Diagnostic accuracy of the Voluntary Breath-Hold Test to
discriminate normal vs. abnormal spirometry:
a two-gate study

Gustavo Périssé Moreira Veras; Amanda Périssé Maia Veras; Thiago Prudente Bartholo; Agnaldo José Lopes; Claudia Henrique da Costa; Rogerio Rufino

doi:10.1016/j.bjane.2026.844737

Original Investigation

Diagnostic accuracy of the Voluntary Breath-Hold Test to discriminate normal vs. abnormal spirometry: a two-gate study

Acurácia diagnóstica do Teste de Apneia Voluntária para discriminar espirometria normal vs. anormal: estudo de dois espectros

Gustavo Périssé Moreira Veras, Amanda Périssé Maia Veras, Thiago Prudente Bartholo, Agnaldo José Lopes, Claudia Henrique da Costa, Rogerio Rufino

http://dx.doi.org/10.1016/j.bjane.2026.844737 Braz J Anesthesiol, vol.76, n3, 844737, 2026

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Abstract

Introduction

The Voluntary Breath-Hold Test (VBHT) is a simple, bedside, and rapid assessment that measures the duration of voluntary apnea. It has shown potential for clinical use, including as a triage tool prior to spirometry in primary care. However, its diagnostic accuracy in detecting abnormal pulmonary function before non-thoracic surgeries has not been established. This study aimed to determine the correlation between VBHT results, Maximal Voluntary Apnea Inspiratory Time (MVAIT) and Maximal Voluntary Apnea Expiratory Time (MVAET), and spirometry, the reference test for assessing pulmonary function.

Methods

This diagnostic-accuracy study included adults with normal spirometry and those with obstructive or restrictive ventilatory defects. Participants were divided into normal and abnormal spirometry groups. Maximal Voluntary Apnea Inspiratory Time (MVAIT) and Expiratory Time (MVAET) were evaluated using Receiver Operating Characteristic (ROC) curve analysis to assess their accuracy in distinguishing between normal and abnormal spirometry patterns.

Results

The study included 293 participants. MVAIT and MVAET were significantly lower for the abnormal (median: 29.32 s; 95% Confidence Interval [95% CI]: 25.99‒32.35 s and median: 20.40 s; 95% CI: 18.66‒22.88 s) than for the normal (median: 47.55 s; 95% CI: 43.93‒51.87 s and median: 28.53 s; 95% CI: 26.74‒30.63 s) group. For the prediction of normal spirometry, MVAIT ≥ 45.49 s and MVAET ≥ 32.86 s had sensitivity and specificity of (90.43%, 55.06%) and (90.43%, 33.71%), respectively.

Conclusion

VBHT is a bedside, low-cost, and safe method that shows moderate-to-good discriminative ability for identifying abnormal spirometry results. As an innovative adaptation of a long-known physiological maneuver, VBHT may serve as a rapid preliminary triage (rule-out) tool prior to formal spirometry, pending external validation in preoperative populations.

CTRI Register Number - ReBEC (Registro Brasileiro de Ensaios Clínicos)

RBR-8hknmn.

Keywords

Breath holding; Diagnostic accuracy; Pulmonary function; Respiratory function tests; Screening; Spirometry

Resumo

Introdução

O Teste de Apneia Voluntária (Voluntary Breath-Hold Test — VBHT) é uma avaliação simples, à beira-leito e rápida que mede a duração da apneia voluntária. Ele tem mostrado potencial para uso clínico, incluindo como ferramenta de triagem antes da espirometria na atenção primária. No entanto, sua acurácia diagnóstica na detecção de função pulmonar anormal antes de cirurgias não torácicas ainda não foi estabelecida. Este estudo teve como objetivo determinar a correlação entre os resultados do VBHT, o Tempo Inspiratório Máximo de Apneia Voluntária (Maximal Voluntary Apnea Inspiratory Time — MVAIT) e o Tempo Expiratório Máximo de Apneia Voluntária (Maximal Voluntary Apnea Expiratory Time — MVAET), e a espirometria, teste de referência para avaliação da função pulmonar.

Métodos

Este estudo de acurácia diagnóstica incluiu adultos com espirometria normal e indivíduos com defeitos ventilatórios obstrutivos ou restritivos. Os participantes foram divididos em grupos de espirometria normal e anormal. O MVAIT e o MVAET foram avaliados por meio de análise de curva ROC (Receiver Operating Characteristic) para determinar sua acurácia na diferenciação entre padrões espirométricos normais e anormais.

Resultados

O estudo incluiu 293 participantes. O MVAIT e o MVAET foram significativamente menores no grupo anormal (mediana: 29,32 s; IC 95%: 25,99–32,35 s e mediana: 20,40 s; IC 95%: 18,66–22,88 s) do que no grupo normal (mediana: 47,55 s; IC 95%: 43,93–51,87 s e mediana: 28,53 s; IC 95%: 26,74–30,63 s). Para predição de espirometria normal, MVAIT ≥ 45,49 s e MVAET ≥ 32,86 s apresentaram sensibilidade e especificidade de (90,43%, 55,06%) e (90,43%, 33,71%), respectivamente.

Conclusão

O VBHT é um método à beira-leito, de baixo custo e seguro que apresenta capacidade discriminativa moderada a boa para identificar resultados anormais na espirometria. Como uma adaptação inovadora de uma manobra fisiológica já conhecida, o VBHT pode servir como ferramenta rápida de triagem inicial (regra de exclusão) antes da espirometria formal, aguardando validação externa em populações pré-operatórias.

Registro Brasileiro de Ensaios Clínicos – ReBEC

RBR-8hknmn.

Palavras-chave

Apneia; Acurácia diagnóstica; Função pulmonar; Testes de função respiratória; Rastreamento; Espirometria

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Submitted date:
20/05/2025

Accepted date:
29/01/2026