INTRODUÇÃOQuando procuramos estabelecer uma relação entre o exercício físico e a morte súbita de origem cardíaca, o pensamento pode nos direcionar tanto para aspectos preventivos associados a tal prática quanto pode nos alertar para fatores relacionados ao tema como uma verdadeira causa. Em outras palavras, o exercício tem sido e realmente pode ser visto de forma antagônica. Se por um lado existe um imenso potencial preventivo na relação entre exercitar-se e morrer subitamente, também existe um risco definido de se morrer subitamente durante ou, especialmente, após a atividade física. Por isso, a morte súbita relacionada ao exercício deve ser analisada de forma crítica, ser embasada nas evidências disponíveis, sendo levada muito a sério, pois mesmo pouco freqüente, quando incidente, tem sempre um impacto profundo na comunidade médica e na população em geral.Visto pelo ângulo positivo, o hábito de exercitar-se de forma regular e crônica proporciona um efeito protetor na prevenção primária e secundária da doença arterial coronária. Alguns destes benefícios podem ser oriundos da diminuição na progressão ou, até mesmo, na regressão da aterosclerose coronária. A melhora no condicionamento físico atlético também pode relacionar-se a alterações benéficas no perfil lipídico, à perda de peso, à diminuição na freqüência cardíaca e na pressão arterial de repouso. Além disso, a prática continuada de atividades aeróbias possibilita uma melhor extração periférica de oxigênio pelos músculos esqueléticos, possivelmente estimula a circulação colateral miocárdica e aumenta a sensibilidade à insulina, entre outros tantos efeitos recomendáveis 1 .No entanto, uma pequena parcela das pessoas possuem patologias que fazem com que o exercício possa perder este papel de proteção contra eventos cardiovasculares agu-dos. Tais situações independem do nível de condicionamento físico, podendo acometer atletas altamente treinados ou pessoas que praticam exercícios físicos apenas eventualmente. A morte súbita é a mais grave manifestação desta situação, sendo vital para o médico e, em especial, para o cardiologista, conhecer e saber identificar em quais situações o exercício físico deva ser desaconselhado. DEFINIÇÕESDefine-se como morte súbita relacionada aos exercícios a morte que ocorre quando da realização de atividade física ou até uma hora após seu término 2 . Deve-se acrescentar a esta definição mais um elemento: a morte deve ser provocada por algum transtorno no funcionamento normal do sistema cardiovascular, a fim de que sejam excluídos atletas que venham a falecer quando da prática de esportes com risco de vida intrínseco, como pára-quedismo, alpinismo, automobilismo, entre outros. EPIDEMIOLOGIASegundo a mitologia grega, Pheidippides correu de Maratona até Atenas com a tarefa de anunciar a vitória dos gregos sobre os persas e morreu ao dar a feliz notícia ao povo ateniense. Provavelmente este foi o primeiro relato de morte súbita relacionada ao exercício físico que se tem notícia. Estudos observacionais 3-6 sugerem que a morte súbita rel...
This study aimed to evaluate the influence of reusing progesterone intravaginal implants using a fixedtime artificial insemination (FTAI) protocol on the conception rates of 593 primiparous and multiparous lactating cows during two different seasons. The cows were divided into two categories: multiparous and primiparous. The experiment was conducted during seasons with high and mild temperatures. To compare the conception rates during both seasons, the animals were randomly divided into three groups according to use progesterone implant (1 st use, 2 nd use and 3 rd use) on the first day of the synchronization protocol for FTAI within each category. A pregnancy diagnosis was performed at 30 days following FTAI. The temperature and humidity index was higher (P<0.01) during the season with higher temperatures (74.4 ± 0.26) than during the season with mild temperatures (67.5 ± 0.34). The different categories (multiparous and primiparous) did not influence the conception rate in terms of the seasonal temperatures or the reuse of progesterone implants. Nevertheless, a 3 rd use implant administered during the season with high temperatures was 1.98 times less likely to result in a pregnancy compared with a 1 st use implant (P=0.01) and 2.83 less likely to result in a pregnancy than the other implants used during the season with mild temperatures (P=0.005). The results indicate that during the season with mild temperatures, the conception rates at 30 days are not influenced by reusing the P 4 implant in any of the categories analyzed. However, during the season with high temperatures, the reuse of the P 4 implant can influence the conception rates of dairy cows.
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influence of age on sleep architecture and daytime sleepiness in a large sample of OSAS patients. Methods: We enrolled 2399 patients with OSAS (apnea-hypopnea index, AHI ≥ 5) divided into two age groups: over 65 (n = 1180, mean age 70.2 ± 4.5 years), and 65 or under (n = 1219, mean age 50.1, ± 10.9 years). Subjective daytime sleepiness, reflected by the Epworth sleepiness scale (ESS), and polysomnographic parameters were recorded and compared between the two groups. Results: There were no significantly differences regarding gender, BMI, daytime sleepiness (31.9% vs 46.7% had ESS>10) between the elderly and younger patients with OSAS, but the incidence of comorbidities such as hypertension and other cardiovascular diseases was significantly higher (p<0.001). The sleep architecture was significantly worse in elderly OSAS patients with lower SE (%) (p<0.001), REM (%) (p<0.001), and higher NREM (%) and WASO (p<0.001) compared with the younger patients. The percentage of SWS, apnea hypopnea index (AHI), and oxygen desaturaion index (ODI) had no significantly difference in the two groups. The mean and the lowest oxygen saturation and arousal index were significantly decreased in elderly OSAS patients (p<0.001). Conclusion: Our results suggest that objective sleep quality was more impaired in elderly compared to younger-aged patients. Additionally the prevalence of sleepiness in the elderly group was low and elderly had more cardiovascular comorbitities. Introduction: Sleep-disordered breathing (SDB) is associated with sleepiness, high blood pressure, and cardiovascular events. Cardiovascular associations have been linked to oxygen desaturation. Less is known regarding SDB associations with sleepiness. Different physiologic associations (e.g. arousal vs desaturation) of SDB events may result in different pathobiologic outcomes. Methods: 2,112 nocturnal polysomnograms (PSGs) from 1,022 subjects in the Wisconsin Sleep Cohort were analyzed with our automated algorithm, which was developed to detect breathing disturbances (decrease of 30% in nasal airflow for at least 10 seconds, without a concomitant increase in oral flow) and desaturations. Breathing disturbance events were time-locked to desaturations, resulting in 2 indices: desaturating (H-BDI) and non-desaturating (NH-BDI) events. Systolic and/or diastolic hypertension was used as a measure of cardiovascular health. Measures of subjective (Epworth Sleepiness Scale) and objective (2,981 MSLTs from a subset of 865 subjects) sleepiness were analyzed. Additional, clinically relevant variables were accounted for in modeling associations. Results: H-BDI, but not NH-BDI, correlated strongly with SDB severity indices that included hypoxia (r≥0.89, p≤0.001 with ODI 3% and AHI with 4%-desaturations). Each twofold increase in desaturation-associated events was associated with an increased risk of hypertension (3% ODI OR=1.06, 95% CI=1.00-1.12, p<0.05) and daytime sleepiness (β=0.20 ESS score, p<0.0001; β=-0.20 min in MSL on MSLT, p<0.01). Non-desaturating events were more stron...
response was collected unanimously by teachers. High risk children for sleep apnea were identified using apnea-associated symptoms related either to sleeping, anxiety, attention deficiency or emotional behavior. The participants whose information was not available were omitted from the analysis. Uni-variable and multivariable regression and logistic analyses were conducted, using SAS version 9.0 software. Results: More than 90% of care-givers responded to the questionnaire, and 75% of them revealed the STBUR score of 0, while 0.3% did STBUR score of 3 or greater. Mostly 1,800 pupils were regarded as having higher risk for sleep apnea, and thus invited for detailed examination. Data from around 700 participants were available for the subsequent analysis. The prevalence of severe sleep apnea (RDI = 5 or over) was 0.9% in those with STBUR scores of 0, 3.0% with STBUR scores of 1, 6.4% with STBUR scores of 2, and 13.3 with STBUR scores of 3, 4, and 5. According to multivariable logistic analysis odds ratio (95% confidence interval) vs STBURN score 0 were 3.54 (0.76 to 16.64) in STBURN score 1, those STBURN score 2 were 8. Children's Hospital of Philadelphia, Philadelphia, PA Introduction: Pediatric obstructive sleep apnea (OSA) is more common in obese children. However, the role of fat distribution in the pathogenesis of OSA in this age group is controversial. We evaluated the association of OSA to excess adiposity and abdominal fat. We hypothesized a positive correlation between anthropometric parameters and OSA and an inverse correlation between obesity and the oxyhemoglobin saturation (SpO2) nadir in a large sample of school-aged children with OSA. Methods: We investigated the baseline data from the childhood adenotonsillectomy trial (CHAT). The relationship between apnea hypopnea index (AHI), SpO2 nadir, peak CO 2 during sleep and body-mass index Z-score (BMI z-score), waist:height ratio (WTHR) and neck:height ratio (NHR) was evaluated. AHI was evaluated using linear regression in log scale which improved its distribution towards normal. Other outcomes were evaluated using Spearman correlations. Results: 452 children were analyzed (52% girls). The mean ± SD age was 7 ± 1.4years. The mean BMI Z-score was 0.8 ± 1.3. There was a positive correlation between log AHI and BMI r=0.10, p=0.03) and WTHR; (β=1.00, r=0.10, p=0.03), and an inverse correlation between SpO2 nadir and BMI z-score (r=-0.19, p=0.00005), and WTHR (r=-0.17, p=0.0002) and NHR (r=-0.12, p=0.008). When corrected for multiple comparisons, there remained an inverse correlation between SpO2 nadir and BMI z-score and SpO2 nadir and WTHR. Conclusion: BMI Z-score and WTHR, an index of visceral fat, correlate with the degree of desaturation during sleep in school-age children. However, in contrast to adults, anthropometric measures do not correlate with indices of upper airway obstruction such as the AHI. We speculate that restrictive lung disease and a lower pulmonary reserve
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