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Reacção paradoxal da pressão arterial ao tratamento com pressão positiva na via aérea em doentes com apneia do sono
Paradoxical reaction of blood pressure on sleep apnoea patients treated with Positive Airway Pressure
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Lorenzi-Filho, P. Rodrigues Genta, L.F. Drager" "autores" => array:3 [ 0 => array:2 [ "nombre" => "G." "apellidos" => "Lorenzi-Filho" ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Rodrigues Genta" ] 2 => array:2 [ "nombre" => "L.F." "apellidos" => "Drager" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0873215911700137?idApp=UINPBA00004E" "url" => "/08732159/0000001700000002/v2_201509070838/S0873215911700137/v2_201509070838/en/main.assets" ] "pt" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Artigo original</span>" "titulo" => "Reacção paradoxal da pressão arterial ao tratamento com pressão positiva na via aérea em doentes com apneia do sono" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "53" "paginaFinal" => "58" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "C. Chaves Loureiro, M. Drummond, J.C. Winck, J. Almeida" "autores" => array:4 [ 0 => array:4 [ "nombre" => "C." "apellidos" => "Chaves Loureiro" "email" => array:1 [ 0 => "cl_loureiro@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M." "apellidos" => "Drummond" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "J.C." "apellidos" => "Winck" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "J." "apellidos" => "Almeida" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Serviço de Pneumologia, Hospitais da Universidade de Coimbra, Coimbra, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Serviço de Pneumologia, Hospital de São João do Porto, Porto, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Faculdade de Medicina da Universidade do Porto, Serviço de Pneumologia, Hospital de São João do Porto, Porto, Portugal" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "*" "correspondencia" => "Autor para correspondência." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Paradoxical reaction of blood pressure on sleep apnoea patients treated with Positive Airway Pressure" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2010-06-22" "fechaAceptado" => "2010-11-08" "PalabrasClave" => array:2 [ "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec566802" "palabras" => array:4 [ 0 => "Doentes hipertensivos" 1 => "SAOS" 2 => "Tratamento com pressão aérea positiva" 3 => "Reacção paradoxal" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec566803" "palabras" => array:4 [ 0 => "Hypertensive patients" 1 => "OSAS" 2 => "Treatment with positive pressure" 3 => "Paradoxical reaction" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<span><span class="elsevierStyleSectionTitle">Introdução</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Doentes com síndrome de Apneia Obstrutiva do Sono (SAOS) podem desenvolver hipertensão arterial (HTA) sendo a pressão positiva na via aérea (PAP) um tratamento eficaz no controlo da pressão arterial (PA).</p></span> <span><span class="elsevierStyleSectionTitle">Objectivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Analisar uma população de doentes com SAOS que desenvolveu aumento inesperado da PA após o uso de PAP e verificar a existência de correlações entre o aumento da PA, quer com os índices de gravidade da SAOS, quer com a adesão ao tratamento com suporte ventilatório nocturno.</p></span> <span><span class="elsevierStyleSectionTitle">Métodos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Análise retrospectiva e descritiva de 30 doentes com SAOS e hipertensão previamente controlada, tratados com PAP, em média durante um ano, que desenvolveram um aumento da pressão arterial, definida como aumento de 5<span class="elsevierStyleHsp" style=""></span>mmHg na Pressão Arterial Sistólica (PAS) e/ou Diastólica (PAD), após instituição de terapêutica PAP. Análise correlativa do aumento da PA com os índices de gravidade da SAOS e com a adesão ao tratamento, utilizando o coeficiente de Pearson.</p></span> <span><span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">De 508 doentes consecutivos seguidos no nosso Departamento, tratados com suporte ventilatório nocturno, 30 evoluíram com aumento de PA após o início do tratamento (idade 58 anos (SD 10,8), índice de Apneia-Hipopneia (IAH) 46,1 (SD 18,68). Após o uso de PAP, a variação da Pressão Arterial Média (PAM), da PAS e da PAD foi, respectivamente, de 16<span class="elsevierStyleHsp" style=""></span>mmHg, 20<span class="elsevierStyleHsp" style=""></span>mmHg e 6<span class="elsevierStyleHsp" style=""></span>mmHg (SD: 15,0; 25,0; 19,4). Nenhum doente mostrou aumento significativo de Índice de Massa Corporal (IMC). O valor da Escala de Sonolência de Epworth (ESE) diminuiu 8,9 pontos (SD 5,48). As variações de PAM, PAS e PAD não se relacionaram com P90/P95, IAH residual, fugas ou adesão a PAP.</p></span> <span><span class="elsevierStyleSectionTitle">Conclusões</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Neste grupo que desenvolveu um aumento da PA com o uso de PAP não se identificaram características específicas. Não foram encontradas correlações entre os aumentos da PA, nem com os índices de gravidade de SAOS nem com a adesão à PAP. Nem a variação do IMC nem do <span class="elsevierStyleItalic">wakefulness status</span> explicaram o aumento da PA. Estudos têm relacionado polimorfismos dos adrenoreceptores β1 com diferentes respostas da PA ao suporte ventilatório. Mais estudos são necessários a fim de clarificar a causa desta reacção paradoxal.</p></span>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span><span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Obstructive Sleep Apnoea Syndrome (OSAS) patients may develop hypertension and Positive Airway Pressure (PAP) is an effective treatment in blood pressure (BP) control.</p></span> <span><span class="elsevierStyleSectionTitle">Objectives</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Analyse a hypertensive OSAS population with unexpected BP rise after PAP usage and verify correlations between BP rise, either with OSAS severity index or nocturnal ventilatory support compliance.</p></span> <span><span class="elsevierStyleSectionTitle">Methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Descriptive, retrospective analysis of 30 patients with PAP treated OSA, for one year, on average, and with previous controlled hypertension, who developed a rise in BP, defined as augmentation of > 5<span class="elsevierStyleHsp" style=""></span>mmHg in systolic (SBP) and/or diastolic BP (DBP), after PAP usage. Co-relational analysis of BP increase, with OSAS severity indexes and therapy compliance, using Pearson coefficient.</p></span> <span><span class="elsevierStyleSectionTitle">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Of 508 consecutive patients followed in our Department, treated with nocturnal ventilatory support, 30 evolved with BP rise after initiating treatment (age 58<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>10.8 years; Apnoea-Hypopnoea Index [AHI], 46.1<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>18.68). After PAP usage, mean blood pressure (MBP), Systolic BP (SBP) and Diastolic BP (DBP) variation was 16<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>15<span class="elsevierStyleHsp" style=""></span>mmHg, 20<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>25 mmHg and 6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>19.4<span class="elsevierStyleHsp" style=""></span>mmHg, respectively. No patient showed significant BMI increase. Epworth Sleepiness Scale (ESS) value decreased 8.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5.48 points. MBP, SBP and DBP variations were not correlated with P90/P95, residual AHI, leaks or PAP compliance.</p></span> <span><span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">No specific characteristics were identified in the group who developed a rise in BP with PAP usage. No correlations were found between rises in BP and OSAS severity indexes or PAP compliance. Neither BMI nor variation in wakefulness status explained the rise in BP. Studies relate polymorphisms of β1-adrenoreceptors with different BP responses to ventilatory support. More studies are needed to clarify the cause of this paradoxical response.</p></span>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografia" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:22 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." 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ISSN: 08732159Original language: Portuguese
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| 2014 May | 48 | 21 | 69 |
| 2014 April | 58 | 7 | 65 |
| 2014 March | 56 | 19 | 75 |
| 2014 February | 63 | 13 | 76 |
| 2014 January | 59 | 21 | 80 |
| 2013 December | 45 | 10 | 55 |
| 2013 November | 50 | 12 | 62 |
| 2013 October | 54 | 15 | 69 |
| 2013 September | 53 | 11 | 64 |
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| 2013 July | 67 | 18 | 85 |
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| 2013 May | 67 | 8 | 75 |
| 2013 April | 82 | 14 | 96 |
| 2013 March | 56 | 9 | 65 |
| 2013 February | 45 | 20 | 65 |
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| 2012 December | 29 | 9 | 38 |
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