IntroductionSleepiness is a cardinal symptom in obstructive sleep apnoea (OSA) but most patients have unspecific symptoms. Arterial stiffness, evaluated by pulse wave velocity (PWV), is related to atherosclerosis and cardiovascular (CV) risk. Arterial stiffness was reported to be higher in patients with OSA, improving after treatment with continuous positive airway pressure (CPAP). This study aims to assess whether the same effect occurs in patients with OSA and without sleepiness.Methods and analysisThis observational study assesses the CV effect of CPAP therapy on a cohort of patients with moderate-to-severe OSA; the effect on the subcohorts of sleepy and non-sleepy patients will be compared. A systematic and consecutive sample of patients advised CPAP therapy will be recruited from a single outpatient sleep clinic (Centro Hospitalar de Lisboa Central—CHLC, Portugal). Eligible patients are male, younger than 65 years, with confirmed moderate-to-severe OSA and apnoea–hypopnea index (AHI) above 15/hour. Other sleep disorders, diabetes or any CV disease other than hypertension are exclusion criteria. Clinical evaluation at baseline includes Epworth Sleepiness Scale (ESS), and sleepiness is defined as ESS above 10. OSA will be confirmed by polygraphic study (cardiorespiratory, level 3). Participants are advised to undertake an assessment of carotid-femoral PWV (cf-PWV) and 24 hours evaluation of ambulatory blood pressure monitoring (ABPM), at baseline and after 4 months of CPAP therapy. Compliance and effectiveness of CPAP will be assessed. The main outcome is the variation of cf-PWV over time.Ethics and disseminationThis protocol was approved by the Ethics Committees of CHLC (reference number 84/2012) and NOVA Medical School (number36/2014/CEFCM), Lisbon. Informed, written consent will be obtained. Its results will be presented at conferences and published in peer-reviewed journals.Trial registration numberNCT02273089; Pre-results.
Respiratory diseases are an important cause of morbidity and mortality and their importance is expected to increase in the near future. The Pneumology speciality in Portugal must accompany the natural evolution of Medicine and contribute to creating competent experts, adapted to new challenges within the European Community. Some changes are currently in the process of implementation, directed at improving the learning experience of future Pneumology specialists in order to obtain the Common Certificate of Pneumology. A survey related to the training in this speciality was conducted to ascertain the opinions and suggestions of Residents, Tutors and Directors of Pneumology departments in Portugal. This paper will present and discuss the results of this survey.
Background Tuberculosis continues to be a significant global health problem. Portugal isn't an exception to this health problem, being considered by the ECDC a high incidence country. According to the SDG target 3.3, the world must end the epidemics of tuberculosis by 2030. However, several parishes in Portugal continue to observe extremely high values of TB, taking into account the WHO goal for pre-elimination of 10 TB cases per million people. Methods A cross-sectional study was conducted with data from the Surveillance System of the National Program against Tuberculosis. Descriptive and regression analyses were carried out using R 3.6.1 and Rstudio 1.2.5033. The geospatial analysis was carried out with ArcMap 10.7.1 using a five-year average of TB incidence. Animations and videos were made with Microsoft Office365 PowerPoint v2002. Results In the period 2008-2012, 55,7% of parishes had registered cases of tuberculosis. That value decreased to 50,6% parishes in the period 2014-2018. For the period of 2014-18, 30,3% of parishes had a five-year average incidence above 20/100.000 people (value defined as high-incidence by the ECDC) and 45,0% parishes an incidence above 10/100.000 people. With ArcMap HotSpot analysis was possible to observe the existence of a significant cluster of TB in the southwest of North Portugal. With animation analysis, it was also possible to see the global spatial reduction of TB cases between 2008 and 2018, and the ongoing problem of a high incidence of TB in specific regions of North Portugal. Conclusions TB continues to be a significant health problem in North Portugal. The spatial analysis pointed to a specific area of North Portugal that needs priority action. Videos produced by the Department of Public Health may guide health professionals and policymakers for future strategies to be implemented to reach SDG3. Key messages The importance of desegregated spatial data for TB elimination. The elimination efforts must be scaled up in specific areas to achieve SDG3.
Introduction Obstructive sleep apnea (OSA) may trigger systemic changes linked to important cardiometabolic risk factors such as hypertension, stroke and diabetes II. As a life-threatening, multifactorial disorder, OSA demands a multiprofessional approach. The most common worldwide treatments are Continuous Positive Airway Pressure (CPAP) and Mandibular Advancement Oral Appliance (OAm). The aim of this study was to evaluate the impact of OAm treatment on CPAP non-adherent patients with severe OSA, comparing objective and subjective data between baseline and follow up. Methods A prospective study was carried out including non-adherent severe OSA patients, which were referred to OAm therapy evaluation. Patients presenting with snoring, gasping/choking during sleep, fatigue and daily sleepiness were evaluated by a sleep medicine specialist and the diagnosis of severe OSA with a basal polysomnography (PSG). All the patients were treated with a standard OAm (PMPositioner®). Baseline and Follow up (6 months) sleep parameters (PSG and Epworth Sleepiness Scale - ESS) were compared to assess treatment efficacy. Results Seventeen patients (9 with hypertension and 8 with hypertension + diabetes) met the inclusion criteria and 13 finished the protocol. After treatment with OAm the following parameters improved significantly: OSA severity (44.5±13.5 to 9.0±4.3, p≤0.001), ODI (46.8±11.6 to 12.1±9.1(p<0.05)), REM (18.4± 4.8 to 21.5± 2.9 (p<0.05)) and SaO2nadir (75.7± 9.4 to 87.0±3.6, p<0.001), ESS (p<0.005). Ten patients (58%) reported a reduction either in systolic and diastolic blood pressure with 3 of them (30%) reduced the hypertensive drug dose. Conclusion Our findings show that OAm is a safe and effective treatment option to CPAP non-adherent severe OSA patients. Furthermore OAm therapy had also a positive impact on cardiometabolic risk factors which are particularly relevant outcomes in OSA patients. Support State of Sao Paulo Research Support Foundation (FAPESP).
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