Observational study on efficacy of negative expiratory pressure test proposed as screening for obstructive sleep apnea syndrome among commercial interstate bus drivers - protocol study

Background: Obstructive sleep apnea (OSA) is a respiratory disease characterized by the collapse of the extrathoracic airway and has important social implications related to accidents and cardiovascular risk. The main objective of the present study was to investigate whether the drop in expiratory flow and the volume expired in 0.2 s during the application of negative expiratory pressure (NEP) are associated with the presence and severity of OSA in a population of professional interstate bus drivers who travel medium and long distances.Methods/Design: An observational, analytic study will be carried out involving adult male subjects of an interstate bus company. Those who agree to participate will undergo a detailed patient history, physical examination involving determination of blood pressure, anthropometric data, circumference measurements (hips, waist and neck), tonsils and Mallampati index. Moreover, specific questionnaires addressing sleep apnea and excessive daytime sleepiness will be administered. Data acquisition will be completely anonymous. Following the medical examination, the participants will perform a spirometry, NEP test and standard overnight polysomnography. The NEP test is performed through the administration of negative pressure at the mouth during expiration. This is a practical test performed while awake and requires little cooperation from the subject. In the absence of expiratory flow limitation, the increase in the pressure gradient between the alveoli and open upper airway caused by NEP results in an increase in expiratory flow.Discussion: Despite the abundance of scientific evidence, OSA is still underdiagnosed in the general population. In addition, diagnostic procedures are expensive, and predictive criteria are still unsatisfactory. Because increased upper airway collapsibility is one of the main determinants of OSA, the response to the application of NEP could be a predictor of this disorder. With the enrollment of this study protocol, the expectation is to encounter predictive NEP values for different degrees of OSA in order to contribute toward an early diagnosis of this condition and reduce its impact and complications among commercial interstate bus drivers.

Local and regional features of surface radiation fluxes over the tropical Atlantic ocean near Sao Pedro and Sao Paulo archipelago: Evidence of small scale upwelling

To properly describe the interactions between the ocean and atmosphere, it is necessary to assess a variety of time and spatial scales phenomena. Here, high resolution oceanographic and meteorological data collected during an observational campaign carried out aboard a ship in the tropical Atlantic Ocean, on May 15-24, 2002, is used to describe the radiation balance at the ocean interface. Data collected by two PIRATA buoys, along the equator at 23°W and 35°W and satellite and climate data are compared with the data obtained during the observational campaign. Comparison indicates remarkable similarity for daily and hourly values of radiation fluxes components as consequence of the temporal and spatial consistence presented by the air and water temperatures measured in situ and estimated from large scale information. The discrepancy, mainly in the Sao Pedro and Sao Paulo Archipelago area, seems to be associated to the local upwelling of cold water, which is not detected in all other estimates investigated here. More in situ data are necessary to clarify whether this upwelling flow has a larger scale effect and what are the meteorological and oceanographic implications of the local upwelling area on the tropical waters at the Brazilian coast.