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Sleep Apnea Syndromes: HELP
Articles from USP Medical School
Based on 121 articles published since 2009
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These are the 121 published articles about Sleep Apnea Syndromes that originated from USP Medical School during 2009-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5
1 Editorial Revaluing the role of the tongue in obstructive sleep apnea. 2019

Cahali, Michel Burihan. ·. Departamento de Otorrinolaringologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil. · . Hospital do Servidor Público Estadual de São Paulo, São Paulo (SP) Brasil. ·J Bras Pneumol · Pubmed #31508674.

ABSTRACT: -- No abstract --

2 Editorial Palatopharyngeus muscle: the key in the pharyngoplasty surgeries for obstructive sleep apnea. 2019

Sennes, Luiz Ubirajara. ·Universidade de São Paulo (USP), Faculdade de Medicina, Disciplina de Otorrinolaringologia, São Paulo, SP, Brazil; Universidade de São Paulo (USP), Programa de Pós-Graduação em Otorrinolaringologia, São Paulo, SP, Brazil. Electronic address: lsennes@usp.br. ·Braz J Otorhinolaryngol · Pubmed #31122884.

ABSTRACT: -- No abstract --

3 Editorial Is obstructive sleep apnoea an innocent bystander in the pathophysiology of arterial stiffening? 2018

Phillips, Craig L / Drager, Luciano F. ·CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia. · Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia. · Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia. · Hypertension Unit, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil. · Hypertension Unit, Renal Division, University of Sao Paulo Medical School, Sao Paulo, Brazil. ·Thorax · Pubmed #30194093.

ABSTRACT: -- No abstract --

4 Editorial Sealing the Leak: A Step Forward in Improving CPAP Adherence. 2018

Genta, Pedro R / Lorenzi-Filho, Geraldo. ·Pulmonary Division, Heart Institute (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil. · Pulmonary Division, Heart Institute (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil. Electronic address: geraldo.lorenzi@gmail.com. ·Chest · Pubmed #29626967.

ABSTRACT: -- No abstract --

5 Editorial Are we missing obstructive sleep apnea diagnosis? 2017

Lorenzi-Filho, G / Genta, P R / Drager, L F. ·Sleep Laboratory, Pulmonary Division, Instituto do Coração, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. Electronic address: geraldo.lorenzi@gmail.com. · Sleep Laboratory, Pulmonary Division, Instituto do Coração, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. · Sleep Laboratory, Pulmonary Division, Instituto do Coração, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Hypertension Unit, Instituto do Coração, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. ·Rev Port Pneumol (2006) · Pubmed #28219608.

ABSTRACT: -- No abstract --

6 Editorial Type I diabetes: a new risk factor for obstructive sleep apnea. 2015

Lorenzi-Filho, Geraldo / Drager, Luciano F. ·Pulmonary Division, Sleep Laboratory; Hospital das Clinicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil. Electronic address: geraldo.lorenzi@gmail.com. · Hypertension Unit, Heart Institute (InCor), Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brasil. ·Rev Port Pneumol (2006) · Pubmed #25926366.

ABSTRACT: -- No abstract --

7 Review Obesity hypoventilation syndrome: a current review. 2018

Athayde, Rodolfo Augusto Bacelar de / Oliveira Filho, José Ricardo Bandeira de / Lorenzi Filho, Geraldo / Genta, Pedro Rodrigues. ·. Serviço de Pneumologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil. · . Laboratório do Sono, Disciplina de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil. ·J Bras Pneumol · Pubmed #30726328.

ABSTRACT: Obesity hypoventilation syndrome (OHS) is defined as the presence of obesity (body mass index ≥ 30 kg/m²) and daytime arterial hypercapnia (PaCO2 ≥ 45 mmHg) in the absence of other causes of hypoventilation. OHS is often overlooked and confused with other conditions associated with hypoventilation, particularly COPD. The recognition of OHS is important because of its high prevalence and the fact that, if left untreated, it is associated with high morbidity and mortality. In the present review, we address recent advances in the pathophysiology and management of OHS, the usefulness of determination of venous bicarbonate in screening for OHS, and diagnostic criteria for OHS that eliminate the need for polysomnography. In addition, we review advances in the treatment of OHS, including behavioral measures, and recent studies comparing the efficacy of continuous positive airway pressure with that of noninvasive ventilation.

8 Review Neurostimulation Treatment of OSA. 2018

Fleury Curado, Thomaz / Oliven, Arie / Sennes, Luiz U / Polotsky, Vsevolod Y / Eisele, David / Schwartz, Alan R. ·Division of Pulmonary and Critical Care Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD; Department of Otorhinolaryngology, University of São Paulo Medical School, São Paulo, Brazil. Electronic address: tfleury2@jhmi.edu. · Department of Medicine, Bnai Zion Medical Center, Technion, Haifa, Israel. · Department of Otorhinolaryngology, University of São Paulo Medical School, São Paulo, Brazil. · Division of Pulmonary and Critical Care Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD. · Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, MD. ·Chest · Pubmed #30222959.

ABSTRACT: Over the past 30 years, hypoglossal nerve stimulation has moved through a development pathway to become a viable treatment modality for patients with OSA. Initial pilot studies in animals and humans laid the conceptual foundation for this approach, leading to the development of fully implantable stimulating systems for therapeutic purposes. These devices were then shown to be both safe and efficacious in feasibility studies. One such closed-loop stimulating device was found to be effective in treating a limited spectrum of apneic patients and is currently approved by the US Food and Drug Administration for this purpose. Another open-loop stimulating system is currently being rigorously tested in a pivotal trial. Collectively, clinical trials of hypoglossal nerve stimulating systems have yielded important insights that can help optimize therapeutic responses to hypoglossal nerve stimulation. These insights include specific patient selection criteria and methods for delivering stimulation to specific portions of the hypoglossal nerve and/or genioglossus muscle. New approaches for activating efferent and afferent motor pathways are currently in early-stage laboratory development and hold some long-term promise as a novel therapy.

9 Review Strategies to manage obstructive sleep apnea to decrease the burden of atrial fibrillation. 2018

Goes, Creuza M / Falcochio, Paola P N F / Drager, Luciano F. ·a Heart Institute (InCor) , University of Sao Paulo Medical School , Sao Paulo , Brazil. ·Expert Rev Cardiovasc Ther · Pubmed #30136604.

ABSTRACT: INTRODUCTION: In the last decades, consistent data derived from experimental, epidemiological, and clinical studies pointed obstructive sleep apnea (OSA), the most common sleep disordered breathing worldwide, as a potential risk factor for incidence and recurrence of atrial fibrillation (AF). Areas covered: This review article describes the impact of OSA on AF and discusses potential strategies for managing OSA in the AF scenario. Expert commentary: Untreated OSA seems to be one important predictor of AF treatment failure after chemical or electrical cardioversion as well as after a successful AF ablation. There is biological plausibility for this association including the effects of intermittent hypoxia and sleep fragmentation promoting sympathetic activation, blood pressure instability, inflammation, and oxidative stress. The negative swings derived from the obstructive events also increases left ventricle afterload contributing to cardiac remodeling. Altogether, these factors provide a structural and electrical substrate for AF. Despite this evidence, however, OSA remains still poorly recognized and consequently undertreated in clinical practice. Therefore, active programs to incorporate valid screening for cardiologists to work in partnership to sleep medicine experts may ultimately contribute to decreasing the burden of AF.

10 Review Treatment of obstructive sleep apnoea as primary or secondary prevention of cardiovascular disease: where do we stand now? 2018

Drager, Luciano F / Lee, Chi-Hang. ·Hypertension Unit, Heart Institute (InCor). · Hypertension Unit, Renal Division, University of Sao Paulo Medical School, Sao Paulo, Brazil. · Department of Cardiology, National University Heart Centre, Singapore, Singapore. ·Curr Opin Pulm Med · Pubmed #30124525.

ABSTRACT: PURPOSE OF REVIEW: The aim of this study was to provide an update of the primary and secondary prevention of obstructive sleep apnoea (OSA) treatment on cardiovascular disease. RECENT FINDINGS: Consistent evidence suggest that OSA can contribute to cardiovascular diseases, including hypertension, atrial fibrillation, coronary artery disease and stroke. In patients with no previous history of cardiovascular events (primary prevention scenario), observational studies suggest that continuous positive airway pressure (CPAP), the main treatment for OSA, is able to prevent hypertension incidence and to decrease nonfatal cardiovascular events in men and fatal cardiovascular events in men, women and elderly. In patients with a previous history of cardiovascular events (secondary prevention scenario), recent randomized trials showed that CPAP was not able to prevent a new cardiovascular event. These findings may suggest that in patients with high cardiovascular risk and multiple comorbidities, OSA may not have an incremental role on cardiovascular disease. However, a subanalysis from the same trials showed that good CPAP compliance was able to prevent cerebrovascular events. SUMMARY: OSA may predispose to cardiovascular disease, but additional efforts for improving CPAP use or development of new treatments may help to understand the magnitude of OSA on cardiovascular disease.

11 Review Sleep Apnea and Cardiovascular Disease: Lessons From Recent Trials and Need for Team Science. 2017

Drager, Luciano F / McEvoy, R Doug / Barbe, Ferran / Lorenzi-Filho, Geraldo / Redline, Susan / Anonymous1150926. ·From Hypertension Unit (L.F.D.) and Sleep Laboratory, Pulmonary Division (G.L.-F.), Instituto do Coracao, and Hypertension Unit, Renal Division (L.F.D.), University of São Paulo Medical School, Brazil · Adelaide Institute for Sleep Health, College of Medicine and Public Health, and School of Medicine, Faculty of Medicine, Nursing, and Health Sciences, Flinders University, Australia (R.D.M.) · Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Australia (R.D.M.) · Respiratory Department, Institut de Recerca Biomèdica de Lleida, Lleida and Centro de Investigacion Biomedica en Red de Enfermedades Respiratorias, Madrid, Spain (F.B.) · and Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (S.R.). ·Circulation · Pubmed #29109195.

ABSTRACT: Emerging research highlights the complex interrelationships between sleep-disordered breathing and cardiovascular disease, presenting clinical and research opportunities as well as challenges. Patients presenting to cardiology clinics have a high prevalence of obstructive and central sleep apnea associated with Cheyne-Stokes respiration. Multiple mechanisms have been identified by which sleep disturbances adversely affect cardiovascular structure and function. Epidemiological research indicates that obstructive sleep apnea is associated with increases in the incidence and progression of coronary heart disease, heart failure, stroke, and atrial fibrillation. Central sleep apnea associated with Cheyne-Stokes respiration predicts incident heart failure and atrial fibrillation; among patients with heart failure, it strongly predicts mortality. Thus, a strong literature provides the mechanistic and empirical bases for considering obstructive sleep apnea and central sleep apnea associated with Cheyne-Stokes respiration as potentially modifiable risk factors for cardiovascular disease. Data from small trials provide evidence that treatment of obstructive sleep apnea with continuous positive airway pressure improves not only patient-reported outcomes such as sleepiness, quality of life, and mood but also intermediate cardiovascular end points such as blood pressure, cardiac ejection fraction, vascular parameters, and arrhythmias. However, data from large-scale randomized controlled trials do not currently support a role for positive pressure therapies for reducing cardiovascular mortality. The results of 2 recent large randomized controlled trials, published in 2015 and 2016, raise questions about the effectiveness of pressure therapies in reducing clinical end points, although 1 trial supported the beneficial effect of continuous positive airway pressure on quality of life, mood, and work absenteeism. This review provides a contextual framework for interpreting the results of recent studies, key clinical messages, and suggestions for future sleep and cardiovascular research, which include further consideration of individual risk factors, use of existing and new multimodality therapies that also address adherence, and implementation of trials that are sufficiently powered to target end points and to support subgroup analyses. These goals may best be addressed through strengthening collaboration among the cardiology, sleep medicine, and clinical trial communities.

12 Review Treating OSA: Current and emerging therapies beyond CPAP. 2017

Lorenzi-Filho, Geraldo / Almeida, Fernanda R / Strollo, Patrick J. ·Sleep Laboratory, Pulmonary Division, Heart Institute, Faculty of Medicine, University of São Paulo, São Paulo, Brazil. · Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada. · Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine and Veterans Administration Pittsburgh Health System, Pittsburgh, PA, USA. ·Respirology · Pubmed #28901030.

ABSTRACT: Continuous positive airway pressure (CPAP) is the standard treatment for moderate-to-severe obstructive sleep apnoea (OSA). However, adherence to CPAP is limited and non-CPAP therapies are frequently explored. Oral appliance (OA) therapy is currently widely used for the treatment of snoring, mild, moderate and severe OSA. The most commonly used and studied OA consists of a maxillary and mandibular splint which hold the lower jaw forward during sleep. The efficacy of OA is inferior to CPAP; however, the effectiveness as measured by sleepiness, quality of life, endothelial function and blood pressure is similar likely due to higher acceptance and subjective adherence. Upper airway stimulation augments neural drive by unilaterally stimulating the hypoglossal nerve. The Stimulation Therapy for Apnea Reduction (STAR) study enrolled 126 patients and demonstrated a 68% reduction in OSA severity. A high upfront cost and variable response are the main limitations. Oropharyngeal exercises consist of a set of isometric and isotonic exercises involving the tongue, soft palate and lateral pharyngeal wall. The collective reported trials (n = 120) showed that oropharyngeal exercises can ameliorate OSA and snoring (~30-40%). Nasal EPAP devices consist of disposable one-way resister valve. A systematic review (n = 345) showed that nasal EPAP reduced OSA severity by 53%. The Winx device consists of a mouthpiece placed inside the oral cavity that is connected by tubing to a console that generates negative pressure. Winx may provide successful therapy for ~30-40% of OSA patients. In conclusion, several non-CPAP therapies to treat OSA are currently available.

13 Review Update in Sleep-disordered Breathing 2016. 2017

Ayas, Najib T / Drager, Luciano F / Morrell, Mary J / Polotsky, Vsevolod Y. ·1 Sleep Disorders Program and. · 2 Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. · 3 Hypertension Unit, Heart Institute (InCor) and. · 4 Hypertension Unit, Renal Division, University of Sao Paulo Medical School, Sao Paulo, Brazil. · 5 Sleep and Ventilation Unit, National Heart and Lung Institute, Imperial College London, London, United Kingdom. · 6 National Institute for Health Research Respiratory Disease Biomedical Research Unit at the Royal Brompton and Harefield National Health Service Foundation Trust and Imperial College London, London, United Kingdom; and. · 7 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland. ·Am J Respir Crit Care Med · Pubmed #28530119.

ABSTRACT: -- No abstract --

14 Review OSA and cardiometabolic risk: What's the bottom line? 2017

Hoyos, Camilla M / Drager, Luciano F / Patel, Sanjay R. ·Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia. · Healthy Brain Ageing Program, School of Psychology, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia. · Hypertension Unit - Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil. · Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. ·Respirology · Pubmed #28161892.

ABSTRACT: Obstructive sleep apnoea (OSA) is a common condition characterized by repetitive upper airway obstruction during sleep. OSA promotes wide intrathoracic pressure swings, intermittent hypoxia and sleep fragmentation. Growing evidence derived from animal models mimicking the oxygen profile observed in patients with OSA as well as clinical studies support that this important sleep-disordered breathing is associated with increased cardiovascular risk. Although the precise mechanisms are not fully established, it is conceivable that the metabolic deregulation promoted by the components of OSA may have an important causal role in the poor cardiovascular prognosis. In this review, we summarize the potential role of OSA and its components on cardiometabolic disease. We also summarize evidence evaluating the impact of OSA treatment (notably continuous positive airway pressure) on reversing the metabolic deregulation promoted by OSA. Finally, we discuss the research agenda and perspectives for this important research area.

15 Review Screening for Obstructive Sleep Apnea in Patients with Atrial Fibrillation. 2017

Genta, Pedro R / Drager, Luciano F / Lorenzi Filho, Geraldo. ·Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas, University of São Paulo School of Medicine, Av Dr. Eneas de Carvalho Aguiar, 44, 8th Floor, São Paulo, São Paulo 05403-000, Brasil. · Hypertension Unit of the Renal Division and Heart Institute (InCor), Hospital das Clínicas, University of São Paulo School of Medicine, Av Dr. Eneas de Carvalho Aguiar, 44, 8th Floor, São Paulo, São Paulo 05403-000, Brasil. · Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas, University of São Paulo School of Medicine, Av Dr. Eneas de Carvalho Aguiar, 44, 8th Floor, São Paulo, São Paulo 05403-000, Brasil. Electronic address: geraldo.lorenzi@gmail.com. ·Sleep Med Clin · Pubmed #28159101.

ABSTRACT: Obstructive sleep apnea (OSA) and atrial fibrillation (AF) are common conditions in the adult population and independently associated with increased morbidity and mortality. There is evidence, although not definitive, that OSA independently contributes to AF incidence and recurrence. Full polysomnography is expensive and may not be readily available to diagnose all patients with OSA and AF. Several patients with OSA do not present the classical signs and symptoms of OSA, impairing the accuracy of screening questionnaires for OSA. In this context, home sleep test is a promising alternative to screen and diagnose OSA in AF patients. However, the cost-effectiveness of such approach need to be studied.

16 Review Managing obstructive sleep apnoea in children: the role of craniofacial morphology. 2016

Bozzini, Maria Fernanda Rabelo / Di Francesco, Renata Cantisani. ·Faculdade de Medicina da Universidade de São Paulo, São Paulo/SP, Brazil. · Faculdade de Medicina da Universidade de São Paulo, Departamento de Otorrinolaringologia, São Paulo/SP, Brazil. ·Clinics (Sao Paulo) · Pubmed #27982168.

ABSTRACT: Obstructive sleep apnoea syndrome is a type of sleep-disordered breathing that affects 1 to 5% of all children. Pharyngeal and palatine tonsil hypertrophy is the main predisposing factor. Various abnormalities are predisposing factors for obstructive sleep apnoea, such as decreased mandibular and maxillary lengths, skeletal retrusion, increased lower facial height and, consequently, increased total anterior facial height, a larger cranio-cervical angle, small posterior airway space and an inferiorly positioned hyoid bone. The diagnosis is based on the clinical history, a physical examination and tests confirming the presence and severity of upper airway obstruction. The gold standard test for diagnosis is overnight polysomnography. Attention must be paid to identify the craniofacial characteristics. When necessary, children should be referred to orthodontists and/or sleep medicine specialists for adequate treatment in addition to undergoing an adenotonsillectomy.

17 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.

18 Review Chronic Kidney Disease and Sleeping Disordered Breathing (SDB). 2016

Santos, Roberto Sávio Silva / Motwani, Shveta S / Elias, Rosilene Motta. ·Faculdade de Medicina da Universidade de São Paulo, Serviço de Nefrologia, Rua Dr. Enéas de Carvalho Aguiar 255, 7º andar, São Paulo, SP, Brazil. rosilenemotta@hotmail.com. ·Curr Hypertens Rev · Pubmed #26778199.

ABSTRACT: The outlines of the current manuscript are: 1. Re-establish the link between hypertension and SDB including prevalence, mechanism, and reversal of process (i.e. improvement in hypertension with improvement in SDB), why it is important-cardiovascular mortality with numbers. 2. Re-establish the link between hypertension and CKD including same points as above. Then ask if both CKD and SDB are combined, what happens to hypertension and cardiovascular mortality. 3. Lastly, talk about links between CKD and SDB on how each process feeds on the other and is a growing, common problem.

19 Review Management of Hypertension in Obstructive Sleep Apnea. 2015

Furlan, Sofia F / Braz, Caio V / Lorenzi-Filho, Geraldo / Drager, Luciano F. ·Hypertension Unit, Heart Institute (InCor), University of Sao Paulo Medical School, Av. Dr. Eneas Carvalho de Aguiar, 44, 05403-904, Sao Paulo, Brazil. · Hypertension Unit, Renal Division, University of Sao Paulo Medical School, Sao Paulo, Brazil. · Sleep Laboratory, Pulmonary Division, University of Sao Paulo Medical School, Sao Paulo, Brazil. · Hypertension Unit, Heart Institute (InCor), University of Sao Paulo Medical School, Av. Dr. Eneas Carvalho de Aguiar, 44, 05403-904, Sao Paulo, Brazil. luciano.drager@incor.usp.br. · Hypertension Unit, Renal Division, University of Sao Paulo Medical School, Sao Paulo, Brazil. luciano.drager@incor.usp.br. ·Curr Cardiol Rep · Pubmed #26482751.

ABSTRACT: Obstructive sleep apnea (OSA) is considered to be a secondary form of hypertension and in clinical practice OSA is frequently associated with hypertension, even if proof of causality cannot be established. Growing evidence suggests that OSA is associated with worse blood pressure control, alterations in night-time blood pressure dipping, increased target organ damage, and arterial stiffness in patients with hypertension. This review summarizes the current evidence for managing hypertension in patients with OSA. Particular focus will be devoted to discuss the impact of lifestyle changes, preferences for anti-hypertensive treatment in patients with OSA, and the effects of OSA treatment with continuous positive airway pressure on blood pressure.

20 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.

21 Review Effects of CPAP on body weight in patients with obstructive sleep apnoea: a meta-analysis of randomised trials. 2015

Drager, Luciano F / Brunoni, André R / Jenner, Raimundo / Lorenzi-Filho, Geraldo / Benseñor, Isabela M / Lotufo, Paulo A. ·Center of Clinical and Epidemiologic Research (CPCE),University of Sao Paulo, Sao Paulo, Brazil Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil Faculdade de Medicina (FMUSP), University of Sao Paulo, Sao Paulo, Brazil. · Center of Clinical and Epidemiologic Research (CPCE),University of Sao Paulo, Sao Paulo, Brazil. · Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil. · Center of Clinical and Epidemiologic Research (CPCE),University of Sao Paulo, Sao Paulo, Brazil Faculdade de Medicina (FMUSP), University of Sao Paulo, Sao Paulo, Brazil. ·Thorax · Pubmed #25432944.

ABSTRACT: INTRODUCTION: The impact of obstructive sleep apnoea (OSA) treatment with CPAP on weight is not clear. This meta-analysis was designed to assess whether OSA treatment with CPAP promotes changes in body mass index (BMI) and weight. METHODS: We searched PubMed, SCOPUS and Cochrane Central Register electronic databases through 1 October 2013 (including papers in press at that time), without language restrictions. We identified randomised trials of CPAP versus controls with a minimum treatment duration of 4 weeks that objectively measured BMI. Data were independently abstracted and reviewed by two investigators using a standardised protocol. RESULTS: We included a total of 3181 patients from 25 randomised trials that measured BMI and weight. All studies enrolled mainly overweight and obese patients. The fixed-effects meta-analysis revealed that CPAP promoted significant increase on BMI (Hedges' g=0.14, 95% CI 0.07 to 0.21, I(2)=16.2%) and weight (Hedges' g=0.17, 95% CI 0.10 to 0.24, I(2)=0%). The funnel plot revealed low risk of publication bias. Meta-regression analyses including age, gender, baseline BMI, baseline weight, OSA severity, CPAP compliance, use of sham CPAP, study duration, study design (crossover/parallel), study origin (Western/Eastern), recommendation for dietary changes or physical activity, revealed that no single predictor influenced the main outcome for weight. Baseline weight was a predictor of increased BMI after CPAP. CONCLUSIONS: OSA treatment with CPAP promotes significant increase in BMI and weight. Additional therapies for body weight reduction must be recommended for overweight or obese patients with OSA initiated on CPAP.

22 Review Bariatric surgery--an update for the endocrinologist. 2014

Mancini, Marcio C. ·Endocrinology & Metabolism Department, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil. ·Arq Bras Endocrinol Metabol · Pubmed #25627042.

ABSTRACT: Obesity is a major public health problem, is associated with increased rates of mortality risk and of developing several comorbidities, and lessens life expectancy. Bariatric surgery is the most effective treatment for morbidly obese patients, reducing risk of developing new comorbidities, health care utilization and mortality. The establishment of centers of excellence with interdisciplinary staff in bariatric surgery has been reducing operative mortality in the course of time, improving surgical safety and quality. The endocrinologist is part of the interdisciplinary team. The aim of this review is to provide endocrinologists, physicians and health care providers crucial elements of good clinical practice in the management of morbidly obese bariatric surgical candidates. This information includes formal indications and contraindications for bariatric operations, description of usual bariatric and metabolic operations as well as endoscopic treatments, preoperative assessments including psychological, metabolic and cardiorespiratory evaluation and postoperative dietary staged meal progression and nutritional supplementation follow-up with micronutrient deficiencies monitoring, surgical complications, suspension of medications in type 2 diabetic patients, dumping syndrome and hypoglycemia.

23 Review Impact of the type of mask on the effectiveness of and adherence to continuous positive airway pressure treatment for obstructive sleep apnea. 2014

Andrade, Rafaela Garcia Santos de / Piccin, Vivien Schmeling / Nascimento, Juliana Araújo / Viana, Fernanda Madeiro Leite / Genta, Pedro Rodrigues / Lorenzi-Filho, Geraldo. ·University of São Paulo, School of Medicine, Hospital das Clínicas, São Paulo, Brazil. Sleep Laboratory, Department of Pulmonology, Heart Institute, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil. · University of São Paulo, School of Medicine, Heart Institute, São Paulo, Brazil. Sleep Laboratory, Department of Pulmonology, Heart Institute, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil. · University of São Paulo, School of Medicine, Hospital das Clínicas, Boston, MA, USA. Sleep Laboratory, Department of Pulmonology, Heart Institute, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil; and Postdoctoral Student, Division of Sleep Medicine, Brigham and Women's Hospital/Harvard University, Boston (MA) USA. ·J Bras Pneumol · Pubmed #25610507.

ABSTRACT: Continuous positive airway pressure (CPAP) is the gold standard for the treatment of obstructive sleep apnea (OSA). Although CPAP was originally applied with a nasal mask, various interfaces are currently available. This study reviews theoretical concepts and questions the premise that all types of interfaces produce similar results. We revised the evidence in the literature about the impact that the type of CPAP interface has on the effectiveness of and adherence to OSA treatment. We searched the PubMed database using the search terms "CPAP", "mask", and "obstructive sleep apnea". Although we identified 91 studies, only 12 described the impact of the type of CPAP interface on treatment effectiveness (n = 6) or adherence (n = 6). Despite conflicting results, we found no consistent evidence that nasal pillows and oral masks alter OSA treatment effectiveness or adherence. In contrast, most studies showed that oronasal masks are less effective and are more often associated with lower adherence and higher CPAP abandonment than are nasal masks. We concluded that oronasal masks can compromise CPAP OSA treatment adherence and effectiveness. Further studies are needed in order to understand the exact mechanisms involved in this effect.

24 Review Sleep disturbances and resistant hypertension: association or causality? 2014

Genta-Pereira, Daniel Castanho / Pedrosa, Rodrigo P / Lorenzi-Filho, Geraldo / Drager, Luciano F. ·Hypertension Unit, Heart Institute (InCor), University of São Paulo Medical School, Avenida Dr Eneas Carvalho de Aguiar, 44, 05403-900, São Paulo, Brazil. ·Curr Hypertens Rep · Pubmed #24913922.

ABSTRACT: Two main sleep disturbances, namely obstructive sleep apnea (OSA) and sleep deprivation, have gained growing interest in the field of hypertension research. This fact is supported not only by evidence that both disturbances are quite common in modern societies but also that OSA and sleep deprivation are associated with several pathways that may contribute to a predisposition to hypertension or even exacerbate blood pressure levels in hypertensive patients. In the present review, we will discuss current evidence supporting a potential role of these sleep disturbances in the resistant hypertension scenario.

25 Review Obstructive sleep apnea: a cardiometabolic risk in obesity and the metabolic syndrome. 2013

Drager, Luciano F / Togeiro, Sônia M / Polotsky, Vsevolod Y / Lorenzi-Filho, Geraldo. ·Heart Institute (InCor), University of Sáo Paulo Medical School, Sáo Paulo, Brazil. luciano.drager@incor.usp.br ·J Am Coll Cardiol · Pubmed #23770180.

ABSTRACT: Obstructive sleep apnea (OSA) is an underdiagnosed condition characterized by recurrent episodes of obstruction of the upper airway leading to sleep fragmentation and intermittent hypoxia during sleep. Obesity predisposes to OSA, and the prevalence of OSA is increasing worldwide because of the ongoing epidemic of obesity. Recent evidence has shown that surrogate markers of cardiovascular risk, including sympathetic activation, systemic inflammation, and endothelial dysfunction, are significantly increased in obese patients with OSA versus those without OSA, suggesting that OSA is not simply an epiphenomenon of obesity. Moreover, findings from animal models and patients with OSA show that intermittent hypoxia exacerbates the metabolic dysfunction of obesity, augmenting insulin resistance and nonalcoholic fatty liver disease. In patients with the metabolic syndrome, the prevalence of moderate to severe OSA is very high (∼60%). In this population, OSA is independently associated with increased glucose and triglyceride levels as well as markers of inflammation, arterial stiffness, and atherosclerosis. A recent randomized, controlled, crossover study showed that effective treatment of OSA with continuous positive airway pressure for 3 months significantly reduced several components of the metabolic syndrome, including blood pressure, triglyceride levels, and visceral fat. Finally, several cohort studies have consistently shown that OSA is associated with increased cardiovascular mortality, independent of obesity. Taken together, these results support the concept that OSA exacerbates the cardiometabolic risk attributed to obesity and the metabolic syndrome. Recognition and treatment of OSA may decrease the cardiovascular risk in obese patients.

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