Apneia obstrutiva do sono e função endotelial em pacientes com hipertensão arterial resistente
Autor(a) principal: | |
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Data de Publicação: | 2013 |
Tipo de documento: | Dissertação |
Idioma: | por |
Título da fonte: | Biblioteca Digital de Teses e Dissertações da UERJ |
Texto Completo: | http://www.bdtd.uerj.br/handle/1/8732 |
Resumo: | Obstructive sleep apnea (OSA) is considered an independent risk factor for cardiovascular disease. There is evidence that individuals with OSA may have increased inflammatory mediators, changes in the metabolic profile, increased sympathetic activity with consequent elevation of blood pressure (BP) and endothelial dysfunction. Resistant hypertension (RH) is defined as uncontrolled blood pressure (BP ≥ 140/90mmHg) despite the current use of three hypotensive drugs at full doses, including a diuretic, or the need for >3 medications to control BP. OSA has been reported as the most common secondary cause of high blood pressure maintenance. The objective was to determine the prevalence of OSA and verify its association with endothelial function and anthropometric parameters in patients with resistant hypertension (RHGroup) and BP controlled by medication (CHGroup). It was a cross-sectional study involving 40 hypertensive patients (20 in RHG and 20 in CHG), aged between 18 and 75 years. Endothelial function and OSA were assessed by peripheral arterial tonometry. BP was measured by oscillometric method on automatic device. Endothelial function was assessed by peripheral arterial tonometry (PAT) by EndoPAT2000 and the OSA diagnosis also through PAT, using the portable device WatchPAT200. Anthropometric evaluation was performed through measurements of waist (WaC), hip and neck circumference (NC), BMI, waist to height ratio (WHtR), and body composition assessed by bioelectrical impedance. Patients were generally late middle-aged (54.95 ± 2.39 in the RH group and 56.15 ± 2.42 in the controlled hypertension [CH] group. The prevalence of OSA in RHG was 85% (17 of 20) [apnea-hypopnea index=12.39±1.89], and 80% (16 of 20) in CHG (AHI=20.74±4.69) and it was more frequent in men (93.7% [15 of 16] vs 75% [16 of 24]; p=0.04, OR=3.86; 95% IC 0.99 to 14.92). Both groups presented similar anthropometric parameters values. Endothelial function evaluated by reactive hyperemia index was similar in both groups (RHG: 1.88±0.09 vs CHG: 2.03±0.09; p=0.28). Although we found differences in oxygen desaturation> 4% (RHG: 28.75 ± 5.08 vs CHG: 64.15 ± 16.97, p = 0.04), total sleep time (RHG: 309.5 ± 15.27 vs CHG: 323.3 ± 18.74 min) and minimum saturation (RHG: 87.8±0.85 vs CHG: 83.3±2.37%) was not different. In general, OSA was correlated with weight (r = 0.51, p = 0.0007), BMI (r = 0.41, p = 0.0078), WaC (r = 0, 44, p = 0.005), NC (r = 0.38, p = 0.01) and WHtR (r = 0.39, p = 0.01) and independently associated with impairment of endothelial function (p = 0.0297, OR = 0.17, 95% CI 0.04 to 0.72). In conclusion, the findings of this study show high prevalence of OSA in patients with resistant hypertension, similar to that of controlled hypertension group. There were no significant differences in endothelial function between resistant and controlled hypertension patients. The presence of OSA in the total group of hypertensive patients was associated with increased risk of impaired endothelial function. |
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Sanjuliani, Antonio Felipehttp://lattes.cnpq.br/3228246432522818Oigman, Willehttp://lattes.cnpq.br/4962697729705577Klein, Márcia Regina Simas Torreshttp://lattes.cnpq.br/8755810383117085Barroso, Sergio Girãohttp://lattes.cnpq.br/9790785572763247http://lattes.cnpq.br/3846692765106971Amorim, Nádia Maria Lopes2021-01-05T19:41:31Z2014-05-232013-06-21AMORIM, Nádia Maria Lopes. Apneia obstrutiva do sono e função endotelial em pacientes com hipertensão arterial resistente. 2013. 119 f. Dissertação (Mestrado em Ciências Médicas) - Universidade do Estado do Rio de Janeiro, Rio de Janeiro, 2013.http://www.bdtd.uerj.br/handle/1/8732Obstructive sleep apnea (OSA) is considered an independent risk factor for cardiovascular disease. There is evidence that individuals with OSA may have increased inflammatory mediators, changes in the metabolic profile, increased sympathetic activity with consequent elevation of blood pressure (BP) and endothelial dysfunction. Resistant hypertension (RH) is defined as uncontrolled blood pressure (BP ≥ 140/90mmHg) despite the current use of three hypotensive drugs at full doses, including a diuretic, or the need for >3 medications to control BP. OSA has been reported as the most common secondary cause of high blood pressure maintenance. The objective was to determine the prevalence of OSA and verify its association with endothelial function and anthropometric parameters in patients with resistant hypertension (RHGroup) and BP controlled by medication (CHGroup). It was a cross-sectional study involving 40 hypertensive patients (20 in RHG and 20 in CHG), aged between 18 and 75 years. Endothelial function and OSA were assessed by peripheral arterial tonometry. BP was measured by oscillometric method on automatic device. Endothelial function was assessed by peripheral arterial tonometry (PAT) by EndoPAT2000 and the OSA diagnosis also through PAT, using the portable device WatchPAT200. Anthropometric evaluation was performed through measurements of waist (WaC), hip and neck circumference (NC), BMI, waist to height ratio (WHtR), and body composition assessed by bioelectrical impedance. Patients were generally late middle-aged (54.95 ± 2.39 in the RH group and 56.15 ± 2.42 in the controlled hypertension [CH] group. The prevalence of OSA in RHG was 85% (17 of 20) [apnea-hypopnea index=12.39±1.89], and 80% (16 of 20) in CHG (AHI=20.74±4.69) and it was more frequent in men (93.7% [15 of 16] vs 75% [16 of 24]; p=0.04, OR=3.86; 95% IC 0.99 to 14.92). Both groups presented similar anthropometric parameters values. Endothelial function evaluated by reactive hyperemia index was similar in both groups (RHG: 1.88±0.09 vs CHG: 2.03±0.09; p=0.28). Although we found differences in oxygen desaturation> 4% (RHG: 28.75 ± 5.08 vs CHG: 64.15 ± 16.97, p = 0.04), total sleep time (RHG: 309.5 ± 15.27 vs CHG: 323.3 ± 18.74 min) and minimum saturation (RHG: 87.8±0.85 vs CHG: 83.3±2.37%) was not different. In general, OSA was correlated with weight (r = 0.51, p = 0.0007), BMI (r = 0.41, p = 0.0078), WaC (r = 0, 44, p = 0.005), NC (r = 0.38, p = 0.01) and WHtR (r = 0.39, p = 0.01) and independently associated with impairment of endothelial function (p = 0.0297, OR = 0.17, 95% CI 0.04 to 0.72). In conclusion, the findings of this study show high prevalence of OSA in patients with resistant hypertension, similar to that of controlled hypertension group. There were no significant differences in endothelial function between resistant and controlled hypertension patients. The presence of OSA in the total group of hypertensive patients was associated with increased risk of impaired endothelial function.A apneia obstrutiva do sono (AOS) é considerada um fator de risco independente para as doenças cardiovasculares. Existem evidências de que indivíduos com apneia obstrutiva do sono podem apresentar elevação nos mediadores inflamatórios, alterações no perfil metabólico, aumento na atividade do sistema nervoso simpático, com consequente elevação da pressão arterial e disfunção endotelial. Nos últimos anos, inúmeros estudos tem apontado a AOS como um dos fatores responsáveis pela hipertensão resistente. O objetivo do estudo foi avaliar a presença da apneia obstrutiva do sono e o comportamento da função endotelial em pacientes com hipertensão resistente, comparando com hipertensos apresentando pressão arterial controlada com até 3 classes diferentes de fármacos anti-hipertensivos. Trata-se de um estudo transversal com 40 pacientes hipertensos: 20 com hipertensão arterial resistente (HAR) e 20 com pressão arterial controlada por medicação (hipertensão arterial controlada; HAC), sem distinção de raça ou gênero, com idade entre 18 e 75 anos. A pressão arterial casual e a monitorização ambulatorial da pressão arterial foram aferidas por método oscilométrico em aparelhos automáticos. A função endotelial e a presença da apneia obstrutiva do sono foram avaliadas através da tonometria arterial periférica pelos equipamentos Endo-PAT2000® e o aparelho portátil Watch-PAT200®, respectivamente. A avaliação antropométrica foi realizada através das aferições das circunferências da cintura e do pescoço, índice de massa corporal (IMC), e relação cintura-estatura. A composição corporal foi avaliada por bioimpedância elétrica BIODYNAMICS® 450. As análises estatísticas foram realizadas pelo software GraphPad PRISM, versão 6.01. A prevalência de AOS no grupo com HAR foi de 85% (Índice de apneia-hipopneia [AHI]= 12,39±1,89) e de 80% no grupo com HAC (AHI =20,74±4,69), sendo mais frequente em homens (p=0,04; OR=3,86; 95% IC 0,99 a 14,52). Os dois grupos apresentaram valores semelhantes das variáveis antropométricas avaliadas. A função endotelial avaliada pelo índice de hiperemia reativa foi similar nos dois grupos (grupo HAR: 1,88±0,09 vs. grupo HAC: 2,03±0,09; p=0,28). Apesar do número de dessaturações de oxigênio >4% ter apresentado diferença significativa entre os grupos (grupo HAR: 28,75±5,08 vs. grupo HAC: 64,15±16,97; p=0,04), o tempo total de sono (grupo HAR: 309,5±15,27 vs. grupo HAC: 323,3±18,74 min) e a saturação mínima da oxi-hemoglobina (grupo HAR: 87,8±0,85 vs. grupo HAC: 83,3±2,37%) não mostraram essa diferença. Considerando todos os pacientes hipertensos, o AHI apresentou correlação significativa com o peso corporal (r=0,51; p=0,0007), o IMC (r=0,41; p=0,007), a circunferência da cintura (r=0,44; p=0,005), a circunferência do pescoço (r=0,38; p=0,01) e a relação cintura-estatura (r=0,39; p=0,01). Os pacientes sem AOS em comparação com os pacientes com AOS, apresentaram risco significativamente menor de apresentar comprometimento da função endotelial (OR=0,17; 95% IC 0,04-0,72; p=0,03). Os achados do presente estudo sugerem que a prevalência de AOS em pacientes com hipertensão resistente é elevada, porém semelhante a de indivíduos com hipertensão controlada. Pacientes com hipertensão resistente e controlada não apresentaram diferenças significativas em relação à função endotelial. A gravidade de AOS no grupo total de hipertensos se associou com maior risco de comprometimento da função endotelial.Submitted by Boris Flegr (boris@uerj.br) on 2021-01-05T19:41:31Z No. of bitstreams: 1 dissertacao_NADIA_AMORIM_final.pdf: 4927313 bytes, checksum: 936091c55320c87d10d07f806125a3c6 (MD5)Made available in DSpace on 2021-01-05T19:41:31Z (GMT). No. of bitstreams: 1 dissertacao_NADIA_AMORIM_final.pdf: 4927313 bytes, checksum: 936091c55320c87d10d07f806125a3c6 (MD5) Previous issue date: 2013-06-21Coordenação de Aperfeiçoamento de Pessoal de Nível Superiorapplication/pdfporUniversidade do Estado do Rio de JaneiroPrograma de Pós-Graduação em Ciências MédicasUERJBRCentro Biomédico::Faculdade de Ciências MédicasObstructive sleep apneaResistant hypertensionEndothelial dysfunctionApneia obstrutiva do sonoHipertensão arterial resistenteDisfunção endotelialApneia do sono tipo obstrutivaHipertensãoEndotélioCNPQ::CIENCIAS DA SAUDE::MEDICINAApneia obstrutiva do sono e função endotelial em pacientes com hipertensão arterial resistenteObstructive sleep apnea and endothelial function in patients with resistant hypertensioninfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisinfo:eu-repo/semantics/openAccessreponame:Biblioteca Digital de Teses e Dissertações da UERJinstname:Universidade do Estado do Rio de Janeiro (UERJ)instacron:UERJORIGINALdissertacao_NADIA_AMORIM_final.pdfapplication/pdf4927313http://www.bdtd.uerj.br/bitstream/1/8732/1/dissertacao_NADIA_AMORIM_final.pdf936091c55320c87d10d07f806125a3c6MD511/87322024-02-26 15:59:59.876oai:www.bdtd.uerj.br:1/8732Biblioteca Digital de Teses e Dissertaçõeshttp://www.bdtd.uerj.br/PUBhttps://www.bdtd.uerj.br:8443/oai/requestbdtd.suporte@uerj.bropendoar:29032024-02-26T18:59:59Biblioteca Digital de Teses e Dissertações da UERJ - Universidade do Estado do Rio de Janeiro (UERJ)false |
dc.title.por.fl_str_mv |
Apneia obstrutiva do sono e função endotelial em pacientes com hipertensão arterial resistente |
dc.title.alternative.eng.fl_str_mv |
Obstructive sleep apnea and endothelial function in patients with resistant hypertension |
title |
Apneia obstrutiva do sono e função endotelial em pacientes com hipertensão arterial resistente |
spellingShingle |
Apneia obstrutiva do sono e função endotelial em pacientes com hipertensão arterial resistente Amorim, Nádia Maria Lopes Obstructive sleep apnea Resistant hypertension Endothelial dysfunction Apneia obstrutiva do sono Hipertensão arterial resistente Disfunção endotelial Apneia do sono tipo obstrutiva Hipertensão Endotélio CNPQ::CIENCIAS DA SAUDE::MEDICINA |
title_short |
Apneia obstrutiva do sono e função endotelial em pacientes com hipertensão arterial resistente |
title_full |
Apneia obstrutiva do sono e função endotelial em pacientes com hipertensão arterial resistente |
title_fullStr |
Apneia obstrutiva do sono e função endotelial em pacientes com hipertensão arterial resistente |
title_full_unstemmed |
Apneia obstrutiva do sono e função endotelial em pacientes com hipertensão arterial resistente |
title_sort |
Apneia obstrutiva do sono e função endotelial em pacientes com hipertensão arterial resistente |
author |
Amorim, Nádia Maria Lopes |
author_facet |
Amorim, Nádia Maria Lopes |
author_role |
author |
dc.contributor.advisor1.fl_str_mv |
Sanjuliani, Antonio Felipe |
dc.contributor.advisor1Lattes.fl_str_mv |
http://lattes.cnpq.br/3228246432522818 |
dc.contributor.referee1.fl_str_mv |
Oigman, Wille |
dc.contributor.referee1Lattes.fl_str_mv |
http://lattes.cnpq.br/4962697729705577 |
dc.contributor.referee2.fl_str_mv |
Klein, Márcia Regina Simas Torres |
dc.contributor.referee2Lattes.fl_str_mv |
http://lattes.cnpq.br/8755810383117085 |
dc.contributor.referee3.fl_str_mv |
Barroso, Sergio Girão |
dc.contributor.referee3Lattes.fl_str_mv |
http://lattes.cnpq.br/9790785572763247 |
dc.contributor.authorLattes.fl_str_mv |
http://lattes.cnpq.br/3846692765106971 |
dc.contributor.author.fl_str_mv |
Amorim, Nádia Maria Lopes |
contributor_str_mv |
Sanjuliani, Antonio Felipe Oigman, Wille Klein, Márcia Regina Simas Torres Barroso, Sergio Girão |
dc.subject.eng.fl_str_mv |
Obstructive sleep apnea Resistant hypertension Endothelial dysfunction |
topic |
Obstructive sleep apnea Resistant hypertension Endothelial dysfunction Apneia obstrutiva do sono Hipertensão arterial resistente Disfunção endotelial Apneia do sono tipo obstrutiva Hipertensão Endotélio CNPQ::CIENCIAS DA SAUDE::MEDICINA |
dc.subject.por.fl_str_mv |
Apneia obstrutiva do sono Hipertensão arterial resistente Disfunção endotelial Apneia do sono tipo obstrutiva Hipertensão Endotélio |
dc.subject.cnpq.fl_str_mv |
CNPQ::CIENCIAS DA SAUDE::MEDICINA |
description |
Obstructive sleep apnea (OSA) is considered an independent risk factor for cardiovascular disease. There is evidence that individuals with OSA may have increased inflammatory mediators, changes in the metabolic profile, increased sympathetic activity with consequent elevation of blood pressure (BP) and endothelial dysfunction. Resistant hypertension (RH) is defined as uncontrolled blood pressure (BP ≥ 140/90mmHg) despite the current use of three hypotensive drugs at full doses, including a diuretic, or the need for >3 medications to control BP. OSA has been reported as the most common secondary cause of high blood pressure maintenance. The objective was to determine the prevalence of OSA and verify its association with endothelial function and anthropometric parameters in patients with resistant hypertension (RHGroup) and BP controlled by medication (CHGroup). It was a cross-sectional study involving 40 hypertensive patients (20 in RHG and 20 in CHG), aged between 18 and 75 years. Endothelial function and OSA were assessed by peripheral arterial tonometry. BP was measured by oscillometric method on automatic device. Endothelial function was assessed by peripheral arterial tonometry (PAT) by EndoPAT2000 and the OSA diagnosis also through PAT, using the portable device WatchPAT200. Anthropometric evaluation was performed through measurements of waist (WaC), hip and neck circumference (NC), BMI, waist to height ratio (WHtR), and body composition assessed by bioelectrical impedance. Patients were generally late middle-aged (54.95 ± 2.39 in the RH group and 56.15 ± 2.42 in the controlled hypertension [CH] group. The prevalence of OSA in RHG was 85% (17 of 20) [apnea-hypopnea index=12.39±1.89], and 80% (16 of 20) in CHG (AHI=20.74±4.69) and it was more frequent in men (93.7% [15 of 16] vs 75% [16 of 24]; p=0.04, OR=3.86; 95% IC 0.99 to 14.92). Both groups presented similar anthropometric parameters values. Endothelial function evaluated by reactive hyperemia index was similar in both groups (RHG: 1.88±0.09 vs CHG: 2.03±0.09; p=0.28). Although we found differences in oxygen desaturation> 4% (RHG: 28.75 ± 5.08 vs CHG: 64.15 ± 16.97, p = 0.04), total sleep time (RHG: 309.5 ± 15.27 vs CHG: 323.3 ± 18.74 min) and minimum saturation (RHG: 87.8±0.85 vs CHG: 83.3±2.37%) was not different. In general, OSA was correlated with weight (r = 0.51, p = 0.0007), BMI (r = 0.41, p = 0.0078), WaC (r = 0, 44, p = 0.005), NC (r = 0.38, p = 0.01) and WHtR (r = 0.39, p = 0.01) and independently associated with impairment of endothelial function (p = 0.0297, OR = 0.17, 95% CI 0.04 to 0.72). In conclusion, the findings of this study show high prevalence of OSA in patients with resistant hypertension, similar to that of controlled hypertension group. There were no significant differences in endothelial function between resistant and controlled hypertension patients. The presence of OSA in the total group of hypertensive patients was associated with increased risk of impaired endothelial function. |
publishDate |
2013 |
dc.date.issued.fl_str_mv |
2013-06-21 |
dc.date.available.fl_str_mv |
2014-05-23 |
dc.date.accessioned.fl_str_mv |
2021-01-05T19:41:31Z |
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info:eu-repo/semantics/publishedVersion |
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info:eu-repo/semantics/masterThesis |
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masterThesis |
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publishedVersion |
dc.identifier.citation.fl_str_mv |
AMORIM, Nádia Maria Lopes. Apneia obstrutiva do sono e função endotelial em pacientes com hipertensão arterial resistente. 2013. 119 f. Dissertação (Mestrado em Ciências Médicas) - Universidade do Estado do Rio de Janeiro, Rio de Janeiro, 2013. |
dc.identifier.uri.fl_str_mv |
http://www.bdtd.uerj.br/handle/1/8732 |
identifier_str_mv |
AMORIM, Nádia Maria Lopes. Apneia obstrutiva do sono e função endotelial em pacientes com hipertensão arterial resistente. 2013. 119 f. Dissertação (Mestrado em Ciências Médicas) - Universidade do Estado do Rio de Janeiro, Rio de Janeiro, 2013. |
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http://www.bdtd.uerj.br/handle/1/8732 |
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por |
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por |
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Universidade do Estado do Rio de Janeiro |
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BR |
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Centro Biomédico::Faculdade de Ciências Médicas |
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Universidade do Estado do Rio de Janeiro |
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