LIM/63 - Laboratório de Investigação Médica em Sono

O Laboratório de Investigação Médica em Sono é ligado ao Departamento de Cardiopneumologia da Faculdade de Medicina da Universidade de São Paulo (FMUSP).

Linhas de pesquisa: fisiopatologia da apneia do sono; desenvolvimento de tratamentos comportamentais e psicológicos para problemas de sono; ensaios clínicos não farmacológicos para insônia; investigação de variáveis psicológicas e ambientais que possam influenciar na manutenção e desenvolvimento da insônia; investigação de fatores responsáveis pelo sucesso e insucesso de diferentes tratamentos psicológicos e comportamentais para insônia; psicologia do sono; distúrbios de sono e doença cardiovascular; distúrbios do sono com enfoque principal nos distúrbios respiratórios do sono: métodos diagnósticos, fisiopatologia, consequências e tratamento.

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Obstructive sleep apnea and falls in COPD patients: a cross-sectional and follow-up study
(2023) CENSO, Caroline Maschio de; PASSINI, Viviane Vieira; VERRI, Barbara Aparecida Teodoro Alcantara; PINTO, Regina Maria De Carvalho; STELMACH, Rafael; XAVIER, Rafaella Fagundes; LORENZI-FILHO, Geraldo; CARVALHO, Celso Ricardo Fernandes De
Oral Breathing Among Obstructive Sleep Apnea Patients Is Associated With Minute Ventilation and Ventilatory Drive
Postural balance assessment in fallers individuals with COPD before and after physical effort
(2023) CENSO, Caroline Maschio de; PASSINI, Viviane Vieira; VERRI, Barbara Aparecida Teodoro Alcantara; PINTO, Regina Maria De Carvalho; STELMACH, Rafael; XAVIER, Rafaella Fagundes; LORENZI-FILHO, Geraldo; CARVALHO, Celso Ricardo Fernandes De
article 1 Citação(ões) na Scopus
Efficacy of Oral Furosemide Test for Primary Aldosteronism Diagnosis
(2023) FREITAS, Thais C.; MACIEL, Ana Alice W.; FAGUNDES, Gustavo F. C.; PETENUCI, Janaina; SANTANA, Lucas S.; GUIMARAES, Augusto G.; FREITAS-CASTRO, Felipe; SROUGI, Victor; TANNO, Fabio Y.; CHAMBO, Jose L.; PEREIRA, Maria Adelaide A.; BRITO, Luciana P.; PIO-ABREU, Andrea; BORTOLOTTO, Luiz A.; LATRONICO, Ana Claudia; V, Maria Candida B. Fragoso; DRAGER, Luciano F.; MENDONCA, Berenice B.; ALMEIDA, Madson Q.
Context: Confirmatory tests represent a fundamental step in primary aldosteronism (PA) diagnosis, but they are laborious and often require a hospital environment due to the risks involved.Objective: To evaluate the efficacy of oral furosemide as a new confirmatory test for PA diagnosis.Methods: We prospectively evaluated the diagnostic performance of 80 mg of oral furosemide in 64 patients with PA and 22 with primary hypertension (controls). Direct renin concentration (DRC) was measured before, and 2 hours and 3 hours after the oral furosemide. In addition, the oral furosemide test was compared with 2 other confirmatory tests: the furosemide upright test (FUT) and saline infusion test (SIT) or captopril challenge test (CCT) in all patients with PA.Results: The cut-off of 7.6 mu U/mL for DRC at 2 hours after oral furosemide had a sensitivity of 92%, specificity of 82%, and accuracy of 90% for PA diagnosis. In 5 out of 6 controls with low-renin hypertension, which might represent a PA spectrum, renin remained suppressed. Excluding these 6 controls with low-renin hypertension, the DRC cut-off of 10 mu U/mL at 2 hours after oral furosemide had a sensitivity of 95.3%, specificity of 93.7% and accuracy of 95% for PA diagnosis. DRC after 3 hours of oral furosemide did not improve diagnostic performance. Using the cut-off of 10 mu U/mL, the oral furosemide test and the FUT were concordant in 62 out of 64 (97%) patients with PA. Only 4 out of 64 cases with PA (6.4%) ended the oral furosemide test with potassium <3.5 mEq/L. Hypotension was not evidenced in any patient with PA during the test.Conclusion: The oral furosemide test was safe, well-tolerated and represents an effective strategy for PA investigation.
article 1 Citação(ões) na Scopus
Cost-Utility Analysis of Continuous Positive Airway Pressure Therapy Compared With Usual Care for Obstructive Sleep Apnea in the Public Health System in Brazil
(2024) PACHITO, Daniela V.; ECKELI, Alan L.; DRAGER, Luciano F.
Objectives: This study aimed to conduct a cost-utility analysis of continuous positive airway pressure (CPAP) therapy compared with usual care as treatment of moderate to severe cases of obstructive sleep apnea (OSA) in Brazil, where decentralized policies of CPAP provision are in place.Methods: Markov cohort model comparing CPAP therapy with usual care, that is, no specific treatment for OSA, for moderate to severe cases was used. The payer perspective from the Unified Health System, Brazil, was adopted. Effectiveness parameters and costs related to health states were informed by literature review. Resource use related to CPAP therapy was defined by specialists and costs informed by recent purchase and leasing contracts. Incremental cost-effectiveness ratios were generated for purchase and leasing contracts to reflect current practices. A conservative willingness-to-pay threshold was set at 1 gross domestic product per capita per quality-adjusted life-year (QALY) (Brazilian reais [BRL] 40 712/QALY). Uncertainties were explored in deterministic and probabilistic sensitivity analyses.Results: Incremental cost-effectiveness ratio for the purchase modality was 8303 BRL/QALY and for leasing 45 192 BRL/QALY. Considering the adopted willingness-to-pay threshold, provision of CPAP by the purchase modality was considered costeffective but not the leasing modality. The parameter related to the greatest uncertainty was the reduction in the risk of having a stroke attributable to CPAP. Probabilistic analysis confirmed the robustness of results.Conclusions: CPAP therapy is a cost-effective alternative compared with usual care for moderate to severe OSA for the purchase modality. These results should help underpinning the decision making related to a uniform policy of CPAP provision across the country.
article 1 Citação(ões) na Scopus
Brazilian Consensus on Sleep-Focused Speech-Language-Hearing Sciences - 2023 Brazilian Sleep Association
(2023) STUDART-PEREIRA, Luciana Moraes; BIANCHINI, Esther Mandelbaum Goncalves; ASSIS, Marcia; BUSSI, Marieli Timpani; CORREA, Camila de Castro; CUNHA, Thays Crosara Abrahao; DRAGER, Luciano Ferreira; IETO, Vanessa; LORENZI-FILHO, Geraldo; LUCCAS, Gabriele Ramos De; BRASIL, Evelyn Lucien; SOVINSKI, Silmara Regina Pavani; ZANCANELLA, Edilson; PIRES, Gabriel Natan
Introduction This consensus aimed to develop a structured document presenting the role of sleep-focused Speech-Language-Hearing (SPH) Sciences (SPHS). The recommendations were based on the expertise of specialists and on evidence in the literature, aiming to guide the coverage of this area and the consequent improvement in the quality of the professionals' approach. Methods A Delphi method was conducted with 49 SLH pathologists (SLHP), four sleep physicians, one dentist, one physical therapist, and one methodologist. Four Delphi panel rounds were conducted in Google Forms. The items were analyzed based on the panelists' percentage of agreement; consensuses were reached when 2/3 (66.6%) of valid responses were on a same on a same answer (either ""agree"" or ""disagree""). Results Participants voted on 102 items. The mean consensus rate was 89.9%10.9%. The essential topics were the importance of professional training, the SLH diagnosis, and the SLH treatment of sleep disorders. It was verified that all fields of the SLHS are related to the area of sleep; that sleep-focused SLH pathologists (SLHP) are the responsible for assessing, indicating, and conducting specific orofacial myofunctional therapy for sleep-disordered breathing alone or in combination with other treatments; that SLHP are included in interdisciplinary teams in the area of sleep in public and private services. Discussion The Brazilian consensus on sleep-focused SLHS is a landmark in this area. This consensus described the scope of action of sleep-focused SLHP and systematized recommendations being useful as a reference for the professional practice in the area of sleep.
article 1 Citação(ões) na Scopus
2023 Guidelines on the Diagnosis and Treatment of Insomnia in Adults - Brazilian Sleep Association
(2023) DRAGER, Luciano Ferreira; ASSIS, Marcia; BACELAR, Andrea Frota Rego; POYARES, Dalva Lucia Rollemberg; CONWAY, Silvia Goncalves; PIRES, Gabriel Natan; AZEVEDO, Alexandre Pinto de; CARISSIMI, Alicia; ECKELI, Allan Luiz; PENTAGNA, Alvaro; ALMEIDA, Carlos Mauricio Oliveira; FRANCO, Clelia Maria Ribeiro; SOBREIRA, Emmanuelle Silva Tavares; STELZER, Fernando Gustavo; MENDES, Giuliana Macedo; MINHOTO, Gisele Richter; LINARES, Ila Marques Porto; SOUSA, Ksdy Maiara Moura; GITAI, Livia Leite Goes; SUKYS-CLAUDINO, Lucia; SOBREIRA-NETO, Manoel Alves; ZANINI, Marcio Andrei; MARGIS, Regina; MARTINEZ, Sandra Cristina Goncalves
Chronic insomnia disorder (simplified in this document as insomnia) is an increasingly common clinical condition in society and a frequent complaint at the offices of different areas of health practice (particularly Medicine and Psychology). This scenario has been accompanied by a significant evolution in treatment, as well as challenges in approaching patients in an appropriately way. This clinical guideline, coordinated by the Brazilian Sleep Association and the Brazilian Association of Sleep Medicine and counting on the active participation of various specialists in the area, encompasses an update on the diagnosis and treatment of insomnia in adults. To this end, it followed a structured methodology. Topics of interest related to diagnosis were written based on theoretical framework, evidence in the literature, and professional experience. As for the topics related to the treatment of insomnia, a series of questions were developed based on the PICO acronym (P - Patient, problem, or population; I - Intervention; C - Comparison, control, or comparator; O - Outcome). The work groups defined the eligible options within each of these parameters. Regarding pharmacological interventions, only the ones currently available in Brazil or possibly becoming available in the upcoming years were considered eligible. Systematic reviews were conducted to help prepare the texts and define the level of evidence for each intervention. The final result is an objective and practical document providing recommendations with the best scientific support available to professionals involved in the management of insomnia.
Obstructive Sleep Apnea Is a Distinct Physiological Endotype in Individuals with Comorbid Insomnia and Sleep Apnea
(2023) BROOKER, Elliot J.; LANDRY, Shane A.; THOMSON, Luke D. J.; HAMILTON, Garun S.; GENTA, Pedro R.; DRUMMOND, Sean P. A.; EDWARDS, Bradley A.
Rationale: With up to 40% of individuals with either insomnia or obstructive sleep apnea (OSA) demonstrating clinically significant symptoms of the other disorder, the high degree of comorbidity among the two most common sleep disorders suggests a bidirectional relationship and/or shared underpinnings. Although the presence of insomnia disorder is believed to influence the underlying pathophysiology of OSA, this influence is yet to be examined directly. Objectives: To investigate whether the four OSA endotypes (upper airway collapsibility, muscle compensation, loop gain, and the arousal threshold) are different in patients with OSA with and without comorbid insomnia disorder. Methods: Using the ventilatory flow pattern captured from routine polysomnography, the four OSA endotypes were measured in 34 patients with OSA who met the diagnostic criteria for insomnia disorder (COMISA) and 34 patients with OSA without insomnia (OSA only). Patients demonstrated mild-to-severe OSA (apnea-hypopnea index, 25.8 +/- 2.0 events/h) and were individually matched according to age (50.2 +/- 1.5 yr), sex (42 male: 26 female), and body mass index (29.3 +/- 0.6 kg/m(2)). Results: Compared with patients with OSA without comorbid insomnia, patients with COMISA demonstrated significantly lower respiratory arousal thresholds (128.9 [118.1 to 137.1] vs. 147.7 [132.3 to 165.0] % eupneic ventilation ((V) overbar(eupnea)); U= 261; 95% confidence interval [CI], 238.3 to 213.9; d= 1.1; P < 0.001), less collapsible upper airways (88.2 [85.5 to 94.6] vs. 72.9 [64.7 to 79.2] %(V) overbar(eupnea); U= 1081; 95% CI, 14.0 to 26.7; d= 2.3; P < 0.001), and more stable ventilatory control (i.e., lower loop gain: 0.51 [0.44 to 0.56] vs. 0.58 [0.49 to 0.70]; U= 402; 95% CI, 20.2 to 20.01; d= 0.05; P= 0.03). Muscle compensation was similar between groups. Moderated linear regression revealed that the arousal threshold moderated the relationship between collapsibility and OSA severity in patients with COMISA but not in patients with OSA only. Conclusions: A low arousal threshold is an overrepresented endotypic trait in individuals with COMISA and may exhibit a greater relative contribution to OSA pathogenesis in these patients. Contrastingly, the prevalence of a highly collapsible upper airway in COMISA was low, suggesting that anatomical predisposition may contribute less to OSA development in COMISA. Based on our findings, we theorize that conditioned hyperarousal perpetuating insomnia may translate to a reduced arousal threshold to respiratory events, thereby increasing the risk or severity of OSA. Therapies that target increased nocturnal hyperarousal (e.g., through cognitive behavior therapy for insomnia) may be effective in individuals with COMISA.
article 0 Citação(ões) na Scopus
Drug use among medical students in São Paulo, Brazil: a cross-sectional study during the coronavirus disease 2019 pandemic
(2024) LEMOS-SANTOS, Pedro; BLUMRICH, Lukas; DEBIA, Jordi Blanes; CASTALDELLI-MAIA, Joao Mauricio; SUEN, Paulo Jeng Chian; MALBERGIER, Andre
BACKGROUND: Medical students demonstrate higher rates of substance use than other university students and the general population. The challenges imposed by the coronavirus disease 2019 (COVID-19) pandemic raised significant concerns about mental health and substance use.OBJECTIVES: Assess the current prevalence of substance use among medical students at the University of Sao Paulo and evaluate the impact of the COVID-19 pandemic on drug consumption.DESIGN AND SETTING: A cross-sectional study was conducted on 275 medical students from the UniverMETHODS: Substance use (lifetime, previous 12 months, and frequency of use before and during the COVID-19 pandemic) and socioeconomic data were assessed using an online self-administered questionnaire. Symptoms of depression were assessed using the Patient Health Questionnaire-9. RESULTS: Alcohol was the most consumed substance in their lifetime (95.6%), followed by illicit drugs (61.1%), marijuana (60%), and tobacco (57.5%). The most commonly consumed substances in the previous year were alcohol (82.9%), illicit drugs (44.7%), marijuana (42.5%), and tobacco (36%). Students in the first two academic years consumed fewer substances than those from higher years. There was a decreasing trend in the prevalence of most substances used after the COVID-19 pandemic among sporadic users. However, frequent users maintained their drug use patterns.CONCLUSION: The prevalence of substance use was high in this population and increased from the basic to the clinical cycle. The COVID-19 pandemic may have affected the frequency of drug use and prevalence estimates.
article 1 Citação(ões) na Scopus
The Cardiovascular Impact of Obstructive Sleep Apnea in Women Current Knowledge and Future Perspectives
(2023) PARISE, Barbara K.; FERREIRA, Naira Lapi; DRAGER, Luciano F.