LUCIANO FERREIRA DRAGER
Projetos de Pesquisa
Unidades Organizacionais
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
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/63, Hospital das Clínicas, Faculdade de Medicina - Líder
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- Effects of continuous positive airway pressure on depression and anxiety symptoms in patients with obstructive sleep apnoea: results from the sleep apnoea cardiovascular Endpoint randomised trial and meta-analysis(2019) ZHENG, Danni; XU, Ying; YOU, Shoujiang; HACKETT, Maree L.; WOODMAN, Richard J.; LI, Qiang; WOODWARD, Mark; LOFFLER, Kelly A.; RODGERS, Anthony; DRAGER, Luciano F.; LORENZI-FILHO, Geraldo; WANG, Xia; QUAN, Wei Wei; TRIPATHI, Manjari; MEDIANO, Olga; OU, Qiong; CHEN, Rui; LIU, Zhihong; ZHANG, Xilong; LUO, Yuanming; MCARDLE, Nigel; MUKHERJEE, Sutapa; MCEVOY, R. Douglas; ANDERSON, Craig S.Background: Whether continuous positive airway pressure (CPAP) treatment can improve depression or anxiety symptoms in obstructive sleep apnoea (OSA) patients remains uncertain. Methods: Secondary analysis of the Sleep Apnea Cardiovascular Endpoints (SAVE) trial, combined with a systematic review of randomised evidence. The SAVE secondary analyses involved 2410 patients with co-existing moderate-severe OSA and established cardiovascular disease randomly allocated to CPAP treatment plus usual care or usual care alone and followed up for 3.7 (SD 1.6) years. We evaluated the effect of CPAP treatment on depression and anxiety caseness (scores >= 8 on the Hospital Anxiety and Depression Scale depression and anxiety subscales [HADS-D and HADS-A]) for OSA patients. Findings: CPAP treatment was associated with reduced odds of depression caseness (adjusted odds ratio [OR] 0.80, 95% confidence interval [CI] 0.65-0.98, P=0.031) compared to usual care in the SAVE trial and the treatment effect was greater in those with pre-existing depression symptoms. A systematic review of 20 randomised trials including 4255 participants confirmed a benefit of CPAP in reducing depression symptoms in OSA patients: the overall effect (standardised mean difference) was -0.18 (95% CI -0.24 to -0.12). No effect of CPAP treatment on anxiety caseness was found both in patients of the SAVE study (adjusted OR 0.98, 95% CI 0.78-1.24, P = 0.89) and the systematic review. Interpretation: CPAP reduces depression symptoms in patients with co-existing OSA and CVD independently of improvements in sleepiness. (C) 2019 Published by Elsevier Ltd.
- KCNJ5 Somatic Mutation Is a Predictor of Hypertension Remission After Adrenalectomy for Unilateral Primary Aldosteronism(2019) VILELA, Leticia A. P.; RASSI-CRUZ, Marcela; GUIMARAES, Augusto G.; MOISES, Caio C. S.; FREITAS, Thais C.; ALENCAR, Natalia P.; PETENUCI, Janaina; GOLDBAUM, Tatiana S.; MACIEL, Ana Alice W.; PEREIRA, Maria Adelaide A.; V, Giovanio Silva; PIO-ABREU, Andrea; ZERBINI, Maria Claudia N.; CAVALCANTE, Aline C. B. S.; CARNEVALE, Francisco C.; PILAN, Bruna; YAMAUCHI, Fernando; SROUGI, Vitor; TANNO, Fabio Y.; CHAMBO, Jose L.; LATRONICO, Ana Claudia; MENDONCA, Berenice B.; V, Maria Candida B. Fragoso; BORTOLOTTO, Luiz A.; DRAGER, Luciano F.; ALMEIDA, Madson Q.Context: Primary aldosteronism (PA) is the most common cause of endocrine hypertension (HT). HT remission (defined as blood pressure <140/90 mm Hg without antihypertensive drugs) has been reported in approximately 50% of patients with unilateral PA after adrenalectomy. HT duration and severity are predictors of blood pressure response, but the prognostic role of somatic KCNJ5 mutations is unclear. Objective: To determine clinical and molecular features associated with HT remission after adrenalectomy in patients with unilateral PA. Methods: We retrospectively evaluated 100 patients with PA (60 women; median age at diagnosis 48 years with a median follow-up of 26 months). Anatomopathological analysis revealed 90 aldosterone-producing adenomas, 1 carcinoma, and 9 unilateral adrenal hyperplasias. All patients had biochemical cure after unilateral adrenalectomy. KCNJ5 gene was sequenced in 76 cases. Results: KCNJ5 mutations were identified in 33 of 76 (43.4%) tumors: p.Gly151Arg (n = 17), p.Leu168Arg (n = 15), and p.GIu145GIn (n = 1). HT remission was reported in 37 of 100 (37%) patients. Among patients with HT remission, 73% were women (P = 0.04), 48.6% used more than three antihypertensive medications (P= 0.0001), and 64.9% had HT duration <10 years (P= 0.0015) compared with those without HT remission. Somatic KCNJ5 mutations were associated with female sex (P = 0.004), larger nodules (P = 0.001), and HT remission (P = 0.0001). In multivariate analysis, only a somatic KCNJ5 mutation was an independent predictor of HT remission after adrenalectomy (P = 0.004). Conclusion: The presence of a KCNJ5 somatic mutation is an independent predictor of HT remission after unilateral adrenalectomy in patients with unilateral PA.
conferenceObject AWARENESS FOR OSA DIAGNOSIS IN A TERTIARY CARDIOLOGY CENTER: A TEMPORAL SURVEY(2019) FURLAN, S. F.; COSTA, L. E.; SINKUNAS, V.; ALVES, R. S. C.; PINTAO, M. C. T.; CAMPOS, B. A.; LORENZI, G.; DRAGER, L. F.- 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.
conferenceObject TEMPORAL TRENDS IN POLYSOMNOGRAPHY REQUEST BY SPECIALTIES IN A LARGE PRIVATE SERVICE IN BRAZIL: THE IMPORTANCE OF CARDIOLOGY IN OSA DIAGNOSIS(2019) FURLAN, S.; CAMPOS, B. A.; PINTAO, M. C. T.; SMANIO, P. E. P.; DRAGER, L. F.; ALVES, R. S. C.bookPart Hipertensão Arterial Secundária(2019) DRAGER, Luciano FerreiraconferenceObject Adherence with PAP Therapy in Latin America: Results from a Big Data Analysis(2019) DRAGER, L. F.; PEPIN, J.; CISTULLI, P. A.; WOEHRLE, H.; MALHOTRA, A.; NUNEZ, C.; ARMITSTEAD, J. P.; BENJAFIELD, A.- 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.
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.conferenceObject Obstructive Sleep Apnea Patients Do Not Spontaneously Avoid Supine Sleep(2019) GENTA, P.; MELLO, A.; D'ANGELO, G. F.; GIATTI, S.; SANTOS, R.; LORENZI-FILHO, G.; LOTUFO, P.; DRAGER, L. F.