Name: LUIS HENRIQUE CÊIA CIPRIANO
Publication date: 28/06/2019
Advisor:
Name |
Role |
|---|---|
| SONIA ALVES GOUVEA | Advisor * |
Examining board:
| Name |
Role |
|---|---|
| JOSE GERALDO MILL | Internal Examiner * |
| SONIA ALVES GOUVEA | Advisor * |
Summary: Obstructive sleep apnea (OSA) is a disease characterized by episodes of complete or partial upper airway obstruction and its prevalence is increasing. Its main risk factors are: age, male gender and obesity. In addition to problems related to sleep fragmentation, OSA can lead to problems related to the cardiovascular system, due to its potential to cause hypertension. These problems are due to some factors such as elevated sympathetic tone, oxidative stress, inflammatory mediators and changes in intrathoracic pressure. However, the autonomic disbalance generated by increased activation of central and peripheral chemoreflex and baroreflex inhibition seems to be the main factor responsible for elevated blood pressure. Thus, it is important to investigate methods that aim to improve the cardiovascular health of these individuals. Objective: To investigate whether physical training can increase the Heart Rate Variability (HRV) and clinical parameters of patients with OSA compared to CPAP. Methods: Open clinical trial with 39 subjects with moderate to severe sleep apnea. Subjects were divided in two groups receiving either exercise therapy or CPAP. The evaluation of HRV, blood pressure, resting heart rate (HR), body composition and application of questionnaires were obtained before and after treatments. Data were analyzed by the Student t test and the Wilcoxon test, using the 95% confidence interval and significance level of 5%. Mean and standard deviation were used. Results: It was observed that individuals with OSA presented autonomic disbalance at the LF/HF ratio when compared to the reference values (P = 0.04, table 1), with a reduction in the HF parameter (P = 0.02, table 1). At sleep scales, there was a significant difference only after CPAP therapy on the Pittsburg scale (P = 03, table 3). After 8 weeks of physical training, a decrease in SBP and HRrest, LF reduction and LF / HF sympatho-vagal ratio were observed (P <0.05, table 4). In the same group there was also an increase in the parasympathetic components PNN50 and HF (P <0.05, table 4). In the stratification we divided the exercise group, we verified that there was an improvement in the parameters SBP, HF (nu) and HF (p <0.05, table 5) in the hypertensive group and an improvement of SBP, PAD, Pnn50, LF AND HF (p <0.05,
table 5) in non-hypertensive patients. And in comparison between groups, we had a more expressive decrease in SBP in hypertensive patients (p <0.05, table 5). Both groups had body weight loss, the exercise group obtained this result and loss of BMI even with an increase in skeletal muscle mass (p <0.05, table 7). The CPAP group had body weight loss due to loss of FM and SMM (p <0.05, table 7).
