GERALDO LORENZI FILHO

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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 11 Citação(ões) na Scopus
    Evaluation of peripheral auditory pathways and brainstem in obstructive sleep apnea
    (2018) MATSUMURA, Erika; MATAS, Carla Gentile; MAGLIARO, Fernanda Cristina Leite; PEDRENO, Raquel Meirelles; LORENZI-FILHO, Geraldo; SANCHES, Seisse Gabriela Gandolfi; CARVALLO, Renata Mota Mamede
    Introduction: Obstructive sleep apnea causes changes in normal sleep architecture, fragmenting it chronically with intermittent hypoxia, leading to serious health consequences in the long term. It is believed that the occurrence of respiratory events during sleep, such as apnea and hypopnea, can impair the transmission of nerve impulses along the auditory pathway that are highly dependent on the supply of oxygen. However, this association is not well established in the literature. Objective: To compare the evaluation of peripheral auditory pathway and brainstem among individuals with and without obstructive sleep apnea. Methods: The sample consisted of 38 adult males, mean age of 35.8 (+/- 7.2), divided into four groups matched for age and Body Mass Index. The groups were classified based on polysomnography in: control (n = 10}. mild obstructive sleep apnea (n = 11) moderate obstructive sleep apnea (n=8) and severe obstructive sleep apnea (n = 9}. All study subjects denied a history of risk for hearing loss and underwent audiometry, tympanometry, acoustic reflex and Brainstem Auditory Evoked Response. Statistical analyses were performed using three-factor ANOVA, 2 factor ANOVA, chi-square test, and Fisher's exact test. The significance level for all tests was 5%. Results: There was no difference between the groups for hearing thresholds, tympanometry and evaluated Brainstem Auditory Evoked Response parameters. An association was observed between the presence of obstructive sleep apnea and changes in absolute latency of wave V (p = 0.03). There was an association between moderate obstructive sleep apnea and change of the latency of wave V (p = 0.01). Conclusion: The presence of obstructive sleep apnea is associated with changes in nerve conduction of acoustic stimuli in the auditory pathway in the brainstem. The increase in obstructive sleep apnea severity does not promote worsening of responses assessed by audiometry, tympanometry and Brainstem Auditory Evoked Response. (C) 2016 Associacao Brasileira de Otorrinolaringologia e Cirurgia Cervico-Facial.
  • 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.
  • article 42 Citação(ões) na Scopus
    Metabolomic and lipidomic profile in men with obstructive sleep apnoea: implications for diagnosis and biomarkers of cardiovascular risk
    (2018) LEBKUCHEN, Adriana; CARVALHO, Valdemir M.; VENTURINI, Gabriela; SALGUEIRO, Jessica S.; FREITAS, Lunara S.; DELLAVANCE, Alessandra; MARTINS, Franco C.; LORENZI-FILHO, Geraldo; CARDOZO, Karina H. M.; DRAGER, Luciano F.
    The use of metabolomic and lipidomic strategies for selecting potential biomarkers for obstructive sleep apnoea (OSA) has been little explored. We examined adult male patients with OSA (defined by an apnoea-hypopnoea index >= 15 events/hour), as well as age-, gender-, and fat-composition-matched volunteers without OSA. All subjects were subjected to clinical evaluation, sleep questionnaires for detecting the risk of OSA (Berlin and NoSAS score), metabolomic analysis by gas chromatography coupled to mass spectrometry and lipidomic analysis with liquid chromatography followed by detection by MALDI-MS. This study included 37 patients with OSA and 16 controls. From the 6 metabolites and 22 lipids initially selected, those with the best association with OSA were glutamic acid, deoxy sugar and arachidonic acid (metabolites), and glycerophosphoethanolamines, sphingomyelin and lysophosphocholines (lipids). For the questionnaires, the NoSAS score performed best with screening for OSA (area under the curve [AUC] = 0.724, p = 0.003). The combination of the NoSAS score with metabolites or lipids resulted in an AUC for detecting OSA of 0.911 and 0.951, respectively. In conclusion, metabolomic and lipidomic strategies suggested potential early biomarkers in OSA that could also be helpful in screening for this sleep disorder beyond traditional questionnaires.
  • 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 4 Citação(ões) na Scopus
    Predictors of Obstructive Sleep Apnea in Consecutive Patients with Metabolic Syndrome
    (2018) PEDROSA, Rodrigo P.; MAKI-NUNES, Cristiane; MIDLEJ-BRITO, Thiago; LOPES, Heno F.; FREITAS, Lunara S.; TROMBETTA, Ivani C.; TOSCHI-DIAS, Edgar; ALVES, Maria Janieire N. N.; FRAGA, Raffael F.; RONDON, Maria U.; NEGRAO, Carlos E.; BORTOLOTTO, Luiz A.; LORENZI-FILHO, Geraldo; DRAGER, Luciano F.
    Background: Recent evidence suggests that obstructive sleep apnea (OSA) is common in patients with metabolic syndrome (MetS) and may contribute to metabolic deregulation, inflammation, and atherosclerosis in these patients. In clinical practice, however, OSA is frequently underdiagnosed. We sought to investigate the clinical predictors of OSA in patients with MetS. Methods: We studied consecutive patients newly diagnosed with MetS (Adult Treatment Panel-III). All participants underwent clinical evaluation, standard polysomnography, and laboratory measurements. We performed a logistic regression model, including the following variables: gender, age >50 years, neck and waist circumferences, hypertension, diabetes, body mass index (BMI) >30kg/m(2), high risk for OSA by Berlin questionnaire, presence of excessive daytime somnolence (Epworth Sleepiness Scale), abnormal serum glucose, triglycerides, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol. Results: We studied 197 patients (60% men; age: 4910 years; BMI: 32.9 +/- 5.1kg/m(2)). OSA (defined by an apnea-hypopnea index 15 events per hour) was diagnosed in 117 patients [59%; 95% confidence interval (CI): 52-66]. In multivariate analysis, male gender [odds ratio (OR): 3.28; 95% CI: 1.68-6.41; P<0.01], abnormal glucose levels (OR: 3.01; 95% CI: 1.50-6.03; P<0.01), excessive daytime sleepiness (OR: 2.38; 95% CI: 1.13-5.04; P=0.02), and high risk for OSA by Berlin questionnaire (OR: 4.33; 95% CI: 2.06-9.11; P<0.001) were independently associated with OSA. Conclusions: Simple clinical and metabolic characteristics may help to improve the underdiagnosis of OSA in patients with MetS.
  • article 0 Citação(ões) na Scopus
    Sleep Disordered Breathing challenges: From diagnosis to treatment
    (2018) LORENZI FILHO, Geraldo; GENTA, Pedro Rodrigues
  • article 3 Citação(ões) na Scopus
    Obstructive Sleep Apnea is Common and Associated with Heart Remodeling in Patients with Chagas Disease
    (2018) MEDEIROS, Carolina de Araujo; SECUNDO, Isaac Vieira; SILVEIRA, Carlos Antonio da Mota; CASTILHO, Jose Maria del; ALBUQUERQUE, Afonso Tuiz Tavares de; MARTINS, Silvia Marinho; OLIVEIRA JUNIOR, Wilson de; LORENZI-FILHO, Geraldo; DRAGER, Luciano E.; PEDROSA, Rodrigo Pinto
    Background: Chagas Disease (CD) is an important cause of morbimortality due to heart failure and malignant arrhythmias worldwide, especially in Latin America. Objective: To investigate the association of obstructive sleep apnea (OSA) with heart remodeling and cardiac arrhythmias in patients CD. Methods: Consecutive patients with CD, aged between 30 to 65 years old were enrolled. Participants underwent clinical evaluation, sleep study, 24-hour Hotter monitoring, echocardiogram and ambulatory blood pressure monitoring. Results: We evaluated 135 patients [age: 56 (45-62) yeas; 30% men; BMI: 26 +/- 4 kg/m2, Chagas cardiomyopathy: 70%]. Moderate to severe OSA (apnea-hypopnea index, AHI, >= 15 events/h) was present in 21% of the patients. OSA was not associated with arrhythmias in this population. As compared to patients with mild or no OSA, patients with moderate to severe OSA had higher frequency of hypertension (79% vs. 72% vs. 44%, p < 0.01) higher nocturnal systolic blood pressure: 119 +/- 17 vs. 113 +/- 13 vs. 110 +/- 11 mmHg, p = 0.01; larger left atrial diameter (37 (33-42) vs. 35 (33-39) vs. 33 (30-36) mm, p < 0.01]; and a greater proportion of left ventricular dysfunction [LVEF < 50% (39% vs. 28% vs. 11%), p < 0.01], respectively. Predictor of left atrial dimension was Log(10) (AHI) (beta = 3.86, 95% CI: 1.91 to 5.81; p < 0.01). Predictors of ventricular dysfunction were AHI > 15 events/h (OR = 3.61, 95% CI: 1.31 - 9.98; p = 0.01), systolic blood pressure (OR = 1.06, 95% CI: 1.02 -1.10; p < 0.01) and male gender (OR = 3.24, 95% CI: 1.31 - 8.01; p = 0.01). Conclusions: OSA is independently associated with atrial and ventricular remodeling in patients with CD.
  • article 25 Citação(ões) na Scopus
    Obesity-Hypoventilation Syndrome: A Current Review
    (2018) ATHAYDE, Rodolfo Augusto Bacelar de; OLIVEIRA FILHO, Jose Ricardo Bandeira de; LORENZI FILHO, Geraldo; GENTA, Pedro Rodrigues
    A síndrome de obesidade-hipoventilação (SOH) é definida pela presença de obesidade (índice de massa corpórea ≥ 30 kg/m2) e hipercapnia arterial diurna (PaCO2 ≥ 45 mmHg), na ausência de outras causas. A SOH é frequentemente negligenciada e confundida com outras patologias associadas à hipoventilação, em particular à DPOC. A importância do reconhecimento da SOH se dá por sua elevada prevalência, assim como alta morbidade e mortalidade se não tratada. Na presente revisão, abordamos os recentes avanços na fisiopatologia e no manejo da SOH. Revisamos a utilidade da medição do bicarbonato venoso como rastreamento e os critérios diagnósticos que descartam a necessidade de polissonografia. Destacamos ainda os avanços no tratamento da SOH, incluindo medidas comportamentais, e estudos recentes que comparam a eficácia do uso de pressão positiva contínua nas vias aéreas e de ventilação não invasiva.
  • article 39 Citação(ões) na Scopus
    Nondipping Blood Pressure Patterns Predict Obstructive Sleep Apnea in Patients Undergoing Ambulatory Blood Pressure Monitoring
    (2018) GENTA-PEREIRA, Daniel Castanho; FURLAN, Sofia F.; OMOTE, Daniel Q.; GIORGI, Dante M. A.; BORTOLOTTO, Luiz A.; LORENZI-FILHO, Geraldo; DRAGER, Luciano F.
    A nondipping blood pressure (BP) pattern is common in patients with obstructive sleep apnea (OSA). However, it is unclear how useful a nondipping BP pattern is in screening for OSA. In this cross-sectional study, we recruited consecutive patients with clinical indications for performing ambulatory BP monitoring evaluating the following dipping patterns: (1) normal: 10% but <20%; (2) extreme: 20%; (3) reduced: 0% but <10%; and (4) reverse (riser): <0%. Sleep questionnaires and sleep studies were performed within 7 days after ambulatory BP monitoring. OSA was defined as an apnea-hypopnea index 15 events/h. We evaluated 153 patients (OSA frequency, 50.3%). Patients with OSA had higher BPs during sleep, were taking more antihypertensive drugs, and more frequently used hypertensive drugs during the night than patients without OSA. Considering systolic BP, the frequency of OSA in patients with reverse dippers (73.5%) was higher than normal (37.3%), extreme (46.2%), and reduced dippers (49.1%; P=0.012). For diastolic BP, OSA was more common in reduced (66.7%) and reverse dippers (69.6%) as compared to normal (41.4%) or extreme dippers (33.3%; P=0.007). In the regression analysis, reverse systolic dipper was independently associated with OSA (odds ratio, 3.92; 95% CI, 1.31-11.78). Both reduced and reverse diastolic dippers increased the likelihood of OSA for 2.7-fold and 3.5-fold, respectively. Snoring and positive sleep questionnaire findings were associated with a modest increase in the accuracy of reverse dipping pattern for predicting OSA. In conclusion, reverse systolic, as well as reduced and reverse diastolic dippers are independently associated with OSA.
  • article 15 Citação(ões) na Scopus
    Does Obstructive Sleep Apnea Influence Blood Pressure and Arterial Stiffness in Response to Antihypertensive Treatment?
    (2018) FATURETO-BORGES, Fernanda; JENNER, Raimundo; COSTA-HONG, Valeria; LOPES, Heno F.; TEIXEIRA, Sandra H.; MARUM, Elias; GIORGI, Dante A. M.; CONSOLIM-COLOMBO, Fernanda M.; BORTOLOTTO, Luiz A.; LORENZI-FILHO, Geraldo; KRIEGER, Eduardo M.; DRAGER, Luciano F.
    Untreated obstructive sleep apnea (OSA) is common in patients with hypertension and may impair blood pressure (BP) and target-organ damage responses to antihypertensive therapy. In this study, we recruited hypertensive patients who underwent treatment with a 30-day regimen of hydrochlorothiazide 25 mg plus enalapril (20 mg BID) or losartan (50 mg BID) and were assessed with a baseline clinical evaluation, polysomnography, 24-hour ambulatory BP monitoring, and carotid-femoral pulse wave velocity. All the examinations except for polysomnography were repeated at 6 and 18 months of follow-up. We studied 94 hypertensive patients (mean age, 55 +/- 9 years). The frequency of OSA was 55%. Compared with baseline, we did not observe significant differences between groups in 24-hour BP, daytime systolic and diastolic BPs, or night-time systolic BP at 6 and 18 months. The BP control rate at 24 hours (<130/80 mmHg) was similar between the groups (baseline, 42.3% versus 45.2%; 6 months, 46.9% versus 57.5%; 18 months, 66.7% versus 61.5%). However, patients with OSA had higher night-time diastolic BP decrease than did the non-OSA group (6 months, -4.9 +/- 11.8 versus -0.3 +/- 10.3 mmHg; 18 months, -6.7 +/- 11.1 versus -1.2 +/- 10.6 mmHg; P=0.027). There were no differences in the number and class of antihypertensive medications prescribed during follow-up. In terms of arterial stiffness, patients with OSA had higher pulse wave velocity than did patients without OSA at baseline (10.3 +/- 1.9 versus 9.2 +/- 1.7 m/s; P=0.024), but both groups had similar decreases in pulse wave velocity during follow-up. In conclusion, with combined antihypertensive treatment aimed at controlling BP, hypertensive patients with OSA had similar 24-hour BP and arterial stiffness to those without OSA.