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1.
PLoS One ; 14(10): e0223838, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31603935

RESUMO

BACKGROUND: Heart failure is associated with exercise intolerance and sleep- disordered breathing; however, studies in patients with chronic constrictive pericarditis are scarce. The purpose of our study was to assess exercise capacity and sleep in patients with chronic constrictive pericarditis (CCP) undergoing a pericardiectomy. METHODS: We studied consecutive patients scheduled for pericardiectomy due to symptomatic CCP. Were performed quality of life (Minnesota Living with Heart Failure Questionnaire-MLHFQ) and sleep questionnaires (Epworth, Pittsburgh Sleep Quality Index-PSQI), serum B-type natriuretic peptide (BNP), serum C-reactive protein, transthoracic echocardiography, cardiopulmonary exercise test and overnight polysomnography immediately before and six months after pericardiectomy. RESULTS: Twenty-five patients (76% males, age: 45.5±13.8 years, body mass index: 24.9±3.7 kg/m2, left ventricular ejection fraction: 60±6%) with CCP (76% idiopathic, 12% tuberculosis) were studied. As compared to the preoperative period, pericardiectomy resulted in reduction in BNP (143 (83.5-209.5) vs 76 (40-117.5) pg/mL, p = 0.011), improvement in VO2 peak (18.7±5.6 vs. 25.2±6.3 mL/kg/min, p<0.001), quality of life (MLHFQ score 62 (43,5-77,5) vs. 18 (8,5-22), p<0,001) and sleep (PSQI score 7.8±4.1 vs. 4.7±3.7, p<0.001) and no significant change in sleep disordered breathing (apnea hypopnea index-AHI 15.6 (8.3-31.7) vs. 14.6 (5.75-29.9) events/h, p = 0.253). CONCLUSION: Patients with symptomatic CCP showed reduced exercise capacity and sleep-disordered breathing. After pericardiectomy, there was improvement in exercise capacity and neutral effect on sleep-disordered breathing.

2.
J Clin Sleep Med ; 15(10): 1397-1402, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31596203

RESUMO

STUDY OBJECTIVES: The aim of the current study was to test the hypothesis that there is a temporal correlation between reflux episodes and respiratory events in patients with laryngopharyngeal reflux and obstructive sleep apnea. METHODS: Adults with clinically diagnosed laryngopharyngeal reflux confirmed by two validated instruments (reflux symptom index ≥ 13 and reflux finding score ≥ 7) and obstructive sleep apnea (OSA) underwent full polysomnography with concomitant and synchronized multichannel intraluminal impedance-pH esophageal monitoring. The apnea-hypopnea and arousal indexes that occurred 15, 30, and 45 minutes before and after each reflux episode were recorded and compared to full-night apnea and hypopnea and arousal index. RESULTS: We studied 27 patients (14 males, age 51.7 ± 9.1 years, body mass index 32.4 ± 4.2 kg/m²) with laryngopharyngeal reflux (reflux symptom index 16 ± 2 and reflux finding score 12 ± 3) and OSA (apnea-hypopnea index = 32.3 ± 28.4 events/h). We evaluated 102 reflux episodes. Almost half of the reflux episodes occurred while awake (43.1%) and only five reflux episodes (4.9%) occurred during an obstructive respiratory event. The apnea and hypopnea and arousal indexes 15, 30, and 45 minutes before and after reflux episodes were lower than full-night apnea and hypopnea and arousal indexes, respectively. CONCLUSIONS: Among patients with well-established laryngopharyngeal reflux and OSA, there is no temporal association between reflux and obstructive respiratory events. Even though the data comprised a small sample size, it seems that a more complex mechanism is involved with these two highly prevalent diseases.

3.
Sleep ; 42(10)2019 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-31587046

RESUMO

STUDY OBJECTIVES: Poor adherence to continuous positive airway pressure (CPAP) commonly affects therapeutic response in obstructive sleep apnea (OSA). We aimed to determine predictors of adherence to CPAP among participants of the Sleep Apnea and cardioVascular Endpoints (SAVE) trial. METHODS: SAVE was an international, randomized, open trial of CPAP plus usual care versus usual care (UC) alone in participants (45-75 years) with co-occurring moderate-to-severe OSA (≥12 episodes/h of ≥4% oxygen desaturation) and established cardiovascular (CV) disease. Baseline sociodemographic, health and lifestyle factors, OSA symptoms, and 1-month change in daytime sleepiness, as well as CPAP side effects and adherence (during sham screening, titration week, and in the first month), were entered in univariate linear regression analyses to identify predictors of CPAP adherence at 24 months. Variables with p <0.2 were assessed for inclusion in a multivariate linear mixed model with country, age, and sex included a priori and site as a random effect. RESULTS: Significant univariate predictors of adherence at 24 months in 1,121 participants included: early adherence measures, improvement in daytime sleepiness at 1 month, fixed CPAP pressure, some measures of OSA severity, cardiovascular disease history, breathing pauses, and very loud snoring. While observed adherence varied between countries, adherence during sham screening, initial titration, and the first month of treatment retained independent predictive value in the multivariate model along with fixed CPAP pressure and very loud snoring. CONCLUSIONS: Early CPAP adherence had the greatest predictive value for identifying those at highest risk of non-adherence to long-term CPAP therapy. CLINICAL TRIAL REGISTRATION: SAVE is registered with clinicaltrials.gov (NCT00738179).

4.
J Clin Sleep Med ; 2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31482801

RESUMO

STUDY OBJECTIVES: The aim of the current study was to test the hypothesis that there is a temporal correlation between reflux episodes and respiratory events in patients with laryngopharyngeal reflux and obstructive sleep apnea. METHODS: Adults with clinically diagnosed laryngopharyngeal reflux confirmed by two validated instruments (reflux symptom index ≥ 13 and reflux finding score ≥ 7) and obstructive sleep apnea (OSA) underwent full polysomnography with concomitant and synchronized multichannel intraluminal impedance-pH esophageal monitoring. The apnea-hypopnea and arousal indexes that occurred 15, 30, and 45 minutes before and after each reflux episode were recorded and compared to full-night apnea and hypopnea and arousal index. RESULTS: We studied 27 patients (14 males, age 51.7 ± 9.1 years, body mass index 32.4 ± 4.2 kg/m²) with laryngopharyngeal reflux (reflux symptom index 16 ± 2 and reflux finding score 12 ± 3) and OSA (apnea-hypopnea index = 32.3 ± 28.4 events/h). We evaluated 102 reflux episodes. Almost half of the reflux episodes occurred while awake (43.1%) and only five reflux episodes (4.9%) occurred during an obstructive respiratory event. The apnea and hypopnea and arousal indexes 15, 30, and 45 minutes before and after reflux episodes were lower than full-night apnea and hypopnea and arousal indexes, respectively. CONCLUSIONS: Among patients with well-established laryngopharyngeal reflux and OSA, there is no temporal association between reflux and obstructive respiratory events. Even though the data comprised a small sample size, it seems that a more complex mechanism is involved with these two highly prevalent diseases.

5.
Artigo em Inglês | MEDLINE | ID: mdl-31465714

RESUMO

Oronasal breathing may adversely impact OSA patients either by increasing upper airway collapsibility and by influencing CPAP treatment outcomes. Predicting preferential breathing route would be helpful to guide CPAP interface prescription. We hypothesized that anthropometric measurements but not self-reported oronasal breathing are predictors of objectively measured oronasal breathing. Seventeen OSA patients and 9 healthy subjects underwent overnight polysomnography with an oronasal mask with 2-sealed compartments attached to independent pneumotacographs. Subjects answered questionnaires about nasal symptoms and perceived breathing route. Oronasal breathing was more common (p=0.011) among OSA patients than controls while awake (65% vs 0%) and during sleep (71% vs 22%, respectively). Oronasal breathing was associated with OSA severity (p=0.038), age (p=0.001) and neck circumference (p=0.017). There was no agreement between objective measurement and self-reported breathing route among OSA patients while awake (kappa=-0.12) and sleep (kappa=-0.02). Breathing route remained unchanged after 92% of obstructive apneas. These results suggest that oronasal breathing is more common among OSA patients than controls both during wakefulness and sleep and is associated with OSA severity and anthropometric measures. Self-perception is not a reliable predictor of oronasal breathing and should not be considered an indication for oronasal CPAP.

6.
Am J Respir Crit Care Med ; 200(3): e6-e24, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31368798

RESUMO

Background: The purpose of this guideline is to optimize evaluation and management of patients with obesity hypoventilation syndrome (OHS).Methods: A multidisciplinary panel identified and prioritized five clinical questions. The panel performed systematic reviews of available studies (up to July 2018) and followed the Grading of Recommendations, Assessment, Development, and Evaluation evidence-to-decision framework to develop recommendations. All panel members discussed and approved the recommendations.Recommendations: After considering the overall very low quality of the evidence, the panel made five conditional recommendations. We suggest that: 1) clinicians use a serum bicarbonate level <27 mmol/L to exclude the diagnosis of OHS in obese patients with sleep-disordered breathing when suspicion for OHS is not very high (<20%) but to measure arterial blood gases in patients strongly suspected of having OHS, 2) stable ambulatory patients with OHS receive positive airway pressure (PAP), 3) continuous positive airway pressure (CPAP) rather than noninvasive ventilation be offered as the first-line treatment to stable ambulatory patients with OHS and coexistent severe obstructive sleep apnea, 4) patients hospitalized with respiratory failure and suspected of having OHS be discharged with noninvasive ventilation until they undergo outpatient diagnostic procedures and PAP titration in the sleep laboratory (ideally within 2-3 mo), and 5) patients with OHS use weight-loss interventions that produce sustained weight loss of 25% to 30% of body weight to achieve resolution of OHS (which is more likely to be obtained with bariatric surgery).Conclusions: Clinicians may use these recommendations, on the basis of the best available evidence, to guide management and improve outcomes among patients with OHS.

7.
J Bras Pneumol ; 45(4): e20180264, 2019 Aug 15.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31432889

RESUMO

OBJECTIVE: To determine whether airway narrowing during obstructive events occurs predominantly at the retropalatal level and results from dynamic changes in the lateral pharyngeal walls and in tongue position. METHODS: We evaluated 11 patients with severe obstructive sleep apnea (OSA) and 7 healthy controls without OSA during wakefulness and during natural sleep (documented by full polysomnography). Using fast multidetector CT, we obtained images of the upper airway in the waking and sleep states. RESULTS: Upper airway narrowing during sleep was significantly greater at the retropalatal level than at the retroglossal level in the OSA group (p < 0.001) and in the control group (p < 0.05). The retropalatal airway volume was smaller in the OSA group than in the control group during wakefulness (p < 0.05) and decreased significantly from wakefulness to sleep only among the OSA group subjects. Retropalatal pharyngeal narrowing was attributed to reductions in the anteroposterior diameter (p = 0.001) and lateral diameter (p = 0.006), which correlated with an increase in lateral pharyngeal wall volume (p = 0.001) and posterior displacement of the tongue (p = 0.001), respectively. Retroglossal pharyngeal narrowing during sleep did not occur in the OSA group subjects. CONCLUSIONS: In patients with OSA, upper airway narrowing during sleep occurs predominantly at the retropalatal level, affecting the anteroposterior and lateral dimensions, being associated with lateral pharyngeal wall enlargement and posterior tongue displacement.

9.
Chest ; 155(6): 1101-1102, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31174633
10.
Chest ; 2019 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-31238041

RESUMO

BACKGROUND: An oronasal mask is frequently used to treat OSA. In contrast to nasal CPAP, the effectiveness of oronasal CPAP varies by unknown mechanisms. We hypothesized that oral breathing and pressure transmission through the mouth compromises oronasal CPAP efficacy. METHODS: Thirteen patients with OSA, well adapted to oronasal CPAP, were monitored by full polysomnography, pharyngeal pressure catheter, and nasoendoscope. Patients slept with low doses of midazolam, using an oronasal mask with sealed nasal and oral compartments. CPAP was titrated during administration by the oronasal and nasal routes, and was then reduced to induce stable flow limitation and abruptly switched to the alternate route. In addition, tape sealing the mouth was used to block pressure transmission to the oral cavity. RESULTS: Best titrated CPAP was significantly higher by the oronasal route rather than the nasal route (P = .005), and patients with > 25% oral breathing (n = 5) failed to achieve stable breathing during oronasal CPAP. During stable flow limitation, inspiratory peak flow was lower, driving pressure was higher, upper airway inspiratory resistance was higher, and retropalatal and retroglossal area were smaller by the oronasal rather than nasal route (P < .05 for all comparisons). Differences were observed even among patients with no oral flow and were abolished when tape sealing the mouth was used (n = 6). CONCLUSIONS: Oral breathing and transmission of positive pressure through the mouth compromise oronasal CPAP.

11.
Chest ; 155(6): 1190-1198, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30948225

RESUMO

BACKGROUND: OSA and short sleep duration (SSD) are frequently associated with daytime symptoms and cardiometabolic deregulation. However, the vast majority of studies addressing OSA have not evaluated SSD, and vice versa. Our aim was to evaluate the association of OSA, SSD, and their interactions with sleepiness and cardiometabolic risk factors in a large cohort of adults. METHODS: Consecutive subjects from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) participated in clinical evaluations, sleep questionnaires, home sleep monitoring, and actigraphy. OSA was defined as an apnea-hypopnea index ≥ 15 events/hour. SSD was defined by a mean sleep duration < 6 h. RESULTS: Data from 2,064 participants were used in the final analysis (42.8% male; mean age, 49 ± 8 years). The overall frequency of OSA and SSD were 32.9% and 27.2%, respectively. Following an adjustment for multiple confounding factors, excessive daytime sleepiness was independently associated with SSD (OR, 1.448; 95% CI, 1.172-1.790) but not with OSA (OR, 1.107; 95% CI, 0.888-1.380). The SSD interaction with OSA was not significant. Prevalent obesity (OR, 3.894; 95% CI, 3.077-4.928), hypertension (OR, 1.314; 95% CI, 1.035-1.667), and dyslipidemia (OR, 1.251; 95% CI, 1.006-1.555) were independently associated with OSA but not with SSD. Similarly, the interactions of OSA with SSD were not significant. An additional analysis using < 5 h for SSD or continuous sleep duration did not change the lack of association with the cardiometabolic risk factors. CONCLUSIONS: Objective SSD but not OSA was independently associated with daytime sleepiness. By contrast, OSA, but not SSD, was independently associated with obesity, hypertension, and dyslipidemia.

12.
Chest ; 156(3): 553-561, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30926396

RESUMO

BACKGROUND: The aim of this study was to compare the effects of CPAP treatment and placebo intervention on the facial appearance of patients with OSA. METHODS: Patients with severe OSA were randomized to receive either CPAP treatment or nasal dilator (placebo) intervention for 1 month. The sequence was interposed by 15 days of washout with no treatment. Patients were evaluated by using questionnaires, polysomnography, and facial photographs at baseline and at the end of both interventions. In an electronic survey, the photographs were presented in a randomized order to 704 observers who rated the perceived age, health, attractiveness, and tiredness of the patients. Observers were unaware of the patients' conditions. RESULTS: Thirty patients (age, 46 ± 9 years; 21 men; apnea-hypopnea index, 61.8 ± 26.2) were evaluated. During each intervention period, patients used CPAP 6.0 ± 1.7 h per night on 94% of the nights and the placebo intervention on 98% of the nights. After CPAP treatment, patients were rated younger (47.9 ± 3.5 years) than they appeared at baseline (53.9 ± 4.0 years) and following the placebo treatment (49.8 ± 3.7 years) (P < .001). Linear regression analysis identified that CPAP adherence, total sleep time, and percentage of total sleep time with oxyhemoglobin saturation < 90% were predictors of a decreased age rating following CPAP treatment. CONCLUSIONS: Patients with severe OSA had a younger appearance following 1 month of CPAP treatment. This benefit can serve as an additional source of motivation for patients with OSA to comply with CPAP treatment and may facilitate OSA management. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT02117271; URL: www.clinicaltrials.gov.

13.
Sleep Med ; 57: 30-35, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30897453

RESUMO

AIM: To test the association between cardiometabolic risk factors and subjective sleep quality assessed by the Pittsburgh sleep quality index (PSQI), independent of obstructive sleep apnea (OSA) and sleep duration. METHODS: A total of 573 participants from the Baependi Heart Study, a rural cohort from Brazil, completed sleep questionnaires and underwent polygraphy for OSA evaluation. Multivariable linear regression analysis tested the association between cardiovascular risk factors (outcome variables) and sleep quality measured by PSQI, adjusting for OSA and other potential confounders (age, sex, race, salary/wage, education, marital status, alcohol intake, obesity, smoking, hypertension, and sleep duration). RESULTS: The sample mean age was 43 ± 16 years, 66% were female, and mean body mass index (BMI) was 26 ± 5 kg/m2. Only 20% were classified as obese (BMI ≥30). Overall, 50% of participants reported poor sleep quality as defined by a PSQI score ≥5. A high PSQI score was significantly associated with higher very-low-density lipoprotein (VLDL) cholesterol levels (beta = 0.392, p = 0.012) and higher triglyceride levels (beta = 0.017, p = 0.006), even after adjustments, including the apnea-hypopnea index. Further adjustments accounting for marital status, alcohol intake, and medication use did not change these findings. No significant association was observed between PSQI scores and glucose or blood pressure. According to PSQI components, sleep disturbances (beta = 1.976, p = 0.027), sleep medication use (beta = 1.121, p = 0.019), and daytime dysfunction (beta = 1.290, p = 0.024) were significantly associated with higher VLDL serum levels. Only the daytime dysfunction domain of the PSQI components was significantly associated with higher triglyceride levels (beta = 0.066, p = 0.004). CONCLUSION: Poorer lipid profile was independently associated with poor sleep quality, assessed by the PSQI questionnaire, regardless of a normal sleep duration and accounting for OSA and socio-economic status.

15.
J. bras. pneumol ; 45(4): e20180264, 2019. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-1019983

RESUMO

ABSTRACT Objective: To determine whether airway narrowing during obstructive events occurs predominantly at the retropalatal level and results from dynamic changes in the lateral pharyngeal walls and in tongue position. Methods: We evaluated 11 patients with severe obstructive sleep apnea (OSA) and 7 healthy controls without OSA during wakefulness and during natural sleep (documented by full polysomnography). Using fast multidetector CT, we obtained images of the upper airway in the waking and sleep states. Results: Upper airway narrowing during sleep was significantly greater at the retropalatal level than at the retroglossal level in the OSA group (p < 0.001) and in the control group (p < 0.05). The retropalatal airway volume was smaller in the OSA group than in the control group during wakefulness (p < 0.05) and decreased significantly from wakefulness to sleep only among the OSA group subjects. Retropalatal pharyngeal narrowing was attributed to reductions in the anteroposterior diameter (p = 0.001) and lateral diameter (p = 0.006), which correlated with an increase in lateral pharyngeal wall volume (p = 0.001) and posterior displacement of the tongue (p = 0.001), respectively. Retroglossal pharyngeal narrowing during sleep did not occur in the OSA group subjects. Conclusions: In patients with OSA, upper airway narrowing during sleep occurs predominantly at the retropalatal level, affecting the anteroposterior and lateral dimensions, being associated with lateral pharyngeal wall enlargement and posterior tongue displacement.


Resumo Objetivo: Determinar se o estreitamento das vias aéreas durante eventos obstrutivos ocorre predominantemente na região retropalatal e resulta de alterações dinâmicas nas paredes laterais da faringe e na posição da língua. Métodos: Avaliamos 11 pacientes com apneia obstrutiva do sono (AOS) grave (grupo AOS) e 7 indivíduos saudáveis sem AOS (grupo controle) durante a vigília e o sono natural (documentado por meio de polissonografia completa). Por meio de TC multidetectores rápida, obtivemos imagens das vias aéreas superiores no estado de vigília e de sono. Resultados: O estreitamento das vias aéreas superiores durante o sono foi significativamente maior na região retropalatal do que na região retrolingual no grupo AOS (p < 0,001) e no grupo controle (p < 0,05). O volume da via aérea retropalatal foi menor no grupo AOS do que no grupo controle durante a vigília (p < 0,05) e diminuiu significativamente da vigília ao sono apenas no grupo AOS. O estreitamento retropalatal da faringe foi atribuído à redução do diâmetro anteroposterior (p = 0,001) e lateral (p = 0,006), que se correlacionou com o aumento do volume das paredes laterais da faringe (p = 0,001) e o deslocamento posterior da língua (p = 0,001). Não ocorreu estreitamento retrolingual da faringe durante o sono no grupo AOS. Conclusões: Em pacientes com AOS, o estreitamento das vias aéreas superiores durante o sono ocorre predominantemente na região retropalatal e afeta as dimensões anteroposterior e lateral, além de estar relacionado com aumento das paredes laterais da faringe e deslocamento posterior da língua.

16.
In. Consolim-Colombo, Fernanda M; Saraiva, José Francisco Kerr; Izar, Maria Cristina de Oliveira. Tratado de Cardiologia: SOCESP / Cardiology Treaty: SOCESP. São Paulo, Manole, 4ª; 2019. p.471-477.
Monografia em Português | LILACS | ID: biblio-1009117
17.
J. bras. pneumol ; 44(6): 510-518, Nov.-Dec. 2018. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-984604

RESUMO

ABSTRACT Obesity hypoventilation syndrome (OHS) is defined as the presence of obesity (body mass index ≥ 30 kg/m²) and daytime arterial hypercapnia (PaCO2 ≥ 45 mmHg) in the absence of other causes of hypoventilation. OHS is often overlooked and confused with other conditions associated with hypoventilation, particularly COPD. The recognition of OHS is important because of its high prevalence and the fact that, if left untreated, it is associated with high morbidity and mortality. In the present review, we address recent advances in the pathophysiology and management of OHS, the usefulness of determination of venous bicarbonate in screening for OHS, and diagnostic criteria for OHS that eliminate the need for polysomnography. In addition, we review advances in the treatment of OHS, including behavioral measures, and recent studies comparing the efficacy of continuous positive airway pressure with that of noninvasive ventilation.


RESUMO A síndrome de obesidade-hipoventilação (SOH) é definida pela presença de obesidade (índice de massa corpórea ≥ 30 kg/m2) e hipercapnia arterial diurna (PaCO2 ≥ 45 mmHg), na ausência de outras causas. A SOH é frequentemente negligenciada e confundida com outras patologias associadas à hipoventilação, em particular à DPOC. A importância do reconhecimento da SOH se dá por sua elevada prevalência, assim como alta morbidade e mortalidade se não tratada. Na presente revisão, abordamos os recentes avanços na fisiopatologia e no manejo da SOH. Revisamos a utilidade da medição do bicarbonato venoso como rastreamento e os critérios diagnósticos que descartam a necessidade de polissonografia. Destacamos ainda os avanços no tratamento da SOH, incluindo medidas comportamentais, e estudos recentes que comparam a eficácia do uso de pressão positiva contínua nas vias aéreas e de ventilação não invasiva.

18.
19.
Med Sci Sports Exerc ; 2018 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-30312214

RESUMO

We demonstrated that patients with obstructive sleep apnea (OSA) have reduced muscle metaboreflex control of muscle sympathetic nerve activity (MSNA). Additionally, exercise training increased muscle metaboreflex control in heart failure patients. OBJECTIVE: We tested the hypothesis that exercise training would increase muscle metaboreflex control of MSNA in patients with OSA. METHODS: Forty-one patients with OSA were randomized into the following two groups: (1) nontrained (OSANT, n=21) and (2) trained (OSAT, n=20). MSNA was assessed by microneurography technique, muscle blood flow (FBF) by venous occlusion plethysmography, heart rate by electrocardiography, and blood pressure (BP) with an automated oscillometric device. All physiological variables were simultaneously assessed at rest, during isometric handgrip exercise at 30% of the maximal voluntary contraction, and during posthandgrip muscle ischemia (PHMI). Muscle metaboreflex sensitivity was calculated as the difference in MSNA between PHMI and the rest period. Patients in the OSAT group underwent seventy-two sessions of moderate exercise training, whereas patients in the OSANT group were clinical follow-up for six months. RESULTS: The OSANT and OSAT groups were similar in anthropometric, neurovascular, hemodynamic and sleep parameters. Exercise training reduced the baseline MSNA (34±2 vs. 25±2 burst/min, P<0.05) and increased the baseline FBF (2.1±0.2 vs. 2.4±0.2 ml/min/100g, P<0.05). Exercise training significantly reduced MSNA levels and increased FBF responses during isometric exercise. Exercise training significantly increased MSNA responses during PHMI (Δ6.5±1 vs. -1.7±1 bursts/min, P<0.01). No significant changes in FBF or hemodynamic parameters in OSANT patients were found. CONCLUSIONS: Exercise training increases muscle metaboreflex sensitivity in patients with OSA. This autonomic change associated with increased muscle blood flow may contribute to the increase in exercise performance in this set of patients.

20.
Chest ; 2018 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-30268694

RESUMO

BACKGROUND: Although recent evidence suggests that OSA treatment may cause weight gain, the long-term effects of CPAP on weight are not well established. METHODS: This study was a post hoc analysis of the Sleep Apnea Cardiovascular Endpoints (SAVE) study, a multicenter, randomized trial of CPAP plus standard care vs standard care alone in adults with a history of cardiac or cerebrovascular events and moderate to severe OSA. Participants with weight, BMI, and neck and waist circumferences measured at baseline and during follow-up were included. Linear mixed models were used to examine sex-specific temporal differences, and a sensitivity analysis compared high CPAP adherers (≥ 4 h per night) with propensity-matched control participants. RESULTS: A total of 2,483 adults (1,248 in the CPAP group and 1,235 in the control group) were included (mean 6.1 ± 1.5 measures of weight available). After a mean follow-up of 3.78 years, there was no difference in weight change between the CPAP and control groups, for male subjects (mean [95% CI] between-group difference, 0.07 kg [-0.40 to 0.54]; P = .773) or female subjects (mean [95% CI] between-group difference, -0.14 kg [-0.37 to 0.09]; P = .233). Similarly, there were no significant differences in BMI or other anthropometric measures. Although male participants who used CPAP ≥ 4 h per night gained slightly more weight than matched male control subjects without CPAP (mean difference, 0.38 kg [95% CI, 0.04 to 0.73]; P = .031), there were no between-group differences in other anthropometric variables, nor were there any differences between female high CPAP adherers and matched control subjects. CONCLUSIONS: Long-term CPAP use in patients with comorbid OSA and cardiovascular disease does not result in clinically significant weight change. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT00738179; URL: www.clinicaltrials.gov.

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