Rationale and design of the Turkish sleep apnea database-TURKAPNE : A national, multicenter, observational, prospective cohort study

OBJECTIVES: The primary aim of The Turkish Sleep Apnea Database (TURKAPNE) study is to generate a cross-sectional nationwide database for defining the clinical and polysomnographic characteristics of the patients with obstructive sleep apnea (OSA) in Turkey. MATERIALS AND METHODS: In this ongoing project, all consecutive adults with suspected OSA are recruited from the sleep centers of the university and research hospitals in Turkey. Information on anthropometric data, educational status, driving license, smoking habits, alcohol use, comorbidities, drug use, questionnaires, polysomnographic, and/or cardiorespiratory polygraphic findings are recorded in a systematized Web-based report form. Blood glucose, lipids and other biochemical markers, lung function, and echocardiography measurements are optionally included. Follow-up data regarding treatment modality and compliance is assessed. Cross-sectional and longitudinal associations between OSA phenotypes and metabolic, pulmonary, and cardiovascular comorbidities as well as traffic accidents, and the impact of treatment will be further explored. We target a total sample of 10,000 participants. RESULTS: The study was registered with ClinicalTrials.gov (NCT02784977) in May 2016 and the first patient was recruited in October 2017. A total of 1911 participants from 19 centers have been enrolled in the study by May 31, 2018. CONCLUSION: The TURKAPNE study will contribute to a better understanding of the health-related burden of OSA phenotypes and its association with the comorbidities and adverse outcomes, including traffic accidents in Turkey. The results may also contribute to a more personalized approach and better management of varying OSA phenotypes with concomitant disorders

Obstrüktif uyku apne sendromu olan hastalarda CPAP tedavisinin klinik periodontal duruma etkisi: Altı yıllık takip

Amaç: Bu çalışmanın amacı, obstrüktif uyku apne sendromu (OUAS) hastalarında sürekli pozitif havayolu basıncı (CPAP) tedavisinin, klinik periodontal durum üzerine olası etkilerini değerlendirmektir. Gereç ve Yöntem: OUAS tanısı konmuş olan ve düzenli CPAP cihazı kullanan toplam 11 hastada (3 hasta orta, 8 hasta ağır OUAS) tedavi başlandıktan 6 yıl sonra kapsamlı klinik periodontal muayene tekrarlandı. Tüm ağız ortalama sondalama derinliği (SD), klinik ataşman seviyesi (KAS), sondalamada kanama indeksi (SKİ) ve plak indeksi (Pİ) değerleri kaydedilerek başlangıç verileri ile karşılaştırıldı. Bulgular: Orta ve ağır OUAS grupları arasında KAS, PI ölçümlerinde başlangıç ve tedavi sonrası 6. yıl verileri arasında anlamlı fark bulunmadı (p>0.05). Başlangıç, 6. yıl SD ve 6. yıl SKİ değerleri orta OUAS grubunda daha yüksek bulundu (sırasıyla p=0.024, p=0.030 ve p=0.014). Diş sayılarına bakıldığında her iki grupta ve tüm hastalarda başlangıç ve 6. yıl değerleri arasında anlamlı fark bulunmadı (p>0.05). Sigara içen ve içmeyen hastalarda başlangıç ve 6. yıl klinik periodontal ölçümleri karşılaştırdığımızda sonuçların benzer olduğu gözlendi (p>0.05). Sonuç: Çalışmamızın sınırları içinde, CPAP cihazı ile yapılan uzun dönem OUAS tedavisinin klinik periodontal durum üzerine anlamlı etki göstermediği söylenebilir

Effect of CPAP Therapy on Clinical Periodontal Status of Patients with Obstructive Sleep Apnea Syndrome: 6-year Follow-up

Amaç: Bu çalışmanın amacı, obstrüktif uyku apne sendromu (OUAS) hastalarında sürekli pozitif havayolu basıncı (CPAP) tedavisinin, klinik periodontal durum üzerine olası etkilerini değerlendirmektir. Gereç ve Yöntem: OUAS tanısı konmuş olan ve düzenli CPAP cihazı kullanan toplam 11 hastada (3 hasta orta, 8 hasta ağır OUAS) tedavi başlandıktan 6 yıl sonra kapsamlı klinik periodontal muayene tekrarlandı. Tüm ağız ortalama sondalama derinliği (SD), klinik ataşman seviyesi (KAS), sondalamada kanama indeksi (SKİ) ve plak indeksi (Pİ) değerleri kaydedilerek başlangıç verileri ile karşılaştırıldı. Bulgular: Orta ve ağır OUAS grupları arasında KAS, PI ölçümlerinde başlangıç ve tedavi sonrası 6. yıl verileri arasında anlamlı fark bulunmadı (p>0.05). Başlangıç, 6. yıl SD ve 6. yıl SKİ değerleri orta OUAS grubunda daha yüksek bulundu (sırasıyla p=0.024, p=0.030 ve p=0.014). Diş sayılarına bakıldığında her iki grupta ve tüm hastalarda başlangıç ve 6. yıl değerleri arasında anlamlı fark bulunmadı (p>0.05). Sigara içen ve içmeyen hastalarda başlangıç ve 6. yıl klinik periodontal ölçümleri karşılaştırdığımızda sonuçların benzer olduğu gözlendi (p>0.05). Sonuç: Çalışmamızın sınırları içinde, CPAP cihazı ile yapılan uzun dönem OUAS tedavisinin klinik periodontal durum üzerine anlamlı etki göstermediği söylenebilir

Arterial bicarbonate is associated with hypoxic burden and uncontrolled hypertension in obstructive sleep apnea- The ESADA cohort

Objective: Blood bicarbonate concentration plays an important role for obstructive sleep apnea (OSA) patients to maintain acid-base balance. We investigated the association between arterial standard bicarbonate ([HCO3-]) and nocturnal hypoxia as well as comorbid hypertension in OSA.Methods: A cross-sectional analysis of 3329 patients in the European Sleep Apnea Database (ESADA) was performed. Arterial blood gas analysis and lung function test were performed in conjunction with polysomnographic sleep studies. The 4% oxygen desaturation index (ODI), mean and minimum oxygen saturation (SpO2), and percentage of time with SpO2 below 90% (T90%) were used to reflect nocturnal hypoxic burden. Arterial hypertension was defined as a physician diagnosis of hypertension with ongoing antihypertensive medication. Hypertensive patients with SBP/DBP below or above 140/90 mmHg were classified as controlled-, uncontrolled hypertension, respectively.Results: The [HCO3-] level was normal in most patients (average 24.0 +/- 2.5 mmol/L). ODI, T90% increased whereas mean and minimum SpO2 decreased across [HCO3-] tertiles (ANOVA, p = 0.030, 0.001, 0.001, and 0.001, respectively). [HCO3-] was independently associated with ODI, mean SpO2, minimum SpO2, and T90% after adjusting for confounders (b value [95%CI]: 1.21 [0.88-1.54], -0.16 [-0.20 to -0.11], -0.51 [-0.64 to -0.37], 1.76 [1.48-2.04], respectively, all p 0.001). 1 mmol/L elevation of [HCO3-] was associated with a 4% increased odds of uncontrolled hypertension (OR: 1.04 [1.01-1.08], p = 0.013). Conclusion: We first demonstrated an independent association between [HCO3-] and nocturnal hypoxic burden as well as uncontrolled hypertension in OSA patients. Bicarbonate levels as an adjunctive measure provide insight into the pathophysiology of hypertension in OSA.(c) 2022 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).The ESADA network has received support from the European Union COST action B26 (2005-2009) and the European Respiratory Society funded Clinical Research Collaboration (CRC; 2015-2020) . Unrestricted seeding grants from the ResMed Foundation and the Philips Respironics Foundation for establishment of the database are gratefully acknowledged. The ESADA has a scientific collabo-ration with Bayer AG. Nonfinancial support was provided by the European Sleep Research Society and the European Respiratory Society in terms of logistics for communication, meetings and data presentations for the ESADA collaborators. The current study was supported by the Swedish Heart and Lung Foundation (project 20180585) and partially supported by MIAI @ Grenoble Alpes, (ANR-19-P3IA-00 03) .European Union COST action [B26]; European Respiratory Society; ResMed Foundation; Philips Respironics Foundation; Swedish Heart and Lung Foundation [20180585]; MIAI @ Grenoble Alpes [ANR-19-P3IA-00 03

Clinical characteristics and positive airway pressure adherence among elderly European sleep apnoea patients from the ESADA cohort

Background The prevalence of obstructive sleep apnoea (OSA) is growing as the population is ageing. However, data on the clinical characteristics of elderly patients with OSA and their adherence to positive airway pressure (PAP) treatment are scarce. Methods Data from 23 418 30-79-year-old OSA patients prospectively collected into the ESADA database during 2007-2019 were analysed. Information on PAP use (h.day(-1)) in association with a first follow-up visit was available for 6547 patients. The data was analysed according to 10-year age groups. Results The oldest age group was less obese, less sleepy and had a lower apnoea-hypopnoea index (AHI) compared with middle-aged patients. The insomnia phenotype of OSA was more prevalent in the oldest age group than in the middle-aged group (36%, 95% CI 34-38 versus 26%, 95% CI 24-27, p0.001). The 70-79-year-old group adhered to PAP therapy equally well as the younger age groups with a mean PAP use of 5.59 h.day(-1) (95% CI 5.44-5.75). PAP adherence did not differ between clinical phenotypes based on subjective daytime sleepiness and sleep complaints suggestive of insomnia in the oldest age group. A higher score on the Clinical Global Impression Severity (CGI-S) scale predicted poorer PAP adherence. Conclusion The elderly patient group was less obese, less sleepy, had more insomnia symptoms and less severe OSA, but were rated to be more ill compared with the middle-aged patients. Elderly patients with OSA adhered to PAP therapy equally well as middle-aged patients. Low global functioning (measured by CGI-S) in the elderly patient predicted poorer PAP adherence.A. Lammintausta was supported by a grant from The Turku University Foundation. This study was partially supported by the Governmental grant 13542 of the Turku University Hospital, The Finnish Anti-Tuberculosis Association Foundation, The Jalmari and Rauha Ahokas Foundation, The Tampere Tuberculosis Foundation and The Research Foundation of the Pulmonary Diseases. The ESADA network is a Clinical Research Collaboration funded by the European Respiratory Society and by unrestricted grants from ResMed, Philips and Bayer Pharmaceuticals. Funding information for this article has been deposited with the Crossref Funder Registry.Turku University Foundation; Turku University Hospital [13542]; Finnish Anti-Tuberculosis Association Foundation; Jalmari and Rauha Ahokas Foundation; Tampere Tuberculosis Foundation; Research Foundation of the Pulmonary Diseases; European Respiratory Society; ResMed; Philips; Bayer Pharmaceutical

Smoking status of medical students at Ege University: A cross-sectional survey of 1040 students in 2018

Introduction We aimed to determine the smoking prevalence and related factors among 1,2,3 and 6th grade students at Ege University Faculty of Medicine. Methods This cross-sectional survey was a part of a multi-centre study throughout Turkey and the data were collected in May-June 2018. The target group of this study was 1537 medical students studying in the first, second, third and sixth grades. Questionnaires were applied to 1040 students (67.7%) who agreed to participate in the study. The coverage was 94.5%, 78.6%, 57.4%, 36.7% for the first, second, third and sixth grades, respectively. Results The overall prevalence of smoking was 18.4%, with 18.1%, 18.6%, 17.0% and 22.1% in the first, second, third and sixth grades, respectively. The mean age at starting to smoke was 16.5±2.3 yrs (min.8, max.23). Current smoking was more prevalent in males compared to females (24.3% vs. 11.7%, p<0.001). Among current smokers, 27.4% had started smoking during medical school. The most common reasons for starting to smoke were the effects of close friends (37.1%) and stress (19.2%). Current smokers spend 201±139 Turkish Liras (min.0, max.800) monthly for cigarettes. Among smokers, 60.4% have tried to quit smoking at least once, and 78% of them thought of smoking cessation. Among e-cigarette users, 93.6% were ever-smokers. According to univariate analyses; male students, students whose parents, partners or best friends were ever-smokers, students living alone and the ones who have smoked hookah at least once have significantly higher prevalence of being ever-smokers compared to their counter-parts. In multivariate analyses; having the hookah use (OR:12.4), living alone at home (OR:3.4), partner (OR:2.3) or best friend (OR:1.9) smoking, and were found to be independent risk factors related to being an ever-smoker. Conclusions The present study shows that the prevalence of smoking in especially male medical students was high (24.3%) in Turkey, and nearly one third of the students started smoking during medical faculty. Therefore, there is a need to include intensive education programs regarding smoking-related health problems and smoking cessation at an early stage in the medical curriculum

Sleep and cardiometabolic comorbidities in the obstructive sleep apnoea-COPD overlap syndrome: data from the European Sleep Apnoea Database

Aim The impact of obstructive sleep apnoea (OSA)-COPD overlap syndrome (OVS) on sleep quality and cardiovascular outcomes has not been fully explored. We aimed to compare clinical and polysomnographic characteristics of patients with OVS versus patients with OSA, and to explore pathophysiological links between OVS and comorbidities. Study design and methods This cross-sectional analysis initially included data from 5600 patients with OSA and lung function in the European Sleep Apnoea Database. Two subgroups of patients with OSA (n=1018) or OVS (n=509) were matched (2:1) based on sex, age, body mass index and apnoea-hypopnea index at baseline. Results After matching, patients with OVS had more severe hypoxia, lower sleep efficiency and presented with higher prevalences of arterial hypertension, ischaemic heart disease and heart failure compared with patients with OSA. OVS was associated with a significant decrease in sleep efficiency (mean difference (beta) -3.0%, 95% CI -4.7 to -1.3) and in nocturnal mean peripheral oxyhaemoglobin saturation (S-pO2) (beta -1.1%, 95% CI -1.5 to -0.7). Further analysis revealed that a decrease in forced expiratory volume in 1 s and arterial oxygen tension was related to a decrease in sleep efficiency and in mean nocturnal S-pO2. A COPD diagnosis increased the odds of having heart failure by 1.75 (95% CI 1.15-2.67) and systemic hypertension by 1.36 (95% CI 1.07-1.73). Nocturnal hypoxia was strongly associated with comorbidities; the mean nocturnal S-pO2 and T90 (increase in time below S-pO2 of 90%) were associated with increased odds of systemic hypertension, diabetes and heart failure but the oxygen desaturation index was only related to hypertension and diabetes. Conclusion Patients with OVS presented with more sleep-related hypoxia, a reduced sleep quality and a higher risk for heart failure and hypertension.The ESADA study group received unrestricted funding grants from the Respironics and Resmed Foundations, and an unrestricted collaboration grant from Bayer AG.Respironics Foundation; Bayer AG; Resmed Foundatio