LUCIANO FERREIRA DRAGER
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Clínica Médica, Faculdade de Medicina - Docente
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/63, Hospital das Clínicas, Faculdade de Medicina - Líder
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/63, Hospital das Clínicas, Faculdade de Medicina - Líder
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- OSA, Short Sleep Duration, and Their Interactions With Sleepiness and Cardiometabolic Risk Factors in Adults The ELSA-Brasil Study(2019) DRAGER, Luciano F.; SANTOS, Ronaldo B.; SILVA, Wagner A.; PARISE, Barbara K.; GIATTI, Soraya; AIELO, Aline N.; SOUZA, Silvana P.; FURLAN, Sofia F.; LORENZI-FILHO, Geraldo; LOTUFO, Paulo A.; BENSENOR, Isabela M.BACKGROUND: OSA and short sleep duration (SSD) are frequently associated with daytime symptoms and cardiometabolic deregulation. However, the vast majority of studies addressing OSA have not evaluated SSD, and vice versa. Our aim was to evaluate the association of OSA, SSD, and their interactions with sleepiness and cardiometabolic risk factors in a large cohort of adults. METHODS: Consecutive subjects from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) participated in clinical evaluations, sleep questionnaires, home sleep monitoring, and actigraphy. OSA was defined as an apnea-hypopnea index >= 15 events/hour. SSD was defined by a mean sleep duration < 6 h. RESULTS: Data from 2,064 participants were used in the final analysis (42.8% male; mean age, 49 +/- 8 years). The overall frequency of OSA and SSD were 32.9% and 27.2%, respectively. Following an adjustment for multiple confounding factors, excessive daytime sleepiness was independently associated with SSD (OR, 1.448; 95% CI, 1.172-1.790) but not with OSA (OR, 1.107; 95% CI, 0.888-1.380). The SSD interaction with OSA was not significant. Prevalent obesity (OR, 3.894; 95% CI, 3.077-4.928), hypertension (OR, 1.314; 95% CI, 1.035-1.667), and dyslipidemia (OR, 1.251; 95% CI, 1.006-1.555) were independently associated with OSA but not with SSD. Similarly, the interactions of OSA with SSD were not significant. An additional analysis using < 5 h for SSD or continuous sleep duration did not change the lack of association with the cardiometabolic risk factors. CONCLUSIONS: Objective SSD but not OSA was independently associated with daytime sleepiness. By contrast, OSA, but not SSD, was independently associated with obesity, hypertension, and dyslipidemia.
- Incident Coronary Calcium Score in Patients With OSA With and Without Excessive Sleepiness Brazilian Longitudinal Study of Adult Health(2024) MIRANDA, Erique Jose Farias Peixoto de; MAZZOTTI, Diego R.; SANTOS, Ronaldo B.; SOUZA, Silvana P.; PARISE, Barbara K.; GIATTI, Soraya; AIELO, Aline N.; CUNHA, Lorenna F.; SILVA, Wagner A.; BORTOLOTTO, Luiz A.; LORENZI-FILHO, Geraldo; LOTUFO, Paulo A.; BENSENOR, Isabela M.; BITTENCOURT, Marcio S.; DRAGER, Luciano F.BACKGROUND: Uncertainty exists about the impact of OSA and its phenotypes on cardio-vascular disease. RESEARCH QUESTION: Are OSA and clinical features such as daytime sleepiness associated with incident subclinical coronary atherosclerosis? STUDY DESIGN AND METHODS: In this prospective community-based cohort study, we administered a sleepiness questionnaire, actigraphy, and home sleep studies at baseline. Coronary artery calcium (CAC; 64-slice multidetector CT scan imaging) was measured at two different time points throughout the study (baseline, between 2010 and 2014, and follow-up, between 2016 and 2018). Incidence of subclinical atherosclerosis was defined as baseline CAC of 0 followed by CAC of > 0 at a 5-year follow-up visit. The association of incident CAC outcome was assessed using logistic regression. Stratified analyses based on excessive daytime sleepiness (EDS) were performed. RESULTS: We analyzed 1,956 participants with available CAC scores at baseline (mean age, 49 +/- 8 years; 57.9% female; 32.4% with OSA). In covariate-adjusted analyses (n = 1,247; mean follow-up, 5.1 +/- 0.9 years), we found a significant association between OSA and incidence of subclinical atherosclerosis (OR, 1.26; 95% CI, 1.06-1.48), with stronger effects among those reporting EDS (OR, 1.66; 95% CI, 1.30-2.12; P = .028 for interaction). Interestingly, EDS per se was not associated with any CAC outcome. An exploratory analysis of the square root of CAC progression (baseline CAC > 0 followed by a numerical increase in scores at follow-up; n = 319) showed a positive association for both OSA (beta = 1.084; 95% CI, 0.032-2.136; P = .043) and OSA with EDS (beta = 1.651; 95% CI, 0.208-3.094; P = .025). INTERPRETATION: OSA, particularly with EDS, predicts the incidence and progression of CAC. These results support biological plausibility for the increased cardiovascular risk observed among patients with OSA with excessive sleepiness.
- Sleepiness and Cardiometabolic Impact of Short Sleep Duration and OSA What About the Clock? Response(2019) DRAGER, Luciano F.; SANTOS, Ronaldo B.; SILVA, Wagner A.; PARISE, Barbara K.; GIATTI, Soraya; AIELO, Aline N.; SOUZA, Silvana P.; LOTUFO, Paulo A.; BENSENOR, Isabela M.
conferenceObject INTERACTIONS BETWEEN OBSTRUCTIVE SLEEP APNEA AND SLEEP DURATION WITH SUBCLINICAL ATHEROSCLEROSIS EVALUATED BY CORONARY CALCIUM SCORE: CROSS-SECTIONAL DATA FROM ELSA-BRASIL STUDY(2019) SOUZA, S. Pereira e; BITTENCOURT, S. M.; PARISE, K. B.; SANTOS, B. R.; SILVA, A. W.; AIELO, N. A.; PADOVESI, G. S.; FILHO, L. G.; BENSENOR, M. I.; LOTUFO, A. P.; DRAGER, F. L.- Excessive daytime sleepiness, but not sleep apnea, sleep duration or insomnia, was associated with poor adherence to anti-hypertensive treatment: The ELSA-Brasil study(2023) AIELO, Aline N.; SANTOS, Ronaldo B.; GIATTI, Soraya; SILVA, Wagner A.; PARISE, Barbara K.; CUNHA, Lorenna F.; SOUZA, Silvana P.; LOTUFO, Paulo A.; BENSENOR, Isabela M.; DRAGER, Luciano F.Hypertension is the leading risk factor for cardiovascular mortality. Poor adherence may partially explain this scenario. Beyond traditional factors, it is conceivable that sleep conditions such as Obstructive Sleep Apnea (OSA), Sleep Duration (SDUR), sleepiness and insomnia may contribute to impair adherence but the evidence is scanty. Consecutive participants with hypertension from the ELSA-Brasil study performed a home sleep monitoring and 7-days actigraphy to determine OSA (apnea-hypopnea index >= 15 events/ hour) and SDUR, respectively. Excessive daytime sleepiness (EDS) and insomnia were evaluated by Epworth Sleepiness Scale (ESS) and Clinical Interview Scheduled Revised (CIS-R), respectively. The 4itens Morisky questionnaire was used to evaluate adherence to anti-hypertensive therapy. A total of 411 patients were including in the analysis (mean age: 54 +/- 8 years, 47% men). Medium/low adherence to anti-hypertensive therapy was observed in 62%. Compared to the high adherence group, the participants with medium/low adherence had lower frequencies of Whites (64.1 vs. 47.8%), high-degree education (50.6 vs. 40%), and monthly per-capita income ($1021.90 vs. $805.20). In contrast, we observed higher frequency of EDS (35.9 vs. 46.1%). No differences were observed for OSA, short SDUR (<6 h) and insomnia. Logistic regression analysis showed that race other than White (OR: 1.80; 95% IC:1.15-2.82), lower monthly income (OR: 1.74; 95% IC:1.01-3.0) and EDS (OR: 1.63; 95% IC:1.05-2.53) were independently associated with medium/low adherence to the anti-hypertensive treatment. Interestingly, EDS mediated the abdominal obesity-adherence outcome. In conclusion, among sleep-related parameters, EDS, but not OSA, short SDUR or insomnia, were associated to impaired adherence to anti-hypertensive therapy.(c) 2023 Elsevier B.V. All rights reserved.
- Influence of the device used for obstructive sleep apnea diagnosis on body position: a comparison between polysomnography and portable monitor(2023) MELLO, Andre A. F.; D'ANGELO, Giovanna; SANTOS, Ronaldo B.; BENSENOR, Isabela; LOTUFO, Paulo A.; LORENZI-FILHO, Geraldo; DRAGER, Luciano F.; GENTA, Pedro R.Purpose Different devices have been used for the diagnosis of obstructive sleep apnea (OSA), which differ in the number of sensors used. The numerous sensors used in more complex sleep studies such as in-lab polysomnography may influence body position during sleep. We hypothesized that patients submitted to in-lab polysomnography (PSG) would spend more time in the supine position than patients submitted to an ambulatory Portable Monitor (PM) sleep study. Methods Body position during PSG and PM studies was compared among two distinct groups of patients matched for age, body-mass index (BMI), apnea-hypopnea index (AHI), and gender. Predictors of time spent in the supine position were determined using a multiple linear regression model. Results Of 478 participants who underwent either PSG or PM studies, mean age: 61[43-66] years; males: 43.9%; BMI: 28.4[26.1-31.1]kg/m(2); AHI 14[7-27] events/hour). Participants who underwent PSG studies spent more time in the supine position (41[16-68]% than participants who underwent PM studies (34[16-51]%), P = 0.014. Participants with OSA spent more time in the supine position than participants without OSA, both among the PSG and PM groups P < 0.05). Gender, BMI, OSA severity, and sleep study type were independent predictors of time spent in the supine position. Conclusion In-lab PSG may increase time spent in the supine position and overestimate OSA severity compared to a PM sleep study. OSA diagnosis is also associated with increased time spent in the supine position. The potential influence on the sleeping position should be taken into account when choosing among the different sleep study types for OSA diagnosis.
- Obstructive sleep apnea, sleep duration and chronic kidney disease in patients with coronary artery disease(2021) FURLAN, Sofia F.; SINKUNAS, Viktor; DAMIANI, Lucas P.; SANTOS, Ronaldo B.; PERES, Matheus; LEMOS, Pedro A.; LEE, Chi-Hang; LORENZI-FILHO, Geraldo; DRAGER, Luciano F.Y Background: Limited evidence is available addressing the potential role of sleep disorders on renal function. Here, we aimed to explore the associations of obstructive sleep apnea (OSA) and sleep duration (SD) with renal function in subjects with high cardiovascular risk. Methods: Consecutive subjects with coronary artery disease (CAD) underwent clinical evaluation, sleep study to define OSA and one-week wrist actigraphy to objectively measure SD. OSA was defined by an apnea-hypopnea index (AHI) of >15 events/hour. The estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI equation. We analyzed the associations of OSA and SD with continuous eGFR values and according to the presence of CKD (eGFR<60 mL/min/1.73 m(2)) after adjusting for multiple confounding factors. Results: We studied 242 subjects (62.8% men). The frequency of OSA was 55.4% and the median SD was 412.8 (363.4-457.25) min. There was no difference in the eGFRs between participants with and without OSA (69.3 +/- 19.1 vs. 74.6 +/- 19.3 mL/min/1.73 m(2), p = 0.72) and the rate of eGFR <60 mL/min/1.73 m(2) (34.3% vs. 25.9%; p = 0.21). Similarly, we did not find differences in patients in eGFR for those with SD > 6 h versus SD < 6 h (72.5 +/- 20.3 vs. 71.4 +/- 19.1 mL/min/1.73 m(2), p = 0.72). In the linear regression analysis, AHI was independently associated with an eGFR<60 mL/min/1.73 m(2) in the unadjusted model [-0.15 (-0.27 to-0.04)], (P = 0.01), but not in the adjusted models. Analyses of continuous SD or the stratification in SD >= 6 h or <6 h also revealed neutral results on eGFR. Conclusion: OSA severity and SD were not independently associated with CKD in subjects with CAD.
- Association between objective sleep measures and cognitive performance: a cross-sectional analysis in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) study(2023) SUEMOTO, Claudia K.; SANTOS, Ronaldo B.; GIATTI, Soraya; AIELO, Aline N.; SILVA, Wagner A.; PARISE, Barbara K.; CUNHA, Lorenna F.; SOUZA, Silvana P.; GRIEP, Rosane H.; BRUNONI, Andre R.; LOTUFO, Paulo A.; BENSENOR, Isabela M.; DRAGER, Luciano F.Sleep disturbances often co-exist, which challenges our understanding of their potential impact on cognition. We explored the cross-sectional associations of insomnia and objective measures of sleep with cognitive performance in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) study stratified by middle-aged and older adults. Participants aged >= 55 years underwent cognitive evaluations, polygraphy for 1 night, and actigraphy for 7 days. Insomnia was evaluated using the Clinical Interview Scheduled Revised. Obstructive sleep apnea (OSA) and short sleep duration (SSD) were defined by an apnea-hypopnea index (AHI) of >= 15 events/h and <6 h/ night, respectively. In 703 participants (mean [SD] age 62 [6] years, 44% men), cognition was evaluated using a 10-word list, verbal fluency, and trail-making tests. The frequencies of insomnia, SSD, and OSA were 11%, 24%, and 33%, respectively. In all, 4% had comorbid OSA and insomnia, and 11% had both OSA and SSD. Higher wake after sleep onset (beta = -0.004, 95% confidence interval [CI] -0.008, -0.001) and the number of awakenings (beta = -0.006, 95% CI -0.012, -0.001) were associated with worse verbal fluency performance. Compared to those without insomnia, older participants with insomnia had worse global performance (beta = -0.354, 95% CI -0.671, -0.038). Insomnia was an effect modifier in the associations between AHI and executive function performance (p for the interaction between insomnia and AHI = 0.004) and between oxygen saturation <90% and memory performance (p for the interaction between insomnia and oxygen saturation = 0.02). Although some associations between sleep measures and cognition were significant, they should be considered with caution due to the large sample size and multiple testing performed in this study.
conferenceObject Association of obstructive sleep apnoea and short sleep duration with hypertension: the Brazilian longitudinal study of adult health ((ELSA-Brasil)(2017) PARISE, B. K.; SANTOS, R. B.; SILVA, W. A.; PEREIRA-SOUZA, S.; AIELO, A. N.; TAMASHIRO, R. D. F.; BENSENOR, I. M.; LOTUFO, P. A.; DRAGER, L. F.- Accuracy of global and/or regional anthropometric measurements of adiposity in screening sleep apnea: the ELSA-Brasil cohort(2019) SANTOS, Ronaldo B.; SILVA, Wagner A.; PARISE, Barbara K.; GIATTI, Soraya; AIELO, Aline N.; SOUZA, Silvana P.; SANTOS, Itamar S.; LOTUFO, Paulo A.; BENSENOR, Isabela M.; DRAGER, Luciano F.Objective: Adiposity is a well-established risk factor for obstructive sleep apnea (OSA) but the existence of a preferable anthropometric measurement is not established or whether the combination of measurements may improve the accuracy to detect OSA. This study aimed to compare the accuracies of body mass index (BMI), several surrogate markers of body fat (in isolation or combined) and validated questionnaires for screening OSA. Methods: A total of 2059 participants from the ELSA-Brasil study given anthropometric measurements using standard procedures and a home sleep study. OSA was defined by an apnea-hypopnea index >= 15 events/hour. Results: The frequency of OSA was 32.3%. Compared with the non-OSA group, all anthropometric measurements were higher in the OSA group. Age and gender-adjusted BMI afforded the highest accuracy to detect OSA [AUC = 0.760 (0.739-0.781)], followed by waist [AUC = 0.753 (0.732-0.775)] and neck [AUC = 0.733 (0.711-0.755)] circumferences, waist-to-hip ratio [AUC = 0.722 (0.699-0.745)] and body shape index [AUC = 0.680 (0.656-0.704)]. The combination of two or more anthropometric measurements did not improve the accuracy of BMI in predicting OSA. The adjusted BMI had similar predictive performance to the NoSAS score [AUC = 0.748 (0.727-0.770)] but a better accuracy than the Berlin Questionnaire [AUC = 0.676 (0.653-0.699)]. Conclusions: Despite one's intuition, surrogate markers of regional adiposity are not better than BMI in screening OSA. Combining measurements of global and/or regional adiposity did not have additional value in detecting OSA. The merely fair accuracy range of BMI and sleep questionnaires underscore the need for additional tools to improve OSA underdiagnosis.