RESUMO
BACKGROUND: Little has been known about the prevalence of sleep apnea in patients with atrial fibrillation (AF). Studies have suggested that the prevalence of AF is increasing in patients with sleep-disordered breathing. We hypothesize that the prevalence of OSA is higher in chronic persistent and permanent AF patients than a sub-sample of the general population without this arrhythmic disorder. OBJECTIVE: Evaluate the frequency of Obstructive Sleep Apnea in a sample of chronic AF compared to a sub-sample of the general population. METHODS: Fifty-two chronic AF patients aged (60.5 +/- 9.5, 33 males) and 32 control (aged 57.3 +/- 9.6, 15 males). All subjects were evaluated by a staff cardiologist for the presence of medical conditions and were referred for polysomnography. The differences between groups were analyzed by ANOVA for continuous variables, and by the Chi-square test for dichotomous variables. Statistical significance was established by alpha=0.05. RESULTS: There were no differences in age, gender, BMI, sedentarism, presence of hypertension, type 2 diabetes mellitus, abdominal circumference, systolic and diastolic blood pressure, and sleepiness scoring between groups. Despite similar BMI, AF patients had a higher neck circumference compared to control group (39.9cm versus 37.7cm, p=0.01) and the AF group showed higher percentage time of stage 1 NREM sleep (6.4% versus 3.9%, p=0.03). Considering a cut-off value for AHI >= 10 per hour of sleep, the AF group had a higher frequency of OSA compared to the control group (81.6% versus 60%, p=0.03). All the oxygen saturation parameters were significantly worse in the AF group, which had lower SaO(2) nadir (81.9% versus 85.3%, p=0.01) and mean SaO(2) (93.4% versus 94.3%, p=0.02), and a longer period of time below 90% (26.4min versus 6.7min, p=0.05). CONCLUSION: Sleep-disordered breathing is more frequent in chronic persistent and permanent AF patients than in age-matched community dwelling subjects.
Assuntos
Fibrilação Atrial/complicações , Apneia Obstrutiva do Sono/epidemiologia , Idoso , Índice de Massa Corporal , Estudos de Casos e Controles , Doença Crônica , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polissonografia , Prevalência , Fatores de RiscoRESUMO
This paper presents the conceptual framework for regulating water use in cases where water is a public good. Public agencies with an independent directive board can successfully manage such a situation. Through a comprehensive system of water permits, charging and control it is possible to effectively manage water resources. Together with the conceptual framework a practical application is presented. The case of the National Water Agency of Brazil--ANA--shows that it is possible to implement modern water resources management concepts in less developed countries. The benefits of this institutional arrangement are demonstrated in the case of managing water conflicts among water users. Two situations are described: the semi-arid water allocation for agricultural use in the Jaraguaribe River Basin in Ceara State and the conflict between the hydropower and navigation sectors in the Parana River Basin.
Assuntos
Conservação dos Recursos Naturais , Países em Desenvolvimento , Meio Ambiente , Formulação de Políticas , Abastecimento de Água , Órgãos Governamentais , Humanos , Relações Interinstitucionais , Estudos de Casos OrganizacionaisRESUMO
Growing demand for water leads to increased competition between water users. A holistic, participatory and decentralized water management approach is promoted to reach a fair allocation mechanism between competing water uses. Domestic political discourse has a strong influence on water policies being developed.