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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  • conferenceObject
    GENDER-RELATED DIFFERENCES IN CORONARY ARTERY DISEASE IN PATIENTS WITH RESISTANT HYPERTENSION
    (2022) SOLIMENE, Maria Cecilia; DRAGER, Luciano; BORTOLOTTO, Luiz
  • conferenceObject
    ADHERENCE TO ANTIHYPERTENSIVE DRUG TREATMENT IN BRAZIL: SYSTEMATIC REVIEW AND META-ANALYSIS
    (2022) COELHO, Juliana; GUIMARAES, Mayra; SANTOS, Juliano Dos; VAZ, Ana; HIGA, Camila; ALVISI, Joyce; LEE, Renata; DRAGER, Luciano; PIERIN, Angela
  • conferenceObject
    GENDER-RELATED DIFFERENCES IN CORONARY ARTERY DISEASE IN PATIENTS WITH RESISTANT HYPERTENSION
    (2022) SOLIMENE, Maria Cecilia; DRAGER, Luciano; BORTOLOTTO, Luiz
  • 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
    Impact of Continuous Positive Airway Pressure on Postoperative Atrial Fibrillation in Patients with Obstructive Sleep Apnea Undergoing Coronary Artery Bypass Graft Surgery: An Exploratory Randomized Multicenter Study
    (2022) CHALEGRE, Sintya T.; BARROS, Martinha M.; SILVA, Bianca P. G.; FURLAN, Sofia F.; GIAMPA, Sara Q. C.; MARQUES, Jeozadak N.; ALBUQUERQUE, Afonso L. T.; MONTEIRO, Veronica S.; DRAGER, Luciano F.; PEDROSA, Rodrigo Pinto
  • conferenceObject
    Effect of CPAP therapy on blood pressure in patients with OSA: a worldwide individual patient data meta-analysis
    (2022) PENGO, M.; SCHWARZ, E. I.; BARBE, F.; DRAGER, L.; FAVA, C.; IP, M. S. M.; GARCIA, M. A. Martinez; MCEVOY, D.; PEKER, Y.; PHILLIPS, C. L.; SORANNA, D.; STEIER, J.; STRADLING, J.; ZAMBON, A.; PARATI, G.
  • article 6 Citação(ões) na Scopus
    Obstructive sleep apnea and its management in patients with atrial fibrillation: An International Collaboration of Sleep Apnea Cardiovascular Trialists (INCOSACT) global survey of practicing cardiologists
    (2022) FAULX, Michael D.; MEHRA, Reena; GEOVANINI, Glaucylara Reis; ANDO, Shin-ichi; ARZT, Michael; DRAGER, Luciano; FU, Michael; HOYOS, Camilla; HAI, Jo; HWANG, Juey-Jen; KARAOGUZ, Remzi; KIMOFF, John; LEE, Pei-Lin; MEDIANO, Olga; PATEL, Sanjay R.; PEKER, Yuksel; PEPIN, Jean Louis; SANCHEZ-DE-LA-TORRE, Manuel; SERIES, Frederic; STADLER, Stefan; STROLLO, Patrick; TAHRANI, A. A.; THUNSTROM, Erik; YAMAUCHI, Motoo; REDLINE, Susan; PHILLIPS, Craig L.
    Background: Among international cardiologists it is unclear whether equipoise exists regarding the benefit of diagnosing and managing obstructive sleep apnea (OSA) to improve atrial fibrillation (AF) outcomes and whether clinical practice and equipoise are linked. Methods: Between January 2019 and June 2020 we distributed a web-based 12-question survey regarding OSA and AF management to practicing cardiologists in 16 countries. Results: The United States, Japan, Sweden, and Turkey accounted for two-thirds of responses. 863 cardiologists responded; half were general cardiologists, a quarter electrophysiologists. Responses regarding treating OSA with CPAP to improve AF endpoints were mixed. 33% of respondents referred AF patients for OSA screening. OSA was diagnosed in 48% of referred patients and continuous positive airway pressure (CPAP) was prescribed for 59% of them. Nearly 70% of respondents believed randomized controlled trials (RCTs) of OSA treatment in AF patients were necessary and indicated willingness to contribute to such trials. Conclusions: There was no clinical equipoise among surveyed cardiologists; a majority expressed certainty that combined OSA and AF treatment is superior to AF treatment alone for improving AF outcomes. However, a minority of surveyed cardiologists referred AF patients for OSA testing, and while half of screened AF patients had OSA, CPAP was prescribed in little more than half of them, reflecting the view that better clinical trial evidence is needed to support this practice. Our results underscore the need for larger, multi-national prospective studies of OSA treatment and AF outcomes to inform more uniform society guideline recommendations.
  • article 6 Citação(ões) na Scopus
    Effect of CPAP treatment on BP in resistant hypertensive patients according to the BP dipping pattern and the presence of nocturnal hypertension
    (2022) SAPINA-BELTRAN, Esther; BENITEZ, Ivan D.; TORRES, Gerard; FORTUNA-GUTIERREZ, Ana M.; MARQUEZ, Paola Ponte; MASA, Juan F.; DRAGER, Luciano F.; CABRINI, Mayara; FELEZ, Miquel; VAZQUEZ, Susana; ABAD, Jorge; LEE, Ch; GARCIA-RIO, Francisco; CASITAS, Raquel; MEDIANO, Olga; PERALTA, Sofia Romero; MARTINEZ, Dolores; SANCHEZ-DE-LA-TORRE, Manuel; BARBE, Ferran; DALMASES, Mireia
    High heterogeneity in the blood pressure (BP) response to continuous positive airway pressure (CPAP) exists in patients with resistant hypertension (RH). Only nondipper normotensive and hypertensive patients exhibited BP reductions when treated with CPAP; the baseline BP dipping pattern has been proposed as a predictor of BP response to CPAP but has never been explored in patients with RH. This study aimed to assess the effect of CPAP on BP in subjects with RH with respect to BP dipping pattern or nocturnal hypertension. This is an ancillary study of the SARAH study. RH subjects with an apnea/hypopnea index (AHI) >= 15/h and who received CPAP treatment for 1 year were included. Subjects underwent a sleep study and ambulatory BP monitoring (ABPM) at baseline and at the 1-year follow-up. Eighty-nine RH subjects were included. The subjects were mainly male (77.5%) and obese, with a mean age of 66 years (25th-75th percentile; 59.0; 70.0) and an AHI of 32.7/h (25th-75th percentile; 25.0; 54.7). A total of 68.5% of participants were nondippers, and 71.9% had nocturnal hypertension. After 1 year of CPAP, no significant differences in ABPM parameters were observed between dippers and nondippers. According to nighttime BP, subjects with nocturnal normotension did not show significant changes in ABPM parameters, while nocturnal hypertensive subjects achieved a significant reduction in mean nighttime BP of -4.38 mmHg (-7.10 to -1.66). The adjusted difference between groups was 3.04 (-2.25 to 8.34), which was not significant. This study shows that the BP response to CPAP in patients with RH does not differ according to the BP dipping pattern (dipper and nondipper) and suggests a differential response according to the presence of nocturnal hypertension.
  • article 9 Citação(ões) na Scopus
    Economic evaluation of CPAP therapy for obstructive sleep apnea: a scoping review and evidence map
    (2022) PACHITO, Daniela V.; BAGATTINI, Angela M.; DRAGER, Luciano F.; ECKELI, Alan L.; ROCHA, Aline
    Purpose To synthesize findings of economic evaluations investigating cost-effectiveness of continuous positive airway pressure (CPAP) for obstructive sleep apnea (OSA) and of strategies of organization of care related to CPAP therapy. Methods Scoping review with searches conducted in MEDLINE, CRD, LILACS, and Embase in August 2020. Eligible studies were economic evaluations comparing CPAP to other alternative or assessing strategies of care for CPAP therapy. Results were presented narratively, and incremental cost-effectiveness ratios (ICER) were presented in evidence maps. Results Of 34 studies, 3 concluded that CPAP is less costly and more effective when compared to usual care. Most studies indicated that CPAP is associated with better health outcomes, but at higher prices. ICER ranged from USD 316 to 98,793 per quality-adjusted life years (QALY) gained (median 16,499; IQR 8267 to 33,119). One study concluded that CPAP is more costly and less effective, when treatment is applied to all patients, regardless of disease severity. Variability of ICER was mainly due to definition of population and applied time horizons. When CPAP was compared to mandibular advancement device, ICER ranged from USD 21,153 to 361,028 (median 89,671; IQR 26,829 to 295,983), which represents the investment in CPAP therapy required to obtain one extra QALY. Three studies assessed the effects of organizing CPAP therapy in primary care, which was cost-effective or cost-saving. Conclusions Compared to usual care, CPAP is cost-effective after the second year of treatment, when indicated for moderate-to-severe OSA. CPAP therapy may be even more cost-effective by using different strategies of organization of care. These findings may inform decision making related to CPAP reimbursement in health systems.
  • article 20 Citação(ões) na Scopus
    Effects of CPAP on Metabolic Syndrome in Patients With OSA A Randomized Trial
    (2022) GIAMPA, Sara Q. C.; FURLAN, Sofia F.; FREITAS, Lunara S.; MACEDO, Thiago A.; LEBKUCHEN, Adriana; CARDOZO, Karina H. M.; CARVALHO, Valdemir M.; MARTINS, Franco C.; AZAM, Indira F. B.; COSTA-HONG, Valeria; LOPES, Heno F.; BAPTISTA, Mariana L.; ROCHITTE, Carlos E.; BORTOLOTTO, Luiz A.; LORENZI-FILHO, Geraldo; DRAGER, Luciano F.
    BACKGROUND: OSA is associated with metabolic syndrome (MS), but it is unclear whether OSA treatment with CPAP can revert MS. RESEARCH QUESTION: Does OSA treatment with CPAP per se have effects on the MS reversibility and the associated metabolic, adiposity and vascular parameters? STUDY DESIGN AND METHODS: The TREATOSA-MS trial is a randomized placebo-controlled trial that enrolled adult patients with a recent diagnosis of MS and moderate or severe OSA (apnea-hypopnea index [AHI], >= 15 events/h) to undergo therapeutic CPAP or nasal dilator strips (placebo group) for 6 months. Before and after each intervention, we measured anthropometric variables, BP, glucose, and lipid profile. To control potential-related mechanisms and consequences, we also measured adiposity biomarkers (leptin and adiponectin), body composition, food intake, physical activity, subcutaneous and abdominal fat (visceral and hepatic fat), and endothelial function. RESULTS: One hundred patients (79% men; mean age, 48 +/- 9 years; BMI, 33 +/- 4 kg/m(2); AHI, 58 +/- 29 events/h) completed the study (n = 50 per group). The mean CPAP adherence was 5.5 +/- 1.5 h/night. After 6 months, most patients with OSA randomized to CPAP retained the MS diagnosis, but the rate of MS reversibility was higher than observed in the placebo group (18% vs 4%; OR, 5.27; 95% CI, 1.27-35.86; P = .04). In the secondary analysis, CPAP did not promote significant reductions in the individual components of MS, weight, hepatic steatosis, lipid profile, adiponectin, and leptin, but did promote a very modest reduction in visceral fat and improved endothelial function (all analyses were adjusted for baseline values). INTERPRETATION: Despite the higher rate of MS reversibility after CPAP therapy as compared with placebo, most patients retained this diagnosis. The lack of significant or relevant effects on adiposity biomarkers and depots supports the modest role of OSA in modulating MS.