Effects of Hypoxia on the Eye in Patients with Obstructive Sleep Apnea Syndrome

Objective: Hypoxia, perfusion pressure changes, systemic hypertension, vasospasm, increase in blood viscosity and small vessels’ resistance may cause ischemia in Obstructive sleep apnea syndrome (OSAS). The aim of this study is to assess the effect of hypoxia on the eye (choroidal and corneal thicknesses) in patients with OSAS. Materials and Methods: In this observational study age and gender-matched 20 severe, 17 modarate, 16 mild OSAS patients without any comorbidity and a control group of 16 healthy subjects were examined with spectral-domain optic coherence tomography (OCT). The central corneal thickness (CCT), subfoveal, and temporal and nasal choroidal thicknesses of the patients were measured by OCT. Results: The mean age of OSAS patients was 52.3±10.6 and 48.8±12.1 in control subjects. Female and male patients made up 23.1% and 76.9%, respectively. The mean CCT of OSAS patients was 560.2±31.1/563.5±29.1 µm, whereas the mean CCT was 560.6±30.4/567.1±28.2 µm in control group (p=0.52/p=0.29). There were significant differences (p<0.001) in choroidal thickness (severe: 228.3±16.8/240.5±17.8; moderate: 236.0±21.6/232.4±18.5; mild: 241.3±23.6/242.6±20.9; control: 267.8±18.6/271.6±18,6 µm) between patients and control groups who were separated by their OSAS severity. Conclusion: In our study choroidal thickness became thinner with increasing OSAS severity. On the other hand, corneal thickness did not seem to be affected from OSAS

Attitudes of Pulmonologists about Obstructive Sleep Apnea Syndrome and its Treatment in Izmir

Objective We aimed to evaluate pulmonary medicine physicians’ attitudes about obstructive sleep apnea syndrome (OSAS) and its treatment in Izmir. Materials and Methods About 78 of 120 pulmonary medicine physicians in Izmir answered the questionnaire containing 24 items (demographics: 6, education: 4, attitudes: 9, knowledge: 5). Results 67.9% of the participants were female. Mean age was 41.06±5.63, mean working year was 11.16±6.09. 52.6% worked in training and research hospitals, 32.1% in state hospitals, and the rest in private and university hospitals. Monthly patient number was 714.10±3.24, patients number with OSA symptoms was 14.85±2.15. 64.1% had completed speciality education in hospitals with sleep disorders centers and this ratio was higher in physicians whose working year was less than 10. 24.4% had practiced sleep study during this education. Participation in sleep study courses after speciality education was 48.7%. 26.9% worked as sleep specialist. 67.9% usually asked patients OSA symptoms and 38.5% asked preoperative OSA symptoms. 97.4% usually referred patients to sleep centers. 65.4% had been working in hospitals with sleep disorders centers. The ratio of correct answers in knowledge part of the questionnaire was 95%. Conclusion OSAS is a major pulmonary disease and it is important in order to find out the patients with OSA risk. 2.07% of patients in clinics have OSA symptoms. Physicians’ confidence in diagnosis is more than managing patients with OSA. Practical part of sleep study is not enough in speciality education. Asking OSA symptoms is not common in pre-operative examination

Effect of Nasal CPAP therapy on functional respiratory parameters and cardiopulmonary exercise test in Obstructive Sleep Apnea Syndrome

Nazal sürekli havayolu basıncı tedavisi (nCPAP), obstrüktif uyku apne sendromu (OUAS) olan hastalarda etkin bir tedavi yöntemidir. Gündüz aşırı uykuluğu, arousal indeksini ve uyku bölünmelerini azaltarak fiziksel ve mental iyileşme sağlar. Ülkemizde, OUAS'lı hastalarda kardiyopulmoner egzersiz testleri (KPET) ile egzersiz kısıtlılığı olduğunu gösteren çalışmalar olmakla beraber, nCPAP tedavisinin fonksiyonel solunumsal parametreler ve KPET parametreleri üzerine etkilerini araştıran çalışma yoktur. Çalışmamızda, nCPAP tedavisi başlanan OUAS'lı olguların sekiz haftalık tedavi sonrası solunum fonksiyonları, KPET ile saptanabilen egzersiz kısıtlılığı ve genel yaşam kalitesinde değişiklik olup olmadığını araştırmayı amaçladık. Olgu grubumuzda, nCPAP öncesi KPET ile saptanabilen egzersiz kısıtlılığı olduğunu ve sekiz haftalık tedavi sonrası egzersiz kısıtlılığının azaldığını ancak tamamen normale dönmediğini; nCPAP tedavisinin olguların kan basıncı kontrolüne yardımcı olduğunu, inspiratuar ve ekspiratuar kas gücünü artırdığını saptadık. Olgularımızda, nCPAP'ın, SF-36 genel yaşam kalitesi ölçeğinin fiziksel fonksiyon, fiziksel rol kısıtlanması, enerji/canlılık, sosyal fonksiyon, duygusal rol kısıtlanması, mental sağlık, fiziksel ve mental özet skorlarında anlamlı düzelme sağladığı saptandı. Olguların akciğer volümlerinde ve FEV1 dışında tüm spirometrik ölçümlerinde vücut kitle indeksi (BMI)'nden bağımsız olarak değişiklik ortaya çıkmadığı ancak FEV1'de anlamlı azalma olduğu gözlendi. Sonuç olarak; OUAS egzersiz kısıtlılığına neden olmaktadır. Nazal CPAP tedavisi egzersiz kısıtlılığının azaltılmasında etkilidir, kan basıncı regülasyonuna yardımcı olur ve solunum kas gücünü artırır. Komorbid hastalığı olmayan ya da komorbiditesi kontrol altında olan OUAS'lı olgularda nCPAP tedavisi, genel yaşam kalitesinde düzelme sağlayabilmektedir. Bu durum, tedavi sonrası hastaların kardiyak fonksiyonlarında, gündüz uykuluğunda ve kondüsyonunda artışa bağlı olabilir. Nasal continuous airway pressure (nCPAP) treatment is an effective treatment modality for patients with OSAS. It can improve physical and mental functions by reducing daytime hypersomnolence, arousal index and sleep fragmentations. To our knowledge, the exercise limitation in patients with OSAS by using cardiopulmonary exercise test (CPET) have been shown before, but the effects of treatment by nCPAP on functional respiratory parameters and CPET in OSAS has never been studied in our country. The purpose of this study was to evaluate whether pulmonary functions, exercise limitation confirmed with CPET and quality of life can be improved after eight weeks of nCPAP treatment. In our case group, we found an exercise limitation with CPET before nCPAP, an improvement in exercise capacity after nCPAP treatment for eight weeks. But exercise capacity did not totally return to normal level. We also found that nCPAP can help to control blood pressure and improve inspiratory and expiratory muscle forces. Patients undergoing nCPAP scored better in physical function, role-physical, general health, energy/vitality, social function, role-emotional, mental health, physical component summary and mental component summary using the SF-36 tool. There were no changes in pulmonary volumes and spirometric parametres indipendent of body mass index (BMI). There was a decrease in FEV1, which was statistically important.In conclusion, OSAS may lead to exercise limitation. Nasal CPAP treatment is effective in reducing exercise limitation, can help to control blood pressure and improves respiratory muscle strength. Nasal CPAP can also improve the quality of life scores in OSA patients without any comorbidity or with comorbidities under control. Our findings may suggest that these changes are the results of improvements in patients' cardiac function, daytime somnolence and fitness

Treatment Emergent Central Sleep Apnea: Should We Repeat Titration?

Most patients with Obstructive sleep apnea syndrome are treated with continuous positive airway pressure (CPAP). However, in some patients central apnea arises during CPAP titration. This clinical condition is defined as treatment-emergent central sleep apnea (CSA). Here, we would like to present a case who was diagnosed with treatment-emergent CSA during the first titration study, however CSA was lost in the second titration. Before the diagnosis of treatment-emergent CSA, factors of titration should be reviewed and if it is not found satisfactory, procedure should be repeated. In most cases CPAP therapy eliminates CSA. However, in some cases bilevel positive airway pressure- spontaneous/timed or adaptive servo ventilator is needed. Repeated titration could be useful tool to predict whether the patient needs CPAP or advanced therapies

The effect of Oxygen application with nCPAP for the prevention of desaturation during EBUS-TBNA

Purpose EBUS-TBNA is a frequently used diagnostic method for mediastinal/hilar lymphadenopathies and masses. This procedure is performed with intravenous sedation (IVS). During IVS, patients often develop hypoxemia and nasal oxygen delivery is insufficient in some patients. The aim of this study was to investigate the effect of oxygen application with nCPAP on hypoxemia during EBUS-TBNA