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
8 resultados
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- Tongue size matters: revisiting the Mallampati classification system in patients with obstructive sleep apnea(2023) ATHAYDE, Rodolfo Augusto Bacelar de; COLONNA, Leonardo Luiz Igreja; SCHORR, Fabiola; GEBRIM, Eloisa Maria Mello Santiago; LORENZI-FILHO, Geraldo; GENTA, Pedro RodriguesObjective: The Mallampati classification system has been used to predict obstructive sleep apnea (OSA). Upper airway soft tissue structures are prone to fat deposition, and the tongue is the largest of these structures. Given that a higher Mallampati score is associated with a crowded oropharynx, we hypothesized that the Mallampati score is associated with tongue volume and an imbalance between tongue and mandible volumes. Methods: Adult males underwent clinical evaluation, polysomnography, and upper airway CT scans. Tongue and mandible volumes were calculated and compared by Mallampati class. Results: Eighty patients were included (mean age, 46.8 years). On average, the study participants were overweight (BMI, 29.3 +/- 4.0 kg/m(2)) and had moderate OSA (an apnea-hypopnea index of 26.2 +/- 26.7 events/h). Mallampati class IV patients were older than Mallampati class II patients ( 53 +/- 9 years vs. 40 +/- 12 years; p < 0.01), had a larger neck circumference (43 +/- 3 cm vs. 40 +/- 3 cm; p < 0.05), had more severe OSA (51 +/- 27 events/h vs. 24 +/- 23 events/h; p < 0.01), and had a larger tongue volume (152 +/- 19 cm(3) v s. 135 +/- 18 cm3; p < 0.01). Mallampati class IV patients also had a larger tongue volume than did Mallampati class III patients (152 +/- 19 cm(3) vs. 135 +/- 13 cm(3); p < 0.05), as well as having a higher tongue to mandible volume ratio (2.5 +/- 0.5 cm(3) vs. 2.1 +/- 0.4 cm(3); p < 0.05). The Mallampati score was associated with the apnea-hypopnea index (r = 0.431, p < 0.001), BMI (r = 0.405, p < 0.001), neck and waist circumference (r = 0.393, p < 0.001), tongue volume (r = 0.283, p < 0.001), and tongue/ mandible volume (r = 0.280, p = 0.012). Conclusions: The Mallampati score appears to be influenced by obesity, tongue enlargement, and upper airway crowding.
- Comorbid association of obstructive sleep apnea (OSA) and thrombotic primary antiphospholipid syndrome (tPAPS): A more severe phenotype?(2023) BALBI, Gustavo Guimaraes Moreira; SIGNORELLI, Flavio; GANDARA, Ana Paula; AZAM, Indira; BARROS, Silvana de; MARREIROS, Dilson; GENTA, Pedro Rodrigues; LOTUFO, Paulo Andrade; BENSENOR, Isabela M.; DRAGER, Luciano F.; ANDRADE, DanieliObjective: We aimed to evaluate the frequency of obstructive sleep apnea (OSA) in patients with thrombotic primary antiphospholipid syndrome (tPAPS), to investigate the performance of screening tools for OSA in this scenario and to compare clinical/laboratorial differences in tPAPS patients with and without OSA.Methods: We consecutively enrolled patients with tPAPS to undergo sleep studies using a portable monitor. OSA was defined as apnea-hypopnea index >= 15 events/h. Frequency of OSA in tPAPS was evaluated and compared with age-, gender-, and BMI-matched controls (1:3 ratio) from the Estudo Longitudinal de Saude do Adulto (ELSA-Brasil). Next, we tested the performance of three different screening tools for assessing OSA in patients with tPAPS. Finally, patients with tPAPS were stratified according to OSA status comparing their clinical and laboratory characteristics (including damage burden measured by Damage Index for Antiphospholipid Syndrome [DIAPS] and biomarkers associated with thrombosis) using standard statistical procedures.Results: Fifty-two patients were included for analysis (females: 82.7%; mean age: 48 +/- 14 years; body-mass index: 31.1 +/- 6.5 Kg/m(2); 25% with moderate-severe OSA). When compared to matched controls from ELSABrasil (n = 115), there was no significant differences in the frequencies of OSA (tPAPS: 12/42 [28.6%] vs. controls: 35/115 [30.4%], p = 0.821). Among screening tools, NoSAS had the highest area under ROC curve (AUC 0.806, CI 95% 0.672-0.939, p = 0.001), followed by STOP-Bang (AUC 0.772, CI 95% 0.607-0.938, p = 0.004). Patients with comorbid tPAPS and OSA presented higher levels of von Willebrand factor (vWF) (median 38.9 vs. 32.6, p = 0.038) and DIAPS (median 5 vs. 2, p = 0.020), when compared to those without OSA. OSA remained statistically associated with higher DIAPS, even after controlling for age, disease duration and BMI.Conclusion: OSA is common in patients with tPAPS, with rates comparable to a non-referred population. Both NoSAS and STOP-Bang scores seems to be useful for screening OSA in these patients. Patients with tPAPS+OSA had higher damage burden and higher levels of vWF, which might suggest a more severe phenotype of tPAPS in this scenario.
- Respiratory arousal threshold among patients with isolated sleep apnea and with comorbid insomnia (COMISA)(2023) YANAGIMORI, Marcela; FERNANDES, Mariana D.; GARCIA, Michelle L.; SCUDELLER, Paula G.; CARVALHO, Carlos R. R.; EDWARDS, Bradley; LORENZI-FILHO, Geraldo; GENTA, Pedro R.Insomnia and obstructive sleep apnea (OSA) are common sleep disorders and frequently coexist (COMISA). Arousals from sleep may be a common link explaining the frequent comorbidity of both disorders. Respiratory arousal threshold (AT) is a physiologic measurement of the level of respiratory effort to trigger an arousal from sleep. The impact of COMISA on AT is not known. We hypothesized that a low AT is more common among COMISA than among patients with OSA without insomnia. Participants referred for OSA diagnosis underwent a type 3 sleep study and answered the insomnia severity index (ISI) questionnaire and the Epworth sleepiness scale. Participants with an ISI score >= 15 were defined as having insomnia. Sleep apnea was defined as an apnea hypopnea index (AHI) >= 15 events/h. Low AT was determined using a previously validated score based on 3 polysomnography variables (AHI, nadir SpO(2) and the frequency of hypopneas). OSA-only (n = 51) and COMISA (n = 52) participants had similar age (61[52-68] vs 60[53-65] years), body-mass index (31.3[27.7-36.2] vs 32.2[29.5-38.3] kg/m(2)) and OSA severity (40.2[27.5-60] vs 37.55[27.9-65.2] events/h): all p = NS. OSA-only group had significantly more males than the COMISA group (58% vs 33%, p = 0.013. The proportion of participants with a low AT among OSA-only and COMISA groups was similar (29 vs 33%, p = NS). The similar proportion of low AT among COMISA and patients with OSA suggests that the respiratory arousal threshold may not be related to the increased arousability of insomnia.
- Influence of the device used for obstructive sleep apnea diagnosis on body position: a comparison between polysomnography and portable monitor(2023) MELLO, Andre A. F.; D'ANGELO, Giovanna; SANTOS, Ronaldo B.; BENSENOR, Isabela; LOTUFO, Paulo A.; LORENZI-FILHO, Geraldo; DRAGER, Luciano F.; GENTA, Pedro R.Purpose Different devices have been used for the diagnosis of obstructive sleep apnea (OSA), which differ in the number of sensors used. The numerous sensors used in more complex sleep studies such as in-lab polysomnography may influence body position during sleep. We hypothesized that patients submitted to in-lab polysomnography (PSG) would spend more time in the supine position than patients submitted to an ambulatory Portable Monitor (PM) sleep study. Methods Body position during PSG and PM studies was compared among two distinct groups of patients matched for age, body-mass index (BMI), apnea-hypopnea index (AHI), and gender. Predictors of time spent in the supine position were determined using a multiple linear regression model. Results Of 478 participants who underwent either PSG or PM studies, mean age: 61[43-66] years; males: 43.9%; BMI: 28.4[26.1-31.1]kg/m(2); AHI 14[7-27] events/hour). Participants who underwent PSG studies spent more time in the supine position (41[16-68]% than participants who underwent PM studies (34[16-51]%), P = 0.014. Participants with OSA spent more time in the supine position than participants without OSA, both among the PSG and PM groups P < 0.05). Gender, BMI, OSA severity, and sleep study type were independent predictors of time spent in the supine position. Conclusion In-lab PSG may increase time spent in the supine position and overestimate OSA severity compared to a PM sleep study. OSA diagnosis is also associated with increased time spent in the supine position. The potential influence on the sleeping position should be taken into account when choosing among the different sleep study types for OSA diagnosis.
- Insomnia symptoms during the covid-19 a case-control(2023) BACELAR, Andrea; CONWAY, Silvia Goncalves; ASSIS, Marcia; SILVA, Victor Menezes; GENTA, Pedro Rodrigues; PACHITO, Daniela Vianna; TAVARES JUNIOR, Almir Ribeiro; SGUILLAR, Danilo Anunciatto; MOREIRA, Gustavo Antonio; DRAGER, Luciano Ferreira; MORENO, Claudia Roberta de CastroOBJECTIVE: To identify lifestyle-related, sociodemographic, and mental health characteristics of people with insomnia symptoms and people without insomnia during the pandemic. METHODS: A case-control study was conducted with data collected by snowball sampling using an online questionnaire. From November 2020 to April 2021, 6,360 people with a mean age of 43.5 years (SD = 14.3) participated in the survey. For this study, we considered 158 cases of insomnia disorder and 476 controls (three controls per case) randomly selected from the participants without sleep problems. RESULTS: The results of the comparative analysis between cases and controls showed that sleeping less than six hours daily (OR = 3.89; 95%CI 2.50-6.05), feeling sadness frequently (OR = 2.95; 95%CI 1.69-5.17), residing in metropolitan areas (OR = 1.71; 95%CI 1.04-2.84), being 40 years or older (OR = 1.93; 95%CI 1.22-3.06), and the interaction between occupation and poorer education (OR = 2.12; 95%CI 1.22-3.69) were predictors for symptoms of insomnia disorder during the pandemic. CONCLUSIONS: In addition to confirming the hypothesis that mental health problems are associated with insomnia symptoms, the results point to insomnia as an important outcome for studies on the effects of unemployment, vulnerability and low education of the population, especially in large cities, highlighting that the effects of the crisis on health and the economy are extremely unequally distributed. DESCRIPTORS: Sleep Initiation and Maintenance Disorders, epidemiology. Risk Factors. Socioeconomic Factors. Case-Control Studies. COVID-19.
- Muscle and visceral fat infiltration: A potential mechanism to explain the worsening of obstructive sleep apnea with age(2023) D'ANGELO, Giovanna F.; MELLO, Andre A. F. de; SCHORR, Fabiola; GEBRIM, Eloisa; FERNANDES, Mariana; LIMA, Giovanni F.; GRAD, Gustavo F.; YANAGIMORI, Marcela; LORENZI-FILHO, Geraldo; GENTA, Pedro RodriguesStudy objectives: Aging is a major risk factor for obstructive sleep apnoea (OSA) and is associated with increased upper airway collapsibility, but the mechanisms are largely unknown. We hypothesized that the increase in OSA severity and upper airway collapsibility with age are partially mediated by upper airway, visceral and muscle fat infiltration.Methods: Male subjects underwent full polysomnography, upper airway collapsibility determination (Pcrit) after sleep induction with midazolam, upper airway and abdominal computed tomography. Tongue and abdominal muscle fat infiltration were assessed by the determination of muscle attenuation with computed tomography. Results: Eighty-four males with a wide range of age (47 +/- 13 years, range 22-69 years) and apnea-hypopnea index (AHI) (30 [14-60] events/h, range 1-90 events/h), were studied. Younger and older males were grouped according to the mean age. Despite similar body mass-index (BMI), older subjects had higher AHI, higher Pcrit, larger neck and waist circumference, higher visceral and upper airway fat volumes (P < 0.01) as compared to younger subjects. Age was associated with OSA severity, Pcrit, neck and waist circumference, upper airway fat volume and visceral fat (P < 0.05), but not with BMI. Older subjects had lower tongue and abdominal muscle attenuation as compared to younger subjects (P < 0.001). Age was inversely associated with tongue and abdominal muscle attenuation, indicating muscle fat infiltration.Conclusions: The associations between age, upper airway fat volume, visceral and muscle fat infiltration may help to explain the worsening of OSA and increased upper airway collapsibility with aging.(c) 2023 Elsevier B.V. All rights reserved.
- Task Accomplished Promising Effects of a New Antagonist in OSA(2023) GENTA, Pedro R.; TARANTO-MONTEMURRO, Luigi
- Staring us in the face: resumption of CPAP therapy(2024) JOOSTEN, Simon A.; GENTA, Pedro R.