In this small case series, lateral pharyngoplasty reduced the values obtained in the 24-hour ABPM due to a significant reduction of blood pressures during sleep in patients with OSA 6 months after surgery. Although the patients presented with reductions in AHI, arousals, and desaturation time, this was not correlated with the improvement in arterial blood pressure.

Working in the ER on a 24-h shift leads to abnormal BP behavior in medical residents, thus suggesting that this type of work may be a risk factor for cardiovascular disease.

Original ArticleCentral nervous system disorders are known to be responsible for the onset of cardiac alterations, frequently observed in the electrocardiogram 1,2 . Although serum potassium disturbance has been suggested as an important factor in these alterations, this finding was not confirmed in several studies 3,4 . The majority of studies suggest that these ECG abnormalities result from disturbances in the autonomous system, due to neurologic disease, promoting a local excess of catecholamines, associated with enhanced adrenal production, and activation of the calcium channels, leading to an increase in cytosolic and mitochondrial calcium, as well as release of free radicals, causing contraction band necrosis and reflected in ECG alterations. Although the causes of cardiac alterations are a matter of scientific speculation, evidence exists that myocardial lesion is mediated by catecholamines, and an important left ventricle dysfunction with the liberation of cardiac enzymes, such as troponin-I, occurs in some cases 5 . The increase in intracranial pressure is also considered a factor in these alterations 6 . Data described by Goldstein 7 in a certain population demonstrated a high incidence (up to 92%) of electrocardiogram alteration in neurological disorders. This result was not observed in clinical practice. In our study, we observed a frequency of electrocardiogram alterations in pathological brain processes contrary to that observed in the literature. MethodsWe carried out a study for 6 years of 1,590 patients admitted because of neurological diseases, such as brain tumor, stroke, subarachnoid hemorrhage, subdural hemorrhage, brain aneurysm, and head injury, with ages ranging from 10 to 60 years. Patients with concomitant diseases that could lead to electrocardiogram alterations, such as systemic hypertension, cardiac valve abnormalities, coronary diseases, congenital cardiopathies, endocrine diseases, and others were excluded. Those patients who did not have a complete clinical history or an electrocardiogram performed at the time of admittance were also excluded. A cardiologist unaware of the neurological diseases and any other clinical data regarding the patient interpreted the elec-

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