Obstructive sleep apnea related to rapid-eye-movement or non-rapid-eye-movement sleep: comparison of demographic, anthropometric, and polysomnographic features

Objective : To determine whether there are significant differences between rapid-eye-movement (REM)-related obstructive sleep apnea (OSA) and non-REM (NREM)-related OSA, in terms of the demographic, anthropometric, and polysomnographic characteristics of the subjects. Methods : This was a retrospective study of 110 patients (75 males) with either REM-related OSA (n = 58) or NREM-related OSA (n = 52). To define REM-related and NREM-related OSA, we used a previously established criterion, based on the apnea-hypopnea index (AHI): AHI-REM/AHI-NREM ratio > 2 and ≤ 2, respectively. Results : The mean age of the patients with REM-related OSA was 49.5 ± 11.9 years, whereas that of the patients with NREM-related OSA was 49.2 ± 12.6 years. The overall mean AHI (all sleep stages combined) was significantly higher in the NREM-related OSA group than in the REM-related OSA group (38.6 ± 28.2 vs. 14.8 ± 9.2; p < 0.05). The mean AHI in the supine position (s-AHI) was also significantly higher in the NREM-related OSA group than in the REM-related OSA group (49.0 ± 34.3 vs. 18.8 ± 14.9; p < 0.0001). In the NREM-related OSA group, the s-AHI was higher among the men. In both groups, oxygen desaturation was more severe among the women. We found that REM-related OSA was more common among the patients with mild-to-moderate OSA, whereas NREM-related OSA was more common among those with severe OSA. Conclusions : We found that the severity of NREM-related OSA was associated mainly with s-AHI. Our findings suggest that the s-AHI has a more significant effect on the severity of OSA than does the AHI-REM. When interpreting OSA severity and choosing among treatment modalities, physicians should take into consideration the sleep stage and the sleep posture

Successful management of pulmonary hemorrhage and aspergillosis in a patient with acute myeloid leukemia (AML-M3)

A 35-year-old man presented with a one month history of gingival bleeding. He was diagnosed with Acute Myeloid Leukemia (AML-M3). During treatment he developed alveolar hemorrhage for which he was treated with a steroid. After the steroid treatment he developed a nodule, a cavitary lesion and atelectasia in the left lung. He was treated with voriconazole. After therapy with voriconazole his lesion significantly decreased. This case illustrates the efficacy and safety of antifungal therapy with voriconazole for aspergillosis complicated by AML

Kronični učinci ambijentalnoga dima iz biomase na histopatologiju pluća u ljudi: opis niza slučajeva

Biomass is widely used for fuel in developing countries. Particles and gases of biomass burning may cause changes in the lung. In this prospective study we investigated histopathological changes in the lungs of 42 non-smoking women [mean age (59±10) years] caused by biomass smoke. We valuated exposure to biomass smoke, case histories, and the findings of physical examination, radiology, bronchoscopy, and lung histopathology. Mean exposure to biomass smoke was (28±9) hour-year (1 hour-year equals 365 hours of exposure per year with average exposure of 1 hour a day). The radiological fi ndings were mass (42 %), reticulonodular opacities (31 %), mediastinal lymphadenopathy (26 %), pleuro-parenchymal fibrotic banding (19 %), widening of the pulmonary artery (14 %), ground glass (11 %), mosaic perfusion (9 %), consolidation (9 %), segmental or subsegmental atelectasis (7 %), and bronchiectasis (7 %). The patients were diagnosed with lung cancer (35 %), interstitial lung disease (31 %), sarcoidosis (9 %), tuberculosis (9 %), chronic obstructive pulmonary disease (4 %), chronic bronchitis (9 %), and metastasis (4 %). Bronchoscopy showed pilies, oedema, erythema, bronchus narrowing, endobronchial tumour, mucosal irregularity, increased vascularisation, blue-black anthracotic plaques, mucosal oedema, and purulent secretion. Transbronchial biopsies revealed neutrophil and lymphocyte leucocytes in the perivascular, peribronchiolar, and interalveolar septa, slightly enlarged connective tissue, thickening of the basal membrane, thickening of interalveolar septa, intimal and medial thickening of the vascular wall and vascular lumen narrowing, anthracosis between the cells and in the bronchiole epithelium. These findings confirm that biomass smoke has important toxic effects on the lung parenchyma, interstitium, and pulmonary vessels that may result in malignancies.Biomasa se u mnogim zemljama u razvoju rabi za gorivo. Čestice i plinovi izgorene biomase mogu dovesti do plućnih promjena. Ovdje smo istražili histološke promjene u plućima ljudi uzrokovane biomasom. Ovo je prospektivno ispitivanje obuhvatilo 42 nepušačice izložene dimu iz biomase u kojih je ocijenjena izloženost dimu, uzeta povijest bolesti, napravljen fi zikalni pregled te analizirani radiološki, bronhoskopski i histopatološki nalazi. Srednja dob ispitanica bila je (59±10) godina. Srednja izloženost dimu iz biomase iznosila je (28±9) sati na godinu. Radiološki nalazi upozorili su na tumorsku tvorbu (u njih 42 %), retikulonodularna zasjenjenja (31 %), limfadenopatiju medijastinuma (26 %), fibrozne promjene pleure i plućnog parenhima (19 %), proširenje plućne arterije (14 %), sliku smrvljenog stakla (11 %), sliku mozaične perfuzije (9 %), konsolidacije (9 %), segmentnu i subsegmentnu atelektazu (7 %) te bronhijektazije (7 %). U njih 35 % dijagnosticiran je rak pluća, u 31 % bolesti plućnog intersticija, u 9 % sarkoidoza, u 9 % tuberkuloza, u 4 % KOPB, u 9 % kronični bronhitis te u 4 % metastaze. Bronhoskopija je pokazala pilije, edem, eritem, sužavanje bronhija, endobronhijalni tumor, neurednu sluznicu, izrazitiju vaskularizaciju, plavo-crne antrakotične plakove, otjecanje sluznice te purulentnu sekreciju. Transbronhijalnom biopsijom pronađeni su neutrofili i limfociti u perivaskularnom, peribronhiolarnom tkivu i interalveolarnim septumima, zadebljanje vezivnoga tkiva, zadebljanje bazalne membrane, zadebljanje interalveolarnih septuma, zadebljanja stijenke žila intimalno i medijalno te suženje njihova lumena, crna antrakoza između stanica te u epitelu bronhiola. Sve to upozorava na značajne promjene uzrokovane biomasom, koje obuhvaćaju zloćudne formacije uslijed toksičnoga djelovanja na plućni parenhim, intersticij i žile

Betatrophin association with serum triglyceride levels in obstructive sleep apnea patients

BACKGROUND: Obstructive sleep apnea (OSA) is a common sleep problem, in which patients are at increased risk for metabolic and cardiovascular problems, including metabolic syndrome, diabetes mellitus (DM), and dyslipidemia. Betatrophin is a novel protein that regulates fatty acid and triglyceride (TG) metabolism and is related to obesity and metabolic abnormalities, including metabolic syndrome, DM, and dyslipidemia. Although OSA and betatrophin share common abnormalities, their relationship has not been investigated. AIM: The aim of this study is to investigate the relationships among betatrophin, OSA, and the serum lipid profile. METHODS: Ninety consecutive patients with suspected OSA underwent polysomnography (PSG) to confirm OSA. Plasma betatrophin, leptin, adiponectin, and the full lipid profile were analyzed. The patients were categorized as OSA or control based on the apnea-hypopnea index (AHI). RESULTS: About 61% of patients had OSA, and 39% had normal PSG. The levels of betatrophin, leptin, and adiponectin were higher in patients with OSA (256.59 ± 29.35, 374.20 ± 37.93, and 17.86 ± 2.63 μg/mL, respectively) compared to the controls (141.86 ± 26.20, 205.53 ± 14.75, and 7.52 ± 1.02 μg/mL, respectively). Betatrophin levels were correlated with the AHI, leptin (r = 0.413, P = 0.002, r = 0.782, P = 0.000). TG levels were significantly higher, and high-density lipoprotein cholesterol (HDL-C) levels were lower, in OSA patients compared to controls (244 ± 20.33 vs. 138 ± 14.89, and 37.21 ± 1.26 vs. 43.78 ± 1.62, respectively). The TG level was correlated with betatrophin (r = 0.353, P = 0.013). Multiple regression analysis showed that the AHI, leptin, and arousals were independent predictors of betatrophin level (B = 1.70 P = 0.046 95%, B = 0.56 P < 0.005, and B = 1, 2, P = 0.003, respectively). CONCLUSIONS: Our results suggest a complex relationship between OSA, betatrophin, TG, and HDL, as well as other adipokines. Our results require further investigation to assess this complex association and re-evaluate previous related studies

Original Article A silent pre-stroke damage: obstructive sleep apnea syndrome

Abstract: Objectives: We investigated the prevalence of silent cerebro-vascular lesions and atrophy in patients with obstructive sleep apnea syndrome (OSAS) and the correlation between OSAS severity and prevalence of silent cerebrovascular lesions in Turkish patients. Methods: Study subjects were 56.35 OSAS, polysomnography (PSG)-confirmed patients who visited the sleep disorders clinic in our university hospital. None had a history of cerebrovascular disease (CVD). The control group consisted of normal subjects who had no history of snorring, apnea, excessive daytime sleepiness and had under 10 score of epworth sleepiness score. We performed a cross-sectional study on OSAS severity and the prevalence of silent cerebrovascular lesions and atrophy detected by brain MRI analysis. Results: The control group included 21 subjects, the moderate OSAS (AHI 15 to &lt; 30/h) group included 7 patients with a mean AHI of 22.0 ± 5.3/h while the severe OSAS (AHI ≥ 30/h) group included 28 patients with a mean AHI of 60.0 ± 27.4/h. A larger percentage of patients with severe OSAS had a higher BMI than those with moderate OSAS and control subjects (P &lt; 0.05). Silent ischemic gliotic lesions was identified in 10 (38.2%) control subjects, 27 (61.8%) with moderate and severe OSAS. Among control subjects and the moderate, and severe OSA groups, 10 (38.2%), 6 (85.7%) and 21 (77.7%) respectively, had periventricular hyperintensity (PVH); most PVH was mild to moderate. Conclusion: Results indicate that patients with moderate to severe (AHI ≥ 15/h) OSAS have a higher prevalence of silent cerebrovascular lesion than those with no OSAS

General characteristics and therapeutic options in lung cancer in Turkey

WOS: 00045197940620

Assesment of palliative care in lung cancer in Turkey (ASPECT study)

WOS: 00045197940703