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1.
Medicina (Kaunas) ; 60(6)2024 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-38929475

RESUMO

Background and Objectives: The role of surgical extraction of the third molar in patients' sleep quality remains unclear, although it is one of the most common oral surgical procedures. The aim of this study is to assess the changes in patient-reported sleep health outcomes after third molar surgery and to investigate any associations between sleep parameters and post-extraction pain. Materials and Methods: Young adults without known comorbidities who were in need of mandibular third molar surgical extraction were included. All participants completed a sleep diary, the Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI) and Athens Insomnia Scale (AIS) questionnaires, which were used to assess sleep habits, daytime sleepiness, sleep quality and insomnia severity one week before and after extraction. In addition, a visual analog scale was completed postoperatively to assess the perception of pain. Results: Out of 75 patients who completed the study protocol, 32 (42.7%) were males and 43 (57.3%) were females, with a mean age of 24.01 (±3.43) years. Postoperatively, statistically significant higher scores were observed for PSQI [4.85 (±2.32) before vs. 5.39 (±2.75) after, p = 0.041], AIS [5.56 (±3.23) before vs. 6.91 (±4.06) after, p < 0.001] and average weekly number of nocturnal awakenings [2.01 (±3.72) before vs. 4.19 (±5.20) after, p < 0.001] but not for ESS, average weekly sleep duration and average weekly sleep onset latency. Pain perception was increased in patients who slept worse on almost all seven postoperative days, although this did not reach statistical significance. Conclusions: Third molar surgery impacts sleep quality and insomnia severity in the first week after extraction, while there is no effect on daytime sleepiness. The worsening of subjective sleep symptoms after extraction may be associated with an increased perception of pain.


Assuntos
Dente Serotino , Extração Dentária , Humanos , Feminino , Masculino , Dente Serotino/cirurgia , Adulto , Extração Dentária/efeitos adversos , Extração Dentária/métodos , Adulto Jovem , Inquéritos e Questionários , Qualidade do Sono , Dor Pós-Operatória/etiologia , Distúrbios do Início e da Manutenção do Sono
2.
J Pers Med ; 14(6)2024 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-38929821

RESUMO

BACKGROUND: Overlap syndrome (OS), the coexistence of chronic obstructive pulmonary disease and obstructive sleep apnea, is frequently characterized by the presence of daytime hypercapnia (pCO2 ≥ 45 mmHg). The aim of this study was to investigate potential differences in anthropometric, sleep and respiratory characteristics between hypercapnic and normocapnic patients with OS. METHODS: Consecutive patients who underwent polysomnography, pulmonary function testing and arterial blood gases and had been diagnosed with OS were enrolled in the study. RESULTS: According to pCO2 levels in wakefulness, the patients were divided into group A, consisting of OS patients without hypercapnia (n = 108) or group B, consisting of OS patients with hypercapnia (n = 55). The majority of included patients in both groups were males (n = 92 in group A vs. n = 50 in group B). Group B had increased BMI (p = 0.001), neck (p = 0.017) and waist circumference (p = 0.013), higher scores in Epworth sleepiness scale (ESS) (p = 0.008), increased sleep efficiency (p = 0.033), oxygen desaturation index (p = 0.004) and time with oxyhemoglobin saturation <90% (p = 0.006) than group A. Also, Group B had decreased average and minimum oxyhemoglobin saturation during sleep (p < 0.001). Hypercapnic patients had lower FEV1% (p = 0.003), FVC% (p = 0.004), pO2 and pCO2 (p < 0.001 for both) values compared with normocapnic patients. In binary regression analysis, which assessed various predictors on the likelihood of having hypercapnia, it was found that BMI (OR: 1.313, 95% CI: 1.048-1.646, p = 0.018) and FVC (OR: 0.913, 95% CI: 0.845-0.986, p = 0.020) were the major determinants of hypercapnia in OS patients. CONCLUSIONS: Hypercapnic OS patients were more obese and sleepy and presented worse respiratory function in wakefulness and sleep hypoxia characteristics compared with normocapnic OS patients.

3.
Healthcare (Basel) ; 12(6)2024 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-38540662

RESUMO

STUDY OBJECTIVES: The aim of this cross-sectional study is to explore the association between serum 25-hydroxyvitamin D [25(OH)D] levels, a marker of Vitamin D status, and excessive daytime sleepiness (EDS), expressed as increased scores of the Epworth Sleepiness Scale (ESS), in a group of prospectively enrolled patients with obstructive sleep apnea (OSA). METHODS: Newly diagnosed patients with OSA, divided into two groups, those with EDS (ESS > 10) and those without EDS (ESS < 10). All patients underwent night polysomnography. Measurement of serum 25(OH)D vitamin was performed using a radioimmunoassay. RESULTS: In total, 217 patients with OSA (197 males and 20 females) were included. Patients with EDS had higher AHI (p < 0.001) values and lower mean serum 25(OH)D levels, compared with those of non-somnolent patients [17.4 (12.2-25.7) versus 21.1 (15.3-28.8) ng/mL, respectively, p = 0.005]. In patients with EDS, serum 25(OH)D levels correlated with average oxyhemoglobin saturation during sleep (r = 0.194, p = 0.043), and negatively with ESS score (r = -0.285, p = 0.003), AHΙ (r = -0.197, p = 0.040) and arousal index (r = -0.256, p = 0.019). Binary regression analysis identified Vit D serum levels (ß = -0.045, OR: 0.956, 95% CI: 0.916-0.997, p = 0.035), total sleep time (ß = 0.011, OR: 1.011, 95% CI: 1.002-1.021, p = 0.016) and AHI (ß = 0.022, OR: 1.022, 95% CI: 1.003-1.043, p = 0.026) as independent predictors of EDS in patients with OSA. In patients with EDS, multiple regression analysis indicated that ESS score was negatively associated with Vit D serum levels (ß = -0.135, p = 0.014) and minimum oxyhemoglobin saturation during sleep (ß = -0.137, p = 0.043). CONCLUSIONS: In the present study, EDS in patients with OSA is associated with low levels of Vitamin D, while sleep hypoxia may play a role in this process.

5.
Medicina (Kaunas) ; 59(10)2023 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-37893477

RESUMO

Background and Objectives: Evidence shows that COPD-OSA overlap syndrome (OS) is more frequently accompanied by cardiovascular disease (CVD) in comparison to either disease alone. The aim of the study was to explore whether patients with OS have a higher burden of subclinical myocardial injury and wall stress compared with OSA patients. Materials and Methods: Consecutive patients, without established CVD, underwent polysomnography and pulmonary function testing, due to suspected sleep-disordered breathing. An equal number of patients with OS (n = 53, with an apnea hypopnea index (AHI) > 5/h and FEV1/FVC < 0.7) and patients with OSA (n = 53, AHI > 5/h and FEV1/FVC > 0.7) were included in the study. The detection of asymptomatic myocardial injury and wall stress was performed via the assessment of serum high-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP), respectively. Results: OS patients were older (p < 0.001) and had worse hypoxemic parameters, namely average oxyhemoglobin saturation (SpO2) (p = 0.002) and time spent with SpO2 < 90% (p = 0.003) during sleep as well as daytime pO2 (p < 0.001), than patients with OSA. No difference was observed between groups in terms of Epworth Sleepiness Scale (p = 0.432) and AHI (p = 0.587). Both levels of hs-cTnT (14.2 (9.1-20.2) vs. 6.5 (5.6-8.7) pg/mL, p < 0.001) and NT-proBNP (93.1 (37.9-182.5) vs. 19.2 (8.3-35.4) pg/mL, p < 0.001) were increased in OS compared to OSA patients. Upon multivariate linear regression analysis, levels of NT-proBNP and hs-cTnT correlated with age and average SpO2 during sleep. Conclusions: Our study demonstrated higher levels of hs-cTnT and NT-proBNP in OS patients, indicating an increased probability of subclinical myocardial injury and wall stress, compared with OSA individuals.


Assuntos
Doenças Cardiovasculares , Doença Pulmonar Obstrutiva Crônica , Apneia Obstrutiva do Sono , Humanos , Biomarcadores , Coração , Apneia Obstrutiva do Sono/diagnóstico , Doença Pulmonar Obstrutiva Crônica/complicações
6.
Clin Respir J ; 17(3): 165-175, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36635888

RESUMO

INTRODUCTION: Patients with overlap syndrome (OS), that is obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD), are at increased risk of acute exacerbations related to COPD (AECOPD). We assessed the effect of CPAP compliance on AECOPD, symptoms and pulmonary function in OS patients. METHODS: Consecutive OS patients underwent assessment at baseline and at 12 months under treatment with CPAP of: AECOPD and hospitalizations, COPD Assessment Test (CAT) and modified British Medical Research Council (mMRC) questionnaires, pulmonary function testing and 6-min walking test (6MWT). RESULTS: In total, 59 patients (54 males) with OS were followed for 12 months and divided post hoc according to CPAP compliance into: group A with good (≥4 h CPAP use/night, n = 29) and group B with poor (<4 h CPAP use/night, n = 30) CPAP compliance. At 12 months, group A showed improvements in FEV1 (p = 0.024), total lung capacity (p = 0.024), RV/TLC (p = 0.003), 6MWT (p < 0.001) and CAT (p < 0.001). COPD exacerbations decreased in patients with good CPAP compliance from baseline to 12 months (17 before vs. 5 after, p = 0.001), but not in those with poor compliance (15 before vs. 15 after, p = 1). At multivariate regression analysis, COPD exacerbations were associated with poor CPAP compliance (ß = 0.362, 95% CI: 0.075-0.649, p = 0.015). CONCLUSIONS: When compared to poorly compliant patients, OS patients with good CPAP compliance had a lower number of AECOPD and showed improved lung function and COPD related symptoms.


Assuntos
Doenças Autoimunes , Doenças do Tecido Conjuntivo , Doença Pulmonar Obstrutiva Crônica , Apneia Obstrutiva do Sono , Masculino , Humanos , Pressão Positiva Contínua nas Vias Aéreas , Doenças do Tecido Conjuntivo/complicações , Doenças Autoimunes/complicações , Cooperação do Paciente , Pulmão
7.
Curr Nutr Rep ; 12(1): 26-38, 2023 03.
Artigo em Inglês | MEDLINE | ID: mdl-36435894

RESUMO

PURPOSE OF REVIEW: The prevalence of obstructive sleep apnea (OSA) is increasing worldwide, in line with the increase in obesity prevalence. Taken into consideration the low compliance rates to continuous positive airway pressure (CPAP) treatment, and since obesity is a risk factor for OSA, these patients should receive additional counseling for weight loss through a diet plan. The aim of this review is to examine the role of a structured diet management plan on OSA severity, nocturnal oxygen indices, and subjective sleep parameters. RECENT FINDINGS: Τhis systematic review of the literature resulted in four studies and demonstrated that severity of OSA, assessed by the apnea-hypopnea index, is reduced by a dietary management plan when delivered through an educational program. Moreover, nocturnal oxygenation is improved, as well as subjective sleep parameters, when initiating a diet on top of CPAP use. In summary, the present systematic review reports on the beneficial effects of a structured diet management plan in patients with OSA. Although CPAP remains the gold standard of OSA treatment, a specific dietary plan should be sought when managing patients with OSA. Nevertheless, still the evidence is low, and further research on this field is needed to reduce the burden of OSA.


Assuntos
Apneia Obstrutiva do Sono , Humanos , Apneia Obstrutiva do Sono/terapia , Apneia Obstrutiva do Sono/epidemiologia , Sono , Dieta , Fatores de Risco , Obesidade
8.
J Pers Med ; 12(10)2022 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-36294836

RESUMO

Background: The coexistence of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) has been defined as overlap syndrome (OVS). Recently, a link between OSA, COPD and Vitamin D (Vit D) serum concentration was reported, however, evidence regarding Vit D status in patients with OVS is scarce. The aim of the present study was to evaluate Vit D serum levels and to explore the association of those levels with anthropometric, pulmonary function and sleep parameters in patients with OVS. Methods: Vit D serum levels were measured in patients diagnosed with OVS, as confirmed by overnight polysomnography and pulmonary function testing. Results: A total of 90 patients (79 males and 11 females) were included in the analysis. The patients were divided into three groups matched for age, gender, and BMI: the control group that included 30 patients (27 males and 3 females), the OSA group that included 30 patients (26 males and 4 females), and the OVS group that included 30 patients (26 males and 4 females). Patients with OVS exhibited decreased serum 25(OH)D levels compared with OSA patients and controls (14.5 vs. 18.6 vs. 21.6 ng/mL, p < 0.001). In the OVS group, multiple linear regression analysis identified AHI and FEV1, as predictors of serum 25(OH)D levels (p = 0.041 and p = 0.038, respectively). Conclusions: Lower Vit D levels have been observed in patients with OVS compared with OSA patients and non-apneic controls, indicating an increased risk of hypovitaminosis D in this population which might be associated with disease severity.

9.
Cureus ; 14(1): e21729, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35223327

RESUMO

INTRODUCTION: Patients with obstructive sleep apnea (OSA) frequently complain of fatigue during exercise. Treatment with continuous positive airway pressure (CPAP) ameliorates OSA-related symptoms and may reduce the burden of OSA on coexistent diseases. However, the role of CPAP on exercise capacity in OSA has not been fully investigated. AIM: The aim of this study is to assess exercise capacity in a group of newly diagnosed OSA patients, without known comorbidities, following treatment with CPAP. METHODS: Consecutively diagnosed OSA patients by polysomnography completed the International Physical Activity Questionnaire (IPAQ) and underwent cardiopulmonary exercise testing (CPET) and pulmonary function testing at baseline of OSA diagnosis three months after adherence to CPAP treatment. RESULTS: A total of 40 OSA patients (Apnea-Hypopnea Index (ΑΗΙ)>15 events/hour) of whom 29 (72.5%) males with an average age of 42±2.5 years were enrolled in the study. OSA patients had a mean peak oxygen uptake (V̇O2) value of 40.3 ±8.4 ml/kg/min (77.7±15%), which was improved after three months on CPAP treatment, 47.6±7.9 ml/kg/min (92.9±10.5%). (p=0.002). In addition, patients' mean work (W) value increased significantly from baseline to three months of treatment with CPAP (101.5±30 watts vs 78.6±18.5 watts. p=0.015, respectively). There were no significant differences in terms of physical activity, as noted in IPAQ, before and after OSA therapy (p=0.075). CONCLUSIONS: In the present study, OSA is associated with impaired exercise capacity, which seems to be improved after short-term treatment with PAP. Further evidence is warranted to elucidate whether CPET could be routinely used to monitor treatment responses of OSA with CPAP.

10.
Medicina (Kaunas) ; 57(11)2021 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-34833419

RESUMO

Background and Objectives: Obstructive sleep apnea syndrome (OSAS) and chronic obstructive pulmonary disease (COPD) are usually associated with multi-morbidity. The aim of this study was to retrospectively investigate the prevalence of comorbidities in a cohort of patients with OSAS and COPD-OSAS overlap syndrome (OS) patients and to explore differences between these two groups. Materials and Methods: Included were consecutive OS patients and OSAS patients who had been referred to our sleep laboratory, and were matched in terms of sex, age, BMI, and smoking history. Presence of comorbidities was recorded based on their medical history and after clinical and laboratory examination. Results: The two groups, OS patients (n = 163, AHI > 5/h and FEV1/FVC < 0.7) and OSAS patients (n = 163, AHI > 5/h, and FEV1/FVC > 0.7), did not differ in terms of apnea hypopnea index (p = 0.346), and oxygen desaturation index (p = 0.668). Compared to OSAS patients, OS patients had lower average SpO2 (p = 0.008) and higher sleep time with oxygen saturation <90% (p = 0.002) during sleep, and lower PaO2 (p < 0.001) and higher PaCO2 (p = 0.04) in wakefulness. Arterial hypertension was the most prevalent comorbidity for both OS and OSAS, followed by dyslipidemia, cardiovascular disease (CVD) and diabetes. OS was characterized by a higher prevalence of total comorbidities (median (IQR):2 (1-3) vs. 2 (1-2), p = 0.033), which was due to the higher prevalence of CVD (p = 0.016) than OSAS. No differences were observed in other comorbidities. Conclusions: In OS patients, nocturnal hypoxia and impaired gas exchange in wakefulness are more overt, while a higher burden of CVD is observed among them in comparison to sex-, age- and BMI-matched OSAS patients.


Assuntos
Doença Pulmonar Obstrutiva Crônica , Apneia Obstrutiva do Sono , Comorbidade , Humanos , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Testes de Função Respiratória , Estudos Retrospectivos , Apneia Obstrutiva do Sono/epidemiologia
11.
Sleep Med ; 86: 56-67, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34474225

RESUMO

The bidirectional relationship between sleep disordered breathing and chronic kidney disease (CKD) has recently gained a lot of interest. Several lines of evidence suggest the high prevalence of coexistent obstructive sleep apnea (OSA) in patients with CKD and end-stage renal disease (ESRD). In addition, OSA seems to result in loss of kidney function in some patients, especially in those with cardio-metabolic comorbidities. Treatment of CKD/ESRD and OSA can alter the natural history of each other; still better phenotyping with selection of appropriate treatment approaches is urgently needed. The aim of this narrative review is to provide an update of recent studies on epidemiological associations, pathophysiological interactions, and management of patients with OSA and CKD or ESRD.


Assuntos
Falência Renal Crônica , Apneia Obstrutiva do Sono , Humanos , Rim , Polissonografia , Pesquisa , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/terapia
15.
BMC Pulm Med ; 21(1): 92, 2021 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-33736634

RESUMO

BACKGROUND: Latest evidence suggests that periodontitis is prevalent among patients with chronic obstructive pulmonary disease (COPD), while recent studies have also reported a potential benefit of periodontal treatment on several COPD outcomes. This systematic review aims to determine the impact of periodontal treatment on exacerbation rate, lung function and quality of life of COPD patients. METHODS: A systematic search of electronic databases of PubMed, Scopus, Virtual Health Library, ScienceDirect, Wiley Online Library, Web of Science, ProQuest Dissertation and Theses Global and Google Scholar was conducted. Search restricted to studies involving human subjects which were published from January 2000 to March 2020 in English language. Distiller Systematic Review software was used for data management. Risk of bias was assessed using Risk of Bias 2 (RoB2) and Risk of Bias for non-randomized studies of intervention (ROBINS-I) tools. Overall quality of evidence was judged based on Grading of Recommendations Assessment, Development and Evaluation working group methodology. RESULTS: Out of 1442 articles retrieved, 7 full text articles were included in the review. Limited evidence suggests that periodontal treatment in patients with COPD and periodontitis is associated with reduced exacerbation frequency and a slower lung function decline rate, while its effects on quality of life remain unclear. In addition, periodontal treatment in COPD is associated with lower hospitalization rates and reduced all-cause mortality. Significant methodological differences were noted amongst included studies, while very low-to-moderate overall quality of evidence was demonstrated. CONCLUSIONS: Although it is reasonable to advise COPD patients not to neglect their dental health, further studies are warranted to determine the role of periodontal therapy on COPD clinical outcomes. TRIAL REGISTRATION: PROSPERO 2020 (CRD42020158481). https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020158481.


Assuntos
Periodontite/terapia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Progressão da Doença , Humanos , Saúde Bucal , Qualidade de Vida
17.
Pathol Res Pract ; 216(9): 153069, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32825942

RESUMO

Bronchiolitis obliterans is a clinical entity which results from a variety of etiologies and has a detrimental impact on patients' quality of life when it remains undiagnosed and untreated. Due to its non-pathognomic clinical symptoms and signs, physicians often proceed to radiological examination, especially with high resolution chest tomography. Histological examination reveals constrictive bronchiolitis, the pathological definition of bronchiolitis obliterans. Due to an almost normal aspect of the lung parenchyma this condition can be missed. However, its recognition and the identification of a possible exposure are important for removing the patient from the incriminating agent. We present a case of constrictive bronchiolitis in a metal-cutting worker, highlighting the principal findings of this disease.


Assuntos
Bronquiolite Obliterante/etiologia , Bronquiolite Obliterante/patologia , Pulmão/patologia , Exposição Ocupacional/efeitos adversos , Qualidade de Vida , Biópsia/métodos , Bronquiolite Obliterante/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
18.
Sleep Med ; 73: 170-176, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32836085

RESUMO

Since late December 2019, COVID-19, the disease caused by the novel coronavirus, SARS-CoV-2, has spread rapidly around the world, causing unprecedented changes in provided health care services. Patients diagnosed with sleep-disordered breathing (SDB) are subject to a higher risk of worse outcomes from COVID-19, due to the high prevalence of coexistent comorbidities. Additionally, treatment with positive airway treatment devices (PAP) can be challenging because of PAP-induced droplets and aerosol. In this context, sleep medicine practices are entering a new era and need to adapt rapidly to these circumstances, so as to provide the best care for patients with SDB. Novel approaches, such as telemedicine, may play an important role in the management of patients with SDB during the COVID-19 pandemic.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Síndromes da Apneia do Sono/terapia , Telemedicina/métodos , COVID-19 , Pressão Positiva Contínua nas Vias Aéreas/métodos , Pressão Positiva Contínua nas Vias Aéreas/tendências , Infecções por Coronavirus/epidemiologia , Contaminação de Equipamentos/prevenção & controle , Humanos , Pneumonia Viral/epidemiologia , SARS-CoV-2 , Síndromes da Apneia do Sono/diagnóstico , Síndromes da Apneia do Sono/epidemiologia , Telemedicina/tendências
19.
Metab Syndr Relat Disord ; 18(6): 296-301, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32379990

RESUMO

Background: Evidence suggests that metabolic syndrome (MetS) is highly prevalent in patients with obstructive sleep apnea syndrome (OSAS) and chronic obstructive pulmonary disease (COPD). However, data on the prevalence of MetS in patients having both OSAS and COPD, or overlap syndrome (OS), are scarce. The aim of this study was to evaluate the prevalence and identify predictors of MetS in patients with OS. Methods: MetS was evaluated in consecutive patients who were diagnosed with OS by polysomnography and pulmonary function testing. Results: A total of 163 subjects (138 males and 25 females) were included. MetS was present in 38% of OS patients. Patients were divided into group A (OS without MetS group: 101 patients) and group B (OS with MetS group: 62 patients). Groups were similar in terms of pulmonary function and sleep parameters. In group B, abdominal obesity was the most prevalent component of MetS (100%), followed by hypertension (82.3%), hypertriglyceridemia (72.6%), and hyperglycemia (51.6%). Age (P = 0.009) and body mass index (P = 0.029) were independent predictors of MetS in patients with OS. Conclusions: An increased prevalence of MetS was observed in a group of patients with OS. Early identification and treatment of MetS may play a significant role in prevention of complications related to OS.


Assuntos
Síndrome Metabólica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Apneia Obstrutiva do Sono/epidemiologia , Idoso , Comorbidade , Estudos Transversais , Feminino , Grécia/epidemiologia , Humanos , Masculino , Síndrome Metabólica/diagnóstico , Pessoa de Meia-Idade , Prevalência , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Medição de Risco , Fatores de Risco , Apneia Obstrutiva do Sono/diagnóstico
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