LUCIANO FERREIRA DRAGER

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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

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  • article 8 Citação(ões) na Scopus
    Weight Gain Induced by Continuous Positive Airway Pressure in Patients with Obstructive Sleep Apnea Is Mediated by Fluid Accumulation: A Randomized Crossover Controlled Trial
    (2021) HERCULANO, Sara; GRAD, Gustavo F.; DRAGER, Luciano F.; ALBUQUERQUE, Andre L. P. de; MELO, Camila M.; LORENZI-FILHO, Geraldo; GENTA, Pedro R.
  • article 12 Citação(ões) na Scopus
    Impact of CPAP on arterial stiffness in patients with obstructive sleep apnea: a meta-analysis of randomized trials
    (2021) CHALEGRE, Sintya T.; LINS-FILHO, Ozeas L.; LUSTOSA, Thais C.; FRANCA, Marcus V.; COUTO, Tarcya L. G.; DRAGER, Luciano F.; LORENZI-FILHO, Geraldo; BITTENCOURT, Marcio S.; PEDROSA, Rodrigo P.
    Purpose This study aimed to perform a systematic review and meta-analysis of randomized trials investigating the effect of continuous positive airway pressure (CPAP) on non-invasive markers of arterial stiffness in patients with OSA. Methods The purpose of the study was to evaluate the effect of CPAP on markers of arterial stiffness (pulse wave velocity (PWV) and augmentation index (Aix)) in patients with OSA. The study adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We systematically reviewed MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, and LILACS databases for randomized trials (RT) evaluating the changes in markers of arterial stiffness (pulse wave velocity (PWV) and augmentation index (Aix) comparing CPAP vs. controls in patients with OSA. Reviewer Manager version 5.3 (R Foundation for Statistical Computing, Vienna, Austria) was used to perform meta-analysis. Risk of bias analysis was performed using the Cochrane tool. Results Of the 464 studies initially retrieved, 9 relevant studies with 685 participants were included in the analysis. The studies presented moderate risk of bias. CPAP did not significantly reduce Aix (mean difference, - 1.96 (95% confidence interval (CI) - 5.25 to 1.33), p = 0.24), whereas it significantly changed PWV (mean difference, - 0.44 (95% confidence interval (CI) - 0.76 to - 0.12), p = 0.00). Conclusion CPAP treatment was effective in improving arterial stiffness by reducing PWV in patients with OSA. Additional randomized trials, however, should be performed to confirm these findings.
  • article 1 Citação(ões) na Scopus
  • article 12 Citação(ões) na Scopus
    Effect of Continuous Positive Airway Pressure on Weight and Local Adiposity in Adults with Obstructive Sleep Apnea A Meta-Analysis
    (2021) CHEN, Baixin; DRAGER, Luciano F.; PEKER, Yuksel; VGONTZAS, Alexandros N.; PHILLIPS, Craig L.; HOYOS, Camilla M.; SALLES, Gil F.; GUO, Miaolan; LI, Yun
    Rationale: Evidence suggests that continuous positive airway pressure (CPAP) treatment promotes weight gain in patients with obstructive sleep apnea (OSA). It is unclear whether weight gain is influenced by CPAP adherence or comorbid disorders. Objectives: To examine the CPAP effects on body mass index (BMI) and local adiposity and the potential moderators of CPAP effects on BMI in patients with OSA. Methods: We searched PubMed/Medline, Embase, and Cochrane through December 2019. Randomized controlled trials of CPAP versus control treatment with >4 weeks' treatment were included. Results: A total of 39 randomized controlled trials with 6,954 subjects were included. In intention-to-treat analysis, the BMI increased significantly after CPAP treatment compared with control treatment (weighted mean difference [WMD], 0.148 kg/m(2); 95% confidence interval, 0.04-0.26; P = 0.001). In studies demonstrating an increase in the BMI, waist and neck circumferences were also significantly increased. Subgroup analyses revealed that an increased BMI was attributable to CPAP use of <5 h/night (WMD, 0.231) but was not attributable to CPAP use of.5 h/night (WMD, 0.001; between-group P value = 0.049). Furthermore, the BMI increased significantly in patients without cardiovascular disease (CVD; WMD, 0.200), whereas it decreased significantly in those with CVD at baseline (WMD, 20.188; between-group P value, 0.001). Moreover, the BMI increased significantly in patients with dysglycemia (WMD, 0.499) but did not increase in those without dysglycemia at baseline (WMD, 0.100; between-group P value = 0.032). Meta-regression confirmed the subgroup findings. Conclusions: The BMI increased significantly in patients with OSA after CPAP treatment, especially in those with CPAP use of <5 h/night, without CVD and/or with dysglycemia at baseline. CPAP use of at least 5 h/night seems to be necessary in mitigating the risk for weight gain in patients with OSA.
  • article 0 Citação(ões) na Scopus
  • article 21 Citação(ões) na Scopus
    Adherence with positive airway pressure therapy for obstructive sleep apnea in developing vs. developed countries: a big data study
    (2021) DRAGER, Luciano F.; MALHOTRA, Atul; YAN, Yang; PEPIN, Jean-Louis; ARMITSTEAD, Jeff P.; WOEHRLE, Holger; NUNEZ, Carlos M.; CISTULLI, Peter A.; V, Adam Benjafield
    Study Objectives: Minimal focus has been placed on variations in health care delivery for obstructive sleep apnea (OSA). This study compared positive airway pressure usage in developing countries (Brazil and Mexico) vs. a developed country (United States) and investigated the impact of a patient engagement tool (myAir; ResMed, San Diego, CA) on adherence. Methods: Deidentified data from the AirView database (ResMed) for patients receiving positive airway pressure therapy with wirelessly connected Air10 (AirSense and AirCurve) devices in Brazil, Mexico, and the United States were analyzed. Adherence was defined using US Center for Medicare and Medicaid Services (CMS) criteria (usage >= 4 h/night on >= 70% of nights in the first 90 days). Results: The analysis included 4,181,490 patients (Brazil: 31,672; Mexico 16,934; United States: 4,132,884). CMS adherence over 90 days was slightly lower in Latin America vs. the United States (Brazil: 71.7%; Mexico: 66.4%; United States: 74.0%). Significantly fewer patients were using the patient engagement tool in Brazil (8.1%) and Mexico (2.8%) vs. the United States (26%; both P < .001). Patients registered to use an engagement tool had a higher rate of CMS adherence and were twice as likely to achieve CMS adherence. Average daily usage and days with usage > 4 hours in the first week were the strongest predictors of CMS adherence. Across all countries, > 80% of patients meeting CMS criteria at 3 months were still using positive airway pressure therapy at 1 year, with 1-year adherences rates of > 75%. Conclusions: Short-term and long-term positive airway pressure adherence rates in Brazil and Mexico were similar to those achieved in the United States. Patients who registered to use an engagement tool consistently had better adherence than those who did not.
  • article 16 Citação(ões) na Scopus
    Obstructive sleep apnea and ambulatory blood pressure monitoring: current evidence and research gaps
    (2021) PIO-ABREU, Andrea; MORENO JR., Heitor; DRAGER, Luciano F.
    Obstructive Sleep Apnea (OSA) is a common condition characterized by intermittent collapse of the upper airway during sleep, resulting in partial (hypopnoeas) and total obstructions (apneas). These respiratory events observed in OSA may trigger multiple pathways involved in the blood pressure (BP) instability during the night and potentially influencing daytime BP as well (carry-over effects). This review provides an update about the impact of OSA and its treatments on 24-h BP control. Overall, there is growing evidence suggest that OSA is associated with higher frequency of nondipping BP pattern and nocturnal hypertension in a dose-dependent manner. The presence of nondiping BP (especially the reverse pattern) is independently associated with OSA regardless of sleep-related symptoms suggesting a potential tool for screening OSA in patients with clinical indication for performing ABPM. Beyond dipping BP, preliminary evidence associated OSA with white-coat effect and higher frequency of masked hypertension and BP variability than the control group (no OSA). Unfortunately, most of the evidence on the evidence addressing the impact of OSA treatment on BP was limited to office measurements. In the last years, data from observational and randomized studies pointed that CPAP is able to promote 24-h BP decrease especially in patients with resistant and refractory hypertension. A randomized trial suggests that CPAP is able to decrease the rate of masked hypertension as compared to no treatment in patients with severe OSA. Interestingly, nondipping BP is a good predictor of BP response to CPAP making ABPM an interesting tool for better OSA management.
  • article 17 Citação(ões) na Scopus
    Phosphodiesterase 2A and 3B variants are associated with primary aldosteronism
    (2021) RASSI-CRUZ, Marcela; MARIA, Andrea G.; FAUCZ, Fabio R.; LONDON, Edra; VILELA, Leticia A. P.; SANTANA, Lucas S.; BENEDETTI, Anna Flavia F.; GOLDBAUM, Tatiana S.; TANNO, Fabio Y.; SROUGI, Vitor; CHAMBO, Jose L.; PEREIRA, Maria Adelaide A.; CAVALCANTE, Aline C. B. S.; CARNEVALE, Francisco C.; PILAN, Bruna; BORTOLOTTO, Luiz A.; DRAGER, Luciano F.; LERARIO, Antonio M.; LATRONICO, Ana Claudia; V, Maria Candida B. Fragoso; MENDONCA, Berenice B.; ZERBINI, Maria Claudia N.; STRATAKIS, Constantine A.; ALMEIDA, Madson Q.
    Familial primary aldosteronism (PA) is rare and mostly diagnosed in early-onset hypertension (HT). However, 'sporadic' bilateral adrenal hyperplasia (BAH) is the most frequent cause of PA and remains without genetic etiology in most cases. Our aim was to investigate new genetic defects associated with BAH and PA. We performed whole-exome sequencing (paired blood and adrenal tissue) in six patients with PA caused by BAH that underwent unilateral adrenalectomy. Additionally, we conducted functional studies in adrenal hyperplastic tissue and transfected cells to confirm the pathogenicity of the identified genetic variants. Rare germline variants in phosphodiesterase 2A (PDE2A) and 3B (PDE3B) genes were identified in three patients. The PDE2A heterozygous variant (p.Ile629Val) was identified in a patient with BAH and early-onset HT at 13 years of age. Two PDE3B heterozygous variants (p.Arg217Gln and p.Gly392Val) were identified in patients with BAH and HT diagnosed at 18 and 33 years of age, respectively. A strong PDE2A staining was found in all cases of BAH in zona glomerulosa and/or micronodules (that were also positive for CYP11B2). PKA activity in frozen tissue was significantly higher in BAH from patients harboring PDE2A and PDE3B variants. PDE2A and PDE3B variants significantly reduced protein expression in mutant transfected cells compared to WT. Interestingly, PDE2A and PDE3B variants increased SGK1 and SCNN1G/ENaCg at mRNA or protein levels. In conclusion, PDE2A and PDE3B variants were associated with PA caused by BAH. These novel genetic findings expand the spectrum of gene tic etiologies of PA.
  • article 4 Citação(ões) na Scopus
    Proposed management model for the use of telemonitoring of adherence to positive airway pressure equipment - position paper of the Brazilian Association of Sleep Medicine - ABMS
    (2021) VIDIGAL, T. De Aguiar; BRASIL, E. L.; FERREIRA, M. N.; MELLO-FUJITA, L. L.; MOREIRA, G. A.; DRAGER, L. F.; SOSTER, L. A.; GENTA, P. R.; POYARES, D.; HADDAD, F. L. M.
    This document ""Proposed management model for the use of telemonitoring to positive airway pressure adherence"" was prepared by a special commission of the Brazilian Association of Sleep Medicine, with the objective of recommending a follow-up model for patients undergoing positive airway pressure therapy using telemonitoring. This proposal was prepared based on a survey and analysis of the most up-to-date national and international literature and uses the best available evidence to facilitate the standardization of care by Sleep Science specialists with potential benefit for patients. Among the conclusions of the document, it is emphasized that telemonitoring is an important tool that allows health professionals trained in sleep-disordered breathing to remotely monitor PAP therapy, allowing prompt and, when necessary, daily adjustments to be made in order to increase adherence to treatment. The authors also conclude that the privacy of the data received and shared during the provision of telemonitoring must be respected by the physician or health professional trained in sleep, with the authorization of the patient and/or person responsible, who should be made aware of the short-, medium- and long-term provision of the service. © 2021 Brazilian Association of Sleep and Latin American Federation of Sleep Societies. All rights reserved.
  • article 300 Citação(ões) na Scopus
    Brazilian Guidelines of Hypertension-2020
    (2021) BARROSO, Weimar Kunz Sebba; RODRIGUES, Cibele Isaac Saad; BORTOLOTTO, Luiz Aparecido; MOTA-GOMES, Marco Antonio; BRANDAO, Andrea Araujo; FEITOSA, Audes Diogenes de Magalhaes; MACHADO, Carlos Alberto; POLI-DE-FIGUEIREDO, Carlos Eduardo; AMODEO, Celso; MION JUNIOR, Decio; BARBOSA, Eduardo Costa Duarte; NOBRE, Fernando; GUIMARAES, Isabel Cristina Britto; VILELA-MARTIN, Jose Fernando; YUGAR-TOLEDO, Juan Carlos; MAGALHAES, Maria Eliane Campos; NEVES, Mario Fritsch Toros; JARDIM, Paulo Cesar Brandao Veiga; MIRANDA, Roberto Dischinger; POVOA, Rui Manuel dos Santos; FUCHS, Sandra C.; ALESSI, Alexandre; LUCENA, Alexandre Jorge Gomes de; AVEZUM, Alvaro; SOUSA, Ana Luiza Lima; PIO-ABREU, Andrea; SPOSITO, Andrei Carvalho; PIERIN, Angela Maria Geraldo; PAIVA, Annelise Machado Gomes de; SPINELLI, Antonio Carlos de Souza; NOGUEIRA, Armando da Rocha; DINAMARCO, Nelson; EIBEL, Bruna; FORJAZ, Claudia Lucia de Moraes; ZANINI, Claudia Regina de Oliveira; SOUZA, Cristiane Bueno de; SOUZA, Dilma do Socorro Moraes de; NILSON, Eduardo Augusto Fernandes; COSTA, Elisa Franco de Assis; FREITAS, Elizabete Viana de; DUARTE, Elizabeth da Rosa; MUXFELDT, Elizabeth Silaid; LIMA JUNIOR, Emilton; CAMPANA, Erika Maria Goncalves; CESARINO, Evandro Jose; MARQUES, Fabiana; ARGENTA, Fabio; CONSOLIM-COLOMBO, Fernanda Marciano; BAPTISTA, Fernanda Spadotto; ALMEIDA, Fernando Antonio de; BORELLI, Flavio Antonio de Oliveira; FUCHS, Flavio Danni; PLAVNIK, Frida Liane; SALLES, Gil Fernando; FEITOSA, Gilson Soares; SILVA, Giovanio Vieira da; GUERRA, Grazia Maria; MORENO JUNIOR, Heitor; FINIMUNDI, Helius Carlos; BACK, Isabela de Carlos; OLIVEIRA FILHO, Joao Bosco de; GEMELLI, Joao Roberto; MILL, Jose Geraldo; RIBEIRO, Jose Marcio; LOTAIF, Leda A. Daud; COSTA, Lilian Soares da; MAGALHAES, Lucelia Batista Neves Cunha; DRAGER, Luciano Ferreira; MARTIN, Luis Cuadrado; SCALA, Luiz Cesar Nazario; ALMEIDA, Madson Q.; GOWDAK, Marcia Maria Godoy; KLEIN, Marcia Regina Simas Torres; MALACHIAS, Marcus Vinicius Bolivar; KUSCHNIR, Maria Cristina Caetano; PINHEIRO, Maria Eliete; BORBA, Mario Henrique Elesbao de; MOREIRA FILHO, Osni; PASSARELLI JUNIOR, Oswaldo; COELHO, Otavio Rizzi; VITORINO, Priscila Valverde de Oliveira; RIBEIRO JUNIOR, Renault Mattos; ESPORCATTE, Roberto; FRANCO, Roberto; PEDROSA, Rodrigo; MULINARI, Rogerio Andrade; PAULA, Rogerio Baumgratz de; OKAWA, Rogerio Toshiro Passos; ROSA, Ronaldo Fernandes; AMARAL, Sandra Lia do; FERREIRA-FILHO, Sebastiao R.; KAISER, Sergio Emanuel; JARDIM, Thiago de Souza Veiga; GUIMARAES, Vanildo; KOCH, Vera H.; OIGMAN, Wille; NADRUZ, Wilson