GERALDO LORENZI FILHO
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cardio-Pneumologia, Faculdade de Medicina - Docente
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
LIM/63, Hospital das Clínicas, Faculdade de Medicina - Líder
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
LIM/63, Hospital das Clínicas, Faculdade de Medicina - Líder
9 resultados
Resultados de Busca
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conferenceObject Effects of CPAP on Metabolic Syndrome in Patients with Obstructive Sleep Apnea: The TREATOSA-MS Randomized Controlled Trial(2020) GIAMPA, S. Q.; FREITAS, L. S.; FURLAN, S. F.; MACEDO, T. A.; LEBKUCHEN, A.; CARDOZO, K. H. M.; MARTINS, F. C.; AZAM, I. F. B.; COSTA-HONG, V.; BAPTISTA, M. L.; ROCHITTE, C. E.; BORTOLOTTO, L. A.; LORENZI-FILHO, G.; DRAGER, L. F.- Discriminating the severity of pharyngeal collapsibility in men using anthropometric and polysomnographic indices(2020) GENTA, Pedro R.; SCHORR, Fabiola; EDWARDS, Bradley A.; WELLMAN, Andrew; LORENZI-FILHO, GeraldoStudy Objectives: Although obstructive sleep apnea results from the combination of different pathophysiologic mechanisms, the degree of anatomical compromise remains the main responsible factor. The passive pharyngeal critical closing pressure (Pcrit) is a technique used to assess the collapsibility of the upper airway and is often used as a surrogate measure of this anatomical compromise. Patients with a low Pcrit (ie, less collapsible airway) are potential candidates for non-continuous positive airway pressure therapies. However, Pcrit determination is a technically complex method not available in clinical practice. We hypothesized that the discrimination between low and high Pcrit can be estimated from simple anthropometric and polysomnographic indices. Methods: Men with and without obstructive sleep apnea underwent Pcrit determination and full polysomnography. Receiver operating characteristics analysis was performed to select the best cutoff of each variable to predict a high Pcrit (Pcrit >= 2.5 cmH(2)O). Multiple logistic regression analysis was performed to create a clinical score to predict a high Pcrit. Results: We studied 81 men, 48 +/- 13 years of age, with an apnea-hypopnea index of 32 [14-60], range 1-96 events/h), and Pcrit of -0.7 +/- 3.1 (range, -9.1 to +7.2 cmH(2)O). A high and low Pcrit could be accurately identified by polysomnographic and anthropometric indices. A score to discriminate Pcrit showed good performance (area under the curve = 0.96; 95% confidence interval, 0.91-1.00) and included waist circumference, non-rapid eye movement obstructive apnea index/apnea-hypopnea index, mean obstructive apnea duration, and rapid eye movement apnea-hypopnea index. Conclusions: A low Pcrit (less collapsible) can be estimated from a simple clinical score. This approach may identify candidates more likely to respond to non-continuous positive airway pressure therapies for obstructive sleep apnea.
- Severe obstructive sleep apnea is associated with circulating microRNAs related to heart failure, myocardial ischemia, and cancer proliferation(2020) FREITAS, Lunara S.; SILVEIRA, Andre C.; MARTINS, Franco C.; COSTA-HONG, Valeria; LEBKUCHEN, Adriana; CARDOZO, Karina H. M.; BERNARDES, Fernanda M.; BORTOLOTTO, Luiz A.; LORENZI-FILHO, Geraldo; OLIVEIRA, Edilamar M.; DRAGER, Luciano F.Purpose Obstructive sleep apnea (OSA) is associated with multiple comorbid conditions including cardiovascular diseases and cancer. There is a growing interest in exploring biomarkers to understand the related mechanisms and improve the risk stratification of OSA. Circulating microRNAs (miRNAs) are single noncoding strands of nearly 22 nucleotides that posttranscriptionally regulate target gene expression. Our aim was to identify miRNA profiles associated with OSA. Methods We studied 48 male subjects, mostly Caucasian (63%) and overweight, divided by polysomnography into the no OSA control group (n = 6), mild OSA group (n = 12), moderate OSA group (n = 15), and severe OSA group (n = 15). The study groups were matched for age, body mass index (BMI), and body fat composition. miRNA profiles were measured from peripheral whole blood using two steps: (1) microarray analysis comprising more than 2500 miRNAs in a subsample of 12 subjects (three from each group); and (2) validation phase using real-time quantitative polymerase chain reaction (RTqPCR). Results The microarray assessment identified 21 differentially expressed miRNAs among the groups. The RT-qPCR assessment showed that miR-1254 and miR-320e presented a gradual increase in expression parallel to OSA severity. Linear regression analysis showed that severe OSA was independently associated with miR-1254 (ss = 68.4; EP = 29.8; p = 0.02) and miR-320e (ss = 76.1; EP = 31.3; p = 0.02). Conclusion Severe OSA is independently associated with miRNAs that are involved in heart failure (miR-1254), myocardial ischemia/reperfusion (miR-320e), and cell proliferation in some cancer types (miR-1254 and miR-320e). Future investigations addressing whether these miRs may provide prognostic information in OSA are needed.
conferenceObject The Role of Fluid Accumulation in Acute Weight Gain During CPAP Treatment in Patients with Obstructive Sleep Apnea(2020) SILVA, S.; GRAD, G. F.; DRAGER, L. F.; ALBUQUERQUE, A. L.; MELO, C. M. de; LORENZI-FILHO, G.; GENTA, P.- Comparison of upper airway obstruction during zolpidem-induced sleep and propofol-induced sleep in patients with obstructive sleep apnea: a pilot study(2020) ORDONES, Alexandre Beraldo; GRAD, Gustavo Freitas; CAHALI, Michel Burihan; LORENZI-FILHO, Geraldo; SENNES, Luiz Ubirajara; GENTA, Pedro RodriguesStudy Objectives: Drug-induced sleep endoscopy (DISE) using propofol is commonly used to identify the pharyngeal structure involved in collapse among patients with obstructive sleep apnea. DISE has never been compared with zolpidem-induced sleep endoscopy. We hypothesized that propofol at recommended sedation levels does not influence upper airway collapsibility nor the frequency of multilevel pharyngeal collapse as compared with zolpidem-induced sleep. Methods: Twenty-one patients with obstructive sleep apnea underwent polysomnography and sleep endoscopy during zolpidem-induced sleep and during DISE with propofol. A propofol target-controlled infusion was titrated to achieve a bispectral index between 50 and 70. Airway collapsibility was estimated and compared in both conditions by peak inspiratory flow and the magnitude of negative effort dependence. Respiratory drive was estimated by the difference between end-expiratory and peak-negative inspiratory pharyngeal pressure (driving pressure). Site and configuration of pharyngeal collapse during zolpidem-induced sleep and DISE with propofol were compared. Results: The frequency of multilevel collapse during zolpidem-induced sleep was similar to that observed during DISE with propofol (72% vs 86%, respectively; difference: 14%; 95% confidence interval: -12% to 40%; P = .453). The endoscopic classification of pharyngeal collapse during both conditions were similar. Peak inspiratory flow, respiratory drive (effect size: 0.05 and 0.03, respectively), and negative effort dependence (difference: -6%; 95% confidence interval: -16% to 4%) were also similar in both procedures. Conclusions: In this pilot study, recommended propofol doses did not significantly increase multilevel pharyngeal collapse or affect upper airway collapsibility and respiratory drive as compared with zolpidem-induced sleep.
- Continuous Positive Airway Pressure Treatment, Glycemia, and Diabetes Risk in Obstructive Sleep Apnea and Comorbid Cardiovascular Disease(2020) LOFFLER, Kelly A.; HEELEY, Emma; FREED, Ruth; MENG, Rosie; BITTENCOURT, Lia R.; CARVALHO, Carolina C. Gonzaga; CHEN, Rui; HLAVAC, Michael; LIU, Zhihong; LORENZI-FILHO, Geraldo; LUO, Yuanming; MCARDLE, Nigel; MUKHERJEE, Sutapa; YAP, Hooi Shan; ZHANG, Xilong; PALMER, Lyle J.; ANDERSON, Craig S.; MCEVOY, R. Doug; DRAGER, Luciano F.OBJECTIVE Despite evidence of a relationship among obstructive sleep apnea (OSA), metabolic dysregulation, and diabetes, it is uncertain whether OSA treatment can improve metabolic parameters. We sought to determine effects of long-term continuous positive airway pressure (CPAP) treatment on glycemic control and diabetes risk in patients with cardiovascular disease (CVD) and OSA. RESEARCH DESIGN AND METHODS Blood, medical history, and personal data were collected in a substudy of 888 participants in the Sleep Apnea cardioVascular Endpoints (SAVE) trial in which patients with OSA and stable CVD were randomized to receive CPAP plus usual care, or usual care alone. Serum glucose and glycated hemoglobin A(1c)(HbA(1c)) were measured at baseline, 6 months, and 2 and 4 years and incident diabetes diagnoses recorded. RESULTS Median follow-up was 4.3 years. In those with preexisting diabetes (n= 274), there was no significant difference between the CPAP and usual care groups in serum glucose, HbA(1c), or antidiabetic medications during follow-up. There were also no significant between-group differences in participants with prediabetes (n= 452) or new diagnoses of diabetes. Interaction testing suggested that women with diabetes did poorly in the usual care group, while their counterparts on CPAP therapy remained stable. CONCLUSIONS Among patients with established CVD and OSA, we found no evidence that CPAP therapy over several years affects glycemic control in those with diabetes or prediabetes or diabetes risk over standard-of-care treatment. The potential differential effect according to sex deserves further investigation.
- The Importance of Mask Selection on Continuous Positive Airway Pressure Outcomes for Obstructive Sleep Apnea An Official American Thoracic Society Workshop Report(2020) GENTA, Pedro R.; KAMINSKA, Marta; EDWARDS, Bradley A.; EBBEN, Matthew R.; KRIEGER, Ana C.; TAMISIER, Renaud; YE, Lichuan; WEAVER, Terri E.; VANDERVEKEN, Olivier M.; LORENZI-FILHO, Geraldo; DEYOUNG, Pam; HEVENER, William; STROLLO, PatrickContinuous positive airway pressure (CPAP) remains the major treatment option for obstructive sleep apnea (OSA). The American Thoracic Society organized a workshop to discuss the importance of mask selection for OSA treatment with CPAP. In this workshop report, we summarize available evidence about the breathing route during nasal and oronasal CPAP and the importance of nasal symptoms for CPAP outcomes. We explore the mechanisms of air leaks during CPAP treatment and possible alternatives for leak control. The impact of nasal and oronasal CPAP on adherence, residual apnea-hypopnea index, unintentional leaks, and pressure requirements are also compared. Finally, recommendations for patient and partner involvement in mask selection are presented, and future directions to promote personalized mask selection are discussed.
- Sleep duration and risk of cardiovascular events: The SAVE study(2020) LI, Jingwei; ZHENG, Danni; LOFFLER, Kelly A.; WANG, Xia; MCEVOY, R. Doug; WOODMAN, Richard J.; LUO, Yuanming; LORENZI-FILHO, Geraldo; BARBE, Ferran; TRIPATHI, Manjari; ANDERSON, Craig S.Background and aim Controversy exists regarding cardiovascular risk in relation to sleep duration. We determined sleep duration and major recurrent cardiovascular event associations in patients with obstructive sleep apnoea and established cardiovascular disease. Methods Secondary analyses of the international, multicenter, Sleep Apnea Cardiovascular Endpoints trial. Sleep duration was estimated from overnight home oximetry (ApneaLink monitor) used for obstructive sleep apnoea diagnosis. Cox proportional hazards models were used to determine associations of categorized sleep duration (<6 h, 6-8 h (reference), and >8 h) and major cardiovascular outcomes: primary composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, and any hospitalization for unstable angina, heart failure, or transient ischemic attack; secondary composite of cardiac and cerebral (stroke/transient ischemic attack) events. Results Oximetry-derived sleep duration estimates were available in 2687 participants (mean 61.2 years, 80.9% males) who experienced a total of 436 cardiovascular events over a mean follow-up of 3.7 years. Compared to the reference category, sleep duration was not associated with risk of the primary composite cardiovascular outcome (adjusted hazard ratio (HR) 1.00, 95% confidence interval 0.76-1.33, and HR 1.22, 95% confidence interval 0.98-1.52, for sleep duration 8 h, respectively). However, long sleep was associated with increased cerebral events (HR 1.67, 95% confidence interval 1.17-2.39; P = 0.005) and stroke alone (HR 1.79, 95% confidence interval 1.22-2.63; P = 0.003). Conclusions Long sleep duration is associated with an increased risk of stroke but not cardiac events in obstructive sleep apnoea patients with existing cardiovascular disease.
- Validation of an Overnight Wireless High-Resolution Oximeter plus Cloud-Based Algorithm for the Diagnosis of Obstructive Sleep Apnea(2020) PINHEIRO, George do Lago; CRUZ, Andrea Fonseca; DOMINGUES, Diego Munduruca; GENTA, Pedro Rodrigues; DRAGER, Luciano F.; STROLLO, Patrick J.; LORENZI-FILHO, GeraldoOBJECTIVES: Obstructive sleep apnea (OSA) is a common but largely underdiagnosed condition. This study aimed to test the hypothesis that the oxygen desaturation index (ODI) obtained using a wireless high-resolution oximeter with a built-in accelerometer linked to a smartphone with automated cloud analysis, Overnight Digital Monitoring (ODM), is a reliable method for the diagnosis of OSA. METHODS: Consecutive patients referred to the sleep laboratory with suspected OSA underwent in-laboratory polysomnography (PSG) and simultaneous ODM. The PSG apnea-hypopnea index (AHI) was analyzed using the criteria recommended and accepted by the American Academy of Sleep Medicine (AASM) for the definition of hypopnea: arousal or >= 3% O-2 desaturation (PSG-AHI(3%)) and >= 4% O-2 desaturation (PSG-AHI(4%)), respectively. The results of PSG and ODM were compared by drawing parallels between the PSG-AHI(3%) and PSG-AHI(4%) with ODM-ODI3% and ODM-ODI4%, respectively. Bland-Altman plots, intraclass correlation, receiver operating characteristics (ROC) and area under the curve (AUC) analyses were conducted for statistical evaluation. ClinicalTrial.gov: NCT03526133. RESULTS: This study included 304 participants (men: 55%; age: 55 +/- 14 years; body mass index: 30.9 +/- 5.7 kg/m(2); PSG-AHI(3%): 35.3 +/- 30.1/h, ODM-ODI3%: 30.3 +/- 25.9/h). The variability in the AASM scoring bias (PSG-AHI(3%) vs PSG-AHI(4%)) was significantly higher than that for PSG-AHI(3%) vs ODM-ODI3% (3%) and PSG-AHI(4%) vs ODM-ODI4% (4%) (9.7, 5.0, and 2.9/h, respectively; p < 0.001). The limits of agreement (2 +/- SD, derived from the Bland-Altman plot) of AASM scoring variability were also within the same range for (PSG vs ODM) 3% and 4% variability: 18.9, 21.6, and 16.5/h, respectively. The intraclass correlation/AUC for AASM scoring variability and PSG vs ODM 3% or 4% variability were also within the same range (0.944/0.977 and 0.953/0.955 or 0.971/0.964, respectively). CONCLUSION: Our results showed that ODM is a simple and accurate method for the diagnosis of OSA.