Glucose metabolism disorders, insulin resistance, levels of IL6, TNF-?, CRP, and hsCRP in obstructive sleep apnea syndrome

YÖK Tez ID: 455942Obstrüktif uyku apne sendromlu hastalarda glukoz metabolizma bozuklukları, insülin direnci, IL6, TNF-?, CRP ve hsCRP düzeyleriObstrüktif uyku apne sendromu (Obstrüktif sleep apne sendromu) (OSAS) ile glukoz metabolizma bozuklukları ve artmış insülin direnci (İD) arasındaki ilişki iyi bilinmemektedir. Ayrıca OSAS'lı hastalarda lokal ve sistemik inflamasyonun artığını gösteren IL-6, TNF-?, CRP, ve hsCRP düzeyleri arteriosklerozis ve koroner arter hastalığı için risk faktörleridir. Biz bu çalışmada OSAS tanılı hastalarda glukoz metabolizma bozuklukları ve IL-6, TNF-?, CRP, hsCRP düzeyleri ile hastalığın derecesi arasındaki ilişkiyi inceledik. Bununla birlikte bu hastalarda hayat kalitesini ve hayat kalitesini belirleyen faktörleri araştırdık. Bu amaçla çalışmaya; tanı konulmuş Diabetes Mellius (DM)'u olmayan 109 OSAS tanılı hasta ile 18 sağlıklı birey kontrol grubu olarak alındı. Bu çalışmada OSAS'lı hastalarda İD kontrol grubuna göre yüksek bulundu. Ancak OSAS'lı hastalar hastalık şiddetine göre gruplara ayrıldığında İD açısından gruplar arası istatistiksel olarak anlamlı farklılık yoktu. Ayrıca lineer regresyon analizinde OSAS'lı hastalarda apne hipopne indeksi (AHI), vucut kitle indeksi (VKİ)'inden bağımsız olarak İD'ini belirleyen önemli faktör idi. OSAS tanılı hastalarda tüm glukoz metabolizma bozuklukları %52.2 oranında görüldü. Bu bozuklukları gruplara ayırdığımızda tüm OSAS'lı hastalarda bozulmuş açlık glikozu (BAG) %24.7, bozulmuş glikoz toleransı (BGT) %12.84, DM %14.67 oranında saptandı. Çalışmamızda OSAS'lı hastalar hastalık şiddetine göre gruplara ayrıldığında tüm glukoz metabolizma bozuklukları, hafif OSAS grubunda %33, orta OSAS'lı hastalarda %50, ağır OSAS'lı hastalarda % 61.8 oranında görüldü. Bu çalışmada OSAS'lı hastalarda hsCRP, CRP, TNF-? ve IL-6 düzeyleri kontrol grubundan istatistiksel olarak yüksek bulundu. Linear regresyon analizine göre TNF-? ve IL-6'yı hastalık şiddeti, hsCRP ve CRP'yi ise VKİ belirliyordu. Tüm kişilerde İD ile IL-6 ve TNF-? arasında basit korelasyon ve lineer regresyon analizinde pozitif ilişki görüldü. Çalışmamızda OSAS'lı hasta grubunda hayat kalitesinin fiziksel ve mental sağlık komponentleri kontrol grubundan daha düşük olmasına rağmen fark istatistiksel öneme erişmiyordu. Ancak linear regresyon analizinde OSAS'lı hastalarda mental sağlık VKİ ve gündüz aşırı uykululuk hali ile ve fiziksel sağlık da VKİ ile negatif ilişkili bulundu. Buna göre, OSAS'lı hastalardaki hayat kalitesini hastalık şiddeti değil obezite ve gündüz aşırı uykululuk halinin belirlediği sonucuna varıldı. OSAS'lı hastalarda hastalık şiddeti arttıkça glukoz metabolizma bozukluklarının görülme sıklığı artmıştır. OSAS'lı hastalarda hsCRP, CRP, TNF-? ve IL-6 düzeylerinin yüksek olması kardiovasküler mortalite ve morbidite için risk artışının varlığını gösterir.Anahtar Kelimeler: Obstrüktif uyku apne sendromu, glukoz metabolizma bozuklukları, insülin direnci, inflamasyon.Glucose metabolism disorders, insulin resistance, levels of IL6, TNF-?, CRP, and hsCRP in obstructive sleep apnea syndromeThe relationship between Obstructive Sleep Apnea Syndrome (OSAS) with increased disorders of glucose metabolism and insulin resistance (IR) is not well known. Moreover, increased levels of IL-6, TNF-?, CRP and hsCRP showing local and systemic inflammation in patients with OSAS are risk factors for coronary artery disease and arteriosklerosis. In this study, the relationship between glucose metabolism disorders and IL-6, TNF-?, CRP, hsCRP levels with the degree of illnes in patients with OSAS were investigated. In addition, quality of life in patients with OSAS and the related factors were studied. For this purpose 109 patients with OSAS in whom Diabetes Mellitus (DM) was not previously diagnosed and 18 healthy individuals were recruited as a control group. In this study, in patients with OSAS IR was found to be higher compared to the control group. However, IR is not different among groups when the patient with OSAS were divided into groups. In addition, apnea hypopnea index (AHI) is the most important factor revealing IR independent of body mass index (BMI), in linear regression analysis. All glucose metabolism disorders in patients with OSAS were seen at an overall rate of 52.2%. When these disorders have been seperated into groups, impaired fasting glucose (IFG) was detected in 24.77%, impaired glucose tolerance (IGT) in 12.84%, and DM was detected in 14.67% of the patients. When the patients with OSAS were seperated into groups according to the severity of the disease, glucose metabolism disorders were found to be 33% in mild OSAS, 50% in moderate and 61.8% in severe OSAS. In this study, hsCRP, CRP, TNF-?, and IL-6 levels in patients with OSAS were significantly higher than the control group. According to linear regression analysis, severity of the disease determined TNF-? and IL-6, whereas BMI determined hsCRP, and CRP levels. In all individuals, there was a positive relationship between IR with IL-6 and TNF-? in simple correlation and linear regression analysis. Although the difference did not reach statistically significance, both physical and mental quality of life were impaired in patients with OSAS compared to the control group. However, there was a significant inverse relationship between mental health and excessive daytime sleepiness, BMI, as well as between physical health and BMI. While obesity and excessive daytime sleepiness determined the quality of life severity of illness didn?t have an effect on quality of life. In conclusion, frequency of glucose metabolism disorders was seen to be increased in patients with the severity of OSAS. High levels of hsCRP, CRP, TNF-?, and IL-6 indicated the increased risk for cardiovascular mortality and morbidity in patients with OSAS.Key Words: Obstructive sleep apnea syndrome, glucose metabolism disorders, insulin resistance, inflammation

Obstrüktif uyku apne sendromlu hastalarda glukoz metabolizma bozuklukları, insülin direnci, IL-6, TNF-?, CRP, hsCRP düzeyleri

Tez (Tıpta Uzmanlık) -- Kırıkkale Üniversitesi87184

Relationship of Clinical Parameters and Inflammation Markers with Pulmonary Hypertension in Patients with Stable Chronic Obstructive Pulmonary Disease

Aim: Inflammation is an important mechanism in the development of pulmonary arterial hypertension (PAH) in patients with COPD. In this study, we investigated the relationship of disease severity parameters and inflammation with PAP in COPD patients. Material and Methods: A patient group consisting of 80 patients with stable COPD including who were obtaining treatment at the outpatient clinic of Kırıkkale University Faculty of Medicine Department of Pulmonary Medicine were included in the study along with a control group of 46 individuals who were compatible with the patient group in terms of age and gender and did not have any airway obstruction. Spirometry measurements were performed (FEV1, FVC, FEV1/FVC, MEF and PEF). Systolic pulmonary artery pressure (sPAP) measurements and standard doppler echocardiography were performed at the outpatient clinic of the department of cardiology.Results: CRP was found to be significantly higher in patients with stable COPD compared to the control group. sPAP values of COPD patients were significantly higher than those of the control group. A statistically significant positive relationship was observed between the sPAP value and age (p = 0.006). There was no statistically significant relationship between sPAP and MCIRS score (p = 0.700). A statistically weak negative relationship was observed between sPAP and FVC% (p = 0.053) Conclusion: Development of PAH increases morbidity and mortality. Therefore, patients with advanced stages of COPD should be screened using echocardiography, which is an easy-to-use, fast and repeatable measurement method to check for PAH development

Affect status and perception of exacerbation in patients with asthma

WOS: 000209656300002PubMed: 21708053Exacerbations occur commonly in patients with asthma but factors affecting perception of dyspnea during exacerbation are not well known. This investigation was designed to determine the effects of negative mood on perception of dyspnea during exacerbation. A total of 47 patient aged 28-78 years (mean age, 52.5 years) admitted with acute asthma had recordings of blood gas pressure, negative mood score, forced expiratory volume in 1 second (FEV1), and dyspnea score at admission and at the 72nd hour. Perceived intensity of dyspnea was estimated using a modified Borg scale. The negative mood was assessed with an overall of six mood adjectives (nervous-anxious, sad-blue, and tired-drowsy). High negative mood score was defined as the score above the cutoff point (median score, >7). Borg sore of patients with a high negative mood score was higher than that of patients with a low negative mood score (6.3 +/- 2.5 versus 4.4 +/- 2.4; p +/- 0.01). The high Borg sore of asthmatic patients with high negative mood persisted even at the 72nd hour (1.6 +/- 0.9 versus 1.0 +/- 0.7; p +/- 0.01). FEV1 values of both groups at admission were similar. The negative mood score (beta = 0.68; p = 0.0001) and initial FEV1 (beta = -0.42; p = 0.01) were the important determinants of Borg score at admission in all patients with multivariate analysis but not arterial oxygen pressure, arterial carbon dioxide pressure, asthma duration, and female sex. This study indicated that emotional factors, as well as the level of airways obstruction, predicted the magnitude of dyspnea at exacerbation of asthmatic patients. Thus, the emotional factors should be taken into account in the treatment of dyspnea at exacerbation

Metabolic syndrome and chronic diseases in COPD

WOS: 000449650901859

Quality of life and metabolic disorders in patients with obstructive sleep apnea

WOS: 000302966500008PubMed: 22469102Purpose: Quality of life (QoL) may be poor in patients with sleep apnea depending on multifactorial reasons. In this observational study, we examined the factors determining QoL in patients with obstructive sleep apnea (OSA) and nonapneic snoring subjects. Methods: Complete assessments were obtained on 111 subjects who diagnosed OSA and 18 nonapneic snoring subjects. Fasting blood samples of all of subjects were taken to determine insulin resistance (IR) and oral glucose tolerance tests were performed to diagnose disorders of glucose metabolism (DGM). Quality of life, with short form (SF)-36, and excessive daytime sleepiness, with epwort sleepness scale (ESS), were evaluated. Results: The mean age of the patients with OSA was higher than that of the nonapneic snoring subjects (48.4 +/- 9.6 years and 43.0 +/- 11.8 years, respectively; p=0.03). BMI was also significantly higher in the patients with OSA than in the nonapneic snorers (31.0 +/- 4.5 and 27.1 +/- 4.0, respectively; p=0.001). The mental health component in the patients with OSA was slightly but not significantly lower than the nonapneic snoring subjects (p=0.05). A negative correlation among most domains of quality of life with scores of ESS, body mass index (BMI), presence of hypertension (HT) and DGM was found. Only physicial functioning was negatively correlated with apnea hypopnea index (AHI). In linear regression analysis, there were negative associations among physical functioning with BMI, presence of HT and DGM while there was no association between physicial functioning and AHI. In addition, there were negative correlations between mental health component with BMI and presence of HT in the multivariate analysis. Obese patients with OSA had lower physicial and mental components compared with nonobese patients with OSA. Conclusion: The impact of OSA on quality of life can be attributed to excessive daytime sleepiness. Obesity and metabolic disorders in patients with OSA may also negatively affect the quality of life

Assessment of patients' preferences regarding the characteristics associated with the treatment of chronic obstructive pulmonary disease

WOS: 000334343300001PubMed: 24790426Objective: Patient preferences regarding characteristics associated with the treatment of chronic obstructive pulmonary disease (COPD) must be determined to increase the compatibility between the patients and the treatments, but as yet no studies have been performed regarding these characteristics. Here, we evaluate the preferred characteristics associated with the treatment of patients with COPD. Method: The expectations of patients receiving COPD therapy were assessed in six categories: time allocated by the physician to listen to patients' complaints, treatment to be applied, estimated adverse effect frequency concerning the therapy, ability of patients to visit the same physician each time, integral approach of the physician to the treatment of the patient, and therapy cost. These groups were divided into categories of therapy indicating 25 alternative treatment methods, using conjoint analysis. Patients were sorted to the 25 types of treatment with regard to their preferences. Results: The major expectation of conjoint analysis associated with the treatment of COPD patients is for the therapy to allow the patients to completely recover from their complaints. The order preferred by patients of other treatment expectations is from sufficient time to be allowed by the physician to listen to the patient, to no cost for the treatment, to minimum adverse effects resulting from the treatment, to each follow-up to be performed by the same physician, and to the physician performing an assessment of the patient's well-being, rather than examining only the areas of complaint. Conclusion: The major expectation of COPD patients regarding treatment was to completely recover with the help of the therapy. Considering the expectations of the patient may help improve the compatibility of the patient with the treatment

Microalbuminuria in chronic obstructive pulmonary disease (conferenceObject)

WOS: 000449650901860

Quality of life and metabolic disorders in patients with obstructive sleep apnea

Purpose: Quality of life (QoL) may be poor in patients with sleep apnea depending on multifactorial reasons. In this observational study, we examined the factors determining QoL in patients with obstructive sleep apnea (OSA) and nonapneic snoring subjects. Methods: Complete assessments were obtained on 111 subjects who diagnosed OSA and 18 nonapneic snoring subjects. Fasting blood samples of all of subjects were taken to determine insulin resistance (IR) and oral glucose tolerance tests were performed to diagnose disorders of glucose metabolism (DGM). Quality of life, with short form (SF)-36, and excessive daytime sleepiness, with epwort sleepness scale (ESS), were evaluated. Results: The mean age of the patients with OSA was higher than that of the nonapneic snoring subjects (48.4 ± 9.6 years and 43.0 ± 11.8 years, respectively; p=0.03). BMI was also significantly higher in the patients with OSA than in the nonapneic snorers (31.0 ± 4.5 and 27.1 ± 4.0, respectively; p=0.001). The mental health component in the patients with OSA was slightly but not significantly lower than the nonapneic snoring subjects (p=0.05). A negative correlation among most domains of quality of life with scores of ESS, body mass index (BMI), presence of hypertension (HT) and DGM was found. Only physicial functioning was negatively correlated with apnea hypopnea index (AHI). In linear regression analysis, there were negative associations among physical functioning with BMI, presence of HT and DGM while there was no association between physicial functioning and AHI. In addition, there were negative correlations between mental health component with BMI and presence of HT in the multivariate analysis. Obese patients with OSA had lower physicial and mental components compared with nonobese patients with OSA. Conclusion: The impact of OSA on quality of life can be attributed to excessive daytime sleepiness. Obesity and metabolic disorders in patients with OSA may also negatively affect the quality of life

Kronik Obstrüktif Akciğer Hastaliğinda Metabolik Sendrom Ve Kronik Hastaliklar

Amaç: Kronik obstrüktif akciğer hastalığı (KOAH), metabolik sendrom (MS) ve komorbidite arasındaki ilişki üzerine yapılan önceki çalışmalarda bulunan sonuçlar tartışmalıdır. Bu nedenle biz bu çalışmada, KOAHlı hastalarda eşlik eden metabolik sendrom ve komorbiditeleri ayrı ayrı olacak şekilde inceledik. Yöntem: Bu çalışma periyodu sırasında, 66 KOAH ve kontrol grubu olarak da 40 kişi dahil edildi. Solunum fonksiyon testleri (SFT) flow sensitif spirometri ile ATS kriterlerine göre yapıldı. BODE indeksleri hesaplandı. Kronik hastalıklar şiddet indeksi Modifiye kümülatif hastalıklar değerlendirme ölçeği (MKHDÖ) kullanılarak değerlendirildi. MS, National Cholesterol Education Program (NCEP)a göre tanımlandı. Total metabolik bozukluk skoru da ayrıca hesaplandı. Bulgular: MKHDÖ skoru KOAHlı hastalarda kontrol grubundan anlamlı olarak yüksekti fakat total metabolik skor KOAH ve kontrol grubu arasında farklı değildi. MS KOAHlı hastalarda 18 kişide (%27.3), kontrol grubunda 8 kişide (%20) görüldü. MS görülme oranı evre II KOAHlı hastalarda evre IV KOAHlı hastalardan daha yüksekti (p:0.04). Lineer regresyon analizinde, MKHDÖ skoru BODE indeksi ile pozitif ilişki gösterirken, FEV1%, FVC%, FEV1/FVC% ile anlamlı negatif ilişki gösterdi. Ancak, MKHDÖ PO2 ile anlamlı ilişki göstermedi. Sonuç: Komorbiditeler ve MS KOAHın farklı evrelerinde görülür. Bu nedenle eşlik eden bu hastalıklar birbirinden ayrı ayrı olarak incelenmelidir.Aim: Results of the previous studies on the relationship amongst the comorbidity, metabolic syndrome (MS) and Chronic Obstructive Pulmonary Disease (COPD) are controversial. Therefore, these accompanying comorbidities and MS were assessed on an individual basis in patients with COPD in the present study. Method: During the study period, 66 consecutive patients with COPD and 40 subjects as a control group were enrolled. Pulmonary Function Tests (PFT) were performed with flow sensitive spirometer according to ATS guidelines. The Body-Mass Index, Airflow Obstruction, Dyspnea, and Exercise Capacity (BODE) index was calculated. The index severity of chronic diseases was evaluated using the Modified Cumulative Illness Rating Scale (MCIRS). MS was defined according to National Cholesterol Education Program. Total score of metabolic disorders was also calculated. Results: MCIRS score was significantly greater in patients with COPD than in control group but the total score of metabolic disorders was the same for the patients with COPD and the control group. MS was detected in 18 subjects (27.3%) in patients with COPD as compared to 8 of subjects in control group (20%). The rate of MS in patients with stage II COPD was higher than the patients with stage IV COPD (p: 0.04). In linear regression model, the MCIRS score exhibited significant inverse associations with FEV1%, FVC% and FEV1/FVC% while exhibiting significant positive association with BODE index. However, the MCIRS did not exhibit significant association with PO2