BackgroundHeart failure (HF) and sleep apnoea (SA) association has been recognized but whether it results from confounding factors (hypertension, ischaemia, obesity) remains unclear.We aimed to determine the prevalence of SA in HF and to identify potential risk factors for SA in HF population.MethodsWe prospectively evaluated 103 patients with stable HF on optimized therapy. In-laboratory polysomnography was performed. Type and severity of SA were defined according international criteria. Demographic, anthropometric and clinical characteristics were collected. Continuous data are expressed as median and interquartile range.ResultsSA was found in 72.8%, moderate to severe in a significant proportion (apnoea-hypopnoea index ≥ 15- 44.7% of all patients) and predominantly obstructive (60.0% of patients with SA). Most patients were non-sleepy (Epworth < 10- 66%). SA patients were predominantly men (85.3 vs 60.7%, p-0.015), had larger neck (38.0 (35.0-42.0) vs 35.0 (33.2-38.0) cm, p-0.003), severe systolic dysfunction, (63.9 vs 33.3%, p-0.018), left ventricle (LV) hypertrophy (16.2 vs 0.0%, p-0.03), LV and left atria (LA) dilatation (49.0 (44.0-52.0) vs 42.0 (38.0-48.0) mm, p < 0.001; 60.0 (54.0-65.0) vs 56.0 (52.0-59.0) mm, p-0.01). However, only LA diameter was an independent predictor of SA. Higher body-mass index (BMI) was associated with moderate to severe SA. Patients with obstructive SA had larger neck and a trend for higher BMI, snoring and sleepiness. Hypocapnia was not associated with central SA.ConclusionsIn our HF population, SA was prevalent, frequently asymptomatic and without characteristic risk factors. Unlike previously reported, obstructive SA was the predominant type. These results suggest that SA is underdiagnosed in HF and there is a possible correlation between them, independent of confounding factors. Recent advances in HF therapy might influence prevalence and type of SA in this population.

Aim: To investigate the prevalence of urinary tract infections in hospitalized patients with type 2 diabetes mellitus and identify corresponding risk factors. Methods: We conducted a cross-sectional study on 7.347 patients with type 2 diabetes mellitus as the principal diagnosis, using hospitalization discharge summary data from January 1 to December 31, 2015. Disease stages were classified as stages 1, 2, and 3. Results: Of 7.347 patients, 16.2% had urinary tract infections. The urinary tract infection prevalence was 24.4% in 428 patients in stage 1 and 4.8% in 2.840 patients in stage 2; it was higher among patients who underwent medical procedures than among those who underwent surgery (24.4% vs 4.8%). In multivariate regression analysis, age (OR = 1.031; 95% CI = 1.02-1.04), length of hospitalization (OR = 1.018; 95% CI = 1.013-1.024), sex (woman) (OR = 2.248; 95% CI = 1.778-2.842), comorbidity of stage 3 cerebrovascular disease (OR = 1.737; 95% CI = 1.111-2.714), and comorbidity of stage 1 colorectal cancer (OR = 2.417; 95% CI = 1.152-5.074) were found to be the risk factors of urinary tract infection in the ten hospitals considered. Conclusions: Our findings suggest that urinary tract infection prevalence was higher in women without evidence of organ injury and those receiving medical treatment. Comorbidities (cerebrovascular disease and colorectal cancer) were identified as risk factors.

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Introduction: Obstructive sleep apnea (OSA) is a disorder characterized by obstructive apneas, hypopneas, and/or arousals related to respiratory effort caused by repetitive collapse of the upper airway during sleep. Left untreated, or with poor adherence to treatment, is likely to lead to negative outcomes, especially cardiac or cerebrovascular diseases. Our objective was to investigate age as a potential factor that may interfere with adherence to treatment with automatic positive airway pressure (APAP). Materials and Methods: This is a cross-sectional study on 1151 patients with OSA and we analyzed the adherence data of all patients who had been on APAP for at least six months during the period from 1 July 2019 to 31 December 2020 at Centro de Medicina do Sono. Spearman correlation was used in the bivariate analysis and to determine the factors associated with APAP adherence, a logistic regression was performed. Results: Of 1151 patients included, 780 patients were men (67.1%) and the majority was under 65 years (59.4%). APAP adherence was higher in older age groups (p < 0.001) and in patients with a higher AHI (p < 0.001), no differences were observed with regards to gender. In the multivariable regression analysis, the main factors associated with adherence were age group over 65 years (OR = 2.435; 95% CI = 1.862–3.185), AHI 15–30/h (OR = 1.733; 95% CI = 1.242–2.416), and AHI > 30/h (OR = 3.406; 95% CI = 2.426–4.782). Conclusions: Patients older than 65 years have better adherence to APAP than younger ones and with moderate but especially severe AHI have better adherence than those with the milder form of the disease.

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