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Background: There is no information on the prevalence of symptoms related to neurotoxicity among carpenters working in underserved populations. To assess the magnitude of the problem, we conducted a population-based study in Atahualpa, a rural Ecuadorian village, where most men work as carpenters under poor safety conditions. Methods: All men aged 40-75 years living in Atahualpa were identified during a door-to-door survey and evaluated with a general demographic questionnaire, the Q16 questionnaire, the depression axis of the Depression Anxiety Stress Scale-21, and the Montreal Cognitive Assessment (MoCA). Results: Among 230 participants, 63% were carpenters. Seventy participants (30%) had a positive Q16 questionnaire (≥6 points), which suggested neurotoxicity. In a logistic regression model adjusted for age, education, alcohol intake, symptoms of depression, and MoCA score, the proportion of Q16 positive persons was 39.1% for carpenters and 15.9% for noncarpenters (odds ratio: 3.53, 95% confidence interval: 1.75-7.15, P < 0.0001). In a generalized linear model, adjusted mean scores in the Q16 questionnaire were 4.9 for carpenters and 3.6 for noncarpenters (β: 1.285, standard error: 0.347, P < 0.0001). There was no correlation between scores in the Q16 questionnaire and the MoCA (Pearson correlation coefficient = -0.02), and the only significant covariate in the multivariate linear model was age, with every 10 years of age difference contributing 0.64 points in the Q16 questionnaire. Conclusion: This study shows a high prevalence of symptoms associated with neurotoxicity among carpenters after adjusting for a number of confounders. Long-term exposure to toxic solvents is the most likely explanation to this finding. [ABSTRACT FROM AUTHOR]

Background: In a population-based sampling study conducted in community-dwelling older adults living in rural Ecuador, we aimed to assess the relation among sleep-disordered breathing, cerebral pulsatility index, and diffuse small vessel disease. Methods: Of 25 participants, 9 (36 %) had moderate-to-severe sleep-disordered breathing, characterized by an apnea/hypopnea index ≥15 per hour, and 10 (40 %) had moderate-to-severe white matter hyperintensities, graded according to the modified Fazekas scale. Mean (SD) pulsatility index in the middle cerebral artery was 1.18 (0.19) and positively correlated with the apnea/hypopnea index (R = .445, P = .03, [Pearson's correlation coefficient]). The middle cerebral artery pulsatility index was increased in persons with moderate-to-severe sleep-disordered breathing compared with persons who had none-to-mild sleep-disordered breathing (mean [SD] 1.11 [0.12] vs. 1.3 [0.23], P = .01). No significant differences were found in the prevalence of moderate-to-severe white matter hyperintensities across groups of sleep-disordered breathing (P = .40) or in the mean apnea/hypopnea index across groups of persons with none-to-mild or moderate-to-severe white matter hyperintensities (P = .16). Conclusions: This pilot study shows that moderate-to-severe sleep-disordered breathing correlates with cerebral pulsatility, but such association might be independent of diffuse small vessel disease. [ABSTRACT FROM AUTHOR]

Background Reported prevalence of restless legs syndrome (RLS), also known as Willis-Ekbom disease (WED), varies from country to country, and methodologic inconsistencies limit comparison of data. Impact of RLS on quality of life and health has been studied primarily in industrialized countries, particularly Europe and the United States. Many studies have relied exclusively on self-report of symptoms or have assessed only medical populations. Recently, interest has emerged on the impact of WED in rural, underserved populations globally. Methods In a population-based survey conducted in rural Ecuador, we assessed the relationship of psychological distress to WED, evaluated with the Depression Anxiety Stress Scales-21. WED was diagnosed through a 2-phase method in which all residents were screened with the International Restless Legs Syndrome Study Group (IRLSSG) questionnaire and all suspected cases were subsequently confirmed through expert medical examination. WED severity was assessed with the IRLSSG rating scale. Results Of 665 persons (mean [SD] age, 59.5 [12.6] years; women, 386 [58%]), 76 had depression, 93 had anxiety, and 60 reported stress. Forty persons (6%) had WED, with 15 (38%) having severe disease. In a regression model adjusted for age and sex, the prevalence of depression, anxiety, and stress was about 3 times greater among persons with WED than the general population. Conclusions Although cross-sectional data cannot establish causation, this study shows the large behavioral health burden associated with WED in an untreated, rural population. [ABSTRACT FROM AUTHOR]

Purpose To assess the effect of age in the association between poor sleep quality and frailty status. Design and Setting Population-based, cross-sectional study conducted in Atahualpa, a rural village located in coastal Ecuador. Methods Out of 351 Atahualpa residents aged ≥60 years, 311 (89%) were interviewed with the Pittsburgh Sleep Quality Index (PSQI) and the Edmonton Frail Scale (EFS). The independent association between PSQI and EFS scores was evaluated by the use of a generalized linear model adjusted for relevant confounders. A contour plot with Shepard interpolation was constructed to assess the effect of age in this association. Results Mean score in the PSQI was 5 ± 2 points, with 34% individuals classified as poor sleepers. Mean score in the EFS was 5 ± 3 points, with 46% individuals classified as robust, 23% as prefrail, and 31% as frail. In the fully adjusted model, higher scores in the PSQI were significantly associated with higher scores in the EFS (β 0.23; 95% CI 0.11–0.35; P < .0001). Several clusters depicted the strong effect of age in the association between PSQI and EFS scores. Older individuals were more likely to have high scores in the EFS and the PSQI, and younger individuals had low EFS scores and were good sleepers. Clusters of younger individuals who were poor sleepers and had high EFS scores accounted for the independent association between PSQI and EFS scores. Conclusions This study shows the strong effect of age in the association between poor sleep quality and frailty status. [ABSTRACT FROM AUTHOR]

Background/objectives: Due to the content of omega-3 and vitamin D, fish consumption is likely to be associated with better sleep. However, current data are limited to a single study that is not representative of the population at large. The present study aimed to assess the effects of oily fish consumption on sleep quality in community dwelling adults living in rural coastal Ecuador.Methods: Atahualpa residents aged ≥40 years and who were identified during a door-to-door survey were interviewed with field instruments directed at assessing cardiovascular risk factors, sleep quality, and fish consumption. Using parametric regression and generalized linear models adjusted for demographics and cardiovascular risk factors, the study evaluated whether oily fish consumption is associated with a lower Pittsburgh sleep quality index (PSQI).Results: Out of 721 eligible people, 677 (94%) were enrolled. Mean oily fish consumption was 9 ± 6 servings per week (one serving = 140 grams). Poor sleep quality was noticed in 187 (28%) individuals. Oily fish intake was higher in individuals with good sleep quality (p = 0.013). There was an inverse association between the PSQI score and oily fish servings per week in both parametric regression (β = -0.040; 95% CI -0.690 to -0.011, p = 0.007) and the adjusted generalized linear model (β = -0.032; 95% CI -0.605 to -0.004, p = 0.025).Conclusions: Oily fish consumption is associated with better sleep quality. Even in people who ingest more than the recommended amount of fish, an increase in fish intake is associated with further improvement in the quality of sleep. [ABSTRACT FROM AUTHOR]

Background and Purpose: Recent studies have suggested an association between dysfunction of the choroid plexus and the glymphatic system. However, information is inconclusive. Following a population-based study design, we aimed to assess the association between choroid plexus calcifications (CPCs)-as a surrogate of choroid plexus dysfunction-and severity and progression of putative markers of glymphatic dysfunction, including white matter hyperintensities (WMH) of presumed vascular origin and abnormally enlarged basal ganglia perivascular spaces (BG-PVS)., Methods: This study recruited community-dwellers aged ≥40 years living in neighboring Ecuadorian villages. Participants who had baseline head CTs and brain MRIs were included in cross-sectional analyses and those who additional had follow-up MRIs (after a mean of 6.4 ± 1.5 years) were included in longitudinal analyses. Logistic and Poisson regression models, adjusted for demographics and cardiovascular risk factors, were fitted to assess associations between CPCs and WMH and enlarged BG-PVS severity and progression., Results: A total of 590 individuals were included in the cross-sectional component of the study, and 215 in the longitudinal component. At baseline, 25% of participants had moderate-to-severe WMH and 27% had abnormally enlarged BG-PVS. At follow-up, 36% and 20% of participants had WMH and enlarged BG-PVS progression, respectively. Logistic regression models showed no significant differences between CPCs volumes stratified in quartiles and severity of WMH and enlarged BG-PVS. Poisson regression models showed no association between the exposure and WMH and enlarged BG-PVS progression. Baseline age remained significant in these models., Conclusions: Choroid plexus calcifications are not associated with putative markers of glymphatic system dysfunction., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Study Objectives: This study assessed changes in sleep quality before and after the peak of the SARS-CoV-2 pandemic in community dwellers enrolled in the Atahualpa Project., Methods: Atahualpa residents aged ≥40 years were eligible if they had a Pittsburgh Sleep Quality Index (PSQI) 9 months before the pandemic and a lateral flow-based test for identification of SARS-CoV-2 antibodies during the peak of the pandemic. Six months later, individuals completed a follow-up PSQI. The independent relationship between SARS-CoV-2 infection and deterioration in sleep quality was assessed by fitting logistic mixed models for longitudinal data., Results: Of 639 participants (mean age at baseline: 59 ± 12.8 years), 325 (51%) had SARS-CoV-2 antibodies. A total of 185 (29%) individuals at baseline and 311 (49%) at follow-up were poor sleepers (p < 0.001). Mixed logistic regression models demonstrated a significant increase in poor sleepers at follow-up (odds ratio [OR]: 2.85; 95% CI: 2.16 to 3.75), which was more marked among SARS-CoV-2 seropositive subjects (OR: 3.8; 95% CI: 2.48 to 5.81). The adjusted proportion of poor sleepers increased from 29% to 56.2% (95% CI: 50.9% to 61.6%) among SARS-CoV-2 seropositive individuals, but only to 40.7% (95% CI: 35.3% to 46.1%) in their seronegative counterparts (p < 0.001). Likewise, progression from a good to a poor sleeper status was higher among seropositive individuals than in their seronegative counterparts (38.1% vs 22.3%; p < 0.001), after adjusting for relevant covariates., Conclusions: This study shows a deleterious effect of SARS-CoV-2 in sleep quality. An effect of SARS-CoV-2 in disrupting sleep-related pathways cannot be ruled out., Trial Registration: The Atahualpa Project has been registered at ClinicalTrials.gov; the identifier number is NCT01627600, and the date was: 10/02/2012 (https://clinicaltrials.gov/ct2/show/NCT01627600?cond=Atahualpa&draw=2&rank=1). The Sleep Disorders substudy has been registered at ClinicalTrials.gov; the identifier number is NCT01877616, and the date was: 06/13/2013 (https://clinicaltrials.gov/ct2/show/NCT01877616?cond=Atahualpa&draw=2&rank=4)., (© Sleep Research Society 2021. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background/objectives: The relationship between physical activity and sleep quality has been reported in specific conditions or in selected individuals. To better understand this association at the population level, we aimed to assess the association between physical activity and sleep quality in community-dwellers residing in three neighboring rural villages of Coastal Ecuador., Methods: A total of 1438 individuals aged ≥40 years were included. Data collection focused on the levels of physical activity and sleep quality. Multivariate models were fitted to assess independent associations between adequate physical activity and good sleep quality, after adjusting for relevant covariates., Results: Physical activity was categorized as ideal in 676 (47%) individuals, intermediate in 644 (45%), and poor in 118 (8%). According to the Pittsburgh Sleep Quality Index (PSQI), 880 (61%) individuals had a good sleep quality. In univariate analysis, the percentage of individuals with a good sleep quality was lower among individuals with poor and intermediate physical activity when compared to those with ideal physical activity. Using individuals with poor physical activity as the referent category, a logistic regression model showed that a good sleep quality was significantly associated with intermediate (odds ratio, OR: 1.54; 95% confidence interval, CI: 1.03-2.30; p = 0.036) and ideal (OR: 1.78; 95% C.I.: 1.18-2.69; p = 0.006) physical activity, after adjusting for relevant covariates., Conclusions: This population-based study provides robust epidemiological evidence favoring an association between adequate levels of physical activity and good sleep quality in middle-aged and older adults living in rural settings., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Introduction: Information on the relationship between the diameters of the abdominal aorta (AA) and the basilar artery (BA) is limited. Using the Atahualpa Project cohort, we aimed to assess this association in Atahualpa residents aged ≥ 60 years., Materials and Methods: Atahualpa residents aged ≥ 60 years underwent abdominal ultrasound and MRA of intracranial vessels. The independent association between both arterial diameters was estimated in a generalized linear model adjusted for demographics, cardiovascular risk factors, the presence of a fetal-type Circle of Willis, and severity of white matter hyperintensities. Fractional polynomials were fitted to model the relationship between AA and BA diameters., Results: The mean age of 277 participants was 69.5 ± 7.7 years (61% women). The mean AA diameter was 19.8 ± 3.3 mm, and the mean BA diameter was 3.1 ± 0.7 mm. The mean diameters of both arteries were significantly higher in men than in women. Locally weighted scatterplot smoothing showed a non-linear relationship between both arterial diameters. Fractional polynomial models showed that AA and BA diameters had a significant non-linear association in men (p = 0.005), but not in women (p = 0.315). When sex was excluded from a generalized linear model, the relationship between both arterial diameters became significant (p = 0.017)., Conclusion: In this population of community-dwelling older adults, the relationship between AA and BA diameters was confined to men. The finding of a large AA diameter in men should prompt the investigation of the intracranial vasculature because of the possibility of BA ectasia.

Background: Evidence of the relationship between periodic limb movements during sleep (PLMS) and cerebral small vessel disease (cSVD) is limited and inconsistent. Here, we aimed to assess the independent association between PLMS and the different neuroimaging signatures of cSVD., Methods: Atahualpa residents aged more than or equal to 60 years enrolled in the Atahualpa Project undergoing polysomnography and MRI with time intervals less than or equal to 6 months were included. MRI readings focused on white matter hyperintensities (WMH) of presumed vascular origin, deep cerebral microbleeds (CMB), silent lacunar infarcts (LI), and more than 10 enlarged basal ganglia-perivascular spaces (BG-PVS). Data from single-night polysomnograms were interpreted according to recommendations of the American Academy of Sleep Medicine. Associations between the PLMS index and neuroimaging signatures of cSVD (as dependent variables) were assessed by means of logistic regression models, adjusted for relevant confounders., Results: A total of 146 individuals (mean age: 71.4 ± 7.5 years; 64% women) were included. A PLMS index more than or equal to 15 per hour were noted in 48 (33%) participants. Moderate-to-severe WMH were present in 33 individuals (23%), deep CMB in 9 (6%), silent LI in 16 (11%), and more than 10 BG-PVS in 44 (30%). In univariate analyses, silent LI (P = .035) and the presence of more than 10 enlarged BG-PVS (P = .034) were significantly higher among participants with a PLMS index more than or equal to 15 per hour. However, fully-adjusted multivariate models showed no significant association between PLMS index more than or equal to 15 per hour and any of the neuroimaging signatures of cSVD., Conclusions: This study shows no independent association between the PLMS index and neuroimaging signatures of cSVD in stroke-free community-dwelling older adults., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Study Objectives: Evidence of an association between atherosclerosis and sleep quality is limited and has not been studied in remote rural settings, where living conditions are different than in urban centers. We aimed to assess the relationship between the aortic pulse wave velocity (PWV) and sleep quality in older adults living in rural Ecuador., Methods: Atahualpa residents aged 60 years or older identified during door-to-door surveys, who consented to participate, underwent face-to-face interviews with the Pittsburgh Sleep Quality Index (PSQI) to assess sleep quality. Aortic PWV determinations were performed for arterial stiffness estimation (as a surrogate of atherosclerosis)., Results: A total of 303 individuals were included (mean age: 70.3 ± 7.8 years; 59% women). Univariate logistic regression showed a significant association between the aortic PWV and poor sleep quality (odds ratio [OR] 1.22; 95% confidence interval [CI] 1.07-1.39; P = .003). A multivariate logistic regression model, adjusted for demographics, cardiovascular risk factors, oily fish intake and psychological distress showed a significant association between increased PWV and poor sleep quality (OR 1.59; 95% CI 1.12-2.25; P = .009). Similar significance was noted when the model was adjusted for neuroimaging signatures of cerebral small-vessel disease and stroke (OR 1.47; 95% CI 1.07-2.03; P = .019)., Conclusions: This study shows a significant independent association between the aortic PWV and poor sleep quality in older adults living in rural Ecuador. Results provide more insights into the relevance of the impact of sleep disorders on cardiovascular diseases., Clinical Trial Registration: The Atahualpa Project has been registered at ClinicalTrials.gov. The identifier number is NCT01627600, and the date was: 10/02/2012., Citation: Del Brutto OH, Mera RM, Peñaherrera E, Costa AF, Peñaherrera R, Castillo PR. On the association between sleep quality and arterial stiffness: a population study in community-dwelling older adults living in rural ecuador (the atahualpa project). J Clin Sleep Med. 2019;15(8):1101-1106., (© 2019 American Academy of Sleep Medicine.)

Background/objectives: Evidence of an association between sleep disorders and extracranial atherosclerosis is limited and has not been studied in remote rural settings, where living conditions and cardiovascular risk factors are different than in urban centers. We assessed the relationship between the carotid intima-media thickness (cIMT) and sleep quality in stroke-free individuals aged ≥40 years living in rural Ecuador., Methods: Applying a population-based study design, participants underwent face-to-face interviews using the Pittsburgh Sleep Quality Index (PSQI) to assess sleep quality, and sonographic examinations for measurement of the carotid intima-media thickness (cIMT). The association between the cIMT and sleep quality (as the dependent variable) was assessed by means of generalized linear models, adjusted for relevant confounders., Results: The mean age of 561 participants was 60.4 ± 12.6 years (58% women). The mean PSQI was 4.6 ± 2.2 points. Of those, 79 (14%) individuals had an increased cIMT (>1 mm). A model adjusted for demographics showed a significant association between increased cIMT and the PSQI score (β: 0.602; 95% C.I.: 0.027-1.177; p = 0.040). This relationship was reduced when cardiovascular risk factors were added to the model (β: 0.514; 95% C.I.: -0.072 - 1.101; p = 0.086). When the model was adjusted for demographics and psychological distress, the association between increased cIMT and the PSQI score became significant (β: 0.573; 95% C.I.: 0.013-1.133; p = 0.045). In addition, both symptoms of depression (p = 0.032) and anxiety (p < 0.001) remained independently significant., Conclusions: This study shows an association between increased cIMT and the PSQI score, which is, at least, partly mediated by manifestations of psychological distress., (Copyright © 2018 Elsevier B.V. All rights reserved.)

There is limited information on participants' adherence and reasons for declining consent in observational cohort studies conducted in remote rural communities. We aimed at sharing lessons learned during the Atahualpa Project, a population-based cohort study conducted in a rural Ecuadorian village. Atahualpa residents aged ≥40 years identified during door-to-door surveys who signed a consent form were enrolled. Annual surveys were conducted to assess the number of participants who moved out of the village, as well as those who died, declined consent, and newly entered the study. Reasons for declining consent were tabulated. Abstracted data included age, sex, education, disability, time between enrollment and declining consent, and reasons for withdrawal. We also counted participants who, despite expressing their willingness to continue in the study, refused specific procedures. After five years of follow-up, 54 (6.3%) of 863 enrolled individuals declined consent. Increasing age and disability had no impact on declining consent. In contrast, refusal was higher among relatives or neighbors of a given participant declining consent. Most people who declined consent did so after one or two years of enrollment. Less than 20% of enrolled individuals refused certain procedures. "Fear of the needle" was the most frequent reason for refusing blood tests, and common reasons for declining complimentary exams were lack of interest and time constraints. Cohort retention in the Atahualpa Project is high. Main reasons for this adherence include adequate selection of the village, detailed planning of procedures, assurance of sponsorship, and field personnel who continuously engage with study participants. This trial is registered with NCT01627600.

Background: Willis-Ekbom disease (WED), also called restless legs syndrome (RLS), is a neurologic sensorimotor disease that may be associated with cardiovascular disease. Given high morbidity and mortality rates of cardiovascular disease worldwide, we assessed the relation between WED/RLS and cardiovascular health risks in a native South American population. We prospectively analyzed data from The Atahualpa Project of Ecuadorian adults aged 40 years and older. Physicians interviewed consented persons on the health behavior and health factors of the American Heart Association (AHA) for ideal cardiovascular health in adults and underwent fasting laboratory blood collection and blood pressure evaluation. Certified neurologists conducted face-to-face interviews using the International Restless Legs Syndrome Study Group (IRLSSG) field instrument. Persons testing positive for WED/RLS and age-and sex-matched controls underwent confirmatory physical examinations conducted by a neurologist and a sleep specialist to whom IRLSSG designation was blinded., Findings: Of 665 persons, 94 (14 %) tested positive in IRLSSG; 40 (6 %) had a diagnosis of WED/RLS after neurologic examination and interview. Patients with WED/RLS were younger (53.5 vs 59.9 years, P = .001), without significant differences in sex ratios. Among AHA risk factors, only obesity was significantly more prevalent among patients with WED/RLS (42.5 % vs 23.5 %, P = .01). However, after adjustment for confounders, body mass index was not significantly associated with WED/RLS., Conclusions: In adult Amerindians, although obesity and body mass index were associated with WED/RLS on univariate analyses, the association was not present after adjustment for confounders. No other significant associations were found between WED/RLS and AHA cardiovascular metrics.

Background/objectives: Evidence of a relationship between non-breathing-related sleep symptoms and silent markers of cerebral small vessel disease (SVD) is scarce. The present study aimed to evaluate this association in older people living in rural Ecuador, where the burden of stroke is on the rise., Methods: A group of Atahualpa residents, aged ≥60 years, were interviewed with a validated Spanish version of the Pittsburgh Sleep Quality Index, and underwent magnetic resonance imaging (MRI) for identification of silent markers of SVD. Using multinomial logistic regression analysis, after adjusting for demographics and cardiovascular health status, it was evaluated whether sleep quality is associated with the severity of white matter hyperintensity (WMH), lacunar infarcts, and deep microbleeds., Results: Out of 311 people aged ≥60 years, 237 (76%) were enrolled into the study. Mean age was 70 ± 8 years, 59% were women, 83% had primary school education only, and 73% had a poor cardiovascular health status. Seventy-eight (33%) had poor sleep quality. The MRI showed: WMH in 154 (65%) participants (moderate-to-severe in 52); silent lacunar infarcts in 28 (12%); and deep microbleeds in 17 (7%). Poor sleep quality was associated with WMH presence (OR 2.44, 95% CI 1.26 to 4.71, p = 0.008) and severity (β coefficient 0.77, SE 0.37, p = 0.037), but not with silent lacunar infarcts or deep microbleeds., Conclusions: The present study showed an association between poor sleep quality and WMH severity. Further longitudinal studies would help to elucidate the cause and effect of this relationship., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Objective: To estimate the prevalence of Willis-Ekbom disease (WED) in a racially homogeneous population of adults Amerindians living in rural coastal Ecuador, and to assess the reliability of the International Restless Legs Syndrome Study Group (IRLSSG) questionnaire when used in population-based studies., Methods: Two-phase, door-to-door, population-based survey. During Phase I, rural doctors screened all Atahualpa residents aged ≥40 years with the IRLSSG questionnaire. In Phase II, neurologists evaluated suspected WED cases and a matched sample of negative individuals., Results: The census identified 665 persons aged ≥40 years. An affirmative response to the questionnaire was obtained in 94 persons. Medical history and neurological examination confirmed the diagnosis of WED in 40 of them. The evaluation of 188 non-suspected individuals revealed no further cases. The questionnaire had a sensitivity of 100% (95% CI, 89% to 100%), a specificity of 78% (95% CI, 72% to 83%), a positive predictive value of 0.43 (95% CI, 0.33 to 0.53), and a negative predictive value of 1 (95% CI, 0.98 to 1). The prevalence of WED in Atahualpa residents aged ≥40 years was 6%., Conclusion: The prevalence of WED in this adult Ecuadorian population is higher than that reported from most studies conducted in tropical countries, but similar to that found in Brazil. Specificity and positive predictive value of the IRLSSG questionnaire are poor, which reinforces the need for a second phase that should include an expert interview., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Objectives: Cardiovascular correlates of sleep disorders have not been well investigated in underserved populations. The aim of this door-to-door survey was to evaluate the association between sleep quality and cardiovascular health status in persons aged ≥40 years living in a village that is representative of rural Ecuador., Methods: All stroke-free Atahualpa residents aged ≥40 years were screened with a validated Spanish version of the Pittsburgh Sleep Quality Index and the seven cardiovascular health (CVH) metrics proposed by the American Heart Association to assess the CVH status., Results: A total of 635 persons (mean age 59 ± 13 years; 58 % women) were identified. A poor sleep quality was present in 27 % of the subjects (95 % CI 24-31 %) and a poor cardiovascular health in 69 % (95 % CI 63-71 %). In a multivariate logistic regression model, a poor sleep quality was associated with some CVH metrics in the poor range, including smoking status (p = 0.026), physical activity (p = 0.01) and blood glucose levels (p = 0.036)., Conclusions: A poor sleep quality may be linked to individual cardiovascular risk factors in this underserved Latin American population. This finding provides useful insights for the implementation of regional prevention priorities.

Background: Little is known on the role of sleep disorders in the increased prevalence of cerebrovascular diseases in the developing world., Aims: The aim of this study is to assess the prevalence of major sleep disorders in a rural South American population and to determine whether these conditions are associated with stroke, ischemic heart disease, or with a poor cardiovascular health (CVH)., Design: Three-phase, population-based, door-to-door survey in Atahualpa. During phase I, all residents aged 40 years or older will be screened with validated Spanish versions of 5 questionnaires to evaluate major sleep disorders. In phase II, neurologists will examine persons suspected of having a sleep disorder and a random sample of negative individuals to assess the prevalence of these conditions and to validate the accuracy of questionnaires. In phase III, patients with a confirmed sleep disorder will undergo nocturnal polysomnography for achieving a more specific diagnosis. The occurrence of sleep disorders will be correlated with the CVH of the population and with the presence of stroke and ischemic heart disease., Discussion: This epidemiologic study may prove cost-effective in improving sleep conditions of people living in rural areas of developing countries and may be used as a model for the evaluation of sleep disorders and their cerebrovascular correlates in these populations., (Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.)

Objective: To determine the prevalence of restless legs syndrome (RLS) in native South Americans and identify the impact of geographic location., Participants and Methods: An epidemiological telephone survey of RLS symptoms involving natives from coastal and mountainous areas was performed during July 2, 2004, through September 28, 2004. The process consisted of 2 phases: the creation of the epidemiological instrument and the telephone survey., Results: Five hundred adults, 250 from the mountainous regions and 250 from the coastal region (190 men and 310 women; age range, 25-85 years) were interviewed and subsequently divided on the basis of International Restless Legs Syndrome Study Group criteria into those who had RLS (RLS+ group) and those who did not (RLS- group). Ten (2.0%) had RLS. The overall rate of RLS in adults living in the mountainous region at 2816 m above sea level (3.2% [8/250]) was significantly higher than that for adults living in the coastal region at 4 m above sea level (0.80% [2/250]; P = .002). The mean age of the RLS+ group was 49.5 years (SD, 15.20 years; range, 25-85 years)., Conclusion: Native South American adults have a prevalence of RLS well below that reported in populations with European ancestry but similar to that in Asian and Turkish populations. Furthermore, in Ecuador, geographic differences were identified in areas of similar population density.