Research Letter
Impact of sleepiness on arterial stiffness and cardio-vascular risk in men with moderate to severe obstructive sleep apnea
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"apellidos" => "Marques" ] 5 => array:1 [ "colaborador" => "on behalf of the GI DPOC-Grupo de Interesse na Doença Pulmonar Obstrutiva Crónica" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511516000142?idApp=UINPBA00004E" "url" => "/21735115/0000002200000003/v1_201605310123/S2173511516000142/v1_201605310123/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Research Letter</span>" "titulo" => "Impact of sleepiness on arterial stiffness and cardio-vascular risk in men with moderate to severe obstructive sleep apnea" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "177" "paginaFinal" => "178" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M.A. Mineiro, P.M. da Silva, M. Alves, D. Virella, M.J.M. Gomes, J. Cardoso" "autores" => array:6 [ 0 => array:4 [ "nombre" => "M.A." "apellidos" => "Mineiro" "email" => array:1 [ 0 => "xmineiro@gmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "P.M." "apellidos" => "da Silva" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "M." "apellidos" => "Alves" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "D." "apellidos" => "Virella" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "M.J.M." "apellidos" => "Gomes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 5 => array:3 [ "nombre" => "J." "apellidos" => "Cardoso" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Pulmonology Department, Centro Hospitalar de Lisboa Central (CHLC), Lisbon, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Internal Medicine Department, Arterial Investigation Unit, CHLC, Lisbon, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Research Unit, CHLC, Lisbon, Portugal" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "NOVA Medical School/Faculdade de Ciências Médicas, Lisbon, Portugal" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Obstructive sleep apnea (OSA), if left untreated, is associated with high cardio-vascular (CV) morbidity and mortality. Based on large-scale epidemiological studies, it is known that excessive sleepiness is a cardinal symptom but the majority of individuals with high Apnea Hypopnea Index (IAH) do not complain of it.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Arterial stiffness, evaluated by pulse wave velocity (PWV), has a predictive value for CV events, beyond classical risk factors, and can be considered as an intermediate endpoint for CV events. Carotid-femoral pulse wave velocity (cf-PWV) remains the most commonly used non-invasive method and is considered as the gold standard.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Increased PWV is associated with various conditions, of which age and blood pressure (BP) are the most important. In OSA cf-PWV value is augmented, with improvement after treatment with CPAP.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In order to explore the association of sleepiness with CV risk in patients with OSA, we conducted a prospective study of consecutive males, younger than 65 years old, referred for snoring or OSA related symptoms. They were included if they had moderate to severe OSA (AHI<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>15) diagnosed by cardiorespiratory polygraphic study, level 3, in our institution's sleep laboratory, and excluded if they had other sleep disturbances, diabetes or CV disease beyond hypertension. Epworth Sleepiness Scale (ESS) score<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>10 defined excessive sleepiness. Patients with high BP in 24<span class="elsevierStyleHsp" style=""></span>h monitoring (ABPM) or already taking antihypertensive drugs were considered hypertensive. Arterial stiffness was assessed by cf-PWV, and 10<span class="elsevierStyleHsp" style=""></span>m/s was used as threshold value. CV risk was calculated by SCORE – European Low Risk Chart.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Univariable logistic regression and stratified Mantel–Haenszel analyses were performed to quantify associations between variables.</p><p id="par0030" class="elsevierStylePara elsevierViewall">From approximately 700 patients referred to the Clinic during the study, 34 patients were recruited, with median age 53.0 years; 24 (70.6%) were hypertensive (15 with medication), 18 (52.9%) had metabolic syndrome and 30 (91%) had dyslipidaemia. The cf-PWV was high in 27 (79.4%) and the median SCORE CV risk was 2 (0–5), 26 out of 33 patients had moderate CV risk.</p><p id="par0035" class="elsevierStylePara elsevierViewall">All patients with normal cf-PWV had moderate OSA, and cf-PWV was significantly higher when OSA was severe rather than moderate OSA (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.047). In fact, weak evidence was found that the odds for high cf-PWV increase with either increasing AHI (OR 1.08; 95%CI 0.99–1.18; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.078) or ODI (OR 1.14; 95%CI 0.98–1.32; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.086). No association was found between cf-PWV and ABPM measurements.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Patients with high cf-PWV also had similar prevalence rates of arterial hypertension (57.1% [95% CI 25.05–84.18] vs. 74.1% [95% CI 55.32–86.83]; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.394) but higher SCORE CV risk (median (maximum) 1 (2) vs. 3 (5); <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.029).</p><p id="par0045" class="elsevierStylePara elsevierViewall">Excessive sleepiness was diagnosed in 10 (29.4%) patients which had significantly higher AHI, ODI and higher SaO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>90% but lower minimum SaO<span class="elsevierStyleInf">2</span> than non-sleepy patients (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Sleepy and non-sleepy patients did not differ in prevalence rates of hypertension (70.0% vs. 70.8%) or average BP values. However, all patients with normal average ABPM values under medication were non-sleepy. Both cf-PWV and SCORE CV risk were similar regarding sleepiness (median (maximum) 2 (4) vs. 2 (5); <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.764). A weak evidence was found of a better control of BP with medication in non-sleepy patients, based on the ABPM values (Mantel–Haenszel, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.091).</p><p id="par0055" class="elsevierStylePara elsevierViewall">Other authors reported similar relationships between sleepiness and cf-PWV in OSA. Drager et al.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> made an observational study of patients with metabolic syndrome, and Kohler et al.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a> used a different arterial stiffness index.</p><p id="par0060" class="elsevierStylePara elsevierViewall">In this sample of male patients without significant comorbidities, who are suspected by their primary care physician of having OSA and needing treatment, a high prevalence of arterial hypertension was found, common in OSA; It should be noted that in 25% of the sample it was previously undiagnosed and in 80% of the patients under drug therapy, it was uncontrolled. High BP was present regardless of sleepiness, but in non-sleepy patients it may be easier to control with medication.</p><p id="par0065" class="elsevierStylePara elsevierViewall">This analysis had, as limitations, the small number of patients and the exclusion of patients with mild OSA, older patients or those patients with serious comorbidities.</p><p id="par0070" class="elsevierStylePara elsevierViewall">In conclusion, sleepy patients have more severe OSA, they tend to be more hypertensive and have uncontrolled BP, but arterial stiffness and CV risk are similar in regard of sleepiness.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Epworth – Epworth Sleepiness Scale; BMI – body mass index; SaO<span class="elsevierStyleInf">2</span> – arterial oxygen saturation; SaO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>90% – time under 90%; ODI – oxygen desaturation index; AHI – Apnoea-Hypopnoea Index; SBP – systolic blood pressure; DBP – diastolic blood pressure; cf-PWV – carotid-femoral pulse wave velocity.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sleepy (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>10) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Non-sleepy (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>24) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>-Value \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Epworth \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 (11.8–14.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.5 (4.0–7.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">54.0 (47.0–57.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">53.0 (46.3–59.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ns \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI (kg/m<span class="elsevierStyleSup">2</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31.5 (27.6–32.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29.7 (26.8–34.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ns \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Waist (cm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">104.5 (94.8–105.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100.0 (94.8–115.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ns \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mean SaO<span class="elsevierStyleInf">2</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">92.3 (90.8–93.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">93.5 (92.0–94.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ns \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Minimum SaO<span class="elsevierStyleInf">2</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">70.5 (68.3–76.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">81.5 (74.8–84.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.031 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SaO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>90% (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.5 (7.4–28.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.5 (2.1–16.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.042 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ODI (events/h) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32.9 (13.4–46.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.2 (6.6–22.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.034 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">AHI (events/h) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">46.9 (23.7–52.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21.9 (16.1–36.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.018 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">24-h SBP, mmHg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">127.5 (119.8–138.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">127.0 (121.0–136.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ns \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">24-h DBP, mmHg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">85.5 (74.3–88.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80.5 (74.0–85.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ns \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Daytime SBP (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">133.5 (125.3–142.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">131.0 (124.3–138.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ns \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Daytime DBP (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">88.0 (78.3–90.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">82.0 (75.5–88.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ns \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Night-time SBP (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">109.5 (104.0–126.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">116.5 (109.0–124.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ns \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Night-time DBP (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">68.5 (64.5–78.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">71.0 (61.3–75.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ns \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">cf-PWV (m/s) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.5 (10.9–12.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.1 (10.1–11.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ns \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1095487.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical characteristics of the participants, classified by sleepiness group. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 8 | 7 | 15 |
| 2024 October | 30 | 28 | 58 |
| 2024 September | 37 | 54 | 91 |
| 2024 August | 53 | 46 | 99 |
| 2024 July | 63 | 28 | 91 |
| 2024 June | 49 | 37 | 86 |
| 2024 May | 69 | 50 | 119 |
| 2024 April | 38 | 41 | 79 |
| 2024 March | 50 | 31 | 81 |
| 2024 February | 36 | 23 | 59 |
| 2024 January | 26 | 34 | 60 |
| 2023 December | 22 | 30 | 52 |
| 2023 November | 27 | 45 | 72 |
| 2023 October | 19 | 32 | 51 |
| 2023 September | 25 | 33 | 58 |
| 2023 August | 10 | 15 | 25 |
| 2023 July | 16 | 25 | 41 |
| 2023 June | 22 | 14 | 36 |
| 2023 May | 22 | 30 | 52 |
| 2023 April | 11 | 11 | 22 |
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