Lateral pharyngoplasty reduces nocturnal blood pressure in patients with obstructive sleep apnea.

OBJECTIVES/HYPOTHESIS: To compare the values of 24-hour ambulatory blood pressure monitoring (ABPM) in patients with obstructive sleep apnea (OSA), before and after lateral pharyngoplasty, and to investigate the influence of pre- and post-treatment polysomnographic and anthropometric variations on changes in ABPM. STUDY DESIGN: Prospective study. METHODS: Arterial blood pressure with 24-hour ABPM and nocturnal polysomnography were measured before and 6 months after surgery in 18 consecutively evaluated adults with OSA at a tertiary center. RESULTS: A total of 83.3% were normotensive patients. Nocturnal measurements showed a decrease of 5.3 mmHg in mean arterial pressure (MAP; P = .01), 7.4 mmHg in mean arterial systolic pressure (SP; P = .006), and 4.2 mmHg in mean arterial diastolic pressure (DP; P = .03), leading to significant reductions in all 24-hour measurements: 3.6 mmHg in MAP, 4.8 mmHg in SP, and 2.9 mmHg in DP. There were also significant mean reductions in the apnea-hypopnea index (AHI), from 33.5 to 20.9 (P = .02), arousal index, from 31.6 to 16.7 (P = .005), and percentage of total sleep time with oxyhemoglobin saturation < 90%, from 10.6% to 0.9% (P = .008). No correlations were noted between the measurements of arterial blood pressure and polysomnographic or anthropometric variations. CONCLUSIONS: In this small case series, lateral pharyngoplasty reduced the values obtained in the 24-hour ABPM due to a significant reduction of blood pressures during sleep in patients with OSA 6 months after surgery. Although the patients presented with reductions in AHI, arousals, and desaturation time, this was not correlated with the improvement in arterial blood pressure.

Avaliação da massa ventricular esquerda em hipertensos com tolerância à glicose diminuída / Evaluation of left ventricular mass in hypertensive patients with decreased glucose tolerance

Fundamentos: cresce em importância a relação entre níveis glicêmicos aumentados, porém não diabéticos (tolerância à glicose diminuída - TGD), fator de risco cardiovascular e hipertrofia ventricular esquerda (HVE). Objetivo: avaliar a massa do ventrículo esquerdo (MVE) em pacientes hipertensos sob tratamento ambulatorial e com TGD. Materiais e métodos: foram avaliados 358 pacientes hipertensos (com média de idade 59 ± 11 anos), divididos em três grupos: grupo I (hipertensos); grupo II (hipertensos com TGD) e grupo III (hipertensos com diabetes tipo 2). Em todos os pacientes foi realizado o ecocardiograma e utilizada a fórmula de Devereux para o cálculo da massa do ventrículo esquerdo (MVE). Para o índice de MVE (IMVE) foram considerados valores normais de até 89 e 103 g/m² para mulheres e homens, respectivamente. Utilizou-se o teste estatístico ANOVA complementado pelo teste de Tukey e Bonferroni para detectar diferenças entre os grupos. Resultados: a média do IMVE foi de 110,2 ± 33,0; 117,6 ± 30,1 e 128,0 ± 46,8 g/m² nos grupos I, II e III, respectivamente, sendo que 65,1% (grupo I), 74,6% (grupo II) e 80,5% (grupo III) dos pacientes apresentaram aumento do IMVE. Não houve diferença estatística no aumento de IMVE entre os grupos I e II, mas foi significantemente maior no grupo III, quando comparado com o grupo I. Conclusões: o grupo dos pacientes hipertensos com TGD (grupo II) não apresentou aumento de MVE estatisticamente significante em relação aos não intolerantes (grupo I) e o grupo de pacientes hipertensos e diabéticos apresentou aumento significante da MVE em relação ao grupo de hipertensos (grupo I).

Background: It is growing in importance the correlation between elevated glycemic levels (impaired glucose tolerance) but no overt diabetes and the risk factor of cardiovascular disease and increased cardiac mass. Objective: We sought to determine the left ventricular mass (LVM) in hypertensive patients under treatment and with impaired glucose tolerance (IGT). Materials and methods: 358 patients were evaluated (mean age 59 ± 11 years) separated in three groups: group I (hypertension); group II (hypertension and IGT) and group III (hypertension and diabetes mellitus 2). Echocardiograms were performed in all patients and the left ventricular mass index (LVMI) was calculated using the Devereux's criteria and values greater than 110 and 134 g/m² for women and man, respectively, were considered for left ventricular hypertrophy. The statistic methods ANOVA together with Tukey and Bonferroni tests were executed to detect differences among groups. Results: 110,2 ± 33,0; 117,6 ± 31,0 and 128,0 ± 46,8 g/m² were the mean of LVMI for groups I, II and III, respectively. The increasing of LVM was 65,1% (group I), 74,6% (group II) and 80,5% (group III). There was not statistic difference between groups I and II in relation to increasing of LVMI, but it was significantly greater in group III. Conclusions: The increasing of LVMI was not observed in the impaired glucose tolerance hypertensive patients when compared with normoglycemic hypertensive patients and the increasing of LVMI was significant in diabetic hypertensive patients.

Effects of 24-h shift work in the emergency room on ambulatory blood pressure monitoring values of medical residents.

BACKGROUND: Medical residency is marked by long work hours and shift work. The acute effects of these factors on the blood pressure (BP) of medical residents have not been adequately evaluated. METHODS: A total of 61 medical residents underwent to ambulatory blood pressure monitoring (ABPM) during a 24-h shift work in the emergency room (ER) and during a common working day. RESULTS: Both mean 24-h systolic and diastolic BP (DBP) and mean diastolic BP readings during sleep were higher during the 24-h shift work in the ER than during common working day (117 v 113 mm Hg, P < .05; 73 v 69 mm Hg, P < .05; and 61 v 58 mm Hg, P < .05, respectively). Abnormally high mean BP readings were more frequent during the 24-h shift work in the ER than in common working day (19 v 8, P < .05). Pressure load, nocturnal BP fall and pulse pressure values were similar in these two different working situations. CONCLUSION: Working in the ER on a 24-h shift leads to abnormal BP behavior in medical residents, thus suggesting that this type of work may be a risk factor for cardiovascular disease.

Electrocardiographic abnormalities in neurological diseases.

OBJECTIVE: To evaluate electrocardiographic abnormalities in patients with neurologic diseases. METHODS: We studied 161 patients with neurologic disorders by analyzing the 12-lead electrocardiogram during the pathological process. An expert who did not know anything about the patients evaluated the traces. RESULTS: Neurological process included brain tumor (41%), stroke (27.3%), cerebral aneurysm (15.5%), subarachnoid hemorrhage (6.8%), subdural hemorrhage (5%), and head injury (4.4%). Electrocardiograms were normal in 61% of cases, and the most frequent abnormality was ventricular repolarization (23.7%). The presence of T waves (4.6%) and prolonged QT intervals (8.8%) was the most characteristic of brain injuries. CONCLUSION: We observed a lower incidence of electrocardiographic abnormalities than that described in the literature.

Alterações eletrocardiográficas nas doenças neurológicas / Electrocardiographic abnormalities in neurological diseases

OBJECTIVE: To evaluate electrocardiographic abnormalities in patients with neurologic diseases. METHODS: We studied 161 patients with neurologic disorders by analyzing the 12-lead electrocardiogram during the pathological process. An expert who did not know anything about the patients evaluated the traces. RESULTS: Neurological process included brain tumor (41 percent), stroke (27.3 percent), cerebral aneurysm (15.5 percent), subarachnoid hemorrhage (6.8 percent), subdural hemorrhage (5 percent), and head injury (4.4 percent). Electrocardiograms were normal in 61 percent of cases, and the most frequent abnormality was ventricular repolarization (23.7 percent). The presence of T waves (4.6 percent) and prolonged QT intervals (8.8 percent) was the most characteristic of brain injuries. CONCLUSION: We observed a lower incidence of electrocardiographic abnormalities than that described in the literature