Martinha Millianny Barros de Carvalho

OSA Is Common and Independently Associated With Hypertension and Increased Arterial Stiffness in Consecutive Perimenopausal Women

BACKGROUND Perimenopause is associated with increased cardiovascular risk. OSA is an emerging risk factor for cardiovascular disease, particularly among men, but the independent contribution of OSA to cardiovascular risk in climacteric women is not clear. METHODS We evaluated 277 consecutive women (age, 56 [52-61] years; BMI, 28 [25-32] kg/m2) without manifest cardiovascular disease (heart failure, coronary disease, or stroke). All women underwent 24-h ambulatory BP monitoring, arterial stiffness evaluation (pulse wave velocity), and portable sleep study. RESULTS OSA (apnea-hypopnea index ≥ 5 events/h) and moderate to severe OSA (apnea-hypopnea index ≥ 15 events/h) were diagnosed in 111 (40.1%) and 31 (11.1%) women, respectively. None of the participants had received a previous diagnosis of OSA. Women with moderate to severe OSA vs those without OSA had a higher prevalence of hypertension, were prescribed more medications for hypertension, had higher awake BP (systolic, 133 [125-142] vs 126 [119-134] mm Hg [P < .01]; diastolic, 82 [78-88] vs 79 [74-85] mm Hg [P = .07]), higher nocturnal BP (systolic, 125 [118-135] vs 115 [109-124] mm Hg [P < .01]; diastolic, 73 [69-79] vs 69 [62-75] mm Hg [P < .01]), and more arterial stiffness (pulse wave velocity, 11.5 [10.1-12.3] m/s vs 9.5 [8.6-10.8] m/s, P < .001). Oxygen desaturation index during the night was independently associated with 24-h arterial BP and arterial stiffness (per five-unit increase in oxygen desaturation index, β = 1.30 [95% CI, 0.02-2.54; P = .04] vs 0.22 [95% CI, 0.03-0.40; P = .02] in women with vs without OSA, respectively). CONCLUSIONS OSA is common, underdiagnosed, and independently associated with high BP and increased arterial stiffness in perimenopausal women.

OSA and Prognosis After Acute Cardiogenic Pulmonary Edema: The OSA-CARE Study

BACKGROUND: Acute cardiogenic pulmonary edema (ACPE) is a life‐threatening condition. OSA may be a modifiable risk factor for ACPE recurrence. This study was designed to evaluate the impact of OSA on the incidence of cardiovascular events following ACPE recovery. METHODS: Consecutive patients with confirmed ACPE from 3 centers underwent a sleep study following clinical stabilization. OSA was defined as an apnea‐hypopnea index (AHI) ≥ 15 events/h. The mean follow‐up was 1 year, and the primary outcome was ACPE recurrence. RESULTS: A total of 104 patients were included in the final analysis; 61% of the patients had OSA. A higher rate of ACPE recurrence (25 vs 6 episodes; P = .01) and a higher incidence of myocardial infarction (15 vs 0 episodes; P = .0004) were observed in patients with OSA than in those without OSA. All 17 deaths occurred in the OSA group (P = .0001). In a Cox proportional hazards regression analysis, OSA was independently associated with ACPE recurrence (hazard ratio [HR], 3.3 [95% CI, 1.2–8.8]; P = .01), incidence of myocardial infarction (HR, 2.3 [95% CI, 1.1–9.5]; P = .02), cardiovascular death (HR, 5.4 [95% CI, 1.4–48.4]; P = .004), and total death (HR, 6.5 [95% CI, 1.2–64.0]; P = .005). When the analysis was limited only to patients with OSA, levels of AHI and hypoxemic burden and rates of sleep‐onset ACPE were significantly higher in those who presented with ACPE recurrence or who died than in those who did not experience these events. CONCLUSIONS: OSA is independently associated with higher rates of ACPE recurrence and both fatal and nonfatal cardiovascular events.

Prevalence of Obstructive Sleep Apnea and Obesity Among Middle-Aged Women: Implications for Exercise Capacity

STUDY OBJECTIVES The aim of the current study was to evaluate the association between obstructive sleep apnea (OSA) and exercise capacity in middle-aged women. METHODS Consecutive middle-aged female subjects without cardiovascular disease, aged 45 to 65 years, from two gynecological clinics underwent detailed clinical evaluation, portable sleep study, and treadmill exercise test. RESULTS We studied 232 women (age: 55.6 ± 5.2 years; body mass index [BMI]: 28.0 ± 4.8 kg/m2). OSA (apnea-hypopnea index ≥ 5 events/h) was diagnosed in 90 (39%) and obesity (BMI > 30 kg/m2) in 76 (33%) women, respectively. Participants with OSA were older, had a higher BMI, and an increased frequency of arterial hypertension compared to women without OSA. Multiple logistic regression models were used to evaluate the association between OSA and exercise capacity, controlling for traditional risk factors including BMI, age, hypertension, diabetes, and sedentary lifestyle. In multivariate analysis, the presence of obesity without OSA was associated with low exercise capacity (odds ratio [OR] 2.88, 95% confidence interval [CI] 1.02-8.11, P = .045), whereas the presence of OSA without obesity was not (OR 1.07, 95% CI 0.31-3.69, P = .912). However, the coexistence of obesity and OSA increased markedly the odds of reduction in exercise capacity (OR 9.40, CI 3.79-23.3, P < .001). CONCLUSIONS Obesity and OSA are common conditions in middle-aged women and may interact to reduce exercise capacity. These results highlight the importance of obesity control programs among women, as well as the diagnosis of comorbid OSA in older women.

Characteristics and predictors of obstructive sleep apnoea in patients with type 2 diabetes

Diabetes & Metabolism - In Press.Proof corrected by the author Available online since samedi 18 mars 2017

A APNEIA OBSTRUTIVA DO SONO ESTÁ ASSOCIADA COM MAIOR MORBIDADE E MORTALIDADE CARDIOVASCULAR EM PACIENTES COM EDEMA AGUDO DOS PULMÕES CARDIOGÊNICO

Durante o período de 2 anos, recrutamos casos consecutivos de EAP nas Unidades de Emergências de três centros terciários de Cardiologia. Após o tratamento de rotina para o EAP e estabilização clínica, todos os pacientes que sobreviveram ao evento foram convidados a realizar a monitorização portátil do sono (Embletta GoldTM). A AOS foi definida por um índice de apneia e hipopneia Z15 eventos/hora. Realizamos o seguimento dos pacientes em busca de eventos cardiovasculares adotando critérios padronizados. O nosso objetivo primário foi o de avaliar a frequência de ocorrência de novo EAP.

A APNEIA OBSTRUTIVA DO SONO MODERADA A GRAVE É INDEPENDENTEMENTE ASSOCIADA COM ATEROSCLEROSE CORONARIANA SUBCLÍNICA ENTRE MULHERES DE MEIA-IDADE

A apneia obstrutiva do sono (AOS) está fortemente associada ao desenvolvimento da hipertensão arterial sistêmica (HAS). O exercício físico além de promover efeitos benéficos, tanto na prevenção como no controle da PA nos hipertensos, pode contribuir também no tratamento das doenças relacionadas ao sono, dentre elas a AOS, que pode estar associada ou não a HAS. A hipotensão pós-exercício (HPE) tem importância clínica, se mostrando presente em normotensos, pré-hipertensos, mas principalmente nos indivíduos hipertensos, os quais apresentam uma maior redução na magnitude da HPE.