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1.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 29(2): 155-159, abr.-jun. 2019. ilus, graf
Artigo em Português | LILACS | ID: biblio-1009492

RESUMO

A apneia obstrutiva do sono (AOS) é uma condição prevalente, que tem sido associada com diversas consequências cardiovasculares, sendo a hipertensão arterial a mais bem descrita. Entretanto, doença arterial coronariana, arritmias cardíacas, acidente vascular cerebral e risco aumentado de mortalidade cardiovascular têm sido descritos na literatura em populações clínicas e na população geral, com diferentes níveis de evidência. Ressaltamos também a maior prevalência de AOS em pacientes com doenças cardiovasculares estabelecidas, possivelmente explicada pela coexistência de fatores de risco comuns tais como a idade, o sexo masculino e o sobrepeso/obesidade. Neste artigo discutiremos brevemente a associação de AOS e cada uma dessas condições clínicas, bem como o que há de evidência até o momento para o efeito do tratamento da AOS com a pressão positiva contínua de vias aéreas (CPAP) na prevenção dos desfechos cardiovasculares e mortalidade


Obstructive sleep apnea (OSA) is a prevalent condition that has been associated with several cardiovascular sequelae, among which hypertension is the best documented condition. However, coronary artery disease, cardiac arrhythmias, stroke and increased risk for cardiovascular mortality have been described in the literature in both the general population and in clinical settings, with different levels of evidence. We also emphasize the higher prevalence of OSA in patients with established cardiovascular disease, possibly due to the coexistence of common risk factors such as age, male sex and overweight/obesity. In this article we will briefly discuss the association of OSA and each of these clinical conditions, as well as the current evidence for the effect of OSA treatment with continuous positive airway sure (CPAP) on the prevention of cardiovascular outcomes and mortality


Assuntos
Humanos , Masculino , Feminino , Doenças Cardiovasculares , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/diagnóstico , Arritmias Cardíacas , Fibrilação Atrial , Bradicardia , Fatores Sexuais , Prevalência , Fatores de Risco , Fatores Etários , Átrios do Coração , Ventrículos do Coração , Hipertensão
2.
Surg Obes Relat Dis ; 15(2): 211-217, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30679036

RESUMO

BACKGROUND: Although Roux-en-Y gastric bypass (RYGB) results in significant weight loss and cardiometabolic risk factors improvements; there is no consensus whether limb lengths may influence these results. OBJECTIVE: To evaluate the correlations between the common limb length (CLL) and hypertension remission rate, cardiometabolic risk factors, and nutritional parameters after RYGB. SETTINGS: Private Hospital, Brazil. METHODS: GATEWAY is a randomized trial designed to evaluate the efficacy of RYGB on hypertension improvement and other cardiometabolic risk factors in patients with grade I and II obesity compared with medical therapy. The follow-up was 1 year. We measured the entire bowel in all patients and used a 150-cm alimentary limb and a 100-cm biliopancreatic limb. Univariate logistic regression was used to estimate the relationship between CLL and hypertension remission. Pearson and Spearman correlation were used to evaluate the correlation between the CLL and the percentage changes of cardiometabolic risk factors and nutritional parameters. RESULTS: From 100 randomized patients, 45 were submitted to RYGB and completed the follow-up. Mean CLL was 466.3 ± 86.4 cm. Of patients, 55.6% from the RYGB group showed remission of hypertension. CLL length was not significantly associated with hypertension remission (odds ratio [95% confidence interval] for 50 units increase in CLL: .97 [.68; 1.38], P = .88). Consistently, we found no correlations between CLL and all changes in cardiometabolic risk factors and nutritional parameters. CONCLUSIONS: In a proximal RYGB, CLL does not influence hypertension remission, cardiometabolic risk factors, and nutritional parameters.

3.
Can J Cardiol ; 34(12): 1641-1647, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30527153

RESUMO

BACKGROUND: Heated water-based exercise (HEx) promotes a marked reduction of blood pressure (BP), but it is not entirely clear whether its effects on BP persist after cessation of HEx. METHODS: We analyzed the effects of cessation of HEx on 24-hour ambulatory BP monitoring (ABPM) in patients with resistant hypertension (RH). Thirty-two patients (aged 53 ± 6 years) with RH (4 to 6 antihypertensive drugs) were randomly assigned to HEx (n = 16) or control (n = 16) groups. Antihypertensive therapy remained unchanged during the protocol. The HEx group participated in 36 sessions (60 minutes) in a heated pool (32oC [89.6°F]) for 12 weeks (training), followed by 12 weeks of cessation of training. The control group was evaluated during the same period and instructed to maintain their habitual activities. RESULTS: HEx and control groups had similar BP levels at baseline. HEx training reduced the 24-hour systolic (-19.5 ± 4.6 vs 3.0 ± 0.7 mm Hg, P = 0.001) and diastolic BP (-11.1 ± 2.4 vs 2.06 ± 0.9 mm Hg, P = 0.001) at week 12, compared with the control group. After 12 weeks of training cessation (week 24), 24-hour BP remained significantly lower in the HEx group than in the control group (-9.6 ± 3.8 vs 6.3 ± 3.5 mm Hg, P = 0.01 and -7.5±2.2 vs 2.2 ± 1.0 mm Hg, P = 0.009, for systolic and diastolic BP, respectively), although these differences were attenuated. CONCLUSIONS: BP remained lower after cessation of 12-week training among patients with RH who underwent HEx compared with the controls. The carryover effects of HEx on BP may help to overcome the challenging problem of exercise compliance in long-term follow-up.


Assuntos
Terapia por Exercício , Temperatura Alta/uso terapêutico , Hipertensão/terapia , Água , Anti-Hipertensivos/uso terapêutico , Resistência a Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio
4.
Arq Bras Cardiol ; 109(3 Supl 1): 1-104, 2017.
Artigo em Inglês, Português | MEDLINE | ID: mdl-29044300
5.
Arq. bras. cardiol ; 109(3,supl.1): 1-104, Sept. 2017. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-887936
6.
Clinics (Sao Paulo) ; 72(7): 411-414, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28793000

RESUMO

OBJECTIVE:: The purpose of this study was to evaluate the association between the presence of clinical symptoms of peripheral artery disease and severe renal artery stenosis in patients referred for renal angiography. METHOD:: We included 82 patients with clinical suspicion of renovascular hypertension and performed an imaging investigation (renal Doppler ultrasound and/or renal scintigraphy) for possible renal artery stenosis. All patients underwent renal arteriography and were examined for peripheral artery disease based on the presence of intermittent claudication and ankle-brachial index test results. Severe renal artery stenosis was defined as a lesion causing 70% obstruction. RESULTS:: Severe renal artery stenosis was present in 32 of 82 (39%) patients. Patients with severe renal artery stenosis were older (63±12 vs 56±12 years, p=0.006), had more intermittent claudication (55 vs 45%, p=0.027), and had a greater prevalence of an ankle-brachial index <0.9 (44% vs 20%, p=0.021) than patients without severe renal artery stenosis. Multivariate logistic regression analysis showed that the presence of intermittent claudication was independently associated with renal artery stenosis ≥70% (OR: 3.33; 95% CI 1.03-10.82, p=0.04), unlike the ankle-brachial index, which showed no association (OR: 1.44; 95% CI 0.37-5.66, p=0.60). CONCLUSION:: Intermittent claudication is independently associated with severe renal artery stenosis (≥70%) in patients clinically suspected of having renovascular hypertension.


Assuntos
Hipertensão Renovascular/complicações , Claudicação Intermitente/complicações , Obstrução da Artéria Renal/complicações , Artéria Renal/diagnóstico por imagem , Angiografia , Feminino , Humanos , Hipertensão Renovascular/diagnóstico por imagem , Claudicação Intermitente/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Cintilografia , Obstrução da Artéria Renal/diagnóstico por imagem , Índice de Gravidade de Doença , Ultrassonografia Doppler
7.
Clinics ; 72(7): 411-414, July 2017. tab
Artigo em Inglês | LILACS | ID: biblio-890712

RESUMO

OBJECTIVE: The purpose of this study was to evaluate the association between the presence of clinical symptoms of peripheral artery disease and severe renal artery stenosis in patients referred for renal angiography. METHOD: We included 82 patients with clinical suspicion of renovascular hypertension and performed an imaging investigation (renal Doppler ultrasound and/or renal scintigraphy) for possible renal artery stenosis. All patients underwent renal arteriography and were examined for peripheral artery disease based on the presence of intermittent claudication and ankle-brachial index test results. Severe renal artery stenosis was defined as a lesion causing 70% obstruction. RESULTS: Severe renal artery stenosis was present in 32 of 82 (39%) patients. Patients with severe renal artery stenosis were older (63±12 vs 56±12 years, p=0.006), had more intermittent claudication (55 vs 45%, p=0.027), and had a greater prevalence of an ankle-brachial index <0.9 (44% vs 20%, p=0.021) than patients without severe renal artery stenosis. Multivariate logistic regression analysis showed that the presence of intermittent claudication was independently associated with renal artery stenosis ≥70% (OR: 3.33; 95% CI 1.03-10.82, p=0.04), unlike the ankle-brachial index, which showed no association (OR: 1.44; 95% CI 0.37-5.66, p=0.60). CONCLUSION: Intermittent claudication is independently associated with severe renal artery stenosis (≥70%) in patients clinically suspected of having renovascular hypertension.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Hipertensão Renovascular/complicações , Claudicação Intermitente/complicações , Obstrução da Artéria Renal/complicações , Artéria Renal/diagnóstico por imagem , Angiografia , Hipertensão Renovascular/diagnóstico por imagem , Claudicação Intermitente/diagnóstico por imagem , Cintilografia , Obstrução da Artéria Renal/diagnóstico por imagem , Índice de Gravidade de Doença , Ultrassonografia Doppler
8.
In. Soeiro, Alexandre de Matos; Leal, Tatiana de Carvalho Andreucci Torres; Oliveira Junior, Múcio Tavares de; Kalil Filho, Roberto. Manual da condutas da emergência do InCor: cardiopneumologia / IInCor Emergency Conduct Manual: Cardiopneumology. São Paulo, Manole, 2ª revisada e atualizada; 2017. p.780-787.
Monografia em Português | LILACS | ID: biblio-848519
9.
Rev. bras. hipertens ; 23(1): 2-7, jan.-mar.2016.
Artigo em Português | LILACS | ID: biblio-881165

RESUMO

A meta ideal para controle da pressão arterial tem sido amplamente discutida ao longo de décadas, sendo objetivo principal de diversos estudos. Se por um lado há os trabalhos que reforçam a importância de um controle mais rigoroso da pressão arterial para diminuir desfechos cerebrais ou cardiovasculares, de outro, aqueles que não demonstraram isso advogam a já tradicional meta da pressão arterial sistólica (PAS), inferior a 140mmHg. Tal controvérsia pode ser explicada pelo grupo de pacientes estudados, pelo maior ou menor poder estatístico do estudo, e pelos desfechos definidos como primários. Dentre esses estudos, especificamente nos pacientes com alto risco cardiovascular, destacam-se o ACCORD BP realizado somente com diabéticos e o SPRINT, realizado com pacientes de alto risco, porém sem diabetes e acidente vascular cerebral (AVC) prévio. Ambos foram ensaios clínicos randomizados e controlados, que compararam desfechos cardiovasculares ocorridos em grupos com controle intensivo da pressão arterial (PAS<120 mmHg) versus controle padrão (PAS<140 mmHg). Enquanto o estudo ACCORD BP não mostrou benefício frente ao controle intensivo, exceto pelo desfecho cerebral (um desfecho secundário), o SPRINT mostrou eventos significativamente menores nesse grupo, sendo inclusive interrompido precocemente. Além do delineamento, ambos os estudos são similares por se tratarem de pacientes de alto risco. Ao mesmo tempo, são diferentes pela exclusão de pacientes com AVC prévio e diabetes no SPRINT, enquanto pela não inclusão da insuficiência cardíaca nos desfechos primários do ACCORD BP. O objetivo desta presente revisão é justamente destacarmos esses pontos que, embora inicialmente controversos, nos permitirá concluir que metas distintas são necessárias para grupos populacionais distintos


The ideal target for blood pressure has been widely discussed for decades in several studies. If on one hand there are observational studies that reinforce the importance of a more rigorous blood pressure control to decrease cerebrovascular and cardiovascular outcomes, on the other hand, those investigations which have not shown these findings reinforce the already traditional systolic blood pressure (SBP) target of less than 140mmHg. This controversy can be explained by differences in the characteristics of patients included in the studies, the statistical power of the studies and differences in primary outcomes. Among these studies, particularly in patients with high cardiovascular risk, we highlight ACCORD BP, performed only in diabetic patients, and the SPRINT trial, carried out in high-risk patients without diabetes and no previous stroke. Both were randomized controlled trials that compared cardiovascular outcomes in patients with intensive blood pressure control (SBP<120 mmHg) versusstandard blood pressure control (SBP<140 mmHg). While the ACCORD BP study showed no benefit in intensive blood pressure control, except by stroke outcome (a secondary outcome), the SPRINT showed significantly lower events in patients randomized to intensive blood pressure control. In relation to the design, both studies are similar because they included high-risk patients. At the same time, they are different by excluding patients with previous stroke and diabetes in the SPRINT Trial, while the ACCORD BP did not include heart failure in the primary outcomes. The aim of this review is to discuss these important issues. Although controversial, both studies allow us to conclude that different goals are needed for different population subgroups.


Assuntos
Estudos Clínicos como Assunto , Hipertensão
10.
In. Kalil Filho, Roberto; Fuster, Valetim; Albuquerque, Cícero Piva de. Medicina cardiovascular reduzindo o impacto das doenças / Cardiovascular medicine reducing the impact of diseases. São Paulo, Atheneu, 2016. p.443-450.
Monografia em Português | LILACS | ID: biblio-971548
11.
In. Kalil Filho, Roberto; Fuster, Valetim; Albuquerque, Cícero Piva de. Medicina cardiovascular reduzindo o impacto das doenças / Cardiovascular medicine reducing the impact of diseases. São Paulo, Atheneu, 2016. p.771-788.
Monografia em Português | LILACS | ID: biblio-971567
12.
In. Kalil Filho, Roberto; Fuster, Valetim; Albuquerque, Cícero Piva de. Medicina cardiovascular reduzindo o impacto das doenças / Cardiovascular medicine reducing the impact of diseases. São Paulo, Atheneu, 2016. p.825-843.
Monografia em Português | LILACS | ID: biblio-971571
13.
Arq. bras. cardiol ; 103(5): 426-432, 11/2014. tab
Artigo em Inglês | LILACS-Express | ID: lil-730361

RESUMO

Background: Changes in the properties of large arteries correlate with higher cardiovascular risk. Recent guidelines have included the assessment of those properties to detect subclinical disease. Establishing reference values for the assessment methods as well as determinants of the arterial parameters and their correlations in healthy individuals is important to stratify patients. Objective: To assess, in healthy adults, the distribution of the values of pulse wave velocity, diameter, intima-media thickness and relative distensibility of the carotid artery, in addition to assessing the demographic and clinical determinants of those parameters and their correlations. Methods: This study evaluated 210 individuals (54% women; mean age, 44 ± 13 years) with no evidence of cardiovascular disease. The carotid-femoral pulse wave velocity was measured with a Complior® device. The functional and structural properties of the carotid artery were assessed by using radiofrequency ultrasound. Results: The means of the following parameters were: pulse wave velocity, 8.7 ± 1.5 m/s; diameter, 6,707.9 ± 861.6 μm; intima-media thickness, 601 ± 131 μm; relative distensibility, 5.3 ± 2.1%. No significant difference related to sex or ethnicity was observed. On multiple linear logistic regression, the factors independently related to the vascular parameters were: pulse wave velocity, to age (p < 0.01) and triglycerides (p = 0.02); intima-media thickness, to age (p < 0.01); diameter, to creatinine (p = 0.03) and age (p = 0.02); relative distensibility, to age (p < 0.01) and systolic and diastolic blood pressures (p = 0.02 and p = 0.01, respectively). Pulse wave velocity showed a positive correlation with intima media thickness (p < 0.01) and with relative distensibility (p < 0.01), while diameter showed a positive correlation with distensibility (p = 0.03). Conclusion: In healthy individuals, ...


Fundamento: Alterações das propriedades de grandes artérias são correlacionadas a maior risco cardiovascular. Recentes diretrizes incluem a avaliação dessas propriedades para detecção de doença subclínica. O estabelecimento de valores de referência dos métodos para essa avaliação e de determinantes dos parâmetros arteriais e suas correlações em indivíduos saudáveis é importante para a estratificação dos pacientes. Objetivo: Avaliar, em adultos saudáveis, a distribuição dos valores de velocidade de onda de pulso e de diâmetro, espessura íntima-média e distensão relativa da artéria carótida, além de avaliar os determinantes demográficos e clínicos desses parâmetros e suas correlações. Métodos: Foram avaliados 210 indivíduos (54% mulheres; idade média, 44 ± 13 anos) sem evidência de doença cardiovascular. A velocidade de onda de pulso carótida-femoral foi medida com o aparelho Complior®. Propriedades funcionais e estruturais da carótida foram avaliadas por ultrassom de radiofrequência. Resultados: As seguintes médias foram obtidas: velocidade de onda de pulso, 8,7 ± 1,5 m/s; diâmetro, 6.707,9 ± 861,6 µm; espessura íntima-média, 601 ± 131 µm; distensão relativa, 5,3 ± 2,1%. Não houve diferenças significativas conforme sexo ou raça. Na análise de regressão logística linear múltipla, os fatores independentemente relacionados aos parâmetros vasculares foram: velocidade de onda de pulso, com idade (p < 0,01) e triglicérides (p = 0,02); espessura íntima-média, com idade (p < 0,01); diâmetro, com creatinina (p = 0,03) e idade (p = 0,02); distensão relativa, com idade (p < 0,01) e ...

14.
Arq Bras Cardiol ; 103(5): 426-432, 2014 Nov.
Artigo em Português, Inglês | MEDLINE | ID: mdl-25211201

RESUMO

Background: Changes in the properties of large arteries correlate with higher cardiovascular risk. Recent guidelines have included the assessment of those properties to detect subclinical disease. Establishing reference values for the assessment methods as well as determinants of the arterial parameters and their correlations in healthy individuals is important to stratify patients. Objective: To assess, in healthy adults, the distribution of the values of pulse wave velocity, diameter, intima-media thickness and relative distensibility of the carotid artery, in addition to assessing the demographic and clinical determinants of those parameters and their correlations. Methods: This study evaluated 210 individuals (54% women; mean age, 44 ± 13 years) with no evidence of cardiovascular disease. The carotid-femoral pulse wave velocity was measured with a Complior® device. The functional and structural properties of the carotid artery were assessed by using radiofrequency ultrasound. Results: The means of the following parameters were: pulse wave velocity, 8.7 ± 1.5 m/s; diameter, 6,707.9 ± 861.6 µm; intima-media thickness, 601 ± 131 µm; relative distensibility, 5.3 ± 2.1%. No significant difference related to sex or ethnicity was observed. On multiple linear logistic regression, the factors independently related to the vascular parameters were: pulse wave velocity, to age (p < 0.01) and triglycerides (p = 0.02); intima-media thickness, to age (p < 0.01); diameter, to creatinine (p = 0.03) and age (p = 0.02); relative distensibility, to age (p < 0.01) and systolic and diastolic blood pressures (p = 0.02 and p = 0.01, respectively). Pulse wave velocity showed a positive correlation with intima media thickness (p < 0.01) and with relative distensibility (p < 0.01), while diameter showed a positive correlation with distensibility (p = 0.03). Conclusion: In healthy individuals, age was the major factor related to aortic stiffness, while age and diastolic blood pressure related to the carotid functional measure. The carotid artery structure was directly related to aortic stiffness, which was inversely related to the carotid artery functional property.

15.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 23(4): 71-76, out.-dez.2013.
Artigo em Português | LILACS | ID: lil-742387

RESUMO

A apneia obstrutiva do sono (AOS) é uma condição caracterizadapor episódios recorrentes de obstrução das vias aéreas superiores,levando à fragmentação do sono e hipóxia intermitente. Sendo umdistúrbio altamente prevalente (dados epiderniológicos recentesapontam que 1/3 da população adulta de São Paulo apresentaalgum grau de AOS), esta condição clínica está despontandocomo um novo fator de risco cardiovascular. Quando não tratada,AOS é associada de forma independente à hipertensão, isquemiamiocárdica e acidente vascular encefálico. Os mecanismos deassociação entre a AOS e doenças cardiovasculares ainda nãoestão bem elucidados, mas há evidências consistentes de que AOSpromove disfunção endotelial (por meio da alteração do tônusvasomotor e por episódios repetitivos de hipóxia/reoxigenaçãoque causam estresse oxidativo e ativação inflamatória) e alteraçãoda capacidade de reparo das células endoteliais. Estudos nãorandomizados e randomizados mostram que o tratamento daAOS com a pressão positiva contínua de vias aéreas superiores(CPAP) promove reversão da disfunção endotelial, melhoria nosmarcadores de atividade inflamatória e aumento da capacidaderegenerativa do endotélio. Como o subdiagnóstico ainda éfrequente, estas evidências claramente indicam a necessidade deestratégias para o melhor reconhecimento e tratamento da AOS.O entendimento detalhado dos mecanismos envolvidos podefavorecer a criação de potenciais biomarcadores específicos delesão vascular na AOS. Em última análise, estes biomarcadorespodem servir tanto para a identificação da AOS como para predizereventos cardiovasculares em pacientes com AOS...


Obstructive sleep apnea (OSA) is a condition characterized byrecurrent episodes of obstruction of the upper airway, leadingto sleep fragmentation and intermittent hypoxia during sleep.Being a widely prevalent sleep disorder (recent epidemiologicdata suggest that 1/3 of adult population of São Paulo has somedegree of OSA), this clinical condition is an emerging riskfactor for cardiovascular diseases. OSA is independently associatedwith hypertension, myocardial ischemia and stroke. Themechanisms whereby OSA leads to cardiovascular diseasesare not fully elucidated, but there are consistent data that OSApromotes endothelial dysfunction (through dysregulation invasomotor tone, recurrent episodes of hypoxia-reoxygenationsleading to oxidative stress and inflammation) and alters endothelialrepair capacity. Randomized and non-randomizedstudies have shown that OSA treatment with continuouspositive airway pressure (CPAP) promotes improvement inendothelial function, inflammatory markers and enhancesendothelial repair capacity. These evidences support the needfor better recognition and treatment of OSA.Improving ourcurrent knowledge of the potential mechanisms involved inthe cardiovascular risk induced by OSA has the potential tostimulate development of specific biomarkers of vasculardamage in OSA. Lastly, these biomarkers may be useful notonly for identifying OSA as for predicting cardiovasculardiseases in OSA patients...


Assuntos
Humanos , Masculino , Feminino , Idoso , Apneia Obstrutiva do Sono/epidemiologia , Aterosclerose/complicações , Doenças Cardiovasculares/terapia , Endotélio/fisiopatologia
16.
Pituitary ; 16(3): 341-50, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22983689

RESUMO

Sleep Apnea is highly prevalent and may contribute to insulin resistance in patients with acromegaly. The primary aim of this study was to assess the impact of sleep apnea treatment with a continuous positive air pressure (CPAP) device on insulin resistance evaluated by hyperinsulinemic euglycemic clamp (HEC). A prospective, randomized, open label, placebo-controlled, crossover study was performed at a tertiary outpatient pituitary center. Twelve acromegalic subjects on somatostatin analogs (SA) with a recent diagnosis of moderate to severe sleep apnea were randomized to CPAP therapy or to nasal dilator adhesive (NDA) with placebo effect for 3 months and then crossed over for another 3 months period without washout. Assessment of HEC, mathematical insulin resistance indexes (HOMA, HOMA2 and QUICKI), GH, IGF-1, HbA1c and free fat acids were performed. A significant reduction on insulin resistance was demonstrated by HEC at the end of the study in patients on CPAP (HEC, pre- and post-CPAP: 4.27 vs. 6.10 mg/Kg/min, P = 0.032). This reduction was not observed in NDA group (HEC, pre- and post-adhesive: 5.53 vs. 5.19 mg/Kg/min, P = 0.455). There was no significant difference on HbA1c or on peripheral insulin resistance indexes in both treatments. CPAP promoted a significant increase on peripheral insulin sensitivity in acromegalic patients with moderate to severe sleep apnea on SA use. Our results support the concept that sleep apnea plays an important role on glucose metabolism. Insulin resistance indexes were unable to detect this finding.


Assuntos
Acromegalia/metabolismo , Síndromes da Apneia do Sono/metabolismo , Acromegalia/tratamento farmacológico , Acromegalia/terapia , Adulto , Idoso , Metabolismo dos Carboidratos/efeitos dos fármacos , Pressão Positiva Contínua nas Vias Aéreas , Feminino , Técnica Clamp de Glucose , Humanos , Masculino , Pessoa de Meia-Idade , Síndromes da Apneia do Sono/tratamento farmacológico , Síndromes da Apneia do Sono/terapia , Somatostatina/análogos & derivados , Somatostatina/uso terapêutico
18.
J Bras Pneumol ; 36 Suppl 2: 38-42, 2010 Jun.
Artigo em Português | MEDLINE | ID: mdl-20944980

RESUMO

Obstructive sleep apnea syndrome (OSAS) is a common condition associated with various cardiovascular diseases, including systemic arterial hypertension, atrial fibrillation, and atherosclerosis. The association between OSAS and cardiovascular disease has been related to the overlapping of risk factors, including obesity, having a sedentary lifestyle, being male, and being older. However, there is mounting evidence that OSAS can also independently contribute to the development and progression of various cardiovascular diseases. The mechanisms by which OSAS can affect the cardiovascular system are multiple, including the activation of the sympathetic nervous system, systemic inflammation, insulin resistance, and oxidative stress. There is also evidence that the treatment of OSAS with CPAP can reduce arterial blood pressure, early signs of atherosclerosis, the risk of atrial fibrillation recurrence, and mortality (principally mortality due to stroke or acute myocardial infarction) in patients with severe OSAS.


Assuntos
Doenças Cardiovasculares/etiologia , Apneia Obstrutiva do Sono/complicações , Pressão Sanguínea/fisiologia , Doenças Cardiovasculares/fisiopatologia , Doenças Cardiovasculares/terapia , Humanos , Masculino , Fatores de Risco , Apneia Obstrutiva do Sono/fisiopatologia , Apneia Obstrutiva do Sono/terapia
20.
J. bras. pneumol ; 36(supl.2): 38-42, jun. 2010. ilus
Artigo em Português | LILACS | ID: lil-560649

RESUMO

Uma condição clínica muito comum é SAOS, que está associada a várias doenças cardiovasculares, incluindo hipertensão arterial sistêmica, fibrilação atrial e aterosclerose. A associação entre SAOS e doença cardiovascular não é somente uma consequência da sobreposição de fatores de risco, incluindo obesidade, sedentarismo, ser do sexo masculino e ter idade maior. Existem evidências crescentes de que SAOS contribui de forma independente para o aparecimento e a progressão de várias doenças cardiovasculares. Os mecanismos pelos quais SAOS pode afetar o sistema cardiovascular são múltiplos e incluem a ativação do sistema nervoso simpático, inflamação sistêmica, resistência a insulina e geração de estresse oxidativo. Existem evidências que o tratamento de SAOS com CPAP pode reduzir a pressão arterial, sinais precoces de aterosclerose, risco de recorrência de fibrilação atrial e mortalidade, principalmente por acidente vascular cerebral e infarto agudo do miocárdio, em pacientes com SAOS grave.


Obstructive sleep apnea syndrome (OSAS) is a common condition associated with various cardiovascular diseases, including systemic arterial hypertension, atrial fibrillation, and atherosclerosis. The association between OSAS and cardiovascular disease has been related to the overlapping of risk factors, including obesity, having a sedentary lifestyle, being male, and being older. However, there is mounting evidence that OSAS can also independently contribute to the development and progression of various cardiovascular diseases. The mechanisms by which OSAS can affect the cardiovascular system are multiple, including the activation of the sympathetic nervous system, systemic inflammation, insulin resistance, and oxidative stress. There is also evidence that the treatment of OSAS with CPAP can reduce arterial blood pressure, early signs of atherosclerosis, the risk of atrial fibrillation recurrence, and mortality (principally mortality due to stroke or acute myocardial infarction) in patients with severe OSAS.


Assuntos
Humanos , Masculino , Doenças Cardiovasculares/etiologia , Apneia Obstrutiva do Sono/complicações , Pressão Sanguínea/fisiologia , Doenças Cardiovasculares/fisiopatologia , Doenças Cardiovasculares/terapia , Fatores de Risco , Apneia Obstrutiva do Sono/fisiopatologia , Apneia Obstrutiva do Sono/terapia
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