This study aimed to investigate the factors that predict the acceptance of distance learning among undergraduate nursing students during the COVID-19 pandemic and to examine Please check if the Citation part is missing the implications of these findings for nursing education in the post-pandemic era. A cross-sectional study was conducted in Greece with a convenience sample of undergraduate nursing students from the Hellenic Mediterranean University and the University of Patras. Data were collected between December 2020 and January 2021 using an online questionnaire. Statistical analysis was performed using IBM SPSS version 21.0. A total of 378 undergraduate nursing students (mean age: 22 years) participated in this study. The regression model predicting students' attitudes toward distance learning (ATel) was statistically significant and explained 18.3% of the variance in ATel scores (R-2 = 0.183, adjusted R-2 = 0.158). Among the psychological and experiential factors, future career concerns (beta = 0.237, p < 0.001), emotional distress related to social isolation (beta = 0.186, p = 0.001), and perceived difficulties in group work (beta = 0.140, p = 0.013) were revealed as significant predictors of the students' attitudes toward distance learning. In contrast, digital readiness, flexibility, and perceived effectiveness of distance learning were not revealed as statistically significant predictors in the multivariate model but were positively associated with students' attitudes. Demographic characteristics were not identified as statistically significant predictors of ATel scores. Psychosocial factors were significantly associated with nursing undergraduate students' attitudes toward distance learning, underscoring the importance of incorporating blended learning in higher education in the post-pandemic era to secure group interaction, effective collaboration, and students' well-being.

INTRODUCTION:This systematic review/meta-analysis evaluated the impact of sarcopenia in patients with cirrhosis before liver transplantation (LT) on outcomes after LT. METHODS:A systematic search was conducted in six medical databases until February 2022. The primary outcome was overall mortality after LT, while several secondary outcomes including liver graft survival and rejection, the need for transfusions, the length of the intensive care unit (ICU) and hospital stay, and surgical complications were evaluated. Sub-group analyses and meta-regression analyses were also performed. RESULTS:Fifty-three studies were evaluated in the systematic review, of which 30, including 5875 patients, were included in the meta-analysis. All studies included were cohort studies of good/high quality on the Newcastle-Ottawa scale (NOS), while in our analysis no publication bias was found, although there was substantial heterogeneity between the studies. Muscle mass was assessed using skeletal muscle index (SMI) in 14 studies, psoas muscle area (PMA) in seven studies, and psoas muscle index (PMI) in four studies. The prevalence of pre-LT sarcopenia ranged from 14.7% to 88.3%. Pre-LT sarcopenia was significantly associated with post-LT mortality (Relative Risk [RR] = 1.84, 95% CI:1.41,2.39), as well as with a high risk of infections post-LT, surgical complications, fresh frozen plasma (FFP) transfusions, and ICU length of stay (LOS). CONCLUSIONS:Pre-LT sarcopenia in patients with cirrhosis is a strong risk factor for clinically meaningful adverse outcomes after LT. Assessment may help identify patients at the highest risk for poor outcomes who may benefit from targeted interventions.

OBJECTIVES:To systematically review the accuracy of spleen stiffness measurement (SSM) by 2D- Shear Wave Elastography (2D-SWE) in predicting high risk for bleeding varices (HRV) in cirrhotic patients. METHODS:PubMed, Embase, Web of Science, Medline, Cochrane, and Google Scholar databases were searched up to 31/05/2023 for all human studies using 2D-SWE to estimate SSM and endoscopy to detect HRV. Meta-analysis was performed using a generalized linear mixed model. Publication bias was evaluated using the funnel plot asymmetry test. The Area Under the Summarized Receiver Operating Characteristic curve (AUSROC) was estimated using the "mada" package. RESULTS:A total of 13 studies and 1970 patients were included. Of them, 27.8 % had HRV. The pooled sensitivity and polled specificity of SSM in detecting HRV were 90 % (95 %CI:87-92 %) and 68 % (95 %CI:58-77 %), respectively, with an AUSROC at 0.86 (95 %CI:0.82-0.90). The median cutoff value of SSM in detecting HRV was 34.2 kPa. In studies including exclusively HBV cirrhotic patients, SSM's polled sensitivity and specificity in predicting HRV was 88 % (95 %CI:82-92 %) and 73 % (95 %CI:68-78 %), respectively. The AUSROC was 0.84 (95 %CI:0.81-0.87). The number of repeated measurements per patient (<5 or ≥ 5) did not affect the method's capability. Using Aixplorer to evaluate SSM had a higher sensitivity in ruling out HRV than other 2D-SWE devices. CONCLUSIONS:Our meta-analysis supports that SSM by 2D-SWE has a good diagnostic performance for ruling out HRV in cirrhosis.

Respiratory disorders significantly impact adolescents' health, often resulting in hospital admissions. Meteorological elements such as wind patterns have emerged as potential contributors to respiratory symptoms. However, it remains uncertain whether fluctuations in wind characteristics over extended periods have a tangible impact on respiratory health, particularly in regions characterized by distinct annual wind patterns. Crete is situated in the central-eastern Mediterranean Sea and frequently faces southerly winds carrying Sahara Desert sand from Africa and northerly winds from the Aegean Sea. This retrospective study analyzes long-term wind direction data and their relationship to respiratory symptoms observed in children up to 14 years old admitted at the University Hospital of Heraklion between 2002 and 2010. Symptoms such as headache, dyspnea, dry cough, dizziness, tachypnea, throat ache, and earache were predominantly reported during the presence of southern winds. Fever, productive cough, and chest pain were more frequently reported during northern winds. Cough was the most common symptom regardless of the wind pattern. Southern winds were significantly associated with higher probabilities of productive or non-productive cough, headache, dyspnea, tachypnea, dizziness, earache, and throat ache. Northern winds were related to a higher incidence of productive cough. Rhinitis, asthma, allergies, pharyngitis, and sinusitis were related to southern winds, while bronchiolitis and pneumonia were associated with northern winds. These findings underscore the critical role of local climatic factors, emphasizing their potential impact on exacerbating respiratory conditions in children. Moreover, they point out the need for further research to elucidate the underlying mechanisms and develop targeted interventions for at-risk populations.

(1) Background: The COVID-19 pandemic posed a major threat to global health and on the educational field. The purpose of this study is to identify and illustrate the psychosocial adaptation of nursing students to the sudden and exclusive application of distance learning during the COVID-19 pandemic; (2) Methods: A qualitative interview research has been designed. Two focus groups of seven members each and six individual interviews were conducted in a sample of undergraduate nursing students in Greece from 3 March 2021, to 9 April 2021.; (3) Results: A qualitative thematic analysis of the data identified six themes: 1. Challenges; 2. Concerns; 3. Social changes; 4. Negative Emotions; 5. Evaluation; and 6. Teaching strategies.; (4) Conclusions: During its implementation, it identified gaps and weaknesses in the entire academic community. The study of the psychosocial adaptation of the academic community is considered crucial, as it can highlight the individual difficulties in distance learning and contribute to the improvement of the methods of its the improvement of its methods.

Background and AimLiver stiffness measurement (LSM) has been predicting liver decompensation and survival in cirrhotics. The aim of our study was to investigate if spleen stiffness measurement (SSM) by 2D shear-wave elastography could predict better the probability of decompensation and mortality, compared with LSM and other parameters. MethodsConsecutive cirrhotic patients were recruited between 1/2017 and 12/2021. LSM and SSM were performed at baseline and epidemiological, clinical, and laboratory data were collected. Clinical events were recorded every 3 months. ResultsTotally, 177 patients were followed for a mean period of 31 +/- 18 months. In Cox regression analysis, only SSM was independently associated with the probability of decompensation (HR: 1.063, 95% CI: 1.009-1.120; P = 0.021), offering an AUROC of 0.710 (P = 0.003) for predicting 1-year liver decompensation (NPV: 81.1% for the cut-off point of 37 kPa). The occurrence of death/liver transplantation was independently associated only with higher SSM (HR: 1.043; 95% CI:1.003-1.084; P = 0.034). The AUROC of SSM for predicting 1-year death/liver transplantation was 0.72 (P = 0.006) (NPV: 95% for the cut-off of 38.8 kPa). The performance of SSM to predict the 1-year death/liver transplantation increased in high-risk patients (CTP: B/C plus MELD >10 plus LSM > 20 kPa), giving an AUROC of 0.80 (P < 0.001). Only 1/26 high-risk patients with SSM < 38.8 kPa died during the first year of follow-up (NPV: 96.4%). ConclusionsSSM was the only factor independently associated with the probability of decompensation and occurrence of death, showing better diagnostic accuracy for the prediction of 1-year decompensation or death compared with LSM and MELD score.

Rationale: In patients with decompensated cirrhosis (DeCi), sarcopenia is associated with higher morbidity and mortality. Although appendicular lean mass index (ALMI) is considered the gold standard for muscle mass evaluation, psoas muscle evaluation has been suggested as an alternative approach. The aim of the study was to evaluate the accuracy of Psoas Muscle Index (PMI) for assessing sarcopenia in DeCi patients.

Conflict is expected in relationships, but the act of violence is not. In the global phenomenon of intimate partner violence (IPV) and international research on effective models for its eradication, Human Systems Therapy (HST) represents a recommended and auspicious form of intervention. The aim of the present research was to empirically evaluate the effectiveness of the HST model in IPV. HST is a systemic model that has been developed over time and has shown significant results in couple and family therapy. It is a multi-level, brief therapy that intervenes in relationships, utilising First and Second Order Cybernetics principles and methods. This present research, conducted as a Multiple Case Study, investigated the effectiveness of HST in eighteen individuals (nine heterosexual couples) referred to therapy by the Public Prosecutor’s Office following a complaint of physical violence by one member of the couple against the other. The investigation of HST effectiveness was conducted using a mixed data collection method, encompassing both quantitative and qualitative data. The Revised Conflict Tactics Scale (CTS2) was administered to record and evaluate the conflict tactics employed by the couples, and the Differential Emotions Scale-modified (DES.MOD) was used to record and assess the degree of positive and negative emotions experienced by the couple members before and after the interventions. The results indicated that the HST model can bring statistically significant changes to the couples’ relationships concerning the eradication of violence and increase positive emotions between them.

Abstract: (1) Background: The Covid-19 pandemic has spread globally since January 2020 and is a threat to public health. This study aims to highlight the psychosocial impact on Greek nursing students and the challenges they received regarding the new sustainable educational reality, in the context of the sudden and exclusive application of distance education during the pandemic Covid-19; (2) Methods: Questionnaires were distributed through an online form (Lime Survey) to undergraduate nursing students enrolled in online courses. Data were collected between De-cember 2020 and January 2021 (3) Results: A total of 341 participants were included in the study. Some of the participants (9.1%) reported that being unemployed because of the Covid-19 affected their sustainability of life. Similarly, distance education had a negative impact on students' par-ticipation in social activities with their classmates (64.5%), while many of the participants were concerned that the sudden transition from face-to-face to distance education would have a negative impact on their future career (46.3%). Furthermore, the majority of students in this study seemed to disagree that distance education could be more effective than face-to-face education (72.1%); (4) Conclusions: It is undoubtedly proven that the effects of the Covid-19 pandemic have a great impact on the educational sector. These social and psychological changes endangered the viability of students in the Greek educational reality.

BACKGROUND:Hepatocellular carcinoma (HCC) is the sixth most common cancer globally, and is attributable mainly to viral hepatitis, alcohol and nonalcoholic fatty liver disease.METHODS:Three hundred Greek patients diagnosed with HCC between 2000 and 2019 were retrospectively evaluated for patient and HCC characteristics. Patients were classified as before 2011 (A) or after 2011 (B) and HCC risk factors were compared with historic Greek cohorts.RESULTS:The median age was 64 years and 86% were male; 45% had chronic hepatitis B virus (HBV) infection, 26% chronic hepatitis C virus (HCV) infection, and 30% non-viral liver diseases (nvLD). No change was observed among liver diseases between periods A and B. However, there was a trend towards a decrease in virally and an increase in non-virally induced HCC (P=0.075). Patients in period B (vs. A) were more likely to be diagnosed with fewer (<3, P=0.006) and smaller (<3 cm, P=0.005) nodules. Compared with 1558 Greek HCC patients from 1974-2000, there was a decrease in HBV and an increase in HCV and nvLD-related HCCs (P<0.001).CONCLUSIONS:In Greece, after 2000, there was a decrease in the proportion of HBV and an increase in the proportion of HCV and nvLD-related HCC, while over the last 2 decades there has been a trend towards a decrease in virally and an increase in non-virally induced HCC. Since 2011, HCC is being diagnosed at an earlier stage, possibly reflecting improved surveillance strategies.

Background and aim The aim of this study is to evaluate the performance of 2D-shear wave elastography (2D-SWE) in patients with nonalcoholic fatty liver disease (NAFLD) and compare it to transient elastography. Methods Over 6 months, 552 patients with NAFLD underwent liver stiffness measurement (LSM) by both 2D-SWE and transient elastography with controlled attenuation parameter (CAP) at the same visit. Results LSM was not feasible by transient elastography (M/XL probe) in 18 (3.3%) and by 2D-SWE in 26 (4.7%) patients. The median LSM of transient elastography was 5.5 (2.8–75) kPa and of 2D-SWE 6.2 (3.7–46.2) kPa. LSMs by transient elastography and 2D-SWE were correlated regardless of the obesity status (r, 0.774; P < 0.001; r, 0.774; P < 0.001; r, 0.75; P < 0.001 in BMI <25, 25–30 and ≥30 kg/m2 respectively), or the degree of liver steatosis (r = 0.63; P < 0.001 and r = 0.743; P < 0.001 in mild and moderate/severe steatosis, respectively). According to transient elastography, 88 (15.9%) patients were classified with at least severe fibrosis (≥F3) and 55 (10%) with cirrhosis. By using the 2D-SWE, 85 (15.4%) patients had at least severe fibrosis and 52 (9.4%) cirrhosis. The correlation between the two methods was strong in patients with at least severe fibrosis (r, 0.84; P < 0.001) or cirrhosis (r, 0.658; P < 0.001). When transient elastography was used as reference, 2D-SWE showed an excellent accuracy of 98.8 and 99.8% in diagnosing severe fibrosis and cirrhosis, respectively. Conclusions In NAFLD, 2D-SWE and transient elastography have comparable feasibility and clinical applicability providing LSMs with strong correlation, even in overweight/obese patients, independently of the severity of liver steatosis and fibrosis. Thus, either of the two methods can be effectively used for the assessment of fibrosis in this setting.

Hepatitis E virus (HEV) is a common cause of acute hepatitis in developing countries, but it can also take a chronic course especially in immunocompromised patients. Its epidemiology after liver transplantation (LT) is hard to assess and treatment options are still explored. Between 2009 and 2020, literature reporting HEV prevalence and treatment in LT recipients was searched and a synthesis was attempted. Sixteen studies reported HEV prevalence in consecutive LT patients: HEV RNA positivity ranged between 0%-1.4% and 0%-7.7% for Western and Eastern cohorts, respectively. In studies published between 2009-2014 and 2015-2020, HEV RNA positivity ranged between 0.35%-1.3% (all European) and 0%-7.7% (European: 0%-1.4%), respectively. Five studies evaluated HEV prevalence in LT recipients with abnormal liver enzymes: HEV RNA positivity was 2.9% in studies published between 2009 and 2014 and from 3.5% to 20% in studies published between 2015 and 2020. Twenty-seven studies reported HEV treatment in LT recipients: sustained virologic response was achieved in 15% by immunosuppression reduction alone and in 83% of cases by ribavirin regiments. Chronic HEV infection is affecting LT recipients, mostly those with abnormal liver enzymes and in Eastern countries. HEV diagnoses should be based on PCR techniques. Successful treatment can be achieved with ribavirin in most cases.

INTRODUCTION During the COVID-19 pandemic, nursing students were challenged with a new digital reality of distance education. The aim of the study was the translation into Greek, cultural adaptation and validation of the Attitude Scale towards e-learning (ATel) during the period of the COVID-19 pandemic. METHODS A questionnaire already developed through theoretical research by experts in the Philippines was used. The present study reports the translation, cultural adaptation and validation of the measurement of the attitude of nursing students regarding the sudden implementation of distance education in Greece during the pandemic. The translation strategy for intercultural research was used to translate the questionnaire into Greek. A cross-sectional study was performed among 341 undergraduate nursing students, who were recruited by convenience sampling and analyzed for validity and reliability. Cronbach's alpha was applied for measuring the internal consistency of data. Independent samples t-test or the corresponding non-parametric Mann-Whitney test was applied for comparing means or distributions between continuous variables divided into two groups. RESULTS The Kaiser-Meyer-Olkin and Cronbach's alpha scores showed satisfactory results. The value of alpha was 0.90, indicating that the sample size was suitable for factor analysis. The validity and reliability of the questionnaire were determined through exploratory and confirmatory factor analysis. The main findings of this study were that the marital status of the participants, their age (which was proportional to their attitude) and their previous experience in distance education through the COVID-19 pandemic restrictive measures, influenced the adaptation of the population to the new educational conditions. CONCLUSIONS The questionnaire was found to have satisfactory psychometric properties in Greece and therefore can be used as a tool in future research on the attitude of nursing students during the COVID-19 pandemic. © 2022. All Rights Reserved.

Aim: The study examined (a) the relationship between caregivers' (CG) quality of life (QoL) and their reports about care receivers' dementia symptoms and (b) whether CG's resilience would be a mediator in this relationship. Method: This was a cross-sectional study based on a purposeful sampling. Face-to-face structured interviews were conducted with 118 CGs (79% females, mean age = 59, SD = 12). CGs provided assessment of their QoL and resilience, and proxy assessments of people with dementia (PwD) symptoms (cognitive functioning, functional activity and behavioural problems (BP)). Results: The BP were the only perceived dementia symptoms associated with the CGs' QoL. CGs' resilience fully mediated the relationship between perceived BP and CGs' QoL. Implications: Tailored training programs designed to improve CGs' QoL should focus on strengthening their personal resources, such as skills to manage the behaviour problems exhibited by PwD and their resilience to adapt to self-perceived behaviour problems common to dementia.

Rationale: Sarcopenia is the syndrome of progressive loss of skeletal muscle mass, strength and function and is correlated with quality of life, disease complications and mortality. The gold standard for muscle mass quantity evaluation is dual-energy x-ray absorptiometry (DXA), but it is not always available. The aim of the study was to evaluate the accuracy of anthropometric methods for the evaluation of muscle mass quantity and to correlate muscle functionality with the measurements of muscle mass quantity in decompensated cirrhosis.

BACKGROUND:Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in the developed countries. The aim of this study was to evaluate the NAFLD prevalence in European adults and children/adolescents of the general population and specific subgroups. METHOD:Search for all articles published between 01/1990-06/2019 reporting NAFLD prevalence from European countries. RESULTS:Nineteen studies with adults and 9 with children/adolescents were included. Pooled NAFLD prevalence in adults was 26.9%, being higher in studies using ultrasonography (27.2%) or fatty liver index (FLI) (30.1%) than liver biochemical tests (19.1%) and without differences between Mediterranean and non-Mediterranean countries or publication periods. Pooled NAFLD prevalence was higher in men than women (32.8% vs. 19.6%) and in patients with than those without metabolic syndrome (75.3% vs. 17.9%) or any of its components (always P<0.01). Ultrasound and FLI performed equally in estimating NAFLD prevalence in most subgroups. A higher prevalence was reported using FLI in obese and in diabetic patients, whereas a higher prevalence was observed with ultrasound in non-obese patients and in individuals without metabolic syndrome. NAFLD prevalence was 2.7% in unselected and 31.6% in obese/overweight children/adolescents. CONCLUSIONS:NAFLD prevalence exceeds 25% in European adults, being higher in those with metabolic syndrome component(s)-related comorbidities. It remains low in unselected NAFLD population, but increased in overweight/obese European children/adolescents, particularly from Mediterranean countries.

The objective of this study was to examine the effect of different concentrations of nitrogen on downy mildew severity on cucumber plants. Nitrogen (100-600 mg L-1) was applied to plants grown in pots under greenhouse conditions through irrigation water. The cucumber leaves were inoculated with a zoospore suspension of Pseudoperonospora cubensis, the causal agent of powdery mildew. Disease symptoms in plants treated with 300 mg L-1 nitrogen were significantly lower and 24% severity reduction was recorded. A positive effect on the leaf area was also noticed in cucumber plants with the application of 300 mg L-1 nitrogen. The results indicated that a cubic regression curve can be fitted to the disease progress for downy mildew, regardless of N treatments. Furthermore, the N enrichment affected the NH4-N and NO3-N content in leaves and soil as well as P content in the leaves. The application of 100 mg L -1 N significantly reduced Mn content in leaves. Therefore, nitrogen supply in the form of ammonium nitrate fertilizer could be considered as an efficient method for the control of downy mildew of cucumber.

The capacity of five white rot fungi species to degrade linuron, metribuzin and chlorpyrifos when applied both as single pesticides and mixed together in different concentrations on nutritionally poor media was investigated. Our results suggested that Pleurotus ostreatus, Pycnoporus coccineus, Phlebiopsis gigatea and Τrametes versicolor showed a remarkable tolerance to the pesticides, in all media tested. The EC50 values presented a noticeable difference in the mixtures as compared with the individual ones. The minimum growth rate in the mixture was obtained by P. ostreatus whereas P. coccineus appeared to be more efficient than the rest fungal isolates, when cultivated in the soil extract medium. P. coccineus, P. gigantea and T. versicolor produce high levels of polyphenol oxidase, but only T. versicolor was capable of decomposing linuron when combined with metribuzin and chlorpyrifos.

Abstract Background: Metastasis remains a major threat for patients (pts) with operable breast cancer (BC). Recurrence could arise from a state of tumour dormancy during which there is growth restriction of undetectable micrometastases. The expression of dormancy and metastasis related miRNAs was evaluated in the plasma of pts with operable BC obtained before adjuvant therapy in order to discover novel biomarkers for the prediction of relapse. Methods: Plasma miR-21, miR-23b, miR-190, miR-200b and miR-200c expression was assessed by qRT-PCR in 133 pts with early BC (non-relapsed, n=84; relapsed, n=49). Expression was classified as high or low according to the median values and was associated with pts' clinicopathological characteristics and clinical outcome. Results: No correlation was observed between the expression of miRNAs and the clinicopathological characteristics of pts. After a median f-up of 90.5 mo, median Disease Free Interval (DFI) was significantly lower in pts with high compared to low miR-21 [105 mo vs not reached (NR); p=0.001], miR-200c (105.2 mo vs NR; p=0.007), or both miR-21 and miR-200c expression (81.37 mo vs NR; p=0.001). miR-21-high was also associated with decreased median Overall Survival (OS; p=0.041). In multivariate analysis the number of infiltrated axillary lymph nodes (N3 vs N0-N2, HR: 2.86; p= 0.004) and miR-21 expression (high vs low, HR: 2.824; p=0.001) were independent negative prognostic factors for DFI, whereas negative hormone receptor status (HR: 3.062; p=0.024) and miR-21 high (HR: 3.545; p=0.029) independently predicted for worse OS. Moreover, miR-21 expression was higher in pts presenting early relapse (defined as relapse at ≤ 3 yrs) compared to those without relapse at 5 yrs (p=0.032). Furthermore, higher miR-21 (p=0.038), miR-23b (p=0.039), miR-200b (p=0.027) and miR-200c (p<0.001) levels were observed in pts with late relapse (at ≥ 5 yrs) compared to those without relapse. Conclusions: Differential expression levels of metastasis and/or dormancy related circulating miRNAs are encountered before adjuvant therapy in pts with operable BC presenting subsequent relapse compared to non-relapsed pts. In addition, circulating miRNAs could predict for early or late recurrence years before clinical detection of metastases. These results merit prospective validation in an independent pt cohort. Citation Format: Agelaki S, Papadaki C, Stratigos M, Spiliotaki M, Markakis G, Mastrostamatis G, Mavroudis D, Ioannis S. Circulating microRNAs as early predictors of relapse in operable breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-07-10.

Obstructive sleep apnoea–hypopnea syndrome (OSAHS) and multimorbidity are common in elderly patients, but a potential link between the two conditions remains unclear. This study aimed to assess the prevalence of OSAHS, chronic multimorbidity and their relation in older adults in primary care settings. A screening study was performed in a cross-section of 490 elderly adults (mean age 77.5 years, 51 % male) receiving home care services in Thessaly, central Greece. The Berlin Questionnaire was employed to assess the likelihood for OSAHS and the Epworth Sleepiness Scale to assess daytime sleepiness. Multimorbidity was defined as a documented history of at least two chronic diseases. The prevalence of high risk for OSAHS, excessive daytime sleepiness and multimorbidity was 33.5, 11.6 and 63.9 %, respectively. None of the study subjects had a confirmed diagnosis for OSAHS prior to this study. A marked dose–response association between a high pre-test likelihood for OSAHS and multimorbidity was noted in patients with two [adjusted odds ratio (OR) 3.13; 95 % confidence interval (CI) 1.85–5.30) and three or more (adjusted OR 4.22; 95 % CI 2.55–6.96) chronic morbidities, independently of age, sex and smoking status. This association persisted across different levels for OSAHS risk in the Berlin questionnaire, was insensitive to varying definitions of multimorbidity and more pronounced in patients with excessive daytime sleepiness. These findings point out that primary care physicians who care for elderly patients who present with several, common and burdensome, chronic diseases should expect to find this multimorbidity often coinciding with undetected, and therefore untreated, OSAHS. Thus it is crucial to consider OSAHS as an important co-morbidity in older adults and systematically screen for OSAHS in primary care practice.