Dissertations / Theses on the topic 'Cardiac metabolic syndrome'

Recent studies support the association between metabolic syndrome (MetS), a cluster of cardiovascular risk factors, and diastolic dysfunction. Disproportionate collagen accumulation, particularly cross-linking of collagen, plays a key role in translating interstitial fibrosis into mechanical chamber stiffness and diastolic dysfunction. Characteristic changes in the expression and activity of myocardial lysyl oxidase (LOX), a matrix modifying enzyme that catalyzes cross-linked collagen, are unclear in MetS. We established a diet-induced MetS model to study diastolic dysfunction by treating male C57BL/6 mice a high-fat high-simple carbohydrate (HFHSC) diet for 6 months. Despite blunted gene expression of LOX isoforms, MetS mice demonstrated significant increase in the ratio of protein expression of mature to proenzyme LOX, enhanced LOX activity, and increased cardiac cross-linked collagen compared with controls. This fibrotic response coincided with marked increase in left ventricular end-diastolic pressure and stiffness and impaired diastolic filling pattern. Our data demonstrate that diet-induced MetS alters the remodeling enzyme LOX, thereby increasing the amount of crosslinking and inducing diastolic dysfunction.Furthermore we examined the role of T-lymphocytes in myocardial LOX regulation in diet-induced fibrotic hearts. Female SCID mice which are devoid of functional T-lymphocytes and C57BL/6 mice were treated with HFHSC diet for 12 months. Similar to male C67BL/6, female HFHSC-fed C57BL/6 mice demonstrated significant increase in maturation and catalytic activity of myocardial LOX, cross-linking, ventricular stiffness and diastolic dysfunction. Whereas induction of LOX protein was minimal in SCID mice compared with wild-type counterparts. Correspondingly fibrillar cross-linked collagen formation and diastolic dysfunction were less prominent in SCID mice. Our results suggest a potential role of T-lymphocytes in induction of myocardial stiffness and diastolic dysfunction through modulation of LOX-dependent collagen maturation.Moreover we studied the role of leptin, an adipokine over-produced in MetS with fibrotic effects in non-cardiac tissues, as a key mediator of profibrogenic responses in the heart by administrating leptin to C57BL/6 and leptin-deficient ob/ob mice. With exogenous leptin administration ob/ob mice displayed passive diastolic filling dysfunction that coincided with increase in myocardial collagen compared with ob/ob controls. Our findings suggest profibrotic effects of leptin in the heart, primarily through predominance of collagen synthesis over degradation.

In males, the widespread prevalence of both obesity-related metabolic syndrome (MetS) and testosterone deficiency (TD) is further exacerbating the socio-economic and health burdens already elicited by the rapidly ageing global population. The strong reciprocal relationship between the MetS and TD in males often results in their shared pathologies presenting together in the clinical setting. Clinical and epidemiological studies have provided convincing evidence that the MetS and TD are highly comorbid [1, 2] and share mutual abnormalities, including visceral obesity, dyslipidaemia and insulin resistance. One or more of these changes associated with the MetS and TD contribute to life-threatening conditions such as cardiovascular disease and increased osteoporotic bone fragility, particularly in the ageing male. Due to limitations of traditional androgen replacement therapy with testosterone (TEST), which is readily converted to active metabolites by enzymes, the therapeutic potential of trenbolone (TREN), a selective androgen receptor modulator (SARM), remains an attractive alternative to TEST. However, TREN’s efficacy has not been investigated in appropriate models representative of obese and TEST-deficient males, especially within the context of cardiometabolic disease and obesity-related osteoporosis/bone strength.
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Medical Science
Griffith Health
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BACKGROUND: Risk factors associated with Metabolic Syndrome (MetS) have been implicated in cardiovascular disease (CVD) development and outcomes. Few studies have investigated relationships between psychological variables, MetS factors, and indices of cardiac structure and function (CSF) among healthy individuals in a single conceptual model. No studies to date have analyzed such relationships in patients with CVD. METHODS: The present study examined associations between cynical hostility (CynHo), MetS factors, and CSF in 186 multi-ethnic post-myocardial infarction (MI) patients. Structural equation modeling was used to test a theory driven model of MetS that had good statistical fit. Primary MetS variables included waist circumference (WC), the homeostatic model of insulin resistance (HOMA-IR), glucose area under the curve (G-AUC), triglycerides (TRIG), high-density lipoprotein cholesterol (HDL-C), and diastolic blood pressures (DBP). Secondary MetS variables included plasminogen activator inhibitor-1 (PAI-1) and a latent inflammation variable comprised of CRP and IL-6. Cardiac function variables were fractional shortening (FS), E/A ratio, and rate-pressure product (RPP). A latent cardiac mass (CM) variable was also created. RESULTS: The final structural model had good model fit (Chi-Square(102)=100.65, p=0.52, CFI=1.00, RMSEA=0.00, and SRMR=0.04). Direct paths were supported between WC and CM and all MetS factors except TRIG and G-AUC. WC was indirectly associated with DBP via CM. The model supported positive direct paths between HOMA-IR and G-AUC, TRIG, and PAI-1, but not inflammation or HDL-C. HOMA-IR demonstrated a direct positive association with RPP and direct inverse associations with FS and E/A ratio. No direct paths were supported between other MetS variables except one between TRIG and HDL-C. CynHo demonstrated a direct positive relationship with HOMA-IR. CONCLUSIONS: Similar to findings in healthy individuals, central adiposity and IR play primary roles in CSF impairment in post-MI patients. Findings suggest that CynHo could promote the progression of metabolic dysfunction and cardiac disease via factors that influence the efficiency of glucose metabolism. Interventions for post-MI patients should take into account both direct and indirect effects of CynHo, central adiposity, and IR on the progression of CVD in this population to reduce adverse outcomes and improve quality of life.

Myocardial ischemia is a major cause of postoperative heart failure and adverse outcome in coronary artery bypass graft surgery (CABG). Conventional treatment of postoperative heart failure with inotropic drugs may aggravate underlying ischemic injury. Glutamate has been claimed to increase myocardial tolerance to ischemia and promote metabolic and hemodynamic recovery after ischemia. The aim of this work was to investigate if intravenous glutamate infusion given in association with CABG for acute coronary syndrome can reduce mortality and prevent or mitigate myocardial injury and postoperative heart failure. We also wanted to assess neurological safety issues, as a concern with the use of glutamate is that it may act as an excitotoxin under certain conditions.A metabolic strategy for perioperative care was assessed in an observational study on 104 consecutive patients with severe left ventricular dysfunction undergoing CABG. Based on encouraging clinical results, unsurpassed in the literature, the GLUTAMICS-trial was initiated. 861 patients undergoing CABG for acute coronary syndrome were randomly allocated to blinded intravenous infusion of L-glutamicacid solution or saline. The primary endpoint was a composite of postoperative mortality (≤30 days), perioperative myocardial infarction and left ventric ular heart failure in association with weaning from cardiopulmonary bypass. Secondary endpoints included neurological safety issues, degree of myocardial injury,postoperative hemodynamic state, use of circulatory support and cardiac mortality.The event rate was lower than anticipated and the primary endpoint did not differ significantly between the groups. Regarding secondary endpoints there were significant differences compatible with a beneficial effect of glutamate on post-ischemic myocardial recovery. The putative effect of glutamate infusion was seen in more ischemic patients (CCS class IV) and in patients with evident or anticipated LV-failure on weaning from CPB. No evidence for increased incidence of clinical or subclinical neurological injury was found. In conclusion, intravenous glutamate infusion is safe in the dosages employed and could provide a novel and important way of promoting myocardial recovery after ischemic injury.

Thesis (MScMedSc (Dept. of Biomedical Sciences. Medical Physiology))University of Stellenbosch, 2010.
ENGLISH ABSTRACT: Background: Obesity is associated with dyslipidemia, insulin resistance and glucose intolerance and together these components characterise the metabolic syndrome (Dandona et al. 2005). In the state of obesity, there are high levels of circulating free fatty acids and increased rates of fatty oxidation which inhibit glucose oxidation. This: (i) reduce the heart‘s contractile ability, (ii) exacerbates ischemic/reperfusion injury and (iii) decreases cardiac mechanical function during reperfusion (Kantor et al. 2000; Liu et al. 2002; Taegtmeyer, 2000). Aim: The aim of our study was to investigate the effect of inhibiting fatty acid oxidation, with oxfenicine (4-Hydroxy-L-phenylglycine), on (i) cardiac mechanical function, (ii) mitochondrial respiration, (iii) myocardial tolerance to ischemia/reperfusion injury, (iv) CPT-I expression, MCAD expression, IRS-1 activation, total GLUT- 4 expression and (v) the RISK pathway (ERK42/44 and PKB/Akt). Methods: Male Wistar rats were fed a control rat chow diet or a high calorie diet (HCD) for 16 weeks. The HCD caused diet induced obesity (DIO). The animals were randomly divided into 4 groups [Control, DIO, Control + oxfen and DIO + oxfen]. The drug was administered for the last 8 weeks of feeding (200mg/kg/day). Animals were sacrificed and the hearts were perfused on the Langendorff perfusion system. After being subjected to regional ischemia and two hours of reperfusion, infarct size was determined. A separate series of animals were fed and/or treated and hearts were collected after 25 minutes global ischemia followed by 30 min reperfusion for determination of GLUT- 4, CPT-1, IRS -1, MCAD, ERK (42/44) and PKB/Akt expression/phosphorylation using Western blot analysis. A third series of hearts were excised and used for the isolation of mitochondria. Results: In the DIO rats, chronic oxfenicine treatment improved cardiac mechanical function by improving mitochondrial respiration. Oxfenicine inhibited CPT-1 expression but had no effect on MCAD or GLUT- 4 expression. Oxfenicine decreased IRS-1 iv expression, but not IRS-1 activation. Oxfenicine also improved myocardial tolerance to ischemia/reperfusion without activation of the RISK pathway (ERK & PKB). In the control rats, chronic oxfenicine treatment worsened cardiac mechanical function by adversely affecting mitochondrial respiration. Oxfenicine also worsened myocardial tolerance to ischemia/reperfusion in the control rats without changes in the RISK pathway (ERK & PKB). Oxfenicine had no effect on CPT-1, MCAD or GLUT- 4 expression. Oxfenicine increased IRS-1 expression, but not IRS-1 activity. Conclusion: Chronic oxfenicine treatment improved cardiac mechanical function and myocardial resistance to ischemia/reperfusion injury in obese animals, but worsened it in control animals. The improved cardiac mechanical function and tolerance to ischemia/reperfusion injury may be due to improvement in mitochondrial respiration.
AFRIKAANSE OPSOMMING: Agtergrond: Vetsug word geassosieer met dislipidemie, insulien weerstandigheid en glukose intoleransie, wat saam die metaboliese sindroom karakteriseer (Dandona et al. 2005). Met vetsug is daar ‗n hoë sirkulasie van vetsure, sowel as verhoogde vertsuur oksidasie wat gevolglik glukose oksidasie onderdruk. Dit: (i) verlaag die hart se vermoë om saam te trek, (ii) vererger isgemiese/herperfusie skade en (iv) verlaag kardiale effektiwiteit gedurende herperfusie (Kantor et al. 2000; Liu et al. 2002; Taegtmeyer, 2000). Doel: Die doel van die studie was om die effekte van vetsuur onderdrukking m.b.v. oksfenisien (4-Hidroksie-L-fenielglisien) op (i) meganiese hart funksie, (ii) mitokondriale respirasie, (iii) miokardiale toleransie teen isgemiese/herperfusie skade, (iv) CPT-I uitdrukking, MCAD uitdrukking, IRS-1 aktiwiteit, totale GLUT-4 uitdrukking en (v) die RISK pad (ERK42/44 en PKB/Akt) te ondersoek. Metodes: Manlike Wistar rotte was gevoer met ‗n kontrole rot dieet of ‗n hoë kalorie dieet (HKD) vir 16 weke. Die HKD lei tot dieet-geïnduseerde vetsug (DGV). Die diere was lukraak verdeel in 4 groepe [kontrole, DGV, kontrole + oksfen en DGV + oksfen]. Die behandeling met die middel was toegedien vir die laaste 8 weke van die voeding protokol (200mg/kg/dag). Die diere was geslag en die harte was geperfuseer op die Langendorff perfusie sisteem. Na blootstelling aan streeks- of globale isgemie en 2 ure herperfusie was infark groottes bepaal. ‗n Aparte reeks diere was gevoer en/of behandel en die harte was versamel na 25 minute globale isgemie gevolg deur 30 minute herperfusie vir die bepaling van GLUT-4, CPT 1, IRS -1, MCAD, ERK (42/44) en PKB/Akt uitdrukking/aktivering d.m.v. Western blot analise. ‗n Derde reeks diere was gebruik vir die isolasie van mitokondria. Resultate: In die DGV diere, het kroniese oksfenisien behandeling meganiese hart funksie verbeter d.m.v. die verbetering van mitokondriale respirasie. Oksfenisien het CPT-1 uitdrukking verlaag terwyl GLUT- 4 en MCAD uitdrukking nie geaffekteer was vi nie. Oksfenisien het IRS-1 uitdrukking verlaag, maar nie IRS-1 aktiwiteit nie. Oksfenisien het ook miokardiale weerstand teen isgemiese/herperfusie verbeter met sonder aktivering van die RISK pad (ERK & PKB). In die kontrole diere, het kroniese oksfenisien behandeling die meganiese hart funksie versleg d.m.v. negatiewe effekte op mitokondriale respirasie. Oksfenisien het die miokardiale weerstand teen isgemiese/herperfusie van die kontrole rotte versleg sonder veranderinge in die RISK pad (ERK & PKB). Oksfenisien het geen effek gehad op CPT-1, MCAD en GLUT-4 uitdrukking nie. Oksfenisien het IRS-1 uitdrukking verhoog, maar nie IRS-1 aktiwiteit nie. Samevatting: Kroniese oksfenisien behandeling het die meganiese hart funksie en miokardiale weerstand teen isgemiese/herperfusie skade in die vet diere verbeter, maar versleg in die kontrole diere. Hierdie verbetering van meganiese hart funksie en weerstand teen isgemiese/herperfusie skade kon dalk wees a.g.v. ‗n verbetering in mitokondriale respirasie.

Thesis (PhD)-- Stellenbosch University, 2014.
ENGLISH ABSTRACT: Introduction: The cardioprotective actions of the hormone melatonin against myocardial ischaemiareperfusion injury (IRI) are well-established. It has recently been shown to prevent the harmful effects of hyperphagia-induced obesity on the susceptibility of the heart to IRI as well as many of the harmful effects of obesity and insulin resistance. However, the exact mechanism whereby it exerts its beneficial action is still unknown. The aims of this study were to determine the effects of relatively short-term melatonin treatment in a rat model of diet-induced obesity on: (i) biometric and metabolic parameters, lipid peroxidation, myocardial IRI and intracellular signalling (ii) mitochondrial oxidative phosphorylation function (iii) cardiomyocyte glucose uptake and intracellular signalling. In addition, the effects of acute melatonin treatment of cardiac microvascular endothelial cells (CMEC) were determined on cell viability, nitric oxide production (NO), TNF- -induced dysfunction and intracellular signalling. Material and Methods: Male Wistar rats were randomly allocated to two groups for 20 weeks feeding with either standard rat chow or a high calorie diet. Each group was subdivided into 3 groups receiving either water throughout or melatonin (4mg/kg/day, in the drinking water) for the last 6 or 3 weeks of the experimental programme. Hearts, perfused in the working mode, were subjected to ischaemia/reperfusion and infarct size determined. Mitochondria and cardiomyocytes were isolated according to standard techniques and oxidative function and glucose uptake respectively determined. CMEC NO production and cell viability were quantified by FACS analysis of the fluorescent probes, DAF-2/DA and propidium iodide/Annexin V respectively. Intracellular signalling was evaluated using Western blot and appropriate antibodies. Results: The high-calorie diet caused significant increases in body weight gain, visceral adiposity, fasting blood glucose, serum insulin, triglycerides, HOMA-IR index and a concomitant reduction in serum adiponectin levels as well as larger myocardial infarct sizes after exposure to IRI compared to the control, indicating increased susceptibility to damage. Three as well as six weeks of melatonin administration to obese and insulin resistant rats reduced serum insulin levels and the HOMA-IR index. Myocardial infarct size was reduced in both control and diet groups. These effects were associated with increased activation of baseline myocardial STAT- 3 and the RISK pathway during reperfusion. The diet had no effect on the oxidative phosphorylation capacity of mitochondria, isolated from non-perfused hearts (baseline), but melatonin administration for 6 weeks induced a reduction in state 3 respiration rate; mitochondria isolated from diet hearts subjected to global ischaemia, exhibited an attenuated oxidative phosphorylation process which was improved by melatonin treatment. Melatonin in vitro enhanced cardiomycyte insulin stimulated glucose uptake of normal young rats but not of insulin resistant rats. In vivo melatonin treatment for 6 weeks increased basal (in diet group) and insulin stimulated glucose uptake in both control and diet groups. Melatonin (1nM) in vitro caused a significant reduction in necrosis and apoptosis of cultured CMEC, associated with a decrease in nitric oxide availability and eNOS activation and a concomitant increase in PKB/Akt, p38MAPK and AMPK activation. The harmful effects of TNF- treatment on signalling in CMEC could be prevented by co-treatment with melatonin. Conclusions: The results suggest that short-term melatonin treatment was able to significantly attenuate the diet-induced increased myocardial susceptibility to ischaemia/reperfusion damage. It may also improve cardiac glucose homeostasis and mitochondrial oxidative phosphorylation in an insulin resistant state. Melatonin in vitro protects CMEC against apoptosis and necrosis and reduces nitric oxide availability. These beneficial effects of melatonin may ultimately be due to its antioxidant capacity or receptor-mediated actions, but this remains to be established.
AFRIKAANSE OPSOMMING: Inleiding: Die vermoë van die hormoon, melatonien, om die hart teen iskemie/ herperfusiebesering (IHB) te beskerm, is welbekend. Onlangs is ook getoon dat melatonien IHB en verskeie van die nadelige effekte van vetsug en insulienweerstandigheid in hiperfagiegeïnduseerde vetsug kan voorkom. Die meganisme(s) betrokke by hierdie voordelige prosesse is egter grootliks onbekend. Die doel van hierdie studie was om die gevolge van korttermyn melatonienbehandeling in ‘n model van hiperfagiegeïnduseerde vetsug te ondersoek op (i) biometriese en metaboliese parameters, lipiedperoksidasie, miokardiale IHB en intrasellulêre seintransduksie, (ii) mitochondriale oksidatiewe fosforilasie, (iii) glukoseopname en intrasellulêre seintransduksie in kardiomiosiete en aanvullend, (iv) die invloed van akute melatonienbehandeling van kardiale mikrovaskulêre endoteelselle op sellulêre oorlewing, stikstofoksiedproduksie, TNF- - geïnduseerde disfunksie en seintransduksie. Metodiek: Manlike Wistarrotte is ewekansig in twee groep verdeel en vir 20 weke met standaard-rotkos of ‘n hoëkaloriedieet gevoer. Elke groep is in 3 subgroepe verdeel, wat deurgaans water of melatonien (4mg/kg/dag in die drinkwater) vir 3 of 6 weke voor die beëindiging van die eksperiment ontvang het. Harte is geperfuseer volgens die werkharttegniek, blootgestel aan iskemie/herperfusie en die infarktgrootte bepaal. Mitochondria en kardiomiosiete is volgens standaardtegnieke geïsoleer vir bepaling van oksidatiewe funksie en glukoseopname respektiewelik. NO produksie en sellewensvatbaarheid was gekwantifiseer deur vloeisitometriese analises (FACS) van die fluoresserende agense, DAF-2/DA en propidium jodied/Annexin V onderskeidelik. Intrasellulêre seintransduksie is evalueer met behulp van die Western kladtegniek en geskikte antiliggame. Resultate: Die hoëkaloriedieet het ‘n beduidende toename in liggaamsgewig, visserale vet, vastende bloedglukose, seruminsulienvlakke, trigliseriede, HOMA-IR-indeks en ‘n gepaardgaande verlaging in serumadiponektienvlakke tot gevolg gehad, sowel as groter miokardiale infarkte na iskemie/herperfusie. Laasgenoemde dui op ‘n groter vatbaarheid vir iskemiese beskadiging in harte van vetsugtige diere. Drie sowel as ses weke van melatonienbehandeling het die seruminsulienvlakke en HOMAindeks in vetsugtige diere beduidend verlaag, vergeleke met die kontroles. Miokardiale infarktgroottes was verminder in beide kontrole- en vetsuggroepe. Hierdie effekte het met ‘n verhoogde aktivering van basislyn STAT-3 en PKB/Akt en ERKp44/p42 tydens herperfusie gepaard gegaan. Die dieet het geen invloed op die oksidatiewe fosforilasiekapasiteit van mitochondria, geïsoleer uit harte van ongeperfuseerde harte, gehad nie (basislyn), maar melatonienbehandeling vir 6 weke het Staat 3 respirasie verlaag. Mitochondria, geïsoleer uit harte van vetsugtige rotte wat aan globale iskemie onderwerp was, het ‘n onderdrukte oksidatiewe fosforilasieproses gehad, wat egter deur melatonienbehandeling verbeter is. Melatonien in vitro het insuliengestimuleerde glukoseopname deur kardiomiosiete van jong, maar nie vetsugtige rotte nie, verhoog. In vivo melatonientoediening vir 6 weke het egter basale (in die dieetgroep) en insuliengestimuleerde glukoseopname in beide kontrole- en vetsuggroepe verhoog. Toediening van melatonien in vitro aan mikrovaskulêre endoteelselkulture het ‘n beduidende afname in nekrose, apoptose, stikstofoksied- beskikbaarheid en eNOS aktivering teweeggebring, tesame met ‘n verhoogde aktivering van PKB/Akt, p38MAPK en AMPK. Die nadelige effekte van TNF- toediening op seintransduksie in die mikrovaskulêre endoteelselle is deur melatonien voorkom. Gevogtrekkings: Die resultate toon dat melatonien ‘n merkwaardige beskermende effek op die toename in vatbaarheid vir iskemiese beskadiging in vetsugtige rotte gehad het. Dit mag ook miokardiale glukose-homeostase en mitochondriale oksidatiewe funksie in insulienweerstandigheid verbeter. Melatonien in vitro beskerm mikrovaskulêre endoteelselle teen nekrose asook apoptose en verminder die beskikbaarheid van stikstofoksied. Hierdie voordelige effekte van melatonien mag aan sy anti-oksidantvermoëns of stimulasie van die melatonienreseptor toegeskryf word, maar bewyse daarvoor ontbreek nog.
Division of Medical Physiology (Stellenbosch University),
National Research Foundation
Harry Crossley Foundation

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Fundação de Amparo à Pesquisa do Estado de Goiás - FAPEG
Introduction: Metabolic Syndrome (MS) is a metabolic disorder that offers increased risk for cardiovascular diseases. The analysis of heart rate (HR) kinetics during exercise and its variability (HRV) is an important tool in assessing neurocardial integrity. A slow response of the HR at the end of the exercise corresponds to a low performance of the parasympathetic activity. Objective: To compare HR variability at rest and HR kinetics during exerciserecovery (phase-off), post exercise exercise in women with and without MS. Methodology: A cross-sectional study was carried out with 36 women (35-55 years of age), divided into two groups: SM group (GMS, n = 19) and non-SM group (GNMS, n = 17). The volunteers were submitted to the Bruce type limiting cardiopulmonary stress test, and for the evaluation of the HRV at rest, the R-R intervals were captured during 12 minutes in the seated position. The KomolgorovSmirnov test was used to verify the normality of the data and to evaluate the difference between two independent groups the t-Test was used for independent samples or Mann-Whitney test, multivariate analysis (MANOVA), multiple linear regression and Test Of Chi-square. The level of significance was set at 5%. Results: There was a statistically significant difference between the groups in the exponential component (p < 0.005) in the GNSM group and in the "τ" component (p = 0.032), being higher in the GSM group. There was no statistically significant difference in the parameter "FCpico." The GNSM group presented higher HR deltas compared to the SM group in the Δ60, Δ105 and Δ120 groups. GSM presented lower values in the parasympathetic modulation indices when compared to the SP group. GNSM, in contrast to a low correlation between glycemia and the highest values of the exponential component "τ", which showed a negative relation with the CC and BMI variables. Conclusion: The volunteers with MS presented autonomic dysfunction with compromised cardiac-parasympathetic modulation attributed to changes in the glycemic state. The exponential and linear analysis of FCoF can provide us with a sensitive and anticipated indicator of health impairments, proving to be useful to identify changes in cardiac autonomic control in the recovery of physical exercise.
Introdução: A Síndrome Metabólica (SM) é uma desordem metabólica que oferece risco aumentado para as doenças cardiovasculares. A análise da cinética da frequência cardíaca (FC) durante o exercício e de sua variabilidade (VFC) é uma ferramenta importante na avaliação da integridade neurocárdica. Uma resposta lentificada da FC ao término do exercício corresponde a uma baixa atuação da atividade parassimpática. Objetivo: Comparar a variabilidade da FC em repouso e cinética da FC durante a passagem exercício-recuperação (fase-off), pós-exercício em mulheres com e sem SM. Metodologia: Estudo transversal realizado com 36 mulheres (de 35 a 55 anos de idade), subdivididas em dois grupos: grupo Síndrome Metabólica (GSM, n = 19) e grupo não Síndrome Metabólica (GNSM, n = 17). As voluntárias foram submetidas ao teste de esforço cardiopulmonar sintoma limitante do tipo Bruce, e, para a avaliação da VFC em repouso, os intervalos R-R foram captados durante 12 minutos em posição “sentada”. Foram usados o Teste de Komolgorov-Smirnov (para verificar a normalidade dos dados); o Teste-T para amostras independentes ou Teste MannWhitney (para avaliar a diferença entre dois grupos independentes); a análise multivariada – MANOVA (para avaliar a diferença entre os grupos GNSM e GSM em relação aos diferentes tempos dos deltas da frequência cardíaca); a regressão linear múltipla (para avaliar a associação entre os fatores de risco cardiometabólicos, índices da VFC durante o repouso, componentes exponencias e consumo pico de oxigênio – VO2  pico); e o Teste de Qui-Quadrado (para avaliar o relacionamento das variáveis categóricas: presença ou não da SM e o nível de aptidão cardiorrespiratória). O nível de significância foi estabelecido em 5%. Resultados: Houve diferença estatisticamente significante na comparação entre os grupos referente ao componente exponencial “amp” (p < 0.005) no GNSM e ao componente “τ” (p = 0.032), sendo maior no GSM. Não houve diferença estatisticamente significante referente ao parâmetro “FCpico”. O GNSM apresentou maiores valores dos deltas da FC em comparação ao GSM nos Δ60, Δ105 e Δ120. O GSM apresentou menores valores referentes aos índices que representam a modulação parassimpática, quando comparado ao GNSM. O GSM apresentou Resumo xiii relação inversa da glicemia dos baixos níveis do índice SDNN, além de ter sido estabelecida relação direta entre a glicemia e os maiores valores do componente exponencial “τ”. O VO2  pico apresentou relação negativa com as variáveis CC e índice de massa corporal (IMC). Conclusão: As voluntárias com SM apresentaram disfunção autonômica com comprometimento da modulação parassimpática cardiovascular atribuído às alterações no estado glicêmico. A análise exponencial e linear da frequência cardíaca de recuperação (FCoff) pode nos fornecer um indicador sensível e antecipado de comprometimentos à saúde, demonstrando-se útil para identificar as alterações do controle autonômico cardíaco na recuperação do exercício físico.

Existe uma significativa associação entre a prevalência de doenças cardiovasculares e a síndrome metabólica. Evidências mostram que a obesidade está associada a alterações estruturais e funcionais do coração. As estatinas podem reduzir a síntese endógena de colesterol e, portanto, são utilizadas como uma importante ferramenta contra a hipercolesterolemia em pacientes obesos. O presente trabalho tem como objetivo estudar os efeitos da rosuvastatina no metabolismo lipídico e dos carboidratos, morfometria do tecido adiposo e no remodelamento cardíaco de camundongos alimentados com uma dieta hiperlipídica. Neste trabalho foram utilizados 50 camundongos distribuidos em cinco grupos: grupo controle (alimentado com dieta padrão), grupo hiperlipídico (alimentado com dieta hipelipídica 60%), grupo hiperlipídico + rosuvastatina 10 (alimentado com dieta hipelipídica 60% - acrescido de 10 mg de rosuvastatina), grupo hiperlipídico + rosuvastatina 20 (alimentado com dieta hipelipídica 60% - acrescido de 20 mg de rosuvastatina), grupo hiperlipídico + rosuvastatina 40 (alimentado com dieta hipelipídica 60% - acrescido de 40 mg de rosuvastatina). Foram estudados os efeitos do tratamento com diferentes doses de rosuvastatina na massa corporal, metabolismo dos carboidratos e lipídios, pressão arterial, remodelamento na estrutura cardíaca e mudanças ultraestruturais no coração de camundongos C57BL / 6 machos alimentados com uma dieta hiperlipídica. O tratamento com rosuvastatina reduziu os níveis de lípidos no sangue, melhorou a resistência à insulina e diminuiu a pressão arterial dos camundongos alimentados com dieta rica em lipídeos. Além disso, atenuou o remodelamento cardíaco, diminuindo a fibrose intersticial e perivascular, e manteve a integridade morfológica mitocondrial, com menor produção de proteina desacopladora-2 (UCP2). Assim, a rosuvastatina tem efeitos benéficos sobre as alterações metabólicas dos carboidratos e lipídios, e no remodelamento cardíaco induzidas por dieta hiperlipídica.
There is a significant association between the prevalence of cardiovascular disease and metabolic syndrome. Evidence shows that obesity is associated with structural and functional changes in the heart. Statins can reduce the endogenous synthesis of cholesterol and are therefore used as an important tool against hypercholesterolemia in obese. The present work aims to study the effects of rosuvastatin in lipid and carbohydrate metabolism, adipose tissue morphometry and cardiac remodeling. In this work we studied the effects of rosuvastatin treatment on the body mass, insulin resistance, lipid profile, blood pressure, cardiac remodeling and structure and ultrastructural changes in the heart of the C57BL/6 male mice fed a high-fat diet. The rosuvastatin treatment reduced levels of blood lipids, improve insulin resistance, reduced blood pressure and body mass of high-fat mice. Furthermore, it attenuated cardiac remodelling, decreasing the interstitial and perivascular fibrosis, and maintained the integrity of mitochondrial morphology, with a lower production of UCP-2. Rosuvastatin had beneficial effects on cardiac changes induced by high-fat diet, as well as in mitochondrial morphology, thus controlled energy production to maintain cardiomyocyte integrity.

Le syndrome d’apnées obstructives du sommeil (SAOS) est associé à de nombreuses co-morbidités métaboliques et cardiovasculaires. L’hypoxie intermittente chronique, une des composantes du SAOS, induit des mécanismes intermédiaires délétères tels que stress oxydatif, inflammation, insulino-résistance ou encore dyslipidémie, à l’origine de ces comorbidités. Ces mécanismes intermédiaires sont également communs à d’autres pathologies respiratoires chroniques telles que la bronchopneumopathie chronique obstructive (BPCO) et le syndrome d’obésité hypoventilation (SOH).L’hypoxie intermittente et les mécanismes intermédiaires associés sont aussi à l’origine de l’existence et de la progression de la stéatopathie métabolique (« non alcoholic fatty liver disease »). Ce lien entre pathologies respiratoires chroniques et atteinte hépatique est un mécanisme essentiel mais plus récemment étudié des co-morbidités dans le SAOS et la BPCO. Différents biomarqueurs cardiométaboliques ont donc été étudiés dans ces pathologies respiratoires chroniques à la fois pour caractériser les co-morbidités et l’atteinte systémique et pour apprécier l’impact de différentes thérapeutiques. La première partie de cette thèse sera consacrée à une revue systématique des différents biomarqueurs cardio-métaboliques liés à chacune de ces 3 pathologies respiratoires chroniques : SAOS, BPCO et SOH.Le traitement du SAOS par pression positive continue (PPC) a un effet bénéfique sur les symptômes fonctionnels liés à cette pathologie. Cependant, l’impact de la PPC sur d’autres conséquences cardio-métaboliques délétères du SAOS reste encore à démontrer par des essais randomisés contrôlés, notamment sur l’atteinte hépatique.Dans la seconde partie de cette thèse, nous détaillerons l’impact de la PPC sur les différents marqueurs cardiométaboliques du SAOS à l’aide d’une revue systématique puis d’une étude randomisée contrôlée sur l’impact de la PPC sur les marqueurs d’atteinte hépatique.Par ailleurs, les patients atteints de SAOS, BPCO ou SOH reçoivent du fait de leur polypathologie (multimorbidité) des traitements médicamenteux multiples qui visent à contrôler au mieux les co-morbidités. Il est donc primordial de considérer la prise en charge globale de ces patients du point de vue de leurs traitements instrumentaux (PPC et ventilation non invasive) mais aussi en considérant l’impact des traitements médicamenteux associés. En effet, les traitements médicamenteux peuvent interférer avec la sévérité de la pathologie elle-même et impacter les biomarqueurs liés aux comorbidités associées. La troisième partie de cette thèse sera consacrée à l’étude d’un antihypertenseur chez le patient SAOS et envisagera l’influence des médicaments sur la pertinence de l’usage des bicarbonates comme marqueurs diagnostiques du SOH.En conclusion, nous insisterons sur la nécessité d’une prise en charge intégrée multi systémique et d’une prise en charge personnalisée de ces patients
Obstructive sleep apnea (OSA) is associated with related metabolic and cardiovascular comorbidities. Chronic intermittent hypoxia the hallmark of OSA induces deleterious intermediary mechanisms such as oxidative stress, systemic inflammation, insulin resistance and dyslipidemia. Cardiovascular and metabolic comorbidities are also key features of other chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD) and obesity hypoventilation syndrome (OHS). Chronic hypoxia and deleterious intermediary mechanisms also trigger occurrence and progression of non alcoholic fatty liver disease. This link between chronic respiratory diseases and liver injury is observed through modifications of specific liver biomarkers in OSA and COPD. A variety of cardiometabolic biomarkers have been studied for stratification of cardio-metabolic risk and assessing treatment impact in chronic respiratory diseases. The first part of this PhD thesis is a systematic review of cardio-metabolic biomarkers in 3 respiratory diseases: OSA, COPD and OHS.Continuous positive airway pressure (CPAP) the first line therapy for OSA improves symptoms and quality of life. However, CPAP effects on cardio-metabolic consequences remains still debated. In the second part of the PhD thesis, we will address CPAP impact on different cardiometabolic biomarkers and more specifically in markers of liver injury by reporting original results of a randomized controlled trial (RCT).Polypharmacy is usual in patients with OSA, COPD or OHS. Beyond CPAP or non invasive ventilation treatment, it is essential address the contribution of associated medications. Indeed, pharmacological treatments can interfere with the severity of the disease and control of associated comorbidities. The third part of the thesis will present a RCT evaluating Bosentan in hypertensive OSA patients and will present how medications for comorbidities decrease bicarbonate diagnosis value for OHS.We will conclude by underlining the crucial importance of personalized medicine and integrated care in chronic respiratory diseases

Principais causas de morbi-mortalidade mundial, as doenças cardiovasculares têm o inicio de sua fisiopatologia em idade precoce e, maior predisposição para seu desenvolvimento na vigência das manifestações clinicas da síndrome metabólica como intolerância à glicose, resistência à insulina, obesidade, dislipidemia e hipertensão. Este trabalho foi conduzido com o objetivo de avaliar o efeito da dieta de cafeteria em ratos, sobre variáveis morfométricas, metabólicas e hemodinâmicas associadas às alterações no controle autonômico. Foram utilizados 32 animais, distribuídos em 2 grupos, com delineamento experimental que compreendeu o tratamento com a dieta (24 semanas) e a coleta dos dados. O modelo experimental usado permitiu observar presença de maior adiposidade abdominal, triacilglicerídeos aumentados caracterizando dislipidemia, aumento da glicemia de jejum e redução da resposta de decaimento da glicose, mostrando aumento da resistência à ação periférica da insulina. Observaram-se também HDL-c mais baixo, similaridade nos valores de pressão arterial e frequência cardíaca e alterações importantes no controle autonômico como, redução da variabilidade da frequência cardíaca, modificação no balanço simpato-vagal em favor da modulação simpática sobre a vagal, e correlação direta com os níveis de triacilglicerídeos. Em conjunto, esses achados demonstraram que a dieta de cafeteria induziu alterações de peso corporal e dos depósitos de gordura visceral (TAB) e muscular (TAM) em ratos normotensos acompanhadas de alterações precoces do sistema nervoso autônomo, identificando-se um papel relevante e precoce desse sistema na fisiopatologia da doença cardiovascular associada à alterações metabólicas.
Cardiovascular disease that has been the leading causes of morbidity and mortality in the global world has the beginning of its pathophysiology in precocious age and, greater predisposition for its development in the validity of the clinical manifestations of the metabolic syndrome as to the glucose intolerance, insulin resistance, dyslipidemia, obesity and hypertension. This study was lead with the objective to evaluate the effect of the cafeteria diet in rats, on morphometric, metabolic and hemodynamic parameters associated with the alterations of autonomic control. Rats (n=32) were distributed in 2 groups, one under cafeteria diet and the other on standard food (24 weeks). At the end of the experimental period data were collected. The treated animals presented bigger abdominal adiposity, increased tryacilglicerides characterizing dyslipidemia and increased of the fasting glycemia. The rate of glucose decay was also reduced showing increased peripheral insulin resistance. It was also observed lower HDL-c levels while values of arterial pressure and heart rate did not change. However significant changes in autonomic control of circulation as reduction of heart rate variability as well as increased sympathovagal balance were also observed. These changes were positively correlated with tryacilglicerides levels indicating that cafeteria diet induced not only alterations of body weight but also of the adipose deposits characterizing visceral (WAT) and muscular fat (BAT). Finally the results suggest that autonomic changes may be the early marker of cardiovascular impairment associated with metabolic illness.

Результаты клинических исследований свидетельствуют о значительном снижении, интегральных показателей качества жизни (КЖ), в том числе – за счет нарушений в психо-эмоциональной сфере (ПЭС) у больных сердечно-сосудистыми заболеваниями (ССЗ) на фоне метаболического синдрома (МС) (Коц Я. И., 1993; Беспалова, И. Д., 2012). Цель исследования: Изучить КЖ и психо-эмоциональный фон у больных ССЗ на фоне МС.

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The metabolic syndrome (MetS) consists of a combination of conditions that tend to cluster together, and increase the risk of type 2 diabetes and cardiovascular disease. The components of the metabolic syndrome include central (abdominal) obesity, elevated fasting glucose, dyslipidemia (abnormally high triglycerides and low high-density lipoprotein cholesterol), and elevated blood pressure. MetS is also associated with proinflammatory and prothrombotic states, non-alcoholic liver steatosis, obstructive sleep apnea and reproduction disorders. Although a common unifying physiopathological mechanism is not known, central obesity and inflammation play a major role in MetS and upon each of its components. The MetS has reached epidemic proportions and to date there are no proven pharmacological interventions that simultaneously target all of the components of this syndrome. Inflammation plays an important role in the pathogenesis of the MetS. Recently, it was discovered that inflammation can be regulated by neural, cholinergic mechanisms and a cholinergic drug, the acetylcholinesterase inhibitor galantamine suppresses abnormal inflammation and alleviates MetS pathologies in rodents. The fact that galantamine is an approved drug, used to treat patients with Alzheimer´s disease with a known safety profile, will facilitate its clinical application in another situations. We hypothesize that treatment of subjects with the MetS with galantamine will result in alleviation in the MetS clinical conditions and inflammation. The objective of our study was to initiate an investigation on the safety profile of galantamine in MetS patients, with special attention on autonomic, hemodynamic and cognitive parameters. A randomized, double-blind, prospective study evaluated clinical, autonomic, hemodynamic and cognitive variables of patients with MetS in two moments: before treatment (basal state) and after 28 days of treatment with galantamine 8 mg daily. There was a statistical tendency in reducing systolic blood pressure in the HRV with Finometer® in patients under galantamine (124.4 ± 4 vs 119.7 ± 3.7 mmHg, basal and 28 days values, respectively) and also a reduction in diastolic blood pressure (72.5 ± 1.3 vs 67.2 ± 1.7 mmHg, basal and 28 days values, respectively). Paradoxically, an increase in the sympathetic modulation of the heart was observed with the HRV study measuring the LF (nu) value (46.2 ± 3.8 vs 57.1 ± 3.4 basal and 28 days, respectively) and a decrease in the parasympathetic modulation HF (nu) value (53.8 ± 3.8 vs 43.0 ± 3.4, basal and 28 days, respectively). We did not observe any significant change in cognitive domains. Our conclusion is that treatment with galantamine 8 mg exhibits a safe clinical profile and can be used in MetS patients.
A síndrome metabólica consiste na combinação de condições agrupadas e aumentam o risco para diabetes tipo 2 e doença cardiovascular. Seus componentes incluem obesidade central, níveis aumentados de glicose, dislipidemia caracterizada por aumento de triglicérides e baixos níveis de HDL e aumento da pressão arterial. Também está associada a um estado proinflamatório, a um estado protrombótico, a esteatose hepática não-alcoólica, apnéia obstrutiva do sono e a desordens reprodutivas. Apesar da não determinação de um mecanismo fisiopatológico unificador, obesidade central e inflamação parecem ser centrais na síndrome metabólica e nos seus componentes individuais. A síndrome metabólica tem alcançado proporções epidêmicas universais e até o presente não há intervenção farmacológica comprovada que atue simultaneamente em todos os seus componentes. Sabe-se hoje que o processo inflamatório tem um papel importante na patogenia da síndrome. Recentemente foi evidenciado que a inflamação pode ser regulada por mecanismos neurais colinérgicos, e que a galantamina, um inibidor da acetilcolinesterase, suprime a inflamação e atua nos componentes da síndrome diminuindo a patogenia em roedores. O fato de a galantamina ser uma droga já aprovada e de perfil seguro em portadores de demência facilita seu uso em outras situações clínicas. Considerando a hipótese de que a galantamina causará melhora da inflamação e dos outros distúrbios relacionados, o objetivo deste estudo foi iniciar a investigação sobre o perfil de segurança da galantamina em pacientes com síndrome metabólica, em especial, em parâmetros hemodinâmicos, autonômicos e de cognição. Realizamos um estudo prospectivo, duplo-cego e randomizado, que avaliou os dados clínicos e os parâmetros descritos, no momento basal e após 28 dias de uso de galantanima (8mg por dia), em portadores de síndrome metabólica. Houve uma tendência à redução da PAS, avaliada batimento-a-batimento com o Finometer no grupo que usou galantamina (124,4 ± 4 vs 119,7 ± 3,7 mmHg, respectivamente basal e após 28 dias de uso, p=0,04), o mesmo ocorrendo com a PAD (72,5 ± 1,3 vs 67,2 ± 1,7, p=0,005), respectivamente basal e após 28 dias de uso). De forma paradoxal, ocorreu um aumento da atividade simpática na modulação autonômica para o coração, avaliada por meio do estudo da variabilidade da freqüência cardíaca como atestado por um valor LF (nu) (46,2 ± 3,8 vs 57,1 ± 3,4 , p=0,0005)), e redução da modulação parassimpática, representada pelo valor do HF (nu) (53,8 ± 3,8 vs 43,0 ± 3,4, p=0,0005) respectivamente basal e após 28 dias de uso. Não observamos alterações significativas nos testes que avaliam o domínio cognitivo dos indivíduos. Concluímos que a dose utilizada de galantamina tem um perfil de segurança clínica que permite expandir seu uso em pacientes portadores de síndrome metabólica.

Le sommeil, de par ses fonctions récupératrices, est essentiel à la vie. Pour autant, la modification du mode de vie et des comportements, tant sédentaires que nutritionnels, sont à l’origine d’une altération du sommeil, conduisant ensemble à des situations d’obésité. Cet excès pondéral s’accompagne fréquemment d’un syndrome d’apnées obstructives du sommeil (SAOS). Lorsque ces deux pathologies sont présentes, les troubles métaboliques s’aggravent et sont à l’origine d’une inflammation de bas grade. A notre connaissance, aucune étude ne s’est intéressée aux bénéfices d’un reconditionnement à l’exercice physique combiné à une modification des habitudes alimentaires, en dehors de ceux induits par la perte de poids, sur ces différents paramètres. L’objectif de ce travail de thèse a donc été, à partir d’une étude ancillaire, d’évaluer le sommeil d’adolescents obèses par polysomnographie (PSG) par comparaison à celui de sujets normo-pondérés. Dans l’étude principale, les effets d’un programme de 9 mois (reconditionnement à l’exercice, activités physiques adaptées, rééquilibre alimentaire) ont été évalués sur l’architecture et la durée du sommeil, le SAOS, les différents facteurs biologiques (inflammatoires, hormonaux, profils glucidique et lipidique) et sur les adaptations physiologiques à l’exercice musculaire, afin de mieux comprendre l’implication de l’endurance aérobie et des troubles du sommeil sur la santé cardio-métabolique. Trente-deux adolescents obèses (âge : 14,6 ans, z-score d’IMC= 4 ,7) ont été recrutés. Toutes les variables ont été analysées en pré et post-intervention. Les résultats montrent une durée de sommeil réduite chez les jeunes obèses avec un SAOS, diagnostiqué chez 58% d’entre eux, malgré une architecture du sommeil satisfaisante. En post-intervention, une perte de poids de 11 kg et une amélioration des paramètres d’adaptation à l’exercice maximal (PMA, VE, VO2pic…) ont été rapportées chez tous les sujets, que le SAOS soit encore, ou non, présent. En effet, ce syndrome s’est normalisé chez 46% d’entre eux. Par ailleurs, grâce à l’intervention, le sommeil s’est amélioré (qualité et quantité). Enfin, la protéine C-réactive basale du groupe SAOS, dont les valeurs atteignaient 11mg/l à l’admission, a considérablement diminué, accompagnée d’une baisse de la leptinémie et d’une hausse de l’adiponectinémie, pouvant expliquer le moindre risque cardio-métabolique. Nos résultats démontrent qu’à l’admission, l’inflammation est liée à l’obésité, alors qu’en post-intervention, sa baisse s’explique par l’augmentation de l’endurance aérobie, et ceci indépendamment du sexe, du poids, de la durée de sommeil et du SAOS. Bien que ce dernier n’ait pas été normalisé chez tous les sujets, sa prévention par l’exercice physique ainsi que celle des troubles métaboliques observés dans ces deux pathologies devrait faire partie intégrante de la prise en charge des jeunes obèses en vue d’atténuer le risque de morbi-mortalité cardiovasculaire à l’âge adulte
Sleep, through its restorative functions, is essential for life. However, lifestyle modifications, sedentary and unhealthy feeding behaviors trigger sleep curtailment and sleep disruption, leading together to weight gain. Obesity is usually associated with obstructive sleep apnea (OSA), and these two diseases both induce metabolic dysfunctions and low-grade systemic inflammation. To the best of our knowledge, no study has assessed the effects of exercise reconditioning and modified food habits on these parameters. The purpose of this work was to assess and compare, from an ancillary study, polysomnographic variables between obese adolescents and normal-weight (NW) controls. In the main study, the effects of a 9-month program (exercise reconditioning, adapted physical activities and modified food habits) on sleep architecture, sleep duration, OSA, biological factors (inflammatory, hormonal, carbohydrates and lipid profiles) and physiological adaptations at exercise were assessed, in order to a better understanding of the roles of cardiorespiratory fitness and sleep disorders on cardio-metabolic health. Thirty-two obese adolescents (age: 14.6 years, BMI z-score: 4.7) were recruited. Every parameters were assessed at admission and post-intervention. Short sleep duration and a high prevalence of OSA (58%) were observed at admission in obese adolescents despite a satisfying sleep architecture, compared with NW controls. Post-intervention, weight loss (11kg) and improved parameters of physiological adaptations at exercise (MAP, VE, VO2peak) were found in every subject and OSA was normalized in 46% of them. Sleep quantity and sleep quality were improved. Decreased C-reactive protein (6.78 vs 10.98 mg/l) and leptin concentrations, and increased adiponectin levels were found, and cardio-metabolic risk (CMR) was decreased. At admission, obesity explains by itself the systemic inflammation whereas the decrease in inflammation, post-intervention, is explained by enhanced cardiorespiratory fitness related to fat-free mass, after controlling for sex, weight loss, change in sleep duration and OSA. Prevention of OSA and metabolic dysfunctions by chronic exercise should be an integral part of the obesity management in youths in order to decrease the risk of cardiovascular morbi-mortality in adulthood

Introdução. A síndrome metabólica (SMet) diminue a capacidade funcional (VO2pico). A apneia obstrutiva do sono (AOS), uma comorbidade frequentemente encontrado nos pacientes com SMet, causa um aumento adicional na atividade nervosa simpática. Testamos as hipóteses que: 1) A sobreposição da SMet e AOS prejudica o VO2pico e as respostas hemodinâmicas, metabólicas e ventilatória durante o teste de esforço cardiopulmonar máximo (TECP); e 2) A hiperativação simpática está envolvida no prejuízo dessas respostas. Métodos. Foram estudados 60 pacientes recém diagnosticados com SMet segundo o ATP-III, sedentários, não medicados, divididos em 2 grupos pelo corte do indíce de apneia-hipopneia (IAH) >= 15 eventos/h: SMet+AOS (49±1,7 anos, n=30), e SMet-AOS (46±1,4 anos, n=30). Um grupo controle saudável pareado por idade foi arrolado (C, 46±1,7 anos, n=16). O IAH foi avaliado pela polissonografia noturna e a atividade nervosa simpática muscular (ANSM) pela microneurografia. No TECP foram avaliados: VO2pico, FC reserva (FCpico-FCrepouso), atenuação da FC na recuperação (deltaFCrec =FCpico-FC no 1º, 2º, 4º e 6º min), comportamento da pressão arterial (PA), duplo produto (PASxFC), ventilação (VE), pulso de oxigênio (VO2/FC), equivalente ventilatório de oxigênio (VE/VO2) e equivalente ventilatório de gás carbônico (VE/VCO2). Resultados. SMet+AOS e SMet-AOS foram semelhantes nas características físicas e nos fatores de risco da SMet. Ambos os grupos com SMet apresentaram maior ANSM comparados com C, sendo que esses níveis foram maiores no SMet+AOS do que no SMet-AOS. O TECP não revelou diferenças nas variáveis ventilatórias e metabólicas entre os grupos. Entretanto, ambos os grupos com SMet apresentaram maiores valores de FCrep e de PAS e PAD (no repouso, durante o exercício, no pico e na recuperação), assim como menor VO2pico e pulso de O2pico, comparados ao C. Ambos os grupos com SMet apresentaram diminuição da FC reserva comparados com C, sendo menor no SMet+AOS comparado com SMet-AOS. SMet+AOS apresentou prejuízo no ?FCrec no 1º (16±2, 18±1 e 24±2 bpm impulsos/min, interação P=0,008), 2º (26±2, 32±2 e 40±3 bpm impulsos/min, interação P < 0,001), 4º (40±2, 50±2 e 61±3 bpm, interação P < 0.001) e 6º min (48±3, 58±2 e 65±3 impulsos/min, interação P < 0,001), enquanto SMet-AOS apresentou prejuízo no ?FCrec no 2º e 4º min comparado com C. Além disso, SMet+AOS apresentou menores valores de deltaFCrec 4º e 6º min comparado ao SMet-AOS. Análises adicionais mostraram uma correlação entre a ANSM e a FCrep (R=-0,37; P < 0,001) e entre a ANSM e o deltaFCrec no 1º (R=-0,35; P=0,004), 2º (R=-0,42; P < 0,001), 4º (R=-0,47; P < 0,001) e 6ºmin (R=-0,35; P=0,006). Conclusão. A sobreposição da AOS diminue o VO2pico e potencializa o prejuízo nas respostas hemodinâmicas durante o exercício e em pacientes com SMet, o que parece ser explicado, pelo menos em parte, pela hiperativação simpática. Portanto, a AOS é uma comorbidade que pode piorar o prognóstico de pacientes com SMet
Introduction. Metabolic syndrome (MetS) decreases functional capacity (peakVO2). Obstructive sleep apnea (OSA), a comorbidity often found in patients with MetS, leads to an additional increase in the sympathetic nerve activity. We tested the hypotheses that: 1) The overlap of MetS and OSA impairs peakVO2 and hemodynamic, metabolic and ventilatory responses during maximal cardiopulmonary exercise testing (CPET); and 2) Sympathetic hyperactivation is involved in this impairment. Methods. We studied 60 newly diagnosed MetS outpatients (ATP III), sedentary, untreated, divided in 2 groups by the cut off the apnea-hypopnea index of (AHI) >= 15 events/h: MetS+OSA (49±1.7yr, n=30), and MetS-OSA (46±1.4yr, n=30). A healthy age-matched control group was also enrolled (C, 46±1.7yr, n=16). The AHI was evaluated by polysomnography and muscle sympathetic nerve activity (MSNA) by microneurography. The variables evaluated from CEPT were: peakVO2, HR reserve (peakHR-restHR), attenuation of HR recovery (deltaHRR=peakHR-HR at 1st, 2nd, 4th and 6th min), blood pressure response (BP), double product (SBPxHR), ventilation (VE), O2 pulse (VO2/HR), ventilatory equivalent ratio for oxygen (VE/VO2) and ventilatory equivalent ratio for carbon dioxide (VE/VCO2). Results. MetS+OSA and MetS-OSA were similar in physical characteristics and risk factors of MetS. Both groups with MetS had higher MSNA compared with C, and these levels were higher in the MetS+OSA compared to MetS-AOS. No differences among groups were found in the CPET on ventilatory and metabolic variables. However, both groups with MetS showed higher restHR, SBP and DBP (at rest, during exercise and at recovery) and lower peakVO2 and peak O2 pulse compared to C. Both MetS groups had lower HR reserve compared with C, with lower levels on MetS+OSA compared with MetS-OSA. MetS+OSA had lower deltaHRR at 1st (16±2, 18±1 and 24±2 bpm, interaction P=0.008), 2nd (26±2, 32±2 and 40±3 bpm, interaction P < 0.001), 4th (40±2, 50±2 and 61±3 bpm, interaction P < 0.001) and 6th min (48±3, 58±2 e 65±3 bpm, interaction P < 0.02), whereas MetS-OSA had lower deltaHRR at 2nd and 4th compared to C. In addition, MetS+OSA had lower deltaHRR at 4th and 6th min compared to MetS-AOS. Further analysis showed association between MSNA with restHR (R=-0,37; P < 0,001) and between MSNA and deltaHRR at 1st (R=-0.35; P=0.004), 2nd (R=-0.42; P < 0.001) 4th (R=-0,47; P < 0,001) and 6thmin (R=-0,35; P=0,006). Conclusion. The overlap of OSA decreases peakVO2 and potentiates the impairement over hemodynamic responses during exercise in patients with MetS, which may be explained, at least in part, by sympathetic hyperactivation. Therefore, OSA is a comorbidity that could worsen the prognosis in MetS patients

碩士
中國醫藥大學
基礎醫學研究所碩士班
101
Metabolic syndrome, also known as insulin resistance syndrome, a metabolic disorder involving multifaceted syndrome, their typical complications include obesity, diabetes. Our research was divided into two parts, involving two kind of typical complications diabetes and obesity, and different natural herbal extracts were given to investigate the effectiveness of our measure. Diabetes and cardiovascular diseases among the top ten causes of death ranked in the second and fifth respectively, and among the diabetes are more causes of death about 80% come from the concurrent cardiovascular diseases. Previous studies point out that diabetes easily cause inflammation, cardiac hypertrophy, myocardial apoptosis and cardiac fibrosis, leading to myocardial remodeling affecting cardiac function and finally cause heart failure. Anthocyanin is a strong antioxidants, and shows effectiveness of cardiovascular protection. Many studies indicate that Anthocyanin could balance blood sugar in whole body. Firstly our aim is to identify if Anthocyanin extracted from purple rice exerts protective effect in diabetes hearts. The five-week-old male Wistar rats were administered with streptozotocin to induce β cells damage, insulin secretion impaired as Type 1 diabetes. Animal were randomly divided into normal group, DM group (by intraperitoneal injection STZ 55 mg / kg), DM plus anthocyanin group (250 mg / kg / day, feeding four weeks). After treatment, the H & E stain, Masson''s trichrome stain, TUNEL, IHC stain and Western Blotting array were applied to observe the changes in heart tissues and protein expression. Secondly our aim is to identify whether Andrographi paniculata extracts could protect myocardial damage in high-fat diet induced obesity mice. Previous results pointed out that the main bioactive ingredient of Andrographi paniculata extract, andrographolide has anti-inflammatory and anti-apoptotic effects. Our research animals were divided into three group of normal, obesity (induced by high fat diet), obesity plus Andrographi paniculata extracts gavage (2 g / kg / day, feeding one week). Same experimental techniques were applied to observe whether Andrographi paniculata extracts could protect high-fat diet-induced obesity heart damage. In the first part of the diabetes, those followed increase of myocardial inflammatory signaling pathways, and further accompanied by cardiac hypertrophy, myocardial apoptosis, fibrosis and associated proteins were significantly expressed. Furthermore, significant reduction of heart function index EF (blood ejection fraction), and FS (systolic fraction) were of served, suggesting the results of myocardial tissue damage and loss of heart function. But these pathological, biochemical and functional indicators were improved significantly by given Anthocyanin. However, we also found myocardial inflammation signaling pathway were increased in the second part of the obese mice, and leads to cardiac hypertrophy, apoptosis. But given the short-term feeding Andrographi paniculata extracts also showed significant inhibition effect. Therefore, our study strongly suggest that Anthocyanin and Andrographi paniculata extracts supplement can be used for prevention and treatment of cardiovascular disease in metabolic syndrome patients.

Oxidative stress is commonly associated with diet-induced metabolic syndrome (MetS) and left ventricular cardiac remodeling, but much remains unknown about the role of redox signaling, sensors, and switches in mediating the effects of high fat and sugar intake. In this work, I describe and apply an optimized method for quantifying changes in reversible protein-cysteine oxidation in the heart. This method uses isobaric tagging of cysteine thiols and mass spectrometry in a modified biotin switch on whole tissue lysate. Analyzing the resulting data with systems biology approaches helped delineate redox pathways playing a role in disease development, while cysteine-specificity provided exact targets for mutation-based mechanistic studies. Initial findings in a mouse model for MetS, wherein C57Bl6J mice were fed a high fat/high sucrose diet, identified energy pathways as the primary target of changing reversible cysteine oxidation. In follow-up studies, our collaborators helped validate the pathophysiological role of two particular cysteines in complex II; their early reversible oxidation and later irreversible oxidation contributed to decreased ATP output from cardiac mitochondria. A subsequent, more robust study revealed a weakness in our original method. While investigating the role of hydrogen peroxide-induced oxidative post-translational modifications (OPTMs) in the development of MetS sequelae, analysis of four mouse groups, each with an n=5, revealed that measurements of reversibly oxidized cysteine thiols were highly variable compared to those of all available thiols. Thus, I developed a strategy to address the source of variability and, in the process, improved many additional steps in the switch protocol. Finally, in an effort to clarify the role of the most stable reversible OPTM, glutathionylation (RSSG), we characterized the HFHS diet response in mice engineered to have more or less RSSG via genetic manipulation of glutaredoxin-1 expression. Those with more RSSG suffered worsened cardiac function, making them an ideal model for future studies with the methods optimized in this work. Studying the progression from poor diet to cardiac involvement in these and other mouse models using the methods described herein will aid in the design of diagnostics and targeted therapies against the growing burden of metabolic CVD.

Cardiovascular and metabolic diseases are still the primary cause of death and disability in modern society. Although genetic factors play a fundamental role in the development of these chronic conditions, the remarkable variability in an individual’s susceptibility to develop these pathologies cannot be completely explained by genetics. The early programming of adult diseases theory became established in the 1980’s, and is now supported by a growing body of evidence demonstrating that exposure to suboptimal environmental conditions during crucial periods of time can predispose an individual to the development of chronic conditions (including cardiovascular and metabolic diseases) later in life. Among the multitude of factors that can cause early programming, we have focused on the study of pregnancy complications leading to fetal hypoxia and causing intrauterine growth restriction (IUGR). To this end, we have used an animal model in which pregnant Sprague Dawley rats were exposed to either normal (∼21% O2) or hypoxic (∼11.5% O2) conditions during the last third of pregnancy. We then followed and studied the cardiovascular and metabolic characteristics of the offspring later in life. The studies presented in this thesis demonstrate that hypoxic prenatal insults have long-term consequences on cardiac structure, function and susceptibility to ischemia. We also demonstrated that programmed susceptibility to myocardial ischemia was associated with changes in cardiac energy metabolism and increased levels of myocardial oxidative stress. Moreover, we described the interaction between prenatal hypoxic insults, aging and sex differences in the later development of cardiovascular conditions. Additional studies presented in this thesis demonstrate that offspring born IUGR are more susceptible to develop most components of the metabolic syndrome when exposed to a high-fat (HF) diet. Furthermore, we also demonstrated that the exacerbated deleterious response to a HF diet described in offspring born IUGR can be prevented by postnatal administration of Resveratrol, which is a natural compound with anti-oxidant and anti-aging properties. In conclusion, the results presented in this thesis are an important contribution to the understanding of the long-term cardiovascular and metabolic effects of prenatal hypoxic insults causing IUGR and provide evidence regarding possible mechanisms and treatment alternatives that could be considered.

The adult heart heavily relies on fatty acid for most of its energy supplies. The heart derives most of the fatty acid from circulation. Hence, fatty acid uptake forms a crucial step in cardiac metabolism. Studies have shown that fatty acid transporters are upregulated during cardiac metabolic syndrome. This results in the accumulation of lipids in the heart leading to cardiac lipotoxicity. To test the role of SIRT6 in fatty acid uptake in the heart, we examined SIRT6 levels in diabetic mice models. Our analysis suggested that SIRT6 was downregulated in the heart of diabetic mice. In addition to this, there was a concomitant increase in the expression of fatty acid transporters in the heart of diabetic mice. In line with these results, an increase in fatty acid uptake in the SIRT6 depleted cardiomyocytes. Moreover, SIRT6 depleted cardiomyocytes have increased lipid accumulation. In addition to this, SIRT6 overexpression significantly attenuated fatty acid uptake as well as fatty acid accumulation. Further, we found SIRT6 regulates fatty acid uptake irrespective of the cell type suggesting a global role. Interestingly, our results suggest that SIRT6 regulates fatty acid uptake independent of its catalytic activity. Both wild-type and catalytic mutants of SIRT6 attenuate fatty acid uptake, concomitantly downregulating the fatty acid transporters in cardiomyocytes. Previous studies indicate that most of the fatty acid transporters' expression is governed transcriptionally under the control of peroxisome proliferator-activated receptors (PPAR). In line with this, we found SIRT6 and PPARγ are interacting partners. Further, our molecular docking experiment suggested SIRT6 interacts with the DNA binding domain of PPARγ. Our chromatin immunoprecipitation experiment showed that SIRT6 binds to the promoters of fatty acid transporters. Mechanistically, SIRT6 haploinsufficiency increased PPARγ occupancy on the promoters of fatty acid transporters. Moreover, inhibiting PPARγ using pharmacological inhibitors significantly rescued both fatty acid uptake and fatty acid accumulation in the cardiomyocytes. Together, our findings reveal a novel role of SIRT6 in regulating cardiac fatty acid transport and lipotoxicity.

Myotonic dystrophy type 1 (DM1) is an autosomal dominant hereditary disease caused by an alteration leading to an abnormal expansion of unstable repetitions of CTG in the 3’ untranslated region of Myotonic Dystrophy Protein Kinase (DMPK) gene. DM1 is characterized by myotonia, progressive distal muscle weakness and by multisystemic involvement namely cataracts, muscle pain, cardiac and respiratory dysfunctions, endocrine dysfunctions (insulin resistance, metabolic syndrome, dyslipidemia), cancer and alterations in the central nervous system (CNS). Patients with DM1 have a frequency of metabolic syndrome higher than in the general population. Thus, the study of the metabolome is of a great importance since it can give new insight regarding the molecular pathways affected in DM1 diseases as well as to discriminate between the different degrees of severities in patients with DM1 and may also, lead to the development of new metabolic therapeutics. Given the previously reported metabolic alterations observed in patients DM1, we considered that the evaluation of the metabolic profile of those patients of paramount importance. Therefore, we started with the literature review for summarizing the metabolic alterations previously reported in patients with DM1 and the relationship of Lipin with the metabolic alterations in DM1 (Chapter I). Essentially, the previous studies showed a clear metabolic alteration between patients with DM1 and control groups, namely, increased total cholestrol, Low-density lipoprotein, triacylglycerol, insulin and HOMA-Insulin resistance levels, increased glucose levels and low levels of high-density lipoprotein. This review also showed a potential relationship between Lipin and its association with metabolic abnormalities found in patients with DM1, namely, the metabolic roles in adipose tissue, skeletal-muscle, liver and its association with dyslipidemia and insulin resistance, which is a characteristic feature in patients with DM1. The metabolic profile of patients with DM1 then was evaluated using the ATR-FTIR spectroscopy technique, together with multivariate analysis, which is suitable for providing a (bio)chemical profile of patients with DM1 and controls. Essentially, DM1-derived fibroblast and controls were used, and the results showed a clear discrimination within DM1-derived fibroblast with different CTG repeat length and age at onset, meaning that they may have a distinct metabolic profile. This discrimination can be attributed mainly to the altered lipid metabolism in 1800-1500 region cm-1 . It was also possible to discriminate between the control groups and both DM1-derived fibroblast from Coriell institute and Centro Hospitalar do Tâmega e Sousa in 3000-2800 cm-1 region (Chapter II). Additionally, a systematic review was made to gather information of all outcome and measurements used to assess muscle strength in adult patients with DM1 (Chapter IV). The cardiac, skeletal and respiratory muscle strength was evaluated. Briefly, the systematic review showed a consistent use of echocardiography, quantitative muscle test, manual muscle test and manometry to assess cardiac, skeletal and respiratory muscle strength. The measures of choice to assess muscle strength were: (1) ejection fraction in cardiac muscle; (2) muscle isometric torque, grip strength and medical research council (0-5 points and 0-60 points) in skeletal-muscle; (3) maximal inspiratory pressure and maximal expiratory pressure in respiratory muscles. In conclusion, our results suggest that there is a need to further research the lipid metabolism of patients with DM1, not only to better characterize these patients but also to understander the underlying mechanism of lipid abnormalities and to have new insights of Lipin in DM1. FTIR spectroscopy is a valuable tool to characterize patients with DM1 severities, which is crucial for a proper diagnosis and further studies. We successfully gather the more consensual and important measures to evaluate muscle strength. The results obtained were important and useful given that they will be valuable for muscle strength evaluation in future clinical trials and observational studies, particularly to test if a drug is improving muscle strength in patients with DM1.
A distrofia miotônica tipo 1 (DM1) é uma doença hereditária autossómica dominante causada por uma alteração que leva a uma expansão anormal de repetições instáveis de CTG na região 3' não traduzida do gene da proteína quinase da distrofia miotônica (DMPK). DM1 é caracterizado por miotonia, fraqueza muscular distal progressiva e por envolvimento multissistémica, nomeadamente cataratas, dores musculares, disfunções cardíacas e respiratórias, disfunções endócrinas (resistência à insulina, síndrome metabólica, dislipidemia), cancro e alterações no sistema nervoso central (SNC). Doentes com DM1 apresentam frequência de síndrome metabólica maior do que na população geral. Assim, o estudo do metaboloma é de grande importância, pois pode fornecer novos ideias sobre as vias moleculares afetadas nas doenças DM1, bem como discriminar entre os diferentes graus de gravidade em doentes com DM1 e também pode levar ao desenvolvimento de novas terapêuticas metabólicas. Dadas as alterações metabólicas previamente descritas e observadas em doentes com DM1, consideramos que a avaliação do perfil metabólico destes doentes é de grande importância. Portanto, elaborou-se uma revisão da literatura para resumir as alterações metabólicas previamente descritas em doentes com DM1 e a relação da Lipina com as alterações metabólicas na DM1 (Capítulo I). Essencialmente, os estudos anteriores mostraram uma clara alteração metabólica entre os doentes com DM1 e os grupos controlo, nomeadamente o aumento dos níveis de colesterol total, lipoproteína de baixa densidade, triacilglicerol, insulina e resistência HOMA-insulina, o aumento dos níveis de glicose, assim como a diminuição dos níveis de lipoproteína de alta densidade. Esta revisão também demonstrou uma potencial relação entre a Lipina e a sua associação com as anormalidades metabólicas encontradas em doentes com DM1, nomeadamente os papéis metabólicos no tecido adiposo, músculo esquelético, fígado e a sua associação com a dislipidemia e a resistência à insulina, que é uma das características em doentes com DM1. O perfil metabólico dos doentes com DM1 foi então avaliado pela técnica de espectroscopia ATR FTIR, em conjunto com a análise multivariada, sendo que é adequada para fornecer um perfil (bio) químico dos doentes com DM1 e controlos. Essencialmente, fibroblastos derivados de DM1 e controlos foram utilizados, e os resultados demonstraram uma clara discriminação dentro de fibroblastos derivados de DM1 com diferentes repetições de CTG e idades de início da doença, o que significa que estes podem ter um perfil metabólico distinto. Esta discriminação pode ser atribuída principalmente ao metabolismo lipídico alterado na região 1800-1500 cm-1 . Também foi possível discriminar entre os grupos controlo e fibroblastos derivados de DM1 do Instituto Coriell e Centro Hospitalar do Tâmega e Sousa na região de 3000-2800 cm-1 (Capítulo II). Além disso, foi feita uma revisão sistemática para reunir informações de todos os resultados e medidas utilizadas para avaliar a força muscular em doentes adultos com DM1 (Capítulo IV). Foi avaliada a força muscular cardíaca, esquelética e respiratória. Resumidamente, a revisão sistemática demonstrou uma utilização consistente da ecocardiografia, teste muscular quantitativo, teste muscular manual e manometria para avaliar a força muscular cardíaca, esquelética e respiratória. As medidas escolhidas para avaliar a força muscular foram: (1) fração de ejeção para a força do musculo cardíaco; (2) torque isométrico muscular, força de preensão e conselho de pesquisa médica (0-5 pontos e 0-60 pontos) para a força do músculo esquelético; (3) pressão inspiratória máxima e pressão expiratória máxima para a força dos músculos respiratórios. Em conclusão, os resultados sugerem que há uma necessidade de estudos adicionais relativamente ao metabolismo lipídico em doentes com DM1, não apenas para caracterizar melhor estes doentes, como também para compreender o mecanismo subjacente das anormalidades lipídicas e ter novas noções sobre a Lipina na DM1. A espectroscopia FTIR é uma ferramenta valiosa para caracterizar doentes com diferentes severidades da DM1, o que é crucial para um diagnóstico adequado e para estudos futuros. Reunimos com sucesso as medidas mais consensuais e importantes para avaliar a força muscular. Os resultados obtidos foram importantes e úteis, pois serão valiosos para avaliação da força muscular em futuros ensaios clínicos e estudos observacionais, principalm
Mestrado em Biologia Molecular e Celular

Le sommeil, de par ses fonctions récupératrices, est essentiel à la vie. Pour autant, la modification du mode de vie et des comportements, tant sédentaires que nutritionnels, sont à l’origine d’une altération du sommeil, conduisant ensemble à des situations d’obésité. Cet excès pondéral s’accompagne fréquemment d’un syndrome d’apnées obstructives du sommeil (SAOS). Lorsque ces deux pathologies sont présentes, les troubles métaboliques s’aggravent et sont à l’origine d’une inflammation de bas grade. A notre connaissance, aucune étude ne s’est intéressée aux bénéfices d’un reconditionnement à l’exercice physique combiné à une modification des habitudes alimentaires, en dehors de ceux induits par la perte de poids, sur ces différents paramètres. L’objectif de ce travail de thèse a donc été, à partir d’une étude ancillaire, d’évaluer le sommeil d’adolescents obèses par polysomnographie (PSG) par comparaison à celui de sujets normo-pondérés. Dans l’étude principale, les effets d’un programme de 9 mois (reconditionnement à l’exercice, activités physiques adaptées, rééquilibre alimentaire) ont été évalués sur l’architecture et la durée du sommeil, le SAOS, les différents facteurs biologiques (inflammatoires, hormonaux, profils glucidique et lipidique) et sur les adaptations physiologiques à l’exercice musculaire, afin de mieux comprendre l’implication de l’endurance aérobie et des troubles du sommeil sur la santé cardio-métabolique. Trente-deux adolescents obèses (âge : 14,6 ans, z-score d’IMC= 4 ,7) ont été recrutés. Toutes les variables ont été analysées en pré et post-intervention. Les résultats montrent une durée de sommeil réduite chez les jeunes obèses avec un SAOS, diagnostiqué chez 58% d’entre eux, malgré une architecture du sommeil satisfaisante. En post-intervention, une perte de poids de 11 kg et une amélioration des paramètres d’adaptation à l’exercice maximal (PMA, VE, VO2pic…) ont été rapportées chez tous les sujets, que le SAOS soit encore, ou non, présent. En effet, ce syndrome s’est normalisé chez 46% d’entre eux. Par ailleurs, grâce à l’intervention, le sommeil s’est amélioré (qualité et quantité). Enfin, la protéine C-réactive basale du groupe SAOS, dont les valeurs atteignaient 11mg/l à l’admission, a considérablement diminué, accompagnée d’une baisse de la leptinémie et d’une hausse de l’adiponectinémie, pouvant expliquer le moindre risque cardio-métabolique. Nos résultats démontrent qu’à l’admission, l’inflammation est liée à l’obésité, alors qu’en post-intervention, sa baisse s’explique par l’augmentation de l’endurance aérobie, et ceci indépendamment du sexe, du poids, de la durée de sommeil et du SAOS. Bien que ce dernier n’ait pas été normalisé chez tous les sujets, sa prévention par l’exercice physique ainsi que celle des troubles métaboliques observés dans ces deux pathologies devrait faire partie intégrante de la prise en charge des jeunes obèses en vue d’atténuer le risque de morbi-mortalité cardiovasculaire à l’âge adulte
Sleep, through its restorative functions, is essential for life. However, lifestyle modifications, sedentary and unhealthy feeding behaviors trigger sleep curtailment and sleep disruption, leading together to weight gain. Obesity is usually associated with obstructive sleep apnea (OSA), and these two diseases both induce metabolic dysfunctions and low-grade systemic inflammation. To the best of our knowledge, no study has assessed the effects of exercise reconditioning and modified food habits on these parameters. The purpose of this work was to assess and compare, from an ancillary study, polysomnographic variables between obese adolescents and normal-weight (NW) controls. In the main study, the effects of a 9-month program (exercise reconditioning, adapted physical activities and modified food habits) on sleep architecture, sleep duration, OSA, biological factors (inflammatory, hormonal, carbohydrates and lipid profiles) and physiological adaptations at exercise were assessed, in order to a better understanding of the roles of cardiorespiratory fitness and sleep disorders on cardio-metabolic health. Thirty-two obese adolescents (age: 14.6 years, BMI z-score: 4.7) were recruited. Every parameters were assessed at admission and post-intervention. Short sleep duration and a high prevalence of OSA (58%) were observed at admission in obese adolescents despite a satisfying sleep architecture, compared with NW controls. Post-intervention, weight loss (11kg) and improved parameters of physiological adaptations at exercise (MAP, VE, VO2peak) were found in every subject and OSA was normalized in 46% of them. Sleep quantity and sleep quality were improved. Decreased C-reactive protein (6.78 vs 10.98 mg/l) and leptin concentrations, and increased adiponectin levels were found, and cardio-metabolic risk (CMR) was decreased. At admission, obesity explains by itself the systemic inflammation whereas the decrease in inflammation, post-intervention, is explained by enhanced cardiorespiratory fitness related to fat-free mass, after controlling for sex, weight loss, change in sleep duration and OSA. Prevention of OSA and metabolic dysfunctions by chronic exercise should be an integral part of the obesity management in youths in order to decrease the risk of cardiovascular morbi-mortality in adulthood