DENISE MOREIRA LIMA LOBO
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conferenceObject Sleep Apnea Worsens Muscle Vasoconstriction During Central and Peripheral Chemoreceptors Stimulation in Patients with Systolic Heart Failure(2016) LOBO, Denise M. L.; TREVIZAN, Patricia F.; TOSCHI-DIAS, Edgar; OLIVEIRA, Patricia A.; PIVETA, Rafael B.; MADY, Charles; BOCCHI, Edimar A.; ALMEIDA, Dirceu R.; LORENZI-FILHO, Gerald; MIDDLEKAUFF, Holly R.; NEGRAO, Carlos E.- Increased Muscle Sympathetic Nerve Activity and Impaired Executive Performance Capacity in Obstructive Sleep Apnea(2016) GOYA, Thiago T.; SILVA, Rosyvaldo F.; GUERRA, Renan S.; LIMA, Marta F.; BARBOSA, Eline R. F.; CUNHA, Paulo Jannuzzi; LOBO, Denise M. L.; BUCHPIGUEL, Carlos A.; BUSATTO-FILHO, Geraldo; NEGRAO, Carlos E.; LORENZI-FILHO, Geraldo; UENO-PARDI, Linda M.Study Objectives: To investigate muscle sympathetic nerve activity (MSNA) response and executive performance during mental stress in obstructive sleep apnea (OSA). Methods: Individuals with no other comorbidities (age = 52 +/- 1 y, body mass index = 29 +/- 0.4, kg/m(2)) were divided into two groups: (1) control (n = 15) and (2) untreated OSA (n = 20) defined by polysomnography. Mini-Mental State of Examination (MMSE) and Inteligence quocient (IQ) were assessed. Heart rate (HR), blood pressure (BP), and MSNA (microneurography) were measured at baseline and during 3 min of the Stroop Color Word Test (SCWT). Sustained attention and inhibitory control were assessed by the number of correct answers and errors during SCWT. Results: Control and OSA groups (apnea-hypopnea index, AHI = 8 +/- 1 and 47 +/- 1 events/h, respectively) were similar in age, MMSE, and IQ. Baseline HR and BP were similar and increased similarly during SCWT in control and OSA groups. In contrast, baseline MSNA was higher in OSA compared to controls. Moreover, MSNA significantly increased in the third minute of SCWT in OSA, but remained unchanged in controls (P < 0.05). The number of correct answers was lower and the number of errors was significantly higher during the second and third minutes of SCWT in the OSA group (P < 0.05). There was a significant correlation (P < 0.01) between the number of errors in the third minute of SCWT with AHI (r = 0.59), arousal index (r = 0.55), and minimum O-2 saturation (r = -0.57). Conclusions: As compared to controls, MSNA is increased in patients with OSA at rest, and further significant MSNA increments and worse executive performance are seen during mental stress.
- Sleep-Disordered Breathing Exacerbates Muscle Vasoconstriction and Sympathetic Neural Activation in Patients with Systolic Heart Failure(2016) LOBO, Denise M. L.; TREVIZAN, Patricia F.; TOSCHI-DIAS, Edgar; OLIVEIRA, Patricia A.; PIVETA, Rafael B.; ALMEIDA, Dirceu R.; MADY, Charles; BOCCHI, Edimar A.; LORENZI-FILHO, Geraldo; MIDDLEKAUFF, Holly R.; NEGRAO, Carlos E.Background-Sleep-disordered breathing (SDB) is common in patients with heart failure (HF), and hypoxia and hypercapnia episodes activate chemoreceptors stimulating autonomic reflex responses. We tested the hypothesis that muscle vasoconstriction and muscle sympathetic nerve activity (MSNA) in response to hypoxia and hypercapnia would be more pronounced in patients with HF and SDB than in patients with HF without SDB (NoSBD). Methods and Results-Ninety consecutive patients with HF, New York Heart Association functional class II-III, and left ventricular ejection fraction <= 40% were screened for the study. Forty-one patients were enrolled: NoSDB (n=13, 46 [39-53] years) and SDB (n=28, 57 [54-61] years). SDB was characterized by apnea-hypopnea index >= 15 events per hour (polysomnography). Peripheral (10% O-2 and 90% N-2, with CO2 titrated) and central (7% CO2 and 93% O-2) chemoreceptors were stimulated for 3 minutes. Forearm and calf blood flow were evaluated by venous occlusion plethysmography, MSNA by microneurography, and blood pressure by beat-to-beat noninvasive technique. Baseline forearm blood flow, forearm vascular conductance, calf blood flow, and calf vascular conductance were similar between groups. MSNA was higher in the SDB group. During hypoxia, the vascular responses (forearm blood flow, forearm vascular conductance, calf blood flow, and calf vascular conductance) were significantly lower in the SDB group compared with the NoSDB group (P<0.01 to all comparisons). Similarly, during hypercapnia, the vascular responses (forearm blood flow, forearm vascular conductance, calf blood flow, and calf vascular conductance) were significantly lower in the SDB group compared with the NoSDB group (P<0.001 to all comparisons). MSNA were higher in response to hypoxia (P=0.024) and tended to be higher to hypercapnia (P=0.066) in the SDB group. Conclusions-Patients with HF and SDB have more severe muscle vasoconstriction during hypoxia and hypercapnia than HF patients without SDB, which seems to be associated with endothelial dysfunction and, in part, increased MSNA response.
- Prescription Of Physical Training In Pacemaker Patients: Compatibility Between The Formulas And Cardiopulmonary Exercise Test(2016) NISHIOKA, Daniel D.; NISHIOKA, SIlvana D.; OLIVEIRA, Patricia A.; FILHO, Martino M.; LOBO, Denise M.; NEGRAO, Carlos E.; TROMBETTA, Ivani C.; APTEKMANN, Nancy P.; APTEKMANN, Nancy P.
conferenceObject Decreased Oscillatory Pattern of Sympathetic Nerve Activity is Associated With Arterial Baroreflex Dysfunction in Chronic Heart Failure Patients(2015) TOSCHI-DIAS, Edgar; GROEHS, Raphaela V.; ANTUNES-CORREA, Ligia M.; TREVIZAN, Patricia F.; LOBO, Denise M.; OLIVEIRA, Patricia; ALVES, Maria Janieire N.; ALMEIDA, Dirceu R.; NEGRAO, Carlos Eduardo; RONDON, Maria Urbana P.