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Alterações da rigidez arterial em doentes com síndrome de apneia obstrutiva do sono, sonolentos e não sonolentos / Maria Alexandra Pessoa de Jesus Mineiro Goulão Martins ; orient. Maria João Marques Gomes

Main Author Martins, Maria Alexandra Pessoa de Jesus Mineiro Goulão Secondary Author Gomes, Maria João Marques Language Português. Country Portugal. Publication Lisboa : NOVA Medical School, Faculdade de Ciências Médicas, 2017 Description 85 p. : il. ; 30 cm Dissertation Note or Thesis: Tese de Doutoramento, Medicina, Investigação Clínica, Universidade Nova de Lisboa
Topical name Obstructive sleep apnea
CDU 616 Classification Medicina
Investigação Clínic
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Monografia Biblioteca NMS|FCM
MAR21 TeseD-2017 Presencial/Restrito 20180133NL

Tese de Doutoramento, Medicina, Investigação Clínica, Universidade Nova de Lisboa

ABSTRACT: Introduction: The management in the treatment of obstructive sleep apnea (OSA) intends to be increasingly comprehensive because of the close link between OSA and cardiovascular disease, and it goes well beyond the cognitive component that usually leads to diagnosis. There are extensive publications that investigate the epidemiology of OSAS, and causal relationships between the two entities (OSAS and cardiovascular disease). Ideally, the identification of a biomarker which could, at an early stage, determine which individuals with OSAS are most affected by the cardiovascular system, would allow a great advance in the treatment of OSA. OSA is associated with increased arterial stiffness, evaluated by carotid-femoral pulse wave velocity, which is a marker of asymptomatic organ damage in the evaluation of hypertensive patients, predictive of cardiovascular mortality. There is an improvement after continuous positive airway treatment (CPAP) but, in the absence of daytime sleepiness, it is not known whether the same effect occurs in vascular endothelium. This study aim to assess differences in changes in arterial stiffness of two groups of patients, defined as having daytime sleepiness or not, after continuous positive airway pressure (CPAP) treatment. Methods: this is a prospective study that studied a selected cohort of consecutive male patients, under 65 years old, with moderate to severe OSA and without great number of comorbidities. All patients were referred to Sleep Consultation by snoring or other complaints suggestive of OSA. Patients were excluded if they had established cardiovascular disease beyond hypertension, diabetes or other chronic diseases, evaluated by chronic use of medication. Metabolic syndrome or dyslipidaemia were allowed. Daytime sleepiness was evaluated by Epworth Sleepiness Scale (ESS) and its was defined by ESS 10. The diagnosis was confirmed by home respiratory poligraphy. An ambulatory blood pressure (BP) monitoring and carotid-femoral pulse wave velocity (cf-PWV) measurements were performed, before and after four months under CPAP. Compliant patients, sleepy and non-sleepy, were compared using linear mixed effects regression models. A further stratified analysis was performed with non-sleepy patients. Results: 34 patients were recruited, with mean age 55.2 (7.9) years, 38.2% were sleepy, 79.4% with hypertension, 61.8% with metabolic syndrome and 82.4% with dyslipidaemia. In 61.2% of patients, hypertension was uncontrolled or was unknown. Sleepy patients presented a more severe OSAS than non-sleepy, with AHI 44.8 (19.0) vs 29.7 (15.7), p = 0.018. There were no differences in the other parameters evaluated - anthropometric, analytical and vascular - but the univariate analysis allowed to identify that cf-PWV was associated with daytime somnolence (p=0.004), systolic blood pressure in 24h (p0.001), systolic diurnal blood pressure (p0.001), nocturnal systolic blood pressure (p= 0.002), and metabolic syndrome (p= 0.025).There was a cf-PWV reduction after CPAP treatment (p=0.086), but the effects of treatment differed significantly between groups, with no changes in non-sleepy patients, while in sleepy patients a significant decrease was observed (p = 0.012). On multivariable regression, a significant interaction between time (CPAP) and sleepiness was found. Evaluating non-sleepy patients group under CPAP therapy, results showed that both higher pulse pressure and lower LDL-cholesterol levels at baseline were associated to higher cf-PWV changes. Conclusions: In a cohort of male patients with moderate to severe OSA, we found that patients with daytime sleepiness had a more severe OSA and presented a greater arterial stiffness improvement after CPAP therapy, independently from age and BP. Besides sleepiness, cf-PWV reduction after CPAP therapy was mainly associated to cardiovascular risk factors, and less to sleep study parameters.

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