Manual Therapy, Posturology & Rehabilitation Journal
https://app.periodikos.com.br/journal/mtprehab/article/doi/10.17784/mtprehabJournal.2016.14.430
Manual Therapy, Posturology & Rehabilitation Journal
Study Protocol

The prevalence and severity of syndrome Z in severely obese male patients on the waiting list for bariatric surgery. A cross‑sectional study protocol

Perez, Eduardo A.; Rodrigues Junior, Wilson; Silva, Anderson Soares; Urbano, Jessica Julioti; Lottenberg, Carina; Brunetti, Ana Carolina Monteiro; Alves, Vera Lucia dos Santos; Oliveira, Patrícia Clemente; Peixoto, Roger André Oliveira; Oliveira, Ezequiel Fernandes; Nacif, Sergio Roberto; Santos, Israel Reis; Santos, Israel Reis dos; Ilias, Elias Jirjoss; Malheiros, Carlos Alberto; Oliveira, Luis V. F.; Stirbulov, Roberto

Downloads: 0
Views: 781

Abstract

Introduction: The Syndrome Z (SyndZ) has been drawing scientific community’s attention on the past years. It is characterized by the interaction between obstructive sleep apnea (OSA) and Metabolic Syndrome (MetS). On its turn, MetS is knew for the association with various metabolic disturbances occurring simultaneously in the same patient, those of which include central obesity, systemic hypertension (SH), glucose intolerance or insulin resitance, low serum high-density lipoprotein cholesterol (HDL), and elevated serum triglycerides. OSA is a prevalent condition all over the world, and presents potential adverse health outcomes, with a particular impact in cardiovascular diseases. Therefore, OSA and MetS present important cardiovascular risk factors, that when superimposed can mean a higher cardiovascular morbi-mortality. This associated pathogenesis has not been completely elucidated. Objectives: A pilot study to determine the prevalence and severity of SyndZ in severely obese female patients on the waiting list for bariatric surgery. Methods/Design: This cross-sectional study will be conducted with severely obese female patients, on waiting list for bariatric surgery, from the Santa Casa de Misericordia de São Paulo Hospital, in the city of Sao Paulo (Brazil). Demographic, anthropometric and clinical data will be collected, as well as blood’s biochemical analysis. The patients will also undergo standard overnight polysomnography at the Sleep Laboratory of Nove de Julho University.

Keywords

Syndrome Z, Metabolic syndrome, Obstructive sleep apnoea, Severe obesity, Polysomnography

References

1. Obesity and overweight. Fact sheet. World Health Organization. Updated June 2016 http://www.who.int/mediacentre/factsheets/fs311/en.

2. Knai C, Suhrcke M, Lobstein T. Obesity in Eastern Europe: an overview of its health and economic implications. Econ Hum Biol. 2007 Dec;5(3):392-408.

3. The NHS Information Centre for Health and Social Care. Health Survey for England 2011: Adult trend tables. http://content.digital.nhs.uk/article/2021/Website-Search?productid=20797&q=obesity&sort=Relevance&size=10&page=1&area=both#top Publication date: October 31, 2016.

4. Roland Sturm, Aiko Hattori, Morbid Obesity Rates Continue to Rise Rapidly in the US. Int J Obes (Lond). 2013 June ; 37(6): 889–891.

5. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report: National Institutes of Health. Obes Res. 1998;Suppl 2:51S–209S.

6. Nieto FJ, Young TB, Lind BK, et al.: Association of sleep disordered breathing, sleep apnea and hypertension in a large community-based study: Sleep Heart Health Study. JAMA 2000; 12(283):1829-1836.

7. Drager LF, Bortolotto LA, Krieger EM, Lorenzi-Filho G: Additive Effects of Obstructive Sleep Apnea and Hypertension on Early Markers of Carotid Atherosclerosis. Hipertension. 2008; 53:64-69.

8. Kanaley JA, Goulopoulou SH, Franklin RM, Baynard T, Holmstrup ME, Carhart R Jr, et al.: Plasticity of heart rate signaling and complexity with exercise training in obese individuals with and without type 2 diabetes. In J Obes (Lond)2009; 33(10):1198-206.

9. Prospective Studies Collaboration. Body mass index and cause specific mortality in 900,000 adults: collaborative analyses of 57 prospective studies. Lancet 2009; 373: 1083–96.

10. Grundy SM. Metabolic Syndrome: Connecting and Reconciling Cardiovascular and Diabetes Worlds. JACC 2006, 47, 6:1093–100.

11. Grundy SM, Cleeman JI, Daniels SR, et al. Diagnosis and management of the metabolic syndrome. An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 2005;112:2735–52.

12. Park SH, Lindholm B. Definition of metabolic syndrome in peritoneal dialysis. Perit Dial Int 2009;29:S137-44.

13. Reaven GM. Banting Lecture 1988. Role of Insulin Resistance in Human disease. DIABETES, 1988. 37, 1595-1607.

14. Kaur J. A Comprehensive Review on Metabolic Syndrome. Cardiology Research and Practice. 2014, article ID 943162, 21 pages

15. Nestel P, Lyu R, Low LP, Sheu WH, Nitiyanant W, et al. (2007) Metabolic syndrome: recent prevalence in East and Southeast Asian populations. Asia Pac J Clin Nutr 16: 362–7.

16. Eapen D, Kalra GL, Merchant N, Arora A, Khan BV (2009) Metabolic syndrome and cardiovascular disease in South Asians. Vasc Health Risk Manag 5: 731–43.

17. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001;285:2486–97.

18. Drager LF, Lopes HF, Maki-Nunes C, et al. The impact of obstructive sleep apneia on metabolic and inflammatory markers in consecutive patients with metabolic syndrome. PLoS One 2010;5:e12065. 3.

19. Trombetta IC, Somers VK, Maki-Nunes C, et al. Consequences of comorbid sleep apneia in the metabolic syndrome implications for cardiovascular risk. Sleep 2010;3:1193-9.

20. Peppard PE, Young T, Palta M, Skatrud J (2000) Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 342: 1378–1384.

21. Punjabi NM, Sorkin JD, Katzel LI, Goldberg AP, Schwartz AR, et al. (2002) Sleep-disordered breathing and insulin resistance in middle-aged and overweight men. Am J Respir Crit Care Med 165: 677–682.

22. Li J, Thorne LN, Punjabi NM, Sun CK, Schwartz AR, et al. (2005) Intermittent hypoxia induces hyperlipidemia in lean mice. Circ Res 97: 698–706.

23. Savransky V, Jun J, Li J, Nanayakkara A, Fonti S, Moser AB, et al. (2008) Dyslipidemia and atherosclerosis induced by chronic intermittent hypoxia are attenuated by deficiency of stearoyl coenzyme A desaturase. Circ Res 103:1173–1180.

24. Coughlin SR, Mawdsley L, Mugarza JA, Calverley PM, Wilding JP (2004) Obstructive sleep apnoea is independently associated with an increased prevalence of metabolic syndrome. Eur Heart J 25: 735–741.

25. Gruber A, Horwood F, Sithole J, Ali NJ, Idris I. Obstructive sleep apnoea is independently associated with the metabolic syndrome but not insulin resistance state. Cardiovasc Diabetol. 2006, 5: 22.

26. Stephen W, Littleton MD, Babak M: The Pickwickian Syndrome – Obesity Hipoventilation Syndrome. Clin Chest Med. 2009; 30:467-478.

27. Berger KI, Ayappa I, Chart-amontri B, Marfatia A, Sorkin IB, Rapoport DM, et al.: Obesity Hypoventilation Syndrome as a Spectrum of Respiratory Disturbances During Sleep. Chest. 2001; 120(4):1231-1238.

28. Weitzenblum E, Kessler R, Chaouat A: Alveolar hypoventilation in the obese: the obesity-hypoventilation syndrome. Rev. Pneumol. Clin. 2002;58(2):83-90.

29. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep. 1999;22:667– 689.

30. Feinsilver SH: Current and future methodology for monitoring sleep. Clinics in Chest Medicine. 1998;19(1):213-18.

31. Wilcox I, McNamara SG, Collins FL, Grunstein RR, Sullivan CE. “Syndrome Z”: the interaction of sleep apnoea, vascular risk factors and heart disease. Thorax 1998;53(Suppl 3):S25–28.

32. World Health Organization. Obesity: preventing and managing the global epidemic. Report of a World Health Organization Consultation. Geneva: World Health Organization, 2000. p. 256. WHO Obesity Technical Report Series, n. 284.

33. Gabrielsen, AM, Lund MB, Kongerud J, Viken,KE, Roislien J, Hjelmesaeth J. The relationship between anthropometric measures, blood gases, and lung function in morbidly obese white subjects. Obes Surg. 2011, 21, 4: 485-491.

34. Hingorjo MR, Qureshi MA, Mehdi A. Neck circumference as a useful marker of obesity: A comparison with body mass index and waist circumference. J Pak Med Assoc 2012;62(1):36-40.

35. Vallianou NG, Evangelopoulos AA, Bountziouka V, et al. Neck circumference is correlated with triglycerides and inversely related with HDL cholesterol beyond BMI and waist circumference. Diabetes Metab Res Rev 2013;29:90–97.

36. Murray WJ: A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14(6):540-545.

37. Murray WJ: Reliability and factor analysis of Epowoth sleepiness scale. Sleep. 1992; 15(4):376-81.

38. Netzer NC, Stoohs RA, Netzer CM, et al. Using the Berlin questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med 1999;131(7):485–491.

39. Rechtschaffen A, Kales A: A manual of standardized terminology: techniques and scoring system for sleep stages of human subjects. Los Angeles: Brain Information Service/Brain Research Institute; 1968. Psychiatry and Clinical Neurosciences. 2001; 55:305–310.

40. Iber C, Ancoli-Israel S, Chesson Jr A, Quan S: The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. Westchester: merican Academy of Sleep Medicine; 2007.

41. American Academy of Sleep Medicine. The AASM Manual for the scoring of sleep and associated events. Rules, terminology and technical especifications; 2007

42. Goodfriend TL, Calhoun DA. Resistant hypertension, obesity, sleep apnea, and aldosterone: theory and therapy. Hypertension 2004;43:518-24.

43. Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 2000;342:1378-84

44. Marin JM, Carrizo SJ, Vicente E, Agusti AGN. Long-term cardiovascular outcomes in men with obstructive sleep apnoea hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 2005;365:1046-53

588167ef7f8c9d710a8b45e7 mtprehab Articles
Links & Downloads

Man. Ther., Posturology Rehabil. J.

Share this page
Page Sections