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
6 resultados
Resultados de Busca
Agora exibindo 1 - 6 de 6
- Discriminating the severity of pharyngeal collapsibility in men using anthropometric and polysomnographic indices(2020) GENTA, Pedro R.; SCHORR, Fabiola; EDWARDS, Bradley A.; WELLMAN, Andrew; LORENZI-FILHO, GeraldoStudy Objectives: Although obstructive sleep apnea results from the combination of different pathophysiologic mechanisms, the degree of anatomical compromise remains the main responsible factor. The passive pharyngeal critical closing pressure (Pcrit) is a technique used to assess the collapsibility of the upper airway and is often used as a surrogate measure of this anatomical compromise. Patients with a low Pcrit (ie, less collapsible airway) are potential candidates for non-continuous positive airway pressure therapies. However, Pcrit determination is a technically complex method not available in clinical practice. We hypothesized that the discrimination between low and high Pcrit can be estimated from simple anthropometric and polysomnographic indices. Methods: Men with and without obstructive sleep apnea underwent Pcrit determination and full polysomnography. Receiver operating characteristics analysis was performed to select the best cutoff of each variable to predict a high Pcrit (Pcrit >= 2.5 cmH(2)O). Multiple logistic regression analysis was performed to create a clinical score to predict a high Pcrit. Results: We studied 81 men, 48 +/- 13 years of age, with an apnea-hypopnea index of 32 [14-60], range 1-96 events/h), and Pcrit of -0.7 +/- 3.1 (range, -9.1 to +7.2 cmH(2)O). A high and low Pcrit could be accurately identified by polysomnographic and anthropometric indices. A score to discriminate Pcrit showed good performance (area under the curve = 0.96; 95% confidence interval, 0.91-1.00) and included waist circumference, non-rapid eye movement obstructive apnea index/apnea-hypopnea index, mean obstructive apnea duration, and rapid eye movement apnea-hypopnea index. Conclusions: A low Pcrit (less collapsible) can be estimated from a simple clinical score. This approach may identify candidates more likely to respond to non-continuous positive airway pressure therapies for obstructive sleep apnea.
conferenceObject The Role of Fluid Accumulation in Acute Weight Gain During CPAP Treatment in Patients with Obstructive Sleep Apnea(2020) SILVA, S.; GRAD, G. F.; DRAGER, L. F.; ALBUQUERQUE, A. L.; MELO, C. M. de; LORENZI-FILHO, G.; GENTA, P.- Improving Airways Patency and Ventilation Through Optimal Positive Pressure Identified by Noninvasive Mechanical Ventilation Titration in Mounier-Kuhn Syndrome: Protocol for an Interventional, Open-Label, Single-Arm Clinical Trial(2020) LIMA, Evelise; NAKAMURA, Maria Aparecida Miyuki; GENTA, Pedro Rodrigues; RODRIGUES, Ascedio Jose; ATHANAZIO, Rodrigo Abensur; RACHED, Samia; COSTA, Eduardo Leite Vieira; STELMACH, RafaelBackground: Mounier-Kuhn syndrome or congenital tracheobronchomegaly is a rare disease characterized by dilation of the trachea and the main bronchi within the thoracic cavity. The predominant signs and symptoms of the disease include coughing, purulent and abundant expectoration, dyspnea, snoring, wheezing, and recurrent respiratory infection. Symptoms of the disease in some patients are believed to be pathological manifestations arising due to resident tracheobronchomalacia. Although treatment options used for the management of this disease include inhaled bronchodilators, corticosteroids, and hypertonic solution, there is no consensus on the treatment. The use of continuous positive airway pressure (CPAP) has been reported as a potential therapeutic option for tracheobronchomalacia, but no prospective studies have demonstrated its efficacy in this condition. Objective: The purpose of this is to identify the presence of tracheobronchomalacia and an optimal CPAP pressure that reduces the tracheobronchial collapse in patients with Mounier-Kuhn syndrome and to analyze the repercussion in pulmonary ventilation. In parallel, we aim to evaluate the prevalence of obstructive sleep apnea/hypopnea syndrome. Methods: This interventional, open-label, single-arm clinical trial will enroll patients who are diagnosed Mounier-Kuhn syndrome. Patient evaluation will be conducted in an outpatient clinic and involve 3 visits. Visit 1 will involve the collection and registration of social demographic, clinical, and functional data. Visit 2 will entail polysomnography, bronchoscopy for the evaluation of tracheobronchomalacia, titration of the optimal pressure that reduces the degree of collapse of the airway, and electrical impedance tomography. In visit 3, patients exhibiting a reduction in collapse areas will be requested to undergo chest computed tomography during inspiration and forced expiration with and without positive pressure (titrated to determine optimal CPAP pressure). Results: This protocol is a doctorate project. The project was submitted to the institutional review board on January 24, 2017, and approval was granted on February 2, 2017 (Brazilian Research database number CAAE 64001317.4.000.0068). Patient evaluations started in April 2018. Planned recruitment is based on volunteers' availability and clinical stability, and interventions will be conducted at least once a month to finish the project at the end of 2020. A preliminary analysis of each case will be performed after each intervention, but detailed results are expected to be reported in the first quarter of 2021. Conclusions: There is no consensus on the best treatment options for managing Mounier-Kuhn syndrome. The use of positive pressure could maintain patency of the collapsed airways, functioning as a ""pneumatic stent"" to reduce the degree of airflow obstruction. This, in turn, could promote mobilization of thoracic secretion and improve pulmonary ventilation.
- Comparison of upper airway obstruction during zolpidem-induced sleep and propofol-induced sleep in patients with obstructive sleep apnea: a pilot study(2020) ORDONES, Alexandre Beraldo; GRAD, Gustavo Freitas; CAHALI, Michel Burihan; LORENZI-FILHO, Geraldo; SENNES, Luiz Ubirajara; GENTA, Pedro RodriguesStudy Objectives: Drug-induced sleep endoscopy (DISE) using propofol is commonly used to identify the pharyngeal structure involved in collapse among patients with obstructive sleep apnea. DISE has never been compared with zolpidem-induced sleep endoscopy. We hypothesized that propofol at recommended sedation levels does not influence upper airway collapsibility nor the frequency of multilevel pharyngeal collapse as compared with zolpidem-induced sleep. Methods: Twenty-one patients with obstructive sleep apnea underwent polysomnography and sleep endoscopy during zolpidem-induced sleep and during DISE with propofol. A propofol target-controlled infusion was titrated to achieve a bispectral index between 50 and 70. Airway collapsibility was estimated and compared in both conditions by peak inspiratory flow and the magnitude of negative effort dependence. Respiratory drive was estimated by the difference between end-expiratory and peak-negative inspiratory pharyngeal pressure (driving pressure). Site and configuration of pharyngeal collapse during zolpidem-induced sleep and DISE with propofol were compared. Results: The frequency of multilevel collapse during zolpidem-induced sleep was similar to that observed during DISE with propofol (72% vs 86%, respectively; difference: 14%; 95% confidence interval: -12% to 40%; P = .453). The endoscopic classification of pharyngeal collapse during both conditions were similar. Peak inspiratory flow, respiratory drive (effect size: 0.05 and 0.03, respectively), and negative effort dependence (difference: -6%; 95% confidence interval: -16% to 4%) were also similar in both procedures. Conclusions: In this pilot study, recommended propofol doses did not significantly increase multilevel pharyngeal collapse or affect upper airway collapsibility and respiratory drive as compared with zolpidem-induced sleep.
- The Importance of Mask Selection on Continuous Positive Airway Pressure Outcomes for Obstructive Sleep Apnea An Official American Thoracic Society Workshop Report(2020) GENTA, Pedro R.; KAMINSKA, Marta; EDWARDS, Bradley A.; EBBEN, Matthew R.; KRIEGER, Ana C.; TAMISIER, Renaud; YE, Lichuan; WEAVER, Terri E.; VANDERVEKEN, Olivier M.; LORENZI-FILHO, Geraldo; DEYOUNG, Pam; HEVENER, William; STROLLO, PatrickContinuous positive airway pressure (CPAP) remains the major treatment option for obstructive sleep apnea (OSA). The American Thoracic Society organized a workshop to discuss the importance of mask selection for OSA treatment with CPAP. In this workshop report, we summarize available evidence about the breathing route during nasal and oronasal CPAP and the importance of nasal symptoms for CPAP outcomes. We explore the mechanisms of air leaks during CPAP treatment and possible alternatives for leak control. The impact of nasal and oronasal CPAP on adherence, residual apnea-hypopnea index, unintentional leaks, and pressure requirements are also compared. Finally, recommendations for patient and partner involvement in mask selection are presented, and future directions to promote personalized mask selection are discussed.
- Validation of an Overnight Wireless High-Resolution Oximeter plus Cloud-Based Algorithm for the Diagnosis of Obstructive Sleep Apnea(2020) PINHEIRO, George do Lago; CRUZ, Andrea Fonseca; DOMINGUES, Diego Munduruca; GENTA, Pedro Rodrigues; DRAGER, Luciano F.; STROLLO, Patrick J.; LORENZI-FILHO, GeraldoOBJECTIVES: Obstructive sleep apnea (OSA) is a common but largely underdiagnosed condition. This study aimed to test the hypothesis that the oxygen desaturation index (ODI) obtained using a wireless high-resolution oximeter with a built-in accelerometer linked to a smartphone with automated cloud analysis, Overnight Digital Monitoring (ODM), is a reliable method for the diagnosis of OSA. METHODS: Consecutive patients referred to the sleep laboratory with suspected OSA underwent in-laboratory polysomnography (PSG) and simultaneous ODM. The PSG apnea-hypopnea index (AHI) was analyzed using the criteria recommended and accepted by the American Academy of Sleep Medicine (AASM) for the definition of hypopnea: arousal or >= 3% O-2 desaturation (PSG-AHI(3%)) and >= 4% O-2 desaturation (PSG-AHI(4%)), respectively. The results of PSG and ODM were compared by drawing parallels between the PSG-AHI(3%) and PSG-AHI(4%) with ODM-ODI3% and ODM-ODI4%, respectively. Bland-Altman plots, intraclass correlation, receiver operating characteristics (ROC) and area under the curve (AUC) analyses were conducted for statistical evaluation. ClinicalTrial.gov: NCT03526133. RESULTS: This study included 304 participants (men: 55%; age: 55 +/- 14 years; body mass index: 30.9 +/- 5.7 kg/m(2); PSG-AHI(3%): 35.3 +/- 30.1/h, ODM-ODI3%: 30.3 +/- 25.9/h). The variability in the AASM scoring bias (PSG-AHI(3%) vs PSG-AHI(4%)) was significantly higher than that for PSG-AHI(3%) vs ODM-ODI3% (3%) and PSG-AHI(4%) vs ODM-ODI4% (4%) (9.7, 5.0, and 2.9/h, respectively; p < 0.001). The limits of agreement (2 +/- SD, derived from the Bland-Altman plot) of AASM scoring variability were also within the same range for (PSG vs ODM) 3% and 4% variability: 18.9, 21.6, and 16.5/h, respectively. The intraclass correlation/AUC for AASM scoring variability and PSG vs ODM 3% or 4% variability were also within the same range (0.944/0.977 and 0.953/0.955 or 0.971/0.964, respectively). CONCLUSION: Our results showed that ODM is a simple and accurate method for the diagnosis of OSA.