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

Papers by Marta Drummond

Sleep and Breathing, Dec 16, 2014

Purpose This study aimed to explore the impact of an 8 year therapy with autoadjusting positive a... more Purpose This study aimed to explore the impact of an 8 year therapy with autoadjusting positive airway pressure (APAP) on fasting lipid level in a sample of Portuguese moderate/severe OSA patients. Besides contributing to the comprehension of the complex relationship between dyslipidemia and OSA, it provided new data regarding the effectiveness of a long term APAP treatment. Methods Thirty-nine male patients with moderate to severe OSA were included in the study. APAP was prescribed to all patients. Fifteen patients were under lipid-lowering medication throughout the study and another fifteen patients never used lipid-lowering medication at any time during the study. Fasting morning venous blood samples were collected at three time points (baseline, 6 months and 8 years) and lipids were estimated. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) 21.0 software. Results After 8 years of APAP treatment, patients presented a similar body mass index but a significantly less severe daytime sleepiness. Patients on lipid-lowering medication exhibited a higher reduction in LDL-c, triglycerides and total cholesterol than those naïf from that medication, but the reduction was not statistically significant after adjusting for medication and APAP adherence. Conclusions Long-term APAP treatment improves OSA but does not seem to contribute to changes in fasting lipids.

Phone medical appointments for Sleep-Disordered Breathing in Covid-19 pandemic – were they useful?

Introduction: The WHO declared the COVID-19 outbreak as a pandemic. The ability to integrate tele... more Introduction: The WHO declared the COVID-19 outbreak as a pandemic. The ability to integrate telecommunications and information systems was crucial. Aims: To evaluate the usefulness of teleconsultations and telemonitoring in Sleep-disordered breathing (SDB) patient’s follow-up. Methods: The study was conducted at the Sleep Lab of a tertiary university hospital between 13th march and 31st May 2020. All patients included were adults with suspected or confirmed SDB. In the first phone medical appointments, a clinical interview was conducted. In the follow-up teleconsultations, all patients had SDB and we analyzed adherence to treatment, control of respiratory sleep events, PAP-related side effects, and changes in therapeutic strategies. Results: A total of 769 phone consultations were performed. In first phone medical appointments (n=149), 109 patients answered the call. In follow-up teleconsultations (n=620), 89,7% answered the call and 86,8% were under PAP-therapy. Information of PAP devices was available in 354 cases; 79.1% of patients had adequate adherence and 76% had residual AHI≤5 events/h. A new therapeutic approach was more often started in patients with nasal congestion (pl.001), rhinorrhea (pl.001), and nosebleeds (p=0.03). Changes in previous therapy were more frequent in patients with nasal congestion (pl.001), rhinorrhea (pl.001), mucosal dryness (pl.001), and nosebleeds (p=0.02). Patients whose PAP settings were changed had a higher median residual AHI, median 5 (8) events/h vs median 2 (3) events/h, pl.001. Conclusions: Teleconsultation and telemonitoring of SDB patients are possible in most cases and allow the resolution of several side effects and therapeutic adjustments.

Screening with limited sleep tests to increase pre-test probability

The European Respiratory Society eBooks, 2023

Sleep and cardiometabolic comorbidities in the OSA-COPD overlap syndrome: Data from ESADA

ERJ Open Research, Apr 6, 2023

AimThe impact of obstructive sleep apnoea (OSA)–COPD overlap syndrome (OVS) on sleep quality and ... more AimThe impact of obstructive sleep apnoea (OSA)–COPD overlap syndrome (OVS) on sleep quality and cardiovascular outcomes has not been fully explored. We aimed to compare clinical and polysomnographic characteristics of patients with OVSversuspatients with OSA, and to explore pathophysiological links between OVS and comorbidities.Study design and methodsThis cross-sectional analysis initially included data from 5600 patients with OSA and lung function in the European Sleep Apnoea Database. Two subgroups of patients with OSA (n=1018) or OVS (n=509) were matched (2:1) based on sex, age, body mass index and apnoea–hypopnea index at baseline.ResultsAfter matching, patients with OVS had more severe hypoxia, lower sleep efficiency and presented with higher prevalences of arterial hypertension, ischaemic heart disease and heart failure compared with patients with OSA. OVS was associated with a significant decrease in sleep efficiency (mean difference (β) −3.0%, 95% CI −4.7 to −1.3) and in nocturnal mean peripheral oxyhaemoglobin saturation (SpO2) (β −1.1%, 95% CI −1.5 to −0.7). Further analysis revealed that a decrease in forced expiratory volume in 1 s and arterial oxygen tension was related to a decrease in sleep efficiency and in mean nocturnalSpO2. A COPD diagnosis increased the odds of having heart failure by 1.75 (95% CI 1.15–2.67) and systemic hypertension by 1.36 (95% CI 1.07–1.73). Nocturnal hypoxia was strongly associated with comorbidities; the mean nocturnalSpO2and T90 (increase in time belowSpO2of 90%) were associated with increased odds of systemic hypertension, diabetes and heart failure but the oxygen desaturation index was only related to hypertension and diabetes.ConclusionPatients with OVS presented with more sleep-related hypoxia, a reduced sleep quality and a higher risk for heart failure and hypertension.

Sleep characteristics and cardio-metabolic comorbidities in the OSA-COPD overlap syndrome: Data from the European Sleep Apnea Database (ESADA)

04.02 - Clinical and epidemiological respiratory sleep medicine, Sep 4, 2022

Revista Portuguesa De Pneumologia, Nov 1, 2010

A Revista Portuguesa de Pneumologia (RPP) tem como um dos seus principais objectivos o de contrib... more A Revista Portuguesa de Pneumologia (RPP) tem como um dos seus principais objectivos o de contribuir de forma significativa e relevante para a literatura médica portuguesa. Os presentes editores consideraram que seria importante a análise e comentário da informação mais relevante publicada em cada uma das áreas da Pneumologia no passado ano de 2009. Os membros do Conselho Editorial convidados fi zeram uma avaliação e evidenciaram os artigos mais relevantes publicados na RPP.

Archivos De Bronconeumologia, Dec 1, 2009

Background and objectives: Obstructive sleep apnoea (OSA) has been increasingly linked to cardiov... more Background and objectives: Obstructive sleep apnoea (OSA) has been increasingly linked to cardiovascular disease. Infl ammatory 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. Primary objective: 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. Patients and methods: This is a prospective study including 98 male patients with moderate to severe OSA confi rmed by domiciliary sleep study. Malignancy and chronic infl ammatory diseases were exclusion criteria. hs-CRP and IL-6 serum levels were evaluated before APAP, 9 days and 6 months after therapy. Community controls (n=103) were selected using random digit dialling, and matched by age and body mass index (BMI) for comparison of hs-CRP levels at baseline. Results: The studied population had a mean age of 55.3±10.7 years, mean BMI 33.2±5.0kg/m 2 , mean apnoeahypopnoea index 51.7±21.3/h and mean desaturation index 86.3±5.3/h. The APAP compliance was good: 91.27&%×000B1;20.45 days usage and 5.76±1.59h/night of usage. Mean basal hs-CRP and IL-6 serum values were 0.52±0.53 μg/l and 17.7±22.5 μg/l, respectively. CRP levels at baseline correlated signifi cantly with apnoea-hypopnoea index, desaturation index and minimum nocturnal oxygen saturation. IL-6 levels at baseline correlated signifi cantly and negatively with minimum nocturnal oxygen saturation. When adjusting for confounding factors found in this study, all these relations lost signifi cance. CRP is signifi cantly increased in patients when compared to controls (P=.002) and when considering hs-CRP cardiovascular risk stratifi ed categories, cases had signifi cantly more patients at high risk of cardiovascular events than controls (P=.002). After adjustment for BMI and arterial hypertension, cases had an almost twofold moderate risk of cardiovascular events and more than a twofold severe risk of cardiovascular events when compared to controls. We found no signifi cant difference between hs-CRP and IL-6 concentrations pre-treatment and in two moments post-treatment (9 days and 6 months) (CRP: P=.720 and P=.387, respectively; IL-6: P=.266 and P=.238, respectively). Conclusions: OSA is associated with a low-grade infl ammatory process; hs-CRP serum levels are elevated in OSA patients when comparing to community controls, independently of age and BMI and the former have a signifi cantly higher risk of cardiovascular events when compared to the latter. There was no signifi cant decrease of both infl amatory mediators (hs-CRP, IL-6) after short and long-term APAP therapy.

Rigid Bronchoscopy

Journal of Bronchology, Jul 1, 2003

ABSTRACT

The usefulness of home medical appointments during the COVID-19 pandemic in Chronic Respiratory Diseases

Introduction: During the COVID-19 pandemic, teleconsultation was used for most non-COVID-19 patie... more Introduction: During the COVID-19 pandemic, teleconsultation was used for most non-COVID-19 patients; however, in some patients, it was imperative to provide immediate face-to-face care. Aim: To evaluate the usefulness of home medical consultations (HMCs) in patients with chronic respiratory failure (CRF) and neuromuscular (NM) diseases. Methods: Retrospective analysis of the HMCs performed between June and August 2020. Patients9 demographic and clinical data were evaluated. Medical observation, the results of the tests performed [SpO2, TcCO2, ABG, pulmonary function tests (PFT)] and the therapeutic changes were analyzed. Results: Twenty-two HMC, 13 females’ patients, median age 63.3 years. The main diagnoses were NM disease (n=8), COPD+CRF (n=7), and multifactorial CRF (n=7). All patients with COPD and multifactorial CRF had dyspnea, mMRC ≥ 3 (n=13). They were under NIV (n=4), LTOT (n=1), NIV+LTOT (n=6) and high-flow nasal oxygen (n=1). PFT were performed in 9 cases (mean FEV1 34.3±9.3%), ABG in 10 cases (mean of PaCO2 46.1±9.1 mmHg), and pulse oximetry in all patients. Regarding NM patients, 6 had motor and 5 bulbar impairment; 3 were NIV-dependent; mean of TcCO2 (n=7) was 37.6±3.5 mmHg; mean vital capacity and mean peak cough flow (n=6) were 2508±1557 ml and 206±149 L/min, respectively. HMCs allowed decisions regarding therapeutic strategies in most patients, including pharmacological changes (n=10), ventilatory optimization (n=7) and de novo indication for NIV (n=5), for PEG (n=1) and for tracheostomy (n=1). Conclusion: HMCs were useful, allowing clinical evaluation and several respiratory assessments, as well as therapeutic changes and the implementation of new strategies.

Sleep Medicine, Dec 1, 2019

neurocognitive function following IH. Previous reports suggest reduced cerebrovascular reactivity... more neurocognitive function following IH. Previous reports suggest reduced cerebrovascular reactivity following IH, however, it is unknown if IH alters cerebral NVC. We tested the hypothesis that acute IH exposure evokes similar loss of NVC in healthy young men and women. Methods: NVC was assessed in 18 humans (8 female; tested 0-5 days in early follicular phase of menstruation, age ¼ 22±1 years, mean±SEM) before and after 40-minutes of IH. Eight men served as a time-matched control group. Dynamic end-tidal forcing was used to control end-tidal O 2 (P ET O 2 ) and CO 2 (P ET CO 2 ) at baseline levels throughout NVC assessment and to administer 40-minutes of IH. Each minute of IH was comprised of 40-seconds hypercapnic hypoxia (nadir S P O 2 ¼ 83.4±1.0%, peak P ET CO 2 ¼ +3.2±0.3 mmHg above baseline) and 20-seconds of normoxic recovery. Beat-by-beat mean arterial pressure (MAP; finger-pulse-photoplethysmography), middle (MCA V ) and posterior (PCA V ) cerebral artery blood velocity (transcranial Doppler) were measured continuously throughout the protocol. Cerebrovascular conductance was calculated as the quotient of MCA V or PCA V and MAP (MCA CVC and PCA CVC respectively). The peak PCA V response to 5 repeated cycles of 30-seconds eyes-open with standardized visual stimulation (flashing checkerboard) followed by 30seconds eyes-closed determined NVC. The MCA V response permitted comparison in regional cerebral blood supply. NVC was quantified as the peak absolute and percent increase (relative to eyes-closed) during visual stimulation averaged over 5-cycles. Results: Resting MAP was augmented following IH exposure (77.9±1.2 vs. 82.7±1.3 mmHg, P< 0.01). Females had higher resting MAP compared to males at baseline (81.0±1.4 vs. 75.4±1.2 mmHg respectively, P¼0.055) and following IH (88.3±1.8 vs. 78.1±1.3 mmHg respectively, P< 0.01). Additionally, females had a larger increase in resting MAP following IH compared to males (sex-by-time interaction: P¼0.02). Following IH, PCA V (-1.6±0.7 cm/s), MCA CVC (-0.057±0.018 mmHg/cm/s), and PCA CVC (-0.046±0.010 mmHg/cm/ s) were reduced (all P< 0.05) while MCA V was unchanged. Additionally, PCA V , MCA CVC and PCA CVC did not differ between sex. The absolute peak PCA V or MCA V response to visual stimulation were not altered by IH. The percent relative PCA V and MCA V response during visual stimulation were similar following IH, however, there were significant increases in the percent relative response for PCA CVC (+4.5±1.5%, P< 0.01) and MCA CVC (+4.1±1.2%, P< 0.01) which did not differ between sex (P¼0.3 and P¼0.4, respectively). Time-matched controls showed no difference in MAP or NVC responses following 40-minutes of room air breathing. Conclusions: Our data show in young healthy humans, (1) NVC is improved following acute IH, (2) NVC is similar between sexes before and following acute IH and (3) MAP responses to acute IH differ between sexes. Acknowledgements: HSFC, NSERC, MSFHR.

DOAJ (DOAJ: Directory of Open Access Journals), Oct 1, 2009

A síndroma de apneia obstrutiva do sono (SAOS) associada ao sono REM tem uma incidência de 10 -36... more 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- 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 Recebido para publicação/received for publication: 09.02.05 Aceite para publicação/accepted for publication: 09.03.20

Efficacy and adherence to chronic non-invasive ventilation in an outpatient setting

Sleep and Breathing, Sep 26, 2022

Differences between FEV6, FVC and VC at the diagnosis of obstructive ventilatory defect

Pulmonology, 2022

INTRODUCTION The diagnosis of airway obstruction can be made through FEV1/FVC ratio <0.7 or FE... more INTRODUCTION The diagnosis of airway obstruction can be made through FEV1/FVC ratio <0.7 or FEV1/VC ratio < lower limit of normality (LLN). Several authors advocate that FEV1/FEV6 ratio is an alternative to diagnosing obstructive ventilatory defect, while others have determined that the best cut-off for this ratio (best combined sensitivity and specificity) is 0.73. OBJECTIVE To evaluate the non-inferiority of FEV1/FEV6 ratio < 0.73 when compared to FEV1/FVC ratio < 0.7 and FEV1/VC < LLN in diagnosing airway obstruction. METHODS A retrospective analysis of the medical records from patients who underwent spirometry or plethysmography in a university central hospital from June 1st to December 31st, 2018 was carried out. Only medical records which included FEV1/FVC < 0.7 or FEV1/VC < LLN were selected, and these results were compared to FEV1/FEV6 ratio. RESULTS A total of 526 patients with obstructive ventilatory defect were identified by one of the two ratios described. Of these, 95.1%, 87.4% and 88.6% were obstructive by FEV1/FVC, FEV1/VC, and FEV1/FEV6 ratio, respectively. The positive predictive value (PPV) of FEV1/FEV6 in relation to FEV1/FVC ratio was 99.6% (p < 0.001) with a diagnostic efficacy of 92.8%, whereas the PPV of FEV1/FEV6 in relation to FEV1/VC was 91.0% (p < 0.001) and diagnostic efficacy was 85.2%. Most false negatives, comparing FEV6 with the other two tests, were found in patients with FEV1 > 70% (mild obstruction) and in individuals aged >50 years. CONCLUSIONS FEV1/FEV6 < 0.73 may be a good alternative ratio, as it is non-inferior to FEV1/VC and FEV1/FVC in diagnosing obstructive ventilatory defect.

Predictors of end-organ damage in patients with Obstructive Sleep Apnea according to the Baveno classification

Referral to a sleep laboratory from primary care – are family doctors on the right track?

Obstructive Sleep Apnea Syndrome (OSAS) is a highly prevalent disease, and screening mostly takes... more Obstructive Sleep Apnea Syndrome (OSAS) is a highly prevalent disease, and screening mostly takes place on a primary care context. Several questionnaires have been validated as predictors of a high risk of OSAS, but a formal diagnosis is necessary, which requires a referral to a sleep laboratory for diagnostic testing. The aim of this study was to assess the accuracy of primary care referral to a sleep lab for suspected OSAS. 421 patients, after referral from primary care, were evaluated on an early diagnosis screening program, which consisted of an appointment with a sleep physician and a domiciliary cardio-respiratory polygraphy. OSA was diagnosed as an AHI ≥5 events/hour. The average body-mass index of the population was 30.7kg/m2 and patients scored an average of 9.7 points on the Epworth Sleepiness Scale. 72 patients (18%) had a negative test for OSA. Out of the 346 (82%) who tested positive, 123 (36%) had mild OSA, 104 (30%) had moderate OSA and 119 (34%) had severe OSA. According to the polygraphy result, along with the reported symptoms and medical history, treatment with positive pressure was initiated in 216 patients (51% of the total sample, 62% of those with OSA). Our results show that while the high prevalence of OSAS can result in a great burden of referrals to sleep laboratories, in a vast majority of the referred patients the diagnosis of OSA is confirmed. The implementation of large-scale screening programs and standardized referral protocols are important tools to manage the high number of referrals and avoid long waiting lists.

Prospective validation of a Bayesian network model in the diagnosis of Obstructive Sleep Apnea: preliminary results

Home mechanical ventilation in chronic hypercapnic COPD patients: impact on acute exacerbations and survival

Are FEV6, FVC and VC different in diagnosing obstructive ventilatory defect?

Impact of PAP in reducing cardiovascular events in OSA patients: a 10-years follow-up

Physiological effects of three different ventilatory modes in patients with obesity hypoventilation syndrome under nocturnal noninvasive ventilation: a pilot randomized study