LUCIANO FERREIRA DRAGER

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Departamento de Clínica Médica, Faculdade de Medicina - Docente
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/63, Hospital das Clínicas, Faculdade de Medicina - Líder

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Autor e Coautores FMUSP-HC Normalizados: ISABELA JUDITH MARTINS BENSEñOR ×

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  • article 52 Citação(ões) na Scopus
    OSA, Short Sleep Duration, and Their Interactions With Sleepiness and Cardiometabolic Risk Factors in Adults The ELSA-Brasil Study
    (2019) DRAGER, Luciano F.; SANTOS, Ronaldo B.; SILVA, Wagner A.; PARISE, Barbara K.; GIATTI, Soraya; AIELO, Aline N.; SOUZA, Silvana P.; FURLAN, Sofia F.; LORENZI-FILHO, Geraldo; LOTUFO, Paulo A.; BENSENOR, Isabela M.
    BACKGROUND: OSA and short sleep duration (SSD) are frequently associated with daytime symptoms and cardiometabolic deregulation. However, the vast majority of studies addressing OSA have not evaluated SSD, and vice versa. Our aim was to evaluate the association of OSA, SSD, and their interactions with sleepiness and cardiometabolic risk factors in a large cohort of adults. METHODS: Consecutive subjects from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) participated in clinical evaluations, sleep questionnaires, home sleep monitoring, and actigraphy. OSA was defined as an apnea-hypopnea index >= 15 events/hour. SSD was defined by a mean sleep duration < 6 h. RESULTS: Data from 2,064 participants were used in the final analysis (42.8% male; mean age, 49 +/- 8 years). The overall frequency of OSA and SSD were 32.9% and 27.2%, respectively. Following an adjustment for multiple confounding factors, excessive daytime sleepiness was independently associated with SSD (OR, 1.448; 95% CI, 1.172-1.790) but not with OSA (OR, 1.107; 95% CI, 0.888-1.380). The SSD interaction with OSA was not significant. Prevalent obesity (OR, 3.894; 95% CI, 3.077-4.928), hypertension (OR, 1.314; 95% CI, 1.035-1.667), and dyslipidemia (OR, 1.251; 95% CI, 1.006-1.555) were independently associated with OSA but not with SSD. Similarly, the interactions of OSA with SSD were not significant. An additional analysis using < 5 h for SSD or continuous sleep duration did not change the lack of association with the cardiometabolic risk factors. CONCLUSIONS: Objective SSD but not OSA was independently associated with daytime sleepiness. By contrast, OSA, but not SSD, was independently associated with obesity, hypertension, and dyslipidemia.
  • article 1 Citação(ões) na Scopus
    Self-reported versus actigraphy-assessed sleep duration in the ELSA-Brasil study: analysis of the short/long sleep duration reclassification
    (2022) SANTOS, Ronaldo B.; GIATTI, Soraya; AIELO, Aline N.; SILVA, Wagner A.; PARISE, Barbara K.; CUNHA, Lorenna F.; SOUZA, Silvana P.; ALENCAR, Airlane P.; LOTUFO, Paulo A.; BENSENOR, Isabela M.; DRAGER, Luciano F.
    Purpose This study was aimed to determine the magnitude and predictors of self-reported short/long sleep duration (SDUR) reclassifications using objective measurements. Methods Adult participants from the ELSA-Brasil study performed self-reported SDUR, 7-day wrist actigraphy, and a portable sleep study. We explored two strategies of defining self-reported SDUR reclassification: (1) short and long SDUR defined by <6 and >= 8h, respectively; (2) reclassification using a large spectrum of SDUR categories (<5, 5-6, 7-8, 8-9, and >9 h). Results Data from 2036 participants were used in the final analysis (43% males; age: 49 +/- 8 years). Self-reported SDUR were poorly correlated (r=0.263) and presented a low agreement with actigraphy-based total sleep time. 58% of participants who self-reported short SDUR were reclassified into the reference (6-7.99 h) or long SDUR groups using actigraphy data. 88% of participants that self-reported long SDUR were reclassified into the reference and short SDUR. The variables independently associated with higher likelihood of self-reported short SDUR reclassification included insomnia (3.5-fold), female (2.5-fold), higher sleep efficiency (1.35-fold), lowest O-2 saturation (1.07-fold), higher wake after sleep onset (1.08-fold), and the higher number of awakening (1.05-fold). The presence of hypertension was associated with a 3.4-fold higher chance of self-reported long SDUR reclassification. Analysis of five self-reported SDUR categories revealed that the more extreme is the SDUR, the greater the self-reported SDUR reclassification. Conclusion In adults, we observed a significant rate of short/long SDUR reclassifications when comparing self-reported with objective data. These results underscore the need to reappraise subjective data use for future investigations addressing SDUR.
  • article 0 Citação(ões) na Scopus
    Sleepiness and Cardiometabolic Impact of Short Sleep Duration and OSA What About the Clock? Response
    (2019) DRAGER, Luciano F.; SANTOS, Ronaldo B.; SILVA, Wagner A.; PARISE, Barbara K.; GIATTI, Soraya; AIELO, Aline N.; SOUZA, Silvana P.; LOTUFO, Paulo A.; BENSENOR, Isabela M.
  • article 0 Citação(ões) na Scopus
    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, Danieli
    Objective: 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.
  • conferenceObject
    INTERACTIONS BETWEEN OBSTRUCTIVE SLEEP APNEA AND SLEEP DURATION WITH SUBCLINICAL ATHEROSCLEROSIS EVALUATED BY CORONARY CALCIUM SCORE: CROSS-SECTIONAL DATA FROM ELSA-BRASIL STUDY
    (2019) SOUZA, S. Pereira e; BITTENCOURT, S. M.; PARISE, K. B.; SANTOS, B. R.; SILVA, A. W.; AIELO, N. A.; PADOVESI, G. S.; FILHO, L. G.; BENSENOR, M. I.; LOTUFO, A. P.; DRAGER, F. L.
  • article 1 Citação(ões) na Scopus
    Excessive daytime sleepiness, but not sleep apnea, sleep duration or insomnia, was associated with poor adherence to anti-hypertensive treatment: The ELSA-Brasil study
    (2023) AIELO, Aline N.; SANTOS, Ronaldo B.; GIATTI, Soraya; SILVA, Wagner A.; PARISE, Barbara K.; CUNHA, Lorenna F.; SOUZA, Silvana P.; LOTUFO, Paulo A.; BENSENOR, Isabela M.; DRAGER, Luciano F.
    Hypertension is the leading risk factor for cardiovascular mortality. Poor adherence may partially explain this scenario. Beyond traditional factors, it is conceivable that sleep conditions such as Obstructive Sleep Apnea (OSA), Sleep Duration (SDUR), sleepiness and insomnia may contribute to impair adherence but the evidence is scanty. Consecutive participants with hypertension from the ELSA-Brasil study performed a home sleep monitoring and 7-days actigraphy to determine OSA (apnea-hypopnea index >= 15 events/ hour) and SDUR, respectively. Excessive daytime sleepiness (EDS) and insomnia were evaluated by Epworth Sleepiness Scale (ESS) and Clinical Interview Scheduled Revised (CIS-R), respectively. The 4itens Morisky questionnaire was used to evaluate adherence to anti-hypertensive therapy. A total of 411 patients were including in the analysis (mean age: 54 +/- 8 years, 47% men). Medium/low adherence to anti-hypertensive therapy was observed in 62%. Compared to the high adherence group, the participants with medium/low adherence had lower frequencies of Whites (64.1 vs. 47.8%), high-degree education (50.6 vs. 40%), and monthly per-capita income ($1021.90 vs. $805.20). In contrast, we observed higher frequency of EDS (35.9 vs. 46.1%). No differences were observed for OSA, short SDUR (<6 h) and insomnia. Logistic regression analysis showed that race other than White (OR: 1.80; 95% IC:1.15-2.82), lower monthly income (OR: 1.74; 95% IC:1.01-3.0) and EDS (OR: 1.63; 95% IC:1.05-2.53) were independently associated with medium/low adherence to the anti-hypertensive treatment. Interestingly, EDS mediated the abdominal obesity-adherence outcome. In conclusion, among sleep-related parameters, EDS, but not OSA, short SDUR or insomnia, were associated to impaired adherence to anti-hypertensive therapy.(c) 2023 Elsevier B.V. All rights reserved.
  • article 1 Citação(ões) na Scopus
    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.
  • article 1 Citação(ões) na Scopus
    The effect of continuous positive airway pressure on blood pressure in patients with obstructive sleep apnea and uncontrolled hypertension- Study design and challenges during the COVID-19 pandemic
    (2021) CRUZ, Fernanda C. S. G.; DRAGER, Luciano F.; QUEIROZ, Daniel B. C.; SOUZA, Gabriela A.; PEDROSA, Rodrigo P.; PATRIOTA, Tarcya L. G. Couto; DOREA, Egidio L.; VIEIRA, Marcelo Luiz C.; RIGHI, Camila G.; MARTINEZ, Denis; SILVA, Geruza A. da; V, Giovanio Silva; PIO-ABREU, Andrea; LOTUFO, Paulo A.; BENSEAOR, Isabela M.; BORTOLOTTO, Luiz A.; FUCHS, Flavio D.; LORENZI-FILHO, Geraldo
    OBJECTIVES: To describe the MORPHEOS (Morbidity in patients with uncontrolled HTN and OSA) trial, and describe the challenges imposed by the COVID-19 pandemic. METHODS: MORPHEOS is a multicenter (n=6) randomized controlled trial designed to evaluate the blood pressure (BP) lowering effects of treatment with continuous positive airway pressure (CPAP) or placebo (nasal strips) for 6 months in adult patients with uncontrolled hypertension (HTN) and moderate-to-severe obstructive sleep apnea (OSA). Patients using at least one antihypertensive medication were included. Uncontrolled HTN was confirmed by at least one abnormal parameter in the 24-hour ABPM and >= 80% medication adherence evaluated by pill counting after the run-in period. OSA was defined by an apnea-hypopnea index >= 15 events/ hours. The co-primary endpoints are brachial BP (office and ambulatory BP monitoring, ABPM) and central BP. Secondary outcomes include hypertension-mediated organ damage (HMOD) to heart, aorta, eye, and kidney. We pre-specified several sub-studies from this investigation. Visits occur once a week in the first month and once a month thereafter. The programmed sample size was 176 patients but the pandemic prevented this final target. A post-hoc power analysis will be calculated from the final sample. RESULTS: The first 100 patients are predominantly males (n=69), age: 52 +/- 10 years, body mass index: 32.7 +/- 3.9 kg/m(2) with frequent co-morbidities. CONCLUSIONS: The MORPHEOS trial has a unique study design inclu ding a run-in period; pill counting, and detailed analysis of hypertension-mediated organ damage in patients with uncontrolled HTN that will allow clarification of the impact of OSA treatment with CPAP.
  • article 4 Citação(ões) na Scopus
    Association between objective sleep measures and cognitive performance: a cross-sectional analysis in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) study
    (2023) SUEMOTO, Claudia K.; SANTOS, Ronaldo B.; GIATTI, Soraya; AIELO, Aline N.; SILVA, Wagner A.; PARISE, Barbara K.; CUNHA, Lorenna F.; SOUZA, Silvana P.; GRIEP, Rosane H.; BRUNONI, Andre R.; LOTUFO, Paulo A.; BENSENOR, Isabela M.; DRAGER, Luciano F.
    Sleep disturbances often co-exist, which challenges our understanding of their potential impact on cognition. We explored the cross-sectional associations of insomnia and objective measures of sleep with cognitive performance in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) study stratified by middle-aged and older adults. Participants aged >= 55 years underwent cognitive evaluations, polygraphy for 1 night, and actigraphy for 7 days. Insomnia was evaluated using the Clinical Interview Scheduled Revised. Obstructive sleep apnea (OSA) and short sleep duration (SSD) were defined by an apnea-hypopnea index (AHI) of >= 15 events/h and <6 h/ night, respectively. In 703 participants (mean [SD] age 62 [6] years, 44% men), cognition was evaluated using a 10-word list, verbal fluency, and trail-making tests. The frequencies of insomnia, SSD, and OSA were 11%, 24%, and 33%, respectively. In all, 4% had comorbid OSA and insomnia, and 11% had both OSA and SSD. Higher wake after sleep onset (beta = -0.004, 95% confidence interval [CI] -0.008, -0.001) and the number of awakenings (beta = -0.006, 95% CI -0.012, -0.001) were associated with worse verbal fluency performance. Compared to those without insomnia, older participants with insomnia had worse global performance (beta = -0.354, 95% CI -0.671, -0.038). Insomnia was an effect modifier in the associations between AHI and executive function performance (p for the interaction between insomnia and AHI = 0.004) and between oxygen saturation <90% and memory performance (p for the interaction between insomnia and oxygen saturation = 0.02). Although some associations between sleep measures and cognition were significant, they should be considered with caution due to the large sample size and multiple testing performed in this study.
  • conferenceObject
    Association of obstructive sleep apnoea and short sleep duration with hypertension: the Brazilian longitudinal study of adult health ((ELSA-Brasil)
    (2017) PARISE, B. K.; SANTOS, R. B.; SILVA, W. A.; PEREIRA-SOUZA, S.; AIELO, A. N.; TAMASHIRO, R. D. F.; BENSENOR, I. M.; LOTUFO, P. A.; DRAGER, L. F.