MELANIA DIRCE OLIVEIRA MARQUES
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
18 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 18
- Phenotyping Pharyngeal Pathophysiology using Polysomnography in Patients with Obstructive Sleep Apnea(2018) SANDS, Scott A.; EDWARDS, Bradley A.; TERRILL, Philip I.; TARANTO-MONTEMURRO, Luigi; AZARBARZIN, Ali; MARQUES, Melania; HESS, Lauren B.; WHITE, David P.; WELLMAN, AndrewRationale: Therapies for obstructive sleep apnea (OSA) could be administered on the basis of a patient's own phenotypic causes (""traits"") if a clinically applicable approach were available. Objectives: Here we aimed to provide a means to quantify two key contributors to OSA-pharyngeal collapsibility and compensatory muscle responsiveness-that is applicable to diagnostic polysomnography. Methods: Based on physiological definitions, pharyngeal collapsibility determines the ventilation at normal (eupneic) ventilatory drive during sleep, and pharyngeal compensation determines the rise in ventilation accompanying a rising ventilatory drive. Thus, measuring ventilation and ventilatory drive (e.g., during spontaneous cyclic events) should reveal a patient's phenotypic traits without specialized intervention. We demonstrate this concept in patients with OSA (N = 29), using a novel automated noninvasive method to estimate ventilatory drive (polysomnographic method) and using ""gold standard"" ventilatory drive (intraesophageal diaphragm EMG) for comparison. Specialized physiological measurements using continuous positive airway pressure manipulation were employed for further comparison. The validity of nasal pressure as a ventilation surrogate was also tested (N = 11). Measurements and Main Results: Polysomnography-derived collapsibility and compensation estimates correlated favorably with those quantified using gold standard ventilatory drive (R = 0.83, P < 0.0001; and R = 0.76, P < 0.0001; respectively) and using continuous positive airway pressuremanipulation (R = 0.67, P < 0.0001; and R = 0.64, P < 0.001; respectively). Polysomnographic estimates effectively stratified patients into high versus low subgroups (accuracy, 69-86% vs. ventilatory drive measures; P < 0.05). Traits were near-identical using nasal pressure versus pneumotach (N = 11, R >= 0.98, both traits; P < 0.001). Conclusions: Phenotypes of pharyngeal dysfunction in OSA are evident from spontaneous changes in ventilation and ventilatory drive during sleep, enabling noninvasive phenotyping in the clinic. Our approach may facilitate precision therapeutic interventions for OSA.
conferenceObject Simplified OSA Phenotyping of Respiratory Events for Predicting Oral Appliance Efficacy(2019) VENA, D.; AZARBARZIN, A.; EDWARDS, B. A.; RADMAND, R.; MARQUES, M.; TARANTO-MONTEMURRO, L. T.; CALIANESE, N.; WHITE, D.; LANDRY, S.; JOOSTEN, S. A.; HAMILTON, G.; THOMSON, L.; SANDS, S. A.; WELLMAN, D.- Predicting sleep apnea responses to oral appliance therapy using polysomnographic airflow(2020) VENA, Daniel; AZARBARZIN, Ali; MARQUES, Melania; BEECK, Sara Op de; VANDERVEKEN, Olivier M.; EDWARDS, Bradley A.; CALIANESE, Nicole; HESS, Lauren B.; RADMAND, Reza; HAMILTON, Garun S.; JOOSTEN, Simon A.; TARANTO-MONTEMURRO, Luigi; KIM, Sang-Wook; VERBRAECKEN, Johan; BRAEM, Marc; WHITE, David P.; SANDS, Scott A.; WELLMAN, AndrewStudy Objectives: Oral appliance therapy is an increasingly common option for treating obstructive sleep apnea (OSA) in patients who are intolerant to continuous positive airway pressure (CPAP). Clinically applicable tools to identify patients who could respond to oral appliance therapy are limited. Methods: Data from three studies (N = 81) were compiled, which included two sleep study nights, on and off oral appliance treatment. Along with clinical variables, airflow features were computed that included the average drop in airflow during respiratory events (event depth) and flow shape features, which, from previous work, indicates the mechanism of pharyngeal collapse. A model was developed to predict oral appliance treatment response (>50% reduction in apnea-hypopnea index [AHI] from baseline plus a treatment AHI <10 events/h). Model performance was quantified using (1) accuracy and (2) the difference in oral appliance treatment efficacy (percent reduction in AHI) and treatment AHI between predicted responders and nonresponders. Results: In addition to age and body mass index (BMI), event depth and expiratory ""pinching"" (validated to reflect palatal prolapse) were the airflow features selected by the model. Nonresponders had deeper events, ""pinched"" expiratory flow shape (i.e. associated with palatal collapse), were older, and had a higher BMI. Prediction accuracy was 74% and treatment AHI was lower in predicted responders compared to nonresponders by a clinically meaningful margin (8.0 [5.1 to 11.6] vs. 20.0 [12.2 to 29.5] events/h, p < 0.001). Conclusions: A model developed with airflow features calculated from routine polysomnography, combined with age and BMI, identified oral appliance treatment responders from nonresponders. This research represents an important application of phenotyping to identify alternative treatments for personalized OSA management. Statement of Significance Treatment response to oral appliance in patients with obstructive sleep apnea can be predicted at baseline from metrics derived from routine polysomnography.
- Loop gain in REM versus non-REM sleep using CPAP manipulation: A pilot study(2019) MESSINEO, Ludovico; TARANTO-MONTEMURRO, Luigi; AZARBARZIN, Ali; MARQUES, Melania; CALIANESE, Nicole; WHITE, David P.; WELLMAN, Andrew; SANDS, Scott A.
conferenceObject Retropalatal and Retroglossal Airway Compliance and Negative Effort Dependence in Patients with Obstructive Sleep Apnea(2018) MARQUES, M. O.; GENTA, P.; AZARBARZIN, A.; SANDS, S. A.; TARANTO-MONTEMURRO, L. T.; MESSINEO, L.; WHITE, D.; WELLMAN, A.- Broadband Sound Administration Improves Sleep Onset Latency in Healthy Subjects in a Model of Transient Insomnia(2017) MESSINEO, Ludovico; TARANTO-MONTEMURRO, Luigi; SANDS, Scott A.; MARQUES, Melania D. Oliveira; AZABARZIN, Ali; WELLMAN, David AndrewBackground: Insomnia is a major public health problem in western countries. Previous small pilot studies showed that the administration of constant white noise can improve sleep quality, increase acoustic arousal threshold, and reduce sleep onset latency. In this randomized controlled trial, we tested the effect of surrounding broadband sound administration on sleep onset latency, sleep architecture, and subjective sleep quality in healthy subjects. Methods: Eighteen healthy subjects were studied with two overnight sleep studies approximately one week apart. They were exposed in random order to normal environmental noise (40.1 [1.3] dB) or to broadband sound administration uniformly distributed in the room by two speakers (46.0 [0.9] dB). To model transient insomnia, subjects went to bed (""lights out"") 90 min before usual bedtime. Results: Broadband sound administration reduced sleep onset latency to stage 2 sleep (time from lights out to first epoch of non-rapid eye movement-sleep stage 2) (19 [16] vs. 13 [23] min, p = 0.011; median reduction 38% baseline). In a subgroup reporting trouble initiating sleep at home (Pittsburgh Sleep Quality Index section 2 score = 1), sound administration improved subjective sleep quality (p = 0.037) and the frequency of arousals from sleep (p = 0.03). Conclusion: In an experimental model of transient insomnia in young healthy individuals, broadband sound administration significantly reduced sleep onset latency by 38% compared to normal environmental noise. These findings suggest that broadband sound administration might be helpful to minimize insomnia symptoms in selected individuals.
- Quantifying the magnitude of pharyngeal obstruction during sleep using airflow shape(2019) MANN, Dwayne L.; TERRILL, Philip I.; AZARBARZIN, Ali; MARIANI, Sara; FRANCIOSINI, Angelo; CAMASSA, Alessandra; GEORGESON, Thomas; MARQUES, Melania; TARANTO-MONTEMURRO, Luigi; MESSINEO, Ludovico; REDLINE, Susan; WELLMAN, Andrew; SANDS, Scott A.Rationale and objectives: Non-invasive quantification of the severity of pharyngeal airflow obstruction would enable recognition of obstructive versus central manifestation of sleep apnoea, and identification of symptomatic individuals with severe airflow obstruction despite a low apnoea-hypopnoea index (AHI). Here we provide a novel method that uses simple airflow-versus-time (""shape"") features from individual breaths on an overnight sleep study to automatically and non-invasively quantify the severity of airflow obstruction without oesophageal catheterisation. Methods: 41 individuals with suspected/diagnosed obstructive sleep apnoea (AHI range 0-91 events.h(-1)) underwent overnight polysomnography with gold-standard measures of airflow (oronasal pneumotach: ""flow"") and ventilatory drive (calibrated intraoesophageal diaphragm electromyogram: ""drive""). Obstruction severity was defined as a continuous variable (flow: drive ratio). Multivariable regression used airflow shape features (inspiratory/expiratory timing, flatness, scooping, fluttering) to estimate flow: drive ratio in 136264 breaths (performance based on leave-one-patient-out cross-validation). Analysis was repeated using simultaneous nasal pressure recordings in a subset (n=17). Results: Gold-standard obstruction severity (flow: drive ratio) varied widely across individuals independently of AHI. A multivariable model (25 features) estimated obstruction severity breath-by-breath (R-2=0.58 versus gold-standard, p<0.00001; mean absolute error 22%) and the median obstruction severity across individual patients (R-2=0.69, p<0.00001; error 10%). Similar performance was achieved using nasal pressure. Conclusions: The severity of pharyngeal obstruction can be quantified non-invasively using readily available airflow shape information. Our work overcomes a major hurdle necessary for the recognition and phenotyping of patients with obstructive sleep disordered breathing.
- Retropalatal and retroglossal airway compliance in patients with obstructive sleep apnea(2018) MARQUES, Melania; GENTA, Pedro R.; AZARBARZIN, Ali; SANDS, Scott A.; TARANTO-MONTEMURRO, Luigi; MESSINEO, Ludovico; WHITE, David P.; WELLMAN, AndrewObjectives: We hypothesized that preferential retropalatal as compared to retroglossal collapse in patients with obstructive sleep apnea was due to a narrower retropalatal area and a higher retropalatal compliance. Patients with a greater retropalatal compliance would exhibit a recognizable increase in negative effort dependence (NED). Methods: Fourteen patients underwent upper airway endoscopy with simultaneous recordings of airflow and pharyngeal pressure during natural sleep. Airway areas were obtained by manually outlining the lumen. Compliance was calculated by the change of airway area from end-expiration to a pressure swing of -5 cm H2O. NED was quantified for each breath as [peak inspiratory flow minus flow at -5 cm H2O]/[peak flow] x 100. Results: Compared to the retroglossal airway, the retropalatal airway was smaller at end-expiration (p < 0.001), and had greater absolute and relative compliances (p < 0.001). NED was positively associated with retropalatal relative area change (r = 0.47; p < 0.001). Conclusions: Retropalatal airway is narrower and more collapsible than retroglossal airway. Retropalatal compliance is reflected in the clinically-available NED value.
- Predicting epiglottic collapse in patients with obstructive sleep apnoea(2017) AZARBARZIN, Ali; MARQUES, Melania; SANDS, Scott A.; BEECK, Sara Op de; GENTA, Pedro R.; TARANTO-MONTEMURRO, Luigi; MELO, Camila M. de; MESSINEO, Ludovico; VANDERVEKEN, Olivier M.; WHITE, David P.; WELLMAN, AndrewObstructive sleep apnoea (OSA) is characterised by pharyngeal obstruction occurring at different sites. Endoscopic studies reveal that epiglottic collapse renders patients at higher risk of failed oral appliance therapy or accentuated collapse on continuous positive airway pressure. Diagnosing epiglottic collapse currently requires invasive studies (imaging and endoscopy). As an alternative, we propose that epiglottic collapse can be detected from the distinct airflow patterns it produces during sleep. 23 OSA patients underwent natural sleep endoscopy. 1232 breaths were scored as epiglottic/nonepiglottic collapse. Several flow characteristics were determined from the flow signal (recorded simultaneously with endoscopy) and used to build a predictive model to distinguish epiglottic from nonepiglottic collapse. Additionally, 10 OSA patients were studied to validate the pneumotachograph flow features using nasal pressure signals. Epiglottic collapse was characterised by a rapid fall(s) in the inspiratory flow, more variable inspiratory and expiratory flow and reduced tidal volume. The cross-validated accuracy was 84%. Predictive features obtained from pneumotachograph flow and nasal pressure were strongly correlated. This study demonstrates that epiglottic collapse can be identified from the airflow signal measured during a sleep study. This method may enable clinicians to use clinically collected data to characterise underlying physiology and improve treatment decisions.
conferenceObject Clinical Predictors of Respiratory System Loop Gain in Healthy Subjects and Patients with Obstructive Sleep Apnea(2018) MESSINEO, L.; TARANTO-MONTEMURRO, L. T.; AZARBARZIN, A.; MARQUES, M.; CALIANESE, N.; WHITE, D. P.; SANDS, S. A.; WELLMAN, A.