ELOISA MARIA MELLO SANTIAGO GEBRIM
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Radiologia, Hospital das Clínicas, Faculdade de Medicina - Médico
8 resultados
Resultados de Busca
Agora exibindo 1 - 8 de 8
- 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.- 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.conferenceObject Tongue Shape And Pharyngeal Critical Closing Pressure(2015) GENTA, P. R.; KAYAMORI, F.; SCHORR, F.; MORIYA, H.; GEBRIM, E.; LORENZI-FILHO, G.