Joao Carlos, Winck | Faculdade de Medicina da Universidade do Porto (original) (raw)
Papers by Joao Carlos, Winck
Respiratory Care, 2012
Noninvasive ventilation (NIV) has been widely used to decrease the complications associated with ... more Noninvasive ventilation (NIV) has been widely used to decrease the complications associated with tracheal intubation in mechanically ventilated patients. However, nasal ulcerations may occur when conventional masks are used for continuous ventilation. A total face mask, which has no contact with the more sensitive areas of the face, is a possible option. We describe 3 patients with acute respiratory failure due to amyotrophic lateral sclerosis, who developed nasal bridge skin necrosis during continuous NIV, and one patient with post-extubation respiratory failure due to a high spinal cord injury, who had facial trauma with contraindication for conventional mask use. The total face mask was very well tolerated by all the patients, and permitted safe and efficient continuous NIV for several days until the acute respiratory failure episode resolved. None of the patients required endotracheal intubation during the acute episode. Key words: noninvasive ventilation; interface; total face mask; acute respiratory failure; nasal bridge sore; amyotrophic lateral sclerosis. [Respir Care 2012;57(3):1-•.
Revista Portuguesa de Pneumologia, 2011
We would like to thank the authors for their comment on our article 1 about the study on the pres... more We would like to thank the authors for their comment on our article 1 about the study on the prescription of ambulatory oxygen (AO) and for raising very pertinent and important issues. Our findings of relatively low adherence to prescribed AO are consistent with other studies ...
Sleep and Breathing, 2011
Prevalence of metabolic syndrome (MS) in obstructive sleep apnea (OSA) patients is high. The effe... more Prevalence of metabolic syndrome (MS) in obstructive sleep apnea (OSA) patients is high. The effect of autoadjusting positive airway pressure (APAP) on MS remains unclear. This study aimed to determine the prevalence of MS in OSA patients before and 6 months after APAP, and to identify potential determinants of metabolic status change. Seventy-four male patients with moderate to severe OSA were enrolled. MS diagnosis was established according to the National Cholesterol Education Program/Adult Treatment Panel III. APAP was prescribed to all patients. In the studied population, mean age was 55.9 years (SD 10.7 years), median body mass index (BMI), Epworth sleepiness scale (ESS), and respiratory disturbance index (RDI) were 33.4 kg/m(2) (interquartile range (IQR) 8.4 kg/m(2)), 12.0 (IQR 8.0), and 46.9/h (IQR 33.6/h), respectively. Prevalence of MS before and 6 months after APAP was 63.5% and 47.3%, respectively, and this difference was statistically significant (p = 0.004). In the subgroup of patients with MS at baseline (n = 47), 14 did not present MS after APAP. In these patients, a significant negative association with RDI (p = 0.016) and a positive association with percent of total days of usage (p = 0.014) were found. Blood pressure (p = 0.018) and serum triglycerides (p = 0.001) had a statistically significant reduction during this period. In patients that still had MS, 22.2% presented a reduction of the number of MS criteria. After 6 months, APAP reduced the prevalence of MS, mainly in patients with less severe OSA and with a better therapeutic compliance. Blood pressure and serum triglycerides reduction contributed to this metabolic status change.
![Research paper thumbnail of [Long term effect of autoadjusting positive airway pressure on C-reactive protein and interleukin-6 in men with obstructive sleep apnoea syndrome]](https://attachments.academia-assets.com/43151508/thumbnails/1.jpg)
](Archivos de bronconeumología, 2009
Obstructive sleep apnoea (OSA) has been increasingly linked to cardiovascular disease. Inflammato... more Obstructive sleep apnoea (OSA) has been increasingly linked to cardiovascular disease. Inflammatory processes associated with OSA may contribute to this morbidity. Some studies have reported serum levels of high sensitivity C-reactive protein (hs-CRP) and interleukin-6 (IL-6) to be increased in these patients. investigate the impact of short and long-term autoadjusting positive airway pressure (APAP) therapy on IL-6 and hs-CRP serum levels in patients with moderate to severe obstructive sleep apnoea. Secundary Objective: evaluate the basal hs-CRP and IL-6 levels in OSA patients and its possible relation to OSA severity, independently of confounders and compare the hs-CRP levels in OSA patients with those in community controls. This is a prospective study including 98 male patients with moderate to severe OSA confirmed by domiciliary sleep study. Malignancy and chronic inflammatory diseases were exclusion criteria. hs-CRP and IL-6 serum levels were evaluated before APAP, 9 days and 6...
BMC Pulmonary Medicine, 2008
Leptin is an hormone that regulates body weight. Studies have shown increasing leptin concentrati... more Leptin is an hormone that regulates body weight. Studies have shown increasing leptin concentrations according to body mass index (BMI) and intermittent hypoxia.
Journal of Medical Case Reports, 2009
Introduction: The standard treatment for obstructive sleep apnoea syndrome is nasal continuous po... more Introduction: The standard treatment for obstructive sleep apnoea syndrome is nasal continuous positive airway pressure. In most cases the obstruction is located at the oropharyngeal level, and nasal continuous positive airway pressure is usually effective. In cases of non-response to nasal continuous positive airway pressure other treatments like mandibular advancement devices or upper airway surgery (especially bi-maxillary advancement) may also be considered.
Leptin is an hormone that regulates body weight. Studies have shown increasing leptin concentrati... more Leptin is an hormone that regulates body weight. Studies have shown increasing leptin concentrations according to body mass index (BMI) and intermittent hypoxia.
Sleep and Breathing, 2012
Objective The purpose of this study was to evaluate the prevalence and assess the response to nas... more Objective The purpose of this study was to evaluate the prevalence and assess the response to nasal automatic positive airway pressure (APAP) therapy of less typical symptoms in patients diagnosed with obstructive sleep apnea (OSA), like fatigue, gasping, nocturia, nocturnal sweating, morning headaches, heartburn, and erectile dysfunction. Methods Ninety-eight male patients with moderate to severe OSA were included in the study (n=98). In the beginning of the study, an overnight sleep study was performed to all subjects using a five-channel recording device. Patients started APAP therapy with pre-determined minimum and maximum pressures of 4 and 15 cmH 2 0, respectively. The total Sleep Disorders Questionnaire was answered by all subjects before and 6 months after APAP therapy. Questions 4, 18, 23, 25, 58, 88, and 148 were used in this study. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) 17.0 software. Results Subjects had a mean (SD) age of 55.1 (10.8) years and an average of 52.2 (21.4) apnea-hypopnea events per hour of sleep. At baseline, nocturia was the most prevalent symptom (38%), followed by nocturnal sweating (34%), gasping (30%), erectile dysfunction (25%), fatigue (23%), heartburn (15%), and morning headaches (10%). After 6 months of APAP therapy, a statistically significant reduction on the prevalence of all symptoms was observed, except for erectile dysfunction and morning headaches.
Sleep and Breathing, 2013
Purpose Auto-titrating continuous positive airway pressure (APAP) is an effective treatment for o... more Purpose Auto-titrating continuous positive airway pressure (APAP) is an effective treatment for obstructive sleep apnea/ hypopnea syndrome (OSAHS). We investigated whether a single group education session on APAP therapy is effective in promoting adherence among patients with OSAHS. Methods This prospective, randomized, controlled, parallel group study included patients newly diagnosed with OSAHS who met criteria for APAP therapy. Patients were randomized into a study group and a control group. All patients in the study group were assigned to a single group education session, 1 month after beginning APAP therapy. Results We evaluated 146 patients. The median percentage of APAP usage days was 88.3 %, with a median duration per day of use of 6.02 h; 59 % were classified as adherent. Overall, no significant difference in adherence was seen between the study and the control groups. Analyzing patient subgroups, the group session significantly improved APAP adherence among males and patients who were younger (<65 years old), obese (BMI ≥35 kg/m 2 ), non-sleepy (Epworth sleepiness scale ≤11), smokers or past smokers, had hypertension or nocturia and those with non-severe OSAHS. Conclusion To maximize the impact of group education sessions and, by that, saving resources, it may be important to select patients likely to benefit from these sessions.
![Research paper thumbnail of [Obstructive sleep apnoea and cardiovascular disease--a retrospective study]](https://attachments.academia-assets.com/43151495/thumbnails/1.jpg)
](Revista portuguesa de pneumologia
Obstructive Sleep Apnea (OSA) is associated with adverse effects in cardiovascular physiology. So... more Obstructive Sleep Apnea (OSA) is associated with adverse effects in cardiovascular physiology. Some studies have connected this pathology with Cardiovascular Disease (CVD). Determine the prevalence of CVD in patients with OSA of different severity and verify the association between CVD and OSA. Retrospective study based on data from 155 consecutive patients with OSA referred to a Sleep Disordered Breathing Clinic in an University Hospital during the year of 2001. The majority of patients were male (83,2%), the mean age was 53,6 +/- 11,9 years. Severe OSA was observed in 52,9% patients, moderate in 20% and mild in 27,1% patients (mean Apnea Hypopnea Index of 35,2 +/- 23,8/hour). Among the studied individuals 52,3% showed CVD, being Arterial Hypertension (AH) the most common disease (45,8%). Acute Myocardial Infarction appeared in 6,5% and Angina in 3,9% cases. The majority of the patients (67,1%) were obese (Body Mass Index - BMI>30). The mean BMI was 33,1 +/- 6,34. A significant ...
Archivos de Bronconeumología, 2009
Efecto a largo plazo de la presió n positiva automá tica en la vía aé rea sobre la proteína C rea... more Efecto a largo plazo de la presió n positiva automá tica en la vía aé rea sobre la proteína C reactiva y la interleucina-6 en varones con síndrome de apnea obstructiva del sueñ o
Respiratory Care, 2012
Noninvasive ventilation (NIV) has been widely used to decrease the complications associated with ... more Noninvasive ventilation (NIV) has been widely used to decrease the complications associated with tracheal intubation in mechanically ventilated patients. However, nasal ulcerations may occur when conventional masks are used for continuous ventilation. A total face mask, which has no contact with the more sensitive areas of the face, is a possible option. We describe 3 patients with acute respiratory failure due to amyotrophic lateral sclerosis, who developed nasal bridge skin necrosis during continuous NIV, and one patient with post-extubation respiratory failure due to a high spinal cord injury, who had facial trauma with contraindication for conventional mask use. The total face mask was very well tolerated by all the patients, and permitted safe and efficient continuous NIV for several days until the acute respiratory failure episode resolved. None of the patients required endotracheal intubation during the acute episode. Key words: noninvasive ventilation; interface; total face mask; acute respiratory failure; nasal bridge sore; amyotrophic lateral sclerosis. [Respir Care 2012;57(3):1-•.
Revista Portuguesa de Pneumologia, 2011
We would like to thank the authors for their comment on our article 1 about the study on the pres... more We would like to thank the authors for their comment on our article 1 about the study on the prescription of ambulatory oxygen (AO) and for raising very pertinent and important issues. Our findings of relatively low adherence to prescribed AO are consistent with other studies ...
Sleep and Breathing, 2011
Prevalence of metabolic syndrome (MS) in obstructive sleep apnea (OSA) patients is high. The effe... more Prevalence of metabolic syndrome (MS) in obstructive sleep apnea (OSA) patients is high. The effect of autoadjusting positive airway pressure (APAP) on MS remains unclear. This study aimed to determine the prevalence of MS in OSA patients before and 6 months after APAP, and to identify potential determinants of metabolic status change. Seventy-four male patients with moderate to severe OSA were enrolled. MS diagnosis was established according to the National Cholesterol Education Program/Adult Treatment Panel III. APAP was prescribed to all patients. In the studied population, mean age was 55.9 years (SD 10.7 years), median body mass index (BMI), Epworth sleepiness scale (ESS), and respiratory disturbance index (RDI) were 33.4 kg/m(2) (interquartile range (IQR) 8.4 kg/m(2)), 12.0 (IQR 8.0), and 46.9/h (IQR 33.6/h), respectively. Prevalence of MS before and 6 months after APAP was 63.5% and 47.3%, respectively, and this difference was statistically significant (p = 0.004). In the subgroup of patients with MS at baseline (n = 47), 14 did not present MS after APAP. In these patients, a significant negative association with RDI (p = 0.016) and a positive association with percent of total days of usage (p = 0.014) were found. Blood pressure (p = 0.018) and serum triglycerides (p = 0.001) had a statistically significant reduction during this period. In patients that still had MS, 22.2% presented a reduction of the number of MS criteria. After 6 months, APAP reduced the prevalence of MS, mainly in patients with less severe OSA and with a better therapeutic compliance. Blood pressure and serum triglycerides reduction contributed to this metabolic status change.
Archivos de bronconeumología, 2009
Obstructive sleep apnoea (OSA) has been increasingly linked to cardiovascular disease. Inflammato... more Obstructive sleep apnoea (OSA) has been increasingly linked to cardiovascular disease. Inflammatory processes associated with OSA may contribute to this morbidity. Some studies have reported serum levels of high sensitivity C-reactive protein (hs-CRP) and interleukin-6 (IL-6) to be increased in these patients. investigate the impact of short and long-term autoadjusting positive airway pressure (APAP) therapy on IL-6 and hs-CRP serum levels in patients with moderate to severe obstructive sleep apnoea. Secundary Objective: evaluate the basal hs-CRP and IL-6 levels in OSA patients and its possible relation to OSA severity, independently of confounders and compare the hs-CRP levels in OSA patients with those in community controls. This is a prospective study including 98 male patients with moderate to severe OSA confirmed by domiciliary sleep study. Malignancy and chronic inflammatory diseases were exclusion criteria. hs-CRP and IL-6 serum levels were evaluated before APAP, 9 days and 6...
BMC Pulmonary Medicine, 2008
Leptin is an hormone that regulates body weight. Studies have shown increasing leptin concentrati... more Leptin is an hormone that regulates body weight. Studies have shown increasing leptin concentrations according to body mass index (BMI) and intermittent hypoxia.
Journal of Medical Case Reports, 2009
Introduction: The standard treatment for obstructive sleep apnoea syndrome is nasal continuous po... more Introduction: The standard treatment for obstructive sleep apnoea syndrome is nasal continuous positive airway pressure. In most cases the obstruction is located at the oropharyngeal level, and nasal continuous positive airway pressure is usually effective. In cases of non-response to nasal continuous positive airway pressure other treatments like mandibular advancement devices or upper airway surgery (especially bi-maxillary advancement) may also be considered.
Leptin is an hormone that regulates body weight. Studies have shown increasing leptin concentrati... more Leptin is an hormone that regulates body weight. Studies have shown increasing leptin concentrations according to body mass index (BMI) and intermittent hypoxia.
Sleep and Breathing, 2012
Objective The purpose of this study was to evaluate the prevalence and assess the response to nas... more Objective The purpose of this study was to evaluate the prevalence and assess the response to nasal automatic positive airway pressure (APAP) therapy of less typical symptoms in patients diagnosed with obstructive sleep apnea (OSA), like fatigue, gasping, nocturia, nocturnal sweating, morning headaches, heartburn, and erectile dysfunction. Methods Ninety-eight male patients with moderate to severe OSA were included in the study (n=98). In the beginning of the study, an overnight sleep study was performed to all subjects using a five-channel recording device. Patients started APAP therapy with pre-determined minimum and maximum pressures of 4 and 15 cmH 2 0, respectively. The total Sleep Disorders Questionnaire was answered by all subjects before and 6 months after APAP therapy. Questions 4, 18, 23, 25, 58, 88, and 148 were used in this study. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) 17.0 software. Results Subjects had a mean (SD) age of 55.1 (10.8) years and an average of 52.2 (21.4) apnea-hypopnea events per hour of sleep. At baseline, nocturia was the most prevalent symptom (38%), followed by nocturnal sweating (34%), gasping (30%), erectile dysfunction (25%), fatigue (23%), heartburn (15%), and morning headaches (10%). After 6 months of APAP therapy, a statistically significant reduction on the prevalence of all symptoms was observed, except for erectile dysfunction and morning headaches.
Sleep and Breathing, 2013
Purpose Auto-titrating continuous positive airway pressure (APAP) is an effective treatment for o... more Purpose Auto-titrating continuous positive airway pressure (APAP) is an effective treatment for obstructive sleep apnea/ hypopnea syndrome (OSAHS). We investigated whether a single group education session on APAP therapy is effective in promoting adherence among patients with OSAHS. Methods This prospective, randomized, controlled, parallel group study included patients newly diagnosed with OSAHS who met criteria for APAP therapy. Patients were randomized into a study group and a control group. All patients in the study group were assigned to a single group education session, 1 month after beginning APAP therapy. Results We evaluated 146 patients. The median percentage of APAP usage days was 88.3 %, with a median duration per day of use of 6.02 h; 59 % were classified as adherent. Overall, no significant difference in adherence was seen between the study and the control groups. Analyzing patient subgroups, the group session significantly improved APAP adherence among males and patients who were younger (<65 years old), obese (BMI ≥35 kg/m 2 ), non-sleepy (Epworth sleepiness scale ≤11), smokers or past smokers, had hypertension or nocturia and those with non-severe OSAHS. Conclusion To maximize the impact of group education sessions and, by that, saving resources, it may be important to select patients likely to benefit from these sessions.
Revista portuguesa de pneumologia
Obstructive Sleep Apnea (OSA) is associated with adverse effects in cardiovascular physiology. So... more Obstructive Sleep Apnea (OSA) is associated with adverse effects in cardiovascular physiology. Some studies have connected this pathology with Cardiovascular Disease (CVD). Determine the prevalence of CVD in patients with OSA of different severity and verify the association between CVD and OSA. Retrospective study based on data from 155 consecutive patients with OSA referred to a Sleep Disordered Breathing Clinic in an University Hospital during the year of 2001. The majority of patients were male (83,2%), the mean age was 53,6 +/- 11,9 years. Severe OSA was observed in 52,9% patients, moderate in 20% and mild in 27,1% patients (mean Apnea Hypopnea Index of 35,2 +/- 23,8/hour). Among the studied individuals 52,3% showed CVD, being Arterial Hypertension (AH) the most common disease (45,8%). Acute Myocardial Infarction appeared in 6,5% and Angina in 3,9% cases. The majority of the patients (67,1%) were obese (Body Mass Index - BMI>30). The mean BMI was 33,1 +/- 6,34. A significant ...
Archivos de Bronconeumología, 2009
Efecto a largo plazo de la presió n positiva automá tica en la vía aé rea sobre la proteína C rea... more Efecto a largo plazo de la presió n positiva automá tica en la vía aé rea sobre la proteína C reactiva y la interleucina-6 en varones con síndrome de apnea obstructiva del sueñ o