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1.
J Clin Sleep Med ; 2020 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-32043960

RESUMO

STUDY OBJECTIVES: The association of mild obstructive sleep apnoea (OSA) with important clinical outcomes remains unclear. We aimed to investigate the association between mild OSA and systemic arterial hypertension (SAH) in the European Sleep Apnoea Database (ESADA) cohort. METHODS: In a multicentre sample of 4732 patients we analyzed the risk of mild OSA (sub-classified into two groups: mildAHI 5-<11/h (apnoea-hypopnoea frequency/hour [AHI] 5 to <11/h) and mildAHI 11-<15/hOSA (AHI ≥11 to <15/h ) compared to non-apnoeic snorers for prevalent SAH after adjustment for relevant confounding factors including gender, age, smoking, obesity, daytime sleepiness, dyslipidaemia, chronic obstructive pulmonary disease, type 2 diabetes and sleep test methodology [polygraphy (PG) or polysomnography (PSG)]. RESULTS: SAH prevalence was higher in the mildAHI 11-<15/h OSA group compared with the mildAHI 5-<11/h group and non-apnoeic snorers (52 vs 45 vs 30%, p<0.001). Corresponding adjusted Odds Ratios (OR) for SAH were 1.789 (mildAHI 11-<15/h, 95% confidence interval [CI] 1.49-2.15) and 1.558 (mildAHI 5-<11/h, 95%, CI 1.34-1.82), respectively; p<0.001. In sensitivity analysis, mildAHI 11-<15/h OSA remained a significant predictor for SAH both in PG (OR = 1.779, 95% CI 1.403-2.256; p<0.001) and PSG group (OR = 1.424, 95% CI 1.047-1.939; p=0.025). CONCLUSION: Our data suggest a dose response relationship between mild OSA and SAH risk, starting from 5 events/hour in PG-recordings and continuing with a further risk increase in the 11 to <15 range. These findings potentially introduce a challenge to traditional thresholds of OSA severity and may help to stratify OSA patients according to cardiovascular risk.

2.
Eur Respir J ; 2020 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-32079643

RESUMO

The treatment for obstructive sleep apnea (OSA) with continuous positive airway pressure (CPAP) or mandibular advancement devices (MAD) is associated with blood pressure (BP) reduction however, the overall effect is modest. The aim of this systematic review and meta-analysis of RCTs comparing the effect of such treatments on BP was to identify subgroups of patients who respond best to treatment.The article search was performed in three different databases with specific search terms and selection criteria. From 2289 articles, we included 68 RCTs that compared CPAP or MAD with either passive or active treatment. When all the studies are pooled together, CPAP and MAD are associated with an average BP reduction of -2.09 (-2.78, -1.40) mmHg [mean (95%CI)] for the systolic and of -1.92 (-2.40, -1.43) mmHg for the diastolic BP, and of -1.27 (-2.34, -0.20) mmHg for systolic and of -1.11 (-1.82, -0.41) mmHg for diastolic BP, respectively. The subgroups of patients who showed a greater response were those: younger than 60 years (systolic BP -2.93 mmHg), with uncontrolled BP at baseline (systolic BP -4.14 mmHg) and with severe oxygen desaturations (SpO2-nadir<77%) at baseline (24 h systolic BP -7.57 mmHg).Although this meta-analysis shows that the expected reduction of BP by CPAP/MADs is modest, it identifies specific characteristics that may predict a pronounced benefit from CPAP in terms of blood pressure control. These findings should be interpreted with caution, however, they are particularly important in identifying potential phenotypes associated with BP reduction in patients treated for OSA.

3.
Eur J Intern Med ; 71: 23-31, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31708358

RESUMO

The increasing number of patients with heart failure HF and comorbidities is due to aging population and increase of life expectancy of patients with cardiovascular disease. Encouraging results derived by recent trials may suggest some comorbidities as new targets for new drugs, highlighting the need for a better understanding of the comorbidities' effects in HF patients and the need of a multidisciplinary approach for the management of chronic HF with comorbidities. We report a brief review about main cardiovascular and non-cardiovascular comorbidities in HF patients in order to update physicians and researchers engaged in the HF research or in "fight against heart failure."

4.
Int J Cardiol ; 301: 173-179, 2020 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-31780104

RESUMO

BACKGROUND: Acute exposure to high altitude (>2500 m) is known to induce a rise in blood pressure (BP) and the appearance of sleep related breathing alterations, in particular central sleep apneas and periodic breathing. Little information is available on whether this is the case in humans also for acute exposure to moderate altitude (between 1500 and 2500 m). Aim of this study was to evaluate the effects of acute exposure of healthy volunteers to moderate altitude on conventional and ambulatory BP as well as on the frequency and severity of breathing alterations during sleep. METHODS: Forty-four healthy lowlanders underwent 24-hour ambulatory BP monitoring and nocturnal cardio-respiratory sleep study at sea level and during acute (1-2 days after arrival) exposure to moderate altitude (2035 m, Sestriere, Italy). The key variables investigated included average systolic and diastolic BP and heart rate over daytime, night-time and 24 h, the frequency of obstructive and central apneas/hypopnoeas and the behaviour of oxygen saturation during sleep. RESULTS: Compared to sea level, during moderate altitude exposure mean systolic/diastolic BP increased significantly during daytime (respectively from 125.6 ±â€¯10.9 to 130.6 ±â€¯12.3, p = 0.0032 and from 78.8 ±â€¯6.7 to 81.8 ±â€¯7.7 mmHg, p = 0.0048) and during night-time (respectively from 102.4 ±â€¯12.4 to 107.4 ±â€¯12.7, p = 0.0028, and from 62.0 ±â€¯8.2 to 65.8 ±â€¯8.2 mmHg, p = 0.0014), with no change in nocturnal BP dipping. BP increase was more evident in participants aged over 40 years. Apnea-hypopnea index (AHI) increased from 1.60 (0.40-2.90) to 5.4 (2.90-10.60), p < 0.0001), mainly because of increasing frequency of hypopneas and central apneas, in particular in males aged over 40 years. No association was found between size of BP changes and AHI. CONCLUSION: Our results indicate that in healthy subjects even exposure to moderate altitude may induce significant, although mild, changes in ambulatory BP and in respiratory patterns during sleep with gender and age-related differences. Further studies are needed to explore the clinical relevance of these findings.

5.
Respirology ; 2019 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-31872530

RESUMO

BACKGROUND AND OBJECTIVE: OSA and PLMS are known to induce acute BP swings during sleep. Our current study aimed to address the independent effect of PLMS on BP in an unselected OSA patient cohort. METHODS: This cross-sectional analysis included 1487 patients (1110 males, no previous hypertension diagnosis or treatment, mean age: 52.5 years, mean BMI: 30.5 kg/m2 ) with significant OSA (defined as AHI ≥ 10) recruited from the European Sleep Apnoea Cohort. Patients underwent overnight PSG. Patients were stratified into two groups: patients with significant PLMS (PLMSI > 25 events/hour of sleep) and patients without significant PLMS (PLMSI < 25 events/hour of sleep). SBP, DBP and PP were the variables of interest. For each of these, a multivariate regression linear model was fitted to evaluate the relationship between PLMS and outcome adjusting for sociodemographic and clinical covariates (gender, age, BMI, AHI, ESS, diabetes, smoking and sleep efficiency). RESULTS: The univariate analysis of SBP showed an increment of BP equal to 4.70 mm Hg (P < 0.001) in patients with significant PLMS compared to patients without significant PLMS. This increment remained significant after implementing a multivariate regression model (2.64 mm Hg, P = 0.044). No significant increment of BP was observed for DBP and PP. CONCLUSION: PLMS is associated with a rise in SBP regardless of AHI, independent of clinical and sociodemographic confounders. A PLMS phenotype may carry an increased risk for cardiovascular disease in OSA patients.

6.
J Sleep Res ; : e12895, 2019 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-31347213

RESUMO

In obstructive sleep apnea, patients' sleep is fragmented leading to excessive daytime sleepiness and co-morbidities like arterial hypertension. However, traditional metrics are not always directly correlated with daytime sleepiness, and the association between traditional sleep quality metrics like sleep duration and arterial hypertension is still ambiguous. In a development cohort, we analysed hypnograms from mild (n = 213), moderate (n = 235) and severe (n = 277) obstructive sleep apnea patients as well as healthy controls (n = 105) from the European Sleep Apnea Database. We assessed sleep by the analysis of two-step transitions depending on obstructive sleep apnea severity and anthropometric factors. Two-step transition patterns were examined for an association to arterial hypertension or daytime sleepiness. We also tested cumulative distributions of wake as well as sleep-states for power-laws (exponent α) and exponential distributions (decay time τ) in dependency on obstructive sleep apnea severity and potential confounders. Independent of obstructive sleep apnea severity and potential confounders, wake-state durations followed a power-law distribution, while sleep-state durations were characterized by an exponential distribution. Sleep-stage transitions are influenced by obstructive sleep apnea severity, age and gender. N2 → N3 → wake transitions were associated with high diastolic blood pressure. We observed higher frequencies of alternating (symmetric) patterns (e.g. N2 → N1 → N2, N2 → wake → N2) in sleepy patients both in the development cohort and in a validation cohort (n = 425). In conclusion, effects of obstructive sleep apnea severity and potential confounders on sleep architecture are small, but transition patterns still link sleep fragmentation directly to obstructive sleep apnea-related clinical outcomes like arterial hypertension and daytime sleepiness.

7.
J Cardiovasc Med (Hagerstown) ; 20(9): 575-583, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31246698

RESUMO

: Cardiovascular disease (CVD) is the leading cause of mortality and morbidity in women.Some authors highlighted that the female risk profile consists of traditional and emerging risk factors. Despite the lower prevalence of type 2 diabetes, years of life lost owing to the disease for women are substantially higher compared with men. In addition, pregnancy complicated by gestational diabetes represents a risk factor for CVD. Women with gestational diabetes have a higher prevalence of coronary artery disease that occur at a younger age and are independent of T2DM.Hypertension is an important cardiovascular risk factor in women. Estrogens and progesterone, known to have an impact on blood pressure levels, have also been proposed to be protective against sleep-disordered breathing. It is very difficult to understand whereas obstructive sleep apnea in women is independently associated with hypertension or if many confounders acting at different stages of the woman lifespan mediate this relation.The cardioprotective effect of physical activity in women of all ages is well known. Women are generally more physically inactive than men. During and after menopause, most women tend to reduce their physical activity levels and together with the reduction in basal metabolic rate, women experience loss of skeletal muscle mass with a negative change in the ratio of fat-to-lean mass.In conclusion, sex differences in the cardiovascular system are because of dissimilarities in gene expression and sex hormones; these result in variations in prevalence and presentation of CVD and associated conditions, such as diabetes, hypertension and vascular and cardiac remodeling.Changes in lifestyle and increase in physical activity could help in prevention of cardiovascular disease in women.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Sistema Cardiovascular/fisiopatologia , Exercício , Disparidades nos Níveis de Saúde , Estilo de Vida Saudável , Hipertensão/terapia , Comportamento de Redução do Risco , Saúde da Mulher , Adulto , Fatores Etários , Idoso , Doenças Cardiovasculares/diagnóstico por imagem , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/fisiopatologia , Diabetes Mellitus Tipo 2/mortalidade , Diabetes Mellitus Tipo 2/fisiopatologia , Diabetes Mellitus Tipo 2/terapia , Diabetes Gestacional/mortalidade , Diabetes Gestacional/fisiopatologia , Diabetes Gestacional/terapia , Feminino , Humanos , Hipertensão/mortalidade , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Gravidez , Prevalência , Prognóstico , Fatores de Proteção , Medição de Risco , Fatores de Risco , Fatores Sexuais
8.
Maturitas ; 124: 32-34, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31097175

RESUMO

Obstructive sleep apnoea (OSA) is a common disorder, in which loss of pharyngeal dilator muscle tone during sleep causes recurrent collapse of the upper airway and temporary cessation of breathing. Repeated apneas and hypopneas lead to cycles of intermittent hypoxia/hypercapnia, increased negative intrathoracic pressure and arousals from sleep. These consequences of OSA are associated with a cascade of cardiovascular and neurohumoral consequences, including sympathetic nervous system hyperactivity, raised heart rate variability, increases in blood pressure, myocardial wall stress, oxidative stress, systemic inflammation, platelet aggregation and impaired vascular endothelial function, which contribute, in turn, to increased cardiovascular risk and, in particular, to the development of chronic systemic arterial hypertension and arrhythmias, especially atrial fibrillation (AF). Given that the prevalence of OSA is modified by age and gender, OSA-related cardiovascular diseases may also be affected by the same factors. This review focuses on the potential role of OSA in systemic arterial hypertension and AF, and discusses the most interesting studies on age and gender as predisposing factors.


Assuntos
Fibrilação Atrial/epidemiologia , Hipertensão/epidemiologia , Menopausa/fisiologia , Apneia Obstrutiva do Sono/epidemiologia , Pressão Arterial , Feminino , Humanos , Prevalência , Fatores de Risco , Apneia Obstrutiva do Sono/fisiopatologia
9.
Maturitas ; 124: 35-38, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31097176

RESUMO

Obstructive sleep apnea (OSA) is a chronic and common adult disorder characterized by recurrent episodes of upper-airway obstruction and reopening during sleep. OSA is associated with intermittent hypoxia, sympathetic overactivity, oxidative stress and high cardiovascular mortality and morbidity. It is known to be more common in men than women, partly due to differences in anatomy and functional respiratory components. There are also gender differences in reported symptoms, leading to potential under-diagnosis in females. This gender difference tends to decrease after menopause, demonstrating a role of menopausal status itself in OSA phenotypes. Aging, fat mass distribution, sex hormones and upper-airway collapsibility are postulated to play a major role in these findings. This review focuses on the most recent studies exploring gender differences in the prevalence, pathogenesis and clinical features of OSA. It discusses the role of menopause in this, and explore the underlying pathophysiological mechanisms.


Assuntos
Menopausa/fisiologia , Apneia Obstrutiva do Sono/epidemiologia , Adiposidade , Fatores Etários , Feminino , Hormônios Esteroides Gonadais/sangue , Humanos , Músculos Faríngeos/fisiopatologia , Prevalência , Índice de Gravidade de Doença , Fatores Sexuais , Apneia Obstrutiva do Sono/fisiopatologia
10.
Curr Hypertens Rep ; 21(4): 30, 2019 04 04.
Artigo em Inglês | MEDLINE | ID: mdl-30949909

RESUMO

PURPOSE OF REVIEW: Obstructive sleep apnea (OSA) and hypertension are two phenomena deeply linked together and, although a causal relationship has been suggested, a recent meta-analysis showed only a very modest effect of OSA treatment on blood pressure (BP). However, a vast number of randomized controlled trials published so far share some limitations, mainly of methodological nature: neither OSA nor BP is always assessed in a standardized way. Moreover, compliance with OSA treatment is often sub-optimal making the results of these trials difficult to interpret. RECENT FINDINGS: Recent studies have shown that antihypertensive drugs can reduce BP more than OSA treatment, showing a better compliance profile and very few side effects. Considering the importance of reducing the overall cardiovascular risk of OSA patients, a more careful management of patient's antihypertensive medication could allow a better BP control also in this condition. In addition, greater efforts should be made to improve patient's acceptance of OSA treatment with the aim of improving their compliance.

13.
Int J Cardiol ; 271: 140-145, 2018 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-30223347

RESUMO

BACKGROUND: In heart failure (HF) sleep problems and sleep-related breathing disorders are frequently reported and are associated with poor prognosis. However, only few large clinical studies have investigated this issue in heart failure through breathing pattern analysis by polysomnography. METHODS AND RESULTS: 370 HF patients, with either moderate-severe reduced ejection fraction or with clinical decompensation, consecutively referred to 10 participating cardiology centers, have been enrolled in the PROMISES Study, an Italian project aimed at generating a large, multidisciplinary database of anthropometric, clinical, echocardiographic and sleep data, the last derived from overnight unattended cardio-respiratory polysomnography in HF patients. Obstructive sleep apnea was the most frequent form of sleep related breathing disorders observed in our cohort (35.4% with an AHI cutoff of 15). The possible determinants of sleep related breathing disorders were analyzed through stepwise logistic regression analysis and two multivariate models showing that a markedly reduced left ventricular ejection fraction was the most important factor associated with central sleep apneas (OR = 7.7 for AHI cutoff = 15 and LVEF ≤ 35%) together with male gender and increasing age. Conventional risk factors for obstructive sleep apnea did not identify HF patients affected by this condition. Conversely, a greater neck circumference was associated with an increased risk for central apneas. CONCLUSIONS: Our paper offers a deeper insight into the features of SRBD and its determinants in HF patients, leading in turn to a better clinical management of these comorbid patients.


Assuntos
Bases de Dados Factuais , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/fisiopatologia , Síndromes da Apneia do Sono/epidemiologia , Síndromes da Apneia do Sono/fisiopatologia , Idoso , Bases de Dados Factuais/tendências , Eletrocardiografia/tendências , Feminino , Insuficiência Cardíaca/diagnóstico , Humanos , Itália/epidemiologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Polissonografia/tendências , Síndromes da Apneia do Sono/diagnóstico
14.
J Heart Lung Transplant ; 37(11): 1361-1371, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30195831

RESUMO

BACKGROUND: Increasing left ventricular assist device (LVAD) pump speed according to the patient's activity is a fascinating hypothesis. This study analyzed the short-term effects of LVAD speed increase on cardiopulmonary exercise test (CPET) performance, muscle oxygenation (near-infrared spectroscopy), diffusion capacity of the lung for carbon monoxide (Dlco) and nitric oxide (Dlno), and sleep quality. METHODS: We analyzed CPET, Dlco and Dlno, and sleep in 33 patients supported with the Jarvik 2000 (Jarvik Heart Inc., New York, NY). After a maximal CPET (n = 28), patients underwent 2 maximal CPETs with LVAD speed randomly set at 3 or increased from 3 to 5 during effort (n = 15). Then, at LVAD speed randomly set at 2 or 4, we performed (1) constant workload CPETs assessing O2 kinetics, cardiac output (CO), and muscle oxygenation (n = 15); (2) resting Dlco and Dlno (n = 18); and (3) nocturnal cardiorespiratory monitoring (n = 29). RESULTS: The progressive pump speed increase raised peak volume of oxygen consumption (12.5 ± 2.5 ml/min/kg vs 11.7 ± 2.8 ml/min/kg at speed 3; p = 0.001). During constant workload, from speed 2 to 4, CO increased (at rest: 3.18 ± 0.76 liters/min vs 3.69 ± 0.75 liters/min, p = 0.015; during exercise: 5.91 ± 1.31 liters/min vs 6.69 ± 0.99 liters/min, p = 0.014), and system efficiency (τ = 65.8 ± 15.1 seconds vs 49.9 ± 14.8 seconds, p = 0.002) and muscle oxygenation improved. At speed 4, Dlco decreased, and obstructive apneas increased despite a significant apnea/hypopnea index and a reduction of central apneas. CONCLUSIONS: Short-term LVAD speed increase improves exercise performance, CO, O2 kinetics, and muscle oxygenation. However, it deteriorates lung diffusion and increases obstructive apneas, likely due to an increase of intrathoracic fluids. Self-adjusting LVAD speed is a fascinating but possibly unsafe option, probably requiring a monitoring of intrathoracic fluids.


Assuntos
Exercício/fisiologia , Insuficiência Cardíaca/terapia , Coração Auxiliar , Troca Gasosa Pulmonar/fisiologia , Sono/fisiologia , Idoso , Monóxido de Carbono/sangue , Desenho de Equipamento , Feminino , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/irrigação sanguínea , Óxido Nítrico/sangue , Consumo de Oxigênio/fisiologia , Capacidade de Difusão Pulmonar/fisiologia
15.
Int J Cardiol ; 272: 231-237, 2018 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-30153992

RESUMO

BACKGROUND: Recent advances in wearable technology make continuous cardiorespiratory monitoring possible, with potential applications in assessment of cardiopulmonary patients, healthy subjects and athletes. The aim of the present study was to qualitatively and quantitatively evaluate a new wearable device (Learn Inspire Free Entertain = L.I.F.E.) by embedding in a compression shirt a 12­lead ECG system and 5 respiratory sensors. METHODS: Thirty cardiorespiratory patients and ten healthy subjects were studied for 24 h during their usual life activities. In 8 healthy subjects, simultaneous measurements of the device and of an ergo-spirometer were performed during different levels of ventilation in five different body positions. The quality of ECG signals in terms of measurability of heart rate, P wave, QRS complex and ST segment, was analyzed by four expert cardiologists/respiratory physiologists using an arbitrary 1-5 scale. The sum of the respiratory signals was used to calculate the respiratory rate, inspiratory time and relative changes of tidal volume. These parameters were compared to ergo-spirometer measurements. RESULTS: Median quality value was >3 for heart rate, QRS complex, ST segment and P wave (except in L3, aVL, aVF, V1 and V2 leads). Median quality of respiratory traces was >4 in patients and between 3 and 4 in healthy subjects. The respiratory monitoring of respiratory rate and inspiratory time was accurate in all body positions. Tidal volumes were underestimated due to a high level of ventilation. CONCLUSIONS: The L.I.F.E. device provides an accurate continuous monitoring of cardiorespiratory signals during the 24 h both in normal subjects and cardiorespiratory patients.


Assuntos
Vestuário/normas , Eletrocardiografia Ambulatorial/normas , Frequência Cardíaca/fisiologia , Mecânica Respiratória/fisiologia , Dispositivos Eletrônicos Vestíveis/normas , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
16.
J Am Heart Assoc ; 7(12)2018 06 09.
Artigo em Inglês | MEDLINE | ID: mdl-29886423

RESUMO

BACKGROUND: Acute exposure to high-altitude hypobaric hypoxia induces a blood pressure rise in hypertensive humans, both at rest and during exercise. It is unclear whether this phenomenon reflects specific blood pressure hyperreactivity or rather an upward shift of blood pressure levels. We aimed at evaluating the extent and rate of blood pressure rise during exercise in hypertensive subjects acutely exposed to high altitude, and how these alterations can be counterbalanced by antihypertensive treatment. METHODS AND RESULTS: Fifty-five subjects with mild hypertension, double-blindly randomized to placebo or to a fixed-dose combination of an angiotensin-receptor blocker (telmisartan 80 mg) and a calcium-channel blocker (nifedipine slow release 30 mg), performed a cardiopulmonary exercise test at sea level and after the first night's stay at 3260 m altitude. High-altitude exposure caused both an 8 mm Hg upward shift (P<0.01) and a 0.4 mm Hg/mL/kg per minute steepening (P<0.05) of the systolic blood pressure/oxygen consumption relationship during exercise, independent of treatment. Telmisartan/nifedipine did not modify blood pressure reactivity to exercise (blood pressure/oxygen consumption slope), but downward shifted (P<0.001) the relationship between systolic blood pressure and oxygen consumption by 26 mm Hg, both at sea level and at altitude. Muscle oxygen delivery was not influenced by altitude exposure but was higher on telmisartan/nifedipine than on placebo (P<0.01). CONCLUSIONS: In hypertensive subjects exposed to high altitude, we observed a hypoxia-driven upward shift and steepening of the blood pressure response to exercise. The effect of the combination of telmisartan/nifedipine slow release outweighed these changes and was associated with better muscle oxygen delivery. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01830530.


Assuntos
Altitude , Bloqueadores do Receptor Tipo 1 de Angiotensina II/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Bloqueadores dos Canais de Cálcio/uso terapêutico , Exercício , Hipertensão/tratamento farmacológico , Nifedipino/uso terapêutico , Telmisartan/uso terapêutico , Adulto , Bloqueadores do Receptor Tipo 1 de Angiotensina II/efeitos adversos , Anti-Hipertensivos/efeitos adversos , Bloqueadores dos Canais de Cálcio/efeitos adversos , Método Duplo-Cego , Combinação de Medicamentos , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Nifedipino/efeitos adversos , Telmisartan/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
17.
Chest ; 154(2): 326-334, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29698721

RESUMO

BACKGROUND: The impact of treating OSA on renal function decline is controversial. Previous studies usually included small samples and did not consider specific effects of different CPAP modalities. The aim of this study was to evaluate the respective influence of fixed and autoadjusting CPAP modes on estimated glomerular filtration rate (eGFR) in a large sample of patients derived from the prospective European Sleep Apnea Database cohort. METHODS: In patients of the European Sleep Apnea Database, eGFR prior to and after follow-up was calculated by using the Chronic Kidney Disease-Epidemiology Collaboration equation. Three study groups were investigated: untreated patients (n = 144), patients receiving fixed CPAP (fCPAP) (n = 1,178), and patients on autoadjusting CPAP (APAP) (n = 485). RESULTS: In the whole sample, eGFR decreased over time. The rate of eGFR decline was significantly higher in the subgroup with eGFR above median (91.42 mL/min/1.73 m2) at baseline (P < .0001 for effect of baseline eGFR). This decline was attenuated or absent (P < .0001 for effect of treatment) in the subgroup of patients with OSA treated by using fCPAP. A follow-up duration exceeding the median (541 days) was associated with eGFR decline in the untreated and APAP groups but not in the fCPAP group (P < .0001 by two-way ANOVA for interaction between treatment and follow-up length). In multiple regression analysis, eGFR decline was accentuated by advanced age, female sex, cardiac failure, higher baseline eGFR, and longer follow-up duration, whereas there was a protective effect of fCPAP. CONCLUSIONS: fCPAP but not APAP may prevent eGFR decline in OSA.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas/métodos , Taxa de Filtração Glomerular , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/terapia , Europa (Continente) , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polissonografia , Estudos Prospectivos , Sistema de Registros , Fatores de Risco
18.
J Hypertens ; 36(6): 1351-1359, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29570509

RESUMO

BACKGROUND AND PURPOSE: Both obstructive sleep apnea (OSA) and cardiac organ damage have a crucial role in acute ischemic stroke. Our aim is to explore the relationship between OSA and cardiac organ damage in acute stroke patients. METHODS: A total of 130 consecutive patients with acute ischemic stroke were enrolled. Patients underwent full multichannel 24-h polysomnography for evaluation of OSA and echocardiography to evaluate left ventricle (LV) mass index (LV mass/BSA, LV mass/height), thickness of interventricular septum (IVS) and posterior wall (LVPW), LV ejection fraction and left atrium enlargement. Information on occurrence of arterial hypertension and its treatment before stroke was obtained from patients' history. RESULTS: 61.9% (70) of patients, mostly men (67.1%), with acute stroke had OSA (AHI > 10). Patients with acute stroke and OSA showed a significant increase (P < 0.05) of LV mass index, IVS and LVPW thickness and a significant left atrial enlargement as compared with patients without OSA. LV ejection fraction was not significantly different in stroke patients with and without OSA and was within normal limits. No relationship was found among cardiac alterations, occurrence of OSA and history of hypertension. CONCLUSION: Acute stroke patients with OSA had higher LV mass and showed greater left atrial enlargement than patients without OSA. This study confirms the high prevalence of OSA in stroke patients, suggesting also an association between OSA and cardiac target organ damage. Our finding of structural LV abnormalities in acute stroke patients with OSA suggests a potential role of OSA as contributing factor in determining both cerebrovascular and cardiac damage, even in absence of clear link with a history of blood pressure elevation.


Assuntos
Coração/fisiopatologia , Apneia Obstrutiva do Sono , Acidente Vascular Cerebral , Feminino , Humanos , Masculino , Polissonografia , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/fisiopatologia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/fisiopatologia
19.
J Hypertens ; 36(1): 199-204, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28800040

RESUMO

OBJECTIVE: Some cases of pseudopheochromocytoma have been described among hypertensive patients with obstructive sleep apnea (OSA). This study examined whether a pathological rise of urinary metanephrines is a common feature in hypertensive OSA patients and, in such a case, whether the ventilation treatment during sleep (continuous or biphasic positive airway pressure) may normalize high metanephrines levels. METHODS: Patients with endocrine diseases, drug abuse, therapy with TCA and cardiovascular events in the previous 6 months were excluded. Thirty-four hypertensive patients with OSA (BMI 40.6 ±â€Š8.7 kg/m(2)) performed three 24-h urine collections for metanephrine assessment, before and after 1 month of ventilation therapy. RESULTS: Urinary normetanephrine (uNMT) was above the normal limit in 21 of 34 of the patients. In the 16 to 21 patients with high uNMT who were compliant to ventilation treatment, uNMT decreased in 13 by 26% and normalized in six of 13. uNMT levels were associated with apnea hypopnea index (AHI) (r = 0.799, P < 0.0001) and minimal SaO2 (r = -0.700, P < 0.01). The ventilation therapy-induced changes in AHI were associated with those in uNMT (r = 0.689, P < 0.005). In the multivariate analysis with uNMT changes as dependent variable and changes in AHI, BMI, SBP as independent variables, only AHI changes were independently associated with uNMT changes (ß = 0.738, P < 0.01). CONCLUSION: Two-thirds of OSA hypertensive patients have uNMT values above the normal limit. The early identification of these patients is important as ventilation therapy can correct the pathological sympathoadrenal activation. Patients who do not normalize uNMT with ventilation therapy deserve a strict follow-up as this lack of normalization may indicate insufficient ventilation therapy or resistance of sympathetic hyperactivity to this treatment, not excluding an early stage of a chromaffin tumor.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas , Hipertensão/urina , Metanefrina/urina , Apneia Obstrutiva do Sono/terapia , Apneia Obstrutiva do Sono/urina , Adulto , Idoso , Feminino , Humanos , Hipertensão/complicações , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Sono/fisiologia , Apneia Obstrutiva do Sono/complicações
20.
J Thorac Dis ; 10(Suppl 34): S4231-S4243, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30687539

RESUMO

There is consistent epidemiological evidence that sleep disordered breathing and systemic arterial hypertension are deeply associated, being linked through a bidirectional complex interaction among multiple mechanisms including autonomic nervous system alterations, inflammation, hormonal and hemodynamic components, sleep alterations. However there are several unanswered questions not only from a pathophysiological perspective, but also regarding the effects of obstructive sleep apnea (OSA) treatment on arterial blood pressure values. At present, while many studies have supported the possibility to obtain at least a small blood pressure reduction with OSA treatment, in particular in hypertensive patients, large trials have not clearly confirmed a significant anti-hypertensive effect, nor a beneficial effect of this intervention on cardiovascular endpoints including cardiovascular mortality. Aim of the present review article is to address the relationship between OSA and hypertension in the light of the latest evidence in the field. Moreover we will discuss research topics which need to be investigated in the future, in order to better clarify still pending issues with the aim of obtaining an early diagnosis, a more suitable phenotyping including comorbidities, and better strategies to improve patients' compliance and adherence to treatment.

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