Ângelo José Gonçalves Bós

Is sleep apnea a winter disease?: meteorologic and sleep laboratory evidence collected over 1 decade.

BACKGROUND The severity of obstructive sleep apnea increases by influence of conditions that are more frequent in winter. The hypothesis that the apnea-hypopnea index (AHI) of different patients undergoing polysomnography may be seasonally affected was tested. METHODS The retrospectively analyzed database included 7,523 patients of both sexes who underwent in-laboratory baseline polysomnography to investigate any complaint of disordered sleep, during 1 decade, between January 2000 and December 2009. Data on climate and air pollution were obtained from official organizations. AHI was the main outcome variable. Cosinor analysis, a statistical method for the investigation of time series, was used to detect seasonality. RESULTS The cosinor analysis confirmed the existence of a circannual pattern of AHI, with acrophase in winter and nadir during the summer. The seasonality is significant even after adjusting for sex, age, BMI, neck circumference, and relative air humidity. Median (25-75 interquartile range) AHI in the 6 months with colder weather was 17.8 (6.5-40.6/h), and in the warmer weather was 15.0 (5.7-33.2/h). The AHI correlated inversely with ambient temperature and directly with atmospheric pressure, relative air humidity, and carbon monoxide levels. Correlations with precipitation, particulate air matter < 10 μm, sulfur dioxide, and ozone were nonsignificant. CONCLUSIONS More sleep-disordered breathing events were recorded in winter than in other seasons. Cosinor analysis uncovered a significant seasonal pattern in the AHI of different patients undergoing polysomnography, independent of sex, age, BMI, neck circumference, and relative air humidity. This finding suggests that obstructive sleep apnea severity may be associated with other seasonal epidemiologic phenomena.

Original ResearchSleep DisordersIs Sleep Apnea a Winter Disease?: Meteorologic and Sleep Laboratory Evidence Collected Over 1 Decade

BACKGROUND The severity of obstructive sleep apnea increases by influence of conditions that are more frequent in winter. The hypothesis that the apnea-hypopnea index (AHI) of different patients undergoing polysomnography may be seasonally affected was tested. METHODS The retrospectively analyzed database included 7,523 patients of both sexes who underwent in-laboratory baseline polysomnography to investigate any complaint of disordered sleep, during 1 decade, between January 2000 and December 2009. Data on climate and air pollution were obtained from official organizations. AHI was the main outcome variable. Cosinor analysis, a statistical method for the investigation of time series, was used to detect seasonality. RESULTS The cosinor analysis confirmed the existence of a circannual pattern of AHI, with acrophase in winter and nadir during the summer. The seasonality is significant even after adjusting for sex, age, BMI, neck circumference, and relative air humidity. Median (25-75 interquartile range) AHI in the 6 months with colder weather was 17.8 (6.5-40.6/h), and in the warmer weather was 15.0 (5.7-33.2/h). The AHI correlated inversely with ambient temperature and directly with atmospheric pressure, relative air humidity, and carbon monoxide levels. Correlations with precipitation, particulate air matter < 10 μm, sulfur dioxide, and ozone were nonsignificant. CONCLUSIONS More sleep-disordered breathing events were recorded in winter than in other seasons. Cosinor analysis uncovered a significant seasonal pattern in the AHI of different patients undergoing polysomnography, independent of sex, age, BMI, neck circumference, and relative air humidity. This finding suggests that obstructive sleep apnea severity may be associated with other seasonal epidemiologic phenomena.

Indicadores demográficos e socioeconômicos associados à incapacidade funcional em idosos

This study analyzed the prevalence of functional disability in the elderly and its association with socioeconomic and demographic factors. This was a population-based cross-sectional study with a sample of 631 elders (≥ 60 years). The Katz index and Lawton scale, respectively, were used to evaluate basic and instrumental activities of daily living. Demographic and socioeconomic variables were analyzed. Numerical variables were tested with the Student t test and non-numerical ones with the chi-square test. The odds of functional disability were measured by logistic regression. Prevalence rates of functional disability for basic and instrumental activities of daily living were 15.5% and 26.1%, respectively. Instrumental activities presented more variables significantly associated with the outcome in the final logistic regression model. Prevalence of functional disability was not higher than described in the Brazilian literature. An important association was found between the outcome and independent variables.

Brown adipose tissue: is it affected by intermittent hypoxia?

BackgroundIntermittent hypoxia (IH), a model of sleep apnea, produces weight loss in animals. We hypothesized that changes in brown adipose tissue (BAT) function are involved in such phenomenon. We investigated the effect of IH, during 35 days, on body weight, brown adipose tissue wet weight (BATww) and total protein concentration (TPC) of BAT.MethodsWe exposed Balb/c mice to 35 days of IH (n = 12) or sham intermittent hypoxia (SIH; n = 12), alternating 30 seconds of progressive hypoxia to a nadir of 6%, followed by 30 seconds of normoxia. During 8 hours, the rodents underwent a total of 480 cycles of hypoxia/reoxygenation, equivalent to an apnea index of 60/hour. BAT was dissected and weighed while wet. Protein was measured using the Lowry protein assay.ResultsBody weight was significantly reduced in animals exposed to IH, at day 35, from 24.4 ± 3.3 to 20.2 ± 2.2 g (p = 0.0004), while in the SIH group it increased from 23.3 ± 3.81 to 24.1 ± 2.96 g (p = 0.23). BATww was also lower in IH than in SIH group (p = 0.00003). TPC of BAT, however, was similar in IH (204.4 ± 44.3 μg/100 μL) and SIH groups (213.2 ± 78.7 μg/100 μL; p = 0.74) and correlated neither with body weight nor with BATww. TPC appeared to be unaffected by exposure to IH also in multivariate analysis, adjusting for body weight and BATww. The correlation between body weight and BATww is significant (rho= 0.63) for the whole sample. When IH and SIH groups are tested separately, the correlations are no longer significant (rho= 0.48 and 0.05, respectively).ConclusionIH during 35 days in a mice model of sleep apnea causes weight loss, BATww reduction, and no change in TPC of BATww. The mechanisms of weight loss under IH demands further investigation.

Fatores socioambientais associados à ocorrência de quedas em idosos

This article seeks to investigate environmental aspects that may be associated with falls among elderly residents in the state of Rio Grande do Sul. It is a population-based, descriptive, cross-sectional study, with primary data collection taken from an epidemiological study entitled A Profile of the Elderly in the state of Rio Grande do Sul. The study was conducted between the years of 2010 and 2011 with 6751 elderly individuals in 59 cities in the state of Rio Grande do Sul. The association between falling and the independent variables was verified by univariate and multivariate analysis, to estimate chances of falling, adjusted for sex and age. The frequency of falls was 10.7%. Factors detected to be effective against falling: being male, having higher education, perception of insecurity, placing of seats in public places and participation in social and civic activities. The following were considered risk factors: old age, use of walking aids and participation in community activities. The results remained significant after adjustment for demographic factors. Falling is commonly associated with physical and behavioral aspects, though social and environmental factors also prove significant in this respect.

Prevalência da síndrome metabólica em indígenas com mais de 40 anos no Rio Grande do Sul, Brasil

OBJECTIVE To investigate the prevalence of the metabolic syndrome (MS) among indigenous people older than 40 years of age from two cities in the State of Rio Grande do Sul, southern Brazil. METHODS A descriptive, analytic, cross-sectional study was conducted in two municipalities, Porto Alegre and Nonoai, between July and August 2009. A total of 150 indigenous people older than 40 years of age (range: 40-104 years), participated in the study. MS prevalence was determined based on National Cholesterol Education Program - Adult Treatment Panel III criteria. Blood samples and anthropometric data were collected. The participants also answered a questionnaire on eating habits, which was then contrasted to the 10 steps to healthy eating proposed by the World Health Organization and recommended by the Brazilian Ministry of Health. RESULTS MS prevalence was 65.3%, affecting women more than men (P < 0.001). Changes in waist circumference, fasting glucose, and HDL-cholesterol and presence of hypertension, hypertriglyceridemia, and obesity were associated with MS. Age, smoking, and sedentary lifestyle were not associated with MS. Indigenous people with MS had a poor diet, with low intake of fruit and vegetables, low levels of physical activity, high consumption of sweets and soft drinks, and high prevalence of obesity. CONCLUSIONS A high prevalence of MS was observed among the indigenous people surveyed, especially in women. Education and motivation for healthy behaviors is possibly the best way to manage MS and promote health in a population that is still neglected by public health policies.

Influência do treinamento de força muscular e de flexibilidade articular sobre o equilíbrio corporal em idosas

INTRODUCTION: Increasing proportion of elderly people in the world population raises the discussion of disabling events in this age group, as the occurrence of falls. Reduction in joint flexibility and muscle strength are the main variable related to the major motor limitations of activities of daily living (ADLs) and high rates of reported falls in elderly. OBJECTIVE: This study aims to assess the influence of muscle strength training and flexibility training on body balance in elderly. METHODOLOGY: The sample was composed by 22 women, from 60 to 75 years old, enrolled in two physical activity programs. Seven subjects were submitted to muscle strength program and 15 subjects were submitted to flexibility training. Body balance was evaluated before and after practicing time (Berg Balance Scale). RESULTS: It was found that both groups had significant improvement in body balance. Average scores in strength training group were 53 and 55.86 points, respectively, before and after training, while the average scores in flexibility group were 52.47 and 55.47 points, before and after training. CONCLUSION: It was found that both training improved the rates of body balance in elderly women, which likely will influence the reduction of incidence of falls and loss of physical independence, as well as better quality of life.

Cobertura vacinal está relacionada à menor mortalidade por doenças respiratórias

The scope of this study was to describe and compare records of the results of lawsuits filed in three Brazilian courts in cases involving the Unified Health System. A survey was made of the judgments listed on electronic sites of Courts of Justice in the states of Pernambuco, Rio Grande do Sul and Minas Gerais using a specific script. A total of 558 judgments was analyzed. There was a greater frequency of ordinary lawsuits (73.1%). In the majority of cases, it was not possible to identify the economic situation of the plaintiff or the legal representative of the defendant (54.5%). In cases where such identification was possible, a public defender was the most common (71.5%). The cases were predominantly individual in all three states. There was a large number of requests for injunctions (83.8%), which were almost always granted (91.2%), with the allegation of urgency/emergency in almost all cases (98.8%). The majority of decisions were favorable to the users of the public healthcare system (97.8%). The decisions studied showed that the users sought to ensure their right to health individually, using the public authorities to file their lawsuit, but there is a perceived difference in posture between legal courts evaluated. There is a strong tendency of the judiciary to accept these requests.As infeccoes respiratorias constituem um conjunto de doencas comumente relacionadas aos idosos, considerando que o virus da influenza e um dos principais agentes etiologicos. A vacinacao desses individuos e considerada pela Organizacao Mundial de Saude como a mais efetiva estrategia para a reducao da morbimortalidade pela doenca. O Brasil tem buscado nesses ultimos anos, como meta vacinar 80% da populacao alvo. Este estudo objetivou relacionar a cobertura vacinal da influenza e a taxa de mortalidade por doencas respiratorias em idosos. Trata-se de um estudo transversal com analise secundaria de dados. Os dados sobre cobertura vacinal no ano de 2010 em idosos dos 496 municipios gauchos foram obtidos na pagina do Programa Nacional de Imunizacao e de mortalidade no Sistema Informacao de Mortalidade. Os resultados evidenciaram que 49% municipios gauchos atingiram a meta de 80% de idosos vacinados, nos municipios com cobertura vacinal abaixo da meta o numero de mortes foi de 5,2 por 1.000 idosos, media essa significativamente maior que nos municipios com cobertura igual ou maior que 80%. Concluimos que a meta proposta pelo Ministerio da Saude Brasileiro de vacinar 80% ou mais de idosos e eficiente para a diminuicao da mortalidade por doencas respiratorias.

Idade como fator prognóstico no câncer de mama em estádio inicial

OBJETIVO: Analisar a idade como fator prognostico no câncer de mama em estadio clinico inicial. METODOS: Estudo retrospectivo que analisou as caracteristicas clinicas e a sobrevida livre de doenca de 280 pacientes entre 25 e 81 anos com câncer de mama estagio clinico I e II com acompanhamento em hospital de Porto Alegre (RS), de 1995 a 2000. Dados clinicos, patologicos, tratamento e desfechos foram extraidos dos prontuarios das pacientes. As pacientes foram divididas em dois grupos conforme a idade ao diagnostico ( 40 anos). Os dois grupos foram comparados quanto ao estagio clinico, histologia, expressao de receptores hormonais, terapia e radioterapia utilizando o teste qui-quadrado e/ou exato de Fisher e para analise de sobrevida, o teste de long-rank e metodo de Kaplan-Meier. RESULTADOS: Do total de 280 mulheres estudadas, 54 (19,3%) tinham ate 40 anos de idade. Ambos os grupos de pacientes eram similares em estagio clinico, histologia e expressao de receptores hormonais. A proporcao de pacientes com sobrevida livre de doenca em seguimento de 56 meses foi significativamente maior nas pacientes acima de 40 anos (84% versus 70%). Proporcionalmente, as pacientes mais jovens receberam mais terapia adjuvante (88,8% versus 77,8%). Houve diferenca significativa na probabilidade das mulheres acima de 40 anos de permanecerem livre de doenca (84%), sendo mais evidente quando comparadas as pacientes com < 40 anos em estagio clinico I. CONCLUSOES: Os achados confirmam que mulheres de ate 40 anos com câncer de mama inicial apresentam um pior prognostico. Entretanto, tal prognostico parece nao estar relacionado a maior numero de casos com receptores hormonais negativos. Pacientes jovens que permaneceram livre de doenca receberam mais terapia adjuvante, sugerindo efeito positivo da quimioterapia e hormonioterapia.OBJECTIVE To analyze age as a prognostic factor in early breast cancer. METHODS Retrospective study analyzing the clinical profile and disease-free survival in a group of 280 subjects aged 25 to 81 years with stage I and II breast cancer followed-up in Porto Alegre, southern Brazil, from 1995 to 2000. Clinical, pathological, treatment and outcome data were obtained from medical records. Subjects were divided into two groups according to age at diagnosis (< or = 40 years and > 40 years). The two groups were compared for clinical stage, histology, hormone receptor expression, therapy and radiotherapy using the chi-square and/or Fishers exact test and for analysis of survival the Kaplan-Meier method with a long-rank test. RESULTS Of 280 women studied, 54 (19.3%) were younger than 40 years. Both groups were similar regarding clinical stage, histology, and hormone receptor expression. The proportion of subjects with disease-free survival in the 56-month follow-up was significantly higher in those over 40 years (84% versus 70%). Proportionally, younger subjects received more adjuvant therapy (88.8% vs. 77.8%). Those women over 40 years were significantly more likely to remain disease-free (84%), and this difference was more remarkable when they were compared to those over 40 years at stage I breast cancer. CONCLUSIONS The study findings confirm that women younger than 40 years with early breast cancer have a poorer prognosis. However, this prognosis does not seem to be related to increased number of hormone receptor-negative cases. Younger patients who remained disease-free received more adjuvant therapy, suggesting a positive effect of chemotherapy and endocrine therapy.

Prescrições medicamentosas de pacientes atendidos no ambulatório de geriatria de um hospital universitário: estudo transversal descritivo

O objetivo foi avaliar prescricoes medicamentosas de pacientes idosos atendidos no ambulatorio de geriatria de um hospital. Metodo: Foi realizado um estudo transversal e descritivo, desenvolvido em um hospital universitario, com o auxilio de um questionario. Os pacientes com idade > 60 anos foram entrevistados sobre os medicamentos prescritos. Resultados: Foram entrevistados 208 pacientes. A media de medicamentos utilizados por pessoa foi de 3,8 e os medicamentos mais utilizados foram do aparelho cardiovascular (37,0%). Foram identificadas 406 interacoes potenciais em 140 pacientes (67,3%) e duplicidade terapeutica em duas prescricoes. O medicamento potencialmente inapropriado para idosos mais utilizado foi o nifedipino (2,4%). Conclusao: Os dados deste estudo corroboram sobre a tematica do uso de medicamentos em idosos, reforcando a importância da avaliacao do processo de prescricao de medicamentos para essa populacao.