GERALDO LORENZI FILHO
Projetos de Pesquisa
Unidades Organizacionais
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
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
LIM/63, Hospital das Clínicas, Faculdade de Medicina - Líder
11 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 11
- Distinct Patterns of Hyperpnea During Cheyne-Stokes Respiration: Implication for Cardiac Function in Patients With Heart Failure(2017) PERGER, Elisa; INAMI, Toru; LYONS, Owen D.; ALSHAER, Hisham; SMITH, Stephanie; FLORAS, John S.; LOGAN, Alexander G.; ARZT, Michael; CANTOLLA, Joaquin Duran; DELGADO, Diego; FITZPATRICK, Michael; FLEETHAM, John; KASAI, Takatoshi; KIMOFF, R. John; LEUNG, Richard S. T.; LORENZI FILHO, Geraldo; MAYER, Pierre; MIELNICZUK, Lisa; MORRISON, Debra L.; PARATI, Gianfranco; PARTHASARATHY, Sairam; REDOLFI, Stefania; RYAN, Clodagh M.; SERIES, Frederic; TOMLINSON, George A.; WOO, Anna; BRADLEY, T. DouglasStudy Objectives: In heart failure (HF), we observed two patterns of hyperpnea during Cheyne-Stokes respiration with central sleep apnea (CSR-CSA): a positive pattern where end-expiratory lung volume remains at or above functional residual capacity, and a negative pattern where it falls below functional residual capacity. We hypothesized the negative pattern is associated with worse HF. Methods: Patients with HF underwent polysomnography. During CSR-CSA, hyperpnea, apnea-hyperpnea cycle, and lung to finger circulation times (LFCT) were measured. Plasma N-terminal prohormone of brain natriuretic peptide (NT-proBNP) concentration and left ventricular ejection fraction (LVEF) were assessed. Results: Of 33 patients with CSR-CSA (31 men, mean age 68 years), 9 had a negative hyperpnea pattern. There was no difference in age, body mass index, and apnea-hypopnea index between groups. Patients with a negative pattern had longer hyperpnea time (39.5 +/- 6.4 versus 25.8 +/- 5.9 seconds, P <.01), longer cycle time (67.8 +/- 15.9 versus 51.7 +/- 9.9 seconds, P <.01), higher NT-proBNP concentrations (2740 [6769] versus 570 [864] pg/ml, P =.01), and worse New York Heart Association class (P =.02) than those with a positive pattern. LFCT and LVEF did not differ between groups. Conclusions: Patients with HF and a negative CSR-CSA pattern have evidence of worse cardiac function than those with a positive pattern. Greater positive expiratory pressure during hyperpnea is likely generated during the negative pattern and might support stroke volume in patients with worse cardiac function. Commentary: A commentary on this article appears in this issue on page 1227.
- 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, GeraldoStudy 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.
- 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. DougStudy 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.
- COVID-19 pandemic impact on sleep habits, chronotype, and health-related quality of life among high school students: a longitudinal study(2021) GENTA, Felipe Dias; RODRIGUES NETO, Guilherme Brito; SUNFELD, Joao Pedro Velletri; PORTO, Joao Fabio; XAVIER, Andressa Dallago; MORENO, Claudia R. C.; LORENZI-FILHO, Geraldo; GENTA, Pedro RodriguesStudy Objectives: The COVID-19 pandemic has challenged the population of affected areas in multiple dimensions. Adolescents have been especially affected with school closure and home confinement. The impact of the pandemic on sleep habits and quality of sleep and quality of life among adolescents has not been adequately characterized. We hypothesized that the COVID-19 pandemic has induced an evening shift of the daily rhythm among adolescents and adversely affected sleep quality and quality of life of high school students. Methods: Students were questioned about their usual bed and wake-up times and answered the Pittsburgh Sleep Quality Index Questionnaire, the Epworth Sleepiness Scale, the Horne-Osteberg Morningness-Eveningness Questionnaire, and the World Health Organization Quality of Life Questionnaire-abbreviated version before and during the pandemic. Results: Ninety-four students (64% females, aged 15 +/- 1 years) participated in both phases of the study. Students delayed bed and wake-up times by 1.5 (0.5-2.0) and 2.0 (1.5-2.5) hours, respectively. Chronotype (per the Morningness-Eveningness Questionnaire) shifted toward eveningness during the pandemic. Sleep duration increased and quality of sleep (per the Pittsburgh Sleep Quality Index) improved only among those students with shorter sleep duration before the pandemic. During the pandemic, the physical and psychological domains of the World Health Organization Quality of Life Questionnaire worsened but the environmental domain improved as compared with the study before the pandemic. Conclusions: High school students have delayed bed and wake-up times and shifted chronotype toward eveningness during the COVID-19 pandemic. The worsening of the physical and psychological World Health Organization Quality of Life Questionnaire domains and improvement in the environmental domain highlight the conflicting experiences that high school students are facing during the COVID-19 pandemic.
- Sleep apnea and atrial fibrillation: the spell of Groundhog Day(2022) LORENZI-FILHO, Geraldo; GENTA, Pedro R.
- Vascular Response During Mental Stress in Sedentary and Physically Active Patients With Obstructive Sleep Apnea(2018) FERREIRA-SILVA, Rosyvaldo; GOYA, Thiago T.; BARBOSA, Eline R. F.; DURANTE, Bruno G.; ARAUJO, Carlos E. L.; LORENZI-FILHO, Geraldo; UENO-PARDI, Linda M.Study Objectives: To compare vascular function of sedentary (SED) versus physically active (ACTIVE) patients with obstructive sleep apnea (OSA) during rest and mental stress. Methods: Patients with untreated OSA without other comorbidities were classified into SED and ACTIVE groups according to the International Physical Activity Questionnaire. Blood pressure (BP), heart rate (HR), forearm blood flow (FBF) (plethysmography), and forearm vascular conductance (FVC = FBF /mean BP x 100) were continuously measured at rest (4 minutes) followed by 3 minutes of mental stress (Stroop Color Word Test). Results: We studied 40 patients with OSA (men = 24, age = 50 +/- 1 years, body mass index = 29.3 +/- 0.5 kg/m(2), apnea-hypopnea index = 39.3 +/- 4 events/h). Leisure time physical activity domain in SED (n = 19) and ACTIVE (n = 21) was 20 +/- 8 and 239 +/- 32 min/wk, (P < .05). Baseline profile and perception of stress were similar in both groups. Baseline FBF (3.5 +/- 0.2 mL/min/100 mL versus 2.4 +/- 0.14 mL/min/100 mL) and FVC (3.5 +/- 0.2 U versus 2.3 +/- 0.1 U) were significantly lower in the SED group than in the ACTIVE group, respectively (P < .05). HR and BP increased similarly during mental stress test in both groups. Changes during mental stress in FBF (0.65 +/- 0.12 versus 1.04 +/- 0.12) and FVC (0.58 +/- 0.11 versus 0.99 +/- 0.11) were significantly lower in the SED group than in the ACTIVE group, respectively (P < .05). There was a significant correlation between leisure time physical activity and FBF (r = .57, P < .05) and FVC (r = .48, P < .05) during mental stress. Conclusions: The vascular response among patients with OSA is influenced by the level of physical activity. A high level of physical activity may partially protect against the cardiovascular dysfunction associated with OSA.
- Comparison of upper airway obstruction during zolpidem-induced sleep and propofol-induced sleep in patients with obstructive sleep apnea: a pilot study(2020) ORDONES, Alexandre Beraldo; GRAD, Gustavo Freitas; CAHALI, Michel Burihan; LORENZI-FILHO, Geraldo; SENNES, Luiz Ubirajara; GENTA, Pedro RodriguesStudy Objectives: Drug-induced sleep endoscopy (DISE) using propofol is commonly used to identify the pharyngeal structure involved in collapse among patients with obstructive sleep apnea. DISE has never been compared with zolpidem-induced sleep endoscopy. We hypothesized that propofol at recommended sedation levels does not influence upper airway collapsibility nor the frequency of multilevel pharyngeal collapse as compared with zolpidem-induced sleep. Methods: Twenty-one patients with obstructive sleep apnea underwent polysomnography and sleep endoscopy during zolpidem-induced sleep and during DISE with propofol. A propofol target-controlled infusion was titrated to achieve a bispectral index between 50 and 70. Airway collapsibility was estimated and compared in both conditions by peak inspiratory flow and the magnitude of negative effort dependence. Respiratory drive was estimated by the difference between end-expiratory and peak-negative inspiratory pharyngeal pressure (driving pressure). Site and configuration of pharyngeal collapse during zolpidem-induced sleep and DISE with propofol were compared. Results: The frequency of multilevel collapse during zolpidem-induced sleep was similar to that observed during DISE with propofol (72% vs 86%, respectively; difference: 14%; 95% confidence interval: -12% to 40%; P = .453). The endoscopic classification of pharyngeal collapse during both conditions were similar. Peak inspiratory flow, respiratory drive (effect size: 0.05 and 0.03, respectively), and negative effort dependence (difference: -6%; 95% confidence interval: -16% to 4%) were also similar in both procedures. Conclusions: In this pilot study, recommended propofol doses did not significantly increase multilevel pharyngeal collapse or affect upper airway collapsibility and respiratory drive as compared with zolpidem-induced sleep.
- Nasal Dilator Strip is an Effective Placebo Intervention for Severe Obstructive Sleep Apnea(2017) YAGIHARA, Fabiana; LORENZI-FILHO, Geraldo; SANTOS-SILVA, RogerioStudy Objectives: The aim of this study was to evaluate the effects of nasal dilator strip (NDS) as a placebo intervention compared with continuous positive airway pressure (CPAP) treatment in patients with severe obstructive sleep apnea (OSA). Methods: Patients were treated with both NDS and nasal CPAP. The sequence was randomized and interposed by 15 days of washout. Polysomnography was performed at baseline and on the first night of intervention with NDS and CPAP (titration). The Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire (FOSQ), and Beck Depression Inventory (BDI) were completed at baseline and at the end of both interventions. A questionnaire on the comfort and satisfaction (0 = no to 10 = total) was completed at the end of each intervention. Results: Twenty-six patients with OSA were evaluated (19 male; age 46.3 +/- 9.3 y; body mass index 33.2 +/- 5.1 kg/m(2); ESS 15.8 +/- 4.1; apnea-hypopnea index 60.7 +/- 25.2). Adherence was high in both NDS (98%) and CPAP interventions (94%; 5.8 +/- 1.7 h/night). In contrast to the baseline values, NDS intervention had no significant effect on all polysomnographic parameters, but NDS improved somnolence (ESS 13.0 +/- 5.4, p = 0.001) and depressive symptoms (BDI 7.7 +/- 6.9, p = 0.005). Reported satisfaction was significantly higher for CPAP than for NDS (sleep quality 9.2 +/- 0.8 vs. 6.1 +/- 2.1; wake up at morning: 8.6 +/- 1.2 vs. 6.0 +/- 2.2; daily activities: 8.9 +/- 1.4 vs. 5.8 +/- 1.5; quality of life: 8.3 +/- 2.1 vs. 3.8 +/- 3.5, p < 0.001), but similar low levels of difficulty for both interventions were observed (1.3 +/- 2.2 vs. 0.3 +/- 1.3, p = 0.098). Conclusions: Our data indicate that NDS is an attractive placebo intervention for randomized controlled trials evaluating the effects of CPAP in sleepy patients with OSA.
- Body Position May Influence Oronasal CPAP Effectiveness to Treat OSA(2016) NASCIMENTO, Juliana Araujo; CARVALHO, Tomas de Santana; MORIYA, Henrique Takachi; FERNANDES, Henrique Sousa; ANDRADE, Rafaela Garcia Santos de; GENTA, Pedro Rodrigues; LORENZI-FILHO, Geraldo; NAKAGAWA, Naomi KondoCPAP applied by a nasal mask is the gold standard treatment of obstructive sleep apnea. Oronasal masks are an alternative interface that can be used, especially in subjects with predominant oral breathing. However, oronasal masks have higher costs, are associated with larger leaks and higher residual apnea-hypopnea index, and in some cases may be ineffective.
- Upper Airway Collapsibility Assessed by Negative Expiratory Pressure while Awake is Associated with Upper Airway Anatomy(2016) HIRATA, Raquel P.; SCHORR, Fabiola; KAYAMORI, Fabiane; MORIYA, Henrique Takachi; ROMANO, Salvatore; INSALACO, Giuseppe; GEBRIM, Eloisa M.; OLIVEIRA, Luis Vicente Franco de; GENTA, Pedro R.; LORENZI-FILHO, GeraldoStudy Objectives: There is a growing interest to develop a simple method to characterize the mechanisms leading to upper airway collapse in order to guide treatment options in patients with obstructive sleep apnea (OSA). Critical closing pressure (Pcrit) during sleep is able to predict the anatomical component of OSA. However, Pcrit is a laborious method that is only used for research purposes. The application of negative expiratory pressure (NEP) is a simple method to assess upper airway collapsibility that can be easily performed during wakefulness. We hypothesized that NEP will be, similarly to Pcrit, associated with upper airway anatomy assessed by computed tomography (CT) scan. Methods: Patients under investigation for OSA underwent polysomnography, CT of the upper airway, NEP while awake, and Pcrit during sleep. NEP was performed with -5 cm H2O in supine position using a nasal mask. Pcrit was measured during sleep induced by low doses of midazolam. Results: Twenty-eight male subjects were studied (age 45 +/- 13 y, body mass index 29.4 +/- 4.9 kg/m(2), apnea-hypopnea index (AHI) 30 +/- 26, range 2 to 86 events/ h). NEP and Pcrit were similarly associated with tongue area (r = 0.646 and r = 0.585), tongue volume (r = 0.565 and r = 0.613) and pharyngeal length (r = 0.580 and r = 0.611), respectively (p < 0.05 for all comparisons). NEP and Pcrit were also significantly correlated with AHI (r = 0.490 and r = 0.531). NEP and Pcrit were significantly higher in patients with severe OSA than the remaining population. Conclusions: NEP is a simple and promising method that is associated with the anatomical component of upper airway collapsibility. NEP may be valuable to select patients for noncontinuous positive airway pressure alternative therapies for OSA.