Exploring the cardiovascular disease continuum: blood pressure and target organ damage

Introduction The objectives of this thesis are to: (1) examine how ambulatory blood pressure monitoring (ABPM) refines office blood pressure (BP) measurement; (2) determine if absolute ambulatory BP or dipping status is better associated with target organ damage (TOD); (3) explore the association of isolated nocturnal hypertension (INH) with TOD; and (4) investigate the association of night-time BP with ultrasound markers of cardiovascular damage. Methods Data from the Mitchelstown Cohort Study was analysed to deliver objectives 1 and 2. Objective 3 was addressed by a systematic review and analysis of data from the Mitchelstown Study. A sample of participants from the Mitchelstown Study underwent an echocardiogram for speckle tracking analysis and carotid ultrasound to achieve objective 4. Results ABPM reclassifies hypertension status in approximately a quarter of individuals, with white coat and masked hypertension prevalence rates of 11% and 13% respectively. Night-time systolic BP is better associated with TOD than daytime systolic BP and dipping level. In multi-variable models the odds ratio (OR) for LVH was 1.4 (95% CI 1.1 -1.8) and for albumin:creatinine ratio ≥ 1.1 mg/mmol was 1.5 (95% CI 1.2 – 1.8) for each 10 mmHg rise in night-time systolic BP. The evidence for the association of INH with TOD is inconclusive. Night-time systolic BP is significantly associated with global longitudinal strain (GLS) (beta coefficient 0.85 for every 10 mmHg rise, 95% CI 0.3 – 1.4) and carotid plaques (OR 1.9 for every 10 mmHg rise, 95% CI 1.1 – 3.2) in univariable analysis. The findings persist for GLS in sex and age adjusted models but not in multivariable models. Discussion Hypertension cannot be effectively managed without using ABPM. Night-time systolic BP is better associated with TOD than daytime systolic BP and dipping level, and therefore, may be a better therapeutic target in future studies.

Towards Night

Sixty artists explore the nocturnal. Curated by Tom Hammick. The evening hour too gives us the irresponsibility which darkness and lamplight bestow. We are no longer quite ourselves. – Virginia Woolf, Street Haunting: A London Adventure, 1930 Towards Night is an exhibition exploring the nocturnal through paintings, prints and drawings by over sixty artists. Drawing on the nineteenth century European Romantic tradition, the show surveys contemporary and historical connections to wonderment and dystopia at dusk, twilight, night and dawn. Towards Night juxtaposes key paintings and prints by Constable, Friedrich, Munch, Nolde, Palmer and Turner, some of the best known visionaries of the Romantic tradition with contemporary artists who work with the transformative aspects of nightfall to convey emotional responses of awe, anxiety and solitude, love and loss, revelry, insomnia, and journey’s end. The exhibition opens with direct and positive responses to the natural world; Marc Chagall’s exotic dreamlike evening in The Poet Reclining (1915) sits close to eighteenth century Indian miniatures depicting brightly painted figures offset against darkening monsoon clouds, and William Crozier’s Balcony at Night, Antibes (2007), of a plant, blue and iridescent against the cool night sky. As the exhibition progresses, the dystopias become darker and more disturbing, and the connections between artists and works intensify: Emma Stibbon’s Rome Aqueduct (2011) takes on a heightened sense of pathos alongside Caspar David Friedrich’s Winter Landscape (1811); Peter Doig’s cinematic Echo Lake (1998) conjures up an increased sense of contemporary angst; and Prunella Clough’s False Flower (1993), a magical tree defying brutalism by growing out of concrete, becomes more miraculous near Night Shift (2015) Nick Carrick’s tomblike high rise. Tom Hammick’s Violetta Alone (2015) and Michael Craig Martin’s Ash Tray (2015), reinforce hedonistic aspects of night-time revelry alongside Four AM, Betsy Dadd’s young woman drinking in the early hours of the morning and L.S. Lowry’s drunken people in a pub in The Crowd (1922). In the final room, a cluster of works explores dreams and insomnia, from Louise Bourgeois’ Spirals (2010) to Munch’s lovers embracing in The Kiss (1902). Tom Hammick, curator of the show said “This exhibition has grown way beyond its original conception, to become a magnificent survey of painting and printmaking from over two hundred years based around the central tenet of night. The exhibition is a kind of painterly response to the way figurative artists use their artistic heroes as starting points for their own work, both compositionally and emotionally.” Artists featured in Towards Night: Christiane Baumgarter, Michael Craig-Martin, Julian Opie, Will Gill, Merlin James, Howard Hodgkin, WillIam Scott, Patrick Caulfield, George Shaw, Stephen Chambers, Basil Beattie, Betsy Dadd, Christopher Le Brun, L.S Lowry, Andrew Cranston, David Willetts, James Fisher, Emma Stibbon, Vija Celmins, William Blake, William Crozier, Tom Hammick, Georgia Keeling, Helen Turner, Humphrey Ocean, Julian Bell, Craigie Aitchison, Mark Wright, Ken Kiff, Matthew Burrows, Andrzej Jackowski, Sarah Raphael, Nick Bodimeade, Nick Carrick, Mary Newcomb, Hurvin Anderson, Peter Doig, Phoebe Unwin, Danny Markey, Sara Lee, Simon Burton, Susie Hamilton, Marc Chagall, Alfred Wallis, Emil Nolde, J.M.W. Turner, Prunella Clough, Samuel Palmer, Louise Bourgeois, Caspar David Friedrich, Alex Katz, Ewan Gibbs, Susie Hamilton, Andrzej Jackowski, Amanda Vesey, Edward Stott, Gertrude Hermes, Rose Wylie, Sidney Nolan, John Constable, J.M.W. Turner, Emil Nolde, Hiroshige, Edvard Munch, Samuel Palmer, Eileen Cooper, Charles Neame-Spencer, Samantha Cary.

Diurnal and seasonal variations in the duration and depth of the longest dives in southern elephant seals (Mirounga leonina): possible physiological and behavioural constraints

This study seeks to understand how the physiological constraints of diving may change on a daily and seasonal basis. Dive data were obtained from southern elephant seals (Mirounga leonina) from South Georgia using satellite relay data loggers. We analysed the longest (95th percentile) dive durations as proxies for physiological dive limits. A strong, significant relationship existed between the duration of these dives and the time of day and week of year in which they were performed. The depth of the deepest dives also showed a significant, but far less consistent, relationship with local time of day and season. Changes in the duration of the longest dives occurred irrespective of their depth. Dives were longest in the morning (04:00-12:00 h) and shortest in the evening (16:00-00:00 h). The size of the fluctuation varied among animals from 4.0 to 20.0 min. The daily pattern in dive depth was phase-shifted in relation to the diurnal rhythm in dive duration. Dives were deeper at midday and shallower around midnight. Greater daily changes in duration occurred in seals feeding in the open ocean than in those foraging on the continental shelf. The seasonal peak in the duration of the longest dives coincided with austral midwinter. The size of the increase in dive duration from autumn/spring to winter ranged from 11.5 to 30.0 min. Changes in depth of the longest dives were not consistently associated with particular times of year. The substantial diurnal and seasonal fluctuations in maximum dive duration may be a result of changes in the physiological capacity to remain submerged, in addition to temporal changes in the ecological constraints on dive behaviour. We speculate about the role of melatonin as a hormonal mediator of diving capability.

Circadian variation with a diurnal bimodal profile on scent-marking behavior in captive common marmosets (callitrhix jacchus)

Scent-marking behavior is associated with different behavioral contexts in callitrichids, including signalizing a territory, location of feeding resources, and social rank. In marmosets and tamarins it is also associated with intersexual communication. Though it appears very important for the daily routine of the individuals, very few researchers have investigated distribution through the 24-h cycle. In a preliminary report, we described a preferential incidence of this behavior 2 h before nocturnal rest in families of common marmosets. We expand the data using 8 family groups (28 subjects), 8 fathers, 6 mothers, 8 nonreproductive adults (4 sons and 4 daughters), and 6 juvenile (3 sons and 3 daughters) offspring that we kept in outdoor cages under natural environmental conditions. We recorded the frequency of anogenital scent marking for each group during the light phase, twice a wk, for 4 consecutive wks, from March 1998 to September 1999. Cosinor test detected 24- and 8-h variations in 89.3% and 85.7% of the subjects, respectively, regardless of sex or reproductive status. The 8-h component is a consequence of the 2 peaks for the behavior, at the beginning and end of the light phase. Daily distribution of scent marking is similar to that others described previously for motor activity in marmosets. The coincident rhythmical patterns for both behaviors seem to be associated with feeding behavior, as described for callitrichids in free-ranging conditions, involving an increase in foraging activities early in the morning and shortly before nocturnal rest

Educação financeira no ensino médio: uma abordagem por meio da análise de produtos financeiros com ênfase em consórcios

This paper presents a differential approach of financial mathematics developed in high school, focusing on financial education. We seek through the insertion of texts, analysis of some financial products and by the interpretation of problems to contribute to the financial training of students. Aiming to make financial mathematics more attractive and accessible to the day-today, there are available for studies some practical tools like the citizen calculator which are available for computers and mobile phones. As well as spreadsheets and software Geogebra, that allow you to compare and analyze the financial costs of consortia, financing and financial applications,in addition to being allied in the preparation and control of personal and family budget. By applying the teaching sequence proposed in a nocturnal class of high school, we realized some difficulties that have limited the financial learning of math concepts.Yet identified progress regarding the financial education of students. These observations were made through qualitative and quantitative analysis from notes in the field diary and also answers given by students in specific form.

Dingoes at the Doorstep: Home Range Sizes and Activity Patterns of Dingoes and Other Wild Dogs around Urban Areas of North-Eastern Australia

Top-predators around the world are becoming increasingly intertwined with humans, sometimes causing conflict and increasing safety risks in urban areas. In Australia, dingoes and dingo � domestic dog hybrids are common in many urban areas, and pose a variety of human health and safety risks. However, data on urban dingo ecology is scant. We GPS-collared 37 dingoes in north-eastern Australia and continuously monitored them each 30 min for 11–394 days. Most dingoes were nocturnal, with an overall mean home range size of 17.47 km2. Overall mean daily distance travelled was 6.86 km/day. At all times dingoes were within 1000 m of houses and buildings. Home ranges appeared to be constrained to patches of suitable vegetation fragments within and around human habitation. These data can be used to reallocate dingo management effort towards mitigating actual conflicts between humans and dingoes in urban areas.

Tendências das aves noturnas em Portugal: metodologias e análise de um programa de monitorização baseado em colaboradores voluntários

Uma avaliação das metodologias de análise e recolha de dados aplicadas pelo Programa NOCTUAPortugal é de extrema importância para se apurar se estas são as mais indicadas em estudos de citizen science. Comparou-se os resultados de diferentes metodologias analíticas de estimação das tendências populacionais das espécies de aves noturnas durante o período de realização do Programa NOCTUA-Portugal (análise gráfica simples, modelos lineares generalizados (GLM-Poisson e GLMM), modelos aditivos generalizados (GAM-LOESS e GAM-mgcv) e software TRIM). Analisou-se a metodologia de censo de modo a avaliar o número de registos face à duração dos pontos de escuta, comparar a eficiência do ponto de deteção com outros estudos, variação das respostas ao longo da noite e efeito da época do ano, vento, nebulosidade e luminosidade da lua. Os resultados mostraram que a metodologia analítica mais indicada era o GLMM e que não era necessário realizar nenhum ajuste em particular na metodologia de censo; Trends in nocturnal birds in Portugal Methods and analysis of a volunteer-based monitoring program ABSTRACT: An evaluation of the methodologies of analysis and data collection applied by NOCTUA-Portugal Program is extremely important to determine whether these are the most suitable in citizen science studies. We compared the results of different analytical methodologies to estimate population trends of the species of nocturnal birds during the period of the NOCTUA-Portugal Program (simple graphical analysis, generalized linear models (GLM-Poisson and GLMM), generalized additive models (GAM-LOESS and GAMmgcv) and software TRIM). We analyzed the field methodology to assess the effect of point duration on the number of records, compared the point count efficiency with other sources, the variation of responses throughout the night, the effect of time of year, wind, cloud cover and moon luminosity. The results showed that the most suitable analytical methodology was the GLMM and it was not necessary to make any particular adjustment in the field methodology.

Neustonic distribution of decapod planktonic stages and competence of brachyuran megalopae in coastal waters

Settlement rate may not reflect larval supply to coastal waters in different marine invertebrates and demersal fishes. The importance of near-shore oceanography and behaviour of late larval stages may be underestimated. The present study conducted neustonic sampling over station grids and along full-length transects at two embayments in south-eastern Brazil to (1) compare diurnal and nocturnal occurrence of most frequent decapod stages to assess their vertical movements, (2) describe the formation of larval patches and (3) measure competence of crab megalopae according to their distance to recruitment grounds. Several shrimp species apparently undergo a diel vertical migration, swimming crab megalopae showed no vertical movements and megalopae of the intertidal crab Pachygrapsus transversus revealed a reversed vertical migration. During the day, crab megalopae aggregated in convergence zones just below surface slicks. These larvae consisted of advanced, pre-moult stages, at both mid-bay and near-shore patches. Competence, measured as the time to metamorphosis in captivity, was similar between larval patches within each taxon. Yet, subtidal portunids moulted faster to juveniles than intertidal grapsids, possibly because they were closer to settlement grounds. Megalopae of Pachygrapsus from benthic collectors moulted faster than those from bay areas. These results suggest that alternative vertical migration patterns of late megalopae favour onshore transport, and actual competence takes place very close to suitable substrates, where larvae may remain for days before settlement. Lack of correlation between larval supply and settlement for Pachygrapsus suggests that biological processes, besides onshore transport, may play an important role in determining settlement success of coastal crabs.

A field study to describe diel, tidal and semilunar rhythms of larval release in an assemblage of tropical rocky shore crabs

Available information on the larval release rhythms of brachyurans is biased to temperate estuarine species and outcomes resulting from some sort of artificial manipulation of ovigerous females. In this study we applied field methods to describe the larval release rhythms of an assemblage of tropical rocky shore crabs. Sampling the broods of ovigerous females of Pachygrapsus transversus at two different shores indicated a spatially consistent semilunar pattern, with larval release maxima around the full and new moon. Yet, synchronism between populations varied considerably, with the pattern obtained at the site exposed to a lower wave action far more apparent. Breeding cohorts at one of the sampled shores apparently belonged to actual age groups composing the ovigerous population. The data suggest that these breeding groups release their larvae in alternate syzygy periods, responding to a lunar cycle instead of the semilunar pattern observed for the whole population. For the description of shorter-term rhythms, temporal series at hour intervals were obtained by sampling the plankton and confinement boxes where ovigerous females were held. Unexpectedly, diurnal release activity prevailed over nocturnal hatching. Yet, only grapsids living higher on the shore exhibited strong preferences over the diel cycle, with P. transversus releasing their larvae during the day and Geograpsus lividus during the night. The pea crab Dissodactylus crinitichelis, the spider crab Epialtus brasiliensis and a suite of xanthoids undertook considerable releasing activity in both periods. Apart from the commensal pea crab D. crinitichelis, all other taxa revealed tide-related rhythms of larval release, with average estimates of the time of maximum hatching always around the time of high tides; usually during the flooding and slack, rather than the ebbing tide. Data obtained for P. transversus females held in confinement boxes indicated that early larval release is mostly due to nocturnal hatching, while zoeal release in diurnal groups took place at the time of high tide. Since nocturnal high tides at the study area occurred late, sometimes close to dusk, early release would allow more time for offshore transport of larvae when the action of potential predators is reduced.

Influência do zinco suplementar na maturação biológica e no crescimento de jovens atletas de futebol do sexo masculino

Introdução O zinco é um importante elemento traço que auxilia na capacidade antioxidante, além de participar da maturação biológica. Em atletas, a suplementação de zinco tem efeito positivo nos parâmetros hematológicos e pode melhorar o rendimento esportivo. Sua deficiência é comumente observada nesses grupo e pode estar associada à diminuição da força física assim como da massa corporal, além de ter efeito significativo no crescimento. Assim os objetivos do presente estudo foram: comparar os métodos de avaliação da maturidade biológica e suas relações com variáveis antropométricas e de rendimento físico de acordo com o estado de zinco em jovens jogadores de futebol; comparar diferentes métodos de avaliação da composição corporal em jovens jogadores de futebol esratificados de acordo com os níveis plasmáticos de zinco e investigar o efeito do zinco suplementar na maturação biológica, no crescimento, na composição corporal e na força muscular de jogadores de futebol púberes do sexo masculino. Materiais e métodos Foram avaliados em dois momentos 48 jovens do sexo masculino (13±1 anos, massa corporal de 48±10kg, estatura de 160±10cm e zinco plasmático de 12,1±2,2 μmol/L). Todos eram jogadores de futebol de um tradicional clube do Rio de Janeiro e foram divididos aleatoriamente em dois grupos. Durante 12 semanas o grupo placebo (n=28) recebeu cápsulas de amido de milho e o grupo suplementado (n=20) recebeu cápsulas de gluconato de Zn (22mg/dia). O valor de 11,0 μmol/L foi considerado como ponto de corte para classificação dos jovens em normozincêmicos ou hipozincêmicos. No início da manhã, após jejum noturno, foram coletados sangue e urina para determinação da concentração de zinco. A massa corporal, alturas (do vértex, acromial, dactiloidal, iliocristal, trocantérica e sentado), composição corporal, força e maturidade esquelética (TW3) também foram determinadas por metodologias validadas. Resultados As comparações entre as categorias maturacionais definidas por cada método de avaliação mostraram que a idade óssea foi o único método que permitiu a identificação de diferenças entre as três categorias, em ao menos duas variáeis relacionadas ao rendimento (massa livre de gordura (MLG) e força na mão dominante (FMD) – p<0,0001). O método da pilosidade axilar foi capaz de discriminar apenas para a FMD (p<0,0001). Embora tenha fornecido quatro categorias maturacionais, o método por dosagem da testosterona não possibilitou a identificação de diferenças entre as categorias relativas a MLG, a FMD e as dobras cutâneas(DC). Quando observamos os métodos de avaliação da composição corporal não foram identificadas diferenças sigificativas entre os grupos hipozincêmico e normozincêmico no percentagem de gordura(PG) nem na MLG obtidas através dos métodos da absortometria de dupla energia (DXA) (p=0,06076 e p=0,5638 respectivamente), das DC (p=0,6840 and 0,5087) e através da bioimpedância elétrica (BIA) (p=0,3475 and p=0,3475). Entre os diferentes métodos também não foi encontrada diferenças significativas (PG: p=0,1272 e p=0,3231 - MLG: p=0,9229 and p=0,8933 para os grupos hipozincêmico e normozincêmico, respectivamente). As correlações entre os métodos foram significativas (PG: r= 0,3414 a 0,9765 e p<0,0001 a 0,0133 - MLG: r=0,9533 a 0,9998 e p<0,0001). Fortes coeficientes de determinação foram obtidos nas regressões múltiplas dos valores do DXA com a equação de Slaughter na estimativa da PG (r=0,86; r2=0,928 e SEE=2,37%) e ainda maiores para MLG (r=0,98; r2=0,990 e SEE=1,18kg). Valores menores foram encontrados para as outras equações com DC e para BIA. Ao analisar os efeitos da suplementação de zinco sobre o crescimento, a maturação, a composição corporal e a força, observou-se que somente as alterações ocorridas nos indicadores de crescimento foram significativas (p=0,0312), sendo que todas as demais não foram significativas - idade óssea (p=0,1391), massa livre de gordura (p=0,0593), percentual de massa gorda (p=0,2212) e força na mão dominante (p=0,6569). Conclusões Observando diferentes métodos de avaliação da maturidade biológica e as categorias por eles definidas, o método da idade óssea (IO) mostrou ser melhor, visto que ele permitiu identificar diferenças entre as três categorias possíveis, nas variáveis MLG e FMD, ao contrário dos outros métodos. Para a avaliação da composição corporal, os métodos baseados nas DC foram melhores que BIA, quando DXA não estiver disponível. A comparação entre os métodos baseados nas DC mostrou que a melhor associação foi obtida com a equação de Slaughter, seguida pela equação de Lohman com a utilização da IO ao invés da idade cronológica. Os níveis de zinco plasmático parecem não serem influenciados pela composição corporal, o que certamente justifica mais estudos. Os resultados da análise dos efeitos da suplementação de zinco no crescimento, na maturação, na composição corporal e na força, nos levam a concluir que o crescimento teve alteração positiva significativa e que os valores das demais variáveis estudadas (maturação, composição corporal e força muscular) não sofreram alterações significativas relacionadas à suplementação de zinco nos jovens jogadores de futebol do sexo masculino, na faixa etária dos 12 aos 14 anos.

Spatial patterns of genetic diversity in Mediterranean eagle owl Bubo bubo populations

Little information is available on the patterns of genetic connectivity in owls. We studied the genetic structure of the eagle owl Bubo bubo (Linnaeus, 1758) in southeastern Spain at two different spatial scales. Seven microsatellites previously described for this species were used, although only six loci amplified correctly. The observed low genetic variation could be explained by the short dispersal distance, high mortality rate and high degree of monogamy shown by this large nocturnal predator. As expected, the highest genetic isolation was detected in the geographically most isolated population. Significant genetic differentiation was found among study units separated by less than 50 km. The territorial analysis showed interesting connectivity patterns related with the gene flow and turnover rate of the breeding individuals. The lowest genetic diversity was found in the region with the largest population, which could imply incipient inbreeding.

Caracterização clínica, metabólica e hormonal de portadores de lipodistrofia parcial familiar

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Ciências da Saúde, Programa de Pós-Graduação em Ciências da Saúde, 2015.

Assessment of an oral Mycobacterium bovis BCG vaccine and an inactivated M. bovis preparation for wild boar in terms of adverse reactions, vaccine strain survival, and uptake by nontarget species

Wildlife vaccination is increasingly being considered as an option for tuberculosis control. We combined data from laboratory trials and an ongoing field trial to assess the risk of an oral Mycobacterium bovis BCG vaccine and a prototype heat-inactivated Mycobacterium bovis preparation for Eurasian wild boar (Sus scrofa). We studied adverse reactions, BCG survival, BCG excretion, and bait uptake by nontarget species. No adverse reactions were observed after administration of BCG (n = 27) or inactivated M. bovis (n = 21). BCG was not found at necropsy (175 to 300 days postvaccination [n = 27]). No BCG excretion was detected in fecal samples (n = 162) or in urine or nasal, oral, or fecal swab samples at 258 days postvaccination (n = 29). In the field, we found no evidence of loss of BCG viability in baits collected after 36 h (temperature range, 11°C to 41°C). Camera trapping showed that wild boar (39%) and birds (56%) were the most frequent visitors to bait stations (selective feeders). Wild boar activity patterns were nocturnal, while diurnal activities were recorded for all bird species. We found large proportions of chewed capsules (29%) (likely ingestion of the vaccine) and lost baits (39%) (presumably consumed), and the proportion of chewed capsules showed a positive correlation with the presence of wild boar. Both results suggest proper bait consumption (68%). These results indicate that BCG vaccination in wild boar is safe and that, while bait consumption by other species is possible, this can be minimized by using selective cages and strict timing of bait deployment.

Salmonid behaviour under winter conditions

Winter conditions are believed to play an important role in the population dynamics of northern temperate stream fish, challenging the ability of fish to physiologically and behaviourally adapt. Climate change is predicted to increase both mean temperature and temperature fluctuations, especially during winter, leading to dynamic environmental conditions in terms of river ice production and flow. Therefore, knowledge about the winter ecology of stream fish is important for predicting and mitigating anthropogenic impacts on fish production in boreal streams. Stream salmonids are relatively active throughout winter, and behavioural responses to different winter conditions may be critical for survival. Yet, relatively little is known about overwintering behaviour of salmonids, particularly in streams with ice. In this doctoral thesis, I report the results from experimental field and laboratory studies on the behavioural ecology of juvenile salmonids under winter conditions. My results from the field show that salmonids grow more and use a broader range of habitats in the presence of surface ice than in its absence. Results from the laboratory experiments show that the presence of surface ice increases food intake rates, reduces stress and affects social interactions. These laboratory results may explain the positive effects of ice cover on growth that was found in the field experiment. Moreover, I show that drift-feeding ability is reduced at low temperatures, and that nocturnal drift foraging under winter conditions has a low efficiency.

Tratamiento quirúrgico del síndrome de apnea hipopnea obstructiva del sueño en la Clínica Rivas, Bogotá – Colombia

Introducción: El Síndrome de Apnea Hipopnea Obstructiva del Sueño es un trastorno respiratorio del sueño mayor ampliamente conocido, con importantes implicaciones para los pacientes y cuya incidencia ha venido en aumento durante los últimos años; comprende diversas manifestaciones clínicas que varían desde el ronquido hasta consecuencias cardiovasculares importantes. Objetivo: Describir la experiencia de los procedimientos quirúrgicos más utilizados para el tratamiento de pacientes con Trastornos Respiratorios del Sueño en la Clínica Rivas. Diseño: Estudio observacional descriptivo. Métodos: Revisión de 366 historias clínicas de pacientes con diagnóstico clínico y Polisomnográfico de SAHOS intervenidos quirúrgicamente debido al Trastorno Respiratorio del Sueño por rechazo de terapia de presión positiva en 3 años de observación. Resultados: Se evaluaron diferencias en medianas de los cambios del IAH, índice de Saturación de oxigeno basal y mínima, y el índice de microdespertares nocturnos tanto prequirúrgica como postquirúrgicamente. Como medida de evaluación secundaria se evaluaron las complicaciones quirúrgicas. Conclusión: En nuestra institución, como centro de referencia en apnea del sueño, la cirugía ha demostrado que disminuye de forma significativa gravedad del SAHOS y disminuye el riesgo de los pacientes con trastornos respiratorios del sueño que han rechazado el dispositivo de presión positiva.