RESUMO ABSTRACT Clinical Presentation of Obese Patients with Polysomnographic Diagnosis of Obstructive Sleep Apnea. Aim:To evaluate the symptoms of obese patients with polysomnographic diagnosis of obstructive sleep apnea (OSA). Methods: All obese patients (BMI ≥ 30 kg/m 2 ) that accomplished overnight polysomnography in two sleep laboratories in the city of Salvador, BA, Brazil, in the period of July to December of 2004, and had an apnea hypopnea index (AHI) ≥ 5. The considered symptoms were excessive daytime sleepiness, awakenings during the night and nocturnal choking or gasping. Results: 73 patients were included, being 57.5% male, with mean age and BMI of 45.2 years old and 38.0 kg/m 2 , respectively. The majority (49.3%) was classified as having severe OSA (AHI ≥ 30). Data revealed that 19.2% of the patients did not have any symptoms, while 28.8% had one symptom, 30.1% had two and 21.9% had three. There was no statistically significant difference in the severity of OSA between the subjects with and without symptoms. There was a higher prevalence of asymptomatic patients in the subgroup with severe obesity -BMI ≥ 35kg/m 2 (30.8% vs. 5.9%; p = 0.007). Conclusions: The polysomnography seems to be a fundamental exam in the evaluation of obese patients due to the elevated prevalence of asymptomatic individuals with OSA in this group, especially the severe obese.

Background When performing the Valsalva maneuver (VM), adults and preadolescents produce the same expiratory resistance values. Objective To analyze heart rate (HR) in preadolescents performing VM, and propose a new method for selecting expiratory resistance. Method The maximal expiratory pressure (MEP) was measured in 45 sedentary children aged 9-12 years who subsequently performed VM for 20 s using an expiratory pressure of 60%, 70%, or 80% of MEP. HR was measured before, during, and after VM. These procedures were repeated 30 days later, and the data collected in the sessions (E1, E2) were analyzed and compared in periods before, during (0-10 and 10-20 s), and after VM using nonparametric tests. Results All 45 participants adequately performed VM in E1 and E2 at 60% of MEP. However, only 38 (84.4%) and 25 (55.5%) of the participants performed the maneuver at 70% and 80% of MEP, respectively. The HR delta measured during 0-10 s and 10-20 s significantly increased as the expiratory effort increased, indicating an effective cardiac autonomic response during VM. However, our findings suggest the VM should not be performed at these intensities. Conclusion HR increased with all effort intensities tested during VM. However, 60% of MEP was the only level of expiratory resistance that all participants could use to perform VM. Therefore, 60% of MEP may be the optimal expiratory resistance that should be used in clinical practice.

ObjetivoInvestigar se um curto programa de treinamento aeróbio poderia causar modifi cação na frequência cardíaca de repouso e alterações na modulação autonômica cardíaca de pré-adolescentes obesos.MétodosEstudo longitudinal que envolveu quinze crianças obesas sedentárias com idades entre 9 e 12 anos que foram submetidas a 12 sessões de treinamento aeróbio de 40 minutos, com intensidade equivalente a 65% da frequência cardíaca submáxima. Para a coleta dos dados de frequência cardíaca e da modulação autonômica cardíaca foram utilizados o monitor Polar S810i e o software Polar Precision Performance que analisa a variabilidade da frequência cardíaca. A análise estatística empregou-se o teste Anova, com nível de significância de p<0,05, para analisar os dados nos momentos pré, durante após o treinamento aeróbio. ResultadosOs valores medianos de frequência cardíaca de repouso foram: pré treinamento aeróbio = 89bpm, após 6 sessões = 95bpm e após 12 sessões = 87,5bpm; e do índice pNN50 da variabilidade da frequência cardíaca estudado para avaliar a modulação autonômica cardíaca, mostrou: pré treinamento aeróbio = 4,95%; após 6 sessões = 3,45%, e após 12 sessões = 11,5%. O índice razão Baixa Frequência/Alta Frequência da Variabilidade da Frequência Cardíaca no domínio da frequência mostrou os seguintes valores: pré Treinamento Aeróbio = 1,28, após seis sessões = 1,22, e após 12 sessões = 0,87. Todos os valores dos índices analisados no estudo não se modificaram significativamente com o treinamento aeróbio.ConclusãoO treinamento aeróbio de curta duração (12 sessões), na intensidade em que foi aplicado, não foi suficiente para promover significativa redução da frequência cardíaca de repouso e alterações no padrão da modulação autonômica cardíaca.