Marta Drummond - Academia.edu (original) (raw)

Papers by Marta Drummond

Research paper thumbnail of Sex-related sleeping differences in non-Obstructive Sleep Apnea patients

Clinical and epidemiological respiratory sleep medicine

Research paper thumbnail of Comparison Of Echocardiographic Findings Between Male Patients With OSA And Community Controls

B72 CONSEQUENCES OF SLEEP DISORDERED BREATHING: CLINICAL ASPECTS 17/8:15 AM-4:00 PM / Area L, Hal... more B72 CONSEQUENCES OF SLEEP DISORDERED BREATHING: CLINICAL ASPECTS 17/8:15 AM-4:00 PM / Area L, Hall G (First Level), Morial Convention Center ... Comparison Of Echocardiographic Findings Between Male Patients With OSA And Community Controls

Research paper thumbnail of Clinical use of the fatigue severity scale on obstructive sleep apnoea patients

European Respiratory Journal, Sep 1, 2013

Introduction-Current obstructive sleep apnoea (OSA) definition includes daytime fatigue as a rele... more Introduction-Current obstructive sleep apnoea (OSA) definition includes daytime fatigue as a relevant symptom. The use of scales might be of help characterizing these subjective symptom allowing quantification and standardization as well as evaluation of treatment response. Aim-To evaluate the relation between fatigue scores and apnoea-hypopnoea index(AHI) and the impact of APAP treatment in that symptom. Methods-All patients with suspected OSA referred to our center between Feb-Mar 2012 were considered eligible. During first the appointment patients completed Fatigue Severity Scale (FSS) and Epworth Severity Scale (ESS) questionnaires, clinical history was collected and a polygraphic cardiorespiratory sleep study performed. If patients were started on APAP treatment with good compliance (>70%/days, >4hours/night) after 3 months of treatment the FSS and ESS questionnaires were repeated. Results-88 patients were included, 71.6% were male, with a mean age of 51.9±13.4 years. Mean values of FSS and ESS questionnaires were 34.64±14.5 and 8.47±5.0, respectively. In 24 (27.3%) patients OSA was excluded, OSA was diagnosed in 64 patients being mild in 25 patients (28.6%), moderate in 20 (22.7%) and severe in 19 (21.6%) patients. A statistically significant correlation was found between FSS score and AHI (r-0.263; p=0.05). Those patients with confirmed OSA but without excessive daytime sleepiness (ESS 36. After 3 months of adequate APAP therapy (n=27) a significant reduction of FSS (p=0.004) and ESS (p=0.035) scores was found. Conclusion-The Portuguese version of the Fatigue Severity Scale seems to be helpful evaluating symptoms related to OSA, specially monitoring the impact of APAP treatment.

Research paper thumbnail of Simultaneous sleep study and nasoendoscopic investigation in a patient with obstructive sleep apnoea syndrome refractory to continuous positive airway pressure: a case report

Journal of Medical Case Reports, Dec 1, 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. Case presentation: We report the case of a 38-year-old Caucasian man with severe obstructive sleep apnoea syndrome, initially refractory to nasal continuous positive airway pressure (and subsequently also to a mandibular advancement devices), in which the visualization of the upper airway with sleep endoscopy and the concomitant titration of positive pressure were useful in the investigation and resolution of sleep disordered breathing. In fact, there was a marked reduction in the size of his nasopharynx, and a paresis of his left aryepiglotic fold with hypertrophy of the right aryepiglotic fold. The application of bi-level positive airway pressure and an oral interface successfully managed his obstructive sleep apnoea. Conclusion: This is a rare case of obstructive sleep apnoea syndrome refractory to treatment with nocturnal ventilatory support. Visualization of the endoscopic changes, during sleep and under positive pressure, was of great value to understanding the mechanisms of refractoriness. It also oriented the therapeutic option. Refractoriness to obstructive sleep apnoea therapy with continuous positive airway pressure is rare, and each case should be approached individually.

Research paper thumbnail of A propósito do papel do Indacaterol na patologia obstrutiva das vias aéreas: PRÓ

Revista Portuguesa De Pneumologia, 2012

Research paper thumbnail of OSA patients not treated with PAP - Evolution over 5 years according to the Baveno classification and cardiovascular outcomes

Sleep Medicine, Dec 1, 2021

INTRODUCTION The evolution of patients with obstructive sleep apnea (OSA) non-eligible for PAP-th... more INTRODUCTION The evolution of patients with obstructive sleep apnea (OSA) non-eligible for PAP-therapy at diagnosis is unknown. Currently, the severity of OSA is based on the apnea-hypopnea index (AHI), but its prognostic relevance has raised concerns. The Baveno classification may allow a better stratification of severity and therapeutic guidance in OSA. METHODS Patients with AHI≥5/h in 2015, classified into Baveno groups A and B and non-eligible for PAP therapy at diagnosis and over 5 years, were analyzed. Patients were reclassified into Baveno groups (A-D) and changes in groups over 5 years were explored. Patients in Baveno groups C and D, who developed major cardiovascular comorbidities (CVC) or end-organ damage (EOD group), were compared with patients in Baveno groups A and B (non-EOD group). To identify predictors of the development of major CVC or EOD, a logistic regression analysis was performed. RESULTS There were 76 patients, 58% male, mean age 51.9 ± 10.1 years, mean body mass index (BMI) of 30.3 ± 5.0 kg/m2 and median AHI of 8.9 (5.9-12.0) events/h. At diagnosis, 46% and 54% of patients were classified into Baveno group A and group B, respectively. In total, 21% of patients developed major CVC or EOD (Baveno group C or D); higher age (p = 0.011) and BMI (p = 0.004) and a higher percentage of central apneas (p = 0.012) at diagnosis significantly predicted it, while sex, sleepiness, insomnia, AHI, ODI and T90 were not. CONCLUSIONS A significant percentage of patients non-eligible for PAP-therapy at diagnosis of OSA developed CVC or EOD; higher age and BMI and a higher percentage of central apneas were significant predictors.

Research paper thumbnail of Clinical and polysomnographic characteristics of patients with REM sleep disordered breathing

Revista Portuguesa De Pneumologia, Sep 1, 2009

Resumo A síndroma de apneia obstrutiva do sono (SAOS) associada ao sono REM tem uma incidência de... more Resumo A síndroma de apneia obstrutiva do sono (SAOS) associada ao sono REM tem uma incidência de 10-36% na população com SAOS. Estudos anteriores têm sugerido, nestes doentes, um aumento de prevalência de distúrbios psiquiátricos, bem como um efeito da idade e do género. Propusemo-nos, por isso, estudar as características clínicas e polissonográficas de doentes com o referido diagnóstico. Os critérios de inclusão foram a identificação de SAOS em REM, por polissonografia (PSG), definida como IAH em REM ≥5/h, IAH em sono não REM (NREM) ≤ 15/h, IAH REM/NREM ≥ 2. Foram ainda analisa-Abstract There is a 10-36% rate of obstructive sleep apnoea syndrome (OSAS) associated with rapid eye movement (REM) in the OSAS population. Prior studies have suggested an increased prevalence of psychiatric disorders and an effect of gender and age on these patients. Our aim was to study the clinical and polysomnograph (PSG) characteristics of our patients with REM-related sleep disordered breathing (REM SDB). Inclusion criteria was the identification of REM SDB detected by PSG defined as apnea-hypopnea index (AHI) in REM sleep ≥5h, AHI in non-REM sleep (NREM) ≤ 15h and REM/NREM AHI ≥2. Características clínicas e polissonográficas de doentes com distúrbio respiratório do sono em REM Clinical and polysomnographic characteristics of patients with REM sleep disordered breathing Recebido para publicação/received for publication: 09.02.05 Aceite para publicação/accepted for publication: 09.03.20

Research paper thumbnail of Air travel and hypoxaemia in real life

The European respiratory journal, Mar 5, 2008

Research paper thumbnail of Síndroma de Apneia Obstrutiva do Sono e Doença Cardiovascular – Estudo retrospectivo

Revista Portuguesa De Pneumologia, Jul 1, 2003

Research paper thumbnail of Baseline clusters and the response to positive airway pressure treatment in obstructive sleep apnoea patients: longitudinal data from the European Sleep Apnea Database cohort

ERJ Open Research

IntroductionThe European Sleep Apnea Database was used to identify distinguishable obstructive sl... more IntroductionThe European Sleep Apnea Database was used to identify distinguishable obstructive sleep apnoea (OSA) phenotypes and to investigate the clinical outcome during positive airway pressure (PAP) treatment.MethodProspective OSA patient data were recruited from 35 sleep clinics in 21 European countries. Unsupervised cluster analysis (anthropometrics, clinical variables) was performed in a random sample (n=5000). Subsequently, all patients were assigned to the clusters using a conditional inference tree classifier. Responses to PAP treatment change in apnoea severity and Epworth sleepiness scale (ESS) were assessed in relation to baseline patient clusters and at short- and long-term follow-up.ResultsAt baseline, 20 164 patients were assigned (mean age 54.1±12.2 years, 73% male, median apnoea–hypopnoea index (AHI) 27.3 (interquartile range (IQR) 14.1–49.3) events·h−1, and ESS 9.8±5.3) to seven distinct clusters based on anthropometrics, comorbidities and symptoms. At PAP follow-...

Research paper thumbnail of Current Practices in Home Mechanical Ventilation for Chronic Obstructive Pulmonary Disease: A Real-Life Cross-Sectional Multicentric Study

International Journal of Chronic Obstructive Pulmonary Disease, 2021

Purpose: Home mechanical ventilation (HMV) use in chronic obstructive pulmonary disease (COPD) is... more Purpose: Home mechanical ventilation (HMV) use in chronic obstructive pulmonary disease (COPD) is becoming increasingly widespread. The aim of this study was to provide an accurate description of the current practices and clinical characteristics of COPD patients on HMV in Portugal. Methods: The study was designed as a cross-sectional, multicenter real-life study of COPD patients established on HMV for at least 30 days. Data related to clinical characteristics, adaptation and ventilatory settings were collected. Results: The study included 569 COPD patients on HMV from 15 centers. The majority were male, with a median age of 72 years and a high prevalence of obesity (43.2%) and sleep apnea (45.8%). A high treatment compliance was observed (median 8h/day), 48.7% with inspiratory positive airway pressure ≥20 cmH 2 O and oronasal masks were the preferred interface (91.7%). There was an equal distribution of patients starting HMV during chronic stable condition and following an exacerbation. Patients in stable condition were initiated in the outpatient setting in 92.3%. Despite the differences in criteria and setting of adaptation and a slightly lower BMI in patients starting HMV following an exacerbation, we found no significant differences regarding age, gender, ventilation pressures, time on HMV, usage, severity of airflow obstruction or current arterial blood gas analysis (ABGs) in relation to patients adapted in stable condition. Conclusion: Patients were highly compliant with the therapy. In agreement with most recent studies and recommendations, there seems to be a move towards higher ventilation pressures, increased use of oronasal masks and an intent to obtain normocapnia. This study shows that chronic hypercapnic and post exacerbation patients do not differ significantly regarding patient characteristics, physiological parameters or ventilatory settings with one exception: chronic hypercapnic patients are more often obese and, subsequently, more frequently present OSA.

Research paper thumbnail of Características clínicas e polissonográficas de doentes com distúrbio respiratório do sono em REM

Revista Portuguesa De Pneumologia, Sep 1, 2009

Research paper thumbnail of Chronic respiratory failure – pathophysiology

Pulmonary Rehabilitation, 2020

Research paper thumbnail of Sleep quality during covid-19 pandemic in a Portuguese cohort of respiratory patients

Journal of Sleep Research, 2020

Research paper thumbnail of Pulmonologists’ sleep quality during COVID-19 pandemic: a nation-wide survey

Occupational and environmental health, 2021

Research paper thumbnail of Surgical and Anesthetic Assessment in Patients With SDB

Encyclopedia of Respiratory Medicine, 2022

Research paper thumbnail of Bariatric surgery in obese OSA patients

Sleep and control of breathing, 2019

Introduction: Obstructive Sleep Apnoea (OSA) is a chronic disease commonly associated with obesit... more Introduction: Obstructive Sleep Apnoea (OSA) is a chronic disease commonly associated with obesity. Bariatric surgery is one of the best weapons to fight the obesity problem. When patients lose substantial weight, it is expected that they become independent of positive airway pressure, but there is still no meta-analysis that allow us to confirm this hypothesis perennially. Aims: To analyse a pool of obese OSA patients followed at the Sleep Laboratory of Hospital Sao Joao, who underwent bariatric surgery and checkpoint the outcomes achieved at 1-year follow-up. Results: Of the 57 patients included (mean age 48.9±11.9years, 68.4% females), 78.9% had comorbidities other than obesity, 47.4% did gastric laparoscopic sleeve and 52.6% gastric bypass. Mean BMI was 46.0±6.5 kg/m2, median AHI=15.6 events/h (IQR 62), median ODI=16.5 (IQR 42), ESS=10.4±6.5, daytime pCO2=38.7±4.1 mmHg, HCO3=24.9±2.6 mmHg, FEV1%=94.3±22.4% and FVC%=100.8±24.4%. Females underwent predominantly sleeves and males bypasses (61.5% vs 66.7%, p=0.047). In patients who started ventilatory support (VS) before surgery (n=43, 75.4%), APAP was the leading option (44.4% males and 61.5% females). 1-year after surgery there was a statistically significant weight loss (-36.7±14.0 kg, p Conclusion: The authors conclude that there was a significant weight loss after bariatric surgery, although there was not a significant alteration in VS therapy. Further studies are needed with larger samples.

Research paper thumbnail of Evaluation of obstructive sleep apnea screening questionnaires in obese women in the first trimester of pregnancy

Research paper thumbnail of Assessment of bariatric surgery efficacy on Obstructive Sleep Apnea (OSA)

Revista Portuguesa de Pneumologia (English Edition), 2016

A worldwide rise in weight and obesity is taking place, associated with an increase in several co... more A worldwide rise in weight and obesity is taking place, associated with an increase in several comorbid conditions, such as Obstructive Sleep Apnea (OSA). Bariatric surgery is an effective treatment approach for obesity, with resultant improvement in obesity-related comorbidities. However, the relationship between this type of treatment and OSA is not well established. This systematic review aims to assess and characterize the impact that different types of bariatric surgery have on obese OSA patients. 22 articles with stated preoperative apnea-hypopnea index (AHI), apnea index (AI) or respiratory disturbance index (RDI) were analyzed in this review. A significant improvement in AHI/AI/RDI occurred after surgery, in addition to the foreseeable reduction in body mass index (BMI). Moreover, almost every study stated a postoperative reduction of the AHI to < 20/h and/or a >50% postoperative reduction of AHI, with few exceptions. The interventions with a combined malabsorptive and restrictive mechanism, like roux-en-Y gastric bypass (RYGB), were more efficacious in resolving and improving OSA than purely restrictive ones, like laparoscopic adjustable gastric banding (LAGB). In conclusion, bariatric surgery has a significant effect on OSA, leading to its resolution or improvement, in the majority of cases, at least in the short/medium term (1-2 years). However, the different results must be interpreted with caution as there are many potential biases resulting from heterogeneous inclusion criteria, duration of follow-up, diagnostic methodology and assessed variables.

Research paper thumbnail of Long-term positive airway pressure therapy is associated with reduced total cholesterol levels in patients with obstructive sleep apnea: data from the European Sleep Apnea Database (ESADA)

Sleep Medicine, 2020

Background and aim: Obstructive sleep apnea (OSA) is an independent risk factor for dyslipidemia.... more Background and aim: Obstructive sleep apnea (OSA) is an independent risk factor for dyslipidemia. The current study examined the effects of positive airway pressure (PAP) treatment on lipid status in the European Sleep Apnea Database (ESADA). Methods: The prospective cohort study enrolled 1564 OSA subjects (74% male, mean age 54±11y, body mass index (BMI) 32.7±6.6 kg/m 2 and apnea-hypopnea index (AHI) 40.3±24.4 n/h) undergoing PAP therapy for at least 3 months (mean 377.6 ± 419.5 days). Baseline and follow-up total cholesterol (TC) from 9 centers were analyzed. Repeated measures and logistic regression tests (adjusted for age, sex, change in weight, lipid lowering medication, PAP compliance and treatment duration) were used for comparing the changes in TC levels. Incident risk for coronary heart disease events (CHD) was calculated according to the Framingham CHD risk score (estimated from age, BMI, blood pressure, and TC). Results: Adjusted means of TC decreased from 194.2 mg/dl to 189.3 mg/dl during follow-up (p=0.019). A clinically significant (10%) reduction of TC at PAP follow-up was observed in 422 patients (27%). Duration of PAP therapy was identified as independent predictor for TC reduction, which implies an approximately 10% risk reduction for incident CHD events (from 26.7% to 24.1% in males, from 11.2% to 10.1% in females, p<0.001 respectively). Conclusion: The present study demonstrates a significant decrease in TC after long-term PAP treatment. Based on the close association of elevated TC levels with increased CV mortality, identification and treatment of OSA may have beneficial effects on overall cardiovascular risk.

Research paper thumbnail of Sex-related sleeping differences in non-Obstructive Sleep Apnea patients

Clinical and epidemiological respiratory sleep medicine

Research paper thumbnail of Comparison Of Echocardiographic Findings Between Male Patients With OSA And Community Controls

B72 CONSEQUENCES OF SLEEP DISORDERED BREATHING: CLINICAL ASPECTS 17/8:15 AM-4:00 PM / Area L, Hal... more B72 CONSEQUENCES OF SLEEP DISORDERED BREATHING: CLINICAL ASPECTS 17/8:15 AM-4:00 PM / Area L, Hall G (First Level), Morial Convention Center ... Comparison Of Echocardiographic Findings Between Male Patients With OSA And Community Controls

Research paper thumbnail of Clinical use of the fatigue severity scale on obstructive sleep apnoea patients

European Respiratory Journal, Sep 1, 2013

Introduction-Current obstructive sleep apnoea (OSA) definition includes daytime fatigue as a rele... more Introduction-Current obstructive sleep apnoea (OSA) definition includes daytime fatigue as a relevant symptom. The use of scales might be of help characterizing these subjective symptom allowing quantification and standardization as well as evaluation of treatment response. Aim-To evaluate the relation between fatigue scores and apnoea-hypopnoea index(AHI) and the impact of APAP treatment in that symptom. Methods-All patients with suspected OSA referred to our center between Feb-Mar 2012 were considered eligible. During first the appointment patients completed Fatigue Severity Scale (FSS) and Epworth Severity Scale (ESS) questionnaires, clinical history was collected and a polygraphic cardiorespiratory sleep study performed. If patients were started on APAP treatment with good compliance (>70%/days, >4hours/night) after 3 months of treatment the FSS and ESS questionnaires were repeated. Results-88 patients were included, 71.6% were male, with a mean age of 51.9±13.4 years. Mean values of FSS and ESS questionnaires were 34.64±14.5 and 8.47±5.0, respectively. In 24 (27.3%) patients OSA was excluded, OSA was diagnosed in 64 patients being mild in 25 patients (28.6%), moderate in 20 (22.7%) and severe in 19 (21.6%) patients. A statistically significant correlation was found between FSS score and AHI (r-0.263; p=0.05). Those patients with confirmed OSA but without excessive daytime sleepiness (ESS 36. After 3 months of adequate APAP therapy (n=27) a significant reduction of FSS (p=0.004) and ESS (p=0.035) scores was found. Conclusion-The Portuguese version of the Fatigue Severity Scale seems to be helpful evaluating symptoms related to OSA, specially monitoring the impact of APAP treatment.

Research paper thumbnail of Simultaneous sleep study and nasoendoscopic investigation in a patient with obstructive sleep apnoea syndrome refractory to continuous positive airway pressure: a case report

Journal of Medical Case Reports, Dec 1, 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. Case presentation: We report the case of a 38-year-old Caucasian man with severe obstructive sleep apnoea syndrome, initially refractory to nasal continuous positive airway pressure (and subsequently also to a mandibular advancement devices), in which the visualization of the upper airway with sleep endoscopy and the concomitant titration of positive pressure were useful in the investigation and resolution of sleep disordered breathing. In fact, there was a marked reduction in the size of his nasopharynx, and a paresis of his left aryepiglotic fold with hypertrophy of the right aryepiglotic fold. The application of bi-level positive airway pressure and an oral interface successfully managed his obstructive sleep apnoea. Conclusion: This is a rare case of obstructive sleep apnoea syndrome refractory to treatment with nocturnal ventilatory support. Visualization of the endoscopic changes, during sleep and under positive pressure, was of great value to understanding the mechanisms of refractoriness. It also oriented the therapeutic option. Refractoriness to obstructive sleep apnoea therapy with continuous positive airway pressure is rare, and each case should be approached individually.

Research paper thumbnail of A propósito do papel do Indacaterol na patologia obstrutiva das vias aéreas: PRÓ

Revista Portuguesa De Pneumologia, 2012

Research paper thumbnail of OSA patients not treated with PAP - Evolution over 5 years according to the Baveno classification and cardiovascular outcomes

Sleep Medicine, Dec 1, 2021

INTRODUCTION The evolution of patients with obstructive sleep apnea (OSA) non-eligible for PAP-th... more INTRODUCTION The evolution of patients with obstructive sleep apnea (OSA) non-eligible for PAP-therapy at diagnosis is unknown. Currently, the severity of OSA is based on the apnea-hypopnea index (AHI), but its prognostic relevance has raised concerns. The Baveno classification may allow a better stratification of severity and therapeutic guidance in OSA. METHODS Patients with AHI≥5/h in 2015, classified into Baveno groups A and B and non-eligible for PAP therapy at diagnosis and over 5 years, were analyzed. Patients were reclassified into Baveno groups (A-D) and changes in groups over 5 years were explored. Patients in Baveno groups C and D, who developed major cardiovascular comorbidities (CVC) or end-organ damage (EOD group), were compared with patients in Baveno groups A and B (non-EOD group). To identify predictors of the development of major CVC or EOD, a logistic regression analysis was performed. RESULTS There were 76 patients, 58% male, mean age 51.9 ± 10.1 years, mean body mass index (BMI) of 30.3 ± 5.0 kg/m2 and median AHI of 8.9 (5.9-12.0) events/h. At diagnosis, 46% and 54% of patients were classified into Baveno group A and group B, respectively. In total, 21% of patients developed major CVC or EOD (Baveno group C or D); higher age (p = 0.011) and BMI (p = 0.004) and a higher percentage of central apneas (p = 0.012) at diagnosis significantly predicted it, while sex, sleepiness, insomnia, AHI, ODI and T90 were not. CONCLUSIONS A significant percentage of patients non-eligible for PAP-therapy at diagnosis of OSA developed CVC or EOD; higher age and BMI and a higher percentage of central apneas were significant predictors.

Research paper thumbnail of Clinical and polysomnographic characteristics of patients with REM sleep disordered breathing

Revista Portuguesa De Pneumologia, Sep 1, 2009

Resumo A síndroma de apneia obstrutiva do sono (SAOS) associada ao sono REM tem uma incidência de... more Resumo A síndroma de apneia obstrutiva do sono (SAOS) associada ao sono REM tem uma incidência de 10-36% na população com SAOS. Estudos anteriores têm sugerido, nestes doentes, um aumento de prevalência de distúrbios psiquiátricos, bem como um efeito da idade e do género. Propusemo-nos, por isso, estudar as características clínicas e polissonográficas de doentes com o referido diagnóstico. Os critérios de inclusão foram a identificação de SAOS em REM, por polissonografia (PSG), definida como IAH em REM ≥5/h, IAH em sono não REM (NREM) ≤ 15/h, IAH REM/NREM ≥ 2. Foram ainda analisa-Abstract There is a 10-36% rate of obstructive sleep apnoea syndrome (OSAS) associated with rapid eye movement (REM) in the OSAS population. Prior studies have suggested an increased prevalence of psychiatric disorders and an effect of gender and age on these patients. Our aim was to study the clinical and polysomnograph (PSG) characteristics of our patients with REM-related sleep disordered breathing (REM SDB). Inclusion criteria was the identification of REM SDB detected by PSG defined as apnea-hypopnea index (AHI) in REM sleep ≥5h, AHI in non-REM sleep (NREM) ≤ 15h and REM/NREM AHI ≥2. Características clínicas e polissonográficas de doentes com distúrbio respiratório do sono em REM Clinical and polysomnographic characteristics of patients with REM sleep disordered breathing Recebido para publicação/received for publication: 09.02.05 Aceite para publicação/accepted for publication: 09.03.20

Research paper thumbnail of Air travel and hypoxaemia in real life

The European respiratory journal, Mar 5, 2008

Research paper thumbnail of Síndroma de Apneia Obstrutiva do Sono e Doença Cardiovascular – Estudo retrospectivo

Revista Portuguesa De Pneumologia, Jul 1, 2003

Research paper thumbnail of Baseline clusters and the response to positive airway pressure treatment in obstructive sleep apnoea patients: longitudinal data from the European Sleep Apnea Database cohort

ERJ Open Research

IntroductionThe European Sleep Apnea Database was used to identify distinguishable obstructive sl... more IntroductionThe European Sleep Apnea Database was used to identify distinguishable obstructive sleep apnoea (OSA) phenotypes and to investigate the clinical outcome during positive airway pressure (PAP) treatment.MethodProspective OSA patient data were recruited from 35 sleep clinics in 21 European countries. Unsupervised cluster analysis (anthropometrics, clinical variables) was performed in a random sample (n=5000). Subsequently, all patients were assigned to the clusters using a conditional inference tree classifier. Responses to PAP treatment change in apnoea severity and Epworth sleepiness scale (ESS) were assessed in relation to baseline patient clusters and at short- and long-term follow-up.ResultsAt baseline, 20 164 patients were assigned (mean age 54.1±12.2 years, 73% male, median apnoea–hypopnoea index (AHI) 27.3 (interquartile range (IQR) 14.1–49.3) events·h−1, and ESS 9.8±5.3) to seven distinct clusters based on anthropometrics, comorbidities and symptoms. At PAP follow-...

Research paper thumbnail of Current Practices in Home Mechanical Ventilation for Chronic Obstructive Pulmonary Disease: A Real-Life Cross-Sectional Multicentric Study

International Journal of Chronic Obstructive Pulmonary Disease, 2021

Purpose: Home mechanical ventilation (HMV) use in chronic obstructive pulmonary disease (COPD) is... more Purpose: Home mechanical ventilation (HMV) use in chronic obstructive pulmonary disease (COPD) is becoming increasingly widespread. The aim of this study was to provide an accurate description of the current practices and clinical characteristics of COPD patients on HMV in Portugal. Methods: The study was designed as a cross-sectional, multicenter real-life study of COPD patients established on HMV for at least 30 days. Data related to clinical characteristics, adaptation and ventilatory settings were collected. Results: The study included 569 COPD patients on HMV from 15 centers. The majority were male, with a median age of 72 years and a high prevalence of obesity (43.2%) and sleep apnea (45.8%). A high treatment compliance was observed (median 8h/day), 48.7% with inspiratory positive airway pressure ≥20 cmH 2 O and oronasal masks were the preferred interface (91.7%). There was an equal distribution of patients starting HMV during chronic stable condition and following an exacerbation. Patients in stable condition were initiated in the outpatient setting in 92.3%. Despite the differences in criteria and setting of adaptation and a slightly lower BMI in patients starting HMV following an exacerbation, we found no significant differences regarding age, gender, ventilation pressures, time on HMV, usage, severity of airflow obstruction or current arterial blood gas analysis (ABGs) in relation to patients adapted in stable condition. Conclusion: Patients were highly compliant with the therapy. In agreement with most recent studies and recommendations, there seems to be a move towards higher ventilation pressures, increased use of oronasal masks and an intent to obtain normocapnia. This study shows that chronic hypercapnic and post exacerbation patients do not differ significantly regarding patient characteristics, physiological parameters or ventilatory settings with one exception: chronic hypercapnic patients are more often obese and, subsequently, more frequently present OSA.

Research paper thumbnail of Características clínicas e polissonográficas de doentes com distúrbio respiratório do sono em REM

Revista Portuguesa De Pneumologia, Sep 1, 2009

Research paper thumbnail of Chronic respiratory failure – pathophysiology

Pulmonary Rehabilitation, 2020

Research paper thumbnail of Sleep quality during covid-19 pandemic in a Portuguese cohort of respiratory patients

Journal of Sleep Research, 2020

Research paper thumbnail of Pulmonologists’ sleep quality during COVID-19 pandemic: a nation-wide survey

Occupational and environmental health, 2021

Research paper thumbnail of Surgical and Anesthetic Assessment in Patients With SDB

Encyclopedia of Respiratory Medicine, 2022

Research paper thumbnail of Bariatric surgery in obese OSA patients

Sleep and control of breathing, 2019

Introduction: Obstructive Sleep Apnoea (OSA) is a chronic disease commonly associated with obesit... more Introduction: Obstructive Sleep Apnoea (OSA) is a chronic disease commonly associated with obesity. Bariatric surgery is one of the best weapons to fight the obesity problem. When patients lose substantial weight, it is expected that they become independent of positive airway pressure, but there is still no meta-analysis that allow us to confirm this hypothesis perennially. Aims: To analyse a pool of obese OSA patients followed at the Sleep Laboratory of Hospital Sao Joao, who underwent bariatric surgery and checkpoint the outcomes achieved at 1-year follow-up. Results: Of the 57 patients included (mean age 48.9±11.9years, 68.4% females), 78.9% had comorbidities other than obesity, 47.4% did gastric laparoscopic sleeve and 52.6% gastric bypass. Mean BMI was 46.0±6.5 kg/m2, median AHI=15.6 events/h (IQR 62), median ODI=16.5 (IQR 42), ESS=10.4±6.5, daytime pCO2=38.7±4.1 mmHg, HCO3=24.9±2.6 mmHg, FEV1%=94.3±22.4% and FVC%=100.8±24.4%. Females underwent predominantly sleeves and males bypasses (61.5% vs 66.7%, p=0.047). In patients who started ventilatory support (VS) before surgery (n=43, 75.4%), APAP was the leading option (44.4% males and 61.5% females). 1-year after surgery there was a statistically significant weight loss (-36.7±14.0 kg, p Conclusion: The authors conclude that there was a significant weight loss after bariatric surgery, although there was not a significant alteration in VS therapy. Further studies are needed with larger samples.

Research paper thumbnail of Evaluation of obstructive sleep apnea screening questionnaires in obese women in the first trimester of pregnancy

Research paper thumbnail of Assessment of bariatric surgery efficacy on Obstructive Sleep Apnea (OSA)

Revista Portuguesa de Pneumologia (English Edition), 2016

A worldwide rise in weight and obesity is taking place, associated with an increase in several co... more A worldwide rise in weight and obesity is taking place, associated with an increase in several comorbid conditions, such as Obstructive Sleep Apnea (OSA). Bariatric surgery is an effective treatment approach for obesity, with resultant improvement in obesity-related comorbidities. However, the relationship between this type of treatment and OSA is not well established. This systematic review aims to assess and characterize the impact that different types of bariatric surgery have on obese OSA patients. 22 articles with stated preoperative apnea-hypopnea index (AHI), apnea index (AI) or respiratory disturbance index (RDI) were analyzed in this review. A significant improvement in AHI/AI/RDI occurred after surgery, in addition to the foreseeable reduction in body mass index (BMI). Moreover, almost every study stated a postoperative reduction of the AHI to < 20/h and/or a >50% postoperative reduction of AHI, with few exceptions. The interventions with a combined malabsorptive and restrictive mechanism, like roux-en-Y gastric bypass (RYGB), were more efficacious in resolving and improving OSA than purely restrictive ones, like laparoscopic adjustable gastric banding (LAGB). In conclusion, bariatric surgery has a significant effect on OSA, leading to its resolution or improvement, in the majority of cases, at least in the short/medium term (1-2 years). However, the different results must be interpreted with caution as there are many potential biases resulting from heterogeneous inclusion criteria, duration of follow-up, diagnostic methodology and assessed variables.

Research paper thumbnail of Long-term positive airway pressure therapy is associated with reduced total cholesterol levels in patients with obstructive sleep apnea: data from the European Sleep Apnea Database (ESADA)

Sleep Medicine, 2020

Background and aim: Obstructive sleep apnea (OSA) is an independent risk factor for dyslipidemia.... more Background and aim: Obstructive sleep apnea (OSA) is an independent risk factor for dyslipidemia. The current study examined the effects of positive airway pressure (PAP) treatment on lipid status in the European Sleep Apnea Database (ESADA). Methods: The prospective cohort study enrolled 1564 OSA subjects (74% male, mean age 54±11y, body mass index (BMI) 32.7±6.6 kg/m 2 and apnea-hypopnea index (AHI) 40.3±24.4 n/h) undergoing PAP therapy for at least 3 months (mean 377.6 ± 419.5 days). Baseline and follow-up total cholesterol (TC) from 9 centers were analyzed. Repeated measures and logistic regression tests (adjusted for age, sex, change in weight, lipid lowering medication, PAP compliance and treatment duration) were used for comparing the changes in TC levels. Incident risk for coronary heart disease events (CHD) was calculated according to the Framingham CHD risk score (estimated from age, BMI, blood pressure, and TC). Results: Adjusted means of TC decreased from 194.2 mg/dl to 189.3 mg/dl during follow-up (p=0.019). A clinically significant (10%) reduction of TC at PAP follow-up was observed in 422 patients (27%). Duration of PAP therapy was identified as independent predictor for TC reduction, which implies an approximately 10% risk reduction for incident CHD events (from 26.7% to 24.1% in males, from 11.2% to 10.1% in females, p<0.001 respectively). Conclusion: The present study demonstrates a significant decrease in TC after long-term PAP treatment. Based on the close association of elevated TC levels with increased CV mortality, identification and treatment of OSA may have beneficial effects on overall cardiovascular risk.