GERALDO LORENZI FILHO

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Lattes
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Departamento de Cardio-Pneumologia, Faculdade de Medicina - Docente
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
LIM/63, Hospital das Clínicas, Faculdade de Medicina - Líder

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  • article 62 Citação(ões) na Scopus
    Predictors of long-term adherence to continuous positive airway pressure in patients with obstructive sleep apnea and cardiovascular disease
    (2019) RYSWYK, Emer Van; ANDERSON, Craig S.; ANTIC, Nicholas A.; BARBE, Ferran; BITTENCOURT, Lia; FREED, Ruth; HEELEY, Emma; LIU, Zhihong; LOFFLER, Kelly A.; LORENZI-FILHO, Geraldo; LUO, Yuanming; MARGALEF, Maria J. Masdeu; MCEVOY, R. Doug; MEDIANO, Olga; MUKHERJEE, Sutapa; OU, Qiong; WOODMAN, Richard; ZHANG, Xilong; CHAI-COETZER, Ching Li
    Study Objectives: Poor adherence to continuous positive airway pressure (CPAP) commonly affects therapeutic response in obstructive sleep apnea (OSA). We aimed to determine predictors of adherence to CPAP among participants of the Sleep Apnea and cardioVascular Endpoints (SAVE) trial. Methods: SAVE was an international, randomized, open trial of CPAP plus usual care versus usual care (UC) alone in participants (45-75 years) with co-occurring moderate-to-severe OSA (>= 12 episodes/h of >= 4% oxygen desaturation) and established cardiovascular (CV) disease. Baseline sociodemographic, health and lifestyle factors, OSA symptoms, and 1-month change in daytime sleepiness, as well as CPAP side effects and adherence (during sham screening, titration week, and in the first month), were entered in univariate linear regression analyses to identify predictors of CPAP adherence at 24 months. Variables with p < 0.2 were assessed for inclusion in a multivariate linear mixed model with country, age, and sex included a priori and site as a random effect. Results: Significant univariate predictors of adherence at 24 months in 1,121 participants included: early adherence measures, improvement in daytime sleepiness at 1 month, fixed CPAP pressure, some measures of OSA severity, cardiovascular disease history, breathing pauses, and very loud snoring. While observed adherence varied between countries, adherence during sham screening, initial titration, and the first month of treatment retained independent predictive value in the multivariate model along with fixed CPAP pressure and very loud snoring. Conclusions: Early CPAP adherence had the greatest predictive value for identifying those at highest risk of non-adherence to long-term CPAP therapy.
  • article 38 Citação(ões) na Scopus
    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.
  • conferenceObject
    Predictors of adherence to continuous positive airway pressure in obstructive sleep apnea and cardiovascular disease
    (2018) RYSWYK, E. V.; ANDERSON, C.; BARBE, F.; LORENZI-FILHO, G.; LOFFLER, K.; LUO, Y. -M.; MCEVOY, D.; CHAI-COETZER, C. L.
  • conferenceObject
    Effect of CPAP on blood pressure variability in obstructive sleep apnea and cardiovascular disease
    (2018) RYSWYK, E. V.; ANDERSON, C.; ARIMA, H.; BARBE, F.; CHEN, R.; HEELEY, E.; LIU, Z.; LOFFLER, K.; LORENZI-FILHO, G.; LUO, Y.; MENG, R.; MUKHERJEE, S.; REDLINE, S.; TRIPATHI, M.; QUAN, W.; WOODMAN, R. J.; XIAO, Y.; XILONG, Z.; ZHENG, D.; MCEVOY, D.
  • article 35 Citação(ões) na Scopus
    The Sleep Apnea cardioVascular Endpoints (SAVE) Trial: Rationale, Ethics, Design, and Progress
    (2015) ANTIC, Nick A.; HEELEY, Emma; ANDERSON, Craig S.; LUO, Yuanming; WANG, Jiguang; NEAL, Bruce; GRUNSTEIN, Ron; BARBE, Ferran; LORENZI-FILHO, Geraldo; HUANG, Shaoguang; REDLINE, Susan; ZHONG, Nanshan; MCEVOY, R. Doug
    The Sleep Apnea cardioVascular Endpoints (SAVE) study is an ongoing investigator-initiated and conducted, international, multicenter, open, blinded endpoint, randomized controlled trial that was designed to determine whether treatment of obstructive sleep apnea (OSA) with continuous positive airways pressure (CPAP) can reduce the risk of serious cardiovascular (CV) events in patients with established CV disease (clinical trial registration NCT00738179). The results of this study will have important implications for the provision of health care to patients with sleep apnea around the world. The SAVE study has brought together respiratory, sleep, CV and stroke clinicians-scientists in an interdisciplinary collaboration with industry and government sponsorship to conduct an ambitious clinical trial. Following its launch in Australia and China in late 2008, the recruitment network expanded across 89 sites that included New Zealand, India, Spain, USA, and Brazil for a total of 2,717 patients randomized by December 2013. These patients are being followed until December 2015 so that the average length of follow-up of the cohort will be over 4 y. This article describes the rationale for the SAVE study, considerations given to the design including how various cultural and ethical challenges were addressed, and progress in establishing and maintaining the recruitment network, patient follow-up, and adherence to CPAP and procedures. The assumptions underlying the original trial sample size calculation and why this was revised downward in 2012 are also discussed.
  • conferenceObject
    Predictors Of Obstructive Sleep Apnoea Severity In Patients Enrolled In The Sleep Apnoea Cardiovascular Endpoint ""save"" Trial
    (2015) HNIN, K.; ANTIC, N. A.; ANDERSON, C.; HEELEY, E.; ZHONG, N.; BARBE, F.; CHAI-COETZER, C.; LORENZI-FILHO, G.; ZHANG, X.; LUO, Y. -M.; OU, Q.; CHEN, R.; LIU, Z. -H.; DU, B. -L.; MEDIANO, O.; MCARDLE, N.; TRIPATHI, M.; WOODMAN, R.; MCEVOY, R. D.
  • article 10 Citação(ões) na Scopus
    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, Geraldo
    Study 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.
  • article 4 Citação(ões) na Scopus
    Effect of Continuous Positive Airway Pressure on Blood Pressure in Obstructive Sleep Apnea with Cardiovascular Disease
    (2019) RYSWYK, Emer Van; ANDERSON, Craig S.; BARBE, Ferran; LOFFLER, Kelly A.; LORENZI-FILHO, Geraldo; LUO, Yuanming; QUAN, Weiwei; WANG, Jiguang; ZHENG, Danni; MCEVOY, R. Doug
  • article 5 Citação(ões) na Scopus
    CPAP increases physical activity in obstructive sleep apnea with cardiovascular disease
    (2021) STEVENS, David; LOFFLER, Kelly A.; BUMAN, Matthew P.; DUNSTAN, David W.; LUO, Yuanming; LORENZI-FILHO, Geraldo; BARBE, Ferran E.; ANDERSON, Craig S.; MCEVOY, R. Doug
    Study Objectives: Uncertainty exists over whether continuous positive airway pressure (CPAP) treatment improves moderate to vigorous physical activity levels in those with obstructive sleep apnea. We aimed to determine effects of CPAP on moderate to vigorous physical activity among participants with co-occurring cardiovascular disease and obstructive sleep apnea. Methods: The Sleep Apnea cardioVascular Endpoints (SAVE) trial recruited participants with confirmed cardiovascular disease history and obstructive sleep apnea, 45-75 years old. The 2,687 participants (1,346 randomized to CPAP plus usual care and 1,341 to usual care alone) were followed up for a mean of 3.7 years. Self-reported physical activity was recorded at baseline, 6, 24, and 48 months using the Godin-Shepard Leisure Time Exercise Questionnaire (LTEQ). We also determined effects on any limitation of physical activity reported on the physical functioning subscale of the 36-item short form questionnaire (SF-36) and proportions of participants reaching guideline recommended physical activity levels. Results: Among 2,601 participants with available data, those in the CPAP group reported significantly more physical activity compared to the usual care group, with approximately 20% higher reported moderate activities on the LTEQ during follow-up (adjusted mean 95% confidence interval) scores: 8.7, 7.5-9.9 vs 7.3, 6.1-8.5; P = .003). Those in the CPAP group also reported less limitation in physical activity (adjusted between-group difference in SF-36 physical functioning subscale score 1.66, 95% confidence interval 0.87-2.45; P< 0.001), and more reported sufficient levels of physical activity to meet recommendations. Conclusions: CPAP has positive effects on improving physical activity levels, consistent with long-term health benefits.
  • article 151 Citação(ões) na Scopus
    Evaluation and Management of Obesity Hypoventilation Syndrome An Official American Thoracic Society Clinical Practice Guideline
    (2019) MOKHLESI, Babak; MASA, Juan Fernando; BROZEK, Jan L.; GURUBHAGAVATULA, Indira; MURPHY, Patrick B.; PIPER, Amanda J.; TULAIMAT, Aiman; AFSHAR, Majid; BALACHANDRAN, Jay S.; DWEIK, Raed A.; GRUNSTEIN, Ronald R.; HART, Nicholas; KAW, Roop; LORENZI-FILHO, Geraldo; PAMIDI, Sushmita; PATEL, Bhakti K.; PATIL, Susheel P.; PEPIN, Jean Louis; SOGHIER, Israa; KAKAZU, Maximiliano Tamae; TEODORESCU, Mihaela
    Background: The purpose of this guideline is to optimize evaluation and management of patients with obesity hypoventilation syndrome (OHS). Methods: A multidisciplinary panel identified and prioritized five clinical questions. The panel performed systematic reviews of available studies (up to July 2018) and followed the Grading of Recommendations, Assessment, Development, and Evaluation evidence-to-decision framework to develop recommendations. All panel members discussed and approved the recommendations. Recommendations: After considering the overall very low quality of the evidence, the panel made five conditional recommendations. We suggest that: 1) clinicians use a serum bicarbonate level <27 mmol/L to exclude the diagnosis of OHS in obese patients with sleep-disordered breathingwhen suspicion for OHS is not very high (<20%) but to measure arterial blood gases in patients strongly suspected of having OHS, 2) stable ambulatory patients with OHS receive positive airway pressure (PAP), 3) continuous positive airway pressure (CPAP) rather than noninvasive ventilation be offered as the first-line treatment to stable ambulatory patients with OHS and coexistent severe obstructive sleep apnea, 4) patients hospitalized with respiratory failure and suspected of having OHS be discharged with noninvasive ventilation until they undergo outpatient diagnostic procedures and PAP titration in the sleep laboratory (ideally within 2-3 mo), and 5) patients with OHS use weight-loss interventions that produce sustained weight loss of 25% to 30% of body weight to achieve resolution of OHS (which is more likely to be obtained with bariatric surgery). Conclusions: Clinicians may use these recommendations, on the basis of the best available evidence, to guide management and improve outcomes among patients with OHS.