Gender Difference in Apnea and Hypopnea Component in Obstructive Sleep Apnea

Introduction We aimed to analyze the apnea and hypopnea structure separately with demographic parameters and sleep architecture in men and women with sleep apnea. Materials and Methods Patients referred for snoring, witnessed apnea and/or day time sleepiness to Dışkapı Yıldırım Beyazıt Research and Educational Hospital Sleep Center and gone under polysomnography (PSG) between December 2010 and June 2012 were taken in order. PSG reports were analyzed retrospectively. The patients with sleep efficiency less than 40% were excluded. The BMI, neck circumference (NC), abdominal circumference (AC) and PSG values were recorded. Results Totally 406 patients (250 male, 156 female patients) were studied. NC was found more in males whereas AC and BMI were found significantly more in females. Mean age, apne-hypopnea index (AHI), oxygen desaturation index (ODI) for 3% were similar in two genders. Percentage of total light sleep (Stage 1+2) was significantly more in males while Stage 3 (slow wave sleep: SWS) was more in females. Total apneas were significantly more in males and hypopneas were significantly more in females. The factors associated with AHI were NC and BMI in males and AC and BMI in females. Discussion We found that, females are more hypopneic and men are more apneic, in a study group of similar apne-hypopnea indexed patients. The different distribution of fat in genders seems to effect the apnea/hypopnea predominance. The clinical significance of the apnea and hypopnea indexes separately can be related with SWS percentage. Prospective studies are needed to evaluate the effect of apneas and hypopneas on morbidity and mortality in both genders

Sleep in Mechanically Ventilated Patients in the Intensive Care Unit

Objective Sleep abnormalities are common in critically ill patients. Polysomnography (PSG) is the gold standard in assessing sleep quality. The aim of this prospective study was to monitor the sleep pattern in mechanically ventilated patients with PSG who were admitted to our medical intensive care unit. Materials and Methods This study was conducted in the Medical Intensive Care Unit of an University Hospital. Patients with endotracheal intubation and mechanical ventilation for at least 24 hours were included in the study. They were monitored for 18 hours per day by continuous PSG. Sleep parameters were recorded; [total sleep time (TST), sleep efficiency (SE) and sleep stages]. Results Records of 12 patients were evaluated. There were nine males and three females. Median age of patients were 72.5 years (min-max=31-92). Median APACHE II was 19 (min-max=10-27). Median sleep time was 489.5 minutes (180-1105), median SE was 77.1% (24.9-96.5) and median arousal number was 147.5/TST (14-450). While REM sleep and non REM stage 3 sleep time and proportion were found to be decreased, non REM stage 2 sleep time and proportion were increased. Conclusion We have shown that mechanically ventilated patients have changes in sleep architecture and that they have severe sleep fragmentation. Future research should address the cause of these problems by using methodology for comprehensive assessment of sleep-disrupting factors and by examining the dynamic effects of changes in illness severity on sleep quality

Importance of Labarotory Parameters in Obstructive Sleep Apnea

Objective Obstructive sleep apnea (OSA) is associated with intermittent hypoxia. OSA leads to increased sympathetic activation, oxidative stress, vascular endothelial dysfunction, coagulation disorders and metabolic dysregulation. These disturbances increase the the risk of inflammation and cardiovascular diseases. The purpose of this article is to review the laboratory parameters of OSA patients without any comorbidities. Materials and Methods This retrospective study of consecutive 675 patients who had polysomnography, was conducted on one hundred and thirty patients who did not have any comorbidities. Laboratory values of patients were evaluated. Patients were grouped according to apnea-hypopnea index (AHI). Group 1 (n=17) AHI 30. Results There were 88 men (67.7%) and 42 women (32.3%) in the study. Mean age, body mass index, Epworth score and AHI were 41.6±11.3 (16-75), 29.6±6.3 (17.1-65.7) 9.9±5.5, 6.2±11.34, respectively. Serum glucose, cholesterol and triglyceride levels were higher in group 4 (p=0.03, p=0.04, p=0.02, respectively). Uric acid and fibrinogen levels were higher in patients with higher AHI (p=0.038). Conclusion Our study indicates that increased blood glucose, uric acid and dyslipidemia are associated with OSA regardless of comorbidities

Hepcidin: A useful marker in chronic obstructive pulmonary disease

Purpose: This study was designed to evaluate the levels of hepcidin in the serum of patients with chronic obstructive pulmonary disease (COPD). Methods: In the study, 74 male patients (ages 45-75) in a stable period for COPD were grouped as Group I: Mild COPD (n:25), Group II: Moderate COPD (n:24), and Group III: Severe COPD (n:25). Healthy non-smoker males were included in Group IV (n:35) as a control group. The differences of hepcidin level among all the groups were examined. Also, in the patient groups with COPD, hepcidin level was compared with age, body mass index, cigarette (package/year), blood parameters (iron, total iron binding capacity, ferritin, hemoglobin, hematocrit [hct]), respiratory function tests, and arterial blood gas results. Results: Although there was no difference between the healthy control group and the mild COPD patient group (P=0.781) in terms of hepcidin level, there was a difference between the moderate (P=0.004) and the severe COPD patient groups (P=0.002). The hepcidin level of the control group was found to be higher than the moderate and severe COPD patient groups. In the severe COPD patients, hepcidin level increased with the increase in serum iron (P=0.000), hct (P=0.009), ferritin levels (P=0.012), and arterial oxygen saturation (SaO2, P=0.000). Conclusion: The serum hepcidin level that is decreased in severe COPD brings into mind that it may play a role in the mechanism to prevent hypoxemia. The results suggest that serum hepcidin level may be a useful marker in COPD. Larger prospective studies are needed to confirm our findings between hepcidin and COPD

Rapid eye movement dependent central apnea with periodic leg movements

Central sleep apnea is a period of at least 10 s without airflow, during which no ventilatory effort is present. Most of the central apneas occur in Non-Rapid eye movement (NREM) sleep. Central apnea occuring in Rapid eye movement (REM) sleep is extremely rare. We present our patient who had a diagnosis of obstructive sleep apnea in another sleep center since 2003. His Auto Continuous Positive Airway Pressure (CPAP) machine was disrupted so he admitted to our center to renew his machine and for daytime sleepiness while using his machine. The polysomnography revealed central apneas ending with respiratory arousals and periodic leg movements in rapid eye movement (REM) stage. We found no cause for central apneas. The patient benefited from servo ventilator therapy. We present this case as an unusual form of central apnea with the review of the literatures. Even the patients diagnosed as obstructive sleep apnea should be analyzed carefully. The diagnosis and the therapeutic approach may change in the favor of the patient

Stężenie białka S100B w surowicy jako przydatny wskaźnik w zespole obturacyjnego bezdechu podczas snu

Background and purpose We aimed to underline the importance of serum S100B protein as a useful biochemical marker in patients with obstructive sleep apnea syndrome (OSAS). Material and methods Forty-three newly diagnosed patients with OSAS (median apnea-hypopnea index [AHI, events/hour]: 37.5 [range 11.3–137]) and 25 subjects with AHI < 5 (median AHI: 4.4 [range 0.7–4.8]) were included in the study. Serum S100B protein level was tested in serum samples taken after polysomnography in both groups and the difference between OSAS patients and the control group regarding that level was assessed. In addition, the association of S100B protein serum level with age, body mass index, AHI, mean O2 saturation percentage during sleep, minimum O2 saturation value (%) at the end of the apneas, and the time spent at an O2 saturation less than 90% were analyzed in the OSAS patient group. Results Median serum S100B protein level was 133.7 pg/mL (range 20.97–230.70 pg/mL) in patients with OSAS and 16.1 pg/mL (range 10.1–22.9 pg/mL) in the control group (p < 0.005). Serum S100B protein level did not correlate with any studied variable (p > 0.05 for each correlation coefficient). Conclusions Serum S100B protein level is increased in patients with OSAS and may be a useful biochemical marker in those patients.Wstęp i cel pracy Celem pracy było podkreślenie znaczenia stężenia białka S100B w surowicy jako przydatnego wskaźnika biochemicznego u chorych na zespół obturacyjnego bezdechu podczas snu (obstructive sleep apnea syndrome – OSAS). Materiał i metody W badaniu wzięło udział 43 chorych ze świeżo rozpoznanym OSAS [mediana wskaźnika bezdechów/spłyconych oddechów, AHI (epizody na godzinę): 37,5 (zakres: 11,3–137)] oraz 25 osób z AHI < 5 [mediana: 4,4 (0,7–4,8)] stanowiących grupę kontrolną. W obu grupach zmierzono stężenie białka S100B w surowicy pobranej po wykonaniu polisomnografii i sprawdzono różnicę w tym zakresie między grupami. Ponadto w grupie chorych na OSAS określono korelację między stężeniem białka S100B w surowicy a wiekiem, wskaźnikiem masy ciała, AHI, średnim wysyceniem krwi tętniczej tlenem podczas snu, najmniejszym wysyceniem krwi tętniczej tlenem na zakończenie okresu bezdechu oraz czasem, w którym wysycenie krwi tętniczej tlenem wynosiło < 90%. Wyniki Mediana stężenia białka S100B w surowicy wyniosła 133,7 pg/ml (zakres: 20,97–230,70 pg/ml) u chorych na OSAS oraz 16,1 pg/ml (zakres: 10,1–22,9 pg/ml) w grupie kontrolnej (p < 0,005). Stężenie białka S100B w surowicy nie korelowało z żadną ocenianą zmienną (p> 0,05 dla każdego współczynnika korelacji). Wnioski Stężenie białka S100B w surowicy jest zwiększone u chorych na OSAS i może być przydatnym wskaźnikiem biochemicznym u tych pacjentów

Is Hepcidin a Good Marker for Inflammation in Obstructive Sleep Apnea Syndrome (OSAS) Patients?

FIRAT, ibrahim Hikmet/0000-0003-2594-4887WOS: 000219740900004Objective: Obstructive Sleep Apnea syndrome (OSAS) is a clinical syndrome characterized by recurrent episodes of upper airway obstruction during sleep, resulting in chronic intermittent hypoxia and causing inflammation. IL-6 and CRP are the most commonly studied inflammation biomarkers in OSAS. Given that IL-6 is an important activator of hepcidin during inflammation. In this study, hepcidin levels in OSAS patients were examined. Materials and Methods: A total of 44 patients undergoing Polysomnography (PSG) for suspected sleep disorder breathing were studied. Patients were classified as having no to mild OSAS (n= 15) or moderate to severe OSAS (n= 29) based on apnea-hypopnea index (AHI) (AHI < 15 vs. AHI = 15, respectively). Blood samples were obtained at night before PSG and in morning to obtain hepcidin levels. Results: Patients with moderate to severe OSAS had lower evening hepcidin levels (U=-3.91, p<. 001) and a greater change in evening to morning hepcidin levels (t=-2.83, p=. 007) than patients with no or mild sleep apnea. AHI was negatively correlated with evening hepcidin (Hep E) (rs=-0.48, p = 0.001) but was not significantly associated with morning hepcidin (Hep M) or change in evening to morning hepcidin levels. Greater Hep E levels were associated with significantly decreased odds of having moderate to severe sleep apnea even after controlling for covariates. A greater change in Hep E to Hep M levels were associated with a 1.08-fold increase in the odds of having moderate to severe sleep apnea (95% CI 1.02-1.15, p=. 02). Conclusion: This is a pioneer study to date to investigate the association between hepcidin and OSAS. Among patients with moderate-severe OSAS, significant increases in Hep E levels and change in Hep E to Hep M levels were found. Hepcidin may be a useful marker for the detection of hypoxia/reoxygenation episodes and inflammation in OSAS