Fundação Carlos Chagas Filho de Amparo a Pesquisa do Estado do Rio de Janeiro / Introdução: a apneia obstrutiva do sono (AOS) é considerada um fator de risco para as doenças cardiovasculares. Os mecanismos responsáveis pelo desenvolvimento da aterosclerose potencializados pela AOS não são completamente conhecidos. Entretanto, existem evidências de que a AOS está associada com aumento no estresse oxidativo, elevação nos mediadores inflamatórios, resistência à insulina, ativação do sistema nervoso simpático, elevação da pressão arterial (PA) e a disfunção endotelial. Objetivo: avaliar a relação da AOS com a função endotelial, o estresse oxidativo, os biomarcadores inflamatórios, o perfil metabólico, a adiposidade corporal, a atividade simpática e a PA em indivíduos obesos. Métodos: estudo transversal envolvendo 53 pacientes obesos, com índice de massa corporal (IMC) &#8805; 30 e < 40 Kg/m2, sem distinção de raça e gênero, apresentando idade entre 20 e 55 anos. O estudo do sono foi realizado com o equipamento Watch-PAT 200, sendo feito o diagnóstico de AOS quando índice apneia-hipopneia (IAH) &#8805; 5 eventos/h. Todos os participantes foram submetidos à avaliação do (a): adiposidade corporal (peso, % gordura corporal e circunferências da cintura, quadril e pescoço); PA; atividade do sistema nervoso simpático (concentrações plasmáticas de catecolaminas); biomarcadores inflamatórios (proteína C reativa ultrassensível (PCR-us) e adiponectina); estresse oxidativo (malondialdeído); metabolismo glicídico (glicose, insulina e HOMA-IR) e lipídico (colesterol total e frações e triglicerídeos); e função endotelial (índice de hiperemia reativa (RHI) avaliado com o equipamento Endo-PAT 2000 e moléculas de adesão celular). A análise estatística foi realizada com o software STATA versão 10. Resultados: dos 53 pacientes avaliados 20 foram alocados no grupo sem AOS (grupo controle; GC) (IAH: 2,550,35 eventos/h) e 33 no grupo com AOS (GAOS) (IAH: 20,163,57 eventos/h). A faixa etária (39,61,48 vs. 32,52,09 anos) e o percentual de participantes do gênero masculino (61% vs. 25%) foram significativamente maiores no GAOS do que no GC (p=0,01). O GAOS em comparação o GC apresentou valores significativamente mais elevados de circunferência do pescoço (CP) (40,980,63 vs. 38,650,75 cm; p=0,02), glicemia (92,541,97 vs. 80,21,92 mg/dL; p=0,0001), PA sistólica (126,051,61 vs.118,16 1,86 mmHg; p=0,003) e noradrenalina (0,160,02 vs. 0,120,03 ng/mL; p=0,02). Após ajustes para fatores de confundimento, a glicose e a PCR-us foram significativamente mais elevadas no GAOS. Os 2 grupos apresentaram valores semelhantes de IMC, insulina, HOMA-IR, perfil lipídico, adiponectina, PA diastólica, adrenalina, dopamina, moléculas de adesão celular e malondialdeído. A função endotelial avaliada pelo RHI também foi semelhante nos 2 grupos (GAOS:1,850,2 vs. GC:1,980,1; p=0,31). Nas análises de correlação, considerando todos os participantes do estudo, o IAH apresentou associação positiva e significativa com CP e PCR-us após ajustes para fatores de confundimento. A saturação mínima de O2 se associou de forma negativa e significativa com a CP, os níveis séricos de insulina e o HOMA-IR, mesmo após ajustes para fatores de confundimento. Conclusões: o presente estudo sugere que em obesos a AOS está associada com valores mais elevados de glicemia e inflamação; o aumento do IAH apresenta associação significativa com a obesidade central e com a inflamação; e a queda na saturação de oxigênio se associa com resistência à insulina. / Introduction: obstructive sleep apnea (OSA) is considered a risk factor for cardiovascular disease. The mechanisms responsible for the development of atherosclerosis triggered by OSA are not completely known. However, there is evidence that OSA is associated with increased oxidative stress, higher levels of inflammatory mediators, insulin resistance, increased sympathetic nervous system activity, elevated blood pressure (BP) and endothelial dysfunction. Objective: to evaluate the relation of OSA with endothelial function, oxidative stress, inflammatory biomarkers, metabolic profile, body adiposity, sympathetic activity and BP in obese individuals. Methods: cross-sectional study involving 53 obese patients with body mass index (BMI) > 30 and < 40 kg/m2, without distinction of race and gender, aged between 20 and 55 years. The sleep study was performed with the equipment Watch-PAT200 and the diagnosis of OSA was made when apnea-hipopnea index (AHI) &#8805; 5 events/h. All participants underwent evaluation of: body adiposity (weight, % body fat and circumferences of waist, hip and neck); BP; sympathetic nervous system activity (plasma levels of catecholamines); inflammatory biomarkers (high sensible c-reactive protein (hs-CRP) and adiponectin); oxidative stress (malondialdehyde); metabolism of glucose (glucose, insulin and HOMA-IR) and lipids (total cholesterol and fractions and triglycerides); and endothelial function (reactive hyperemia index (RHI) evaluated by Endo-PAT 2000 and cellular adhesion molecules). Statistical analysis was performed with software STATA version 10. Results: of the 53 evaluated patients, 20 were included in the group without OSA (Control group; CG) (AHI: 2.550.35 events/h) and 33 in the group with OSA (OSAG) (IAH: 20.163.57 events/h). The mean age (39.61.48 vs. 32.52.09 years) and the percentage of male participants (61% vs. 25%) were significantly higher in OSAG than in CG (p=0.01). The OSAG compared the CG showed significantly higher values of neck circumference (NC) (40.980.63 vs. 38.650.75 cm, p=0.02), glucose (92.541.97 vs. 80.21.92 mg/dL, p=0.0001), systolic BP (126.051.61 vs. 118.161.86 mmHg, p=0.003) and noradrenaline (0.160.02 vs. 0.120.03 ng/mL, p=0.02). After adjustment for confounders, glucose and hs-CRP were significantly higher in OSAG. Both groups presented similar values of BMI, insulin, HOMA-IR, lipid profile, adiponectin, diastolic BP, adrenaline, dopamine, adhesion cellular molecules and malondialdehyde. Endothelial function evaluated by RHI was also similar in both groups (OSAG: 1.850.2 vs. CG: 1.980.1, p=0.31). In correlation analysis, considering the whole group of patients, AHI presented a positive and significant association with NC and hs-CRP after adjustments for confounders. The minimum oxygen saturation was associated negatively and significantly with NC, insulin and HOMA-IR even after adjustments for confounders. Conclusions: the present study suggests that in obese individuals, OSA is associated with higher values of glucose and inflammation; higher AHI presents significant association with central adiposity and with inflammation; and lower oxygen saturation is associated with insulin resistance.

Demonstramos na fase crônica da hipertensão por coarctação, depressão acentuada do controle reflexo da freqüência cardíaca (Michelini et al, Hypertension, 1992; 19:II159-II163) e que o tratamento crônico com losartan, embora não reverta os elevados níveis de pressão, normaliza o controle reflexo da freqüência cardíaca (Santos et al, Am. J. Physiol, 1995; 269:H812-H818). No presente estudo investigamos em ratos hipertensos e seus controles normotensos os efeitos do bloqueio crônico dos receptores AT1 sobre a atividade aferente do nervo depressor aórtico (NDA, protocolo I) e sobre a atividade simpática esplâncnica (ASE, protocolo II) na situação basal e após estimulação por hipotensões e hipertensões transitórias. Ratos Wistar adultos machos (180-300g) foram tratados cronicamente com veículo (VEH=água destilada, 0,1ml/100g/dia, po.) ou losartan (LOS= 10mg/kg/dia, po.) por 8 dias. No 4º dia após a determinação da pressão de cauda, foram submetidos à coarctação subdiafragmática da aorta (CH) ou à cirurgia fictícia (SHAM) e ao final do 7º dia, instrumentados com cânula arterial para registro direto da pressão arterial, realizada no 8º dia, com os animais acordados. Foram a seguir anestesiados para isolamento do nervo depressor aórtico ou do simpático esplâncnico, que foram registrados simultaneamente à pressão arterial em duas situações distintas: a) durante a situação basal (registro da atividade espontânea por 10-15 minutos), b) durante estimulação dos pressorreceptores por variações transitórias da pressão arterial (infusões/retiradas de sangue e injeções/infusões de fenilefrina e nitroprussiato de sódio iv.). Os registros da atividade neural foram retificados, integrados e aquisitados simultaneamente aos registros de pressão arterial em computador (programa de aquisição de dados Codas - Windaq DI-200, Ohio, USA). Tratamento com LOS determinou queda significante da pressão de cauda (104+-3 vs. 117+-3 mmHg nos grupos VEH). Em ambos os grupos VEH e LOS, CH determinou aumento significativo e similar da pressão arterial (em média 29%) que foi acompanhada, nos grupos tratados com VEH, por significativo aumento da variabilidade associada à depressão no ganho da correlação da atividade do NDA com a pressão arterial (CHVEH=1,04+-0,11 vs. SHAMVEH=1,63+-0,14 %/ciclo/mmHg, p<0,05, protocolo I) e por facilitação da resposta da ASE (CHVEH=-10,36+-1,05 vs. SHAMVEH=-5,81+-0,60 %/ciclo/mmHg, p<0,05, protocolo II). Nos grupos tratados com LOS, o estabelecimento da hipertensão foi acompanhado por redução da variabilidade e significativa melhora no ganho do NDA, uma vez que na faixa fisiológica de variações da pressão a depressão da atividade do NDA foi significativamente menor (CHLOS=3,30+-0,33 vs. CHVEH=2,18+-0,37 %/ciclo/mmHg, p<0,05, uma recuperação de 40% quando comparado aos respectivos controles ~5,01+-0,33 %/ciclo/mmHg). Houve ainda nos CHLOS normalização do ganho de resposta de ASE (CHLOS=-6,58+-0,62 %/ciclo/mmHg que não diferia dos SHAMLOS e SHAMVEH). O tratamento crônico com LOS determinou ainda correção parcial da atividade basal do NDA, mas não alterou a descarga espontânea da ASE. As alterações de atividade do NDA e ASE observadas nos CHLOS ocorreram simultaneamente, mas foram independentes da redução da pressão arterial pelo LOS. Nossos dados sugerem que a Ang II, ativada durante o desenvolvimento da CH, deprime a sinalização aferente pelo NDA, sendo responsável pela facilitação da resposta simpática durante alterações transitórias da pressão arterial. Nossos dados permitem ainda discriminar entre o efeito pressor e o efeito modulatório da Ang II, indicando restauração parcial do ganho da NDA e normalização da resposta simpática após o bloqueio crônico dos receptores AT1, mesmo na presença da hipertensão. / In the chronic phase of coarctation hypertension (CH) we have shown both marked depression of baroreceptor reflex control of heart rate (Michelini et al, Hypertension, 1992, 19: II159-II163) and normalization of the depressed reflex control even with the persistence of hypertension in losartan-treated animals (Santos et al, Am. J. Physiol, 1995, 269: H812-H818). In the present study we analyzed the effects of chronic AT1tors blockade on the both the afferent aortic nerve activity (AON, protocol I) and splanchnic sympathetic nerve activity (SSNA, protocol II) of CH and sham operated controls in two conditions: spontaneous activity (basal condition) and stimulated discharge during transient increases/decreases in arterial pressure. Male Wistar rats (180-300g aged 2-3 months) were chronically treated with vehicle (VEH=distilled water, 1ml/kg/day, po.) or losartan (LOS=10mg/kg/day, po.) during 8 days. Tail pressure was measured at the beginning and on the 4th day, before subdiaphragmatic aortic coarctation (CH) or sham surgery (SHAM). On day 7 the rats were instrumented with a catheter to record arterial pressure in conscious freely moving rats on day 8. Rats were then anesthetized to record AON or SSNA simultaneously with pressure during 10-15 min (basal or spontaneous activity) and during baroreceptor loading/unloading (infusion/withdrawal of blood or injections/infusions of phenylephrine and sodium nitroprusside iv.). Nerve activity was rectified and integrated and acquired simultaneously with pressure in a computer (Windaq DI-200, Ohio, USA). Losartan-treatment caused a significant decrease in tail pressure (104+-3 vs. 117+-3 mmHg in VEH groups). In both LOS- and VEH-treated groups, CH caused significant and similar increases in arterial pressure (mean of 29%) that was accompanied in the VEH groups by both significant increase in variability and depression of the AON/activity/pressure relationship (CHVEH=1,04+-0,11 vs. SHAMVEH=1,63+-0,14 %/cycle/mmHg, p<0,05, protocol I) and by potentiation of SSNA responses (CHVEH=-10,36+-1,05 vs. SHAMVEH=-5,81+-0,60 %/cycle/mmHg, p<0,05, protocol II). In the LOS-treated groups, establishment of CH was accompanied by smaller variability and marked improvement in AON gain: in the physiological range of pressure changes, depression of AON activity was significantly smaller (CHLOS=3,30+-0,33 vs. CHVEH=2,18+-0,37 %/cycle/mmHg, p<0,05, a recovery of 40% when compared to respective controls of ~5,01+-0,33 %/cycle/mmHg). CHLOS showed also normalization of SSNA responses: gain in the CHLOS=-6,58+-0,62 %/cycle/mmHg, that was not different from SHAMLOS and SHAMVEH groups. In addition chronic treatment with LOS caused partial correction of spontaneous AON activity but did not change spontaneous SSNA discharge. Both AON and SSNA responses observed in CHLOS occurred simultaneously but were independent from pressure reductions observed in these groups. The date suggested that Ang II, activated during development of hypertension, depresses the afferent signaling by aortic receptors and is factor responsible for the facilitation of SSNA during pressure changes. The date permits to discriminate between pressor and a modulatory effects of Ang II and indicates that after chronic AT1 receptors blockade hypertension persists, but there is a partial restoration of AON gain accompanied by normalization of the sympathetic response.

A intervenção nutricional para perda ponderal é uma das opções terapêuticas para a apneia obstrutiva do sono (AOS) em pacientes com excesso de adiposidade corporal. No entanto, os efeitos da restrição energética moderada, recomendada pelas diretrizes atuais para o tratamento da obesidade, sobre a AOS ainda não são conhecidos. Avaliar em indivíduos obesos com diagnóstico de AOS os efeitos da restrição energética moderada sobre a adiposidade corporal; gravidade da AOS; pressão arterial; atividade simpática; estresse oxidativo; biomarcadores inflamatórios; perfil metabólico e função endotelial. Ensaio clínico randomizado, com duração de 16 semanas, envolvendo 21 indivíduos obesos grau I ou II, apresentando idade entre 20-55 anos e índice de apneia/hipopneia (IAH) > 5 eventos/h. Os participantes foram randomizados em 2 grupos: 11 no grupo restrição energética (GRE) e 10 no grupo controle (GC). O GRE foi orientado a realizar restrição energética (-800 Kcal/dia) e o GC não modificou sua ingestão alimentar. No início e ao final do estudo, os participantes foram submetidos à avaliação do (a): AOS com o equipamento Watch-PAT 200 incluindo a determinação dos seguintes parâmetros de gravidade da AOS: IAH, saturação mínima de O2, número de dessaturações de O2>4%; adiposidade corporal (peso, % gordura corporal e circunferências da cintura, quadril e pescoço); pressão arterial (PA); atividade do sistema nervoso simpático (concentrações plasmáticas de catecolaminas); biomarcadores inflamatórios (proteína C reativa e adiponectina); estresse oxidativo (malondialdeído); metabolismo glicídico (glicose, insulina e HOMA-IR) e lipídico (colesterol total e frações e triglicerídeos); e função endotelial (índice de hiperemia reativa avaliado com o equipamento Endo-PAT 2000 e moléculas de adesão). A análise estatística foi realizada com o software STATA v. 10. O nível de significância estatística adotado foi p<0,05. Resultados: O GRE, em comparação com o GC, apresentou redução significativamente maior no peso corporal (-5,571,81 vs. 0,431,21kg, p<0,001) e nos demais parâmetros de adiposidade corporal; no IAH (-7,222,79 vs. 0,131,88 eventos/h, p=0,04); no número de dessaturações de O2>4% (-33,7015,57 vs. 1,807,85, p=0,04); nas concentrações plasmáticas de adrenalina (-12,703,00 vs. -1,303,90pg/mL, p=0,04); além de aumento significativamente maior na saturação mínima de O2 (4,601,55 vs. -0,601,42%,p=0,03). O GRE, em comparação com o GC, apresentou maior redução, porém sem alcançar significância estatística, na PA sistólica (-4,231,95 vs. 2,341,39mmHg, p=0,05), na concentração de insulina (-5,111,93 vs. -0,651,28&#61549;U/mL, p=0,07) e no HOMA-IR (-1,150,49 vs. -0,080,33, p=0,09). Durante o período do estudo, as modificações na adiposidade corporal total e central apresentaram correlação significativa com as variações nos parâmetros de gravidade da AOS; na PA sistólica e diastólica; nas concentrações de insulina e no HOMA-IR, mesmo após ajuste para fatores de confundimento. As modificações na adiposidade corporal central apresentaram associação significativa com as variações nas concentrações de noradrenalina e adiponectina. As modificações nos parâmetros de gravidade da AOS apresentaram associação significativa com as variações nas concentrações séricas da proteína C reativa. Este estudo sugere que em pacientes obesos com AOS a restrição energética moderada é capaz de reduzir a adiposidade corporal total e central, os parâmetros de avaliação da gravidade da AOS e a atividade do sistema nervoso simpático. / Nutritional intervention for weight loss is one of the treatment options for obstructive sleep apnea (OSA) in patients with excess body adiposity. However, the effects of moderate energy restriction, recommended by current guidelines for the treatment of obesity, on OSA are not yet known. To evaluate the effects of moderate energy restriction on the body adiposity; severity of OSA; blood pressure; sympathetic activity; oxidative stress; inflammatory biomarkers; metabolic profile and endothelial function in obese patients with OSA. Methods: A 16-week randomized clinical trial, involving 21 subjects with obesity (grade I or II), aged 20-55 years and presenting an apnea/hipopnea index (AHI) > 5 events/h. Participants were randomized into 2 groups: 11 in the energy restriction group (ERG) and 10 in the control group (CG). The ERG was instructed to follow an energy-restricted diet (-800 kcal/day) and the CG was advised not to change their food intake. At the beginning and at the end of the study, participants underwent evaluation of: OSA with the equipment Watch- PAT200 including the determination of the following parameters of OSA severity: AHI, minimum O2 saturation, number of O2 desaturations >4%; body adiposity (weight, %body fat and circumferences of waist, hip and neck); blood pressure (BP); sympathetic nervous system activity (plasma levels of catecholamines); inflammatory biomarkers (c-reactive protein and adiponectin); oxidative stress (malondialdehyde); metabolism of glucose (glucose, insulin and HOMA-IR) and lipids (total cholesterol and fractions and triglycerides); and endothelial function (index of reactive hyperemia evaluated by Endo - PAT 2000 and cellular adhesion molecules). The statistical analysis was performed with the software STATA v. 10. The level of statistical significance was p < 0.05. Results: The ERG, compared to the CG, presented significantly greater reduction in body weight (-5.571.81 vs. 0.431.21kg, p<0.001) and in the others parameters of body adiposity; in AHI (-7.222.79 vs. 0.131.88 events/h, p=0.04); in the number of O2 desaturation >4% (-33.7015.57 vs. 1.80 7.85, p=0.04), in plasma concentrations of adrenaline (-12.703.00 vs. -1.303.90pg/mL, p=0.04); and significantly greater increase in minimum O2 saturation (4.601.55 vs. -0.601.42%, p=0.03). The ERG, in comparison with the CG, showed a greater decrease, however without statistical significance, in systolic BP (-4.231.95 vs. 2.341.39mmHg, p=0.05), in insulin levels (-5.111.93 vs. -0.651.28U/mL, p=0.07) and HOMA-IR (-1.150.49 vs. -0.080.33, p=0.09). During the study period, the modifications in total and central adiposity presented a significant correlation with changes in parameters of OSA severity; in systolic and diastolic BP; and in insulin levels and in HOMA-IR, even after adjustments for confounding factors. The changes in central adiposity were significantly associated with modifications in levels of norepinephrine and adiponectin. The changes in parameters of OSA severity presented significant association with the modifications in serum levels of C-reactive protein. This study suggests that in obese patients with OSA moderate energy restriction is able to reduce total and central adiposity, parameters of OSA severity and sympathetic nervous system activity.

Ratos jovens submetidos à hipóxia crônica intermitente (HCI) por um período de 10 dias apresentam hipertensão arterial e alterações no padrão de acoplamento das atividades simpática e respiratória. A exposição à HCI promove aumento da atividade simpática na fase expiratória final, mas o pico de atividade observado no final da inspiração/pós-inspiração também permanece. Estudos do nosso laboratório realizados em animais acordados mostraram por meio da análise espectral e do bloqueio ganglionar que a atividade simpática total está aumentada após um protocolo de 10 dias de HCI, caracterizando esse como sendo um modelo de hipertensão neurogênica. Em outros estudos voltados para verificar a reversibilidade da hipertensão arterial após o encerramento do protocolo de HCI, foi demonstrado que a pressão arterial desses animais se normaliza dentro de 15 dias em condição de normóxia. No entanto, estudos anteriores do nosso laboratório mostraram que a transmissão sináptica no núcleo do trato solitário permanece alterada mesmo após duas semanas de recuperação do protocolo de HCI. Sendo assim um dos objetivos desse trabalho foi avaliar as respostas cardiovasculares e respiratórias de ratos submetidos a um novo protocolo de HCI depois de 15 dias do encerramento do primeiro protocolo. Adicionalmente, avaliamos se as respostas cardiovasculares e respiratórias induzidas pela HCI seriam ou não influenciadas pelo pré-condicionamento com hipóxia mantida (HM). Assim como na HCI, nos modelos de hipertensão neurogênica a principal causa associada ao aumento de pressão arterial é a hiperatividade simpática. Dentre esses modelos, podemos destacar a hipertensão renovascular 1 rim, 1 clipe (1R, 1C) e os ratos espontaneamente hipertensos (SHR). Nesse contexto, avaliamos também se a pré-exposição à HCI poderia influenciar as respostas cardiovasculares e respiratórias observadas nesses 2 modelos de hipertensão. Os resultados mostraram que o pré-condicionamento com HCI ou com HM não alterou as respostas cardiovasculares promovidas por uma subsequente exposição à HCI. Por outro lado, o nível de hipertensão promovido pelo modelo 1R, 1C foi significativamente menor em animais pré-condicionados com HCI, via inibição do tônus simpático vascular. O procedimento de desnervação renal praticamente eliminou o aumento de pressão arterial associado ao modelo 1R, 1C. Adicionalmente, após a remoção bilateral do corpúsculo carotídeo, o nível de hipertensão decorrente do modelo 1R, 1C foi o mesmo, independente do pré-condicionamento com HCI. Por outro lado, o pré-condicionamento com HCI não alterou o desenvolvimento da hipertensão arterial de ratos SHR. / Juvenile rats submitted to chronic intermittent hypoxia (CIH) during 10 days present hypertension and alterations in the sympathetic and respiratory coupling. Exposure to CIH produces sympathetic overactivity in the late expiratory phase, whereas the peak of activity observed at the end of inspiration/post-inspiration was also maintained. Studies from our laboratory performed in awake animals, using spectral analyses and ganglionic blockade showed that the total sympathetic activity is increased after CIH protocol, characterizing this as a neurogenic model of hypertension. Other studies, designed to verify the reversibility of hypertension at the end of the CIH protocol, showed that the arterial pressure normalizes within 15 days in normoxic conditions. Nevertheless, previous studies from our laboratory showed that the synaptic transmission in the nucleus of the solitary tract continues altered even after two weeks of recovery from the CIH protocol. Thus, one of our goals was to evaluate the cardiovascular and respiratory responses in rats submitted to a new CIH protocol 15 days after the first protocol. Additionally, we evaluated whether or not the cardiovascular and respiratory responses induced by CIH would be influenced by preconditioning with sustained hypoxia (SH). As in CIH, in other models of hypertension the main cause associated with the rise of arterial pressure relies on the sympathetic overactivity. Among those models are the renovascular hypertension 1 kidney, 1 clip (1K, 1C) and the spontaneous hypertensive rats (SHR). In this sense, another goal of this study was to evaluate whether a previous exposure to CIH could affect the cardiovascular and respiratory responses produced by the 1K, 1C and the SHR model. Our results are showing that preconditioning with either CIH or SH did not alter the cardiovascular response produced by a subsequent exposure to CIH. On the other side, the level of hypertension promoted by 1K, 1C was significantly reduced in CIH preconditioned rats, via inhibition of the vascular sympathetic tone. The procedure of renal denervation practically eliminated the rise in arterial pressure associated with 1K, 1C. Additionally, after bilateral carotid body removal, the level of hypertension observed in 1K, 1C rats was the same, regardless CIH preconditioning. However, preconditioning with CIH did not affect the development of hypertension in SHR.

Neste trabalho investigamos a interação entre ATP-glutamato na modulação de potenciais de ação e atividade sináptica de neurônios PVN-RVLM, além de avaliar se esta interação induziria mudanças na atividade simpática lombar (ANSL) por estímulo osmótico. Utilizamos de técnicas de imunohistoquímica, whole-cell patch clamp e registro eletroneurográfico. Observou-se que o ATP aumenta a frequência de potenciais de ação em neurônios PVN-RVLM, efeito bloqueado por acido quinurênico (KYN) e PPADS. A injeção de ATP no PVN aumenta a ANSL (25 nmol: 72%), um efeito atenuado por PPADS e/ou KYN, e também por CNQX. O ATP não afeta a função sináptica, mas aumenta correntes glutamatérgicas induzidas por aplicação AMPA em 52%, a qual foi bloqueada por PPADS ou por quelação de Ca2+ intracelular. Além disso, o estímulo osmótico ativa neurônios do PVN que expressam receptores P2X2 e potencia as correntes mediadas por AMPA (53%), um efeito bloqueado por PPADS. Finalmente, demonstrou-se que receptores P2 no PVN são importantes na simpatoexcitação induzida por estímulo osmótico agudo. / In the present study we investigate the interaction of ATP-glutamate on the firing activity and synaptic function in PVN-RVLM neurons, besides whether that interaction would be translated in changes on sympathetic nerve activity (SNA) induced by osmotic stimulus. Immunohistochemistry, whole-cell patch clamp and electroneurography technical approaches were used. Our data have shown that ATP increases firing rate of PVN-RVLM neurons, an effect blocked by kynurenic acid (KYN) or PPADS. ATP injection into the PVN enhanced SNA (72%), which was attenuated by PPADS and/or KYN, or CNQX. ATP did not affect synaptic function but, glutamatergic currents evoked by AMPA application were augmented with ATP (AMPA area: 52%), blocked by PPADS and chelation of intracellular Ca2+. In addition, we observed that acute osmotic stimulus activates P2X2 expressing neurons in the PVN. Moreover, an osmotic challenge potentiated AMPA responses (53%), an effect blocked by PPADS. Finally, we demonstrated that P2 receptors in the PVN are important for osmotically-driven sympathoexcitation.

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Introduction – Objectives. The cardiovascular system is in direct and constant interaction with its environment. Exposure to various environmental parameters, such as low temperature, air pollution and tobacco smoke, has been strongly associated with serious or even fatal cardiovascular outcomes. Arterial stiffening and greater wave reflection are age-related vascular modifications that lead to an increased risk of cardiovascular events. The aim of this work was to explore the relationship between selected environmental factors and arterial elastic properties in an effort to elucidate the underlying mechanisms that link these factors to increased cardiovascular mortality.<p><p>Study 1: Effects of cold exposure on central and peripheral vascular tone. Our first study explored the effects of cold exposure on aortic stiffness and peripheral microvascular tone. We observed that cold exposure, in addition to its chronotropic effects, provoked an increase in aortic stiffness, as assessed by aortic pulse wave velocity, as well as significant vasoconstriction of peripheral arterioles in the microcirculation. Moreover, we explored the magnitude of this effect in a different population (Black subjects of African origin), which is traditionally characterized by exaggerated reactions to adrenergic stimuli. We noted that the vascular reactions, in terms of both aortic stiffness and microvascular vasoconstriction, were more profound in Black Africans than in age-matched Caucasian-Whites. These results argue for a direct effect of cold exposure on arterial stiffness and peripheral vascular tone, probably through activation of the orthosympathetic system.<p><p>Study 2: Exposure to ambient particulate matter and arterial stiffness. We explored the effects of acute exposure to outdoor particulate matter on aortic stiffness and aortic wave reflection. We studied the relationship between central hemodynamic parameters and ambient concentration of particulate matter in a population of patients who attended the Hypertension Clinics of Athens University. After statistical correction for a number of potential confounders, we did not observe an association between ambient concentrations of particulate matter and aortic stiffness. However, in men, particulate matter concentration was related to the amplitude of the reflected wave reaching the aorta from the periphery. These results suggest a direct acute interaction between particulate matter concentration and vascular tone, leading to an enhanced arterial wave reflection.<p><p>Study 3: The role of nicotine on the vascular effects of environmental tobacco smoke. Environmental tobacco smoke is considered as the most important source of particulate matter in the indoor environment. We recently demonstrated that exposure to tobacco smoke augmented wave reflection, an effect that was not seen after equivalent exposure to the smoke of non-tobacco, herbal cigarettes. We also noticed that the increased wave reflection was proportional to the plasma concentrations of nicotine. However, a direct causal effect between nicotine, arterial wave reflection and aortic stiffness has never been clearly demonstrated. We observed that increasing nicotine plasma concentration to levels comparable to those seen after extensive exposure to environmental tobacco smoke, provoked an increase in both aortic stiffness and arterial wave reflection after correction for heart rate and blood pressure changes. These results confirm the significant participation of nicotine in the vascular effects of passive smoking.<p><p>Conclusions. Globally, our results reveal the deleterious effects of cold, particulate matter exposure, and nicotinic stimulation on arterial stiffness, peripheral microcirculation and aortic wave reflection. The hemodynamic modifications associated with these effects may at least partially explain the causal relation between cold exposure, ambient air pollution and cardiovascular mortality.<p><p>Introduction-Objectifs. Le système cardiovasculaire est en relation directe et constante avec l’environnement. L’exposition au froid, la pollution atmosphérique et le tabagisme passif sont associés à des événements cardiovasculaires aigus graves et même fatals. La rigidification des artères et l’intensification de la réflexion de l’onde de pouls au niveau de l’aorte accompagnent le vieillissement et prédisent un risque cardiovasculaire accru. Nous avons testés l’hypothèse que les effets cardiovasculaires délétères des facteurs environnementaux comportent une altération des propriétés élastiques artérielles. Ceci pourrait être un des mécanismes physiopathologiques qui lie la mortalité cardiovasculaire aux variables environnementales.<p><p>Étude 1 :Exposition au froid ;effets centraux et périphériques. Notre première étude portait sur l’effet de l’exposition au froid sur la rigidité aortique et le tonus vasculaire des artérioles périphériques. Nous avons démontré que l’exposition au froid, hormis ses effets chronotropes, provoquait une augmentation de la rigidité artérielle – mesuré par la vitesse de l’onde de pouls au niveau de l’aorte - ainsi qu’une vasoconstriction importante au niveau des artérioles de la microcirculation. Nous avons ensuite déterminé l’amplitude de cet effet dans une autre population (sujets Africains-Noirs) qui se caractérise par des réactions plus prononcées aux différentes stimulations adrénergiques. Nous avons observé que les réactions vasculaires, tant au niveau de la rigidité aortique qu’au niveau de la microcirculation, étaient plus marquées chez les Africains-Noirs que chez les Caucasiens. Ces résultats révèlent un effet délétère de l’exposition au froid sur la rigidité aortique et le tonus vasculaire des artères périphériques, probablement via une activation du système orthosympathique.<p><p>Étude 2 :Exposition aux microparticules atmosphériques et rigidité artérielle. Nous avons ensuite investigué les effets de la pollution atmosphérique sur la rigidité artérielle et la réflexion de l’onde de pouls vers l’aorte. Nous avons étudié la relation entre les paramètres hémodynamiques centraux et la concentration atmosphérique de microparticules dans une population de patients qui ont consulté la Clinique Universitaire d’Hypertension Artérielle d’Athènes. Après correction statistique pour les facteurs confondants, nous n’avons pas observé de corrélation entre la rigidité artérielle et le taux de microparticules atmosphériques dans l’ensemble de la population investiguée. Par contre, si on restreint l’analyse aux résultats obtenus chez les sujets masculins, on s’aperçoit que la concentration atmosphérique de microparticules était associée de façon significative avec l’amplitude de l’onde réfléchie par la périphérie vers l’aorte et la pression pulsée aortique. Ces résultants suggèrent un effet direct des microparticules au niveau de la microcirculation. L’augmentation de l’amplitude de l’onde réfléchie consécutive à une vasoconstriction périphérique, modifie vraisemblablement les pressions au niveau de l’aorte chez le sujet masculin lors de pics de pollution.<p><p>Etude 3 :Le rôle de la nicotine dans les effets vasculaires du tabagisme passif. Le tabagisme passif est considéré comme la source la plus importante d’émission de microparticules au niveau domestique. Cependant, la composition chimique des particules semble jouer un rôle essentiel sur les ondes de réflexion. Nous avons démontré récemment que l’exposition passive à la fumée des cigarettes du tabac augmente l’intensité de la réflexion de l’onde de pouls. Ceci n’a pas été observé avec l’exposition à la fumée des cigarettes non tabagiques, en dépit d’une concentration ambiante tout à fait comparable de microparticules. Par ailleurs, nous avons observé que l’augmentation de l’incidence de l’onde de pouls au niveau de l’aorte était fortement associée à la concentration plasmatique de la nicotine. Un lien causal entre la nicotine, réflexion de l’onde de pouls et rigidité artérielle n’avait jamais clairement été établi. Nous avons testé cette hypothèse en administrant la nicotine pure chez des sujets sains. Nous avons observé que l’augmentation des taux plasmatiques de la nicotine à des valeurs comparables à celles qui surviennent après une exposition intensive au tabagisme passif, intensifiait la réflexion de l’onde de pouls et augmentait la rigidité artérielle. La correction statistique pour l’augmentation de la fréquence cardiaque et l’augmentation de la pression artérielle en réponse à la nicotine ne modifiait pas ces conclusions. Nos résultats démontrent ainsi les effets cardiovasculaires importants de faibles concentrations de nicotine, similaires à ceux qui sont atteints en cas d’exposition à un tabagisme passif.<p><p>Conclusions. Nos résultats révèlent les effets néfastes de l’exposition au froid et aux microparticules atmosphériques sur la rigidité artérielle, la microcirculation périphérique et la réflexion de l’onde de pouls. Nous avons pu également démontrer le rôle de la stimulation nicotinique dans les effets vasculaires aigus du tabagisme passif, comme en témoigne l’augmentation de la réflexion de l’onde de pouls au niveau aortique. Ces modifications hémodynamiques favorisent l’ischémie myocardique, et constituent un des mécanismes par lesquels l’exposition au froid et à la pollution atmosphérique favorisent la pathologie cardiovasculaire.<p> / Doctorat en Sciences médicales / info:eu-repo/semantics/nonPublished

<p>Experiment One: The Effect of Noise on Autonomic Arousal</p><p><br></p><p>In response to the growing demand for research that helps us understand the complex interactions between Autonomic Arousal (AA) on behavior and performance there is an increasing need for robust techniques to efficiently utilize stimuli, such as sound, to vary the level of AA within a study. The goal of this study was to look at the impact of several factors, including sound intensity, order of presentation, and direction of presentation on skin conductance level, a widely utilized technique for approximating levels of AA. To do this we had 34 young adults ages 18- 34 listen to a series of 2-minute blocks of a sound stimuli based off a heating, ventilation, and air conditioning system (HVAC). Blocks included 5 single intensity conditions each block differing in 10 dBA steps ranging from 35-75 dBA. We presented blocks in both rising and falling level of intensity, with half the participants hearing them in a rising order first and half in a falling order first. The evidence found by this study suggests that increasing the sound level plays an important role in increasing AA and habituation is an extremely important factor that must be accounted for as it, in the case of typical young adults, quickly dampens the response to stimuli and subsequent stimuli. These findings suggest that researchers can best efficiently maximize the range of AA they can use while keeping their participants comfortable by starting out with the most intense stimuli and proceeding to the less intense stimuli, working with habitation instead of against it.</p><p> </p><p><br></p><p> Experiment Two: The Effect of Autonomic Arousal on Visual Attention</p><p><br></p><p>The goal of this study was to better understand how various levels of autonomic arousal impact different components of attentional control and if ASD-related traits indexed by Autism Quotient scores (AQ) might relate to alterations in this relationship. This study had 41 young adult participants (23 women, 17 men, 1 prefer not to say), ages ranging from 18 to 38 years old. Participants listened to varying levels of noise to induce changes in AA, which were recorded as changes in skin conductance level (SCL). To evaluate attentional control, participants preformed pro and anti-saccade visual gap–overlap paradigm tasks as measures of attentional control. The findings of this study suggest that increased levels of autonomic arousal are helpful for improving performance on anti-saccade tasks, which are heavily dependent on top-down attentional control. Additionally, increases in AQ scores were related to having less of a benefit from increasing levels of arousal on anti-saccade tasks. Additional interactions were also found and are discussed in this paper.</p>

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