ELOISA MARIA MELLO SANTIAGO GEBRIM
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Radiologia, Hospital das Clínicas, Faculdade de Medicina - Médico
11 resultados
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- Tongue size matters: revisiting the Mallampati classification system in patients with obstructive sleep apnea(2023) ATHAYDE, Rodolfo Augusto Bacelar de; COLONNA, Leonardo Luiz Igreja; SCHORR, Fabiola; GEBRIM, Eloisa Maria Mello Santiago; LORENZI-FILHO, Geraldo; GENTA, Pedro RodriguesObjective: The Mallampati classification system has been used to predict obstructive sleep apnea (OSA). Upper airway soft tissue structures are prone to fat deposition, and the tongue is the largest of these structures. Given that a higher Mallampati score is associated with a crowded oropharynx, we hypothesized that the Mallampati score is associated with tongue volume and an imbalance between tongue and mandible volumes. Methods: Adult males underwent clinical evaluation, polysomnography, and upper airway CT scans. Tongue and mandible volumes were calculated and compared by Mallampati class. Results: Eighty patients were included (mean age, 46.8 years). On average, the study participants were overweight (BMI, 29.3 +/- 4.0 kg/m(2)) and had moderate OSA (an apnea-hypopnea index of 26.2 +/- 26.7 events/h). Mallampati class IV patients were older than Mallampati class II patients ( 53 +/- 9 years vs. 40 +/- 12 years; p < 0.01), had a larger neck circumference (43 +/- 3 cm vs. 40 +/- 3 cm; p < 0.05), had more severe OSA (51 +/- 27 events/h vs. 24 +/- 23 events/h; p < 0.01), and had a larger tongue volume (152 +/- 19 cm(3) v s. 135 +/- 18 cm3; p < 0.01). Mallampati class IV patients also had a larger tongue volume than did Mallampati class III patients (152 +/- 19 cm(3) vs. 135 +/- 13 cm(3); p < 0.05), as well as having a higher tongue to mandible volume ratio (2.5 +/- 0.5 cm(3) vs. 2.1 +/- 0.4 cm(3); p < 0.05). The Mallampati score was associated with the apnea-hypopnea index (r = 0.431, p < 0.001), BMI (r = 0.405, p < 0.001), neck and waist circumference (r = 0.393, p < 0.001), tongue volume (r = 0.283, p < 0.001), and tongue/ mandible volume (r = 0.280, p = 0.012). Conclusions: The Mallampati score appears to be influenced by obesity, tongue enlargement, and upper airway crowding.
- Different Craniofacial Characteristics Predict Upper Airway Collapsibility in Japanese-Brazilian and White Men(2016) SCHORR, Fabiola; KAYAMORI, Fabiane; HIRATA, Raquel P.; DANZI-SOARES, Naury J.; GEBRIM, Eloisa M.; MORIYA, Henrique T.; MALHOTRA, Atul; LORENZI-FILHO, Geraldo; GENTA, Pedro R.BACKGROUND: OSA pathogenesis is complex and may vary according to ethnicity. The anatomic component predisposing to OSA is the result of the interaction between bony structure and upper airway soft tissues and can be assessed using passive critical closing pressure (Pcrit). We hypothesized that Japanese-Brazilians and whites present different predictors of upper airway collapsibility, suggesting different causal pathways to developing OSA in these two groups. METHODS: Male Japanese-Brazilians (n = 39) and whites (n = 39) matched for age and OSA severity were evaluated by full polysomnography, Pcrit, and upper airway and abdomen CT scans for determination of upper airway anatomy and abdominal fat, respectively. RESULTS: Pcrit was similar between the Japanese-Brazilians and the whites (-1.0 +/- 3.3 cm H2O vs -0.4 +/- 3.1 cm H2O, P = .325). The Japanese-Brazilians presented smaller upper airway bony dimensions (cranial base, maxillary, and mandibular lengths), whereas the whites presented larger upper airway soft tissue (tongue length and volume) and a greater imbalance between tongue and mandible (tongue/mandibular volume ratio). The cranial base angle was associated with Pcrit only among the Japanese-Brazilians (r = -0.535, P < .01). The tongue/mandibular volume ratio was associated with Pcrit only among the whites (r = 0.460, P < .01). Obesity-related variables (visceral fat, BMI, and neck and waist circumferences) showed a similar correlation with Pcrit in the Japanese-Brazilians and the whites. CONCLUSIONS: Japanese-Brazilians and whites present different predictors of upper airway collapsibility. Although craniofacial bony restriction influenced Pcrit only in the Japanese-Brazilians, an anatomic imbalance between tongue and mandible volume influenced Pcrit among the whites. These findings may have therapeutic implications regarding how to improve the anatomic predisposition to OSA across ethnicities.
- State-dependent changes in the upper airway assessed by multidetector CT in healthy individuals and during obstructive events in patients with sleep apnea(2019) PASSOS, Ula Lindoso; GENTA, Pedro Rodrigues; MARCONDES, Bianca Fernandes; LORENZI-FILHO, Geraldo; GEBRIM, Eloisa Maria Mello SantiagoObjective: To determine whether airway narrowing during obstructive events occurs predominantly at the retropalatal level and results from dynamic changes in the lateral pharyngeal walls and in tongue position. Methods: We evaluated 11 patients with severe obstructive sleep apnea (OSA) and 7 healthy controls without OSA during wakefulness and during natural sleep (documented by full polysomnography). Using fast multidetector CT, we obtained images of the upper airway in the waking and sleep states. Results: Upper airway narrowing during sleep was significantly greater at the retropalatal level than at the retroglossal level in the OSA group (p < 0.001) and in the control group (p < 0.05). The retropalatal airway volume was smaller in the OSA group than in the control group during wakefulness (p < 0.05) and decreased significantly from wakefulness to sleep only among the OSA group subjects. Retropalatal pharyngeal narrowing was attributed to reductions in the anteroposterior diameter (p = 0.001) and lateral diameter (p = 0.006), which correlated with an increase in lateral pharyngeal wall volume (p = 0.001) and posterior displacement of the tongue (p = 0.001), respectively. Retroglossal pharyngeal narrowing during sleep did not occur in the OSA group subjects. Conclusions: In patients with OSA, upper airway narrowing during sleep occurs predominantly at the retropalatal level, affecting the anteroposterior and lateral dimensions, being associated with lateral pharyngeal wall enlargement and posterior tongue displacement.
conferenceObject The Interaction Between Obesity And Craniofacial Characteristics On Upper Airway Collapsibility: Japanese Descendants Versus Caucasians(2013) SCHORR, F.; GENTA, P. R.; ECKERT, D. J.; KAYAMORI, F.; DANZI, N. D. J.; GEBRIM, E.; MORIYA, H. T.; MALHOTRA, A.; WHITE, D. P.; LORENZI-FILHO, G.conferenceObject Determinants Of Upper Airway Collapsibility Are Different In Male Japanese-Descendants And Caucasians(2014) SCHORR, F.; GENTA, P. R.; KAYAMORI, F.; DANZI-SOARES, N. D. J.; GEBRIM, E.; MORIYA, H. T.; LORENZI-FILHO, G.- Muscle and visceral fat infiltration: A potential mechanism to explain the worsening of obstructive sleep apnea with age(2023) D'ANGELO, Giovanna F.; MELLO, Andre A. F. de; SCHORR, Fabiola; GEBRIM, Eloisa; FERNANDES, Mariana; LIMA, Giovanni F.; GRAD, Gustavo F.; YANAGIMORI, Marcela; LORENZI-FILHO, Geraldo; GENTA, Pedro RodriguesStudy objectives: Aging is a major risk factor for obstructive sleep apnoea (OSA) and is associated with increased upper airway collapsibility, but the mechanisms are largely unknown. We hypothesized that the increase in OSA severity and upper airway collapsibility with age are partially mediated by upper airway, visceral and muscle fat infiltration.Methods: Male subjects underwent full polysomnography, upper airway collapsibility determination (Pcrit) after sleep induction with midazolam, upper airway and abdominal computed tomography. Tongue and abdominal muscle fat infiltration were assessed by the determination of muscle attenuation with computed tomography. Results: Eighty-four males with a wide range of age (47 +/- 13 years, range 22-69 years) and apnea-hypopnea index (AHI) (30 [14-60] events/h, range 1-90 events/h), were studied. Younger and older males were grouped according to the mean age. Despite similar body mass-index (BMI), older subjects had higher AHI, higher Pcrit, larger neck and waist circumference, higher visceral and upper airway fat volumes (P < 0.01) as compared to younger subjects. Age was associated with OSA severity, Pcrit, neck and waist circumference, upper airway fat volume and visceral fat (P < 0.05), but not with BMI. Older subjects had lower tongue and abdominal muscle attenuation as compared to younger subjects (P < 0.001). Age was inversely associated with tongue and abdominal muscle attenuation, indicating muscle fat infiltration.Conclusions: The associations between age, upper airway fat volume, visceral and muscle fat infiltration may help to explain the worsening of OSA and increased upper airway collapsibility with aging.(c) 2023 Elsevier B.V. All rights reserved.
- Upper Airway Collapsibility is Associated with Obesity and Hyoid Position(2014) GENTA, Pedro R.; SCHORR, Fabiola; ECKERT, Danny J.; GEBRIM, Eloisa; KAYAMORI, Fabiane; MORIYA, Henrique T.; MALHOTRA, Atul; LORENZI-FILHO, GeraldoStudy Objectives: Upper airway anatomy plays a major role in obstructive sleep apnea (OSA) pathogenesis. An inferiorly displaced hyoid as measured by the mandibular plane to hyoid distance (MPH) has been consistently associated with OSA. The hyoid is also a common landmark for pharyngeal length, upper airway volume, and tongue base. Tongue dimensions, pharyngeal length, and obesity are associated with OSA severity, although the link between these anatomical variables and pharyngeal collapsibility is less well known. We hypothesized that obesity as measured by body mass index (BMI), neck and waist circumferences, and variables associated with hyoid position (pharyngeal length, upper airway volume, and tongue dimensions) would be associated with passive pharyngeal critical closing pressure (Pcrit). Design: Cross-sectional. Setting: Academic hospital. Patients: 34 Japanese-Brazilian males age 21 to 70 y. Interventions: N/A. Measurements and Results: We performed computed tomography scans of the upper airway, overnight polysomnography, and Pcrit measurements in all subjects. On average, subjects were overweight (BMI = 28 +/- 4 kg/m(2)) and OSA was moderately severe (apnea-hypopnea index = 29 [13-51], range 1-90 events/h). Factor analysis identified two factors among the studied variables: obesity (extracted from BMI, neck and waist circumferences) and hyoid position (MPH, pharyngeal length, tongue length, tongue volume, and upper airway volume). Both obesity and hyoid position correlated with Pcrit (r = 0.470 and 0.630, respectively) (P < 0.01). In addition, tongue volume, tongue length, pharyngeal length, and MPH correlated with waist and neck circumferences (P < 0.05). Conclusions: Pharyngeal critical closing pressure is associated with obesity and hyoid position. Tongue dimensions, pharyngeal length, and the mandibular plane to hyoid distance are associated with obesity variables. These findings provide novel insight into the potential factors mediating upper airway collapse in obstructive sleep apnea.
- Influence of interface and position on upper airway collapsibility assessed by negative expiratory pressure(2017) HIRATA, Raquel Pastrello; KAYAMORI, Fabiane; SCHORR, Fabiola; MORIYA, Henrique Takachi; ROMANO, Salvatore; INSALACO, Giuseppe; GEBRIM, Eloisa; OLIVEIRA, Luis Vicente Franco de; GENTA, Pedro Rodrigues; LORENZI-FILHO, GeraldoPurpose Negative expiratory pressure (NEP) is a simple technique for the evaluation of upper airway collapsibility in patients with obstructive sleep apnea (OSA). Most studies evaluated NEP using a mouthpiece that may exclude the cephalic portion of the upper airway. We hypothesize that NEP determination is influenced by interface and position. Methods We evaluated patients with suspected OSA using polysomnography, NEP (-5 cmH(2)O in sitting and supine position with mouthpiece and nasal mask). A subgroup also underwent computed tomography (CT) of the upper airway. Results We studied a total of 86 subjects (72 male, age 46 +/- 12 yrs, body mass index 30.0 +/- 4.4 kg/m(2), neck circumference 40.0 +/- 3.5 cm, AHI 32.9 +/- 26.4, range 0.5 to 122.5 events/hour). NEP was influenced by interface and position (p = 0.007), and upper airwaywas more collapsible with mouthpiece than with nasal mask in sitting position (p = 0.001). Position influenced NEP and was worse in supine only when evaluated by nasal mask. Expiratory resistance (R-0.2) at 0.2 s during NEP was significantly higher and independent of position with mouthpiece than with nasal mask (20.7 versus 8.6 cmH(2)O/L s(-1), respectively, p = 0.018). NEP evaluated with nasal mask in supine position and with mouthpiece in sitting position, but not when evaluated with mouthpiece in supine position, were correlated with upper airway anatomical measurements including tongue dimensions and pharyngeal length. Conclusions Interface and position influence NEP. NEP evaluated with nasal mask in supine position may convey more relevant information for patients under investigation for OSA than when evaluated with mouthpiece.
conferenceObject Association Between Mallampati Score And Tongue Volume(2017) ATHAYDE, R. B. De; SCHORR, F.; GEBRIM, E.; LORENZI-FILHO, G.; GENTA, P.- 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.