Migraine and Markers of Carotid Atherosclerosis in Middle-Aged Women: A Cross-Sectional Study.

OBJECTIVE: This study evaluated the association between migraine and the markers of carotid artery disease. BACKGROUND: Migraine increases the risk of cardiovascular events, but its relationship with vascular dysfunction is unclear. METHODS: In this cross-sectional study, middle-aged women with no known cardiovascular diseases underwent clinical, neurological, and laboratory evaluations; pulse wave velocity (PWV) assessment; and carotid artery ultrasonography. We divided the participants based on the presence of migraine and, further, based on the type of migraine. Associations between migraine and carotid thickening (intima-media thickness >0.9 mm), carotid plaques, or arterial stiffening (PWV >10 m/s) were evaluated using a multiple regression analysis. RESULTS: The study comprised 112/277 (40%) women with migraine, of whom 46/277 (17%) reported having an aura. Compared to the non-migraineurs, the migraine with aura group had an increased risk of diffuse carotid thickening (3/46 [6.8%] vs 2/165 [1.3%], adjusted OR = 7.12, 95% CI 1.05-48.49). Migraine without aura was associated with a low risk of carotid plaques (3/66 [4.7%] vs 26/165 [16.7%], adjusted OR = 0.28, 95% CI 0.08-0.99) and arterial stiffening (21/66 [34.4%] vs 82/165 [51.2%], adjusted OR = 0.39, 95% CI 0.19-0.79). There were no correlations between migraine characteristics and arterial stiffness or carotid thickness measurements. CONCLUSION: Migraine with aura is associated with an increased risk of carotid thickening, and migraine without aura is associated with a low risk of carotid plaques and arterial stiffening.

Predictors of coronary stent thrombosis: a case-control study.

To verify the frequency and predictors associated with stent thrombosis (ST) in a developing country. Observational, case-control study including 2535 consecutive patients undergoing percutaneous coronary intervention (PCI) in two reference hospitals in Brazil, from October 2013 to December 2015. ST patients were matched to controls in a 1:3 ratio for gender, age, procedure indication, and performing hospital. From the total sample, 65 (2.5%) ST occurred and were matched with 195 controls (age 64.9 ± 11.8 years; hypertension, 78.8%; diabetes, 30%). Clopidogrel and aspirin early withdrawal (OR 19.25; 95% CI 1.66-23.52; p < 0.01 and OR 4.36; 95% CI 1.81-10.50; p = 0.001, respectively), hypertension (OR 3.64; 95% CI 1.38-9.61; p = 0.006), dyslipidemia (OR 2.84; 95% CI 1.48-5.45; p = 0.002), smoking (OR 3.09; 95% CI 1.28-7.43; p = 0.02), body mass index ≥ 30 kg/m2 (OR 2.10; 95% CI 1.02-4.49; p = 0.012), previous myocardial infarction (OR 2.98; 95% CI 1.14-7.47; p < 0.001), bifurcation lesion (OR 2.44; 95% CI 1.05-5.67; p = 0.03), and ≥ 3 stents (OR 3.90; 95% CI 1.78-8.52; p = 0.002) were associated with ST. Stent type, diameter or length, severity of coronary artery disease, calcified lesions, and thrombus were not associated with ST. We found a similar frequency of ST from developed countries and identified strong predictors (clopidogrel and aspirin withdrawal, hypertension, dyslipidemia, smoking, obesity, previous myocardial infarction, bifurcation lesion, number of stents), which are in line with reports from developed countries.

Effectiveness of inspiratory muscle training on sleep and functional capacity to exercise in obstructive sleep apnea: a randomized controlled trial.

PURPOSE: The aim of this study was to evaluate the effectiveness of inspiratory muscle training (IMT) on sleep and functional capacity to exercise in subjects with obstructive sleep apnea (OSA). METHODS: This is a controlled, randomized, double-blind study conducted in 16 OSA patients divided into two groups: training (IMT: n = 8) and placebo-IMT (P-IMT: n = 8). IMT was conducted during 12 weeks with a moderate load (50-60% of maximal inspiratory pressure-MIP), while P-IMT used a load < 20% of MPI. Total daily IMT time for both groups was 30 min, 7 days per week, twice a day. RESULTS: There was no difference comparing IMT to P-IMT group after training for lung function (p > 0.05) and respiratory muscle strength (p > 0.05). Maximal oxygen uptake (VO2Max) was not significantly different between IMT and P-IMT group (mean difference - 1.76, confidence interval (CI) - 7.93 to 4.41, p = 0.71). The same was observed for the other ventilatory and cardiometabolic variables measured (p > 0.05). A significant improvement in sleep quality was found when Pittsburgh Sleep Quality Index (PSQI) values of IMT and P-IMT group after training were compared (mean difference: 3.7, confidence interval 95% (CI95%) 0.6 to 6.9, p = 0.02) but no significant changes were seen in daytime sleepiness between both groups after the intervention (mean difference: 3.4, CI 95%: - 3.3 to 10.0; p = 0.29). CONCLUSION: According to these results, 12 weeks of moderate load IMT resulted in improved sleep quality, but there were no significant repercussions on functional capacity to exercise or excessive daytime sleepiness.

The role played by gender and age on poor sleep quality among institutionalized adolescents.

PURPOSE: The aim of this study was to analyze the prevalence and association between sleep quality with gender and age and to examine the relation between age and the components of the PSQI in institutionalized adolescents. METHODS: High school internal students of both genders, aged between 14 and 19 years old, were analyzed. After a full clinical evaluation, the Pittsburg Sleep Quality Index Score was obtained from all participants. RESULTS: We studied 210 participants [male: 15. 7 ± 1.2 years; BMI: 21.7 ± 2.6 kg/m2; female: 15.7 ± 1. 2 years; BMI: 21.9 ± 4.5 kg/m2]. Poor sleep quality was present in 137 (65.3%) participants and was predominant among girls than boys (PSQI = 76.3 vs 55.8%; p < 0.001), respectively. There were positive correlations between PSQI components with age in boys (sleep latency: R = 0.23; p = 0.02; sleep duration: R = 0.28; p < 0.01 and overall sleep quality: R = 0.21; p = 0.03), but not among girls. CONCLUSION: Institutionalized girls have worse sleep quality than boys and positive correlations between sleep quality components with age were only present among boys.

Clinical predictors of a positive genetic test in hypertrophic cardiomyopathy in the Brazilian population.

BACKGROUND: Hypertrophic cardiomyopathy is a genetic autosomal dominant disease characterized by left ventricular hypertrophy. The molecular diagnosis is important but still expensive. This work aimed to find clinical predictors of a positive genetic test in a Brazilian tertiary centre cohort of index cases with HCM. METHODS: In the study were included patients with HCM clinical diagnosis. For genotype x phenotype comparison we have evaluated echocardiographic, electrocardiographic, and nuclear magnetic resonance measures. All patients answered a questionnaire about familial history of HCM and/or sudden death. ß-myosin heavy chain, myosin binding protein C, and troponin T genes were sequenced for genetic diagnosis. RESULTS: The variables related to a higher probability of a positive genetic test were familial history of HCM, higher mean heart frequency, presence of NSVT and lower age. Probabilities of having a positive molecular genetic test were calculated from the final multivariate logistic regression model and were used to identify those with a higher probability of a positive molecular diagnosis. CONCLUSIONS: We developed an easy and fast screening method that takes into account only clinical data that can help to select the patients with a high probability of positive genetic results from molecular sequencing of Brazilian HCM patients.

Effect of 12-week high-intensity interval training on hemodynamic variables at rest and during exercise in patients with obstructive sleep apnoea.

This study aimed to investigate the impact of 12 weeks of high-intensity interval training (HIIT) on hemodynamic variables at rest and during exercise in patients with obstructive sleep apnoea. Twenty-six obese adults with moderate-to-severe OSA (AHI = 42 ±â€Š22.9 e/h) were randomly assigned to HIIT or a control group. Sleep parameters, ambulatorial, aortic, and during-exercise SBP and DBP were assessed at baseline and after 12 weeks. Generalized estimated equations assessed differences between groups over time. When compared with control group, HIIT reduced AHI (17.1 ±â€Š6.2; e/h, P  < 0.01), SBP nighttime (10.2 ±â€Š5.0 mmHg; P  = 0.034), DBP nighttime (7.9 ±â€Š4.0 mmHg; P  = 0.038), DBP aortic (5.5 ±â€Š2.9 mmHg; P  = 0.048), and SBP max (29.6 ±â€Š11.8 mmHg; P  = 0.045). In patients with OSA, 12 weeks of HIIT decreases sleep apnoea severity and blood pressure in rest and during exercise.

Primary results of the brazilian registry of atherothrombotic disease (NEAT).

There is limited contemporary prospective real-world evidence of patients with chronic arterial disease in Latin America. The Network to control atherothrombosis (NEAT) registry is a national prospective observational study of patients with known coronary (CAD) and/or peripheral arterial disease (PAD) in Brazil. A total of 2,005 patients were enrolled among 25 sites from September 2020 to March 2022. Patient characteristics, medications and laboratorial data were collected. Primary objective was to assess the proportion of patients who, at the initial visit, were in accordance with good medical practices (domains) for reducing cardiovascular risk in atherothrombotic disease. From the total of patients enrolled, 2 were excluded since they did not meet eligibility criteria. Among the 2,003 subjects included in the analysis, 55.6% had isolated CAD, 28.7% exclusive PAD and 15.7% had both diagnoses. Overall mean age was 66.3 (± 10.5) years and 65.7% were male patients. Regarding evidence-based therapies (EBTs), 4% were not using any antithrombotic drug and only 1.5% were using vascular dose of rivaroxaban (2.5 mg bid). Only 0.3% of the patients satisfied all the domains of secondary prevention, including prescription of EBTs and targets of body-mass index, blood pressure, LDL-cholesterol, and adherence of lifestyle recommendations. The main barrier for prescription of EBTs was medical judgement. Our findings highlight that the contemporary practice does not reflect a comprehensive approach for secondary prevention and had very low incorporation of new therapies in Brazil. Large-scale populational interventions addressing these gaps are warranted to improve the use of evidence-based therapies and reduce the burden of atherothrombotic disease.ClinicalTrials.gov NCT04677725.

Screening of MYH7, MYBPC3, and TNNT2 genes in Brazilian patients with hypertrophic cardiomyopathy.

BACKGROUND: Hypertrophic cardiomyopathy (HC) is the most prevalent genetic cardiac disease caused by a mutation in sarcomeres, Z-disks, or calcium-handling genes and is characterized by unexplained left ventricular hypertrophy. The aim of this study was to determine the genetic profile of Brazilian patients with HC and correlate the genotype with the phenotype. METHODS: We included 268 index patients from São Paulo city and 3 other cities in Brazil and extracted their DNA from whole blood. We amplified the coding sequencing of MYH7, MYBPC3, and TNNT2 genes and sequenced them with an automatic sequencer. RESULTS: We identified causal mutations in 131 patients (48.8%). Seventy-eight (59.5%) were in the MYH7 gene, 50 (38.2%) in the MYBPC3 gene, and 3 (2.3%) in the TNNT2 gene. We identified 69 mutations, 24 not previously described. Patients with an identified mutation were younger at diagnosis and at current age, had a higher mean heart rate and higher nonsustained ventricular tachycardia frequency compared with those without a mutation. Patients with MYH7 gene mutations had a larger left atrium and higher frequency of atrial fibrillation than did patients with MYBPC3 gene mutations. CONCLUSION: The presence of a mutation in one of the genes suggests a worse prognosis. Mutations in the MYH7 gene, rather than in the MYBPC3 gene, were also related to a worse prognosis. This is the first work characterizing HC molecular epidemiology in the Brazilian population for the 3 most important genes.

Dialysis headache: characteristics, impact and cerebrovascular evaluation.

BACKGROUND: Headache is one of the most frequent symptoms that occur during hemodialysis sessions. Despite the high prevalence of dialysis headache, it has been little studied. OBJECTIVE: To evaluate the characteristics, impact and factors associated with dialysis headache. The behavior of the cerebral vasculature was also compared between patients with and without dialysis headache. METHODS: This was a cross-sectional study. Consecutive patients who underwent hemodialysis were assessed through a semi-structured questionnaire, the Headache Impact Test (HIT-6), the Hospital Anxiety and Depression Scale and the Short Form-36 Health Survey (SF-36). Transcranial Doppler ultrasonography was performed in the first and fourth hours of hemodialysis. RESULTS: A total of 100 patients were included; 49 of them had dialysis headache. Women (OR=5.04; 95%CI 1.95-13.04), younger individuals (OR=1.05; 95%CI 1.01-1.08), individuals with higher schooling levels (OR=3.86; 95%CI 1.4-10.7) and individuals who had spent longer times on dialysis programs (OR=0.99; 95%CI 0.98-1) had more dialysis headache (logistic regression). Individuals with dialysis headache had worse quality of life in the domains of pain and general state of health (56.9 versus 76.4, p=0.01; 49.7 versus 60.2, p=0.03, respectively). Dialysis headache was associated with significantly greater impact on life (OR=24.4; 95%CI 2.6-226.6; logistic regression). The pulsatility index (transcranial Doppler ultrasonography) was lower among patients with dialysis headache than among those without them. CONCLUSIONS: Dialysis headaches occur frequently and are associated with worse quality of life and patterns of cerebral vasodilatation.

Effect of exercise training on body composition in patients with obstructive sleep apnea: a systematic review and meta-analysis.

Reduction in adiposity is considered a cornerstone in the treatment of obstructive sleep apnea (OSA). Exercise training is one of the interventions used in the treatment of OSA. However, it remains unclear whether exercise training alleviates OSA by improving body composition. This study aimed to verify the effect of exercise training on body composition and the apnea-hypopnea index (AHI) in patients with OSA. This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered in PROSPERO. PubMed/Medline, Scopus, and Cochrane databases were used for systematic review. Analyses were performed using Review Manager software (version 5.3; R Foundation for Statistical Computing, Vienna, Austria). Exercise training significantly reduced body mass index (mean difference = -0.55 kg/m2; 95% CI = -0.95 to -0.15), body fat percentage (mean difference = -1.19%; 95% CI = -2.03 to -0.35), neck circumference (mean difference = -0.55 cm; 95% CI = -1.08 to -0.02), total body weight (mean difference = -2.13 kg; 95% CI = -4.30 to 0.04), and AHI -8.06 events/hour; 95% CI = -10.47 to -5.66). Although body composition was improved by exercise, this improvement was clinically small. Moreover, improvement in AHI by exercise may not be entirely due to improvements in adiposity. PROSPERO #: CRD42020210509.

Effect of exercise training on subjective parameters in patients with obstructive sleep apnea: a systematic review and meta-analysis.

Obstructive sleep apnea (OSA) has many effects on subjective parameters of the disease, such as reduction in quality of life (QoL), sleep quality (SQ), and increases in daytime sleepiness. Studies have reported the beneficial effect of exercise training on OSA severity; however, whether it improves subjective parameters remains unclear. The purpose of the present review was to investigate the effect of exercise training on QoL, daytime sleepiness, and SQ in adults with OSA by summarizing the results of clinical trials. The study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered in PROSPERO. A systematic review of the PubMed, Scopus, and Cochrane (CENTRAL) databases was conducted. Risk of bias analysis was performed using the Cochrane tool, and Review Manager version 5.2 (R Foundation for Statistical Computing, Vienna, Austria) was used to perform the meta-analysis. Of the 1573 studies initially retrieved, 8 relevant studies with 228 participants were included in the analysis. The studies presented moderate risk of bias. Exercise training significantly improved QoL (mean difference, 12.9 [95% confidence interval (CI) 6.4 to 19.5]) and SQ (mean difference, -2.0 [95% CI -3.6 to -0.5]), and reduced daytime sleepiness (mean difference, -3.7 [95% CI -6.1 to -1.2]), and OSA severity (mean difference, -11.4 [95% CI -13.4 to -9.4 events/h]). Thus, physical exercise training was effective in improving subjective parameters and reducing the severity of OSA. Additional randomized clinical trials, however, should be performed to confirm these findings.

Inspiratory Muscle Training in the Severity of Obstructive Sleep Apnea, Sleep Quality and Excessive Daytime Sleepiness: A Placebo-Controlled, Randomized Trial.

PURPOSE: Exercise programs have been considered as an adjuvant treatment in obstructive sleep apnea (OSA). However, few studies have focused on the effects of the inspiratory muscle training (IMT) in reducing the severity and the symptoms of OSA. PATIENTS AND METHODS: A randomized controlled trial was conducted and approved by the local Ethics Committee. All subjects signed the informed consent form and were randomized into 2 groups: a) IMT group (n = 8), 8 weeks of IMT with 75% of maximal inspiratory pressure (MIP) and b) placebo group (n = 8): subjects performed IMT without load. RESULTS: IMT group showed reduction in the apnea-hypopnea index (AHI) (p = 0.01), in the Berlin questionnaire score (p = 0.001) and an increase in inspiratory muscle strength (p = 0.018). IMT group demonstrated a reduction in the AHI (31.7 ± 15.9 events/h vs 29.9 ± 15.8 events/h; p <0.001), in the Berlin questionnaire scores (2.6 ± 0.5 vs 1.2 ± 0.5; p = 0.016), Pittsburgh Sleep Quality Index (PSQI) score (7.2 ± 3.6 vs 3.7 ± 1.3; p = 0.008), in the Epworth Sleepiness Scale (ESS) (12.5 ± 4.0 vs 7.7 ± 3.0; p = 0.008) and increase in MIP (83.6 ± 26.5 cmH2O and 127.9 ± 32.5 cmH2O; p = 0.010). CONCLUSION: The IMT promotes discrete changes in the AHI and improves sleep quality and excessive daytime sleepiness in OSA. Moreover, IMT is a cheap, useful and simple home-based training program and can be considered as an adjunct therapy for OSA patients.

Obstructive sleep apnea and quality of life in elderly patients with a pacemaker.

OBJECTIVE: To evaluate quality of life in elderly patients with obstructive sleep apnea (OSA) who have a pacemaker. METHODS: This was a cross-sectional study involving elderly patients (≥ 60 years of age) with a pacemaker. The dependent variable was quality of life, as evaluated with the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). Sociodemographic and clinical parameters, including anxiety and depression (Hospital Anxiety and Depression Scale score), as well as the presence of OSA (defined as an apnea-hypopnea index ≥ 15 events/h), were analyzed as independent variables. Patients with cognitive/neurological deficits or decompensated heart failure were excluded. RESULTS: We evaluated 72 patients, 17 (23.6%) of whom presented OSA. Of those 17 patients, 9 (52.9%) were male. The mean age was 72.3 ± 9.3 years. A diagnosis of OSA was not associated with gender (p = 0.132), age (p = 0.294), or body mass index (p = 0.790). There were no differences between the patients with OSA and those without, in terms of the SF-36 domain scores. Fourteen patients (19.4%) presented moderate or severe anxiety. Of those 14 patients, only 3 (21.4%) had OSA (p = 0.89 vs. no OSA). Twelve patients (16.6%) had moderate or severe depression. Of those 12 patients, only 2 (16.6%) had OSA (p = 0.73 vs. no OSA). CONCLUSIONS: In elderly patients with a pacemaker, OSA was not found to be associated with quality of life or with symptoms of anxiety or depression.

Influence of obesity in pulmonary function and exercise tolerance in obese women with obstructive sleep apnea.

OBJECTIVE: To evaluate the influence of obesity on pulmonary function and exercise tolerance in women with obstructive sleep apnea (OSA). SUBJECTS AND METHODS: A descriptive analytic cross- sectional study was carried out. Thirty-nine (39) sedentary climacteric women, aged 45 to 60 years, were evaluated and submitted to polysomnography. The participants were divided into 4 groups: a) 'eutrophic non-OSA' (n = 13); b) 'eutrophic OSA' (n = 5); c) 'obese non-OSA' (n = 6); d) 'obese OSA' (n = 15). All subjects underwent clinical and anthropometric evaluation, followed by pulmonary function tests and 6-minute walk test (6MWT). RESULTS: There was a significant difference in the predicted percentage values of FEV1/FVC when comparing 'eutrophic OSA' and 'obese OSA' (97.6% ± 6.1% vs. 105.7% ± 5.7%, respectively; p = 0.025). The other spirometric variables did not show any differences between the studied groups. There was no significant difference in the maximum distance walked when the 'eutrophic non-OSA', 'eutrophic OSA', 'obese non-OSA' and 'obese OSA' groups were compared. CONCLUSION: Considering the results of this study, OSA itself did not influence pulmonary function or functional capacity parameters compared to eutrophic women. However, not only isolated obesity but also obesity associated with OSA can negatively impact sleep quality and lung function.

Predictors of subclinical carotid atherosclerosis in middle-aged women.

BACKGROUND: Traditional strategies for primary cardiovascular prevention have been insufficient in reducing the high rates of coronary ischemic events in women, probably because these women are often stratified into low-risk groups. However, cardiovascular diseases continue to be the main cause of morbidity and mortality in women worldwide. We hypothesized that carotid atherosclerosis (CA) is common in middle-aged women. METHODS: We prospectively evaluated asymptomatic peri- and post-menopausal women with no cardiovascular diseases or the use of hormone therapy from two gynecologic clinics. All the patients underwent full clinical and laboratory evaluation and underwent a B-mode ultrasound for carotid evaluations. The presence of CA was defined as the presence of plaque and/or carotid intima-media thickness (CIMT)>1.00 mm. We performed logistic regression to evaluate independent predictors of CA. RESULTS: We studied 823 women (age: 54.4±5.4 years; body mass index-BMI: 28.5±4.9 kg/m2; diabetes:10%; hypertension: 58%). The prevalence of CA was 12.7% for the entire population and 11% for the low-risk sub-group as defined by a Framingham risk score <5%. In the multivariate model, age: odds ratio (OR) = 1.54, 95% confidence interval (CI) = 1.25-1.89,p<0.001; current smoker status: OR = 2.69, 95% CI = 1.48-4.91, p = 0.001; total cholesterol: OR = 1.13, 95% CI = 1.03-1.24, p = 0.008; and systolic blood pressure: OR = 1.01, 95% CI = 1.00-1.02, p = 0.030 remained independently associated with CA. CONCLUSION: Subclinical CA is common among asymptomatic middle-aged women, and traditional risk factors are independently associated with CA. These findings are particularly relevant for improving cardiovascular health in women.

Obstructive Sleep Apnea is Common and Associated with Heart Remodeling in Patients with Chagas Disease.

BACKGROUND: Chagas Disease (CD) is an important cause of morbimortality due to heart failure and malignant arrhythmias worldwide, especially in Latin America. OBJECTIVE: To investigate the association of obstructive sleep apnea (OSA) with heart remodeling and cardiac arrhythmias in patients CD. METHODS: Consecutive patients with CD, aged between 30 to 65 years old were enrolled. Participants underwent clinical evaluation, sleep study, 24-hour Holter monitoring, echocardiogram and ambulatory blood pressure monitoring. RESULTS: We evaluated 135 patients [age: 56 (45-62) years; 30% men; BMI: 26 ± 4 kg/m2, Chagas cardiomyopathy: 70%]. Moderate to severe OSA (apnea-hypopnea index, AHI, ≥ 15 events/h) was present in 21% of the patients. OSA was not associated with arrhythmias in this population. As compared to patients with mild or no OSA, patients with moderate to severe OSA had higher frequency of hypertension (79% vs. 72% vs. 44%, p < 0.01) higher nocturnal systolic blood pressure: 119 ± 17 vs. 113 ± 13 vs. 110 ± 11 mmHg, p = 0.01; larger left atrial diameter [37 (33-42) vs. 35 (33-39) vs. 33 (30-36) mm, p < 0.01]; and a greater proportion of left ventricular dysfunction [LVEF < 50% (39% vs. 28% vs. 11%), p < 0.01], respectively. Predictor of left atrial dimension was Log10 (AHI) (b = 3.86, 95% CI: 1.91 to 5.81; p < 0.01). Predictors of ventricular dysfunction were AHI > 15 events/h (OR = 3.61, 95% CI: 1.31 - 9.98; p = 0.01), systolic blood pressure (OR = 1.06, 95% CI: 1.02 - 1.10; p < 0.01) and male gender (OR = 3.24, 95% CI: 1.31 - 8.01; p = 0.01). CONCLUSIONS: OSA is independently associated with atrial and ventricular remodeling in patients with CD.

Prevalence of Obstructive Sleep Apnea and Obesity Among Middle-Aged Women: Implications for Exercise Capacity.

STUDY OBJECTIVES: The aim of the current study was to evaluate the association between obstructive sleep apnea (OSA) and exercise capacity in middle-aged women. METHODS: Consecutive middle-aged female subjects without cardiovascular disease, aged 45 to 65 years, from two gynecological clinics underwent detailed clinical evaluation, portable sleep study, and treadmill exercise test. RESULTS: We studied 232 women (age: 55.6 ± 5.2 years; body mass index [BMI]: 28.0 ± 4.8 kg/m2). OSA (apnea-hypopnea index ≥ 5 events/h) was diagnosed in 90 (39%) and obesity (BMI > 30 kg/m2) in 76 (33%) women, respectively. Participants with OSA were older, had a higher BMI, and an increased frequency of arterial hypertension compared to women without OSA. Multiple logistic regression models were used to evaluate the association between OSA and exercise capacity, controlling for traditional risk factors including BMI, age, hypertension, diabetes, and sedentary lifestyle. In multivariate analysis, the presence of obesity without OSA was associated with low exercise capacity (odds ratio [OR] 2.88, 95% confidence interval [CI] 1.02-8.11, P = .045), whereas the presence of OSA without obesity was not (OR 1.07, 95% CI 0.31-3.69, P = .912). However, the coexistence of obesity and OSA increased markedly the odds of reduction in exercise capacity (OR 9.40, CI 3.79-23.3, P < .001). CONCLUSIONS: Obesity and OSA are common conditions in middle-aged women and may interact to reduce exercise capacity. These results highlight the importance of obesity control programs among women, as well as the diagnosis of comorbid OSA in older women.

Dialysis headache: characteristics, impact and cerebrovascular evaluation / Cefaleia da diálise: características, impacto e avaliação cerebrovascular

ABSTRACT Background: Headache is one of the most frequent symptoms that occur during hemodialysis sessions. Despite the high prevalence of dialysis headache, it has been little studied. Objective: To evaluate the characteristics, impact and factors associated with dialysis headache. The behavior of the cerebral vasculature was also compared between patients with and without dialysis headache. Methods: This was a cross-sectional study. Consecutive patients who underwent hemodialysis were assessed through a semi-structured questionnaire, the Headache Impact Test (HIT-6), the Hospital Anxiety and Depression Scale and the Short Form-36 Health Survey (SF-36). Transcranial Doppler ultrasonography was performed in the first and fourth hours of hemodialysis. Results: A total of 100 patients were included; 49 of them had dialysis headache. Women (OR=5.04; 95%CI 1.95-13.04), younger individuals (OR=1.05; 95%CI 1.01-1.08), individuals with higher schooling levels (OR=3.86; 95%CI 1.4-10.7) and individuals who had spent longer times on dialysis programs (OR=0.99; 95%CI 0.98-1) had more dialysis headache (logistic regression). Individuals with dialysis headache had worse quality of life in the domains of pain and general state of health (56.9 versus 76.4, p=0.01; 49.7 versus 60.2, p=0.03, respectively). Dialysis headache was associated with significantly greater impact on life (OR=24.4; 95%CI 2.6-226.6; logistic regression). The pulsatility index (transcranial Doppler ultrasonography) was lower among patients with dialysis headache than among those without them. Conclusions: Dialysis headaches occur frequently and are associated with worse quality of life and patterns of cerebral vasodilatation.

RESUMO Antecedentes: A cefaleia é um dos sintomas mais frequentes que ocorrem durante as sessões de hemodiálise. Apesar da alta prevalência, essa cefaleia é pouco estudada. Objetivo: Avaliar as características, impacto e fatores associados à cefaleia da diálise. O comportamento da vasculatura cerebral também foi comparado entre pacientes com e sem cefaleia da diálise. Métodos: Este foi um estudo transversal. Pacientes consecutivos submetidos à hemodiálise foram avaliados por meio de questionário semiestruturado, do Headache Impact Test (HIT-6), Hospital Anxiety and Depression Scale e Short Form-36 Health Survey (SF-36). Foi realizada ultrassonografia Doppler transcraniana na primeira e na quarta horas de hemodiálise. Resultados: Foram incluídos 100 pacientes, 49 deles tinham cefaleia da diálise. Mulheres (OR=5,04; IC95% 1,95-13,04), indivíduos mais jovens (OR=1,05; IC95% 1,01-1,08), com maior escolaridade (OR=3,86; IC95% 1,4-10,7) e que passaram mais tempo em programas de diálise (OR=0,99, IC95% 0,98-1) tiveram mais cefaleia da diálise (regressão logística). Indivíduos com cefaleia dialítica tiveram pior qualidade de vida nos domínios dor e estado geral de saúde (56,9 versus 76,4, p=0,01; 49,7 versus 60,2, p=0,03, respectivamente). A cefaleia da diálise foi associada a um impacto significativamente maior na vida (OR=24,4; IC95% 2,6-226,6; regressão logística). O índice de pulsatilidade (ultrassonografia Doppler transcraniana) foi menor entre os pacientes com cefaleia da diálise do que entre aqueles sem. Conclusões: A cefaleia da diálise ocorre com frequência e está associada a pior qualidade de vida e a padrões de vasodilatação cerebral.

Intermittent claudication and severe renal artery stenosis are independently associated in hypertensive patients referred for renal arteriography.

OBJECTIVE:: The purpose of this study was to evaluate the association between the presence of clinical symptoms of peripheral artery disease and severe renal artery stenosis in patients referred for renal angiography. METHOD:: We included 82 patients with clinical suspicion of renovascular hypertension and performed an imaging investigation (renal Doppler ultrasound and/or renal scintigraphy) for possible renal artery stenosis. All patients underwent renal arteriography and were examined for peripheral artery disease based on the presence of intermittent claudication and ankle-brachial index test results. Severe renal artery stenosis was defined as a lesion causing 70% obstruction. RESULTS:: Severe renal artery stenosis was present in 32 of 82 (39%) patients. Patients with severe renal artery stenosis were older (63±12 vs 56±12 years, p=0.006), had more intermittent claudication (55 vs 45%, p=0.027), and had a greater prevalence of an ankle-brachial index <0.9 (44% vs 20%, p=0.021) than patients without severe renal artery stenosis. Multivariate logistic regression analysis showed that the presence of intermittent claudication was independently associated with renal artery stenosis ≥70% (OR: 3.33; 95% CI 1.03-10.82, p=0.04), unlike the ankle-brachial index, which showed no association (OR: 1.44; 95% CI 0.37-5.66, p=0.60). CONCLUSION:: Intermittent claudication is independently associated with severe renal artery stenosis (≥70%) in patients clinically suspected of having renovascular hypertension.