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Autonomic, metabolic and inflammatory aspects of metabolic syndrome associated with obstructive sleep apnea: effect of hypocaloric diet and physical training

Abstract

Context. Metabolic syndrome (MetS) is strongly associated with obstructive sleep apnea (OSA). MetS and OSA cause sympathetic hyperactivation, which mechanisms are not completely known. Metabolic, inflammatory and baro/chemoreflex control alterations may could explain, at least in part, the sympathetic hyperactivation. Objectives. In this study we intend to investigate whether OSA has an additive effect on hemodynamic and autonomic control and on metabolic and inflammatory markers and if there is association between sympathetic nerve hyperactivity with metabolic and inflammatory markers. In addition, we will investigate the effect of hypocaloric diet associated with exercise training (D+ET) on the severity of OSA, on the hemodynamic and autonomic control and on the metabolic/inflammatory controlin these MetS patients. Design, participants and intervertions. Prospective randomized clinical trial, blind. The MetS patients (according ATP-III) will be divided into MetS+OSA and MetS-OSA and all will be randomized for interventions by D (decrease of 500 kcal/day) and ET (3x/week, 50-70% VO2peak) or control period for 4 months. A normal control group will be also enrolled in this study. Methods. We will evaluate: OSA (polysomnography - measurer blind), physical fitness (ergospirometry), baroreflex sensitivity (spontaneous fluctuations of BP and HR), peripheral chemoreflex control (inhalation of hypoxic gas mixture with 10%O2 and 90% N2 for 3 min) and central (hypercapnic inhalation of 7%CO2 and 93%O2 for 3 min), insulin resistance (HOMA and OGTT) leptin and adiponectin and inflammatory markers, sympathetic nerve activity (microneurography), muscle blood flow (plethysmography), blood pressure (oscillometric); heart rate (ECG), oxygen saturation (oximetry), end-tidal CO2 (capnography), respiratory rate (piezoeletric), pulmonary ventilation (pneumotachograph) and pulse wave velocity.Main outcome measures. Absolute change from pre to post D+ET on hemodynamic, autonomic, metabolic and inflammatory control in MetS patients. (AU)

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Scientific publications (11)
(References retrieved automatically from Web of Science and SciELO through information on FAPESP grants and their corresponding numbers as mentioned in the publications by the authors)
SARMENTO, ADRIANA OLIVEIRA; ANTUNES-CORREA, LIGIA M.; ALVES, MARIA J. N. N.; BACURAU, ALINE V. N.; FONSECA, KEILA C. B.; PESSOA, FERNANDA G.; LOBO, DENISE M. L.; MOREIRA, LEILA D. P.; TROMBETTA, IVANI C.; RONDON, MARIA U. P. B.; et al. Effect of exercise training on cardiovascular autonomic and muscular function in subclinical Chagas cardiomyopathy: a randomized controlled trial. CLINICAL AUTONOMIC RESEARCH, v. 31, n. 2, . (13/15651-7, 11/17533-6, 10/50048-1)
CEPEDA, FELIPE X.; VIRMONDES, LESLIE; RODRIGUES, SARA; DUTRA-MARQUES, AKOTHIRENE C. B.; TOSCHI-DIAS, EDGAR; FERREIRA-CAMARGO, FERNANDA C.; HUSSID, MARIA FERNANDA; RONDON, MARIA URBANA P. B.; ALVES, MARIA JANIEIRE N. N.; TROMBETTA, IVANI C.. Identifying the risk of obstructive sleep apnea in metabolic syndrome patients: Diagnostic accuracy of the Berlin Questionnaire. PLoS One, v. 14, n. 5, . (15/03274-0, 16/16831-7, 11/17533-6, 13/15323-0, 13/07651-7)
LOPES-VICENTE, WANDA R. P.; RODRIGUES, SARA; CEPEDA, FELIPE X.; JORDAO, CAMILA PAIXAO; COSTA-HONG, VALERIA; DUTRA-MARQUES, AKOTHIRENE C. B.; CARVALHO, JEFFERSON C.; ALVES, MARIA JANIEIRE N. N.; BORTOLOTTO, LUIZ A.; TROMBETTA, IVANI C.. Arterial stiffness and its association with clustering of metabolic syndrome risk factors. DIABETOLOGY & METABOLIC SYNDROME, v. 9, . (11/17533-6, 13/15323-0, 16/16831-7)
RODRIGUES, SARA; CEPEDA, FELIPE X.; TOSCHI-DIAS, EDGAR; DUTRA-MARQUES, AKOTHIRENE C. B.; CARVALHO, JEFFERSON C.; COSTA-HONG, VALERIA; ALVES, MARIA JANIEIRE N. N.; RONDON, MARIA URBANA P. B.; BORTOLOTTO, LUIZ A.; TROMBETTA, IVANI C.. The role of increased glucose on neurovascular dysfunction in patients with the metabolic syndrome. JOURNAL OF CLINICAL HYPERTENSION, v. 19, n. 9, p. 840-847, . (15/03274-0, 13/15323-0, 13/07651-7, 11/17533-6)
PEREZ, EDUARDO ARAUJO; FRANCO OLIVEIRA, LUIS VICENTE; FREITAS, JR., WILSON RODRIGUES; MALHEIROS, CARLOS ALBERTO; ILIAS, ELIAS JIRJOSS; SILVA, ANDERSON SOARES; URBANO, JESSICA JULIOTI; OLIVEIRA, PATRICIA CLEMENTE; CEPEDA, FELIPE X.; SAMPAIO, LUCIANA M. M.; et al. Prevalence and severity of syndrome Z in women with metabolic syndrome on waiting list for bariatric surgery: a cross-sectional study. DIABETOLOGY & METABOLIC SYNDROME, v. 9, . (11/17533-6)
TOSCHI-DIAS, EDGAR; TROMBETTA, IVANI C.; DIAS DA SILVA, VALDO J.; MAKI-NUNES, CRISTIANE; CEPEDA, FELIPE X.; ALVES, MARIA-JANIEIRE N. N.; DRAGER, LUCIANO F.; LORENZI-FILHO, GERALDO; NEGRAO, CARLOS E.; RONDON, MARIA URBANA P. B.. Time delay of baroreflex control and oscillatory pattern of sympathetic activity in patients with metabolic syndrome and obstructive sleep apnea. AMERICAN JOURNAL OF PHYSIOLOGY-HEART AND CIRCULATORY PHYSIOLOGY, v. 304, n. 7, p. H1038-H1044, . (11/17533-6, 08/03714-6)
CEPEDA, FELIPE X.; TOSCHI-DIAS, EDGAR; MAKI-NUNES, CRISTIANE; RONDON, MARIA URBANA P. B.; ALVES, MARIA JANIEIRE N. N.; BRAGA, ANA MARIA F. W.; MARTINEZ, DANIEL G.; DRAGER, LUCIANO F.; LORENZI-FILHO, GERALDO; NEGRAO, CARLOS E.; et al. Obstructive Sleep Apnea Impairs Postexercise Sympathovagal Balance in Patients with Metabolic Syndrome. Sleep, v. 38, n. 7, p. 1059-1066, . (11/17533-6)
MAKI-NUNES, CRISTIANE; TOSCHI-DIAS, EDGAR; CEPEDA, FELIPE X.; RONDON, MARIA URBANA P. B.; ALVES, MARIA-JANIEIRE N. N.; FRAGA, RAFFAEL F.; BRAGA, ANA MARIA F. W.; AGUILAR, ADRIANA M.; AMARO, ALINE C.; DRAGER, LUCIANO F.; et al. Diet and exercise improve chemoreflex sensitivity in patients with metabolic syndrome and obstructive sleep apnea. OBESITY, v. 23, n. 8, p. 1582-1590, . (12/02953-2, 11/17533-6, 13/07651-7, 08/03714-6)
TOSCHI-DIAS, EDGAR; TROMBETTA, IVANI C.; SILVA, VALDO J. D.; MAKI-NUNES, CRISTIANE; CEPEDA, FELIPE X.; ALVES, MARIA JANIEIRE N. N.; CARVALHO, GLAUCE L.; DRAGER, LUCIANO F.; LORENZI-FILHO, GERALDO; NEGRAO, CARLOS E.; et al. Diet associated with exercise improves baroreflex control of sympathetic nerve activity in metabolic syndrome and sleep apnea patients. Sleep and Breathing, v. 23, n. 1, p. 143-151, . (12/02953-2, 11/17533-6, 13/07651-7, 10/50048-1, 16/16831-7, 08/03714-6)
DUTRA-MARQUES, AKOTHIRENE C.; RODRIGUES, SARA; CEPEDA, FELIPE X.; TOSCHI-DIAS, EDGAR; RONDON, EDUARDO; CARVALHO, JEFFERSON C.; ALVES, MARIA JANIEIRE N. N.; BRAGA, ANA MARIA F. W.; RONDON, MARIA URBANA P. B.; TROMBETTA, IVANI C.. Exaggerated Exercise Blood Pressure as a Marker of Baroreflex Dysfunction in Normotensive Metabolic Syndrome Patients. FRONTIERS IN NEUROSCIENCE, v. 15, . (16/16831-7, 11/17533-6, 15/03274-0, 13/07651-7)
TROMBETTA, IVANI C.; MAKI-NUNES, CRISTIANE; TOSCHI-DIAS, EDGAR; ALVES, MARIA-JANIEIRE N. N.; RONDON, MARIA URBANA P. B.; CEPEDA, FELIPE X.; DRAGER, LUCIANO F.; BRAGA, ANA MARIA F. W.; LORENZI-FILHO, GERALDO; NEGRAO, CARLOS E.. Obstructive Sleep Apnea is Associated with Increased Chemoreflex Sensitivity in Patients with Metabolic Syndrome. Sleep, v. 36, n. 1, p. 41-49, . (11/17533-6)

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