Transitory increased blood pressure after upper airway surgery for snoring and sleep apnea correlates with the apnea-hypopnea respiratory disturbance index

A transitory increase in blood pressure (BP) is observed following upper airway surgery for obstructive sleep apnea syndrome but the mechanisms implicated are not yet well understood. The objective of the present study was to evaluate changes in BP and heart rate (HR) and putative factors after uvulopalatopharyngoplasty and septoplasty in normotensive snorers. Patients (N = 10) were instrumented for 24-h ambulatory BP monitoring, nocturnal respiratory monitoring and urinary catecholamine level evaluation one day before surgery and on the day of surgery. The influence of postsurgery pain was prevented by analgesic therapy as confirmed using a visual analog scale of pain. Compared with preoperative values, there was a significant (P < 0.05) increase in nighttime but not daytime systolic BP (119 ± 5 vs 107 ± 3 mmHg), diastolic BP (72 ± 4 vs 67 ± 2 mmHg), HR (67 ± 4 vs 57 ± 2 bpm), respiratory disturbance index (RDI) characterized by apnea-hypopnea (30 ± 10 vs 13 ± 4 events/h of sleep) and norepinephrine levels (22.0 ± 4.7 vs 11.0 ± 1.3 µg l-1 12 h-1) after surgery. A positive correlation was found between individual variations of BP and individual variations of RDI (r = 0.81, P < 0.01) but not between BP or RDI and catecholamines. The visual analog scale of pain showed similar stress levels on the day before and after surgery (6.0 ± 0.8 vs 5.0 ± 0.9 cm, respectively). These data strongly suggest that the cardiovascular changes observed in patients who underwent uvulopalatopharyngoplasty and septoplasty were due to the increased postoperative RDI.

Trajetória do crescimento da cidade de Colatina

It approaches the growth of the city of Colatina-ES, the county seat that has urban economy and urban population, and territory with most of the rural area. Rural areas, however, contribute little to the city s economy and are largely environmentally degraded, idle and waiting for recovery. The objective is to understand the growth of the city of Colatina, and the factors and consequences of this growth. Land division projects, investments and interventions in urban and rural areas were collected for the analysis. As a median-sized city characterized by central and regional polarity, but outside of the main investments in the state, Colatina seeks to take advantage of its situation of commercial warehouse city and road junction to stay alive in the regional economy. The citys economy is based on trade and services, but seeks to attract investment to the industry and logistics. The expansion of the city since the early formation follows the road system, which creates a dispersed spatiality. The characteristics of the urban growth of Colatina are the result of economic development strategies, interests in the property market and a government that abstains from urban control. These factors lead a sprawl urbanization that presents itself costly and not sustainable for urban and rural areas because it creates segregation, higher infrastructure costs, low-density and monofunctional urban spaces, pollution, and worsening of environmental depletion. The challenges for sustainable growth of the city of Colatina depends on a municipal and regional planning, which qualifies and diversifies its urban areas, avoids unnecessary expansion of the urban perimeter, retrieves its environmental degraded areas and leverages the agricultural activities in a productive and less aggressive way to the environment