Symptoms and steroid dose adjustments following the Covid-19 vaccine in patients with adrenal insufficiency.

BACKGROUND: A proportion of patients with adrenal insufficiency (AI) require increases in their maintenance glucocorticoids following the Covid-19 vaccine as a result of vaccine-related symptoms or development of incipient or frank adrenal crisis. In a large cohort of AI patients, we aim to characterise symptoms, changes in glucocorticoid dosage, occurrence of adrenal crises and whether there are differences between the mRNA and adenovirus vector vaccines. PATIENTS AND METHODS: Patients with AI of any aetiology were invited to complete a short, structured questionnaire of their experience of the Covid-19 vaccination. RESULTS: 279 of the 290 patients enrolled to this study fully completed the questionnaires. 176, 100 and 3 received the Astra Zeneca (AZ), Pfizer-BioNTech (PB) and Moderna (MD) as initial vaccine respectively; and for the second vaccine, 170, 99 and 10 received AZ, PB and MD respectively. Moderate to severe symptoms occurred in 44.8 and 39.7% after the first and second vaccines respectively, were of early onset (6.0 h, IQR 2-12 &. 6.0 h, IQR 2-24 h) and short duration (24 h, IQR 12-72 h & 26 h, IQR 12-72 h). 34.4 and 29.7% increased their maintenance glucocorticoid dose. DISCUSSION: The Covid-19 vaccines appear well-tolerated in patients with AI, with similar frequency of symptoms to that reported in the background population. The AZ vaccine leads to slightly greater post-vaccination symptom burden and need to increase glucocorticoid dosage, but this does not translate to greater adverse outcomes.

Screening for obstructive sleep apnea among patients undergoing coronary catheterization in Jordan.

Aims: This study aimed to utilize a validated sleep questionnaire as a screening tool for symptoms and risk of obstructive sleep apnea in patients undergoing coronary catheterization in Jordan. Materials and methods: A cross-sectional design was used to screen adult patients undergoing coronary catheterization for obstructive sleep apnea (OSA). The Berlin sleep questionnaire was used to record nocturnal and daytime symptoms of OSA and to stratify patients into "low-risk" or "high-risk" for OSA. Coronary artery disease was defined as ≥50% intraluminal stenosis in at least one coronary vessel. Results: A total of 398 patients were studied, mean age was 58.7 years (SD=10.70), ranging from 21-92 years, and 68.6% were males. Based on the Berlin sleep questionnaire's definition, 176 patients (44.2%) were at high-risk for obstructive sleep apnea. Snoring was reported by 61%; loud in 42.1%, and frequent in 62%. Daytime sleepiness was reported by 36%, and 18.9% had fallen asleep while driving. Witnessed apnea during sleep was less reported (7.8%). Prevalence of symptoms and risk of OSA were not different between patients with and without coronary artery disease, P>0.05. In addition, logistic regression indicated that there was no significant association between risk of OSA and coronary artery disease, adjusted (odds ratio=0.93, 95% Confidence Interval=0.60-1.44, P=0.752). Conclusions: Symptoms and risk of obstructive sleep apnea were common among adult Jordanians undergoing coronary catheterization. There was no association between risk of obstructive sleep apnea and coronary artery disease. Larger studies are needed to assess the role of screening for obstructive sleep apnea in this patient population.