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1.
Cas Lek Cesk ; 158(5): 178-184, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31703529

RESUMO

Sleep is a condition of physiological relaxation for the cardiovascular system, and sleep-disordered breathing disturbs it. Recurrent episodes of sleep apnea disrupt the physiological interactions between sleep and the cardiovascular system. Sleep apnea can affect not only patients quality of life with cardiovascular diseases, but also their morbidity and mortality. Thus sleep apnea becomes a significant, influential risk factor in cardiology.


Assuntos
Doenças Cardiovasculares , Síndromes da Apneia do Sono , Doenças Cardiovasculares/complicações , Humanos , Qualidade de Vida , Fatores de Risco , Síndromes da Apneia do Sono/complicações
2.
Anaesthesia ; 74(12): 1572-1579, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31508815

RESUMO

Adenotonsillectomies are commonly performed procedures and sleep-disordered breathing is becoming increasingly important as an indication for surgery. Because of the higher risks in patients with obstructive sleep apnoea, the required level of postoperative care for these patients is currently under discussion, and better identification of patients at risk may reduce unnecessary postoperative monitoring. To evaluate the influence of obstructive sleep apnoea, and other risk factors, on peri-operative complications in children requiring adenotonsillectomy, we performed a retrospective case-control study that included 1995 patients treated between January 2009 and June 2017. In our analysis, young age (OR 3.8, 95%CI 2.1-7.1), low body weight (OR 2.6, 95%CI 1.5-4.4), obstructive sleep apnoea (OR 2.4, 95%CI 1.5-3.8), pre-existing craniofacial or syndromal disorders (OR 2.3, 95%CI 1.4-3.8) and adenotonsillectomy, compared with adenoidectomy alone, (OR 7.9, 95%CI 4.7-13.1) were identified as risk factors for complications during or after surgery, p < 0.001. All 13 patients suffering from complications more than 3 h postoperatively had obstructive sleep apnoea plus at least one more of these risk factors. Patients at risk of postoperative complications can therefore be identified by several criteria pre-operatively, and should be monitored postoperatively using pulse oximetry overnight. For all other patients, postoperative observation on a surgical ward without extra monitoring is sufficient. Admission to paediatric intensive care should be reserved for patients suffering serious intra-operative complications.


Assuntos
Adenoidectomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Tonsilectomia/efeitos adversos , Adenoidectomia/estatística & dados numéricos , Adolescente , Fatores Etários , Peso Corporal , Estudos de Casos e Controles , Criança , Pré-Escolar , Anormalidades Craniofaciais/complicações , Feminino , Humanos , Lactente , Masculino , Monitorização Fisiológica , Oximetria , Estudos Retrospectivos , Fatores de Risco , Síndromes da Apneia do Sono/complicações , Síndromes da Apneia do Sono/epidemiologia , Tonsilectomia/estatística & dados numéricos
3.
Praxis (Bern 1994) ; 108(12): 793-798, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31530127

RESUMO

Fatigue - a Common Symptom in General Practice Abstract. When patients suffering from fatigue consult a GP surgery, GPs should understand what patients mean by fatigue, how strongly they are affected in everyday life and how they themselves explain the symptom. In a next step, dangerous diseases such as depression, addiction or sleep apnea syndrome must be excluded. The main somatic and psychiatric causes of fatigue should be explored simultaneously with a more in-depth history. A simple physical exam and a few lab examinations are sufficient to capture the major disorders that present with the isolated symptom of fatigue. For further care, a primary biopsychosocial approach with a viable physician-patient relationship is crucial. Rough conclusions based on laboratory findings should be avoided; comorbidities must be considered.


Assuntos
Fadiga , Medicina Geral , Comorbidade , Depressão/complicações , Depressão/diagnóstico , Medicina de Família e Comunidade , Fadiga/diagnóstico , Fadiga/etiologia , Humanos , Síndromes da Apneia do Sono/complicações , Síndromes da Apneia do Sono/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/diagnóstico
4.
Zh Nevrol Psikhiatr Im S S Korsakova ; 119(4. Vyp. 2): 73-80, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31317919

RESUMO

AIM: To assess the association between stroke and self-reported sleep disorders in the epidemiological studies of cardiovascular diseases in various regions of Russia (ESSE-RF). MATERIAL AND METHODS: A questionnaire survey included unorganized male and female population, aged 25 to 64 years, from 13 regions of the Russian Federation. In the analysis, answers to the question related to history of stroke: 'Did the doctor ever tell you that you had / had the following diseases?' (the 'Diseases' module) were included. The authors also evaluated answers about sleep duration, insomnia complaints, and sleepiness (the 'Sleep assessment' module). RESULTS AND CONCLUSION: Of 20 357 respondents, 422 (2%) confirmed the history of stroke. Both short and long sleep duration were not associated with stroke. Complaints of sleep disorders (snoring, sleep apnea, difficulty falling and maintaining sleep, as well as their combinations) were more frequently correlated with stroke. After adjustment for gender, age, body mass index, office blood pressure, the regression analysis showed that odds ratio was not significant for all complaints, except the combination of sleep apnea with frequent daytime sleepiness (1.7 (95% CI 1.04-2.8) (p=0.034). Therefore, symptoms of sleep-disordered breathing and insomnia are more common in respondents with the history of stroke. The combination of sleep apnea and frequent sleepiness complaints may indicate more severe sleep disorders in post-stroke patients.


Assuntos
Síndromes da Apneia do Sono , Transtornos do Sono-Vigília , Acidente Vascular Cerebral , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Federação Russa/epidemiologia , Síndromes da Apneia do Sono/complicações , Síndromes da Apneia do Sono/epidemiologia , Transtornos do Sono-Vigília/complicações , Transtornos do Sono-Vigília/epidemiologia , Ronco , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/epidemiologia , Inquéritos e Questionários
5.
Zh Nevrol Psikhiatr Im S S Korsakova ; 119(4. Vyp. 2): 99-104, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31317922

RESUMO

Cheyne-Stokes respiration (CSR) is a form of sleep-disordered breathing seen in approximately half of patients with chronic heart failure and low left ventricular ejection fraction. The authors describe clinical features of CSR, mortality rate, treatment variants. Effects of continuous positive airway pressure (CPAP), bi-level ventilation, adaptive servoventilation (ASV) in patients with CSR and chronic heart failure are discussed. Diuretic acetazolamide is one more therapeutic option for CSR. It improves central sleep apnea and related daytime symptoms in patients with heart failure.


Assuntos
Insuficiência Cardíaca , Síndromes da Apneia do Sono , Apneia do Sono Tipo Central , Respiração de Cheyne-Stokes/complicações , Pressão Positiva Contínua nas Vias Aéreas , Insuficiência Cardíaca/complicações , Humanos , Síndromes da Apneia do Sono/complicações , Apneia do Sono Tipo Central/complicações
6.
J Diabetes Res ; 2019: 8417575, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31179343

RESUMO

Background: Metabolic syndrome (MS) and sleep-disordered breathing (SDB) are highly prevalent in patients with diabetes mellitus type 2 (DM2). The present study examined whether there is an independent association between SDB and MS in a sample of outpatients with DM2. Methods: MS was determined in 679 patients of the DIACORE-SDB substudy, a study of outpatients with DM2. According to the National Cholesterol Education Program (NCEP) criteria, MS is defined by at least three of the following five criteria: waist circumference of >102 cm (men)/>88 cm (women), blood pressure of ≥130/85 mmHg, a fasting triglyceride level of >150 mg/dl, high-density lipoprotein (HDL) of <40 mg/dl (men)/<50 mg/dl (women), and a fasting glucose level of ≥110 mg/dl. The apnea-hypopnea index (AHI) was assessed with a 2-channel ambulatory monitoring device and used to define the severity of SDB (AHI < 15.0: no/mild SDB; AHI 15.0-29.9: moderate SDB; AHI ≥ 30.0: severe SDB). Results: 228 (34%) of the 679 participants (mean age 66 years, mean body mass index (BMI) 31.2 kg/m2, and mean AHI 14/hour) had SDB. MS was significantly more frequent in patients with more severe SDB (no/mild SDB vs. moderate SDB vs. severe SDB: 72% vs. 79% vs. 85%, respectively, p = 0.038). Logistic regression analysis adjusted for sex, age, obesity (BMI ≥ 30 kg/m2), and the HOMA index showed a significant association between the AHI and the presence of MS (OR (95%CI) = 1.039 (1.011; 1.068); p = 0.007). Further, male sex, obesity, and the HOMA index were significantly associated with MS. Conclusion: SDB is significantly and independently associated with MS in outpatients with DM2.


Assuntos
Diabetes Mellitus Tipo 2/fisiopatologia , Síndrome Metabólica/fisiopatologia , Síndromes da Apneia do Sono/fisiopatologia , Idoso , Apneia , Glicemia/análise , Pressão Sanguínea , Índice de Massa Corporal , Colesterol/sangue , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Hipóxia , Masculino , Síndrome Metabólica/complicações , Pessoa de Meia-Idade , Obesidade/complicações , Pacientes Ambulatoriais , Prevalência , Estudos Prospectivos , Análise de Regressão , Fatores de Risco , Síndromes da Apneia do Sono/complicações , Triglicerídeos/sangue
7.
Rom J Ophthalmol ; 63(1): 2-9, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31198891

RESUMO

The purpose of this paper is to review the association between a medical entity called the floppy eyelid syndrome (FES) and a very serious respiratory disease with repercussions on various other body organs and systems: the obstructive sleep apnea syndrome. The epidemiology, pathophysiology, and treatment of these two diseases are intertwined but still not enough recognized. Eye disorders affect a great number of patients in modern societies and the cause of their suffering is often left undiscovered, practitioners preferring a symptomatic treatment. However, the ophthalmologist should be aware of the possibility of a sleep disorder in their patients with certain pathologies, as well as sleep physicians, who should be aware of the possibility of eye problems and refer them for a checkup. Finally, a review of literature is undergone, evaluating the possibility that the treatment of one or the other disease may benefit both.


Assuntos
Doenças Palpebrais/etiologia , Síndromes da Apneia do Sono/complicações , Doenças Palpebrais/diagnóstico , Doenças Palpebrais/epidemiologia , Saúde Global , Humanos , Incidência , Polissonografia , Fatores de Risco , Síndromes da Apneia do Sono/diagnóstico , Síndrome , Lágrimas/metabolismo
9.
Diabetes Res Clin Pract ; 152: 16-22, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31078669

RESUMO

OBJECTIVE: To estimate the prevalence of Obstructive Sleep Apnea (OSA) among patients with type 2 Diabetes Mellitus (T2DM) in Jordan, and to explore the association between sleep apnea and clinical and demographic variables. METHOD: A cross-sectional study was carried out from the 1st of November 2011 to the 1st of February 2012 on 1143 patients with T2DM (aged 30-90 years) at the National Center for Diabetes, Endocrinology, and Genetics (NCDEG). The center is considered to be the only referral center in the country and accordingly, the patients represent the population in different parts of the country. All participants completed the Arabic version of the Berlin Questionnaire and were categorized as either low or high-risk patients for OSA. RESULTS: A total of 1143 patients with T2DM were included in this study. There were 587 (51.4%) males and 556 (48.6%) females. The findings showed that 554 (48.5%) patients were at high risk for OSA and 589 (51.5%) were low risk for OSA. Logistic regression analysis revealed that age, smoking, and neck circumference were significantly correlated with high risk for OSA. The clinical and demographic variables were also collected for analysis. CONCLUSIONS: The study found that high risk for OSA was highly prevalent among Jordanian patients with T2DM and that age, smoking and neck circumference were significantly correlated with OSA. Health care providers should be made aware of the high prevalence of sleep problems affecting patients with diabetes and should consider the appropriate screening and treatment for these patients, therefore improving their quality of life.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Apneia Obstrutiva do Sono/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Jordânia/epidemiologia , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Prevalência , Qualidade de Vida , Fatores de Risco , Síndromes da Apneia do Sono/complicações , Síndromes da Apneia do Sono/diagnóstico , Síndromes da Apneia do Sono/epidemiologia , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/diagnóstico , Inquéritos e Questionários
10.
J Arthroplasty ; 34(5): 959-964.e1, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30814026

RESUMO

BACKGROUND: Sleep apnea (SA) negatively affects bone mineralization, cognition, and immunity. There is paucity in the literature regarding the impact of SA on total joint arthroplasty (TJA). The purpose of this study is to compare complications in patients with and without SA undergoing either total knee (TKA) or total hip arthroplasty (THA). METHODS: A retrospective review from 2005 to 2014 was conducted using the Medicare Standard Analytical Files. Patients with and without SA on the day of the primary TJA were queried using the International Classification of Diseases, ninth revision codes. Patients were matched by age, gender, Charlson Comorbidity Index), and body mass index. Patients were followed for 2 years after their surgery. Ninety-day medical complications, complications related to implant, readmission rates, length of stay, and 1-year mortality were quantified and compared. Logistic regression was used to calculate odds ratios (OR) with their respective 95% confidence interval and P values. RESULTS: After the random matching process there were 529,240 patients (female = 271,656, male = 252,106, unknown = 5478) with (TKA = 189,968, THA = 74,652) and without (TKA = 189,968, THA = 74,652) SA who underwent primary TJA between 2005 and 2014. Patients with SA had greater odds of developing medical complications following TKA (OR 3.71) or THA (OR 2.48). CONCLUSION: The study illustrates an increased risk of developing postoperative complications in patients with SA following primary TJA. Surgeons should educate patients on these adverse effects and encourage the use of continuous positive airway pressure which has been shown to mitigate many postoperative complications.


Assuntos
Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Osteoartrite/cirurgia , Síndromes da Apneia do Sono/complicações , Idoso , Artroplastia de Quadril/economia , Artroplastia do Joelho/economia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite/complicações , Osteoartrite/economia , Estudos Retrospectivos , Síndromes da Apneia do Sono/economia , Estados Unidos
11.
J Atheroscler Thromb ; 26(4): 315-327, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30814385

RESUMO

Sleep disordered breathing (SDB), which causes sleep deprivation, intermittent hypoxia, and negative intrathoracic pressure swings, can be accompanied by other harmful pathophysiologies relating to cardiovascular diseases (CVD), including sudden death, atrial fibrillation, stroke, and coronary artery disease leading to heart failure. Continuous positive airway pressure (CPAP) therapy for SDB has been reported to provide favorable effects such as lowered systemic blood pressure and improved endothelial function. However, in recent randomized controlled trials, CPAP has failed to demonstrate its beneficial prognostic impact on the primary or secondary setting of CVD. In this review article, we describe the characteristics of SDB complicated with CVD, the prognostic impacts of SDB in CVD, and the beneficial effects of CPAP on CVD.


Assuntos
Doenças Cardiovasculares/etiologia , Síndromes da Apneia do Sono/complicações , Doenças Cardiovasculares/patologia , Doenças Cardiovasculares/terapia , Pressão Positiva Contínua nas Vias Aéreas/métodos , Humanos , Prognóstico
12.
Rev Mal Respir ; 36(3): 326-332, 2019 Mar.
Artigo em Francês | MEDLINE | ID: mdl-30898469

RESUMO

INTRODUCTION: The sleep apnoea syndrome (SAS) is a public health problem particularly due to its involvement in cardiovascular and metabolic disorders. The aim of this study was to investigate the epidemiological characteristics of the affected population in order to facilitate screening for SAS. MATERIALS AND METHODS: The study was retrospective, monocentric and observational. It was undertaken at the Château-Thierry hospital from 01/01/2010 to 31/12/2014. Several epidemiological parameters were collected. Two groups were created according to the apnoea/hypopnoea index (AHI) and compared with the R software. RESULTS: In all, 629 patients were included and separated into two groups with a division at an AHI limit of 15/h: 425 sick patients (AHI>15/h) and 204 healthy (AHI<15/h). Differences in sex were observed (more sick men, P<0.05), of age (sick patients were older P<0.001), obesity (sick patients were on average 5kg heavier, P<0.05) and of cardiovascular history (hypertension P<0.05, coronary disease P<0.05 and arhythmic heart disease P<0.05). We found no difference using the Epworth scale, nor in benzodiazepine consumption or the presence of dementia. CONCLUSION: This study highlights several risk factors for sleep apnoea in this population but also shows that the Epworth scale is not a good screening tool.


Assuntos
Síndromes da Apneia do Sono/diagnóstico , Síndromes da Apneia do Sono/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Feminino , França/epidemiologia , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Síndromes da Apneia do Sono/complicações , Adulto Jovem
13.
Blood Press ; 28(3): 173-183, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30836778

RESUMO

BACKGROUND: Arterial hypertension is associated with obstructive sleep apnoea, poor quality and duration of sleep, which might contribute to hypertension-mediated organ damage. METHODS: We investigated the presence of insomnia, restless legs syndrome, and obstructive sleep apnoea using validated questionnaires (Insomnia Severity Index, Restless Legs Syndrome Rating Scale, and STOP-Bang), and their relationship with hypertension-mediated organ damage, in hypertensive patients. RESULTS: In 159 consecutive consenting hypertensive patients [age 47(11) years, median and (interquartile range), body mass index 25.5(5.9) kg/m2, office systolic and diastolic blood pressure 144(23)/92(12) mmHg], the STOP-Bang, but not the other scores, predicted cardiac remodelling: compared to patients with a STOP-Bang score < 3, those at high risk of obstructive sleep apnoea showed higher left ventricular mass index [49.8(11.9) vs. 43.3(11.9) g/m2.7, p < 0.0001], left atrium volume [25.7(2.5) vs. 25.0(2.8) ml/m2, p = 0.003], and aortic root diameter [33.6(3.0) vs. 33.0(3.7) mm, p < 0.0001]. They did not differ for microalbuminuria and estimated glomerular filtration rate. At multivariate analysis, after adjustment for office systolic blood pressure values, the STOP-Bang score remained a predictor of left ventricular mass index; while the Insomnia Severity Index and restless legs syndrome risk score had no predictive value. However, a significant interaction between STOP-Bang and Restless Legs Syndrome Rating Scale scores in determining left ventricular remodelling was found. CONCLUSIONS: In consecutive hypertensive stage I patients the STOP-Bang questionnaire allowed identification of a high-risk cohort featuring a more prominent cardiac damage. Hence, this inexpensive tool can be useful for risk stratification purposes in municipalities with limited access to health care resources.


Assuntos
Traumatismos Cardíacos/etiologia , Hipertensão/complicações , Apneia Obstrutiva do Sono/complicações , Adulto , Feminino , Coração , Humanos , Rim/lesões , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Síndromes da Apneia do Sono/complicações , Síndromes da Apneia do Sono/patologia , Apneia Obstrutiva do Sono/patologia , Inquéritos e Questionários
14.
Artigo em Inglês | MEDLINE | ID: mdl-30857293

RESUMO

Sleep-disordered breathing (SDB) is an emerging dementia risk factor. Data on the prevalence of SDB in dementia patients and its association with cognitive impairment is so far only based on patients with severe dementia. In 101 geriatric patients mostly with mild dementia recruited on German geriatric wards, SDB was assessed during overnight polygraphy in the patient room with a portable sleep apnea examination device and associations of SDB severity with severity of impairment in cognitive and emotional function as well as mobility were investigated. We also elucidated which factors influence compliance of SDB diagnostics. In 82 of the 101 dementia patients (81.2%), SDB could be assessed. Of those, only 12.2% had an apnea-hypopnea index (AHI) < 5/h demonstrating the absence of SDB. 40.2% exhibited 5/h ≤ AHI < 15/h representing mild SDB, and 47.6% revealed an AHI ≥ 15/h representing moderate/severe SDB. Patients in these three AHI categories did not significant differ from each other in demographical and clinical characteristics. Patients with an AHI ≥ 15/h particularly often presented with heart failure and vitamin D deficiency. We observed a low to moderate association between severity of SDB and severity of dementia. Tolerance of the nasal airflow sensor of at least 6 h was present in less than one third of all patients. The tolerant group exhibited more symptoms of depression and higher physical fitness compared to the non-tolerant group. We observed a high prevalence of SDB also in geriatric patients with mild dementia underlining the importance of SDB screening in the elderly.


Assuntos
Cognição , Emoções , Hospitalização , Movimento , Síndromes da Apneia do Sono/complicações , Idoso , Idoso de 80 Anos ou mais , Demência/complicações , Feminino , Insuficiência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Síndromes da Apneia do Sono/fisiopatologia , Síndromes da Apneia do Sono/psicologia
15.
Rev. patol. respir ; 22(1): 14-21, ene.-mar. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-185692

RESUMO

Recientemente se ha vinculado al Síndrome de apnea e hipopnea del sueño (SAHS) con la incidencia y mortalidad por cáncer, aunque la literatura epidemiológica al respecto no es concluyente. A partir de modelos animales y algunos estudios en humanos sobre todo en pacientes con melanoma, se ha propuesto que la hipoxia intermitente y la fragmentación del sueño propias del SAHS constituyen el sustrato fisiopatológico de su relación con el cáncer, y al parecer el punto clave es la regulación del sistema inmune defensor de células con potencial oncogénico. La presente revisión pretende resumir una actualización en este campo dada la cantidad ingente de estudios publicados en los últimos años, con la propuesta de futuras líneas de investigación para mejorar la atención de los pacientes que acuden a las Unidades de Sueño


Recently, obstructive sleep apnea (OSA) has been related to cancer incidence and mortality, though epidemiological studies are not conclusive on the matter. Out of basic research and some studies in humans specially of patients with melanoma, it has been proposed that intermittent hypoxia and sleep fragmentation, hallmarks of OSA, are the main physiopathological factors in this relationship, and immune regulation against potentially oncogenic cells appears to be the key point of the effect of OSA on cancer. This review aims to present an updated revision highlighting future research areas in order to improve the medical care of OSA patients


Assuntos
Humanos , Síndromes da Apneia do Sono/complicações , Melanoma/etiologia , Neoplasias da Mama/etiologia , Neoplasias Pulmonares/etiologia , Neoplasias Pancreáticas/etiologia , Neoplasias Colorretais/etiologia
17.
Stroke ; 50(3): 571-576, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30744545

RESUMO

Background and Purpose- Limited data are available about the relationship between sleep-disordered breathing (SDB) and recurrent stroke and mortality, especially from population-based studies, large samples, or ethnically diverse populations. Methods- In the BASIC project (Brain Attack Surveillance in Corpus Christ), we identified patients with ischemic stroke (2010-2015). Subjects were offered screening for SDB with the ApneaLink Plus device, from which a respiratory event index (REI) score ≥10 defined SDB. Demographics and baseline characteristics were determined from chart review and interview. Recurrent ischemic stroke was identified through active and passive surveillance. Cause-specific proportional hazards models were used to assess the association between REI (modeled linearly) and ischemic stroke recurrence (as the event of interest), and all-cause poststroke mortality, adjusted for multiple potential confounders. Results- Among 842 subjects, the median age was 65 (interquartile range, 57-76), 47% were female, and 58% were Mexican American. The median REI score was 14 (interquartile range, 6-26); 63% had SDB. SDB was associated with male sex, Mexican American ethnicity, being insured, nonsmoking status, diabetes mellitus, hypertension, lower educational attainment, and higher body mass index. Among Mexican American and non-Hispanic whites, 85 (11%) ischemic recurrent strokes and 104 (13%) deaths occurred, with a median follow-up time of 591 days. In fully adjusted models, REI was associated with recurrent ischemic stroke (hazard ratio, 1.02 [hazard ratio for one-unit higher REI score, 95% CI, 1.01-1.03]), but not with mortality alone (hazard ratio, 1.00 [95% CI, 0.99-1.02]). Conclusions- Results from this large population-based study show that SDB is associated with recurrent ischemic stroke, but not mortality. SDB may therefore represent an important modifiable risk factor for poor stroke outcomes.


Assuntos
Isquemia Encefálica/complicações , Síndromes da Apneia do Sono/complicações , Acidente Vascular Cerebral/complicações , Idoso , Isquemia Encefálica/epidemiologia , Isquemia Encefálica/mortalidade , Grupos Étnicos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Masculino , Americanos Mexicanos/estatística & dados numéricos , Pessoa de Meia-Idade , Vigilância da População , Modelos de Riscos Proporcionais , Recidiva , Fatores de Risco , Síndromes da Apneia do Sono/epidemiologia , Síndromes da Apneia do Sono/mortalidade , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/mortalidade , Estados Unidos/epidemiologia
18.
Am J Physiol Renal Physiol ; 316(5): F1041-F1052, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30810064

RESUMO

Obstructive sleep apnea is characterized by recurrent episodes of pharyngeal collapse during sleep, resulting in intermittent hypoxia (IH), and is associated with a high incidence of hypertension and accelerated renal failure. In rodents, endothelin (ET)-1 contributes to IH-induced hypertension, and ET-1 levels inversely correlate with glomerular filtration rate in patients with end-stage chronic kidney disease (CKD). Therefore, we hypothesized that a dual ET receptor antagonist, macitentan (Actelion Pharmaceuticals), will attenuate and reverse hypertension and renal dysfunction in a rat model of combined IH and CKD. Male Sprague-Dawley rats received one of three diets (control, 0.2% adenine, and 0.2% adenine + 30 mg·kg-1·day-1 macitentan) for 2 wk followed by 2 wk of recovery diet. Rats were then exposed for 4 wk to air or IH (20 short exposures/h to 5% O2-5% CO2 7 h/day during sleep). Macitentan prevented the increases in mean arterial blood pressure caused by CKD, IH, and the combination of CKD + IH. However, macitentan did not improve kidney function, fibrosis, and inflammation. After CKD was established, rats were exposed to air or IH for 2 wk, and macitentan feeding continued for 2 more wk. Macitentan reversed the hypertension in IH, CKD, and CKD + IH groups without improving renal function. Our data suggest that macitentan could be an effective antihypertensive in patients with CKD and irreversible kidney damage as a way to protect the heart, brain, and eyes from elevated arterial pressure, but it does not reverse toxin-induced tubule atrophy.


Assuntos
Anti-Hipertensivos/farmacologia , Pressão Arterial/efeitos dos fármacos , Antagonistas do Receptor de Endotelina A/farmacologia , Antagonistas do Receptor de Endotelina B/farmacologia , Hipertensão/prevenção & controle , Rim/efeitos dos fármacos , Pirimidinas/farmacologia , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/tratamento farmacológico , Síndromes da Apneia do Sono/complicações , Síndromes da Apneia do Sono/tratamento farmacológico , Sulfonamidas/farmacologia , Animais , Modelos Animais de Doenças , Endotelina-1/genética , Endotelina-1/metabolismo , Taxa de Filtração Glomerular/efeitos dos fármacos , Hipertensão/etiologia , Hipertensão/fisiopatologia , Rim/metabolismo , Rim/patologia , Rim/fisiopatologia , Masculino , Ratos Sprague-Dawley , Insuficiência Renal Crônica/patologia , Insuficiência Renal Crônica/fisiopatologia , Síndromes da Apneia do Sono/fisiopatologia
19.
Clin Respir J ; 13(5): 280-288, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30793493

RESUMO

BACKGROUND: Sleep-disordered breathing (SDB) and atrial fibrillation (AF) are associated. This study investigated the impact of AF intervention on 6-month home sleep testing data. METHODS: Sixty-seven patients (aged 66 to 86, 53% male) with persistent AF were randomized (1:1:1) to direct current cardioversion (DCCV) (22 patients), permanent pacemaker (PPM) + atrioventricular node ablation (AVNA) + DCCV (22 patients) or AF ablation (23 patients). Baseline and 6-month multichannel home sleep tests with the Watch-PAT200 (Itamar Medical Lts., Caesarea, Israel) were recorded. Implantable cardiac monitors (ICMs) (Medtronic Reveal XT, Minneapolis, Minnesota) in the DCCV and AF ablation groups, and PPM Holters in the 'pace and ablate' group were utilized to assess cardiac rhythm beat-to-beat throughout the study period. RESULTS: The prevalence of moderate-to-severe SDB [apnoea-hypopnoea index (AHI) ≥ 15/h] was 60%. At 6 months there was no change in AHI, Epworth sleepiness scale, sleep time, % REM sleep, respiratory desaturation index or central apnoeic events. Twenty-five patients (15 AF ablation, 9 DCCV and 1 following DCCV post-AVNA) maintained SR at 6 months confirmed on ICMs in these patients. AHI fell from 29.8 ± 26.6/h to 22.2 ± 20.4/h; P = 0.049. CONCLUSIONS: SDB is highly prevalent in patients with persistent AF. Restoration of sinus rhythm, and the associated long-term recovery of haemodynamics, is associated with a significant reduction in AHI. This implicates reversal of fluid shift from the lower limbs to the neck region, a key mechanism in the pathogenesis of SDB.


Assuntos
Fibrilação Atrial/complicações , Fibrilação Atrial/terapia , Síndromes da Apneia do Sono/complicações , Síndromes da Apneia do Sono/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Ablação por Cateter , Cardioversão Elétrica , Eletrocardiografia Ambulatorial , Feminino , Humanos , Masculino , Marca-Passo Artificial , Polissonografia , Prevalência , Síndromes da Apneia do Sono/epidemiologia
20.
Semin Ophthalmol ; 34(2): 59-65, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30669924

RESUMO

PURPOSE: To evaluate whether the features of sleep-disordered breathing (SDB) are stronger independent factors for proliferative diabetic retinopathy (PDR) compared to the incidence of metabolic syndrome (MetS) and the number of its individual components. METHODS: We studied a cross-sectional total of 132 patients with type 2 diabetes. Thirty-nine patients had non-proliferative diabetic retinopathy (NPDR) and 93 patients had PDR. Pulse oximetry was conducted, and the patients' mean oxygen saturation (mean SpO2%) and 4% oxygen desaturation index (4% ODI times/hour) were evaluated. We compared the SDB and MetS variables between the NPDR and PDR patients. A logistic regression analysis was used to determine the independent factors for the diagnosis of PDR. RESULTS: The MetS diagnosis was made significantly more often in the PDR group (p = 0.04). The number of individual MetS components was significantly greater in the PDR group compared to the NPDR group (p = 0.01). The mean SpO2 of the NPDR group was not significantly different from that of the PDR group. The 4% ODI in the NPDR group was significantly lower than that in the PDR group (p = 0.01). The logistic regression analysis using the prevalence of MetS and the number of MetS components revealed that younger age and high 4%ODI value were independent factors contributing to the diagnosis of PDR. CONCLUSION: Our findings confirmed that compared to MetS and the number of its individual components, SDB may be a factor contributing to the progression to PDR. However, further careful longitudinal validation studies are needed.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Retinopatia Diabética/etiologia , Síndrome Metabólica/complicações , Síndromes da Apneia do Sono/complicações , Idoso , Estudos Transversais , Retinopatia Diabética/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Japão/epidemiologia , Masculino , Síndrome Metabólica/diagnóstico , Pessoa de Meia-Idade , Oximetria , Polissonografia , Prevalência , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Síndromes da Apneia do Sono/diagnóstico , Síndromes da Apneia do Sono/fisiopatologia
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