Efeito da apneia obstrutiva do sono sobre a pressão arterial de obesos normotensos

• Ano de defesa: 2017
• Autor(a) principal: Corrêa, Cláudia Maria Nogueira
• Orientador(a): Oigman, Wille
• Banca de defesa: Neves, Mário Fritsch Toros , Klein, Márcia Regina Simas Torres , Salles, Gil Fernando da Costa Mendes de , Cardoso, Claudia Regina Lopes
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade do Estado do Rio de Janeiro
• Programa de Pós-Graduação: Programa de Pós-Graduação em Ciências Médicas
• Departamento: Centro Biomédico::Faculdade de Ciências Médicas
• País: BR
• Palavras-chave em Português: Apneia do sono tipo obstrutiva; Hipertensão; Obesidade; Monitorização ambulatorial da pressão arterial; Monitorização do sono
• Palavras-chave em Inglês: Sleep apnea; obstructive; Ambulatory blood pressure monitoring; Obesity; Hypertension; Sleep monitoring
• Área do conhecimento CNPq: CNPQ::CIENCIAS DA SAUDE::MEDICINA::CLINICA MEDICA
• Link de acesso: http://www.bdtd.uerj.br/handle/1/8618

Obesity, systemic arterial hypertension (AH) and obstructive sleep apnea (OSA) are closely related. Up to 70% of patients with OSA may be asymptomatic, and there is evidence that these patients have cardiovascular disease, especially nocturnal AH. The main objective of this study was to evaluate the circadian rhythm of blood pressure (BP) in normotensive obese individuals with moderate/severe OSA compared to those with mild/absent OSA. Eighty-six normotensive obese subjects were recruited from our primary care clinics, and eighty-one patients underwent clinical evaluation, anthropometric measures, blood assays, sleep questionnaires: Berlin (BQ), Epworth excessive sleepiness scale (ESS), and Pittsburgh sleep quality index (PSQI), ambulatory blood pressure monitoring (ABPM), measures of pulse wave velocity and central aortic pressure and sleep monitor. We divided the study population into two groups: the group with moderate-to-severe OSA (AHI&#8805;15events/h) and the group with mild/absent OSA (AHI<15events/h). Moderate-to-severe OSA individuals had greater neck circumference and waist-to-hip ratio (40.5±3.2cm vs. 38.0±3.7cm, p=0.002, and 0.94±0.05 vs. 0.89±0.05, p=0.001, respectively), higher 24-h SBP and 24-h DBP (122±6 vs.118±8 mmHg, p=0.014, and 78±6 vs. 73±7 mmHg, p=0.008), higher night-time diastolic BP load (45±26% vs. 31±27%, p=0.041); masked hypertension and night-time hypertension (30,9% vs. 61,5%, p=0,009). Moreover, in the moderate-to-severe OSA group, night-time diastolic BP were positively correlated to AHI (r=0.43, p<0.03). The values of VOP, aortic SBP, AIx and PP (aortic pressures) did not show significant differences between the groups. The groups did not present statistical difference for biochemistry exams, neither for metabolic syndrome. In relation to the sleep questionnaires, twenty-three of eighty-one subjects had AHI&#8805;15 events/h and 88.5% of them were classified as being at high risk of sleep apnea with BQ (88.5% vs. 61.8% (p<0.014), 57.6% of them were classified as having excessive daytime sleepiness with ESS (57.6% vs. 50.0%, p=0,758) and 57.6% of them were classified as having bad quality of sleep with PSQI (57.6% vs. 43.6, p=0,353). The BQ predicted at a cut-off value of AHI&#8805;15 events/h, sensitivity of 78.6% and specificity of 44.6%, vs. a sensitivity of 53.6% and a specificity of 44.6% with the ESS, vs. a sensitivity of 82.1% and a specificity of 10.7 with the PSQI. It was demonstraded high value for NPV in BQ, 80,6% (IC95%, 72,2-89,1). ABPM may be useful in the evaluation of normotensive obese patients with moderate-to-severe OSA due to the high prevalence of HN and MH found in this study; central obesity indexes are good indicators for OSA; QB may have utility in the selection of individuals from a population of normotensive obese individuals to OSA; the ESEE and IQSP were not useful to help identify individuals with OSA.