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Sleep Apnea, Coronary Atherosclerosis and Heart Failure in Diabetes Patients With Nephropathy (SLEEP)

4 lutego 2022 zaktualizowane przez: University of Aarhus

Background:

Diabetes, and especially diabetic kidney disease is associated with the development of cardiovascular disease such as calcification in the coronary arteries and heart failure. Sleep apnea is frequent among patients with diabetes and diabetic kidney disease and sleep apnea itself is a solitary risk factor in the development of cardiovascular disease. Nonetheless, sleep apnea is underdiagnosed in diabetes patients because of a discrepancy between sleep apnea severity and actual oxygen deficiency symptoms which makes the diagnosis difficult. For that reason, many diabetics have undiagnosed sleep apnea together with cardiovascular disease. Early discovery of sleep apnea among high risk diabetic patients may therefore be considered crucial before cardiovascular complications develop. For this reason, sleep apnea screening of high-risk diabetics can possibly improve early diagnostics of cardiovascular disease.

Aim:

This study will seek to establish the association between obstructive sleep apnea (OSA) and coronary calcification and heart failure in patients with diabetic kidney disease. The basic hypothesis of the study is that patients with diabetic kidney disease and concurrent OSA have a higher prevalence and severity of coronary calcification and heart failure compared to patients without OSA.

Methods:

Diabetic adult patients with scheduled check-ups at Steno Diabetes Center Aarhus, or Department of Renal Medicine on Aarhus University Hospital will be included in the study.

Firstly, all included patients are screened for sleep apnea with the devices SomnoTouch® and ApneaLink®. Based on the sleep apnea determination; 40 patients with moderate-severe sleep apnea are compared with 40 patients without sleep apnea. In both groups, the patients are examined for calcification in the coronary vessels using a CT-scan while the function of the heart is examined by ultrasound (echocardiography). The stiffness of aorta is measured and performed using radial artery tonometry (SphygmoCor®).

Furthermore, range of blood- and urine samples will be performed

The perspectives are that patients with diabetes should be regularly evaluated for sleep apnea and that patients with moderate/severe sleep apnea should undergo further examination for cardiovascular disease even though the patients don't display any symptoms of either cardiovascular disease or sleep apnea.

Przegląd badań

Status

Zakończony

Warunki

Typ studiów

Obserwacyjny

Zapisy (Rzeczywisty)

74

Kontakty i lokalizacje

Ta sekcja zawiera dane kontaktowe osób prowadzących badanie oraz informacje o tym, gdzie badanie jest przeprowadzane.

Lokalizacje studiów

  • Dania
      • Aarhus, Dania, 8200
        • Aarhus University Hospital

Kryteria uczestnictwa

Badacze szukają osób, które pasują do określonego opisu, zwanego kryteriami kwalifikacyjnymi. Niektóre przykłady tych kryteriów to ogólny stan zdrowia danej osoby lub wcześniejsze leczenie.

Kryteria kwalifikacji

Wiek uprawniający do nauki

18 lat i starsze (Dorosły, Starszy dorosły)

Akceptuje zdrowych ochotników

Tak

Płeć kwalifikująca się do nauki

Wszystko

Metoda próbkowania

Próbka bez prawdopodobieństwa

Badana populacja

Diabetic adult patients (Type 2) with scheduled check-ups at Steno Diabetes Center Aarhus, or Department of Renal Medicine on Aarhus University Hospital can be included in the study if they satisfy all eligible criteria. Additionally, patients from the GP and within the including area of Aarhus University Hospital were invited to participate in the study.

The study cohort will consist of:

Generel characteristics of both groups:

- Diabetes Mellitus Type 2 with an eGFR between 10-60 ml/min/1,73 m^2

Sleep Apnea:

  1. 40 patients with an apnea/hyponea-index above ≥ 15 per hour.

    Non-Sleep Apnea:

  2. 40 patients with an apnea/hyponea-index below < 5 per hour.

Opis

Inclusion Criteria:

  • ≥ 18 years.
  • Diabetes Mellitus Type 2 with an eGFR between 10-60 ml/min/1,73 m^2 (Equalling CKD-group 3, 4 and 5 non-dialysis).

Exclusion Criteria:

  • Known sleep apnea in continuous positive airway pressure(CPAP) treatment.
  • Known mild sleep apnea (AHI 5-14) after the sleep apnea measurement.
  • Participants with central apnea (> 50 % of central apnea episodes in the AHI ≥ 15 group.) or Cheyne Stokes after the sleep apnea measurement.
  • < 4 hours of recording (ApneaLink)
  • Known coronary arterial disease with previous revascularization (PCI or CABG)

Plan studiów

Ta sekcja zawiera szczegółowe informacje na temat planu badania, w tym sposób zaprojektowania badania i jego pomiary.

Jak projektuje się badanie?

Szczegóły projektu

Kohorty i interwencje

Grupa / Kohorta
Sleep Apnea (AHI ≥ 15 per hour)
Patients with moderate/severe sleep apnea (Apnea/hypopnea-index ≥ 15 per hour).
Non-Sleep Apnea (AHI < 5 per hour)
Patients without sleep apnea (Apnea/hypopnea-index < 5 per hour).

Co mierzy badanie?

Podstawowe miary wyniku

Miara wyniku
Opis środka
Ramy czasowe
The association between sleep apnea and coronary atherosclerosis (Agatston Score) measured with cardiac CT-scan in patients with diabetic nephropathy.
Ramy czasowe: Cardiac CT-scan will be performed no later than 1 month after inclusion. All Agatston scores will be estimated straight after the cardiac CT-scan.

The degree of atherosclerosis in the coronary artery walls is evaluated by cardiac CT-scan and subsequent quantified by Agatston score. Patients with an estimated glomerular filtration rate (eGFR) ≤ 25 ml/min/1,73 m2 is scanned without contrast whereas patients with an eGFR 26-60 ml/min/1,73 m2 are screened with contrast.

All Agatston scoring will be performed by a cardiologist blinded to information on patient biochemical characteristics and AHI. The only biochemical parameter which the cardiologist is not blinded to is eGFR.
Cardiac CT-scan will be performed no later than 1 month after inclusion. All Agatston scores will be estimated straight after the cardiac CT-scan.
The association between sleep apnea and systolic function in patients with diabetic nephropathy.
Ramy czasowe: Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan

All patients included in the study will undergo transthoracic echocardiography. Systolic function is evaluated by two-dimensional automated evaluation of ejection fraction (2-D auto-EF).

The echocardiographic-clinician is blinded to AHI-status.
Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan
The association between sleep apnea and diastolic heart failure in patients with diabetic nephropathy.
Ramy czasowe: Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan

All patients included in the study will undergo transthoracic echocardiography. Diastolic function is evaluated by E/e´.

The echocardiographic-clinician is blinded to AHI-status.
Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan
The association between sleep apnea and systolic function in patients with diabetic nephropathy.
Ramy czasowe: Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan

All patients included in the study will undergo transthoracic echocardiography. Systolic function is evaluated by Left Ventricular Global Longitudinal Strain (GLS).

The echocardiographic-clinician is blinded to AHI-status.
Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan

Miary wyników drugorzędnych

Miara wyniku
Opis środka
Ramy czasowe
The association between sleep apnea and coronary plaque volume in patients with diabetic nephropathy.
Ramy czasowe: Cardiac CT-scan will be performed no later than 1 month after inclusion.

Coronary plaque volume is estimated by a cardiac CT-scan with contrast.

All coronary plaque volume analysing will be performed by a cardiologist blinded to information on patient biochemical characteristics and AHI. The only biochemical parameter which the cardiologist is not blinded to is eGFR.
Cardiac CT-scan will be performed no later than 1 month after inclusion.
Association of sleep apnea and aortic stiffness (defined as Pulse Wave Velocity (PWV)) in patients with diabetic nephropathy.
Ramy czasowe: PWV is performed the same day as the patient is included.
To get a non-invasive estimate of the aortic stiffness, measurement of Pulse Wave Velocity (PWV) (carotid-femoral and carotid-radial) will be performed. PWV will be recorded with the Sphygmocor® device according to regular protocol. If possible, two acceptable measurements will be conducted for each included patient. Calculation of PWV will be performed automatically by the device using a previously published formula.
PWV is performed the same day as the patient is included.
Association between Matrix Gla Protein (MGP) and coronary calcification in patients with sleep apnea and diabetic nephropathy.
Ramy czasowe: Analysis will be performed as batch-analysis at the end of inclusion of patients summer 2021
To establish a deeper understanding of the pathogenesis of central arterial calcification in patients with sleep apnea and diabetic nephropathy. MGP, a novel biochemical marker of arterial calcification, will be collected and analysed in all patients.
Analysis will be performed as batch-analysis at the end of inclusion of patients summer 2021
Association between Calcification propensity score (T50test) and coronary calcification in patients with sleep apnea and diabetic nephropathy.
Ramy czasowe: Analysis will be performed as batch-analysis at the end of inclusion of patients summer 2021
To establish a deeper understanding of the pathogenesis of central arterial calcification in patients with sleep apnea and diabetic nephropathy. Calcification propensity score (T50test) will be collected and analysed in all patients.
Analysis will be performed as batch-analysis at the end of inclusion of patients summer 2021
Association between sRANKL (soluble receptor activator of nuclear factor kappa-B ligand) and coronary calcification in patients with sleep apnea and diabetic nephropathy.
Ramy czasowe: Analysis will be performed as batch-analysis at the end of inclusion of patients summer 2021
To establish a deeper understanding of the pathogenesis of central arterial calcification in patients with sleep apnea and diabetic nephropathy. sRANKL (soluble receptor activator of nuclear factor kappa-B ligand) will be collected and analysed in all patients.
Analysis will be performed as batch-analysis at the end of inclusion of patients summer 2021
Association between 25-OH-Vitamin D(D3+D2) and coronary calcification in patients with sleep apnea and diabetic nephropathy.
Ramy czasowe: Analysis will be performed as batch-analysis at the end of inclusion of patients summer 2021
To establish a deeper understanding of the pathogenesis of central arterial calcification in patients with sleep apnea and diabetic nephropathy. 25-OH-Vitamin D(D3+D2) will be collected and analysed in all patients.
Analysis will be performed as batch-analysis at the end of inclusion of patients summer 2021
Association between Fetuin-A(alfa-2-Heremans Schmid glycoprotein; AHSG) and coronary calcification in patients with sleep apnea and diabetic nephropathy.
Ramy czasowe: Analysis will be performed as batch-analysis at the end of inclusion of patients summer 2021.
To establish a deeper understanding of the pathogenesis of central arterial calcification in patients with sleep apnea and diabetic nephropathy. Fetuin-A(alfa-2-Heremans Schmid glycoprotein; AHSG) will be collected and analysed in all patients
Analysis will be performed as batch-analysis at the end of inclusion of patients summer 2021.
Association between Sclerostin and coronary calcification in patients with sleep apnea and diabetic nephropathy.
Ramy czasowe: Analysis will be performed as batch-analysis at the end of inclusion of patients summer 2021
To establish a deeper understanding of the pathogenesis of central arterial calcification in patients with sleep apnea and diabetic nephropathy., Sclerostin will be collected and analysed in all patients
Analysis will be performed as batch-analysis at the end of inclusion of patients summer 2021
Association between osteoprotegerin and coronary calcification in patients with sleep apnea and diabetic nephropathy.
Ramy czasowe: Analysis will be performed as batch-analysis at the end of inclusion of patients summer 2021
To establish a deeper understanding of the pathogenesis of central arterial calcification in patients with sleep apnea and diabetic nephropathy., osteoprotegerin will be collected and analysed in all patients.
Analysis will be performed as batch-analysis at the end of inclusion of patients summer 2021
Association between BsAP (bone-specific alkaline phosphatase) and coronary calcification in patients with sleep apnea and diabetic nephropathy.
Ramy czasowe: Analysis will be performed as batch-analysis at the end of inclusion of patients summer 2021
To establish a deeper understanding of the pathogenesis of central arterial calcification in patients with sleep apnea and diabetic nephropathy., BsAP (bone-specific alkaline phosphatase) will be collected and analysed in all patients
Analysis will be performed as batch-analysis at the end of inclusion of patients summer 2021
Association between TRAP5B (tartrate-resistant acid phosphatase 5b) and coronary calcification in patients with sleep apnea and diabetic nephropathy.
Ramy czasowe: Analysis will be performed as batch-analysis at the end of inclusion of patients summer 2021
To establish a deeper understanding of the pathogenesis of central arterial calcification in patients with sleep apnea and diabetic nephropathy, TRAP5B (tartrate-resistant acid phosphatase 5b) will be collected and analysed in all patients.
Analysis will be performed as batch-analysis at the end of inclusion of patients summer 2021
Association between P1NP (procollagen type 1 N propeptide) and coronary calcification in patients with sleep apnea and diabetic nephropathy.
Ramy czasowe: Analysis will be performed as batch-analysis at the end of inclusion of patients summer 2021
To establish a deeper understanding of the pathogenesis of central arterial calcification in patients with sleep apnea and diabetic nephropathy., P1NP (procollagen type 1 N propeptide) will be collected and analysed in all patients
Analysis will be performed as batch-analysis at the end of inclusion of patients summer 2021
Association between LVEDd (Left ventricular end diastolic diameter) as determined during echocardiography and sleep apnea in patients with diabetic nephropathy.
Ramy czasowe: Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan

All patients included in this study will undergo echocardiography. In particular systolic and diastolic function will be in focus.

The echocardiographic-clinician is blinded to AHI-status.
Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan
Association between LVEDs (Left ventricular end systolic diameter) as determined during echocardiography and sleep apnea in patients with diabetic nephropathy.
Ramy czasowe: Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan

All patients included in this study will undergo echocardiography. In particular systolic and diastolic function will be in focus.

The echocardiographic-clinician is blinded to AHI-status.
Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan
Association between IVSd (Interventricular Septal Thickness at Diastole) as determined during echocardiography and sleep apnea in patients with diabetic nephropathy.
Ramy czasowe: Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan

All patients included in this study will undergo echocardiography. In particular systolic and diastolic function will be in focus.

The echocardiographic-clinician is blinded to AHI-status.
Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan
Association between IVSs (Interventricular Septal Thickness at Systole) as determined during echocardiography and sleep apnea in patients with diabetic nephropathy.
Ramy czasowe: Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan

All patients included in this study will undergo echocardiography. In particular systolic and diastolic function will be in focus.

The echocardiographic-clinician is blinded to AHI-status.
Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan
Association between PWTd (Posterior wall thickness at end-diastole) as determined during echocardiography and sleep apnea in patients with diabetic nephropathy.
Ramy czasowe: Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan

All patients included in this study will undergo echocardiography. In particular systolic and diastolic function will be in focus.

The echocardiographic-clinician is blinded to AHI-status.
Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan
Association between PWTs (Posterior wall thickness at end-systole) as determined during echocardiography and sleep apnea in patients with diabetic nephropathy.
Ramy czasowe: Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan

All patients included in this study will undergo echocardiography. In particular systolic and diastolic function will be in focus.

The echocardiographic-clinician is blinded to AHI-status.
Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan
Association between Aorta (sinus valsalva) diameter as determined during echocardiography and sleep apnea in patients with diabetic nephropathy.
Ramy czasowe: Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan

All patients included in this study will undergo echocardiography. In particular systolic and diastolic function will be in focus.

The echocardiographic-clinician is blinded to AHI-status.
Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan
Association between Aorta (Ascendens) diameter as determined during echocardiography and sleep apnea in patients with diabetic nephropathy.
Ramy czasowe: Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan

All patients included in this study will undergo echocardiography. In particular systolic and diastolic function will be in focus.

The echocardiographic-clinician is blinded to AHI-status.
Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan
Association between Aorta (Abdominalis) diameter as determined during echocardiography and sleep apnea in patients with diabetic nephropathy.
Ramy czasowe: Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan

All patients included in this study will undergo echocardiography. In particular systolic and diastolic function will be in focus.

The echocardiographic-clinician is blinded to AHI-status.
Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan
Association between maximum Vena Cava Inferior diameter as determined during echocardiography and sleep apnea in patients with diabetic nephropathy.
Ramy czasowe: Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan

All patients included in this study will undergo echocardiography. In particular systolic and diastolic function will be in focus.

The echocardiographic-clinician is blinded to AHI-status.
Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan
Association between minimum Vena Cava Inferior diameter as determined during echocardiography and sleep apnea in patients with diabetic nephropathy.
Ramy czasowe: Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan

All patients included in this study will undergo echocardiography. In particular systolic and diastolic function will be in focus.

The echocardiographic-clinician is blinded to AHI-status.
Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan
Association between Early mitral inflow velocity (E) as determined during echocardiography and sleep apnea in patients with diabetic nephropathy.
Ramy czasowe: Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan

All patients included in this study will undergo echocardiography. In particular systolic and diastolic function will be in focus.

The echocardiographic-clinician is blinded to AHI-status.
Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan
Association between Late mitral inflow velocity (A) as determined during echocardiography and sleep apnea in patients with diabetic nephropathy.
Ramy czasowe: Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan

All patients included in this study will undergo echocardiography. In particular systolic and diastolic function will be in focus.

The echocardiographic-clinician is blinded to AHI-status.
Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan
Association between E/A-ratio as determined during echocardiography and sleep apnea in patients with diabetic nephropathy.
Ramy czasowe: Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan

All patients included in this study will undergo echocardiography. In particular systolic and diastolic function will be in focus.

The echocardiographic-clinician is blinded to AHI-status.
Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan
Association between Deceleration time of early diastolic transmittal flow (dtE) as determined during echocardiography and sleep apnea in patients with diabetic nephropathy.
Ramy czasowe: Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan

All patients included in this study will undergo echocardiography. In particular systolic and diastolic function will be in focus.

The echocardiographic-clinician is blinded to AHI-status.
Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan
Association between Right ventricular diameter (RVD) as determined during echocardiography and sleep apnea in patients with diabetic nephropathy.
Ramy czasowe: Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan

All patients included in this study will undergo echocardiography. In particular systolic and diastolic function will be in focus.

The echocardiographic-clinician is blinded to AHI-status.
Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan
Association between left atrial volume (LAV) as determined during echocardiography and sleep apnea in patients with diabetic nephropathy.
Ramy czasowe: Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan
All patients included in this study will undergo echocardiography. In particular systolic and diastolic function will be in focus. The echocardiographic-clinician is blinded to AHI-status.
Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan
Association between 2D atrial global strain as determined during echocardiography and sleep apnea in patients with diabetic nephropathy.
Ramy czasowe: Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan
All patients included in this study will undergo echocardiography. In particular systolic and diastolic function will be in focus. The echocardiographic-clinician is blinded to AHI-status.
Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan

Współpracownicy i badacze

Tutaj znajdziesz osoby i organizacje zaangażowane w to badanie.

Sponsor

University of Aarhus

Śledczy

  • Krzesło do nauki: Niels H. Buus, MD PhD DMSc, Department of Renal diseases, Aarhus University Hospital
  • Główny śledczy: Sebastian Nielsen, MD student, Department of Renal diseases, Aarhus University Hospital
  • Krzesło do nauki: Jakob T. Nyvad, MD, The Clinic of Hypertension, Aarhus University Hospital

Daty zapisu na studia

Daty te śledzą postęp w przesyłaniu rekordów badań i podsumowań wyników do ClinicalTrials.gov. Zapisy badań i zgłoszone wyniki są przeglądane przez National Library of Medicine (NLM), aby upewnić się, że spełniają określone standardy kontroli jakości, zanim zostaną opublikowane na publicznej stronie internetowej.

Główne daty studiów

Rozpoczęcie studiów (Rzeczywisty)

1 października 2020

Zakończenie podstawowe (Rzeczywisty)

24 stycznia 2022

Ukończenie studiów (Rzeczywisty)

24 stycznia 2022

Daty rejestracji na studia

Pierwszy przesłany

8 września 2020

Pierwszy przesłany, który spełnia kryteria kontroli jakości

14 września 2020

Pierwszy wysłany (Rzeczywisty)

16 września 2020

Aktualizacje rekordów badań

Ostatnia wysłana aktualizacja (Rzeczywisty)

7 lutego 2022

Ostatnia przesłana aktualizacja, która spełniała kryteria kontroli jakości

4 lutego 2022

Ostatnia weryfikacja

1 października 2021

Więcej informacji

Terminy związane z tym badaniem

Dodatkowe istotne warunki MeSH

Inne numery identyfikacyjne badania

  • 1-10-72-122-20

Plan dla danych uczestnika indywidualnego (IPD)

Planujesz udostępniać dane poszczególnych uczestników (IPD)?

NIE

Opis planu IPD

IPD. pas

Informacje o lekach i urządzeniach, dokumenty badawcze

Bada produkt leczniczy regulowany przez amerykańską FDA

Nie

Bada produkt urządzenia regulowany przez amerykańską FDA

Nie

Te informacje zostały pobrane bezpośrednio ze strony internetowej clinicaltrials.gov bez żadnych zmian. Jeśli chcesz zmienić, usunąć lub zaktualizować dane swojego badania, skontaktuj się z register@clinicaltrials.gov. Gdy tylko zmiana zostanie wprowadzona na stronie clinicaltrials.gov, zostanie ona automatycznie zaktualizowana również na naszej stronie internetowej .

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