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Sleep Apnea Syndromes: HELP
Articles from Universidade Federal de Sao Paulo
Based on 186 articles published since 2008

These are the 186 published articles about Sleep Apnea Syndromes that originated from Universidade Federal de Sao Paulo during 2008-2019.
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8
1 Editorial Sleep apnea as a potential threat to reproduction. 2014

Hirotsu, Camila / Tufik, Sergio / Levy Andersen, Monica. ·Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil. ·Sleep · Pubmed #25364067.

ABSTRACT: -- No abstract --

2 Editorial Can CPAP prevent myocardial damage? 2014

Poyares, Dalva / Oliveira, Wercules / Fujita, Luciane. ·Department of Psychobiology, Sleep Medicine and Biology Division, Universidade Federal de; São Paulo-Brazil. ·Anadolu Kardiyol Derg · Pubmed #24662582.

ABSTRACT: -- No abstract --

3 Review Obesity metabolic and hormonal disorders associated with obstructive sleep apnea and their impact on the risk of cardiovascular events. 2018

Carneiro, Glaucia / Zanella, Maria T. ·Disciplina de Endocrinologia, Departamento de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, Brazil. Electronic address: glauciacarneiro@uol.com.br. · Disciplina de Endocrinologia, Departamento de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, Brazil. ·Metabolism · Pubmed #29534971.

ABSTRACT: OBJECTIVE: To analyze metabolic and hormonal disorders resulting from the association between obesity and obstructive sleep apnea (OSA) syndrome that predispose to cardiovascular diseases and investigate the clinical benefits obtained from treatment approaches for both conditions. METHODS: A literature review between 1997 and 2017 was conducted in the PubMed search database. RESULTS: Obesity is the most important risk factor for OSA, and the progressive increase in its prevalence also affects OSA incidence. In addition, OSA may aggravate weight gain and obesity comorbidities. Both conditions lead to an increase in the risk of cardiovascular events and mortality. The gold standard treatment for moderate to severe OSA is CPAP, but significant reduction in major cardiovascular events was not observed in clinical trials. Body weight reduction appears effective to improve OSA, as long as it is maintained. Lifestyle modifications and drug therapy seem to be the preferred approach to treat obesity, but in severe obesity and moderate to severe OSA, bariatric surgery is probably the most adequate treatment. CONCLUSIONS: Weight control is essential to decrease the risk of cardiovascular events and mortality potentially linked to both obesity and OSA. CPAP seems to treat only OSA without decreasing these risks. Other treatment strategies are lifestyle modifications and drug therapy, which need further investigation as well as bariatric surgery for severe cases.

4 Review Sleepiness in Children: An Update. 2017

Moreira, Gustavo Antonio / Pradella-Hallinan, Marcia. ·Department of Psychobiology, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925, São Paulo, São Paulo 04024-002, Brazil; Department of Pediatrics, Universidade Federal de São Paulo, Rua Botucatu, 598, São Paulo, São Paulo 04023-062, Brazil. Electronic address: gustavo_a_moreira@hotmail.com. · Department of Psychobiology, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925, São Paulo, São Paulo 04024-002, Brazil. ·Sleep Med Clin · Pubmed #28778238.

ABSTRACT: Sleep is essential for children's learning, memory processes, school performance, and general well-being. The prevalence of sleepiness in children is approximately 4%. Reductions of sleep duration have daytime consequences, including sleepiness, behavior problems, cognitive deficits, poor school performance, inflammation, and metabolic dysfunction. Chronic pain, movement disorders, and sleep-disordered breathing also may lead to daytime somnolence, inattention, hyperactivity, oppositional behaviors, and mood dysregulation. Parent-report questionnaires are useful tools to assess subjective sleepiness in children. Sleepiness in children may be secondary to a sleep problem, such as narcolepsy, central hypersomnia, Kleine-Levin disease, or circadian rhythm disorder.

5 Review Pharmacotherapy for residual excessive sleepiness and cognition in CPAP-treated patients with obstructive sleep apnea syndrome: A systematic review and meta-analysis. 2016

Avellar, Ariane B C C / Carvalho, Luciane B C / Prado, Gilmar F / Prado, Lucila B F. ·Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil. · Neuro-Sono, Department of Neurology, Universidade Federal de São Paulo, Brazil. · Neuro-Sono, Department of Neurology, Universidade Federal de São Paulo, Brazil. Electronic address: neuro.sono.unifesp@gmail.com. ·Sleep Med Rev · Pubmed #27865102.

ABSTRACT: Pharmacotherapy has been used as an adjunct to CPAP for treatment of residual excessive sleepiness in patients with a diagnosis of obstructive sleep apnea syndrome (OSAS). However, no studies with a high level of evidence have been conducted to support this practice and confirm its effectiveness. We conducted a meta-analysis to summarize and quantify the effects of pharmacological treatment in adults with OSAS who experience residual excessive sleepiness despite adequate CPAP use. We reviewed clinical trials that compared medications to placebo and evaluated the outcomes residual excessive sleepiness, cognition, and quality of life, as well as treatment effectiveness and safety. The MEDLINE, EMBASE, LILACS, Cochrane Central Register of Controlled Trials - CENTRAL, and PsycINFO electronic databases were searched using highly sensitive search strategies. Trials were only included if measures were taken to ensure effective CPAP treatment. Eight randomized clinical trials were included. Pharmacotherapy with modafinil and armodafinil led to improvement of excessive daytime sleepiness, attention/alertness, and clinical condition as measured with the CGI-C. No improvements in quality of life or other cognitive domains (including memory, executive function, and language) could be confirmed. Pharmacotherapy did not cause any severe adverse effects, but was associated with significant dropout rates as compared with placebo. In conclusion, although our results demonstrate the effectiveness of pharmacological treatment as an adjunct to CPAP, further investigation is necessary to improve confidence in its effects. Many findings on the impact of pharmacotherapy on cognition and quality of life were evaluated through analysis of single studies, with heterogeneity in tests and absence of standardization, which reduced certainty as to whether actual improvement occurred in these outcomes.

6 Review Oral appliances and functional orthopaedic appliances for obstructive sleep apnoea in children. 2016

Carvalho, Fernando R / Lentini-Oliveira, Débora A / Prado, Lucila Bf / Prado, Gilmar F / Carvalho, Luciane Bc. ·Neuro-Sono Sleep Center, Department of Neurology, Universidade Federal de São Paulo, Rua Americo Salvador Novelli 508, São Paulo, São Paulo, Brazil, 08210-090. ·Cochrane Database Syst Rev · Pubmed #27701747.

ABSTRACT: BACKGROUND: Apnoea is a breathing disorder marked by the absence of airflow at the nose or mouth. In children, risk factors include adenotonsillar hypertrophy, obesity, neuromuscular disorders and craniofacial anomalies. The most common treatment for obstructive sleep apnoea syndrome (OSAS) in childhood is adeno-tonsillectomy. This approach is limited by its surgical risks, mostly in children with comorbidities and, in some patients, by recurrence that can be associated with craniofacial problems. Oral appliances and functional orthopaedic appliances have been used for patients who have OSAS and craniofacial anomalies because they hold the lower jaw (mandible) forwards which potentially enlarges the upper airway and increases the upper airspace, improving the respiratory function. OBJECTIVES: To assess the effects of oral appliances or functional orthopaedic appliances for obstructive sleep apnoea in children. SEARCH METHODS: We searched the following electronic databases: Cochrane Oral Health's Trials Register (to 7 April 2016); Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 3) in the Cochrane Library (searched 7 April 2016); MEDLINE Ovid (1946 to 7 April 2016); Embase Ovid (1980 to 7 April 2016); LILACS BIREME (from 1982 to 7 April 2016); BBO BIREME (from 1986 to 7 April 2016) and SciELO Web of Science (from 1997 to 7 April 2016). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials on 7 April 2016. We placed no restrictions on the language or date of publication when searching the electronic databases. SELECTION CRITERIA: All randomised or quasi-randomised controlled trials comparing all types of oral and functional orthopaedic appliances with placebo or no treatment, in children 15 years old or younger. PRIMARY OUTCOME: reduction of apnoea to less than one episode per hour. SECONDARY OUTCOMES: dental and skeletal relationship, sleep parameters improvement, cognitive and phonoaudiological function, behavioural problems, quality of life, side effects (tolerability) and economic evaluation. DATA COLLECTION AND ANALYSIS: Two review authors screened studies and extracted data independently. Authors were contacted for additional information. We calculated risk ratios with 95% confidence intervals for all important dichotomous outcomes. We assessed the quality of the evidence of included studies using GRADEpro software. MAIN RESULTS: The initial search identified 686 trials. Only one trial, reporting the results from a total of 23 children and comparing an oral appliance to no treatment, was suitable for inclusion in the review. The trial assessed apnoea-hypopnoea, daytime symptoms (sleepiness, irritability, tiredness, school problems, morning headache, thirstiness in the morning, oral breathing and nasal stuffiness) and night-time symptoms (habitual snoring, restless sleep and nightmares measured by questionnaire). Results were inconsistent across outcomes measures and time points. The evidence was considered very low quality. AUTHORS' CONCLUSIONS: There is insufficient evidence to support or refute the effectiveness of oral appliances and functional orthopaedic appliances for the treatment of obstructive sleep apnoea in children. Oral appliances or functional orthopaedic appliances may be considered in specified cases as an auxiliary in the treatment of children who have craniofacial anomalies which are risk factors for apnoea.

7 Review Challenges in the diagnosis and management of acromegaly: a focus on comorbidities. 2016

Abreu, Alin / Tovar, Alejandro Pinzón / Castellanos, Rafael / Valenzuela, Alex / Giraldo, Claudia Milena Gómez / Pinedo, Alejandro Castellanos / Guerrero, Doly Pantoja / Barrera, Carlos Alfonso Builes / Franco, Humberto Ignacio / Ribeiro-Oliveira, Antônio / Vilar, Lucio / Jallad, Raquel S / Duarte, Felipe Gaia / Gadelha, Mônica / Boguszewski, Cesar Luiz / Abucham, Julio / Naves, Luciana A / Musolino, Nina Rosa C / de Faria, Maria Estela Justamante / Rossato, Ciliana / Bronstein, Marcello D. ·Endocrinology Unit, Centro Médico Imbanaco Cali, Cali, Colombia. · Internal Medicine Department, Hospital of Neiva, University Surcolombiana, Neiva, Colombia. · Internal Medicine Department, University Industrial of Santander, Bucaramanga, Colombia. · Department of Internal Medicine, Endocrinology Fundación Cardio-Infantil, Instituto de Cardiología, Universidad del Rosario, Bogotá, Colombia. · Endocrinology Unit, Hospital Universitario San Ignacio, Bogotá, Colombia. · Internal Medicine Department, Hospital San Jerónimo de Montería, Montería, Córdoba, Colombia. · Endocrinology Unit, Hospital Universitario Departamental de Nariño, CENTRO de Endocrinologia CENDOO, Universidad Nacional de Colombia, Pasto, Colombia. · Endocrinology Department, Hospital Universitario San Vicente Fundación, Universidad de Antioquia, Medellín, Colombia. · Endocrinology Faculty, Universidad Caldas, Manizales, Colombia. · Federal University of Minas Gerais, Belo Horizonte, Brazil. · Endocrinology and Chair, Division of Endocrinology, Hospital das Clínicas, Pernambuco Federal University Medical School, Recife, Brazil. · Neuroendocrine Unit, Division of Endocrinology and Metabolism, Hospital das Clínicas, University of São Paulo Medical School, Av. Dr. Eneas de Carvalho, 255, 7ºandar, sala 7037, São Carlos, SP, CEP 05403-000, Brazil. · Endocrine Section, Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil. · Department of Internal Medicine, Endocrine Division (SEMPR), Federal University of Paraná, Curitiba, Brazil. · Neuroendocrine Unit, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil. · Department of Endocrinology, Faculty of Medicine, University of Brasilia, Brasília, Brazil. · Neuroendocrine Unit, Division of Neurosurgery, Hospital das Clínicas, University of Sao Paulo School of Medicine, São Paulo, SP, Brazil. · Department of Odontology, Central Unit, Hospital das Clínicas, University of Sao Paulo School of Medicine, São Paulo, SP, Brazil. · Neuroendocrine Unit, Division of Endocrinology and Metabolism, Hospital das Clínicas, University of São Paulo Medical School, Av. Dr. Eneas de Carvalho, 255, 7ºandar, sala 7037, São Carlos, SP, CEP 05403-000, Brazil. mdbronstein@uol.com.br. ·Pituitary · Pubmed #27279011.

ABSTRACT: INTRODUCTION: Acromegaly is a rare, insidious disease resulting from the overproduction of growth hormone (GH) and insulin-like growth factor 1 (IGF-1), and is associated with a range of comorbidities. The extent of associated complications and mortality risk is related to length of exposure to the excess GH and IGF-1, thus early diagnosis and treatment is imperative. Unfortunately, acromegaly is often diagnosed late, when patients already have a wide range of comorbidities. The presence of comorbid conditions contributes significantly to patient morbidity/mortality and impaired quality of life. METHODS: We conducted a retrospective literature review for information relating to the diagnosis of acromegaly, and its associated comorbidities using PubMed. The main aim of this review is to highlight the issues of comorbidities in acromegaly, and to reinforce the importance of early diagnosis and treatment. FINDINGS AND CONCLUSIONS: Successful management of acromegaly goes beyond treating the disease itself, since many patients are diagnosed late in disease evolution, they present with a range of comorbid conditions, such as cardiovascular disease, diabetes, hypertension, and sleep apnea. It is important that patients are screened carefully at diagnosis (and thereafter), for common associated complications, and that biochemical control does not become the only treatment goal. Mortality and morbidities in acromegaly can be reduced successfully if patients are treated using a multimodal approach with comprehensive comorbidity management.

8 Review The role inflammatory response genes in obstructive sleep apnea syndrome: a review. 2016

de Lima, Francisco Fábio Ferreira / Mazzotti, Diego R / Tufik, Sergio / Bittencourt, Lia. ·Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925 Vila Clementino, São Paulo, SP, 04024-002, Brazil. · Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925 Vila Clementino, São Paulo, SP, 04024-002, Brazil. mazzottidr@gmail.com. ·Sleep Breath · Pubmed #26201496.

ABSTRACT: BACKGROUND: Obstructive sleep apnea syndrome (OSAS) has a negative impact on health and behavior of millions of individuals worldwide. The pathogenesis of this disorder is a multifactorial process related to a variety of mechanisms, including selective activation of inflammatory response pathways. A number of inflammatory factors, such as IL-6, IL-8, and TNF-α, can be found in high concentrations in subjects with OSAS and may serve as biological markers of this disease. The concentration of these cytokines contributes to weight gain in patients with OSAS and can also modify the risk of obesity-related metabolic disorders, especially insulin resistance. Nevertheless, the mechanisms by which specific genes are associated with these processes are still poorly known. In addition to gene expression studies, investigations aiming at the identification of epigenetic factors associated with OSAS are still scarce in the literature. The documented data support the hypothesis that the molecular changes that mediate inflammatory response are important mechanisms in the pathogenesis of OSAS, sleepiness, insulin resistance, visceral obesity, and cardiovascular disease, perhaps by leading to a more severe OSAS. Often, systemic changes may not be detected in mild OSA; however, molecular changes, which are much more sensitive to the mechanisms of intermittent hypoxia and oxidative stress, may be present. PURPOSE: This review aimed to show an updated view on the studies evaluating the genetic basis of inflammatory response in many aspects of OSAS and to highlight potential research areas not fully explored to date in this field.

9 Review Translational approaches to understanding metabolic dysfunction and cardiovascular consequences of obstructive sleep apnea. 2015

Drager, Luciano F / Polotsky, Vsevolod Y / O'Donnell, Christopher P / Cravo, Sergio L / Lorenzi-Filho, Geraldo / Machado, Benedito H. ·Hypertension Unit, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil; Hypertension Unit, Renal Division, University of São Paulo Medical School, São Paulo, Brazil; luciano.drager@incor.usp.br. · Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; · Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; · Department of Physiology, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil; · Sleep Laboratory, Pulmonary Division, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil; and. · Department of Physiology, School of Medicine of Ribeirao Preto, University of São Paulo, São Paulo, Brazil. ·Am J Physiol Heart Circ Physiol · Pubmed #26232233.

ABSTRACT: Obstructive sleep apnea (OSA) is known to be independently associated with several cardiovascular diseases including hypertension, myocardial infarction, and stroke. To determine how OSA can increase cardiovascular risk, animal models have been developed to explore the underlying mechanisms and the cellular and end-organ targets of the predominant pathophysiological disturbance in OSA-intermittent hypoxia. Despite several limitations in translating data from animal models to the clinical arena, significant progress has been made in our understanding of how OSA confers increased cardiovascular risk. It is clear now that the hypoxic stress associated with OSA can elicit a broad spectrum of pathological systemic events including sympathetic activation, systemic inflammation, impaired glucose and lipid metabolism, and endothelial dysfunction, among others. This review provides an update of the basic, clinical, and translational advances in our understanding of the metabolic dysfunction and cardiovascular consequences of OSA and highlights the most recent findings and perspectives in the field.

10 Review The bidirectional interactions between psoriasis and obstructive sleep apnea. 2015

Hirotsu, Camila / Nogueira, Heloisa / Albuquerque, Rachel G / Tomimori, Jane / Tufik, Sergio / Andersen, Monica L. ·Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, SP, Brazil. · Department of Dermatology, Universidade Federal de São Paulo, São Paulo, SP, Brazil. ·Int J Dermatol · Pubmed #26220730.

ABSTRACT: Psoriasis is a chronic inflammatory skin disorder which can impair general routine activities and has been closely related to poor quality of life. Pruritus and scratching are frequently observed, occurring mainly during sleep and precipitating nighttime arousals. Indeed, sleep quality has been shown to be negatively affected in psoriatic patients, in a close relationship with stress exposure and immune response. Although psoriasis is known to impair sleep, leading to insomnia, its association with obstructive sleep apnea (OSA) is controversial. Similarly, OSA is considered a multifactorial inflammatory disease, characterized by intermittent hypoxia, sleep fragmentation and autonomic dysfunction, with important outcomes on the cardiovascular and metabolic systems. Importantly, immunological activities and pro-inflammatory cytokines play a prominent role in both OSA and psoriasis. Currently it is not clear whether OSA is a risk factor for psoriasis development or if psoriasis is a possible predictor of OSA. Thus, our main purpose is to provide an overview of this intriguing relationship and show the current link between psoriasis and OSA in a bidirectional relationship.

11 Review Treatment of obstructive sleep apnea syndrome associated with stroke. 2015

Mello-Fujita, Luciane / Kim, Lenise Jihe / Palombini, Luciana de Oliveira / Rizzi, Camila / Tufik, Sergio / Andersen, Monica Levy / Coelho, Fernando Morgadinho. ·Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil. · Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil; Departamento de Neurologia e Neurocirurgia, Universidade Federal de São Paulo, São Paulo, Brazil. Electronic address: fernandomorgadinho@hotmail.com. ·Sleep Med · Pubmed #25953300.

ABSTRACT: The association between sleep-disordered breathing and stroke has been a subject of increased interest and research. Obstructive sleep apnea (OSA) is an important risk factor for stroke incidence and mortality. Moreover, OSA is a common clinical outcome after stroke, directly influencing the patient's recovery. The treatment of choice for OSA is positive airway pressure (PAP) support and the PAP appliance is considered the most recommended clinical management for the treatment of patients with cardiovascular complications. However, the implementation of PAP in stroke patients remains a challenge, considering the increased frequency of motor and language impairments associated with the cerebrovascular event. In the present study, we reviewed the main findings describing the association between stroke and OSA treatment with continuous positive airway pressure. We also discussed the types of OSA treatment, the different options and indications of PAP treatment, PAP adherence and the clinical outcomes after treatment.

12 Review Treatment of chronic insomnia disorder in menopause: evaluation of literature. 2015

Attarian, Hrayr / Hachul, Helena / Guttuso, Thomas / Phillips, Barbara. ·From the 1Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL; 2Departments of Psychobiology and Gynecology, Universidade Federal de São Paulo, São Paulo, Brazil; 3Department of Neurology, University at Buffalo School of Medicine, State University of New York, Buffalo, NY; and 4Department of Medicine, University of Kentucky College of Medicine, Lexington, KY. ·Menopause · Pubmed #25349958.

ABSTRACT: OBJECTIVE: Insomnia both as a symptom and as part of chronic insomnia disorder is quite common in menopause. Comorbid conditions, such as restless legs syndrome and obstructive sleep apnea, occur with high prevalence among perimenopausal women with insomnia. Insomnia in this population group is associated with adverse health outcomes, and there are no clear standards on how to treat it. METHODS: Based on extensive literature search, 76 articles were identified. Two authors independently graded evidence according to the Oxford Centre for Evidence-Based Medicine Levels of Evidence. RESULTS: Evaluation and treatment of other comorbid sleep disorders are recommended, as is cognitive-behavioral therapy for insomnia. Hormone therapy, eszopiclone, escitalopram, gabapentin, isoflavones, valerian, exercise, and hypnosis are suggested. Zolpidem, quiteiapine XL, citalopram, mirtazapine followed by long-acting melatonin, ramelteon, Pycnogenol, Phyto-Female Complex, yoga, and massage may be considered. Kampo formulas are not recommended. Acupuncture may not be suggested, and cognitive-behavioral therapy that is not tailored for insomnia probably should not be considered. CONCLUSIONS: Although a variety of interventions are shown to be helpful in improving sleep in menopause, there is a need for well-designed head-to-head trials with uniform outcome measures.

13 Review Sleep apnea: an underestimated cause of resistant hypertension. 2014

de Abreu-Silva, Erlon Oliveira / Beltrami-Moreira, Marina. ·Division of Interventional Cardiology, Federal University of Sao Paulo and Kidney Hospital, Address: 719 Dr. Bacelar Street apt 24. Sao Paulo-SP, Brazil Zip Code: 04026-001. erlon@terra.com.br. ·Curr Hypertens Rev · Pubmed #25392136.

ABSTRACT: Hypertension is a well established cardiovascular risk factor and its deleterious effects had already been largely studied. Although the benefits of adequate blood pressure (BP) control have already been demonstrated, the prevalence of persons who fail to achieve such control is alarming. A number of causes for uncontrolled hypertension can be listed. According to recent guidelines, obstructive sleep apnea (OSA) is an important, although neglected cause of hypertension that is resistant to optimal medical therapy. Specific treatment for OSA with continuous positive airway pressure (CPAP) can be a helpful adjunct to conventional pharmacological therapy to attain controlled BP levels.

14 Review The use of portable monitoring for sleep apnea diagnosis in adults. 2014

Oliveira, Marcia G / Garbuio, Silvério / Treptow, Erika C / Polese, Jessica F / Tufik, Sergio / Nery, Luiz E / Bittencourt, Lia. ·Departamento de Medicina - Universidade Federal de São Paulo, Disciplina de Pneumologia. Rua Pedro de Toledo, 720 - 3° andar - CEP: 04039-002 - São Paulo, Brasil. ·Expert Rev Respir Med · Pubmed #24308652.

ABSTRACT: Due to increasing demand for sleep services, there has been growing interest in ambulatory models of care for patients with obstructive sleep apnea (OSA). The implementation of alternative approaches to the current management by full polysomnography (PSG) in the sleep laboratory is necessary for diagnosing this syndrome due to the high cost of full-night PSG. A good alternative option for OSA diagnosis is portable monitoring (PM), which is known for its accuracy, ease of management and lower cost when compared with full PSG. PM has not been well validated for OSA diagnosis in patients with medical comorbidities or in elderly individuals and children. PM may be recommended as an alternative method to PSG for patients with high clinical risk for OSA. In the present review, we describe the use of PM for OSA diagnosis and evaluate the current progress, costs, limitations and applications of these devices in various groups of patients, particularly for patients with comorbid diseases.

15 Review Sleep disordered breathing in Parkinson's disease: a critical appraisal. 2014

da Silva-Júnior, Francisco P / do Prado, Gilmar F / Barbosa, Egberto R / Tufik, Sergio / Togeiro, Sônia M. ·Department of Neurology, Universidade de São Paulo (USP), R Dr Enéas Carvalho de Aguiar, 255, 5° andar, CEP 05403-000, São Paulo, Brazil. Electronic address: franciscops@hotmail.com. · Department of Neurology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil. · Department of Neurology, Universidade de São Paulo (USP), R Dr Enéas Carvalho de Aguiar, 255, 5° andar, CEP 05403-000, São Paulo, Brazil. · Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil. ·Sleep Med Rev · Pubmed #23886661.

ABSTRACT: Parkinson's disease (PD) is the second most common neurodegenerative disorder, characterized by resting tremor, rigidity, bradykinesia and postural instability, and is associated with non-motor features, including sleep abnormalities. The high prevalence of excessive daytime sleepiness and snoring in PD patients has led to the suggestion that sleep disordered breathing (SDB) is more common in these individuals than in normal subjects. We aimed to review the literature on SDB prevalence and its clinical repercussions in PD. A PubMed search was performed to identify controlled studies, published from January 1990 through October 2012, which addressed the prevalence of SDB diagnosed by polysomnography in idiopathic PD. From the seven studies included, five reported similar or lower prevalence of SDB in patients when compared to healthy age-matched controls. Two studies reported less oxyhemoglobin desaturation during sleep among patients. These results did not support the idea that PD patients are at increased risk of SDB and indicate that they may not present significant hypoxemia. The prevalence of obstructive sleep apnea syndrome and the long-term outcomes of disordered breathing events during sleep have not been adequately studied in PD.

16 Review Oxidative stress, cancer, and sleep deprivation: is there a logical link in this association? 2013

Noguti, Juliana / Andersen, Monica Levy / Cirelli, Chiara / Ribeiro, Daniel Araki. ·Department of Pathology, Federal University of São Paulo-UNIFESP, Sao Paulo, Brazil. ·Sleep Breath · Pubmed #23371889.

ABSTRACT: INTRODUCTION: Sleep disorders are associated with various human pathologies and interfere with biological processes essential for health and quality of life. On the other hand, cancer is one of the most common diseases worldwide with an average of 1,500 deaths per day in the USA. Is there a factor common to both sleep disorders and cancer that serves to link these conditions? DISCUSSION: It is a normal process for cellular metabolism to produce reactive oxidant series (ROS). However, when the production of ROS overcomes the antioxidant capacity of the cell to eliminate these products, the resulting state is called oxidative stress. Oxidative DNA damage may participate in ROS-induced carcinogenesis. Moreover, ROS are also produced in the sleep deprivation process. The aim of this article is to review pathways and mechanisms that may point to oxidative stress as a link between sleep deprivation and cancer.

17 Review Does physical exercise reduce excessive daytime sleepiness by improving inflammatory profiles in obstructive sleep apnea patients? 2013

Alves, Eduardo da Silva / Ackel-D'Elia, Carolina / Luz, Gabriela Pontes / Cunha, Thays Crosara Abrahão / Carneiro, Gláucia / Tufik, Sergio / Bittencourt, Lia Rita Azeredo / de Mello, Marco Tulio. ·Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo-UNIFESP, São Paulo, CEP: 04020-050, Brazil. ·Sleep Breath · Pubmed #22760814.

ABSTRACT: INTRODUCTION: Obstructive sleep apnea syndrome (OSAS) is associated with a variety of long-term consequences such as high rates of morbidity and mortality, due to excessive diurnal somnolence as well as cardiovascular and metabolic diseases. Obesity, recurrent episodes of upper airway obstruction, progressive hypoxemia, and sleep fragmentation during sleep cause neural, cardiovascular, and metabolic changes. These changes include activation of peripheral sympathetic nervous system and the hypothalamic-pituitary-adrenal axis, insulin sensitivity, and inflammatory cytokines alterations, which predispose an individual to vascular damage. DISCUSSION: Previous studies proposed that OSAS modulated the expression and secretion of inflammatory cytokines from fat and other tissues. Independent of obesity, patients with OSAS exhibited elevated levels of C-reactive protein, tumor necrosis factor-α and interleukin-6, which are associated with sleepiness, fatigue, and the development of a variety of metabolic and cardiovascular diseases. OSAS and obesity are strongly associated with each other and share many common pathways that induce chronic inflammation. Previous studies suggested that the protective effect of exercise may be partially attributed to the anti-inflammatory effect of regular exercise, and this effect was observed in obese patients. Although some studies assessed the effects of physical exercise on objective and subjective sleep parameters, the quality of life, and mood in patients with OSAS, no study has evaluated the effects of this treatment on inflammatory profiles. In this review, we cited some studies that directed our opinion to believe that since OSAS causes increased inflammation and has excessive daytime sleepiness as a symptom and being that physical exercise improves inflammatory profiles and possibly OSAS symptoms, it must be that physical exercise improves excessive daytime sleepiness due to its improvement in inflammatory profiles.

18 Review Portable monitoring devices in the diagnosis of obstructive sleep apnea: current status, advantages, and limitations. 2010

Polese, Jéssica Fábia / Santos-Silva, Rogério / Kobayashi, Rafael Freire / Pinto, Indira Nunes de Paula / Tufik, Sérgio / Bittencourt, Lia Rita Azeredo. ·Sleep Medicine and Biology Division, Psychobiology Department, Universidade Federal de São Paulo, São Paulo, Brasil. ·J Bras Pneumol · Pubmed #20835599.

ABSTRACT: Recent years have seen a growing interest in the use of portable monitoring devices for the diagnosis of obstructive sleep apnea syndrome. These have the potential to be used in lieu of the more complicated and uncomfortable alternative, polysomnography, which has long been considered to be the gold standard for the diagnosis of this relatively prevalent condition. Following their approval in 2008 by the Center of Medicare and Medicaid Services, the federal agency which administers Medicare and Medicaid in the United States, there has been extensive discussion about the utility and validity of these devices for use in the diagnosis of obstructive sleep apnea syndrome. Although there are various models of portable monitoring devices, the literature contains little information regarding how each device should be used in specific age groups, patients presenting comorbidities, and asymptomatic patients. Additionally, studies about the cost-effectiveness of this diagnostic method are scarce and conflicting. Therefore, this objective of this study was to review what has been learned about portable monitoring devices over time, as well as to examine the recent progress, advantages, limitations, and applications of these devices in the diagnosis of obstructive sleep apnea syndrome in different groups of patients.

19 Review Methods for increasing upper airway muscle tonus in treating obstructive sleep apnea: systematic review. 2010

Valbuza, Juliana Spelta / de Oliveira, Márcio Moysés / Conti, Cristiane Fiquene / Prado, Lucila Bizari F / de Carvalho, Luciane Bizari Coin / do Prado, Gilmar Fernandes. ·Department of Emergency Medicine and Evidence-Based Medicine, Universidade Federal de São Paulo (UNIFESP), Sao Paulo, Sao Paulo, Brazil. juspelta@hotmail.com ·Sleep Breath · Pubmed #20563659.

ABSTRACT: OBJECTIVE: Treatment of obstructive sleep apnea (OSA) using methods for increasing upper airway muscle tonus has been controversial and poorly reported. Thus, a review of the evidence is needed to evaluate the effectiveness of these methods. DESIGN: The design used was a systematic review of randomized controlled trials. DATA SOURCES: Data sources are from the Cochrane Library, Medline, Embase and Scielo, registries of ongoing trials, theses indexed at Biblioteca Regional de Medicina/Pan-American Health Organization of the World Health Organization and the reference lists of all the trials retrieved. REVIEW METHODS: This was a review of randomized or quasi-randomized double-blind trials on OSA. Two reviewers independently applied eligibility criteria. One reviewer assessed study quality and extracted data, and these processes were checked by a second reviewer. The primary outcome was a decrease in the apnea/hypopnea index (AHI) of below five episodes per hour. Other outcomes were subjective sleep quality, sleep quality measured by night polysomnography, quality of life measured subjectively and adverse events associated with the treatments. DATA SYNTHESIS: Three eligible trials were included. Two studies showed improvements through the objective and subjective analyses, and one study showed improvement of snoring, but not of AHI while the subjective analyses showed no improvement. The adverse events were reported and they were not significant. CONCLUSIONS: There is no accepted scientific evidence that methods aiming to increase muscle tonus of the stomatognathic system are effective in reducing AHI to below five events per hour. Well-designed randomized controlled trials are needed to assess the efficacy of such methods.

20 Review Evaluation of the upper airway in obstructive sleep apnoea. 2010

Togeiro, Sonia Maria G P / Chaves, Cauby M / Palombini, Luciana / Tufik, Sergio / Hora, Francisco / Nery, Luiz Eduardo. ·Sleep Institute, Universidade Federal de São Paulo (UNIFESP), São Paulo , Brazil. sonia@psicobio.epm.br ·Indian J Med Res · Pubmed #20308748.

ABSTRACT: The evaluation of the upper airway (UA) includes the physical examination of pharyngeal structures and a number of imaging techniques that vary from the mostly used lateral cephalometry and computed tomography to more sophisticated methods such as tri-dimensional magnetic resonance image (MRI). Other complex techniques addressing UA collapsibility assessed by measurement of pharyngeal critical pressure and negative expiratory pressure however are not routinely performed. These methods provide information about anatomic abnormalities and the level of pharyngeal narrowing or collapse while the patient is awake or asleep. Data suggest that individual patients have different patterns of UA narrowing. So, the best method for evaluating obstruction during obstructive events remains controversial. In general, in clinical practice physical examination including a systematic evaluation of facial morphology, mouth, nasal cavity and the pharynx as well as simple imaging techniques such as nasopharyngoscopy and cephalometry have been more routinely utilized. Findings associated with obstructive sleep apnoea (OSA) are UA narrowing by the lateral pharyngeal walls and enlargements of tonsils, uvula and tongue. Additionally cephalometry identifies the most significant craniofacial characteristics associated with this disease. MRI studies demonstrated that lateral narrowing of UA in OSA is due to parapharyngeal muscle hypertrophy and/or enlargement of non adipose soft tissues. The upper airway evaluation has indubitably contributed to understand the pathophysiology and the diagnosis of OSA and snoring. Additionally, it also helps to identify the subjects with increased OSA risk as well as to select the more appropriate modality of treatment, especially for surgical procedures.

21 Review Is there a connection between long airplane flight, venous thromboembolism, and sleep-disordered breathing? 2009

Lopes, Maria-Cecilia / da Silva, Henrique Salmazo / Bittencourt, Lia Rita A / Chervin, Ronald D / Tufik, Sergio. ·Department of Psychobiology in UNIFESP, R. Dr. Napoleão de Barros, 925, CEP: 04024-002, São Paulo, SP, Brazil. m.cecilialopes@psicobio.epm.br ·Sleep Med · Pubmed #18653382.

ABSTRACT: Commercial passenger flights have been increasing around the world. The effect of these flights on health is unclear. Venous thromboembolism has been noted after recent long-distance airplane flight, even in the absence of other risk factors. Hypoxia caused by the low ambient pressure during flights could contribute, and individuals with obstructive sleep apnea may be particularly vulnerable. The association between the effects of long airplane travel and sleep-disordered breathing deserves further study.

22 Review The effects of testosterone on sleep and sleep-disordered breathing in men: its bidirectional interaction with erectile function. 2008

Andersen, Monica Levy / Tufik, Sergio. ·Department of Psychobiology, Universidade Federal de São Paulo, Escola Paulista de Medicina (UNIFESP/EPM), Rua Napoleão de Barros, 925, Vila Clementino, SP 04024-002 São Paulo, Brazil. ·Sleep Med Rev · Pubmed #18519168.

ABSTRACT: As a major androgen with a key role in developing and maintaining male sexual characteristics, testosterone exerts a broad range of actions regulating several systems throughout human life. This article reviews data on the role of sleep in modulating endocrine release, as well as data on the effects of testosterone and androgen-replacement therapy on sleep architecture and breathing. This review also discusses the interaction of testosterone and sleep, with a particular emphasis on bilateral effects. Changes in nocturnal testosterone are sleep-related, with levels rising during sleep and falling on waking, whereas circadian effects are apparently marginal. Peak testosterone levels coincide with rapid-eye movement (REM) sleep onset. The decreasing sleep efficiency and numbers of REM sleep episodes with altered REM sleep latency observed in older men are associated with lower concentrations of circulating testosterone. The well-established male preponderance of sleep apnea suggests that sex hormones are involved in the pathogenesis of this breathing disorder. In addition, androgens are most certainly key players in the central and peripheral modulation of erectile function. Among other effects, sleep curtailment has been shown to lead to reduced levels of circulating androgens in healthy men and male rodents, and this highlights the biological significance of sleep homeostasis for endocrine regulation.

23 Clinical Trial The effect of the severity of obstructive sleep apnea syndrome on telomere length. 2016

Tempaku, Priscila Farias / Mazzotti, Diego Robles / Hirotsu, Camila / Andersen, Monica Levy / Xavier, Gabriela / Maurya, Pawan Kumar / Rizzo, Lucas Bortolotto / Brietzke, Elisa / Belangero, Sintia Iole / Bittencourt, Lia / Tufik, Sergio. ·Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brasil. · Laboratório Interdisciplinar de Neurociências Clínicas (LINC), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brasil. · Departamento de Morfologia e Genética, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brasil. · Amity Institute of Biotechnology, Amity University Uttar Pradesh, Noida, India. · Department of Psychiatry, University of Tuebingen, Tuebingen, Germany. · Grupo de Pesquisa em Neurociência Comportamental e Molecular do Transtorno Bipolar, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brasil. ·Oncotarget · Pubmed #27690344.

ABSTRACT: Aging is associated with an increase in the prevalence of obstructive sleep apnea syndrome (OSAS) as well as the shortening of telomeres. It is known that OSAS-related factors are stimuli that can contribute to the acceleration of cellular senescence. Thus, the present study aimed to compare the leukocyte telomere length (LTL) between OSAS patients and controls, as well as to verify the correlation between LTL and sleep parameters. We used DNA extracted of 928 individuals from EPISONO to measure the LTL by the quantitative real-time polymerase chain reaction. All individuals were subjected to one full-night polysomnography. LTL was significantly shorter in OSAS patients compared to controls. The results showed negative correlations between LTL and the following variables: apnea-hypopnea index, respiratory disturbance index, desaturation index and wake after sleep onset. LTL was positively correlated with sleep efficiency, total sleep time, basal, minimum and maximum oxygen saturation. Lastly, it was observed that OSAS severity was associated with shorter LTL even after adjusting for sex, age, years of schooling, body mass index, diabetes, stroke and heart attack. In conclusion, our study indicates the presence of an association between LTL and OSAS and a significant impact of severity of OSAS in telomeres shortening.

24 Clinical Trial The Effect of Donepezil on Arousal Threshold and Apnea-Hypopnea Index. A Randomized, Double-Blind, Cross-Over Study. 2016

Li, Yanru / Owens, Robert L / Sands, Scott / Orr, Jeremy / Moraes, Walter / DeYoung, Pamela / Smales, Erik / Jen, Rachel / Malhotra, Atul. ·1 Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China. · 2 Division of Pulmonary and Critical Care Medicine, University of California, San Diego, La Jolla, California. · 3 Division of Sleep Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. · 4 Department of Allergy, Immunology and Respiratory Medicine and Central Clinical School, Alfred and Monash University, Melbourne, Australia. · 5 Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil; and. · 6 Division of Respiratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada. ·Ann Am Thorac Soc · Pubmed #27442715.

ABSTRACT: RATIONALE: Obstructive sleep apnea (OSA) has multiple pathophysiological causes. A low respiratory arousal threshold (ArTh) and a high loop gain (unstable ventilatory control) can contribute to recurrent respiratory events in patients with OSA. Prior studies have shown that donepezil, an acetylcholinesterase inhibitor, might improve OSA, but the mechanism is unknown. OBJECTIVES: To determine whether a single dose of donepezil lowers the apnea-hypopnea index by modulating the ArTh or loop gain. METHODS: In this randomized, double-blind, crossover trial, 41 subjects with OSA underwent two polysomnograms with ArTh and loop gain evaluated, during which 10 mg of donepezil or placebo was administered. MEASUREMENTS AND MAIN RESULTS: Compared with placebo, sleep efficiency (77.2 vs. 71.9%; P = 0.015) and total sleep time decreased with donepezil (372 vs. 351 min; P = 0.004). No differences were found in apnea-hypopnea index (51.8 vs. 50.0 events/h; P = 0.576) or nadir oxygen saturation as determined by pulse oximetry (80.3 vs. 81.1%; P = 0.241) between placebo and donepezil, respectively. ArTh was not significantly changed (-18.9 vs. -18.0 cm H CONCLUSIONS: A single dose of donepezil did not appear to affect the overall severity of OSA in this patient group, and no consistent effects on ArTh or loop gain were observed. Donepezil may have minor effects on sleep architecture. Clinical trial registered with www.clinicaltrials.gov (NCT02264353).

25 Clinical Trial Quality-adjusted life-years gain and health status in patients with OSAS after one year of continuous positive airway pressure use. 2014

Rizzi, Camila F / Ferraz, Marcos B / Poyares, Dalva / Tufik, Sergio. ·Sleep Medicine and Biology Discipline, Psychobiology Department, Universidade Federal de Sao Paulo, Sao Paulo, Brazil. · Sleep Medicine and Biology Discipline, Psychobiology Department, Universidade Federal de Sao Paulo, Sao Paulo, Brazil: Sao Paulo Center for Health Economics - GRIDES, Universidade Federal de Sao Paulo, Sao Paulo, Brazil. ·Sleep · Pubmed #25325505.

ABSTRACT: STUDY OBJECTIVES: To estimate the health utility score and quality-adjusted life-years (QALY) index of obstructive sleep apnea syndrome (OSAS) in patients over 1 y of continuous positive airway pressure (CPAP) treatment. DESIGN: Longitudinal interventional study. SETTING: The study was carried out in Sao Paulo Sleep Institute, Brazil. PATIENTS AND PARTICIPANTS: Ninety-five patients with OSAS and with apnea-hypopnea index (AHI) > 20 of either sex, body mass index < 40 kg/m(2), and no previous contact with CPAP were included. INTERVENTIONS: The participants underwent baseline and titration polysomnographies, clinical evaluation, and ambulatory blood pressure (BP) measurement, completed Short-Form 6 Dimension Health Survey (SF-6D) and Epworth Sleepiness Scale (ESS) questionnaires, and implementation of CPAP. The patients were followed for 1 y. MEASUREMENTS AND RESULTS: The mean AHI and age were 57.6 ± 29.2 events/h and 53.3 ± 9.3 y, respectively. One year of CPAP treatment increased the health utility score from 0.611 ± 0.112 to 0.710 ± 0.121 (P < 0.01). Therefore, CPAP resulted in a mean gain of 0.092 QALY/patient. The improvements in utility scores were associated with decreases in the ESS after 1 mo, in systolic BP after 1 y, and in diastolic BP at 6 mo. BP normalization group (≤ 130/85 mmHg) showed higher QALY than that of the non-normalization group (0.10 ± 0.09 versus 0.05 ± 0.10; P = 0.03). One-year ESS score (P = 0.03), diastolic BP reduction P = 0.01) and baseline utility scores (P < 0.01) were significantly associated with QALY gain. CONCLUSION: This study showed a significant QALY/patient gain after 1 y of regular CPAP use. In addition, BP normalization was associated with higher QALY gain. Thus, utility studies can provide more complete analyses of the total benefits of CPAP treatment in patients with OSAS and should be encouraged.