Heart rate variability during wakefulness as a marker of obstructive sleep apnea severity

Study ObjectivesPatients with obstructive sleep apnea (OSA) exhibit heterogeneous heart rate variability (HRV) during wakefulness and sleep. We investigated the influence of OSA severity on HRV parameters during wakefulness in a large international clinical sample.Methods1247 subjects (426 without OSA and 821 patients with OSA) were enrolled from the Sleep Apnea Global Interdisciplinary Consortium. HRV parameters were calculated during a 5-minute wakefulness period with spontaneous breathing prior to the sleep study, using time-domain, frequency-domain and nonlinear methods. Differences in HRV were evaluated among groups using analysis of covariance, controlling for relevant covariates.ResultsPatients with OSA showed significantly lower time-domain variations and less complexity of heartbeats compared to individuals without OSA. Those with severe OSA had remarkably reduced HRV compared to all other groups. Compared to non-OSA patients, those with severe OSA had lower HRV based on SDNN (adjusted mean: 37.4 vs. 46.2 ms; p < 0.0001), RMSSD (21.5 vs. 27.9 ms; p < 0.0001), ShanEn (1.83 vs. 2.01; p < 0.0001), and Forbword (36.7 vs. 33.0; p = 0.0001). While no differences were found in frequency-domain measures overall, among obese patients there was a shift to sympathetic dominance in severe OSA, with a higher LF/HF ratio compared to obese non-OSA patients (4.2 vs. 2.7; p = 0.009).ConclusionsTime-domain and nonlinear HRV measures during wakefulness are associated with OSA severity, with severe patients having remarkably reduced and less complex HRV. Frequency-domain measures show a shift to sympathetic dominance only in obese OSA patients. Thus, HRV during wakefulness could provide additional information about cardiovascular physiology in OSA patients.Clinical Trial Information: A Prospective Observational Cohort to Study the Genetics of Obstructive Sleep Apnea and Associated Co-Morbidities (German Clinical Trials Register - DKRS, DRKS00003966) https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00003966     

Lessons From Participation in a Web-Based Substance Use Preventive Program in Uruguay

We analyzed individual and program characteristics associated with participation in an Information and Communication Technologies (ICT)-based substance use preventive intervention in Uruguay, South America. The intervention was directed at ninth- and tenth-grade students in 10 private schools in Montevideo. Participation in the program was non-mandatory and effective participation rates were low. We found that individual characteristics, such as prior heavy engagement with alcohol and opportunity costs of time, were associated with the decision to participate. We also found that sending the participants periodic reminders via e-mail and short message service (SMS) text messages had a positive impact on participation. The lessons from this intervention suggest that participation in non-mandatory Web-based programs aimed at preventing substance use among adolescents could be substantially improved with a more structured, mandatory, and longer intervention.     

Refractory ascites in systemic lupus erythematosus: further biological support of intraperitoneal steroid treatment as a suitable therapeutical option

Clinical Rheumatology - The objective of this report was to evaluate the ascitic fluid of a patient with refractory lupus ascites (proband) at different time points—pre- and...     

Lice infestation in goats in western Santa Catarina,Brazil

Parasitic diseases affecting goats are able to cause major economic losses, standing out, among them, the lice infestation. According to the literature, lice can act as vectors of other diseases, including the ones caused by blood protozoan. In this sense, this survey study aimed to assess the ectoparasites of goats in the west region of Santa Catarina (SC). Two hundred seventeen goats from 24 different rural properties located in 17 towns in SC were examined. From them, ectoparasites were collected and evaluated in laboratory, where the parasitological classification was performed. In 13 properties, it was possible to identify ectoparasites. Damalinia caprae lice were observed in 126 animals (58 %), while Linognathus stenopsis were found in 10 animals (4.6 %). It is noteworthy that, in these properties, all the animals were under lice parasitism, independent of sex or age. The goats had peeling skin, particularly in the back region (lumbar). All of the 24 properties evaluated were reported having problems with lice in different seasons of the year, even under regular treatment with cypermethrin (spraying). Based on our findings, it was possible to conclude that D. caprae is the major ectoparasite of goats in the investigated area.