Alterações cardiovasculares na síndrome da apneia obstrutiva de grau leve
Data
2015-09-30
Autores
Guimarães, Thais de Moura 
Orientadores
Bittencourt, Lia Rita Azeredo
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: A existência de repercussões cardiovasculares relacionadas à Síndrome da Apneia Obstrutiva do Sono (SAOS) já está bem estabelecida na literatura. Entretanto, a maioria dos estudos aborda pacientes com índices de apneia-hipopneia moderada a grave. Objetivo: Avaliar o efeito da Apneia Obstrutiva do sono (AOS) de grau leve em parâmetros cardiovasculares, tais como pressão arterial (PA) de 24 horas e função endotelial. Métodos: A amostra foi composta por voluntários de ambos os gêneros; idade entre 18 e 65 anos e índice de massa corpórea maior ou igual 35Kg/m2. Foram selecionados 2 grupos: grupo AOS leve, que apresentava IAH entre 5 e 15 e grupo controle, com índice de apneia-hipopneia (IAH) < 5, índice de distúrbio respiratório (IDR) < 5, índice de despertar (ID) < 15 e escala de sonolência de Epworth < 10. A avaliação entre grupos foi composta por exame físico, exames laboratoriais, polissonografia de noite inteira, monitorização ambulatorial da pressão arterial de 24 horas (MAPA) e avaliação da função endotelial da microvasculatura pela tonômetria arterial periférica (EndoPAT®). Para análise estatística foi realizada análise descritiva (média±desvio-padrão) e, para análise entre grupos, teste GLM univariado e teste Mann-Whitney. Para pesquisa dos fatores associados, foi realizada uma regressão logística múltipla, e, para pesquisa de fatores preditivos, foi realizada regressão linear multivariada, o p significante foi ? 0.05. Resultados: A amostra foi composta por 107 indivíduos, 35 no grupo controle e 72 no grupo AOS leve. Em um subgrupo com 30 pacientes em cada grupo, sem diferença entre idade, IMC e sexo, não houve diferença entre o grupo AOS leve e o grupo controle para variáveis de PA de 24 horas, frequência de Hipertensão Arterial Sistêmica (HAS) e função endotelial. Quando avaliado apenas mulheres nesta sub-amostra, o grupo AOS leve apresentou maior frequência de HAS que o grupo controle. Nas análises sobre fenótipos de AOS leve, não houve diferença entre sonolento e não sonolento para variáveis da PA de 24 horas e função endotelial. No fenótipo obesidade, o subgrupo AOS leve obeso apresentou maior PA sistólica do sono e variação da PA diastólica do sono que o grupo AOS leve não obeso. No fenótipo descenso da PA noturna, o subgrupo AOS leve sem descenso da PA noturna apresentou maior rigidez arterial e média da PA de 24 horas que o grupo AOS leve com descenso da PA no sono, o que não foi encontrado comparando o grupo com e xvii sem descenso da PA noturna no grupo Controle. Conclusão: O grupo AOS leve não apresentou alterações na PA de 24 horas e na função endotelial comparado com grupo controle. Entretanto, no subgrupo feminino, a AOS leve apresentou maior frequência de HAS. Comparando apenas fenótipos de AOS leve, o grupo de AOS leve obeso apresentou maiores valores da PA do sono e quem não apresentava descenso da PA noturna apresentou maior rigidez arterial e maior PA, comparado com quem apresentava descenso da PA noturna normal.
Introduction: The existence of cardiovascular repercussions related to Obstructive Sleep Apnea Syndrome (OSAS) is already well established in the literature. However, most studies address patients with Moderate to severe apnea-hypopnea. Objective: To evaluate the effect of apnea Sleep obstructive sleep apnea (OSA) in cardiovascular parameters, such as Such as 24-hour blood pressure (BP) and endothelial function. Methods: A Sample was composed of volunteers of both genders; Age between 18 and 65 years and body mass index < or = 35 kg / m2. We selected 2 groups: Group, who presented AHI between 5 and 15 and control group, with Apnea-hypopnea index (AHI) <5, respiratory distress index (RDI) <5, Wakefulness index (ID) <15 and Epworth sleepiness scale <10. Evaluation between groups was composed of physical examination, laboratory tests, Night-time polysomnography, ambulatory blood pressure monitoring Of 24 hours (ABPM) and evaluation of the endothelial function of the microvasculature by Peripheral arterial tonometer (EndoPAT®). Statistical analysis was performed Descriptive analysis (mean ± standard deviation) and, for analysis between groups, Univariate GLM and Mann-Whitney test. To investigate the associated factors, A multiple logistic regression was performed, and, to investigate factors Multivariate linear regression, p significant was ? 0.05. Results: The sample consisted of 107 individuals, 35 in the control group And 72 in the mild AOS group. In a subgroup with 30 patients in each group, Without difference between age, BMI and gender, there was no difference between the AOS group And the control group for variables of 24-hour BP, Systemic Arterial Hypertension (SAH) and endothelial function. When evaluated Only in this sub-sample, the mild AOS group presented greater Frequency of SAH than the control group. In the analyzes on AOS phenotypes There was no difference between sleepy and non-sleepy for 24-hour PA and endothelial function. In the obesity phenotype, the AOS subgroup Obese had higher systolic BP and diastolic BP Of sleep that the mild non-obese AOS group. In the phenotype Night, the mild AOS subgroup without nocturnal BP decreased Mean arterial stiffness and mean 24-hour BP that the OSA group Decreased BP in sleep, which was not found comparing the group with and Xvii With no decrease in nocturnal BP in the Control group. Conclusion: The AOS group Presented no alterations in the 24-hour BP and endothelial function Compared to the control group. However, in the female subgroup, mild OSA Presented a higher frequency of SAH. Comparing only AOS phenotypes Mild OSA group presented higher values ??of sleep Who did not present nocturnal BP decreased more rigidly Arterial pressure and higher BP, compared with those with BP Normal night.
Introduction: The existence of cardiovascular repercussions related to Obstructive Sleep Apnea Syndrome (OSAS) is already well established in the literature. However, most studies address patients with Moderate to severe apnea-hypopnea. Objective: To evaluate the effect of apnea Sleep obstructive sleep apnea (OSA) in cardiovascular parameters, such as Such as 24-hour blood pressure (BP) and endothelial function. Methods: A Sample was composed of volunteers of both genders; Age between 18 and 65 years and body mass index < or = 35 kg / m2. We selected 2 groups: Group, who presented AHI between 5 and 15 and control group, with Apnea-hypopnea index (AHI) <5, respiratory distress index (RDI) <5, Wakefulness index (ID) <15 and Epworth sleepiness scale <10. Evaluation between groups was composed of physical examination, laboratory tests, Night-time polysomnography, ambulatory blood pressure monitoring Of 24 hours (ABPM) and evaluation of the endothelial function of the microvasculature by Peripheral arterial tonometer (EndoPAT®). Statistical analysis was performed Descriptive analysis (mean ± standard deviation) and, for analysis between groups, Univariate GLM and Mann-Whitney test. To investigate the associated factors, A multiple logistic regression was performed, and, to investigate factors Multivariate linear regression, p significant was ? 0.05. Results: The sample consisted of 107 individuals, 35 in the control group And 72 in the mild AOS group. In a subgroup with 30 patients in each group, Without difference between age, BMI and gender, there was no difference between the AOS group And the control group for variables of 24-hour BP, Systemic Arterial Hypertension (SAH) and endothelial function. When evaluated Only in this sub-sample, the mild AOS group presented greater Frequency of SAH than the control group. In the analyzes on AOS phenotypes There was no difference between sleepy and non-sleepy for 24-hour PA and endothelial function. In the obesity phenotype, the AOS subgroup Obese had higher systolic BP and diastolic BP Of sleep that the mild non-obese AOS group. In the phenotype Night, the mild AOS subgroup without nocturnal BP decreased Mean arterial stiffness and mean 24-hour BP that the OSA group Decreased BP in sleep, which was not found comparing the group with and Xvii With no decrease in nocturnal BP in the Control group. Conclusion: The AOS group Presented no alterations in the 24-hour BP and endothelial function Compared to the control group. However, in the female subgroup, mild OSA Presented a higher frequency of SAH. Comparing only AOS phenotypes Mild OSA group presented higher values ??of sleep Who did not present nocturnal BP decreased more rigidly Arterial pressure and higher BP, compared with those with BP Normal night.
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Citação
GUIMARÃES, Thais de Moura. Alterações cardiovasculares na síndrome da apneia obstrutiva de grau leve: estudo caso controle. 2015. 96 f. Dissertação (Mestrado em Psicobiologia) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, 2015.