GLAUCYLARA REIS GEOVANINI
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/13 - Laboratório de Genética e Cardiologia Molecular, Hospital das Clínicas, Faculdade de Medicina
LIM/13 - Laboratório de Genética e Cardiologia Molecular, Hospital das Clínicas, Faculdade de Medicina
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conferenceObject Obstructive Sleep Apnea Is Extremely Common And Associated With Myocardial Ischemia In Patients With Refractory Angina(2014) GEOVANINI, G. R.; PEREIRA, A. C.; GOWDAK, L. H. W.; DOURADO, L. O.; POPPI, N.; CESAR, L. M.; DRAGER, L. F.; LORENZI-FILHO, G.conferenceObject The Effectiveness To Treat Obstructive Sleep Apnea(2013) MONTES, M. I.; SARDINHA, P. S.; PIRES, T. B.; MARTINS, B. D.; GEOVANINI, G. R.; GENTA, P. R.; LORENZI-FILHO, G.conferenceObject Obstructive Sleep Apnea In The Spectrum Of Coronary Artery Disease: Stable Versus Refractory Angina Patients(2013) GEOVANINI, G. R.; DANZI-SOARES, N.; DOURADO, L. O. C.; POPPI, N. T.; PEREIRA, A. C.; GOWDAK, L. W.; DRAGER, L. F.; LORENZI-FILHO, G.- OSA and Depression Are Common and Independently Associated With Refractory Angina in Patients With Coronary Artery Disease(2014) GEOVANINI, Glaucylara R.; GOWDAK, Luis H. W.; PEREIRA, Alexandre C.; DANZI-SOARES, Naury de Jesus; DOURADO, Luciana O. C.; POPPI, Nilson T.; CESAR, Luiz Antonio Machado; DRAGER, Luciano F.; LORENZI-FILHO, GeraldoOBJECTIVE: Refractory angina is a severe form of coronary artery disease (CAD) characterized by persistent angina despite optimal medical therapy. OSA and depression are common in patients with stable CAD and may contribute to a poor prognosis. We hypothesized that OSA and depression are more common and more severe in patients with refractory angina than in patients with stable CAD. METHODS: We used standardized questionnaires and full polysomnography to compare consecutive patients with well-established refractory angina vs consecutive patients with stable CAD evaluated for coronary artery bypass graft surgery. RESULTS: Patients with refractory angina (n = 70) compared with patients with stable CAD (n = 70) were similar in sex distribution (male, 61.5% vs 75.5%; P = .07) and BMI (29.5 +/- 4 kg/m(2) vs 28.5 +/- 4 kg/ m(2), P = .06), and were older (61 +/- 10 y vs 57 +/- 7 y, P = .013), respectively. Patients with refractory angina had significantly more symptoms of daytime sleepiness (Epworth Sleepiness Scale score, 12 +/- 6 vs 8 +/- 5; P < .001), had higher depression symptom scores (Beck Depression Inventory score, 19 +/- 8 vs 10 +/- 8; P < .001) despite greater use of antidepressants, had a higher apnea-hypopnea index (AHI) (AHI, 37 +/- 30 events/h vs 23 +/- 20 events/h; P = .001), higher proportion of oxygen saturation < 90% during sleep (8% + 13 vs 4% + 9, P = .04), and a higher proportion of severe OSA (AHI >= 30 events/h, 48% vs 27%; P = .009) than patients with stable CAD. OSA (P = .017), depression (P < .001), higher Epworth Sleepiness Scale score (P = .007), and lower sleep efficiency (P = .016) were independently associated with refractory angina in multivariate analysis. CONCLUSIONS: OSA and depression are independently associated with refractory angina and may contribute to poor cardiovascular outcome.
- Cardiac rhythm disorders in obstructive sleep apnea(2018) GEOVANINI, Glaucylara Reis; LORENZI-FILHO, GeraldoObstructive sleep apnea (OSA) is common among patients with cardiac rhythm disorders. OSA may contribute to arrhythmias due to acute mechanisms, such as generation of negative intrathoracic pressure during futile efforts to breath, intermittent hypoxia, and surges in sympathetic activity. In addition, OSA may lead to heart remodeling and increases arrhythmia susceptibility. Atrial distension and remodeling, that has been shown to be associated with OSA, is a well-known anatomical substrate for atrial fibrillation (AF). AF is the arrhythmia most commonly described in patients with OSA. Several observational studies have shown that the treatment of OSA with continuous positive airway pressure (CPAP) reduces recurrence of AF after electrical cardioversion and catheter ablation. There is also evidence that nocturnal hypoxemia, a hallmark of OSA, predicts sudden cardiac death (SCD) independently of well-established cardiovascular risk factors. Among patients with an implantable cardiac defibrillator, those with OSA have a higher risk of receiving treatment for life-threatening arrhythmias. Nocturnal hypoxemia may also increase vagal tone, which increases susceptibility to bradycardic and conduction rhythm disorders that have also been described in patients with OSA. In conclusion, there are several biological pathways linking OSA and increased cardiac arrhythmogenesis propensity. However, the independent association is derived from observational studies and the direction of the association still needs clarification due to the lack of large clinical trials. This review focuses on the current scientific evidence linking OSA to cardiac rhythm disorders and point out future directions.
- OSA and Prognosis After Acute Cardiogenic Pulmonary Edema The OSA-CARE Study(2017) UCHOA, Carlos Henrique G.; PEDROSA, Rodrigo P.; JAVAHERI, Shahrokh; GEOVANINI, Glaucylara R.; CARVALHO, Martinha M. B.; TORQUATRO, Ana Claudia S.; LEITE, Ana Paula D. L.; GONZAGA, Carolina C.; BERTOLAMI, Adriana; AMODEO, Celso; PETISCO, Ana Claudia G. P.; BARBOSA, Jose Eduardo M.; MACEDO, Thiago A.; BORTOLOTTO, Luiz A.; OLIVEIRA JR., Mucio Tavares; LORENZI-FILHO, Geraldo; DRAGER, Luciano F.BACKGROUND: Acute cardiogenic pulmonary edema (ACPE) is a life-threatening condition. OSA may be a modifiable risk factor for ACPE recurrence. This study was designed to evaluate the impact of OSA on the incidence of cardiovascular events following ACPE recovery. METHODS: Consecutive patients with confirmed ACPE from 3 centers underwent a sleep study following clinical stabilization. OSA was defined as an apnea-hypopnea index (AHI) >= 15 events/h. The mean follow-up was 1 year, and the primary outcome was ACPE recurrence. RESULTS: A total of 104 patients were included in the final analysis; 61% of the patients had OSA. A higher rate of ACPE recurrence (25 vs 6 episodes; P = .01) and a higher incidence of myocardial infarction (15 vs 0 episodes; P = .0004) were observed in patients with OSA than in those without OSA. All 17 deaths occurred in the OSA group (P = .0001). In a Cox proportional hazards regression analysis, OSA was independently associated with ACPE recurrence (hazard ratio [HR], 3.3 [95% CI, 1.2-8.8]; P = .01), incidence of myocardial infarction (HR, 2.3 [95% CI, 1.1-9.5]; P = .02), cardiovascular death (HR, 5.4 [95% CI, 1.4-48.4]; P = .004), and total death (HR, 6.5 [95% CI, 1.2-64.0]; P = .005). When the analysis was limited only to patients with OSA, levels of AHI and hypoxemic burden and rates of sleep-onset ACPE were significantly higher in those who presented with ACPE recurrence or who died than in those who did not experience these events. CONCLUSIONS: OSA is independently associated with higher rates of ACPE recurrence and both fatal and nonfatal cardiovascular events.
conferenceObject The Impact Of Obstructive Sleep Apnea On Cardiovascular Events And Mortality In Consecutive Patients With Acute Cardiogenic Pulmonary Edema(2015) UCHOA, C. H. G.; GEOVANINI, G. R.; PEDROSA, R. P.; TORQUATTO, A. S.; CARVALHO, M.; BORTOLOTTO, L. A.; OLIVEIRA, M. T.; LORENZI-FILHO, G.; DRAGER, L. F.conferenceObject High Frequency Of Obstructive Sleep Apnea In Consecutive Patients With Acute Cardiogenic Pulmonary Edema: Preliminary Data From Two Cardiology Centers(2014) UCHOA, C. H. G.; GEOVANINI, G. R.; PEDROSA, R. P.; TORQUATO, A. S.; CARVALHO, M. M. B. De; BORTOLOTTO, L. A.; OLIVEIRA JUNIOR, M. T.; LORENZI-FILHO, G.; DRAGER, L. F.