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  1. Article ; Online: Sympathetic overactivity, hypertension and cardiovascular disease: state of the art.

    Grassi, Guido / Drager, Luciano F

    Current medical research and opinion

    2024  Volume 40, Issue sup1, Page(s) 5–13

    Abstract: Cardiovascular disease (CVD) remains the most prevalent cause of premature death worldwide. It had been suspected for decades that increased activity of the sympathetic nervous system (SNS) might play a pathogenetic role in the development and ... ...

    Abstract Cardiovascular disease (CVD) remains the most prevalent cause of premature death worldwide. It had been suspected for decades that increased activity of the sympathetic nervous system (SNS) might play a pathogenetic role in the development and progression of hypertension, heart failure (HF) and CVD. The use of microneurographic techniques to directly assess the SNS has allowed this field to advance considerably in recent years. We now have compelling evidence for a key role of sympathetic overactivity in the pathogenesis and progression of hypertension and associated hypertension-mediated organ damage (such as endothelial dysfunction, arterial stiffness and left ventricular hypertrophy), HF (with or without reduced left ventricular ejection fraction). Sympathetic overactivity also drives increased cardiovascular risk in the settings of obesity, metabolic syndrome, chronic kidney disease and obstructive sleep apnoea, among other conditions. Thus, sympathetic overactivity is an important factor that drives patients through the CVD continuum, from the early appearance of cardiovascular risk factors, to impairments of the structure and function of components of the heart and arteries, to established CVD, and ultimately to a life-threatening cardiovascular event. A deeper understanding of the role of sympathetic overactivity in the pathogenesis of CVD and HF will support the optimization of therapeutic interventions for these conditions.
    MeSH term(s) Humans ; Cardiovascular Diseases/etiology ; Cardiovascular Diseases/complications ; Stroke Volume ; Ventricular Function, Left ; Hypertension/drug therapy ; Heart Failure ; Sympathetic Nervous System
    Language English
    Publishing date 2024-04-10
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 80296-7
    ISSN 1473-4877 ; 0300-7995
    ISSN (online) 1473-4877
    ISSN 0300-7995
    DOI 10.1080/03007995.2024.2305248
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 955: Show issues Location:
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  2. Article ; Online: Cost-Utility Analysis of Continuous Positive Airway Pressure Therapy Compared With Usual Care for Obstructive Sleep Apnea in the Public Health System in Brazil.

    Pachito, Daniela V / Eckeli, Alan L / Drager, Luciano F

    Value in health regional issues

    2023  Volume 40, Page(s) 81–88

    Abstract: Objectives: This study aimed to conduct a cost-utility analysis of continuous positive airway pressure (CPAP) therapy compared with usual care as treatment of moderate to severe cases of obstructive sleep apnea (OSA) in Brazil, where decentralized ... ...

    Abstract Objectives: This study aimed to conduct a cost-utility analysis of continuous positive airway pressure (CPAP) therapy compared with usual care as treatment of moderate to severe cases of obstructive sleep apnea (OSA) in Brazil, where decentralized policies of CPAP provision are in place.
    Methods: Markov cohort model comparing CPAP therapy with usual care, that is, no specific treatment for OSA, for moderate to severe cases was used. The payer perspective from the Unified Health System, Brazil, was adopted. Effectiveness parameters and costs related to health states were informed by literature review. Resource use related to CPAP therapy was defined by specialists and costs informed by recent purchase and leasing contracts. Incremental cost-effectiveness ratios were generated for purchase and leasing contracts to reflect current practices. A conservative willingness-to-pay threshold was set at 1 gross domestic product per capita per quality-adjusted life-year (QALY) (Brazilian reais [BRL] 40 712/QALY). Uncertainties were explored in deterministic and probabilistic sensitivity analyses.
    Results: Incremental cost-effectiveness ratio for the purchase modality was 8303 BRL/QALY and for leasing 45 192 BRL/QALY. Considering the adopted willingness-to-pay threshold, provision of CPAP by the purchase modality was considered cost-effective but not the leasing modality. The parameter related to the greatest uncertainty was the reduction in the risk of having a stroke attributable to CPAP. Probabilistic analysis confirmed the robustness of results.
    Conclusions: CPAP therapy is a cost-effective alternative compared with usual care for moderate to severe OSA for the purchase modality. These results should help underpinning the decision making related to a uniform policy of CPAP provision across the country.
    MeSH term(s) Humans ; Continuous Positive Airway Pressure/methods ; Cost-Benefit Analysis ; Brazil ; Public Health ; Sleep Apnea, Obstructive/therapy
    Language English
    Publishing date 2023-12-05
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2679127-4
    ISSN 2212-1102 ; 2212-1099
    ISSN (online) 2212-1102
    ISSN 2212-1099
    DOI 10.1016/j.vhri.2023.10.006
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    Zs.A 6969: Show issues Location:
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  3. Article ; Online: The Cardiovascular Impact of Obstructive Sleep Apnea in Women: Current Knowledge and Future Perspectives.

    Parise, Barbara K / Ferreira, Naira Lapi / Drager, Luciano F

    Sleep medicine clinics

    2023  Volume 18, Issue 4, Page(s) 473–480

    Abstract: Overall, cardiovascular diseases have many sex-related differences in prevalence, clinical presentation, and outcomes. A considerable amount of evidence suggests that obstructive sleep apnea (OSA) increases the risk for several cardiovascular diseases. ... ...

    Abstract Overall, cardiovascular diseases have many sex-related differences in prevalence, clinical presentation, and outcomes. A considerable amount of evidence suggests that obstructive sleep apnea (OSA) increases the risk for several cardiovascular diseases. Only recently, the sex-related differences in cardiovascular outcomes gained interest in the literature. In this review, the authors discuss the current evidence addressing the cardiovascular impact of OSA in women. Particular attention is devoted to hypertension, target-organ damage, heart failure, atrial fibrillation, and cardiovascular events (including mortality). A research agenda is proposed to increase the understanding of the relevance of OSA in women from the Cardiology perspective.
    MeSH term(s) Humans ; Female ; Cardiovascular Diseases/complications ; Cardiovascular Diseases/epidemiology ; Cardiovascular Diseases/therapy ; Sleep Apnea, Obstructive/complications ; Sleep Apnea, Obstructive/epidemiology ; Sleep Apnea, Obstructive/therapy ; Hypertension ; Atrial Fibrillation ; Heart Failure ; Risk Factors
    Language English
    Publishing date 2023-07-21
    Publishing country United States
    Document type Journal Article ; Review
    ISSN 1556-4088
    ISSN (online) 1556-4088
    DOI 10.1016/j.jsmc.2023.06.008
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  4. Article ; Online: Reply: Salt, Diuretics, and Obstructive Sleep Apnea.

    Giatti, Soraya / Drager, Luciano F

    Annals of the American Thoracic Society

    2021  Volume 18, Issue 12, Page(s) 2103–2104

    MeSH term(s) Diuretics/adverse effects ; Humans ; Sleep Apnea, Obstructive ; Sodium Chloride
    Chemical Substances Diuretics ; Sodium Chloride (451W47IQ8X)
    Language English
    Publishing date 2021-06-15
    Publishing country United States
    Document type Letter ; Research Support, Non-U.S. Gov't ; Comment
    ZDB-ID 2717461-X
    ISSN 2325-6621 ; 1943-5665 ; 2325-6621
    ISSN (online) 2325-6621 ; 1943-5665
    ISSN 2325-6621
    DOI 10.1513/AnnalsATS.202106-654LE
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    Zs.A 5828: Show issues Location:
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  5. Article ; Online: To Dip or not to Dip Blood Pressure in Chronic Obstructive Pulmonary Disease: That is the Question!

    Furlan, Sofia F / Drager, Luciano F

    Arquivos brasileiros de cardiologia

    2021  Volume 116, Issue 2, Page(s) 303–304

    Title translation Pressão Dipper ou não Dipper na Doença Pulmonar Obstrutiva Crônica: Eis a Questão!
    MeSH term(s) Blood Pressure ; Blood Pressure Monitoring, Ambulatory ; Humans ; Pulmonary Disease, Chronic Obstructive ; Quality of Life
    Language Portuguese
    Publishing date 2021-03-22
    Publishing country Brazil
    Document type Editorial ; Comment
    ZDB-ID 730261-7
    ISSN 1678-4170 ; 0066-782X
    ISSN (online) 1678-4170
    ISSN 0066-782X
    DOI 10.36660/abc.20201379
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    Zs.A 548: Show issues Location:
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  6. Article: New Challenges for Sleep Apnea Research: Simple Diagnostic Tools, Biomarkers, New Treatments and Precision Medicine.

    Drager, Luciano F

    Sleep science (Sao Paulo, Brazil)

    2017  Volume 10, Issue 1, Page(s) 55–56

    Language English
    Publishing date 2017-05-23
    Publishing country Brazil
    Document type Editorial
    ZDB-ID 2697016-8
    ISSN 1984-0063 ; 1984-0659
    ISSN (online) 1984-0063
    ISSN 1984-0659
    DOI 10.5935/1984-0063.20170009
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  7. Article ; Online: What is the Best Antihypertensive Treatment for OSA?

    Lima-Junior, José Gilvam A / Martins, Ana Vitoria Vitoreti / Drager, Luciano F

    Archivos de bronconeumologia

    2023  Volume 59, Issue 9, Page(s) 548–549

    MeSH term(s) Humans ; Antihypertensive Agents/therapeutic use ; Hypertension/complications ; Hypertension/drug therapy ; Sleep Apnea, Obstructive/complications ; Sleep Apnea, Obstructive/drug therapy ; Blood Pressure ; Continuous Positive Airway Pressure
    Chemical Substances Antihypertensive Agents
    Language Spanish
    Publishing date 2023-03-21
    Publishing country Spain
    Document type Editorial
    ZDB-ID 733126-5
    ISSN 1579-2129 ; 0300-2896
    ISSN (online) 1579-2129
    ISSN 0300-2896
    DOI 10.1016/j.arbres.2023.03.006
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    Zs.B 2655: Show issues Location:
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  8. Article ; Online: Obstructive sleep apnea and metabolic syndrome.

    Giampá, Sara Q C / Lorenzi-Filho, Geraldo / Drager, Luciano F

    Obesity (Silver Spring, Md.)

    2023  Volume 31, Issue 4, Page(s) 900–911

    Abstract: Metabolic syndrome (MS) is a heterogeneous condition associated with increased cardiovascular risk. There is growing evidence from experimental, translational, and clinical investigations that has suggested that obstructive sleep apnea (OSA) is ... ...

    Abstract Metabolic syndrome (MS) is a heterogeneous condition associated with increased cardiovascular risk. There is growing evidence from experimental, translational, and clinical investigations that has suggested that obstructive sleep apnea (OSA) is associated with prevalent and incident components of MS and MS itself. The biological plausibility is supportive, primarily related to one of the main features of OSA, namely intermittent hypoxia: increased sympathetic activation with hemodynamic repercussions, increased hepatic glucose output, insulin resistance through adipose tissue inflammation, pancreatic β-cell dysfunction, hyperlipidemia through the worsening of fasting lipid profiles, and the reduced clearance of triglyceride-rich lipoproteins. Although there are multiple related pathways, the clinical evidence relies mainly on cross-sectional data preventing any causality assumptions. The overlapping presence of visceral obesity or other confounders such as medications challenges the ability to understand the independent contribution of OSA on MS. In this review, we revisit the evidence on how OSA/intermittent hypoxia could mediate adverse effects of MS parameters independent of adiposity. Particular attention is devoted to discussing recent evidence from interventional studies. This review describes the research gaps, the challenges in the field, perspectives, and the need for additional high-quality data from interventional studies addressing the impact of not only established but promising therapies for OSA/obesity.
    MeSH term(s) Humans ; Metabolic Syndrome/complications ; Cross-Sectional Studies ; Insulin Resistance/physiology ; Obesity/complications ; Hypoxia/complications ; Hypoxia/metabolism ; Sleep Apnea, Obstructive/complications
    Language English
    Publishing date 2023-03-02
    Publishing country United States
    Document type Journal Article ; Review ; Research Support, Non-U.S. Gov't
    ZDB-ID 2230457-5
    ISSN 1930-739X ; 1071-7323 ; 1930-7381
    ISSN (online) 1930-739X
    ISSN 1071-7323 ; 1930-7381
    DOI 10.1002/oby.23679
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    Zs.A 4061: Show issues Location:
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    Zs.MG 87: Show issues

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  9. Article ; Online: What is the effect of catecholamines on diastolic function in patients with pheochromocytoma and paraganglioma?

    Macedo, Thiago Andrade / Drager, Luciano F / Vieira, Marcelo Luiz Campos

    Journal of clinical ultrasound : JCU

    2022  

    Abstract: Pheochromocytoma is a rare form of secondary hypertension characterized by excessive production of catecholamines typically due to a benign tumor in the adrenal medulla. Among the potential cardiac repercussions of pheochromocytoma and paraganglioma, ... ...

    Abstract Pheochromocytoma is a rare form of secondary hypertension characterized by excessive production of catecholamines typically due to a benign tumor in the adrenal medulla. Among the potential cardiac repercussions of pheochromocytoma and paraganglioma, previous studies described echocardiographic abnormalities such as dynamic left ventricular outflow tract obstruction (i), cardiomyopathy (ii, iii, iv), reversible dilatation of the left ventricle (v) and left ventricular functional changes (vi) in patients with pheochromocytoma.
    Language English
    Publishing date 2022-12-05
    Publishing country United States
    Document type Journal Article
    ZDB-ID 189393-2
    ISSN 1097-0096 ; 0091-2751
    ISSN (online) 1097-0096
    ISSN 0091-2751
    DOI 10.1002/jcu.23295
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  10. Article: Struggling with comorbid sleep disturbances: insights from the ELSA-Brasil study.

    Drager, Luciano F / Santos, Ronaldo B

    Sleep science (Sao Paulo, Brazil)

    2020  Volume 13, Issue 2, Page(s) 94–96

    Language English
    Publishing date 2020-07-08
    Publishing country Brazil
    Document type Journal Article
    ZDB-ID 2697016-8
    ISSN 1984-0063 ; 1984-0659
    ISSN (online) 1984-0063
    ISSN 1984-0659
    DOI 10.5935/1984-0063.20200028
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