PEDRO RODRIGUES GENTA
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/63, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/63, Hospital das Clínicas, Faculdade de Medicina - Líder
14 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 14
- Screening for Obstructive Sleep Apnea in Patients with Atrial Fibrillation(2017) GENTA, Pedro R.; DRAGER, Luciano F.; LORENZI FILHO, Geraldo
- Airflow Shape Is Associated With the Pharyngeal Structure Causing OSA(2017) GENTA, Pedro R.; SANDS, Scott A.; BUTLER, James P.; LORING, Stephen H.; KATZ, Eliot S.; DEMKO, B. Gail; KEZIRIAN, Eric J.; WHITE, David P.; WELLMAN, AndrewBACKGROUND: OSA results from the collapse of different pharyngeal structures (soft palate, tongue, lateral walls, and epiglottis). The structure involved in collapse has been shown to impact non-CPAP OSA treatment. Different inspiratory airflow shapes are also observed among patients with OSA. We hypothesized that inspiratory flow shape reflects the underlying pharyngeal structure involved in airway collapse. METHODS: Subjects with OSA were studied with a pediatric endoscope and simultaneous nasal flow and pharyngeal pressure recordings during natural sleep. The mechanism causing collapse was classified as tongue-related, isolated palatal, lateral walls, or epiglottis. Flow shape was classified according to the degree of negative effort dependence (NED), defined as the percent reduction in inspiratory flow from peak to plateau. RESULTS: Thirty-one subjects with OSA (mean apnea-hypopnea index score +/- SD, 54 +/- 27 events/h) who were 50 +/- 9 years of age were studied. NED was associated with the structure causing collapse (P <.001). Tongue-related obstruction (n = 13) was associated with a small amount of NED (median, 19; interquartile range [IQR], 14%-25%). Moderate NED was found among subjects with isolated palatal collapse (median, 45; IQR, 39%-52%; n = 8) and lateral wall collapse (median, 50; IQR, 44%-64%; n = 8). The epiglottis was associated with severe NED (median, 89; IQR, 78%-91%) and abrupt discontinuities in inspiratory flow (n = 9). CONCLUSIONS: Inspiratory flow shape is influenced by the pharyngeal structure causing collapse. Flow shape analysis may be used as a noninvasive tool to help determine the pharyngeal structure causing collapse.
conferenceObject Comparison Of Objective Adherence And Effectiveness Between Two Types Of Mandibular Advancement Devices For The Treatment Of Obstructive Sleep Apnea: A Crossover Randomized Study(2017) BRANCO, N. Castello; NUNES, S.; MARTINS, R. O.; GENTA, P.; LORENZI-FILHO, G.conferenceObject Comparison Of Site And Configuration Of Upper Airway Collapse Between Natural And Propofol-Induced Sleep Endoscopy - Preliminary Results(2017) ORDONES, A. B.; GRAD, G.; CAHALI, M.; SENNES, L. U.; LORENZI-FILHO, G.; GENTA, P.- Predicting epiglottic collapse in patients with obstructive sleep apnoea(2017) AZARBARZIN, Ali; MARQUES, Melania; SANDS, Scott A.; BEECK, Sara Op de; GENTA, Pedro R.; TARANTO-MONTEMURRO, Luigi; MELO, Camila M. de; MESSINEO, Ludovico; VANDERVEKEN, Olivier M.; WHITE, David P.; WELLMAN, AndrewObstructive sleep apnoea (OSA) is characterised by pharyngeal obstruction occurring at different sites. Endoscopic studies reveal that epiglottic collapse renders patients at higher risk of failed oral appliance therapy or accentuated collapse on continuous positive airway pressure. Diagnosing epiglottic collapse currently requires invasive studies (imaging and endoscopy). As an alternative, we propose that epiglottic collapse can be detected from the distinct airflow patterns it produces during sleep. 23 OSA patients underwent natural sleep endoscopy. 1232 breaths were scored as epiglottic/nonepiglottic collapse. Several flow characteristics were determined from the flow signal (recorded simultaneously with endoscopy) and used to build a predictive model to distinguish epiglottic from nonepiglottic collapse. Additionally, 10 OSA patients were studied to validate the pneumotachograph flow features using nasal pressure signals. Epiglottic collapse was characterised by a rapid fall(s) in the inspiratory flow, more variable inspiratory and expiratory flow and reduced tidal volume. The cross-validated accuracy was 84%. Predictive features obtained from pneumotachograph flow and nasal pressure were strongly correlated. This study demonstrates that epiglottic collapse can be identified from the airflow signal measured during a sleep study. This method may enable clinicians to use clinically collected data to characterise underlying physiology and improve treatment decisions.
- Aerophagia During CPAP for OSA: The Case for Auto-CPAP and Nasal Mask(2017) GENTA, Pedro Rodrigues; GRAD, Gustavo Freitas; HERCULANO, Sara
conferenceObject Identifying Epiglottic Collapse From Airflow Patterns During Sleep(2017) AZARBARZM, A.; MARQUES, M.; SANDSL, S. A.; GENTA, P.; MONTEMURRO, L. Taranto; WHITEL, D. P.; WELLMAN, A.conferenceObject Characterizing Site And Severity Of Upper Airway Collapse To Guide Patient Selection For Oral Appliance Therapy For Obstructive Sleep Apnea(2017) MARQUES, M.; GENTA, P.; SANDS, S. A.; MONTEMURRO, L. Taranto; AZARBARZIN, A.; MELO, C. De; WHITE, D. P.; WELLMAN, A.- Are we missing obstructive sleep apnea diagnosis?(2017) LORENZI-FILHO, G.; GENTA, P. R.; DRAGER, L. F.
- The influence of head-of-bed elevation in patients with obstructive sleep apnea(2017) SOUZA, Fabio Jose Fabricio de Barros; GENTA, Pedro Rodrigues; SOUZA FILHO, Albino Jose de; WELLMAN, Andrew; LORENZI-FILHO, GeraldoThe purpose of this study is to test the effects of a mild degree of head-of-bed elevation (HOBE) (7.5A degrees) on obstructive sleep apnea (OSA) severity and sleep quality. OSA patients were recruited from a single sleep clinic (CriciAma, Santa Catarina, Brazil). Following a baseline polysomnography (PSG), all patients underwent a PSG with HOBE (within 2 weeks). In addition, a subset of patients performed a third PSG without HOBE. Fifty-two patients were included in the study (age 53.2 +/- 9.1 years; BMI 29.6 +/- 4.8 kg/m(2), neck circumference 38.9 +/- 3.8 cm, and Epworth Sleepiness Scale 15 +/- 7). Compared to baseline, HOBE significantly decreased the apnea-hypopnea index (AHI) from 15.7 [11.3-22.5] to 10.7 [6.6-16.5] events/h; p < 0.001 and increased minimum oxygen saturation from 83.5 [77.5-87] to 87 [81-90]%; p = 0.003. The sleep architecture at baseline and HOBE were similar. However, sleep efficiency increased slightly but significantly with HOBE (87.2 [76.7-90.7] vs 88.8 [81.6-93.3]; p = 0.005). The AHI obtained at the third PSG without HOBE (n = 7) returned to baseline values. Mild HOBE significantly improves OSA severity without interfering in sleep architecture and therefore is a simple alternative treatment to ameliorate OSA.