Obesity is a growing disorder in the United States, affecting over 60% of the population. We previously defined sympathetic nervous system (SNS) outflow from brain to white adipose tissue (WAT) using a viral transneuronal tract tracer. SNS innervation of WAT is the principle initiator of lipolysis, whereas decreases in sympathetic drive promote lipid accumulation. Which of the many origins of SNS outflow from brain to WAT results in SNS-mediated changes in lipid mobilization (increases in drive) or accumulation (decrease in drive) is unknown. Previous research indicates that sympathetic denervation blocks lipid mobilization; thus, rostral sites in the neuroaxis connected to WAT via the SNS may promote WAT lipid mobilization. The hypothalamic paraventricular nucleus (PVN) may play a role via its descending projections to the intermediolateral horn of the spinal cord. Therefore, the consequences of PVN lesions (PVNx) on WAT mobilization or accumulation were tested. PVNx resulted in increased lipid accumulation, indicated by increases in retroperitoneal (RWAT) , epididymal (EWAT) , and inguinal WAT (IWAT) pad masses, in fed hamsters, but PVNx did not block fasting (56 h)-induced lipid mobilization. Because adrenal medullary catecholamines, especially epinephrine, also play a minor role in lipid mobilization, we tested the contribution of catecholamine release on lipid mobilization through adrenal demedullation (ADMEDx), with and without PVNx, and found fastinginduced lipid mobilization was not blocked. There was, however, a suggestion that distal denervation of IWAT, with and without ADMEDx, partially blocked lipid mobilization. In addition, evidence suggests SNS also may be an important controller of fat cell proliferation. Surgical denervation of WAT triggers increases in fat cell number (FCN), but have not determined if this FCN increase is due to preadipocyte proliferation or differentiation of preadipocytes into mature fat cells. We also have not demonstrated what role sensory innervation may have in regulating white adipocyte proliferation. Therefore, the role of WAT sympathetic or sensory innervation on adipocyte proliferation was tested. The SNS but not sensory denervation triggered bona fide proliferation as indicated by bromodeoxyuridine plus AD3, a specific adipocyte membrane protein, colabeling. These and previous data suggest that the SNS plays a role in regulating adiposity.

Hypertension is associated with marked cardiac sympathetic over-activity and end organ hyper-responsiveness. The sympathetic dysfunction is caused by aberrant calcium (Ca²⁺) handling resulting in enhanced neurotransmission. However, it remains unclear whether the sympathetic neuron or the myocytes is the primary driver behind the initiation and maintenance of the autonomic phenotype. The work in this thesis characterises the Ca²⁺ dysfunction and regulation at the membrane level. Further, it employs physiologically coupled sympathetic neurons and ventricular myocytes to determine the cellular driver of cardiac dysautonomia in the pro-hypertensive state. <b>Chapter 1</b> provides a general overview of the field of autonomic hypertension with a specific focus on the sympathetic control of cardiac excitability. In particular, the role of Ca²⁺ and cyclic nucleotides in the facilitation of neurotransmission are explored. <b>Chapter 2</b> details the methods used in this thesis. It provides rationale for the approaches taken to record membrane Ca2+ currents, cyclic adenosine monophosphate (cAMP) levels and cAMP-activated protein kinase (PKA) activity, and the development and uses of a co-culture of coupled sympathetic neurons and ventricular myocytes. <b>Chapter 3</b> describes the successful development of an effective voltage clamp method to isolate whole cell Ca²⁺ currents in sympathetic neurons. It details the issue of space clamp problem when using this technique on peripheral neurons and provides experimental guidance on how to quantify and limit theses issues. <b>Chapter 4</b> identifies that the pro-hypertensive four-week old neurons from the spontaneously hypertensive rat (SHR) have significantly larger whole cell Ca²⁺ currents when compared to normotensive (Wistar Kyoto-WKY) neurons, that are largely N-type in nature. Restoring the cGMP cyclic nucleotide dysfunction seen in these cells, rescues the ion channel phenotype and bring the Ca²⁺ down to levels seen in the normotensive WKY neuron. Further, it identifies that phosphodiesterase (PDE) 2A inhibition differentially affects the currents in the WKY and SHR, further supporting the notion of PDE2A dominance. <b>Chapter 5</b> identifies the presence and functional relevance of cGMP cross-talk with the cAMP-PKA pathway in sympathetic neurons. This cross talk is significantly altered in the pro-hypertensive state, via the differential involvement of PDEs. It functionally identifies the presence of PDE3 and PDE2A and provides further evidence that these enzymes could be dysregulated in pro-hypertensive neurons. <b>Chapter 6</b> describes the use of a co-culture model of ventricular myocytes and sympathetic neurons. Physiological stimulation of the sympathetic neuron with nicotine whilst monitoring cAMP levels in the myocytes confirms that the cellular phenotypes seen in the individual cells are functionally present in the co-culture. Using cross-cultures, it identifies the neuron as the principal driver behind the cardiac sympathetic responses observed in pro-hypertension. The results provide evidence for a dominant role played by the neuron in driving the adrenergic phenotype seen in cardiovascular disease and highlights the potential of using healthy neurons to turn down the gain of neurotransmission, akin to a smart pre-synaptic &beta;-blocker. <b>Chapter 7</b> forms the concluding discussion that summarises the main findings of this thesis and attempt to place it in a clinical context, and highlights avenues of further research. In particular, the possibility of using a cell therapeutic approach to treat sympathetic hyperactivity.

Orientador: Carlos Marcelo Pastre / Banca: Luiz Carlos Marques Vanderlei / Banca: Moacir Fernandes de Godoy / Resumo: O sistema nervoso autônomo (SNA) desempenha um papel importante na regulação dos processos fisiológicos do organismo humano tanto em condições normais quanto patológicas. Dentre as técnicas utilizadas para sua avaliação, a variabilidade da frequência cardíaca (VFC) tem emergido como uma medida simples e não-invasiva dos impulsos autonômicos, representando um dos mais promissores marcadores quantitativos do balanço autonômico. A VFC descreve as oscilações no intervalo entre batimentos cardíacos consecutivos (intervalos R-R), assim como oscilações entre frequências cardíacas instantâneas consecutivas. Trata-se de uma medida que pode ser utilizada para avaliar a modulação do SNA sob condições fisiológicas, tais como em situações de vigília e sono, diferentes posições do corpo, treinamento físico, e também em condições patológicas. Mudanças nos padrões da VFC fornecem um indicador sensível e antecipado de comprometimentos na saúde. Uma alta variabilidade na frequência cardíaca é sinal de boa adaptação, caracterizando um indivíduo saudável, com mecanismos autonômicos eficientes, enquanto que, baixa variabilidade é frequentemente um indicador de adaptação anormal e insuficiente do SNA, implicando a presença de mau funcionamento fisiológico no indivíduo. Diante da sua importância como um marcador que reflete a atividade do SNA sobre o nódulo sinusal e como uma ferramenta clínica para avaliar e identificar comprometimentos na saúde, este artigo revisa aspectos conceituais da VFC, dispositivos de mensuração, métodos de filtragem, índices utilizados para análise da VFC, limitações de utilização e aplicações clínicas da VFC. / Abstract: Autonomic nervous system (ANS) plays an important role in the regulation of the physiological processes of the human organism during normal and pathological conditions. Among the techniques used in its evaluation, the heart rate variability (HRV) has arising as a simple and non-invasive measure of the autonomic impulses, representing one of the most promising quantitative markers of the autonomic balance. The HRV describes the oscillations in the interval between consecutive heart beats (RR interval), as well as the oscillations between consecutive instantaneous heart rates. It is a measure that can be used to assess the ANS modulation under physiological conditions, such as wakefulness and sleep conditions, different body positions, physical training and also pathological conditions. Changes in the HRV patterns provide a sensible and advanced indicator of health involvements. Higher HRV is a signal of good adaptation and characterizes a health person with efficient autonomic mechanisms, while lower HRV is frequently an indicator of abnormal and insufficient adaptation of the autonomic nervous system, provoking poor patient's physiological function. Because of its importance as a marker that reflects the ANS activity on the sinus node and as a clinical instrument to assess and identify health involvements, this study reviews conceptual aspects of the HRV, measurement devices, filtering methods, indexes used in the HRV analyses, limitations in the use and clinical applications of the HRV. / Mestre

Les facteurs de risque cardiovasculaires et métaboliques qui caractérisent le syndrome métabolique (SM), y compris l'hypertension, l'obésité et l'intolérance au glucose, sont accompagnés d'hyperactivité sympathique. Dans cette étude, nous avons étudié les effets d'un traitement antihypertenseur chronique utilisant des médicaments d’action centrale sur les paramètres métaboliques et microvasculaires chez les rats soumis à un régime riche en gras et en sel. Pour cela, cinquante rats Wistar ont reçu un régime normal ou riche en gras pendant 20 semaines. Le groupe HFD a reçu clonidine par voie orale, rilmenidine, LNP 599 ou véhicule. La microcirculation fonctionnelle a été évaluée par vidéomicroscopie intravitale. La microcirculation structurale a été étudiée par analyse histochimique. Nous avons conclu que la modulation de l'activité sympathique corrige la raréfaction capillaire dans le muscle squelettique et le ventricule gauche dans un modèle expérimental de SM chez le rat. / Cardiovascular and metabolic risk factors that characterize the metabolic syndrome (MS), including high blood pressure, obesity and glucose intolerance, are accompanied by sympathetic hyperactivity. In this study, we investigated the effects of a chronic oral antihypertensive treatment using centrally-acting sympatho-inhibitory drugs on the metabolic and microvascular parameters in rats under long-term high-fat diet with salt supplementation. For that, fifty male adult Wistar rats were maintained under normal or high-fat diet during 20 weeks. The HFD group received oral clonidine, rilmenidine, LNP 599 or vehicle. Functional microcirculation was evaluated by intravital videomicroscopy and the structural was studied using histochemical analysis. We concluded that the modulation of sympathetic activity reverses the capillary rarefaction in the skeletal muscle and left ventricle in an experimental model of MS in rats.

Le syndrome métabolique (SMet) est caractérisé par la conjonction de troubles cardiovasculaires et métaboliques. Une hyperactivité du système nerveux sympathique pourrait être impliquée dans le développement du SMet. Les récepteurs I1 des imidazolines (RI1) identifiés par notre équipe ont une action sympatho-inhibitrice et représentent donc une cible de choix pour le développement de nouveaux médicaments. Dans notre laboratoire, des études de pharmaco-chimie ont permis de synthétiser une série d’aminopyrrolines sélectives des RI1. Des études préliminaires nous ont permis de sélectionner un chef de file, le LNP599, qui diminue la pression artérielle et induit des effets métaboliques bénéfiques. Des effets périphériques additionnels liés à l’adiponectine ont également été remarqués. Le premier objectif de ma thèse a consisté au développement d’un modèle original de SMet chez le ouistiti pour y tester l’intérêt thérapeutique du LNP599. Le second objectif fut d’étudier les effets périphériques potentiels des ligands RI1. Ces études ont été menées chez le rat âgé, un modèle d’insulino-résistance modérée, et sur les cellules hépatocytaires HepG2. / Metabolic syndrome (MetS) can be defined as a combination of cardiovascular and metabolic disorders. Sympathetic nervous system overactivity may be involved in the development of MetS. I1 imidazoline receptors (I1R), identified by our team, have a sympatho-inhibitory action and therefore, represent a target for developing new drugs. In our laboratory, pharmaco-chemical studies led to the synthesis of I1R selectives aminopyrrolines. Preliminary studies allowed us to select a leader, the LNP599, which lowers blood pressure and induces beneficial metabolic effects. Additional peripheral effects related to adiponectin were also noted. The first aim of my thesis consisted in the development of an original model of MetS in marmoset in order to test the therapeutic benefit of LNP599. The second objective was to study the potential effects of peripheral I1R ligands. These studies were conducted in elderly rats, a model of moderate insulin resistance, and in the HepG2 cells.

Recentemente foi descrito que camundongos com ablação dos receptores \'alfa\' 2A and \'alfa\' 2C adrenérgicos (KO) desenvolvem cardiomiopatia induzida por hiperatividade simpática. No presente trabalho caracterizamos o fenótipo desses camundongos aos três e sete meses de idade avaliando a tolerância ao esforço, a função ventricular e a ultraestrutura cardíaca. Além disso, estudamos o efeito da hiperatividade simpática sobre o sistema renina angiotensina (SRA) cardíaco avaliando a expressão de Ang II cardíaca, a atividade da enzima conversora de angiotensina (ECA), a atividade e expressão da renina e a expressão do angiotensinogênio cardíaco. Aos três meses de idade os camundongos KO apresentaram redução de 16% na fração de encurtamento e aumento do diâmetro dos cardiomiócitos em relação ao grupo controle (CO), caracterizando uma cardiomiopatia em estágio inicial. Concomitantemente, os animais KO apresentaram aumento da Ang II, atividade da ECA e expressão do angiotensinogênio cardíacos; e aumento da atividade da renina plasmática. Aos sete meses de idade, os camundongos KO apresentaram intolerância ao esforço, redução de 34% na fração de encurtamento, dilatação do ventrículo esquerdo, retenção hídrica nos pulmões, aumento do diâmetro dos cardiomiócitos e acúmulo de colágeno cardíaco em relação ao grupo CO, caracterizando uma cardiomiopatia grave com sinais clínicos de IC. Nessa fase, os camundongos KO apresentaram aumento da Ang II e expressão do angiotensinogênio cardíacos; e diminuição da expressão e atividade da renina. Dessa forma, os dados evidenciaram a ativação do SRA cardíaco na progressão da cardiomiopatia induzida por hiperatividade simpática / We have recently reported that disruption of both \'alfa\' 2A and \'alfa\' 2C adrenergic receptor subtypes (KO) in mice leads to sympathetic hyperactivity with evidence of heart failure (HF) by seven months (mo) of age. In the present study, we have performed the phenotypical characterization on KO mice at three and seven month of age. In addition, we evaluated the effect of sympathetic hyperactivity on cardiac renin-angiotensin system (RAS) components. For that, we evaluated cardiac Ang II content, angiotensin converting activity (ACE), plasma renin activity and cardiac angiotensinogen expression. At three mo, KO mice displayed reduced fractional shortening (16%) and increased cardiomyocyte width compared with age-matched wild type (WT). Indeed, KO mice showed significantly increased cardiac Ang II content, cardiac ACE activity, angiotensinogen expression and plasma renin activity. At seven mo, KO mice displayed exercise intolerance, reduced fractional shortening (34%), cardiac dilatation, lung edema, increased cardiomyocyte width and increased cardiac collagen content compared with age-matched WT. In addition, KO mice presented an increased cardiac Ang II content and angiotensinogen expression, concomitantly with a decreased plasma renin activity. Collectively, these results uncover potential feedback regulation of cardiac and circulating components of SNS and RAS, which may contribute to a better understanding of the processes taking place during the progression of cardiomyopathy induced by sympathetic hyperactivit.

A insuficiência cardíaca (IC) é uma síndrome clínica de alta incidência e mau prognóstico, caracterizada por fadiga, dispnéia e grande limitação aos esforços físicos. Essas alterações não estão apenas limitadas ao comprometimento cardíaco, mas em parte, são decorrentes também de alterações morfo-funcionais da musculatura esquelética. Para a dissertação foram utilizados camundongos com deleção dos genes para os receptores ?2A e ?2C adrenérgicos (KO) que desenvolvem cardiomiopatia induzida por hiperatividade simpática, associada à sinais clínicos de IC e 50% de mortalidade aos sete meses de idade. Foi objetivo desse estudo realizar a caracterização fenotípica do músculo esquelético por meio de avaliações funcionais e morfológicas em camundongos KO previamente ao desenvolvimento da IC (três meses de idade), e ao longo de sua progressão (cinco e sete meses de idade). Somente na faixa etária de sete meses de idades foi constatado o estabelecimento da miopatia muscular esquelética. Nessa fase, observou-se rarefação vascular, atrofia muscular, aumento na porcentagem de fibras glicolíticas e redução na atividade máxima da enzima citrato sintase, que em conjunto, contribuem para a antecipação da fadiga observada nesse modelo, e como conseqüência, para a redução da tolerância aos esforços. Os resultados sugerem que os camundongos KO apresentam alterações morfo-funcionais da musculatura esquelética semelhantes às observadas nos demais modelos de IC e em indivíduos portadores dessa síndrome. Portanto, sendo um ótimo modelo experimental para estudos de futuras estratégias terapêuticas que visem minimizar as alterações na musculatura esquelética decorrentes da IC / Heart failure (HF) is a clinical syndrome with high incidence and bad prognostic, characterized by fatigue, dyspnea, and increased intolerance to exercise. These changes are not only related to the cardiovascular tissue, but are at least in part, consequence of morphofunctional alterations in skeletal muscles. To the present study it was used mice lacking both ?2A/?2C AR subtypes (KO) which develop cardiomyopathy induced by sympathetic hyperactivity, associated to clinical signals of HF and 50% of mortality at seven months of age. The aim of the present study was characterize the phenotype of skeletal muscle by functional and morphological evaluations in KO before (three months of age) and during the HF progression (five and seven months of age). Skeletal muscle alterations due HF were observed only at seven months of age. The alterations were characterized by vascular rarefaction, muscular atrophy, increase in glycolitic fibers percentage and reduction of maximal activity of citrate synthase and contributed with early fatigue observed in this model, and consequently, exercise intolerance. The results of present study suggest that KO mice present morphofunctional changes in skeletal muscles in a similarly to others models of HF and in patients that have this syndrome. Therefore, consisting in an excellent experimental model to future studies related to therapeutic strategies to minimize the skeletal muscle changes due HF

C75, um inibidor sintético da ácido graxo sintase, causa anorexia e perda de peso em roedores, mas os mecanismos envolvidos com esses efeitos ainda não são totalmente conhecidos. A hipótese testada nesse trabalho foi que o tecido adiposo marrom (TAM), um órgão com importante função no controle da termogênese, poderia estar envolvido nos efeitos mediados pelos inibidores da ácido graxo sintase. Para isso, ratos Wistar foram submetidos ao implante de cânula no ventrículo lateral direito seguido, ou não, pela desnervação simpática cirúrgica do TAM. Sete dias após, C75 (150 g/7,5 L), cerulenina, um inibidor natural da ácido graxo sintase, (150 g/7,5 L) ou RPMI (veículo) foi administrado nos animais com privação alimentar de 24 horas. Foi demonstrado que uma única injeção intracerebroventricular de C75 reduziu a ingestão alimentar no primeiro dia e induziu perda de peso por dois dias. Além disso, as análises de telemetria mostraram que o C75 promoveu um rápido aumento na temperatura corporal interna, maior taxa de estoque de calor de 30 minutos a 6 horas da administração, e um aumento na dissipação de calor por 4 horas. A desnervação do TAM atenuou os efeitos do C75 sobre a regulação térmica bem como seu efeito sobre o peso corporal e a ingestão alimentar. Em paralelo, o C75 induziu aumento na temperatura do TAM (até 8 horas após a injeção), no conteúdo de noradrenalina e na atividade da citocromo c oxidase mitocondrial e da expressão do RNAm da UCP-1 no tecido. Todos esses efeitos foram abolidos com a desnervação simpática do TAM. Tal como o C75, a cerulenina, também induziu um aumento na temperatura corporal interna e do TAM, o qual também foi abolido pela desnervação do TAM. A atividade locomotora espontânea não foi alterada por nenhum inibidor da ácido graxo sintase. A imunohistoquímica para c-Fos revelou que o C75 aumentou o número de células imunorreativas a c-Fos na área pré-óptica, núcleo paraventricular, dorsomedial do hipotálamo, ventromedial do hipotálamo, locus coeruleus e rafe pálida, regiões que estão envolvidas com a regulação central da temperatura. Estes dados sugerem um papel do TAM no aumento da temperatura corporal evocado pelos inibidores da ácido graxo sintase e provêm novos mecanismos para explicar a hipofagia e o aumento do gasto energético observados com a administração desses compostos. / C75, a synthetic inhibitor of fatty acid synthase, causes anorexia and weight loss in rodents, but the underlying mechanisms are not totally known. Thus, the hypothesis tested in this work was that brown adipose tissue (BAT), an organ with important role for control of thermogenesis, could be involved in the anti-obesity effects of fatty acid synthase inhibitors. To address this issue, Wistar rats were submitted to cannula implant into right lateral ventricle and following, or not, by surgical sympathetic denervation of BAT. Seven days later, C75 (150g/7.5L), cerulenin, a natural fatty acid synthase inhibitor, (150 g/7.5 L) or RPMI (vehicle) was administered in 24h-fasted animals. It was demonstrated that a single intracerebroventricular injection of C75 decreased the food intake on the first day, and induced weight loss for two days. Furthermore, telemetry analyzes shown that the C75 induced a rapid increase in core body temperature, a higher heat storage rate from 30 minutes until 6 hours of injection, and an increase in heat dissipation for 4 hours. The BAT denervation attenuated the thermoregulatory effects of C75 as well as its effect on body weight and food intake. In parallel, C75 induced an increase in BAT temperature (up to 8 hours of the injection), higher content of norepinephrine, and an increase in the activity of cytochrome c oxidase and mRNA expression of UCP-1 in the tissue. All these effects were abolished by sympathetic denervation. Like C75, the central administration of cerulenin also induced an increase in the BAT and core body temperature, which was also abolished by BAT denervation. The spontaneous locomotor activity was not altered by any fatty acid synthase inhibitor. The immunohistochemistry for c-Fos revealed that the C75 increased numbers of Fos-immunoreactive cells in preoptica area, paraventricular nucleus, dorsomedial hypothalamus, ventromedial hypothalamus, locus coeruleus and raphe pallidus, regions which are involved in the central thermoregulation. These data implicate a role for BAT in the fatty acid synthase inhibitors-evoked increase in body temperature and provide new mechanisms to explain hypophagia and increased energy expenditure observed with the administration of these compounds.

Introdução: Alterações autonômicas e reduzido desempenho cognitivo têm sido reportados em pacientes com apneia obstrutiva do sono (AOS). Estudos anteriores demonstraram que o treinamento físico (TF) reduz a atividade nervosa simpática muscular (ANSM) durante testes que exige maior demanda cognitiva em pacientes obesos e com insuficiência cardíaca. O objetivo do estudo foi avaliar o efeito do TF na ANSM e no desempenho executivo durante o teste de controle inibitório e sustentação da atenção em pacientes com AOS. Métodos: Trinta e três pacientes com AOS (índice de apneia e hipopneia = 43 ± 5 eventos por hora de sono, idade = 52 ± 1 anos, índice de massa corporal = 30 ± 1 kg/m2) e sem outras comorbidades foram randomizados em grupo não treinado (n = 15) e grupo treinado (n = 18). A ANSM (microneurografia), frequência cardíaca (eletrocardiograma), pressão arterial média (método oscilométrico) foram coletados durante 4 minutos em repouso seguido pela aplicação de 3 minutos do Stroop Color Word Test (SCWT), conhecido como teste de estresse mental. O consumo de oxigênio no pico do exercício (VO2 pico) foi avaliado pela ergoespirometria. O desempenho executivo foi avaliado pelo total de cores corretas faladas durante 3 minutos de SCWT. O TF consistiu de 3 sessões semanais de exercício aeróbio, exercícios resistidos e flexibilidade pelo período 6 meses. Resultados: Os grupos foram semelhantes no início do estudo em relação ao nível de escolaridade, mini exame de estado mental, índice de massa corporal, VO2 pico, fração de ejeção, frequência cardíaca, pressão arterial de repouso e percepção subjetiva de estresse (P > 0,05). O TF aumentou o consumo de oxigênio pico (P < 0,05), reduziu o IAH (P < 0,05), índice de despertares (P < 0,05) e os eventos de dessaturação de O2 durante o sono (P < 0,05). O TF também reduziu a ANSM tanto na condição basal como durante o esforço cognitivo ao longo da aplicação do SCWT (P < 0,05). No período pré e pós dos grupos não treinado e treinado, a frequência cardíaca e pressão arterial média durante o SCWT não diferiu entre os grupos (P > 0,05), entretanto, ambos os grupos apresentaram um aumento significativo (P < 0,05) da frequência cardíaca (nos 3 minutos de SCWT) em relação ao basal e aumento da pressão arterial média (no 2º e 3º minutos de SCWT) em relação ao basal e ao 1º minuto de SCWT. Após a intervenção o grupo treinado obteve maior quantidade de cores corretas faladas durante 3 minutos de SCWT quando comparado ao grupo não treinado (P < 0,05). Conclusões: O TF reduziu a ANSM e melhorou o desempenho executivo durante o teste de SCWT em pacientes com AOS. Estes efeitos estão associados a um menor risco de eventos cardiovasculares, assim como melhor desempenho na realização de tarefas que exijam maior demanda cognitiva nos pacientes com AOS moderada a grave / Introduction: Autonomic alterations and reduced cognitive performance have been reported in patients with obstructive sleep apnea (OSA). Previous studies have shown that exercise training (ET) reduces muscle sympathetic nerve activity (MSNA) during tests that demand greater cognitive demand in obeses and heart failure patients. The aim of the study is to evaluate the effect of physical training on MSNA and executive performance during the inhibitory control and attention span test in patients with OSA. Methods: Thirty-three patients with OSA (apnea and hyponea índex = 43 ± 5 events per hour of sleep, age = 52 ± 1 years, body mass index = 30 ± 1 kg/m²) and without other comorbidities were randomized into a untrained group (n = 15) and exercise-trained group (n = 18). The MSNA (microneurography), heart rate (electrocardiogram), mean arterial pressure ( oscillometric methods) were collected during 4 minutes at rest followed by the 3-minute application of the Stroop Color Word test (SCWT), known as mental stress test. Oxygen consumption at peak exercise (VO2 peak) was evaluated by ergospirometry. Executive performance was assessed by the total correct colors spoken during 3 minutes of SCWT. The ET consisted of 3 weekly sessions of aerobic exercise, resisted exercises and flexibility for the 6-month period. Results: The groups were similar in relation to level of schooling, mini mental state examination, body mass index, VO2 peak, ejection fraction, heart rate, resting blood pressure and subjective perception of stress (P > 0.05). The ET increased the peak oxygen consumption (P < 0.05), reduced AHI (P < 0.05), arousal index (P < 0.05) and O2 desaturation events (P < 0.05) and weight (P < 0.05). The ET also reduced MSNA both at baseline and during cognitive effort throughout the SCWT application (P < 0.05). Heart rate and mean arterial pressure during SCWT did not differ between groups (P > 0.05); however, both groups showed a significant increase (P < 0.05) in heart rate (in the 3 minutes of SCWT) in baseline and increase mean arterial pressure (at the 2nd and 3rd minutes of SCWT) in relation to the baseline and at the 1st minute of SCWT. The exercise-trained group obtained the highest amount of correct colors spoken during 3 minutes of SCWT when compared to the control group (P < 0.05). Conclusions: The ET reduces MSNA and improves executive performance during the SCWT test in patients with OSA. These effects are associated with a lower risk of cardiovascular events, as well as better performance in tasks requiring greater cognitive demand in patients with moderate to severe OSA

Apesar de não alterar a pressão de normotensos, o treinamento físico (T) promove importantes ajustes periféricos e adapatações centrais do controle cardiovascular mediados pelo vago e simpático. Neste trabalho investigamos os efeitos do T (55% da capacidade máxima) sobre a inervação simpática vascular para os territórios muscular esquelético (locomotor e não locomotor) e renal e adrenais, através de imunohistoquimica e Western Blot para Tirosina-Hidroxilase (TH). T aumentou a capacidade física (+0,07±0,06 Km/h) e reduziu a FC (de 327±7 para 308±10 bpm), sem alterar a PA (126mmHg) e a estrutura de arteriolas dos diferentes territórios. T também determinou redução na imunoreatividade para TH nos músculos locomotores (-48%, p<0,05), sem alterações nos não locomotores e rins. A noradrenalina na artéria femoral (HPLC) encontrava-se reduzida após T. Nenhuma alteração foi detectada nas catecolaminas adrenais.Os dados indicam, que o T não altera as catecolaminas plasmáticas, mas reduz a atividade simpática vascular em normotensos, sendo este efeito tecido-específico. / Exercise training (T) does not reduce pressure in normotensive, but causes peripheral and central adjustments on cardiovascular system, mediated by autonomic nervous system. In this study we investigated whether T (55% maximal exercise capacity) is able to change vascular sympathetic drive to skeletal muscle (locomotor, non-locomotor), kidney and adrenals, using immunohistochemistry and western blot for tyrosine hydroxylase (TH). T improved performance (+0,07±0,06 Km/h) and reduced resting HR (from 327±7 to 308±10 bpm) without changing MAP (126mmHg) and arterioles wall/ lumen ratio in any tissue. T caused 48% decrease on TH-immunoreactivity of exercised muscles arterioles, without changes on non-exercised tissues. Norepinephrine concentration on femoral arteries was reduced after T. There was no change on adrenal. TH content. Decreased sympathetic drive to skeletal muscles arterioles (without changes on plasma cathecolamines) is a beneficial, tissue-specific effect in normotensive individuals.