value of PaCO(2), the patients were divided in hypercapnic (PaCO(2)>45 mmHg) patients and normocapnic patients. They were also divided into three groups in relation to the presence of "simple" or "pure" OSAS, to the presence of OSAS associated with COPD, to the presence of OSAS associated with OHS. Seventeen per cent of the patients were hypercapnic. They were significantly heavier, had more severe lung function test abnormalities and more severe nocturnal oxyhemoglobin desaturations than the normocapnic ones, while Forced Expiratory Volume in one second as a percentage of Forced Vital Capacity (FEV1/FVC %) and Apnoea/Hypopnoea Index (AHI) were similar. OHS patients (13%) were significantly younger and heavier, had lower PaO(2) and higher PaCO(2) than "simple" OSAS patients (77%) and Overlap patients (10%) and had more severe restrictive defect. There was no difference in terms of AHI among the three groups, but nocturnal oxyhemoglobin desaturations were more severe in OHS group. In OHS group hypercapnia was correlated to FVC% of predicted and FEV1% of predicted and to the mean nocturnal oxyhemoglobin saturation; in Overlap patients PaCO(2) was correlated to Forced Expiratory Flow rate at low Vital Capacity. Seventeen per cent of OSAS patients referred to a Department of Respiratory Medicine were hypercapnic. Hypercapnia in OHS patients correlates to the restrictive ventilatory defect whereas in Overlap patients it seems to correlate to peripheral airways obstruction. The distinction between patients with "simple" or "pure" OSAS and patients affected by OSAS associated with OHS or COPD could be important not only for clinical and prognostic implications, but also for the consequences in terms of ventilatory treatment.
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Perceived air quality, Sick Building Syndrome (SBS) symptoms and productivity were studied in a normally furnished office space (108 m3) ventilated with an outdoor airflow of 3, 10 or 30 L/s per person, corresponding to an air change rate of 0.6, 2 or 6 h-1. The temperature of 22 degrees C, the relative humidity of 40% and all other environmental parameters remained unchanged. Five groups of six female subjects were each exposed to the three ventilation rates, one group and one ventilation rate at a time. Each exposure lasted 4.6 h and took place in the afternoon. Subjects were unaware of the intervention and remained thermally neutral by adjusting their clothing. They assessed perceived air quality and SBS symptoms at intervals, and performed simulated normal office work. Increasing ventilation decreased the percentage of subjects dissatisfied with the air quality (P < 0.002) and the intensity of odour (P < 0.02), and increased the perceived freshness of air (P < 0.05). It also decreased the sensation of dryness of mouth and throat (P < 0.0006), eased difficulty in thinking clearly (P < 0.001) and made subjects feel generally better (P < 0.0001). The performance of four simulated office tasks improved monotonically with increasing ventilation rates, and the effect reached formal significance in the case of text-typing (P < 0.03). For each two-fold increase in ventilation rate, performance improved on average by 1.7%. This study shows the benefits for health, comfort and productivity of ventilation at rates well above the minimum levels prescribed in existing standards and guidelines. It confirms the results of a previous study in the same office when the indoor air quality was improved by decreasing the pollution load while the ventilation remained unchanged.
Textbook in Medical Physiology and Pathophysiology " Copenhagen
  • P E Paulev
Paulev, P. E. (2000) " Textbook in Medical Physiology and Pathophysiology " Copenhagen, ISBN 87-984078-0-5; http://www.mfi.ku.dk/ppaulev/content.htm.