MICHEL BURIHAN CAHALI
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/32 - Laboratório de Otorrinolaringologia, Hospital das Clínicas, Faculdade de Medicina
LIM/32 - Laboratório de Otorrinolaringologia, Hospital das Clínicas, Faculdade de Medicina
19 resultados
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- Contributions of the Melanopsin-Expressing Ganglion Cells, Cones, and Rods to the Pupillary Light Response in Obstructive Sleep Apnea(2019) DUQUE-CHICA, Gloria L.; GRACITELLI, Carolina P. B.; MOURA, Ana L. A.; NAGY, Balazs V.; VIDAL, Kallene S.; MELO, Geraldine de; PARANHOS JR., Augusto; CAHALI, Michel B.; VENTURA, Dora F.PURPOSE. To investigate the impact of obstructive sleep apnea (OSA) on the contribution of inner and outer retinal photoreceptors to the pupillary light response (PLR). METHODS. Ninety-three eyes from 27 patients with OSA and 25 healthy controls were tested. OSA severity was graded according to the apnea-hypopnea index. PLR was measured monocularly with an eye tracker in a Ganzfeld in response to 1-second blue (470 nm) and red (640 nm) flashes at -3, -2, -1, 0, 1, 2, and 2.4 log cd/m(2). Peak pupil constriction amplitude, peak latency, and the postillumination pupil response were measured. The Cambridge Colour Test, standard automatic perimetry, spectral domain optical coherence tomography, polysomnography, and the Pittsburgh Sleep Quality Index were used. RESULTS. OSA patients have a significantly decreased peak pupil constriction amplitude for blue stimuli at -3, -2, -1, 1 log cd/m(2) and at all red flash luminances (P < 0.050), revealing reduction of outer retina contributions to PLR. OSA patients showed reduced peak latency for blue (-2, 0, 2, 2.4 log cd/m(2)) and red stimuli (-2, 0 log cd/m(2); P < 0.040). No significant difference was found in the melanopsin-mediated PLR. CONCLUSIONS. This study is the first to evaluate the inner and outer retinal contributions to PLR in OSA patients. The results showed that the outer retinal photoreceptor contributions to PLR were affected in moderate and severe OSA patients. In contrast, the inner retina contributions to PLR are preserved.
bookPart Ronco primário(2018) SENNES, Luiz Ubirajara; NAKASATO, Alexandre; FORMIGONI, Gilberto Guanaes S.; CAHALI, Michel Burihan- LwPTL: a novel classification for upper airway collapse in sleep endoscopies(2019) ELSOBKI, Ahmed; CAHALI, Michel Burihan; KAHWAGI, MohamedIntroduction: There is no consensus on a single classification system for the obstructive findings in drug-induced sleep endoscopy. Previous classification systems have neglected to address the upper retropalatal obstruction, the segmental division of the lateral pharyngeal wall and the primary or secondary nature of laryngeal collapse. Objective: To propose, illustrate and evaluate a more comprehensive and yet simple classification for drug-induced sleep endoscopy findings. Methods: Cross sectional study in a tertiary sleep surgery unit. A total of 30 patients with obstructive sleep apnea underwent drug-induced sleep endoscopy according to a new classification system called LwPTL, and its findings were analyzed according to obstructive sleep apnea severity and body mass index. LwPTL incorporates the description of upper retropalatal collapse, distinguishes the lateral pharyngeal wall collapse into three levels and clarify when laryngeal collapses are primary or secondary. Results: 93.3% of the patients presented lateral pharyngeal wall collapse, usually at the level of the velum (73.3%). 80% presented multilevel collapse. Regarding the upper retropalatal region, LwPTL identified 10% of the cases presenting lateral salpingopharyngeal obstruction and 6.6% with high palatal collapse. 3.3% presented epiglottic collapse. Patients presenting lower levels of collapse, either from the lateral wall and/or tongue and/or larynx, represented 30% of the cases and had significantly more severe obstructive sleep apnea, without significant differences in body mass indexes. Conclusion: LwPTL seems a simple and straightforward staging system for classifying drug-induced sleep endoscopy, distinguishing the important upper retopalatal obstruction and the primary and secondary laryngeal collapses, providing more information for appropriate treatment selection. (C) 2019 Associacao Brasileira de Otorrinolaringologia e Cirurgia Cervico-Facial.
conferenceObject Comparison Of Site And Configuration Of Upper Airway Collapse Between Natural And Propofol-Induced Sleep Endoscopy - Preliminary Results(2017) ORDONES, A. B.; GRAD, G.; CAHALI, M.; SENNES, L. U.; LORENZI-FILHO, G.; GENTA, P.- Tonsil volume, tonsil grade and obstructive sleep apnea: is there any meaningful correlation?(2011) CAHALI, Michel Burihan; SOARES, Carolina Ferraz de Paula; DANTAS, Danielle Andrade da Silva; FORMIGONI, Gilberto Guanaes SimoesOBJECTIVES: The aims of this study were to evaluate the correlation between oropharyngeal examination and objective palatine tonsil volume in snoring adults and verify the influence of the oropharyngeal anatomy, body mass index, age, and severity of obstructive sleep apnea on actual tonsil volume. In addition, we aimed to assess the influence of tonsil size on obstructive sleep apnea in adults. INTRODUCTION: Pharyngeal wall geometry is often altered in adults who have obstructive sleep apnea, and this might influence the findings of the oropharyngeal examination that, in turn, are the key factors when considering surgical management for this condition. Furthermore, the correlation between the actual tonsil volume and the severity of obstructive sleep apnea in adults is currently unknown. METHODS: We prospectively studied 130 patients with obstructive sleep apnea or primary snoring who underwent pharyngeal surgery with intraoperative measurement of tonsil volume. We compared tonsil volume with preoperative polysomnography, oropharyngeal examination, and anthropometric data. RESULTS: We found a significant correlation between actual tonsil volume and subjective tonsil grade. We also found a significant correlation between tonsil volume and the apnea-hypopnea index. Using a multivariate linear regression model, tonsil volume was found to be significantly correlated with age, body mass index, and oropharyngeal examination, but not with polysomnography. Clinically, only the rare tonsil grade IV was indicative of more severe obstructive sleep apnea. CONCLUSIONS: There is a strong correlation between clinical tonsil grade and objective tonsil volume in snoring adults, and this correlation exists regardless of the presence or severity of obstructive sleep apnea. Pharyngeal tissue volume likely reflects the body mass index rather than obstructive sleep apnea severity.
- Obstructive sleep apnea and primary snoring: diagnosis (vol 80, pg S1, 2014)(2014) ZANCANELLA, E.; HADDAD, F. M.; OLIVEIRA, L. A. M. P.; NAKASATO, A.; DUARTE, B. B.; SOARES, C. F. P.; CAHALI, M. B.; ECKELI, A.; CARAMELLI, B.; DRAGER, L. F.; RAMOS, B. D.; NOBREGA, M.; FAGONDES, S. C.; ANDRADA, N. C.
- Lateral Pharyngoplasty Reduces Nocturnal Blood Pressure in Patients With Obstructive Sleep Apnea(2014) SOARES, Carolina F. de Paula; CAVICHIO, Luciano; CAHALI, Michel B.Objectives/HypothesisTo compare the values of 24-hour ambulatory blood pressure monitoring (ABPM) in patients with obstructive sleep apnea (OSA), before and after lateral pharyngoplasty, and to investigate the influence of pre- and post-treatment polysomnographic and anthropometric variations on changes in ABPM. Study DesignProspective study. MethodsArterial blood pressure with 24-hour ABPM and nocturnal polysomnography were measured before and 6 months after surgery in 18 consecutively evaluated adults with OSA at a tertiary center. ResultsA total of 83.3% were normotensive patients. Nocturnal measurements showed a decrease of 5.3 mmHg in mean arterial pressure (MAP; P=.01), 7.4 mmHg in mean arterial systolic pressure (SP; P=.006), and 4.2 mmHg in mean arterial diastolic pressure (DP; P=.03), leading to significant reductions in all 24-hour measurements: 3.6 mmHg in MAP, 4.8 mmHg in SP, and 2.9 mmHg in DP. There were also significant mean reductions in the apnea-hypopnea index (AHI), from 33.5 to 20.9 (P=.02), arousal index, from 31.6 to 16.7 (P=.005), and percentage of total sleep time with oxyhemoglobin saturation<90%, from 10.6% to 0.9% (P=.008). No correlations were noted between the measurements of arterial blood pressure and polysomnographic or anthropometric variations. ConclusionsIn this small case series, lateral pharyngoplasty reduced the values obtained in the 24-hour ABPM due to a significant reduction of blood pressures during sleep in patients with OSA 6 months after surgery. Although the patients presented with reductions in AHI, arousals, and desaturation time, this was not correlated with the improvement in arterial blood pressure. Level of Evidence4 Laryngoscope, 124:311-316, 2014
- Upper airway modifications after weight loss: a systematic review(2023) SOARES, Carolina Ferraz de Paula; CAHALI, Michel BurihanObjective: Weight loss is one of the most often prescribed treatments to reduce the level of sleep apnea severity; however, objective assessment of airway alterations after loss of weight has only been studied in the last decades. This study aimed at evaluating alterations after weight loss reported in the literature.Methods: A literature review was performed in the medical databases: PubMed, Web of Science, Scopus and Embase. A total of 681 articles were found in the databases and after evaluation only 10 studies were selected for data extraction.Results: Most studies observed an increase of the area in the retropalatal region; some indicat-ing that this increase occurred mostly in the lateral pharyngeal region. Studies with volumetric reconstruction showed a significant reduction in parapharyngeal fat deposits, lateral wall and tongue fat, and volumetric reduction in all soft tissues of the pharynx, pterygoid and genioglos-sus muscles. Studies evaluating craniofacial bone structures showed a reduction in the airway height by bringing the hyoid closer to the posterior nasal spine and a reduction in the distance from the hyoid to the chin.Conclusion: There is a limited number of studies with a good level of scientific evidence evaluating changes in the upper airways after weight loss and how these changes impact obstructive sleep apnea. The studies included in this review indicate that weight loss increases the airways space by reducing the volume of the parapharyngeal structures, particularly at the retropalatal site, where there is an apparent gain in the lateral area of the airway and hyoid relocation. & COPY; 2022 Associacao Brasileira de Otorrinolaringologia e Cirurgia C & PRIME;ervico-Facial.
conferenceObject Study of the pupil light reflex in patients with Obstructive Sleep Apnea(2015) DUQUE-CHICA, Gloria L.; GRACITELLI, Carolina; MOURA, Ana Laura de Araujo; NAGY, Balazs V.; MELO, Geraldine de; CAHALI, Michel B.; PARANHOS, Augusto; VENTURA, Dora Fix- The Extracellular Matrix of the Lateral Pharyngeal Wall in Obstructive Sleep Apnea(2012) DANTAS, Danielle Andrade da Silva; MAUAD, Thais; SILVA, Luiz F. F.; LORENZI-FILHO, Geraldo; FORMIGONI, Gilberto G. S.; CAHALI, Michel B.Study Objectives: To compare the components of the extracellular matrix in the lateral pharyngeal muscular wall in patients with and without obstructive sleep apnea (OSA). This may help to explain the origin of the increased collapsibility of the pharynx in patients with OSA. Design: Specimens from the superior pharyngeal constrictor muscle, obtained during pharyngeal surgeries, were evaluated using histochemical and immunohistochemical analyses to determine the fractional area of collagen types I and II, elastic fibers, versican, fibronectin, and matrix metalloproteinases 1 and 2 in the endomysium. Setting: Academic tertiary center. Patiens: A total of 51 nonobese adult patients, divided into 38 patients with OSA and 13 nonsnoring control subjects without OSA. Interventions: Postintervention study performed on tissues from patients after elective surgery. Measurements and Results: Pharyngeal muscles of patients with OSA had significantly more collagen type I than pharyngeal muscles in control subjects. Collagen type I was correlated positively and independently with age. The other tested components of the extracellular matrix did not differ significantly between groups. In a logistic regression, an additive effect of both the increase of collagen type I and the increase in age with the presence of OSA was observed (odds ratio (OR), 2.06; 95% confidence interval (CI), 1.17-3.63), when compared with the effect of increased age alone (OR, 1.11; 95% CI, 1.03-1.20). Conclusion: Collagen type I in the superior pharyngeal constrictor muscle was more prevalent in patients with OSA and also increased with age. It was hypothesized that this increase could delay contractile-relaxant responses in the superior pharyngeal constrictor muscle at the expiratory-inspiratory phase transition, thus increasing pharyngeal collapsibility.