Gabriela Costa Pontes Luz

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

IntroductionObstructive 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.DiscussionPrevious 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.

Comparison of the effects of continuous positive airway pressure, oral appliance and exercise training in obstructive sleep apnea syndrome

OBJECTIVE: There are several treatments for obstructive sleep apnea syndrome, such as weight loss, use of an oral appliance and continuous positive airway pressure, that can be used to reduce the signs and symptoms of obstructive sleep apnea syndrome. Few studies have evaluated the effectiveness of a physical training program compared with other treatments. The aim of this study was to assess the effects of physical exercise on subjective and objective sleep parameters, quality of life and mood in obstructive sleep apnea patients and to compare these effects with the effects of continuous positive airway pressure and oral appliance treatments. METHODS: Male patients with moderate to severe obstructive sleep apnea and body mass indices less than 30 kg/m2 were randomly assigned to three groups: continuous positive airway pressure (n = 9), oral appliance (n = 9) and physical exercise (n = 7). Polysomnographic recordings, blood samples and daytime sleepiness measurements were obtained prior to and after two months of physical exercise or treatment with continuous positive airway pressure or an oral appliance. Clinicaltrials.gov: NCT01289392 RESULTS: After treatment with continuous positive airway pressure or an oral appliance, the patients presented with a significant reduction in the apnea-hypopnea index. We did not observe changes in the sleep parameters studied in the physical exercise group. However, this group presented reductions in the following parameters: T leukocytes, very-low-density lipoprotein and triglycerides. Two months of exercise training also had a positive impact on subjective daytime sleepiness. CONCLUSIONS: Our results suggest that isolated physical exercise training was able to modify only subjective daytime sleepiness and some blood measures. Continuous positive airway pressure and oral appliances modified the apnea-hypopnea index.

Avaliação do broncoespasmo induzido pelo exercício avaliado pelo Peak Flow Meter em adolescentes obesos

INTRODUCAO: Criancas e adolescentes com excesso de peso apresentam maior prevalencia de broncoespasmo induzido pelo exercicio (BIE), quando comparados a eutroficos. A espirometria e o peak flow meter sao importantes metodos avaliativos da funcao pulmonar. Porem, a aplicabilidade do medidor do pico de fluxo expiratorio (peak flow meter) na deteccao do BIE em criancas e adolescentes com excesso de peso nao e conhecida, o que justifica o desenvolvimento desta pesquisa. OBJETIVOS: Avaliar e comparar o desencadeamento de broncoespasmo induzido pelo exercicio (BIE) em criancas e adolescentes nao asmaticos com excesso de peso, avaliados pela espirometria e pelo peak flow meter (PFE). CASUISTICA E METODOS: Participaram do estudo 39 voluntarios acima do percentil 85o (OB) e 30 eutroficos (EU), de oito a 15 anos. A avaliacao da funcao pulmonar pre e pos-teste de broncoprovocacao foi realizada pela espirometria e peak flow meter, de acordo com o protocolo de Del Rio-Navarro et al., (2000). O BIE foi considerado positivo quando o voluntario apresentou uma reducao > 10% do VEF1 basal ou reducao > 20% do PFEPFM e/ou PFEE. RESULTADOS: Na deteccao do BIE, a prevalencia do grupo obeso foi de 26% avaliado pelo peak flow meter (PFEPFM) e 23% pelo VEF1. O tempo do BIE ocorreu nos primeiros 15 minutos pos-exercicio em ambos os parâmetros: (PFEPFM) e VEF1. CONCLUSAO: Os voluntarios obesos apresentaram tempo e prevalencias similares de BIE, quando avaliados por ambos os metodos de avaliacao pulmonar. O facil manejo e o baixo custo facilitam a maior acessibilidade para a populacao geral do peak flow meter, o que demonstra sua importância como parte integrante de um programa educacional no diagnostico inicial do BIE em vias aereas de grande calibre.

Late-onset, insidious course and invasive treatment of congenital central hypoventilation syndrome in a case with the Phox2B mutation: case report

Congenital central hypoventilation syndrome (CCHS) is a rare disorder of respiratory control characterized by ventilatory impairment that results in arterial hypoxemia. This condition is worse during sleep and occurs in patients with normal mechanical properties of the lung. It is diagnosed in the absence of primary neuromuscular disease, identifiable brainstem lesions, and other sleep disturbances or substance use [1]. Amiel et al. [2] identified a mutation in the Phox2B gene associated with CCHS, characterized by five to nine alanine expansions within a 20-residue polyalanine region in exon 3 of the Phox2B gene. Several reports confirmed the findings of Amiel et al., supporting the view that this gene is a master switch for the development of the autonomic nervous system network linked to respiratory control [3–6]. Transgenic animals carrying the human Phox2B mutation develop a similar phenotype and lack glutamatergic neurons located in the parafacial region in the brainstem, which are involved in breathing control [7]. Although patients typically present with CCHS as newborns and rarely in later infancy, there have been reports of patients presenting with CCHS in adulthood. In cases of late-onset CCHS, most patients report having had some symptoms since childhood, and they have parents with a history of CCHS. Symptoms of right-sided heart failure are generally observed at the time of diagnosis, and nocturnal noninvasive ventilation is frequently indicated [8–15]. L. R. A. Bittencourt (*) :M. Pedrazzoli : F. Yagihara : G. P. Luz : S. Garbuio :G. A. Moreira : S. Tufik Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de Sao Paulo, Rua Napoleao de Barros, 925, 04024-002 Sao Paulo, Sao Paulo, Brazil e-mail: lia@psicobio.epm.br

Avaliação antropométrica e do ângulo quadricipital na osteoartrite de joelho em mulheres obesas

Osteoarthritis (OA) is a degenerative joint disease characterized by inflammatory process, pain, and deformity; one of its main predictive factors is obesity. The aim of this study was to search for possible correlations between anthropometric measures, the Q angle and knee osteoarthritis. A sample of 50 obese women (30 with knee osteoarthritis and 20 with no joint disease), aged between 40 to 60 years, were assessed as to BMI (body mass index), abdominal circumference (AC), waist and hip perimeters (so as to calculate waist-hip ratio), and the Q angle; osteoarthritis was diagnosed by clinical exam and knee joint radiography. Results showed a positive, poor correlation between BMI and Q angle, as well as between time of obesity onset and degree of joint degeneration. AC was found to positively, though weakly, correlate with the degree of joint degeneration and of OA severity. Adjusted odds ratio for OA showed that women with BMI>34 kg/m 2 and AC>110 cm were respectively 3.7 and 7 times more likely to develop OA. The degree and duration of central obesity possibly contribute to incidence of knee OA in obese women. Abdominal circumference was the measure that most correlated with the degree of joint degeneration and of OA severity, which suggests it should be used in clinical evaluation.