MARIA JANIEIRE DE NAZARE NUNES ALVES
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
32 resultados
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- Identifying the risk of obstructive sleep apnea in metabolic syndrome patients: Diagnostic accuracy of the Berlin Questionnaire(2019) CEPEDA, Felipe X.; VIRMONDES, Leslie; RODRIGUES, Sara; DUTRA-MARQUES, Akothirene C. B.; TOSCHI-DIAS, Edgar; FERREIRA-CAMARGO, Fernanda C.; HUSSID, Maria Fernanda; RONDON, Maria Urbana P. B.; ALVES, Maria Janieire N. N.; TROMBETTA, Ivani C.Background Obstructive sleep apnea (OSA) is a risk factor frequently present in patients with metabolic syndrome (MetS). Additionally, moderate and severe OSA are highly prevalent in patients with cardiac disease, as they increase the riskfor cardiovascular events by 80%. The gold standard diagnostic method for OSA is overnight polysomnography (PSG), which remains unaffordable for the overall population. The aim of the present study was to evaluate whether the Berlin Questionnaire (BQ) is anuseful tool for assessing the risk of OSA in patients with MetS. Methods 97 patients, previously untreated and recently diagnosed with MetS (National Cholesterol Education Program, Adult Treatment Panel III, ATP-III) underwent a PSG. OSA was characterized by the apnea-hypopnea index (AHI). BQ was administered before PSG and we evaluated sensitivity, specificity, positive and negative predictive values, and accuracy. Results Of the 97 patients with MetS, 81 patients had OSA, with 47 (48.5%) presenting moderate and severe OSA. For all MetS with OSA (AHI >= 5 events/hour), the BQ showed good sensitivity (0.65, 95% CI 0.54 to 0.76) and fair specificity (0.38, 95% CI 0.15-0.65) with a positive predictive value of 0.84, a negative predictive value of 0.18 and an 84% accuracy. Similarly, for moderate-to-severe OSA (AHI >= 15 events/hour) we found good sensitivity (0.73, 95% CI 0.58-0.85) and fair specificity (0.40, 95% CI 0.27-0.55). Interestingly, for severe OSA (AHI. 30 events/hour), there was a very good sensitivity (0.91, 95% CI 0.72-0.99) and moderate specificity (0.42, 95% CI 0.31-0.54). Conclusion The BQ is a valid tool for screening the risk of OSA in MetS patients in general, and it is particularly useful in predicting severe OSA.
conferenceObject Obstructive Sleep Apnea Impairs the Time Delay of the Baroreflex Control and the Oscilattory Pattern of the Sympathetic Activity in Patients with Metabolic Syndrome(2012) TOSCHI-DIAS, Edgar; TROMBETTA, Ivani C.; SILVA, Valdo J. Dias da; MAKI-NUNES, Cristiane; CEPEDA, Felipe X.; ALVES, Maria Janieire N.; DRAGER, Luciano F.; LORENZI-FILHO, Geraldo; NEGRAO, Carlos E.; RONDON, Maria Urbana P.conferenceObject Impaired Baroreflex Sensitivity in Anabolic Steroid Users(2012) SANTOS, Marcelo Rodrigues dos; PORELLO, Rafael Armani; SAYEGH, Ana L. C.; HONG, Valeria; TOSCHI-DIAS, Edgar; BORTOLOTTO, Luiz A.; YONAMINE, Mauricio; NEGRAO, Carlos E.; ALVES, Maria-Janieire N. N.Purpose: Exacerbated sympathetic nerve activity and increased blood pressure have been documented in anabolic androgenic steroid users (AASU). We tested the hypothesis that arterial baroreflex sensitivity (BRS) and carotid distensibility would be reduced in AASU. Methods: Ten AASU and 10 age-paired anabolic androgenic steroid nonusers (AASNU) were studied. Both groups were involved in strength training (90% 1MR) and AASU were self-administered anabolic steroids for at least 2 years. The use of AAS was proved by urine. Heart rate (HR) was evaluated by EKG and blood pressure non-invasively on a beat to beat. BRS was analyzed by time domain through spontaneous fluctuations between systolic blood pressure (SBP) and HR. Carotid artery distensibility was measured by doppler (M-mode). Results: HR was higher in AASU compared to AASNU (69±3 vs. 59±3 bpm, P≤0.05). Systolic (123±4 vs. 118±2 mmHg, P=0.29), diastolic (72±2 vs. 67±2 mmHg, P=0.12) and mean blood pressure (90±3 vs. 85±2 mmHg, P=0.15) were not different between groups. BRS for increases (14.2±2 vs. 22.8±3 msec/mmHg, P=0.05) and decreases (13.3±1 vs. 19.2±2 msec/mmHg, P=0.04) were lower in AASU. Carotid distensibility was reduced in AASU (7±1 vs. 9±1 %, P≤0.05). Conclusion: Impaired BRS and reduced carotid distensibility may prematurely lead to increased cardiovascular risk in AASU.- Predictors of Obstructive Sleep Apnea in Consecutive Patients with Metabolic Syndrome(2018) PEDROSA, Rodrigo P.; MAKI-NUNES, Cristiane; MIDLEJ-BRITO, Thiago; LOPES, Heno F.; FREITAS, Lunara S.; TROMBETTA, Ivani C.; TOSCHI-DIAS, Edgar; ALVES, Maria Janieire N. N.; FRAGA, Raffael F.; RONDON, Maria U.; NEGRAO, Carlos E.; BORTOLOTTO, Luiz A.; LORENZI-FILHO, Geraldo; DRAGER, Luciano F.Background: Recent evidence suggests that obstructive sleep apnea (OSA) is common in patients with metabolic syndrome (MetS) and may contribute to metabolic deregulation, inflammation, and atherosclerosis in these patients. In clinical practice, however, OSA is frequently underdiagnosed. We sought to investigate the clinical predictors of OSA in patients with MetS. Methods: We studied consecutive patients newly diagnosed with MetS (Adult Treatment Panel-III). All participants underwent clinical evaluation, standard polysomnography, and laboratory measurements. We performed a logistic regression model, including the following variables: gender, age >50 years, neck and waist circumferences, hypertension, diabetes, body mass index (BMI) >30kg/m(2), high risk for OSA by Berlin questionnaire, presence of excessive daytime somnolence (Epworth Sleepiness Scale), abnormal serum glucose, triglycerides, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol. Results: We studied 197 patients (60% men; age: 4910 years; BMI: 32.9 +/- 5.1kg/m(2)). OSA (defined by an apnea-hypopnea index 15 events per hour) was diagnosed in 117 patients [59%; 95% confidence interval (CI): 52-66]. In multivariate analysis, male gender [odds ratio (OR): 3.28; 95% CI: 1.68-6.41; P<0.01], abnormal glucose levels (OR: 3.01; 95% CI: 1.50-6.03; P<0.01), excessive daytime sleepiness (OR: 2.38; 95% CI: 1.13-5.04; P=0.02), and high risk for OSA by Berlin questionnaire (OR: 4.33; 95% CI: 2.06-9.11; P<0.001) were independently associated with OSA. Conclusions: Simple clinical and metabolic characteristics may help to improve the underdiagnosis of OSA in patients with MetS.
- Obstructive Sleep Apnea Impairs Postexercise Sympathovagal Balance in Patients with Metabolic Syndrome(2015) CEPEDA, Felipe X.; TOSCHI-DIAS, Edgar; MAKI-NUNES, Cristiane; RONDON, Maria Urbana P. B.; ALVES, Maria Janieire N. N.; BRAGA, Ana Maria F. W.; MARTINEZ, Daniel G.; DRAGER, Luciano F.; LORENZI-FILHO, Geraldo; NEGRAO, Carlos E.; TROMBETTA, Ivani C.Study Objectives: The attenuation of heart rate recovery after maximal exercise (Delta HRR) is independently impaired by obstructive sleep apnea (OSA) and metabolic syndrome (MetS). Therefore, we tested the hypotheses: (1) MetS + OSA restrains Delta HRR; and (2) Sympathetic hyperactivation is involved in this impairment. Design: Cross-sectional study. Participants: We studied 60 outpatients in whom MetS had been newly diagnosed (ATP III), divided according to apnea-hypopnea index (AHI) >= 15 events/h in MetS + OSA (n = 30, 49 +/- 1.7 y) and AHI < 15 events/h in MetS - OSA (n = 30, 46 +/- 1.4 y). Normal age-matched healthy control subjects (C) without MetS and OSA were also enrolled (n = 16, 46 +/- 1.7 y). Interventions: Polysomnography, microneurography, cardiopulmonary exercise test. Measurements and Results: We evaluated OSA (AHI - polysomnography), muscle sympathetic nerve activity (MSNA - microneurography) and cardiac autonomic activity (LF = low frequency, HF = high frequency, LF/HF = sympathovagal balance) based on spectral analysis of heart rate (HR) variability. Delta HRR was calculated (peak HR minus HR at first, second, and fourth minute of recovery) after cardiopulmonary exercise test. MetS + OSA had higher MSNA and LF, and lower HF than MetS - OSA and C. Similar impairment occurred in MetS - OSA versus C (interaction, P < 0.01). MetS + OSA had attenuated Delta HRR at first, second, and at fourth minute than did C, and attenuated Delta HRR at fourth minute than did MetS - OSA (interaction, P < 0.001). Compared with C, MetS - OSA had attenuated Delta HRR at second and fourth min (interaction, P < 0.001). Further analysis showed association of the Delta HRR (first, second, and fourth minute) and AHI, MSNA, LF and HF components (P < 0.05 for all associations). Conclusions: The attenuation of heart rate recovery after maximal exercise is impaired to a greater degree where metabolic syndrome (MetS) is associated with moderate to severe obstructive sleep apnea (OSA) than by MetS with no or mild or no OSA. This is at least partly explained by sympathetic hyperactivity.
- Resting spontaneous baroreflex sensitivity and cardiac autonomic control in anabolic androgenic steroid users(2018) SANTOS, Marcelo R. dos; SAYEGH, Ana L. C.; ARMANI, Rafael; COSTA-HONG, Valeria; SOUZA, Francis R. de; TOSCHI-DIAS, Edgar; BORTOLOTTO, Luiz A.; YONAMINE, Mauricio; NEGRAO, Carlos E.; ALVES, Maria-Janieire N. N.OBJECTIVES: Misuse of anabolic androgenic steroids in athletes is a strategy used to enhance strength and skeletal muscle hypertrophy. However, its abuse leads to an imbalance in muscle sympathetic nerve activity, increased vascular resistance, and increased blood pressure. However, the mechanisms underlying these alterations are still unknown. Therefore, we tested whether anabolic androgenic steroids could impair resting baroreflex sensitivity and cardiac sympathovagal control. In addition, we evaluate pulse wave velocity to ascertain the arterial stiffness of large vessels. METHODS: Fourteen male anabolic androgenic steroid users and 12 nonusers were studied. Heart rate, blood pressure, and respiratory rate were recorded. Baroreflex sensitivity was estimated by the sequence method, and cardiac autonomic control by analysis of the R-R interval. Pulse wave velocity was measured using a noninvasive automatic device. RESULTS: Mean spontaneous baroreflex sensitivity, baroreflex sensitivity to activation of the baroreceptors, and baroreflex sensitivity to deactivation of the baroreceptors were significantly lower in users than in nonusers. In the spectral analysis of heart rate variability, high frequency activity was lower, while low frequency activity was higher in users than in nonusers. Moreover, the sympathovagal balance was higher in users. Users showed higher pulse wave velocity than nonusers showing arterial stiffness of large vessels. Single linear regression analysis showed significant correlations between mean blood pressure and baroreflex sensitivity and pulse wave velocity. CONCLUSIONS: Our results provide evidence for lower baroreflex sensitivity and sympathovagal imbalance in anabolic androgenic steroid users. Moreover, anabolic androgenic steroid users showed arterial stiffness. Together, these alterations might be the mechanisms triggering the increased blood pressure in this population.
conferenceObject Hypocaloric diet and exercise training improve postexercise sympatho-vagal balance in patients with metabolic syndrome and obstructive sleep apnea(2014) CEPEDA, F. X.; TOSCHI-DIAS, E.; MAKI-NUNES, C.; RODRIGUES, S.; RONDON, M. U. P. B.; DRAGER, L. F.; ALVES, M. J. N. N.; LORENZI-FILHO, G.; NEGRAO, C. E.; TROMBETTA, I. C.- Exaggerated Exercise Blood Pressure as a Marker of Baroreflex Dysfunction in Normotensive Metabolic Syndrome Patients(2021) DUTRA-MARQUES, Akothirene C.; RODRIGUES, Sara; CEPEDA, Felipe X.; TOSCHI-DIAS, Edgar; RONDON, Eduardo; CARVALHO, Jefferson C.; ALVES, Maria Janieire N. N.; BRAGA, Ana Maria F. W.; RONDON, Maria Urbana P. B.; TROMBETTA, Ivani C.Introduction Exaggerated blood pressure response to exercise (EEBP = SBP >= 190 mmHg for women and >= 210 mmHg for men) during cardiopulmonary exercise test (CPET) is a predictor of cardiovascular risk. Sympathetic hyperactivation and decreased baroreflex sensitivity (BRS) seem to be involved in the progression of metabolic syndrome (MetS) to cardiovascular disease. Objective To test the hypotheses: (1) MetS patients within normal clinical blood pressure (BP) may present EEBP response to maximal exercise and (2) increased muscle sympathetic nerve activity (MSNA) and reduced BRS are associated with this impairment. Methods We selected MetS (ATP III) patients with normal BP (MetS_NT, n = 27, 59.3% males, 46.1 +/- 7.2 years) and a control group without MetS (C, n = 19, 48.4 +/- 7.4 years). We evaluated BRS for increases (BRS+) and decreases (BRS-) in spontaneous BP and HR fluctuations, MSNA (microneurography), BP from ambulatory blood pressure monitoring (ABPM), and auscultatory BP during CPET. Results Normotensive MetS (MetS_NT) had higher body mass index and impairment in all MetS risk factors when compared to the C group. MetS_NT had higher peak systolic BP (SBP) (195 +/- 17 vs. 177 +/- 24 mmHg, P = 0.007) and diastolic BP (91 +/- 11 vs. 79 +/- 10 mmHg, P = 0.001) during CPET than C. Additionally, we found that MetS patients with normal BP had lower spontaneous BRS- (9.6 +/- 3.3 vs. 12.2 +/- 4.9 ms/mmHg, P = 0.044) and higher levels of MSNA (29 +/- 6 vs. 18 +/- 4 bursts/min, P < 0.001) compared to C. Interestingly, 10 out of 27 MetS_NT (37%) showed EEBP (MetS_NT+), whereas 2 out of 19 C (10.5%) presented (P = 0.044). The subgroup of MetS_NT with EEBP (MetS_NT+, n = 10) had similar MSNA (P = 0.437), but lower BRS+ (P = 0.039) and BRS- (P = 0.039) compared with the subgroup without EEBP (MetS_NT-, n = 17). Either office BP or BP from ABPM was similar between subgroups MetS_NT+ and MetS_NT-, regardless of EEBP response. In the MetS_NT+ subgroup, there was an association of peak SBP with BRS- (R = -0.70; P = 0.02), triglycerides with peak SBP during CPET (R = 0.66; P = 0.039), and of triglycerides with BRS- (R = 0.71; P = 0.022). Conclusion Normotensive MetS patients already presented higher peak systolic and diastolic BP during maximal exercise, in addition to sympathetic hyperactivation and decreased baroreflex sensitivity. The EEBP in MetS_NT with apparent well-controlled BP may indicate a potential depressed neural baroreflex function, predisposing these patients to increased cardiovascular risk.
- Exercise training prevents the deterioration in the arterial baroreflex control of sympathetic nerve activity in chronic heart failure patients(2015) GROEHS, Raphaela V.; TOSCHI-DIAS, Edgar; ANTUNES-CORREA, Ligia M.; TREVIZAN, Patricia F.; RONDON, Maria Urbana P. B.; OLIVEIRA, Patricia; ALVES, Maria J. N. N.; ALMEIDA, Dirceu R.; MIDDLEKAUFF, Holly R.; NEGRAO, Carlos E.Arterial baroreflex control of muscle sympathetic nerve activity (ABRMSNA) is impaired in chronic systolic heart failure (CHF). The purpose of the study was to test the hypothesis that exercise training would improve the gain and reduce the time delay of ABRMSNA in CHF patients. Twenty-six CHF patients, New York Heart Association Functional Class II-III, EF <= 40%, peak (V) over dot O-2 <= 20 ml.kg(-1).min(-1) were divided into two groups: untrained (UT, n = 13, 57 +/- 3 years) and exercise trained (ET, n = 13, 49 +/- 3 years). Muscle sympathetic nerve activity (MSNA) was directly recorded by microneurography technique. Arterial pressure was measured on a beat-to-beat basis. Time series of MSNA and systolic arterial pressure were analyzed by autoregressive spectral analysis. The gain and time delay of ABRMSNA was obtained by bivariate autoregressive analysis. Exercise training was performed on a cycle ergometer at moderate intensity, three 60-min sessions per week for 16 wk. Baseline MSNA, gain and time delay of ABRMSNA, and low frequency of MSNA (LFMSNA) to high-frequency ratio (HFMSNA) (LFMSNA/HFMSNA) were similar between groups. ET significantly decreased MSNA. MSNA was unchanged in the UT patients. The gain and time delay of ABRMSNA were unchanged in the ET patients. In contrast, the gain of ABRMSNA was significantly reduced [3.5 +/- 0.7 vs. 1.8 +/- 0.2, arbitrary units (au)/mmHg, P = 0.04] and the time delay of ABRMSNA was significantly increased (4.6 +/- 0.8 vs. 7.9 +/- 1.0 s, P = 0.05) in the UT patients. LFMSNA-to-HFMSNA ratio tended to be lower in the ET patients (P < 0.08). Exercise training prevents the deterioration of ABRMSNA in CHF patients.
conferenceObject Exercise training and hypocaloric diet improves sympathetic arterial baroreflex control in patients with metabolic syndrome and obstructive sleep apnea(2013) TOSCHI-DIAS, Edgar; TROMBETTA, Ivani C.; SILVA, Valdo J. D.; MAKI-NUNES, Cristiane; CEPEDA, Felipe X.; ALVES, Maria Janieire N. N.; CARVALHO, Glauce; DRAGER, Luciano; LORENZI-FILHO, Geraldo; NEGRAO, Carlos E.; RONDON, Maria Urbana P. B.Metabolic syndrome (MetS) decreases arterial baroreflex control of muscle sympathetic nerve activity (ABRMSNA). And, the obstructive sleep apnea (OSA) exacerbates this autonomic dysfunction. We tested the hypothesis that exercise training and hypocaloric diet (ET+D) would restore ABRMSNA in patients with MetS and OSA. Forty-four MetS patients were allocated into four groups: Sedentary with OSA (MetS+OSA Sed, n=10) or without OSA (MetS-OSA Sed, n=10), and ET+D with OSA (MetS+OSA ET+D, n=11) or without OSA (MetS-OSA ET+D, n=13). The ET+D groups were submitted to –500 kcal/day and 40 min bicycle exercise for 4-months. OSA was deferred as apnea-hypopnea index>15 events/hour. MSNA (microneurography), blood pressure (beat-to-beat, noninvasive) and spontaneous ABRMSNA (gain, sensitivity and time delay, latency) were evaluated. ET+D decreased MSNA (P<0.05) and increased ABRMSNA gain in both MetS+OSA (13±1 vs. 24±2 ms/mmHg, P=0.01) and MetS-OSA (27±3 vs. 37±3ms/mmHg, P=0.03) groups. The time delay of ABRMSNA was reduced by ET+D only in MetS+OSA group (4.1±0.2 vs. 2.8±0.3 s, P=0.04). No changes were observed in the sedentary groups. In conclusion, the ET+D improve ABRMSNA sensitivity in patients with MetS regardless of OSA. However, this effect of ET+D is more pronounced in patients with MetS+OSA.