1
|
Hora AF, Nápolis LM, Villaça DS, dos Santos R, Galvão TD, Togeiro SMG, Bittencourt LR, Nery LE. Risk prediction for Obstructive Sleep Apnea prognostic in Obese patients referred for bariatric surgery. J Bras Pneumol 2022; 48:e20210360. [PMID: 36477170 PMCID: PMC9720887 DOI: 10.36416/1806-3756/e20210360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 09/07/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES (i) To assess the anthropometric measurements, along with the clinical characteristics and quality of life profiles of the studied patients; (ii) To determine the occurrence and severity of Obstructive Sleep Apnea (OSA), using polysomnography; and (iii) To identify the best anthropometric and clinical indicators to predict OSA in obese patients who are candidates for bariatric surgery. METHODS a prospective observational study conducted in a private clinic, using consecutive sampling of patients eligible for bariatric surgery with a BMI ≥ 40, or with a BMI of ≥ 35 kg/m² accompanied by comorbidities associated with obesity. RESULTS Sixty patients were initially selected, of whom 46 agreed to take part in the preoperative evaluation. OSA was observed in 76% of patients, 59% of whom had moderate-to-severe OSA, with a predominance of men in these groups. Among the variables suggesting statistical difference between groups, waist-to-hip ratio (WHR) was the only clinical factor associated with scores the apnea hypopnea index (AHI) ≥ 15, with a cut-off value of 0.95. The results showed that patients scoring above 0.95 are three times more likely to have moderate-to-severe apnea. CONCLUSION The best risk factor for the prognostic of moderate-to-severe OSA was presenting a WHR score with a cut-off value of 0.95 or above.
Collapse
Affiliation(s)
- Adriana Fontes Hora
- Departamento de Pneumologia, Universidade Federal de São Paulo, São Paulo (SP), Brasil.
| | - Lara Maris Nápolis
- Departamento de Pneumologia, Universidade Federal de São Paulo, São Paulo (SP), Brasil.
| | - Débora Strose Villaça
- Departamento de Pneumologia, Universidade Federal de São Paulo, São Paulo (SP), Brasil.
| | - Renata dos Santos
- Departamento de Pneumologia, Universidade Federal de São Paulo, São Paulo (SP), Brasil.
| | | | | | - Lia Rita Bittencourt
- Departamento de Pneumologia, Universidade Federal de São Paulo, São Paulo (SP), Brasil.
| | - Luiz Eduardo Nery
- Departamento de Pneumologia, Universidade Federal de São Paulo, São Paulo (SP), Brasil.
| |
Collapse
|
2
|
Silva-Reis A, Rodrigues Brandao-Rangel MA, Moraes-Ferreira R, Gonçalves-Alves TG, Souza-Palmeira VH, Aquino-Santos HC, Bachi ALL, de Oliveira LVF, Lopes-Martins RÁB, Oliveira-Silva I, Albertini R, Frison CR, Vieira RP. Combined resistance and aerobic training improves lung function and mechanics and fibrotic biomarkers in overweight and obese women. Front Physiol 2022; 13:946402. [PMID: 36160852 PMCID: PMC9491379 DOI: 10.3389/fphys.2022.946402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Obesity impairs lung function and mechanics and leads to low-grade inflammation, but the effects of combined physical exercise (CPE) on that are unknown. Methods: We investigated the effects of 12 weeks of combined physical exercise (aerobic + resistance training), in non-obese (n = 12), overweight (n = 17), and obese grade I (n = 11) women. Lung function and lung mechanics were evaluated. The systemic immune response was evaluated by whole blood analysis and biomarker measurements, while pulmonary fibrotic biomarkers were evaluated in the breath condensate. Result: CPE improved forced vital capacity (FVC) % (p < 0.001) and peak expiratory flow (PEF) % (p < 0.0003) in the obese group; resistance of the respiratory system (R5Hz) in non-obese (p < 0.0099), overweight (p < 0.0005), and obese (p < 0.0001) groups; resistance of proximal airways (R20Hz) in non-obese (p < 0.01), overweight (p < 0.0009), and obese (p < 0.0001) groups; resistance of distal airways (R5Hz–R20Hz) in non-obese (p < 0.01), overweight (p < 0.0012), and obese (p < 0.0001) groups; reactance of the respiratory system (X5Hz) in non-obese (p < 0.01), overweight (p < 0.0006), and obese (p < 0.0005) groups; impedance of the respiratory system (Z5Hz) in non-obese (p < 0.0099), overweight (p < 0.0005), and obese (p < 0.0001) groups; central resistance (RCentral) in non-obese (p < 0.01), overweight (p < 0.001), and obese (p < 0.0003) groups; and the peripheral resistance (RPeripheral) in non-obese (p < 0.03), overweight (p < 0.001), and obese (p < 0.0002) groups. CPE reduced the pro-fibrotic IGF-1 levels in BC in overweight (p < 0.0094) and obese groups (p < 0.0001) and increased anti-fibrotic Klotho levels in BC in obese (p < 0.0001) groups, and reduced levels of exhaled nitric oxide in overweight (p < 0.03) and obese (p < 0.0001) groups. Conclusion: CPE improves lung function, mechanics, and pulmonary immune response in overweight and obese grade I women by increasing anti-fibrotic protein Klotho and reducing pro-fibrotic IGF-1.
Collapse
Affiliation(s)
- Anamei Silva-Reis
- Post-graduation Program in Sciences of Human Movement and Rehabilitation, Federal University of Sao Paulo, São Paulo, Brazil
| | | | - Renilson Moraes-Ferreira
- Post-graduation Program in Sciences of Human Movement and Rehabilitation, Federal University of Sao Paulo, São Paulo, Brazil
| | - Thiago Gibson Gonçalves-Alves
- Post-graduation Program in Sciences of Human Movement and Rehabilitation, Federal University of Sao Paulo, São Paulo, Brazil
| | - Victor Hugo Souza-Palmeira
- Post-graduation Program in Sciences of Human Movement and Rehabilitation, Federal University of Sao Paulo, São Paulo, Brazil
| | - Helida Cristina Aquino-Santos
- Post-graduation Program in Sciences of Human Movement and Rehabilitation, Federal University of Sao Paulo, São Paulo, Brazil
| | | | | | | | - Iranse Oliveira-Silva
- Post-graduation Program in Human Movement and Rehabilitation, Centro Universitário UniEvangélica, Anápolis, Brazil
| | - Regiane Albertini
- Post-graduation Program in Sciences of Human Movement and Rehabilitation, Federal University of Sao Paulo, São Paulo, Brazil
| | - Claudio Ricardo Frison
- Post-graduation Program in Sciences of Human Movement and Rehabilitation, Federal University of Sao Paulo, São Paulo, Brazil
| | - Rodolfo P Vieira
- Post-graduation Program in Sciences of Human Movement and Rehabilitation, Federal University of Sao Paulo, São Paulo, Brazil
- Post-graduation Program in Human Movement and Rehabilitation, Centro Universitário UniEvangélica, Anápolis, Brazil
- *Correspondence: Rodolfo P Vieira,
| |
Collapse
|
3
|
de Sousa ART, Freitas Junior WR, Perez EA, Ilias EJ, Silva AS, Alves VLS, Afonso JPR, Oliveira MC, Fonseca AL, da Silva MM, Lino MEM, Oliveira Junior MC, Vieira RP, Pedro WJS, Bachi ALL, Insalaco G, Malheiros CA, Oliveira LVF. Surgery for Obesity and Weight-Related Diseases Changes the Inflammatory Profile in Women with Severe Obesity: a Randomized Controlled Clinical Trial. Obes Surg 2021; 31:5224-5236. [PMID: 34554379 DOI: 10.1007/s11695-021-05702-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION/PURPOSE Obesity increases significantly every year worldwide. Since 1980, the prevalence of individuals with obesity has practically doubled. Obesity plays an important role in the pathophysiology of diseases that arise from a complex interaction of nutritional, genetic, and metabolic factors, characterizing a chronic inflammatory state. This study aimed to verify the systemic inflammatory response through the analysis of IGF-1, IL-23, and resistin levels and the lipid profile in severely obese women undergoing surgery for obesity and weight-related diseases. MATERIALS AND METHODS This randomized controlled clinical trial includes female patients clinically diagnosed with severe obesity with an indication for bariatric surgery. RESULTS In the initial evaluation, no significant difference was observed between the control (CG) and bariatric surgery (BSG) groups. The weight, BMI, systolic and diastolic blood pressures, total cholesterol, LDL, HDL, total non-HDL cholesterol, and glucose in BSG patients showed a significant change after surgery. Pre- and post-surgery levels of resistin, IGF-1, and IL-23 showed a significant difference in the BSG group, but only IL-23 was changed after 6 months in the CG. CONCLUSION The results of this study confirmed that weight loss induced by surgery for obesity and weight-related diseases improved the lipid profile and reduced the chronic inflammatory status in women with severe obesity.
Collapse
Affiliation(s)
| | | | - Eduardo Araujo Perez
- Post Graduation Program in Health Sciences, Santa Casa of Sao Paulo Medical School, Sao Paulo, SP, 01221-010, Brazil
| | - Elias Jirjoss Ilias
- Post Graduation Program in Health Sciences, Santa Casa of Sao Paulo Medical School, Sao Paulo, SP, 01221-010, Brazil
| | - Anderson Soares Silva
- Post Graduation Program in Health Sciences, Santa Casa of Sao Paulo Medical School, Sao Paulo, SP, 01221-010, Brazil
| | - Vera Lucia Santos Alves
- Post Graduation Program in Health Sciences, Santa Casa of Sao Paulo Medical School, Sao Paulo, SP, 01221-010, Brazil
| | - João Pedro Ribeiro Afonso
- Human Movement and Rehabilitation Post-Graduation Program, Evangelical University of Goiás (UniEVANGELICA), Anápolis, GO, 75083-515, Brazil
| | - Miriã Cândida Oliveira
- Human Movement and Rehabilitation Post-Graduation Program, Evangelical University of Goiás (UniEVANGELICA), Anápolis, GO, 75083-515, Brazil
| | - Adriano Luís Fonseca
- Human Movement and Rehabilitation Post-Graduation Program, Evangelical University of Goiás (UniEVANGELICA), Anápolis, GO, 75083-515, Brazil
| | - Marcos Mota da Silva
- Human Movement and Rehabilitation Post-Graduation Program, Evangelical University of Goiás (UniEVANGELICA), Anápolis, GO, 75083-515, Brazil
| | - Maria Eduarda Moreira Lino
- Human Movement and Rehabilitation Post-Graduation Program, Evangelical University of Goiás (UniEVANGELICA), Anápolis, GO, 75083-515, Brazil
| | - Manoel Carneiro Oliveira Junior
- Brazilian Institute of Teaching and Research in Pulmonary and Exercise Immunology (IBEPIPE), São José dos Campos, SP, 12245-520, Brazil
| | - Rodolfo Paula Vieira
- Brazilian Institute of Teaching and Research in Pulmonary and Exercise Immunology (IBEPIPE), São José dos Campos, SP, 12245-520, Brazil.,Postgraduate Program in Bioengineering, Universidade Brasil, São Paulo, SP, 08230-030, Brazil
| | - Wilson José Sena Pedro
- Clínica de Gastroenterologia e Medicina Avançada (GASTROMED), Anápolis, GO, 75080-620, Brazil
| | - André Luis Lacerda Bachi
- Brazilian Institute of Teaching and Research in Pulmonary and Exercise Immunology (IBEPIPE), São José dos Campos, SP, 12245-520, Brazil.,Department of Otorhinolaryngology, ENT Lab, Federal University of São Paulo (UNIFESP), São Paulo, SP, 04021-001, Brazil.,Post-Graduation Program in Health Science, Santo Amaro University (UNISA), São Paulo, SP, 04743-030, Brazil
| | - Giuseppe Insalaco
- Institute for Biomedical Research and Innovation, National Research Council of Italy (CNR), 90146, Palermo, Italy
| | - Carlos Alberto Malheiros
- Post Graduation Program in Health Sciences, Santa Casa of Sao Paulo Medical School, Sao Paulo, SP, 01221-010, Brazil
| | - Luis Vicente Franco Oliveira
- Post Graduation Program in Health Sciences, Santa Casa of Sao Paulo Medical School, Sao Paulo, SP, 01221-010, Brazil. .,Human Movement and Rehabilitation Post-Graduation Program, Evangelical University of Goiás (UniEVANGELICA), Anápolis, GO, 75083-515, Brazil.
| |
Collapse
|
4
|
Kilavuz A, Celikhisar H, Dasdemir Ilkhan G. The Association of Serum 25(OH) Vitamin D Level with Severity of Obstructive Sleep Apnea Syndrome in Patients with Syndrome Z (the Interaction of Obstructive Sleep Apnea with Metabolic Syndrome). Metab Syndr Relat Disord 2021; 19:549-555. [PMID: 34515542 DOI: 10.1089/met.2021.0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The interaction of obstructive sleep apnea syndrome (OSAS) with metabolic syndrome (MetS) is known as syndrome Z. The aim of this study was to investigate the association of serum vitamin D levels with severity of OSAS in patients with Syndrome Z. Methods: In this retrospective study, 270 patients with MetS and OSAS were included. Demographic data, lifestyle habits, anthropometric measurements, sleep characteristics, polysomnographic indices, and laboratory results were recorded from the patient files. Multivariable logistic regression analyses were performed to determine the associations of serum 25(OH)D3 levels with OSAS. Results: Of the 270 patients, 71.9% were female. The mean age was 46.86 ± 8.46 (33-72) years. Of the participants, 8.2% did not have OSAS (control group), while 30.4% had mild, 28.1% had moderate, and 33.3% had severe OSAS. There were significant differences in gender, waist circumference, hip circumference, waist/hip ratio, neck circumference, body mass index, apnea-hypopnea index, total sleep time, average SpO2 and Epworth sleepiness scale score, oxygen desaturation index, blood glucose, total cholesterol, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and 25(OH)D3 levels. There was a significant difference in serum 25(OH)D3 level with increasing severities of OSAS (none+mild to moderate+severe OSAS). After adjusting for potential confounding factors in multivariable logistic regression analyses, we found that serum 25(OH)D3 level was significantly associated with the severity of OSAS. Conclusions: Serum 25(OH)D3 level was significantly associated with the severity of OSAS in patients with Syndrome Z. Therefore, patients with MetS and OSAS should be investigated for the presence of vitamin D insufficiency and, if observed, referred for vitamin D treatment.
Collapse
Affiliation(s)
- Asli Kilavuz
- Department of Internal Medicine, Ege University Faculty of Medicine, Izmir, Turkey
| | - Hakan Celikhisar
- Department of Chest Diseases, Izmir Metropolitan Municipality Hospital, Izmir, Turkey
| | | |
Collapse
|
5
|
Soin D, Kumar PA, Chahal J, Chawla SPS, Kaur S, Garg R, Kaur R. Evaluation of obstructive sleep apnea in metabolic syndrome. J Family Med Prim Care 2019; 8:1580-1586. [PMID: 31198718 PMCID: PMC6559083 DOI: 10.4103/jfmpc.jfmpc_175_19] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background: Metabolic syndrome has become one of the most important public health problems with a growing prevalence in both developed and developing countries. Obesity is a major risk factor for obstructive sleep apnea (OSA), which is associated with significant cardiorespiratory morbidity. Aims: The aims of this study were to find out the prevalence of OSA in patients with metabolic syndrome and to highlight the importance of assessment of OSA in these patients. Methods: This cross-sectional analytical study was conducted on 100 subjects aged 30–60 years, comprising 50 cases of metabolic syndrome and 50 controls without metabolic syndrome. Overnight polysomnography was done in all the subjects. Prevalence and severity of OSA were assessed and compared between the two groups. Results: Prevalence of OSA was significantly higher (66%) in patients with metabolic syndrome than in subjects without metabolic syndrome (12%). Out of 33 (66%) OSA patients with metabolic syndrome, 8 (16%) had mild OSA, 11 (22%) had moderate OSA, and 14 (28%) had severe OSA. Increasing severity of OSA was associated with higher mean levels of all the metabolic syndrome parameters except serum high density lipoprotein (HDL). Conclusions: OSA is highly prevalent in patients with metabolic syndrome. Also, the increasing severity of OSA is associated with poorer control of diabetes, hypertension, and dyslipidemia, which are all components of metabolic syndrome. Therefore, effective treatment of metabolic syndrome can prevent and control OSA in these patients. Similarly, reducing the severity of OSA (by early diagnosis and treatment) in patients with metabolic syndrome might help to optimize control of blood sugar, blood pressure, and serum lipids, thereby reducing the risk of cardiovascular disease. Therefore, the need for screening metabolic syndrome patients for OSA has been reinforced by this study.
Collapse
Affiliation(s)
- Divya Soin
- Department of Medicine, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Praveen Ashok Kumar
- Department of Medicine, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Jasmeen Chahal
- Department of Medicine, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Sumit Pal Singh Chawla
- Department of Medicine, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Sarabjot Kaur
- Department of Medicine, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Ravinder Garg
- Department of Medicine, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Rupinderjeet Kaur
- Department of Medicine, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| |
Collapse
|