LIM/63 - Laboratório de Investigação Médica em Sono
URI Permanente desta comunidade
O Laboratório de Investigação Médica em Sono é ligado ao Departamento de Cardiopneumologia da Faculdade de Medicina da Universidade de São Paulo (FMUSP).
Linhas de pesquisa: fisiopatologia da apneia do sono; desenvolvimento de tratamentos comportamentais e psicológicos para problemas de sono; ensaios clínicos não farmacológicos para insônia; investigação de variáveis psicológicas e ambientais que possam influenciar na manutenção e desenvolvimento da insônia; investigação de fatores responsáveis pelo sucesso e insucesso de diferentes tratamentos psicológicos e comportamentais para insônia; psicologia do sono; distúrbios de sono e doença cardiovascular; distúrbios do sono com enfoque principal nos distúrbios respiratórios do sono: métodos diagnósticos, fisiopatologia, consequências e tratamento.
Site oficial: https://limhc.fm.usp.br/portal/lim-63-laboratorio-de-investigacao-medica-em-sono/
Linhas de pesquisa: fisiopatologia da apneia do sono; desenvolvimento de tratamentos comportamentais e psicológicos para problemas de sono; ensaios clínicos não farmacológicos para insônia; investigação de variáveis psicológicas e ambientais que possam influenciar na manutenção e desenvolvimento da insônia; investigação de fatores responsáveis pelo sucesso e insucesso de diferentes tratamentos psicológicos e comportamentais para insônia; psicologia do sono; distúrbios de sono e doença cardiovascular; distúrbios do sono com enfoque principal nos distúrbios respiratórios do sono: métodos diagnósticos, fisiopatologia, consequências e tratamento.
Site oficial: https://limhc.fm.usp.br/portal/lim-63-laboratorio-de-investigacao-medica-em-sono/
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Coleções desta Comunidade
- LIM/63 - Laboratório de Investigação Médica em Sono
- LIM/63 - Laboratório de Investigação Médica em Sono
- LIM/63 - Laboratório de Investigação Médica em Sono
Submissões Recentes
Obstructive sleep apnea and falls in COPD patients: a cross-sectional and follow-up study
(2023) CENSO, Caroline Maschio de; PASSINI, Viviane Vieira; VERRI, Barbara Aparecida Teodoro Alcantara; PINTO, Regina Maria De Carvalho; STELMACH, Rafael; XAVIER, Rafaella Fagundes; LORENZI-FILHO, Geraldo; CARVALHO, Celso Ricardo Fernandes De
Oral Breathing Among Obstructive Sleep Apnea Patients Is Associated With Minute Ventilation and Ventilatory Drive
(2023) FINNSSON, E.; FARIAS, G.; AGUSTSSON, J.; LORENZI-FILHO, G.; VENA, D.; WELLMAN, D.; SANDS, S. A.; GENTA, P.
Postural balance assessment in fallers individuals with COPD before and after physical effort
(2023) CENSO, Caroline Maschio de; PASSINI, Viviane Vieira; VERRI, Barbara Aparecida Teodoro Alcantara; PINTO, Regina Maria De Carvalho; STELMACH, Rafael; XAVIER, Rafaella Fagundes; LORENZI-FILHO, Geraldo; CARVALHO, Celso Ricardo Fernandes De
Efficacy of Oral Furosemide Test for Primary Aldosteronism Diagnosis
(2023) FREITAS, Thais C.; MACIEL, Ana Alice W.; FAGUNDES, Gustavo F. C.; PETENUCI, Janaina; SANTANA, Lucas S.; GUIMARAES, Augusto G.; FREITAS-CASTRO, Felipe; SROUGI, Victor; TANNO, Fabio Y.; CHAMBO, Jose L.; PEREIRA, Maria Adelaide A.; BRITO, Luciana P.; PIO-ABREU, Andrea; BORTOLOTTO, Luiz A.; LATRONICO, Ana Claudia; V, Maria Candida B. Fragoso; DRAGER, Luciano F.; MENDONCA, Berenice B.; ALMEIDA, Madson Q.
Context: Confirmatory tests represent a fundamental step in primary aldosteronism (PA) diagnosis, but they are laborious and often require a hospital environment due to the risks involved.Objective: To evaluate the efficacy of oral furosemide as a new confirmatory test for PA diagnosis.Methods: We prospectively evaluated the diagnostic performance of 80 mg of oral furosemide in 64 patients with PA and 22 with primary hypertension (controls). Direct renin concentration (DRC) was measured before, and 2 hours and 3 hours after the oral furosemide. In addition, the oral furosemide test was compared with 2 other confirmatory tests: the furosemide upright test (FUT) and saline infusion test (SIT) or captopril challenge test (CCT) in all patients with PA.Results: The cut-off of 7.6 mu U/mL for DRC at 2 hours after oral furosemide had a sensitivity of 92%, specificity of 82%, and accuracy of 90% for PA diagnosis. In 5 out of 6 controls with low-renin hypertension, which might represent a PA spectrum, renin remained suppressed. Excluding these 6 controls with low-renin hypertension, the DRC cut-off of 10 mu U/mL at 2 hours after oral furosemide had a sensitivity of 95.3%, specificity of 93.7% and accuracy of 95% for PA diagnosis. DRC after 3 hours of oral furosemide did not improve diagnostic performance. Using the cut-off of 10 mu U/mL, the oral furosemide test and the FUT were concordant in 62 out of 64 (97%) patients with PA. Only 4 out of 64 cases with PA (6.4%) ended the oral furosemide test with potassium <3.5 mEq/L. Hypotension was not evidenced in any patient with PA during the test.Conclusion: The oral furosemide test was safe, well-tolerated and represents an effective strategy for PA investigation.
Cost-Utility Analysis of Continuous Positive Airway Pressure Therapy Compared With Usual Care for Obstructive Sleep Apnea in the Public Health System in Brazil
(2024) PACHITO, Daniela V.; ECKELI, Alan L.; DRAGER, Luciano F.
Objectives: This study aimed to conduct a cost-utility analysis of continuous positive airway pressure (CPAP) therapy compared with usual care as treatment of moderate to severe cases of obstructive sleep apnea (OSA) in Brazil, where decentralized policies of CPAP provision are in place.Methods: Markov cohort model comparing CPAP therapy with usual care, that is, no specific treatment for OSA, for moderate to severe cases was used. The payer perspective from the Unified Health System, Brazil, was adopted. Effectiveness parameters and costs related to health states were informed by literature review. Resource use related to CPAP therapy was defined by specialists and costs informed by recent purchase and leasing contracts. Incremental cost-effectiveness ratios were generated for purchase and leasing contracts to reflect current practices. A conservative willingness-to-pay threshold was set at 1 gross domestic product per capita per quality-adjusted life-year (QALY) (Brazilian reais [BRL] 40 712/QALY). Uncertainties were explored in deterministic and probabilistic sensitivity analyses.Results: Incremental cost-effectiveness ratio for the purchase modality was 8303 BRL/QALY and for leasing 45 192 BRL/QALY. Considering the adopted willingness-to-pay threshold, provision of CPAP by the purchase modality was considered costeffective but not the leasing modality. The parameter related to the greatest uncertainty was the reduction in the risk of having a stroke attributable to CPAP. Probabilistic analysis confirmed the robustness of results.Conclusions: CPAP therapy is a cost-effective alternative compared with usual care for moderate to severe OSA for the purchase modality. These results should help underpinning the decision making related to a uniform policy of CPAP provision across the country.