ABC | Volume 111, Nº3, September 2018

Original Article Medeiros et al Obstructive sleep apnea in chagas disease Arq Bras Cardiol. 2018; 111(3):364-372 lower in patients with moderate-to-severe OSA compared with patients with mild and no OSA -16(-19/-13)% vs. -17(-20/-12)% and -19 (-21/-15)%, p = 0.04. The prevalence of ventricular dysfunction [LVEF < 50% (39% vs 28% and 11%), p < 0.01] was also higher in the group with moderate-to-severe OSA than in participants with mild or no OSA (Figure 3). This higher prevalence was also observed in the subgroup of patients with Chagas cardiomyopathy. Table 1 – Anthropometrics and clinical characteristics Total n = 135 No OSA n = 57 Mild OSA n = 50 Mod/Severe OSA n = 28 p Age, years 56 (45–62) 48 (42–58) 59 (55–63) 61 (51–63) < 0.001* Male, n (%) 40 (30) 15 (26) 15 (30) 10 (36) 0.67 † BMI, kg/m 2 26.3 ± 4.2 24.7 ± 3.9 27.4 ± 3.9 27.6 ± 4.5 0.001 ¥ Neck circumference, cm 35 (33–38) 34 (32–36) 36 (33–39) 38 (34–39) 0.02 † Waist, cm 92 (83–96) 87 (79-92) 96 (89–102) 96 (91–104) < 0.001* Caucasians, n (%) 43 (32) 19 (33) 16 (32%) 8 (29%) 0.86 † Diabetes mellitus, n (%) 17 (13) 5 (9) 7 (14) 5 (18) 0.46 † Hypertension, n (%) 83 (62) 25 (44) 36 (72) 22 (79) 0.001 † Office Systolic BP, mmHg 131 ± 22 128 ± 20 135 ± 22 133 ± 26 0.27 ¥ Office Diastolic BP, mmHg 81 ± 11 83 ± 11 81 ± 12 78 ± 11 0.14 ¥ Use of antihypertensive drugs, n 1 (0–2) 1 (0–2) 2 (1–2) 2 (0–3) 0.001 † Diuretics, n (%) 54 (40) 13 (23%) 26 (52%) 15 (54%) < 0.001 † ACE inhibitors / AT1 inhibitors n (%) 76 (56) 23 (30%) 35 (46%) 14 (24%) < 0.001 † B-blockers, n (%) 57 (42) 17 (30%) 25 (50%) 13 (54%) 0.04 † Spironolactone, n (%) 14 (10) 5 (9%) 5 (10%) 4 (14%) 0.73 † Epworth sleepiness scale, Score, n (%) 9.8 ± 4.9 9.3 ± 5.2 10.2 ± 5.2 10.1 ± 3.8 0.57 ¥ Values are mean (±SD). Variables with skewed distribution presented as median (interquartile range). OSA: obstructive sleep apnea; BMI body mass index; BP: blood pressure. *: Test of Kruskal-Wallis; † : Chi-square test of Pearson; ¥ : Anova test. Table 2 – Holter evaluation – Distribution of atrial and ventricular arrhythmias Variable Total n = 135 No OSA n = 57 Mild OSA n = 50 Mod/Severe OSA n = 28 p HR Minimum (b.p.m) 50 (45–55) 50 (45–56) 50 (45–56) 52 (46–54) 0.97* HR Average (b.p.m) 71 (65–77) 71 (66–79) 71 (65–74) 71 (62–75) 0.82* HR Maximum (b.p.m) 113 (105–25) 118 (109–132) 112 (103–121) 109 (98–121) 0.045* Total awake ventricular (%) 94 (70) 39 (68) 37 (74) 18 (64) 0.65 † Total sleep ventricular (%) 95 (70) 36 (63) 40 (80) 19 (68) 0.16 † Isolated ventricular arrhythmias (%) 107 (79) 44 (77) 40 (80) 23 (82) 0.86 † Ventricular bigeminy (%) 38 (79) 14 (25) 14 (28) 10 (36) 0.56 † Ventricular paired (%) 50 (37) 18 (32) 19 (38) 13 (46) 0.41 † Non-sustained ventricular tachycardia 27 (20) 10 (18) 10 (20) 7 (25) 0.72 † Total awake supraventricular 115 (85) 47 (83) 42 (84) 26 (93) 0.43 † Total sleep supraventricular 118 (87) 48 (84) 44 (88) 26 (93) 0.52 † Isolated supraventricular tachycardia (%) 124 (92) 51 (90) 48 (96) 25 (89) 0.40 † Supraventricular paired (%) 47 (35) 13 (23) 20 (40) 14 (50) 0.03 † Non-sustained supraventricular tachycardia (%) 27 (20) 10 (18) 10 (20) 7 (25) 0.26 † Chronic atrial fibrillation (%) 1 (0.7) 0 1 (2) 0 0.43 † Paroxysmal atrial fibrillation (%) 1 (0.7) 0 0 1 (3.6) 0.15 † Right bundle-branch block (%) 62 (46) 23 (46) 23 (54) 9 (41) 0.59 † OSA: obstructive sleep apnea; HR: Heart Rate; *: Test of Kruskal-Wallis; † : Chi-square test of Pearson. 367