A carregar...
Publicação
Intersected pathways in comisa implications for distress and cardiometabolic risk
| Nome: | Descrição: | Tamanho: | Formato: | |
|---|---|---|---|---|
| 3.68 MB | Adobe PDF |
Autores
Orientador(es)
Resumo(s)
Enquadramento A coexistência, no mesmo paciente, de insónia e distúrbios respiratórios do sono, as doenças do sono mais prevalentes e impactantes, determina desafios no diagnóstico e tratamento. O termo COMISA tem sido utilizado para categorizar essa concorrência. Dada a elevada prevalência tanto da insónia quanto da apneia obstrutiva do sono (AOS), a principal forma de perturbação respiratória do sono (PRS), e o impacto potencial das suas manifestações combinadas na saúde, um estudo minucioso e sistemático da sua sobreposição é de extrema importância. Caracterizar a COMISA é crucial para uma melhor compreensão das vias e mecanismos fisiopatológicos, para refinar os critérios de diagnóstico e para desenvolver estratégias terapêuticas mais eficazes adaptadas aos desafios únicos desta prática clínica. Entretanto, ambas as perturbações têm sido associadas a níveis elevados de stress e risco cardiometabólico. A relação cíclica entre insónia e stress, juntamente com as queixas relacionadas ao stress frequentemente observadas em pacientes com AOS, sugere uma resposta ao stress matizada em pacientes com COMISA, o que pode levar a doenças cardiovasculares e metabólicas associadas, num contexto que ainda não é totalmente compreendido. Investigação Com este trabalho, tivemos como objetivo identificar e caracterizar a COMISA em populações distintas, com diferentes faixas etárias, e com queixas, tanto de insónia como de AOS, e investigar, nestas populações, a interação entre stress, risco cardiometabólico e COMISA. Também procurámos caracterizar importantes aspetos fisiológicos apresentados em pacientes com COMISA, e relacionados com o stress e com fatores de risco cardiometabólicos. Além disso, avaliámos a eficácia de intervenções terapêuticas orientadas, no tratamento da COMISA, e na mitigação do stress e do risco cardiometabólico desses pacientes. Esta abordagem abrangente aprimorou a nossa compreensão e permitiu a elaboração de estratégias promissoras para gerenciar efetivamente a interação entre COMISA, stress e doença cardiometabólica. Para atingir este objetivo, dentro de um estudo multicêntrico, investigámos sistematicamente a interação entre insónia e AOS, em adultos e crianças.
Background The coexistence in the same patient of insomnia and sleep disordered breathing, the most prevalent and impacting sleep disorders, leads to challenges in diagnosis and treatment. The term COMISA has been used to categorize such concurrence. Given the high prevalence of both insomnia and obstructive sleep apnoea (OSA), as the main form of sleep disordered breathing (SDB), and the potential impact of their combined manifestations in health, a thorough and systematic study of their overlap is of utmost importance. Characterizing COMISA would be critical for better understanding pathophysiological pathways and mechanisms, refining diagnostic criteria, and for developing more effective therapeutic strategies tailored to the unique challenges of an interaction between insomnia and OSA in clinical practice. Meanwhile, both disorders have been shown to be associated with increased stress levels and cardiometabolic risk. The cyclical relationship between insomnia and stress together with the stress-related complaints commonly observed in OSA patients suggests a nuanced stress response in COMISA patients which may lead to cardiovascular and associated metabolic disorders and is not fully understood. Research With this work we aimed to identify and characterize COMISA in distinct populations with different ranges of age, reporting both insomnia and OSA and to investigate the nuanced interaction between stress, cardiometabolic risk and COMISA. We have also characterized important stress-related physiological aspects and cardiometabolic risk factors presented in COMISA patients. Furthermore, we assessed the effectiveness of targeted therapeutic interventions in addressing both the treatment of COMISA and the mitigation of related stress and cardiometabolic risk among these patients. This comprehensive approach enhanced our understanding and devised promising strategies for effectively managing the interplay between COMISA, stress, and cardiometabolic disorders.
Background The coexistence in the same patient of insomnia and sleep disordered breathing, the most prevalent and impacting sleep disorders, leads to challenges in diagnosis and treatment. The term COMISA has been used to categorize such concurrence. Given the high prevalence of both insomnia and obstructive sleep apnoea (OSA), as the main form of sleep disordered breathing (SDB), and the potential impact of their combined manifestations in health, a thorough and systematic study of their overlap is of utmost importance. Characterizing COMISA would be critical for better understanding pathophysiological pathways and mechanisms, refining diagnostic criteria, and for developing more effective therapeutic strategies tailored to the unique challenges of an interaction between insomnia and OSA in clinical practice. Meanwhile, both disorders have been shown to be associated with increased stress levels and cardiometabolic risk. The cyclical relationship between insomnia and stress together with the stress-related complaints commonly observed in OSA patients suggests a nuanced stress response in COMISA patients which may lead to cardiovascular and associated metabolic disorders and is not fully understood. Research With this work we aimed to identify and characterize COMISA in distinct populations with different ranges of age, reporting both insomnia and OSA and to investigate the nuanced interaction between stress, cardiometabolic risk and COMISA. We have also characterized important stress-related physiological aspects and cardiometabolic risk factors presented in COMISA patients. Furthermore, we assessed the effectiveness of targeted therapeutic interventions in addressing both the treatment of COMISA and the mitigation of related stress and cardiometabolic risk among these patients. This comprehensive approach enhanced our understanding and devised promising strategies for effectively managing the interplay between COMISA, stress, and cardiometabolic disorders.
Descrição
Tese de doutoramento em Ciências Biomédicas (Fisiologia), Universidade de Lisboa, Faculdade de Medicina, 2024
Palavras-chave
COMISA Insomnia Sleep apnoea OSA Stress Digital health COMISA Insónia Apneia do sono SAOS Stress Saúde digital