Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 35
Filtrar
Mais filtros










Intervalo de ano de publicação
1.
Arch Endocrinol Metab ; 63(1): 40-46, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30864630

RESUMO

OBJECTIVE: To evaluate the influence of obesity on pulmonary function and exercise tolerance in women with obstructive sleep apnea (OSA). SUBJECTS AND METHODS: A descriptive analytic cross- sectional study was carried out. Thirty-nine (39) sedentary climacteric women, aged 45 to 60 years, were evaluated and submitted to polysomnography. The participants were divided into 4 groups: a) 'eutrophic non-OSA' (n = 13); b) 'eutrophic OSA' (n = 5); c) 'obese non-OSA' (n = 6); d) 'obese OSA' (n = 15). All subjects underwent clinical and anthropometric evaluation, followed by pulmonary function tests and 6-minute walk test (6MWT). RESULTS: There was a significant difference in the predicted percentage values of FEV1/FVC when comparing 'eutrophic OSA' and 'obese OSA' (97.6% ± 6.1% vs. 105.7% ± 5.7%, respectively; p = 0.025). The other spirometric variables did not show any differences between the studied groups. There was no significant difference in the maximum distance walked when the 'eutrophic non-OSA', 'eutrophic OSA', 'obese non-OSA' and 'obese OSA' groups were compared. CONCLUSION: Considering the results of this study, OSA itself did not influence pulmonary function or functional capacity parameters compared to eutrophic women. However, not only isolated obesity but also obesity associated with OSA can negatively impact sleep quality and lung function.


Assuntos
Teste de Esforço/métodos , Tolerância ao Exercício/fisiologia , Capacidade Residual Funcional/fisiologia , Obesidade/fisiopatologia , Apneia Obstrutiva do Sono/fisiopatologia , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Polissonografia , Comportamento Sedentário , Espirometria
2.
J Bras Pneumol ; 45(1): e20170333, 2019 Feb 11.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30758426

RESUMO

OBJECTIVE: To evaluate quality of life in elderly patients with obstructive sleep apnea (OSA) who have a pacemaker. METHODS: This was a cross-sectional study involving elderly patients (≥ 60 years of age) with a pacemaker. The dependent variable was quality of life, as evaluated with the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). Sociodemographic and clinical parameters, including anxiety and depression (Hospital Anxiety and Depression Scale score), as well as the presence of OSA (defined as an apnea-hypopnea index ≥ 15 events/h), were analyzed as independent variables. Patients with cognitive/neurological deficits or decompensated heart failure were excluded. RESULTS: We evaluated 72 patients, 17 (23.6%) of whom presented OSA. Of those 17 patients, 9 (52.9%) were male. The mean age was 72.3 ± 9.3 years. A diagnosis of OSA was not associated with gender (p = 0.132), age (p = 0.294), or body mass index (p = 0.790). There were no differences between the patients with OSA and those without, in terms of the SF-36 domain scores. Fourteen patients (19.4%) presented moderate or severe anxiety. Of those 14 patients, only 3 (21.4%) had OSA (p = 0.89 vs. no OSA). Twelve patients (16.6%) had moderate or severe depression. Of those 12 patients, only 2 (16.6%) had OSA (p = 0.73 vs. no OSA). CONCLUSIONS: In elderly patients with a pacemaker, OSA was not found to be associated with quality of life or with symptoms of anxiety or depression.


Assuntos
Marca-Passo Artificial , Qualidade de Vida , Apneia Obstrutiva do Sono/fisiopatologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Ansiedade/fisiopatologia , Estudos Transversais , Depressão/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Marca-Passo Artificial/psicologia , Escalas de Graduação Psiquiátrica , Qualidade de Vida/psicologia , Autorrelato , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/psicologia , Estatísticas não Paramétricas
3.
ABC., imagem cardiovasc ; 32(1)jan.-mar. 2019. ilus, tab
Artigo em Português | LILACS | ID: biblio-969892

RESUMO

Atualmente, a avaliação da função atrial esquerda é um método emergente que pode ter relação com o prognóstico dos pacientes. Classicamente, as medidas estáticas de diâmetro, área e volume são as mais usadas com esta finalidade. A técnica conhecida como speckle tracking é capaz de fornecer informações dinâmicas do átrio esquerdo ao longo do ciclo cardíaco, assim como detectar alterações na função atrial esquerda em fases subclínicas, antes de ocorrerem aumentos volumétricos ou disfunções diastólicas. Valores de normalidade para o speckle tracking estão sendo propostos, mas as diferenças metodológicas e de técnicas empregadas dificultam sua padronização. Esta revisão da literatura se propõe a discutir os avanços na análise da função atrial esquerda, em especial via speckle tracking


Assuntos
Humanos , Masculino , Feminino , Fibrilação Atrial , Ecocardiografia/métodos , Função do Átrio Esquerdo/fisiologia , Cardiomiopatias/complicações , Cardiomiopatias/diagnóstico , Prognóstico , Volume Sistólico/fisiologia , Ecocardiografia Doppler/métodos , Fatores de Risco , Função Atrial/fisiologia , Acidente Vascular Cerebral , Eletrocardiografia/métodos , Átrios do Coração , Insuficiência Cardíaca , Infarto do Miocárdio
4.
Arch. endocrinol. metab. (Online) ; 63(1): 40-46, Jan.-Feb. 2019. tab
Artigo em Inglês | LILACS-Express | ID: biblio-989296

RESUMO

ABSTRACT Objective: To evaluate the influence of obesity on pulmonary function and exercise tolerance in women with obstructive sleep apnea (OSA). Subjects and methods: A descriptive analytic cross- sectional study was carried out. Thirty-nine (39) sedentary climacteric women, aged 45 to 60 years, were evaluated and submitted to polysomnography. The participants were divided into 4 groups: a) 'eutrophic non-OSA' (n = 13); b) 'eutrophic OSA' (n = 5); c) 'obese non-OSA' (n = 6); d) 'obese OSA' (n = 15). All subjects underwent clinical and anthropometric evaluation, followed by pulmonary function tests and 6-minute walk test (6MWT). Results: There was a significant difference in the predicted percentage values of FEV1/FVC when comparing 'eutrophic OSA' and 'obese OSA' (97.6% ± 6.1% vs. 105.7% ± 5.7%, respectively; p = 0.025). The other spirometric variables did not show any differences between the studied groups. There was no significant difference in the maximum distance walked when the 'eutrophic non-OSA', 'eutrophic OSA', 'obese non-OSA' and 'obese OSA' groups were compared. Conclusion: Considering the results of this study, OSA itself did not influence pulmonary function or functional capacity parameters compared to eutrophic women. However, not only isolated obesity but also obesity associated with OSA can negatively impact sleep quality and lung function.

5.
J. bras. pneumol ; 45(1): e20170333, 2019. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-984619

RESUMO

ABSTRACT Objective: To evaluate quality of life in elderly patients with obstructive sleep apnea (OSA) who have a pacemaker. Methods: This was a cross-sectional study involving elderly patients (≥ 60 years of age) with a pacemaker. The dependent variable was quality of life, as evaluated with the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). Sociodemographic and clinical parameters, including anxiety and depression (Hospital Anxiety and Depression Scale score), as well as the presence of OSA (defined as an apnea-hypopnea index ≥ 15 events/h), were analyzed as independent variables. Patients with cognitive/neurological deficits or decompensated heart failure were excluded. Results: We evaluated 72 patients, 17 (23.6%) of whom presented OSA. Of those 17 patients, 9 (52.9%) were male. The mean age was 72.3 ± 9.3 years. A diagnosis of OSA was not associated with gender (p = 0.132), age (p = 0.294), or body mass index (p = 0.790). There were no differences between the patients with OSA and those without, in terms of the SF-36 domain scores. Fourteen patients (19.4%) presented moderate or severe anxiety. Of those 14 patients, only 3 (21.4%) had OSA (p = 0.89 vs. no OSA). Twelve patients (16.6%) had moderate or severe depression. Of those 12 patients, only 2 (16.6%) had OSA (p = 0.73 vs. no OSA). Conclusions: In elderly patients with a pacemaker, OSA was not found to be associated with quality of life or with symptoms of anxiety or depression.


RESUMO Objetivo: Avaliar a qualidade de vida em idosos portadores de marca-passo e apneia obstrutiva do sono (AOS). Métodos: Estudo de corte transversal com idosos (idade ≥ 60 anos) portadores de marca-passo cardíaco. A variável dependente foi qualidade de vida, avaliada por meio do Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). Dados sociodemográficos e clínicos foram analisados como variáveis independentes, entre os quais ansiedade e depressão (por meio da Hospital Anxiety and Depression Scale), assim como presença de AOS (definida como um índice de apneia-hipopneia ≥ 15 eventos/h). Pacientes com déficits cognitivos/neurológicos ou descompensação cardíaca foram excluídos. Resultados: A amostra foi composta por 72 pacientes, 17 dos quais (23,6%) apresentaram AOS - 9 homens (52,9%). A média de idade foi de 72,3 ± 9,3 anos. Não houve associações de presença de AOS com sexo (p = 0,132), idade (p = 0,294) e índice de massa corpórea (p = 0,790). Não foram observadas diferenças dos domínios do SF-36 entre os grupos com e sem AOS. Em relação à ansiedade, 14 pacientes (19,4%) apresentaram sintomas moderados ou graves, dos quais apenas 3 (21,4%) tinham AOS (p = 0,89 vs. sem AOS). No tocante à depressão, 12 pacientes (16,6%) apresentaram sintomas moderados ou graves, dos quais 2 (16,6%) tinham AOS (p = 0,73 vs. sem AOS). Conclusões: Nesta amostra em idosos portadores de marca-passo, a presença de AOS não foi associada a qualidade de vida e sintomas de ansiedade e depressão.

6.
Headache ; 2018 Dec 05.
Artigo em Inglês | MEDLINE | ID: mdl-30516278

RESUMO

OBJECTIVE: This study evaluated the association between migraine and the markers of carotid artery disease. BACKGROUND: Migraine increases the risk of cardiovascular events, but its relationship with vascular dysfunction is unclear. METHODS: In this cross-sectional study, middle-aged women with no known cardiovascular diseases underwent clinical, neurological, and laboratory evaluations; pulse wave velocity (PWV) assessment; and carotid artery ultrasonography. We divided the participants based on the presence of migraine and, further, based on the type of migraine. Associations between migraine and carotid thickening (intima-media thickness >0.9 mm), carotid plaques, or arterial stiffening (PWV >10 m/s) were evaluated using a multiple regression analysis. RESULTS: The study comprised 112/277 (40%) women with migraine, of whom 46/277 (17%) reported having an aura. Compared to the non-migraineurs, the migraine with aura group had an increased risk of diffuse carotid thickening (3/46 [6.8%] vs 2/165 [1.3%], adjusted OR = 7.12, 95% CI 1.05-48.49). Migraine without aura was associated with a low risk of carotid plaques (3/66 [4.7%] vs 26/165 [16.7%], adjusted OR = 0.28, 95% CI 0.08-0.99) and arterial stiffening (21/66 [34.4%] vs 82/165 [51.2%], adjusted OR = 0.39, 95% CI 0.19-0.79). There were no correlations between migraine characteristics and arterial stiffness or carotid thickness measurements. CONCLUSION: Migraine with aura is associated with an increased risk of carotid thickening, and migraine without aura is associated with a low risk of carotid plaques and arterial stiffening.

7.
J Clin Sleep Med ; 14(9): 1471-1475, 2018 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-30176969

RESUMO

STUDY OBJECTIVES: The aim of the current study was to evaluate the association between obstructive sleep apnea (OSA) and exercise capacity in middle-aged women. METHODS: Consecutive middle-aged female subjects without cardiovascular disease, aged 45 to 65 years, from two gynecological clinics underwent detailed clinical evaluation, portable sleep study, and treadmill exercise test. RESULTS: We studied 232 women (age: 55.6 ± 5.2 years; body mass index [BMI]: 28.0 ± 4.8 kg/m2). OSA (apnea-hypopnea index ≥ 5 events/h) was diagnosed in 90 (39%) and obesity (BMI > 30 kg/m2) in 76 (33%) women, respectively. Participants with OSA were older, had a higher BMI, and an increased frequency of arterial hypertension compared to women without OSA. Multiple logistic regression models were used to evaluate the association between OSA and exercise capacity, controlling for traditional risk factors including BMI, age, hypertension, diabetes, and sedentary lifestyle. In multivariate analysis, the presence of obesity without OSA was associated with low exercise capacity (odds ratio [OR] 2.88, 95% confidence interval [CI] 1.02-8.11, P = .045), whereas the presence of OSA without obesity was not (OR 1.07, 95% CI 0.31-3.69, P = .912). However, the coexistence of obesity and OSA increased markedly the odds of reduction in exercise capacity (OR 9.40, CI 3.79-23.3, P < .001). CONCLUSIONS: Obesity and OSA are common conditions in middle-aged women and may interact to reduce exercise capacity. These results highlight the importance of obesity control programs among women, as well as the diagnosis of comorbid OSA in older women.

8.
Arq. bras. cardiol ; 111(3): 364-372, Sept. 2018. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-973751

RESUMO

Abstract Background: Chagas Disease (CD) is an important cause of morbimortality due to heart failure and malignant arrhythmias worldwide, especially in Latin America. Objective: To investigate the association of obstructive sleep apnea (OSA) with heart remodeling and cardiac arrhythmias in patients CD. Methods: Consecutive patients with CD, aged between 30 to 65 years old were enrolled. Participants underwent clinical evaluation, sleep study, 24-hour Holter monitoring, echocardiogram and ambulatory blood pressure monitoring. Results: We evaluated 135 patients [age: 56 (45-62) years; 30% men; BMI: 26 ± 4 kg/m2, Chagas cardiomyopathy: 70%]. Moderate to severe OSA (apnea-hypopnea index, AHI, ≥ 15 events/h) was present in 21% of the patients. OSA was not associated with arrhythmias in this population. As compared to patients with mild or no OSA, patients with moderate to severe OSA had higher frequency of hypertension (79% vs. 72% vs. 44%, p < 0.01) higher nocturnal systolic blood pressure: 119 ± 17 vs. 113 ± 13 vs. 110 ± 11 mmHg, p = 0.01; larger left atrial diameter [37 (33-42) vs. 35 (33-39) vs. 33 (30-36) mm, p < 0.01]; and a greater proportion of left ventricular dysfunction [LVEF < 50% (39% vs. 28% vs. 11%), p < 0.01], respectively. Predictor of left atrial dimension was Log10 (AHI) (b = 3.86, 95% CI: 1.91 to 5.81; p < 0.01). Predictors of ventricular dysfunction were AHI > 15 events/h (OR = 3.61, 95% CI: 1.31 - 9.98; p = 0.01), systolic blood pressure (OR = 1.06, 95% CI: 1.02 - 1.10; p < 0.01) and male gender (OR = 3.24, 95% CI: 1.31 - 8.01; p = 0.01). Conclusions: OSA is independently associated with atrial and ventricular remodeling in patients with CD.


Resumo Fundamento: A doença de Chagas (DC) é uma causa importante de morbimortalidade por insuficiência cardíaca e arritmias malignas em todo o mundo, especialmente na América Latina. Objetivo: Investigar a associação entre apneia obstrutiva do sono (AOS) com remodelação cardíaca e arritmias cardíacas em pacientes com DC. Métodos: Foram incluídos pacientes consecutivos com DC, com idade entre 30 e 65 anos. Os participantes foram submetidos à avaliação clínica, estudo do sono, Holter de 24 horas, ecocardiograma e monitorização ambulatorial da pressão arterial. Resultados: Foram avaliados 135 pacientes [idade: 56 (45-62) anos; 30% homens; IMC: 26 ± 4 kg/m2, cardiomiopatia chagásica: 70%]. AOS moderada a grave (índice de apneia-hipopneia, IAH, ≥ 15 eventos/h) estava presente em 21% dos pacientes. AOS não estava associada a arritmias nessa população. Em comparação com pacientes com AOS leve ou ausente, pacientes com AOS moderada a grave apresentaram maior frequência de hipertensão (79% vs. 72% vs. 44%, p < 0,01) e pressão arterial sistólica noturna mais alta: 119 ± 17 vs. 113 ± 13 vs. 110 ± 11 mmHg, p = 0,01; diâmetro do átrio esquerdo maior [37 (33‑42) vs. 35 (33-39) vs. 33 (30-36) mm, p < 0,01]; e maior proporção de disfunção ventricular esquerda [FEVE < 50% (39% vs. 28% vs. 11%), p < 0,01], respectivamente. O preditor de dimensão do átrio esquerdo foi Log10 (IAH) (β = 3,86, IC 95%: 1,91 a 5,81; p < 0,01). Os preditores de disfunção ventricular foram IAH >15 eventos/h (OR = 3,61, IC 95%: 1,31 - 9,98; p = 0,01), pressão arterial sistólica (OR = 1,06, IC95%: 1,02 - 1,10; p < 0,01) e sexo masculino (OR = 3,24, IC 95%: 1,31 - 8,01; p = 0,01). Conclusões: A AOS está independentemente associada à remodelação atrial e ventricular em pacientes com DC.

9.
Arq Bras Cardiol ; 111(3): 364-372, 2018 Sep.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30088557

RESUMO

BACKGROUND: Chagas Disease (CD) is an important cause of morbimortality due to heart failure and malignant arrhythmias worldwide, especially in Latin America. OBJECTIVE: To investigate the association of obstructive sleep apnea (OSA) with heart remodeling and cardiac arrhythmias in patients CD. METHODS: Consecutive patients with CD, aged between 30 to 65 years old were enrolled. Participants underwent clinical evaluation, sleep study, 24-hour Holter monitoring, echocardiogram and ambulatory blood pressure monitoring. RESULTS: We evaluated 135 patients [age: 56 (45-62) years; 30% men; BMI: 26 ± 4 kg/m2, Chagas cardiomyopathy: 70%]. Moderate to severe OSA (apnea-hypopnea index, AHI, ≥ 15 events/h) was present in 21% of the patients. OSA was not associated with arrhythmias in this population. As compared to patients with mild or no OSA, patients with moderate to severe OSA had higher frequency of hypertension (79% vs. 72% vs. 44%, p < 0.01) higher nocturnal systolic blood pressure: 119 ± 17 vs. 113 ± 13 vs. 110 ± 11 mmHg, p = 0.01; larger left atrial diameter [37 (33-42) vs. 35 (33-39) vs. 33 (30-36) mm, p < 0.01]; and a greater proportion of left ventricular dysfunction [LVEF < 50% (39% vs. 28% vs. 11%), p < 0.01], respectively. Predictor of left atrial dimension was Log10 (AHI) (b = 3.86, 95% CI: 1.91 to 5.81; p < 0.01). Predictors of ventricular dysfunction were AHI > 15 events/h (OR = 3.61, 95% CI: 1.31 - 9.98; p = 0.01), systolic blood pressure (OR = 1.06, 95% CI: 1.02 - 1.10; p < 0.01) and male gender (OR = 3.24, 95% CI: 1.31 - 8.01; p = 0.01). CONCLUSIONS: OSA is independently associated with atrial and ventricular remodeling in patients with CD.

10.
Artigo em Inglês | MEDLINE | ID: mdl-29931618

RESUMO

To verify the frequency and predictors associated with stent thrombosis (ST) in a developing country. Observational, case-control study including 2535 consecutive patients undergoing percutaneous coronary intervention (PCI) in two reference hospitals in Brazil, from October 2013 to December 2015. ST patients were matched to controls in a 1:3 ratio for gender, age, procedure indication, and performing hospital. From the total sample, 65 (2.5%) ST occurred and were matched with 195 controls (age 64.9 ± 11.8 years; hypertension, 78.8%; diabetes, 30%). Clopidogrel and aspirin early withdrawal (OR 19.25; 95% CI 1.66-23.52; p < 0.01 and OR 4.36; 95% CI 1.81-10.50; p = 0.001, respectively), hypertension (OR 3.64; 95% CI 1.38-9.61; p = 0.006), dyslipidemia (OR 2.84; 95% CI 1.48-5.45; p = 0.002), smoking (OR 3.09; 95% CI 1.28-7.43; p = 0.02), body mass index ≥ 30 kg/m2 (OR 2.10; 95% CI 1.02-4.49; p = 0.012), previous myocardial infarction (OR 2.98; 95% CI 1.14-7.47; p < 0.001), bifurcation lesion (OR 2.44; 95% CI 1.05-5.67; p = 0.03), and ≥ 3 stents (OR 3.90; 95% CI 1.78-8.52; p = 0.002) were associated with ST. Stent type, diameter or length, severity of coronary artery disease, calcified lesions, and thrombus were not associated with ST. We found a similar frequency of ST from developed countries and identified strong predictors (clopidogrel and aspirin withdrawal, hypertension, dyslipidemia, smoking, obesity, previous myocardial infarction, bifurcation lesion, number of stents), which are in line with reports from developed countries.

11.
PLoS One ; 13(5): e0197582, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29791465

RESUMO

BACKGROUND: Traditional strategies for primary cardiovascular prevention have been insufficient in reducing the high rates of coronary ischemic events in women, probably because these women are often stratified into low-risk groups. However, cardiovascular diseases continue to be the main cause of morbidity and mortality in women worldwide. We hypothesized that carotid atherosclerosis (CA) is common in middle-aged women. METHODS: We prospectively evaluated asymptomatic peri- and post-menopausal women with no cardiovascular diseases or the use of hormone therapy from two gynecologic clinics. All the patients underwent full clinical and laboratory evaluation and underwent a B-mode ultrasound for carotid evaluations. The presence of CA was defined as the presence of plaque and/or carotid intima-media thickness (CIMT)>1.00 mm. We performed logistic regression to evaluate independent predictors of CA. RESULTS: We studied 823 women (age: 54.4±5.4 years; body mass index-BMI: 28.5±4.9 kg/m2; diabetes:10%; hypertension: 58%). The prevalence of CA was 12.7% for the entire population and 11% for the low-risk sub-group as defined by a Framingham risk score <5%. In the multivariate model, age: odds ratio (OR) = 1.54, 95% confidence interval (CI) = 1.25-1.89,p<0.001; current smoker status: OR = 2.69, 95% CI = 1.48-4.91, p = 0.001; total cholesterol: OR = 1.13, 95% CI = 1.03-1.24, p = 0.008; and systolic blood pressure: OR = 1.01, 95% CI = 1.00-1.02, p = 0.030 remained independently associated with CA. CONCLUSION: Subclinical CA is common among asymptomatic middle-aged women, and traditional risk factors are independently associated with CA. These findings are particularly relevant for improving cardiovascular health in women.


Assuntos
Doenças das Artérias Carótidas/epidemiologia , Artéria Carótida Primitiva/patologia , Idoso , Aterosclerose/diagnóstico por imagem , Aterosclerose/epidemiologia , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/fisiopatologia , Artéria Carótida Primitiva/diagnóstico por imagem , Estudos Transversais , Feminino , Humanos , Arteriosclerose Intracraniana , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Fatores de Risco , Ultrassonografia
12.
Sleep Breath ; 22(3): 631-639, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29124630

RESUMO

PURPOSE: The aim of this study was to evaluate the effectiveness of inspiratory muscle training (IMT) on sleep and functional capacity to exercise in subjects with obstructive sleep apnea (OSA). METHODS: This is a controlled, randomized, double-blind study conducted in 16 OSA patients divided into two groups: training (IMT: n = 8) and placebo-IMT (P-IMT: n = 8). IMT was conducted during 12 weeks with a moderate load (50-60% of maximal inspiratory pressure-MIP), while P-IMT used a load < 20% of MPI. Total daily IMT time for both groups was 30 min, 7 days per week, twice a day. RESULTS: There was no difference comparing IMT to P-IMT group after training for lung function (p > 0.05) and respiratory muscle strength (p > 0.05). Maximal oxygen uptake (VO2Max) was not significantly different between IMT and P-IMT group (mean difference - 1.76, confidence interval (CI) - 7.93 to 4.41, p = 0.71). The same was observed for the other ventilatory and cardiometabolic variables measured (p > 0.05). A significant improvement in sleep quality was found when Pittsburgh Sleep Quality Index (PSQI) values of IMT and P-IMT group after training were compared (mean difference: 3.7, confidence interval 95% (CI95%) 0.6 to 6.9, p = 0.02) but no significant changes were seen in daytime sleepiness between both groups after the intervention (mean difference: 3.4, CI 95%: - 3.3 to 10.0; p = 0.29). CONCLUSION: According to these results, 12 weeks of moderate load IMT resulted in improved sleep quality, but there were no significant repercussions on functional capacity to exercise or excessive daytime sleepiness.

13.
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
14.
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
15.
Sleep Breath ; 21(1): 197-202, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28102484

RESUMO

PURPOSE: The aim of this study was to analyze the prevalence and association between sleep quality with gender and age and to examine the relation between age and the components of the PSQI in institutionalized adolescents. METHODS: High school internal students of both genders, aged between 14 and 19 years old, were analyzed. After a full clinical evaluation, the Pittsburg Sleep Quality Index Score was obtained from all participants. RESULTS: We studied 210 participants [male: 15. 7 ± 1.2 years; BMI: 21.7 ± 2.6 kg/m2; female: 15.7 ± 1. 2 years; BMI: 21.9 ± 4.5 kg/m2]. Poor sleep quality was present in 137 (65.3%) participants and was predominant among girls than boys (PSQI = 76.3 vs 55.8%; p < 0.001), respectively. There were positive correlations between PSQI components with age in boys (sleep latency: R = 0.23; p = 0.02; sleep duration: R = 0.28; p < 0.01 and overall sleep quality: R = 0.21; p = 0.03), but not among girls. CONCLUSION: Institutionalized girls have worse sleep quality than boys and positive correlations between sleep quality components with age were only present among boys.


Assuntos
Adolescente Institucionalizado/estatística & dados numéricos , Transtornos do Sono-Vigília/epidemiologia , Adolescente , Fatores Etários , Brasil , Estudos Transversais , Feminino , Humanos , Masculino , Fatores de Risco , Fatores Sexuais
16.
Motriz (Online) ; 23(spe2): e101788, 2017. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-895033

RESUMO

Abstract Aims: To analyze the average and individual responses of sleep quality and daytime sleepiness in adolescents after four weeks of strength training. Methods: 19 adolescents with sleep problems recruited in the Federal Institute of Pernambuco, were subject to anthropometric evaluations as well as those for body composition assessment, a 1 repetition maximum test, the sleep parameters (Pittsburgh Sleep Quality Index-PSQI and Epworth Sleepiness Scale-ESS) and were submitted to four weeks of strength-training, performed alternately by segment, two sessions per week, according to recommendations for this population. Results: A decrease in the average PSQI score was observed (10.3±3.3 vs 8.8±4.0; p=0.006), but not in ESS (p>0.05), after intervention. The individual analyses demonstrated that ~63% of adolescents experienced reductions ≥ 3 points in the PSQI and ~58% of them experienced reductions ≥ 3 points in the measure of daytime sleepiness. The prevalence of poor sleep quality and daytime sleepiness reduced from 84.2% to 68.4% and from 52.6% to 31.6%, respectively. The comparisons of high and low responders to exercise training show that adolescents who reduced ≥3 points in the score of a least one sleep parameter presented lower weight, fat mass, and fat percentage (p<0.05). Conclusion: A short-term strength-training program is able to improve global sleep quality, but not daytime sleepiness in adolescents. Furthermore, the changes after training are highly heterogeneous. Further studies are required to better understand the effects of strength training on sleep parameters of adolescents.

17.
J. bras. pneumol ; 42(6): 457-464, Nov.-Dec. 2016. graf
Artigo em Inglês | LILACS | ID: biblio-841244

RESUMO

ABSTRACT Obstructive sleep apnea (OSA) is a common clinical condition, with a variable and underestimated prevalence. OSA is the main condition associated with secondary systemic arterial hypertension, as well as with atrial fibrillation, stroke, and coronary artery disease, greatly increasing cardiovascular morbidity and mortality. Treatment with continuous positive airway pressure is not tolerated by all OSA patients and is often not suitable in cases of mild OSA. Hence, alternative methods to treat OSA and its cardiovascular consequences are needed. In OSA patients, regular physical exercise has beneficial effects other than weight loss, although the mechanisms of those effects remain unclear. In this population, physiological adaptations due to physical exercise include increases in upper airway dilator muscle tone and in slow-wave sleep time; and decreases in fluid accumulation in the neck, systemic inflammatory response, and body weight. The major benefits of exercise programs for OSA patients include reducing the severity of the condition and daytime sleepiness, as well as increasing sleep efficiency and maximum oxygen consumption. There are few studies that evaluated the role of physical exercise alone for OSA treatment, and their protocols are quite diverse. However, aerobic exercise, alone or combined with resistance training, is a common point among the studies. In this review, the major studies and mechanisms involved in OSA treatment by means of physical exercise are presented. In addition to systemic clinical benefits provided by physical exercise, OSA patients involved in a regular, predominantly aerobic, exercise program have shown a reduction in disease severity and in daytime sleepiness, as well as an increase in sleep efficiency and in peak oxygen consumption, regardless of weight loss.


RESUMO A apneia obstrutiva do sono (AOS) é uma condição clínica comum, possuindo prevalência variável e subestimada. Principal condição associada à hipertensão arterial sistêmica secundária, associa-se ainda à fibrilação atrial, acidente vascular encefálico e doença arterial coronariana, aumentando a morbidade e mortalidade cardiovascular. O tratamento da AOS com pressão positiva contínua em vias aéreas não é tolerado por todos os pacientes e, muitas vezes, não é indicado para formas leves. Daí, métodos alternativos de tratamento da AOS e de suas consequências cardiovasculares são necessários. A prática usual de exercícios físicos promove benefícios adicionais à redução do peso em pacientes com AOS; contudo, os mecanismos ainda são incertos. Entre as adaptações fisiológicas proporcionadas pelo exercício físico nessa população destacam-se o aumento do tônus da musculatura dilatadora das vias aéreas superiores e do tempo do estágio do sono de ondas lentas e a redução do acúmulo cervical de líquido, da resposta inflamatória sistêmica e do peso corpóreo. Os principais benefícios de programas de exercício físico para essa população incluem a redução da gravidade da AOS e da sonolência diurna e o aumento da eficiência do sono e consumo máximo de oxigênio. Poucos estudos avaliaram o papel do exercício físico realizado de forma isolada no tratamento da AOS, além de existirem muitas diferenças relacionadas aos protocolos de exercício utilizados. Entretanto, o emprego de exercícios aeróbios isolados ou combinados aos exercícios resistidos é um ponto comum entre os estudos. Nessa revisão, os principais estudos e mecanismos envolvidos no tratamento da AOS por meio da realização de exercícios físicos são apresentados. Além dos benefícios clínicos sistêmicos proporcionados pelo exercício físico, pacientes com AOS submetidos a um programa regular de exercícios predominantemente aeróbicos, apresentam redução da gravidade da doença e da sonolência diurna, aumento da eficiência do sono e do pico de consumo de oxigênio, independentemente da perda de peso.


Assuntos
Humanos , Doenças Cardiovasculares/etiologia , Terapia por Exercício , Exercício/fisiologia , Apneia Obstrutiva do Sono/terapia , Doenças Cardiovasculares/fisiopatologia , Terapia por Exercício/métodos , Terapia por Exercício/normas , Fatores de Risco , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/fisiopatologia
18.
Rev. nutr ; 29(5): 665-678, Sept.-Oct. 2016. tab, graf
Artigo em Português | LILACS-Express | ID: biblio-830642

RESUMO

RESUMO Objetivo: Correlacionar os perfis metabólico e nutricional com a presença e gravidade da síndrome da apneia obstrutiva do sono. Métodos: Estudo transversal com pacientes adultos e idosos, de ambos os sexos, atendidos no Laboratório do Sono e Coração do Pronto Socorro Cardiológico Universitário de Pernambuco, entre junho e setembro de 2014. Os pacientes se submeteram à polissonografia, à bioimpedância elétrica e a aferições antropométricas. Foram verificadas a presença da síndrome metabólica e outras morbidades. Resultados: A amostra total foi constituída por 50 pacientes, com idade média de 57,52±9,80 anos, sendo que 94% receberam diagnóstico de síndrome da apneia obstrutiva do sono e 74% possuíam síndrome metabólica. As seguintes médias foram obtidas: índice de massa corporal (31,54±5,82 kg/m2); circunferência do pescoço (39,14±4,33 cm); circunferência da cintura (106,72±11,22 cm); diâmetro abdominal sagital (23,00 cm [21,00-24,00]). O índice de massa corporal, a circunferência da cintura e o diâmetro abdominal sagital apresentaram valores mais elevados (p<0,05) entre os pacientes com síndrome da apneia obstrutiva do sono grave, quando comparados aqueles com a forma leve. O diâmetro abdominal sagital apresentou moderada correlação com o índice de apneia e hipopneia e a gordura corporal apresentou fraca correlação. Conclusão: A obesidade, a circunferência do pescoço, o diâmetro abdominal sagital e a síndrome metabólica tiveram associação positiva com a gravidade da síndrome da apneia obstrutiva do sono. Dentre os parâmetros antropométricos avaliados, o diâmetro abdominal sagital mostrou ser o mais adequado preditor para avaliar a presença e gravidade da síndrome da apneia obstrutiva do sono.


ABSTRACT Objective: To compare metabolic and nutritional profiles with the presence and severity of obstructive sleep apnea syndrome. Methods: This cross-sectional study included male and female adults and older adults treated at the Sleep and Heart Laboratory of Pernambuco Cardiologic Emergency Medical Services between June and September 2014. Patients underwent polysomnography, bioelectrical impedance analysis, and anthropometric measurements. Presence of the metabolic syndrome and other morbidities was investigated. Results: The sample consisted of 50 patients with a mean age of 57.52±9.80 years, of which 94% were diagnosed with obstructive sleep apnea syndrome, and 74% had the metabolic syndrome. Other mean sample characteristics were: body mass index (31.54±5.82 kg/m2); neck circumference (39.14±4.33 cm); waist circumference (106.72±22.11 cm); sagittal abdominal diameter (23.00 cm [21.00-24.00]). Patients with severe obstructive sleep apnea syndrome had higher body mass index, waist circumference, and sagittal abdominal diameter (p<0.05) than those with mild condition. Sagittal abdominal diameter was correlated moderately with the apnea-hypopnea index and mildly with body fat. Conclusion: Obesity, neck circumference, and the metabolic syndrome had a positive association with obstructive sleep apnea syndrome severity. Of the study anthropometric parameters, sagittal abdominal diameter was the most suitable predictor of presence and severity of obstructive sleep apnea syndrome.

19.
J Bras Pneumol ; 42(6): 457-464, 2016 Nov-Dec.
Artigo em Inglês, Português | MEDLINE | ID: mdl-28117479

RESUMO

Obstructive sleep apnea (OSA) is a common clinical condition, with a variable and underestimated prevalence. OSA is the main condition associated with secondary systemic arterial hypertension, as well as with atrial fibrillation, stroke, and coronary artery disease, greatly increasing cardiovascular morbidity and mortality. Treatment with continuous positive airway pressure is not tolerated by all OSA patients and is often not suitable in cases of mild OSA. Hence, alternative methods to treat OSA and its cardiovascular consequences are needed. In OSA patients, regular physical exercise has beneficial effects other than weight loss, although the mechanisms of those effects remain unclear. In this population, physiological adaptations due to physical exercise include increases in upper airway dilator muscle tone and in slow-wave sleep time; and decreases in fluid accumulation in the neck, systemic inflammatory response, and body weight. The major benefits of exercise programs for OSA patients include reducing the severity of the condition and daytime sleepiness, as well as increasing sleep efficiency and maximum oxygen consumption. There are few studies that evaluated the role of physical exercise alone for OSA treatment, and their protocols are quite diverse. However, aerobic exercise, alone or combined with resistance training, is a common point among the studies. In this review, the major studies and mechanisms involved in OSA treatment by means of physical exercise are presented. In addition to systemic clinical benefits provided by physical exercise, OSA patients involved in a regular, predominantly aerobic, exercise program have shown a reduction in disease severity and in daytime sleepiness, as well as an increase in sleep efficiency and in peak oxygen consumption, regardless of weight loss. RESUMO A apneia obstrutiva do sono (AOS) é uma condição clínica comum, possuindo prevalência variável e subestimada. Principal condição associada à hipertensão arterial sistêmica secundária, associa-se ainda à fibrilação atrial, acidente vascular encefálico e doença arterial coronariana, aumentando a morbidade e mortalidade cardiovascular. O tratamento da AOS com pressão positiva contínua em vias aéreas não é tolerado por todos os pacientes e, muitas vezes, não é indicado para formas leves. Daí, métodos alternativos de tratamento da AOS e de suas consequências cardiovasculares são necessários. A prática usual de exercícios físicos promove benefícios adicionais à redução do peso em pacientes com AOS; contudo, os mecanismos ainda são incertos. Entre as adaptações fisiológicas proporcionadas pelo exercício físico nessa população destacam-se o aumento do tônus da musculatura dilatadora das vias aéreas superiores e do tempo do estágio do sono de ondas lentas e a redução do acúmulo cervical de líquido, da resposta inflamatória sistêmica e do peso corpóreo. Os principais benefícios de programas de exercício físico para essa população incluem a redução da gravidade da AOS e da sonolência diurna e o aumento da eficiência do sono e consumo máximo de oxigênio. Poucos estudos avaliaram o papel do exercício físico realizado de forma isolada no tratamento da AOS, além de existirem muitas diferenças relacionadas aos protocolos de exercício utilizados. Entretanto, o emprego de exercícios aeróbios isolados ou combinados aos exercícios resistidos é um ponto comum entre os estudos. Nessa revisão, os principais estudos e mecanismos envolvidos no tratamento da AOS por meio da realização de exercícios físicos são apresentados. Além dos benefícios clínicos sistêmicos proporcionados pelo exercício físico, pacientes com AOS submetidos a um programa regular de exercícios predominantemente aeróbicos, apresentam redução da gravidade da doença e da sonolência diurna, aumento da eficiência do sono e do pico de consumo de oxigênio, independentemente da perda de peso.


Assuntos
Doenças Cardiovasculares/etiologia , Terapia por Exercício , Exercício/fisiologia , Apneia Obstrutiva do Sono/terapia , Doenças Cardiovasculares/fisiopatologia , Terapia por Exercício/métodos , Terapia por Exercício/normas , Humanos , Fatores de Risco , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/fisiopatologia
20.
PLoS One ; 10(12): e0144259, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26713613

RESUMO

BACKGROUND: The presence of nucleated red blood cells (NRBCs) in the peripheral blood of critically ill patients is associated with a poorer prognosis, though data on cardiovascular critical care patients is lacking. The aim of the present study was to assess the role of NRBCs as a predictor of intensive care unit (ICU) and in hospital all-cause mortality among cardiologic patients. METHODS: NRBCs were measured daily in consecutive cardiac ICU patients, including individuals with both coronary and non-coronary acute cardiac care. We excluded patients younger than 18 years, with cancer or hematological disease, on glucocorticoid therapy, those that were readmitted after hospital discharge and patients who died in the first 24 hours after admission. We performed a multiple logistic analysis to identify independent predictors of mortality. RESULTS: We included 152 patients (60.6 ± 16.8 years, 51.8% female, median ICU stay of 7 [4-11] days). The prevalence of NRBCs was 54.6% (83/152). The presence of NRBC was associated with a higher ICU mortality (49.4% vs 21.7%, P<0.001) as well as in-hospital mortality (61.4% vs 33.3%, p = 0.001). NRBC were equally associated with mortality among coronary disease (64.71% vs 32.5% [OR 3.80; 95%CI: 1.45-10.0; p = 0.007]) and non-coronary disease patients (61.45% vs 33.3% [OR 3.19; 95%CI: 1.63-6.21; p<0.001]). In a multivariable model, the inclusion of NRBC to the APACHE II score resulted in a significant improvement in the discrimination (p = 0.01). CONCLUSIONS: NRBC are predictors of all-cause in-hospital mortality in patients admitted to a cardiac ICU. This predictive value is independent and complementary to the well validated APACHE II score.


Assuntos
Cardiopatias/mortalidade , Adulto , Idoso , Cuidados Críticos , Estado Terminal , Eritroblastos/patologia , Contagem de Eritrócitos , Feminino , Cardiopatias/sangue , Cardiopatias/patologia , Cardiopatias/terapia , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Curva ROC , Análise de Sobrevida
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA