An analysis of the causes of mortality and co-morbidities in hospitalised patients with chronic obstructive pulmonary disease

Wstęp: Przewlekła obturacyjna choroba płuc (POChP) jest czwartą przyczyną zgonu w Stanach Zjednoczonych i przewiduje się, że w 2020 roku będzie już na miejscu trzecim. U chorych na POChP często występują inne schorzenia: choroby układu sercowo-naczyniowego, osteoporoza, kacheksja, niedokrwistość, które są konsekwencją systemowego zapalenia. Uważa się, że choroby współistniejące wiążą się z cięższym przebiegiem POChP oraz gorszym rokowaniem. Trwa dyskusja, czy główną przyczyną zgonu chorych na POChP są pozapłucne choroby współistniejące, czy powikłania ze strony układu oddechowego. Celem pracy była analiza przyczyn zgonu chorych na POChP oraz analiza chorób współistniejących u zmarłych w Klinice Chorób Wewnętrznych, Pneumonologii i Alergologii WUM w latach 2004–2008. Materiał i metody: Analizie poddano 266 kolejnych historii chorób pacjentów z POChP, którzy zmarli podczas hospitalizacji. Było wśród nich 179 (67%) mężczyzn i 87 (33%) kobiet. Średni wiek zmarłych wyniósł 73 ± 8 lat (73 ± 8 M, 74 ± 9 K). Wyniki: Przyczynami zgonu w analizowanej grupie chorych były: zaostrzenie POChP (n = 81 [30%], K = 32, M = 49), zapalenie płuc (n = 67 [25%], K = 17, M = 50), rak płuca (n = 50 [19%], K = 18, M = 32), choroba niedokrwienna serca (n = 20 [7%], K = 5, M = 15), niewydolność serca (n = 14 [5%], K = 6, M = 8) i inne (n = 34, 14%). Zgony z powodu raka płuca dotyczyły osób młodszych (p = 0,002), a z powodu zapalenia płuc — osób starszych (p = 0,02). W badanej grupie do najczęstszych chorób współistniejących należały: przewlekła niewydolność serca (n = 169), nadciśnienie tętnicze (n = 103), choroba niedokrwienna serca (n = 102), cukrzyca typu 2 (n = 55), niewydolność nerek (n = 43), przerost prostaty (n = 36), miażdżyca tętnic kończyn dolnych (n = 28), osteoporoza (n = 19), niedokrwistość (n = 14). Wnioski: 1. Najczęstszymi przyczynami zgonu w badanej grupie były patologie związane z układem oddechowym: zaostrzenie POChP, zapalenie płuc i rak płuca. 2. W analizowanym materiale do schorzeń najczęściej współistniejących z POChP należały choroby układu krążenia i cukrzyca typu 2. Pneumonol. Alergol. Pol. 2011; 79, 5: 343–346Introduction: Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the United States. Patients with COPD often suffer from various co-morbidities, such as cardiovascular disease, osteoporosis, cachexia and anaemia, which are a consequence of systemic inflammation. The co-morbidities of COPD are believed to be associated with a more severe course of the underlying disease and with a poorer prognosis. It is being disputed whether extrapulmonary co-morbidities or respiratory complications are the main cause of mortality in patients with COPD. The aim of the study was to analyse the causes of death and co-morbidities in COPD patients who had died during hospitalisation at the Department of Internal Medicine, Pneumonology and Allergy, Medical University of Warsaw, Poland, between 2004 and 2008. Material and methods: We analysed 266 consecutive medical records of COPD patients who had died during hospitalisation. They included 179 men (67%) and 87 women (33%). The mean age at death was 73 ± 8 years (women: 74 ± 9 years). Results: The causes of death in the analysed group of patients included: acute exacerbation of COPD (n = 81 [81%]; 49 men and 32 women), pneumonia (n = 67 [25%]; 50 men and 17 women), lung cancer (n = 50 [19%]; 32 men and 18 women), ischaemic heart disease (n = 20 [7%]; 15 men and 5 women), heart failure (n = 14 [5%]; 8 men and 6 women) and other causes (n = 34 [14%]). Most of the deaths from lung cancer were observed among younger patients (p = 0.002), while most of the deaths from pneumonia among older patients (p = 0.02). The most common co-morbidities in the study population included: chronic heart failure (n = 169), hypertension (n = 103), ischaemic heart disease (n = 102), type 2 diabetes mellitus (n = 55), renal failure (n = 43), benign prostatic hyperplasia (n = 36), lower limb atherosclerosis (n = 28), osteoporosis (n = 19) and anaemia (n = 14). Conclusions: Respiratory tract pathologies, such as acute exacerbation of COPD, pneumonia and lung cancer, were the most common causes of death in the study population, while cardiovascular disease and type 2 diabetes mellitus were the most common co-morbidities seen in these patients. Pneumonol. Alergol. Pol. 2011; 79, 5: 343–34

A ascensão da convenção de desenvolvimento Neoliberal no Brasil

O objetivo deste trabalho é compreender os fatores determinantes da conformação da convenção em torno dos problemas de o desenvolvimento econômico que se deu no Brasil depois da “década perdida”. Isto é, pretende-se analisar a importância do poder que as ideias (as crenças dos atores sociais) tem nesse processo – o campo da cognição –, além de entender como as relações de poder influenciam na formação e na hegemonia de uma convenção de desenvolvimento – o campo da economia política -, em particular da convenção neoliberal. Simplificada e sucintamente, tenciona-se alcançar com este trabalho um esclarecimento sobre o papel desempenhado tanto pelo poder das ideias, quanto pelas ideias do poder na hegemonia da convenção neoliberal no Brasil

Przydatność oznaczania NT-proBNP w diagnostyce duszności u chorych na POChP

Introduction. Cardiovascular diseases often coexist with chronic obstructive pulmonary disease (COPD), and in some cases it is difficult to differentiate between cardiac and pulmonary cause of dyspnoea. It is well known that the serum concentration of NT-proBNP in patients with cardiovascular diseases, especially with congestive heart failure, is elevated. The aim of this study was to estimate the usefulness of NT-proBNP serum level measurement in patients with COPD complaining of chronic dyspnoea. Material and methods. The study group consisted of 81 stable COPD patients in middle age, 65 ± 7 years, (57 of them with concomitant cardiovascular disease). Serum concentration of NT-proBNP was measured using VITROS laboratory test. Results. There were no statistical differences in serum NT-proBNP between patients stratified according to the GOLD staging system for COPD severity or BODE index and mMRC breathlessness scale. The concentration of NT-proBNP was statistically significantly higher in the patients with coexisting cardiovascular diseases (220.8 ± 258.1 vs. 95.4±56.1 pg/ml). The group of patients with NT-proBNP concentration > 125 pg/ml (n = 36) was statistically significantly older (67.5 ± 6 years old vs. 63.2 ± 7.1 years old; p = 0.009) and had statistically significantly lower PaO2 (67.4 ± 11.8 mm Hg vs. 73.0 ± 11.6 mm Hg; p = 0.04). Conclusions. 1. In the group of stable COPD patients there were no differences between NT-proBNP serum concentration according to GOLD staging, BODE index, and mMRC breathlessness scale. 2. The NT-proBNP serum concentration was statistically significantly higher in the group of COPD patients with the concomitant cardiovascular disease. 3. In patients with chronic dyspnoea testing of serum NT-proBNP may be useful in the detection of patients with cardiovascular problems, who require more intensive therapy.Wstęp. U chorych na przewlekłą obturacyjną chorobę płuc (POChP), często współistnieją choroby serca, co utrudnia ustalenie przyczyny występującej duszności. Wzrost stężenia NT-proBNP w surowicy jest charakterystyczny dla zastoinowej niewydolności serca. Celem pracy była ocena przydatności pomiaru stężenia NT-proBNP w surowicy u chorych na POChP, u których występowała przewlekła duszność. Materiał i metody. Do badania zakwalifikowano 81 chorych na POChP w stabilnej fazie choroby, w wieku 65 ± 7 lat, u 55 chorych współistniały choroby układu krążenia. Stężenie NT-proBNP w surowicy oznaczano przy użyciu zestawu odczynnikowego NT-proBNP VITROS i kalibratorów NT proBNP VITROS. Wyniki. Nie wykazano istotnych różnic w stężeniu NT-proBNP w zależności od stopnia zaawansowania choroby według GOLD, wskaźnika BODE, duszności w skali MRC. Stężenie NT-proBNP było natomiast statystycznie istotnie wyższe u chorych z towarzyszącymi chorobami układu krążenia (220,8 ± 258,1 v. 95,4 ± 56,1 pg/ml; p = 0,03). Chorzy z podwyższonym stężeniem NT-proBNP > 125 pg/ml (n = 36) byli statystycznie starsi (67,5 ± 6 lat v. 63,2 ± 7,1 roku; p = 0,009) i mieli istotnie niższe PaO2 (67,4 ± 11,8 v. 73,0 ± 11,6 v. mm Hg; p = 0,04) w porównaniu z chorymi z prawidłowym stężeniem NT-proBNP. Wnioski. 1. W grupie chorych na POChP w stabilnym stadium choroby nie stwierdzono istotnych różnic w stężeniu NT-proBNP w surowicy w zależności od stopnia ciężkości choroby według GOLD, wskaźnika BODE i skali nasilenia duszności MRC. 2. W grupie chorych na POChP i towarzyszącymi chorobami układu krążenia stężenie NT-proBNP jest statystycznie istotnie wyższe niż u chorych bez chorób towarzyszących. 3. U chorych z przewlekłą dusznością oznaczenie stężenia NT-proBNP może wyłonić grupę chorych, którzy wymagają wdrożenia lub intensyfikacji leczenia niewydolności serca

Metastasising leiomyoma of the uterus with pulmonary involvement — case report

  Benign metastasising leiomyoma (BML) is characterised by extrauterine smooth muscle tumours in women after surgical treatment for uterine leiomyoma. Usually manifested as solitary or multiple focal lesions in various organs, it imposes a scrutinous diagnostic work-up to exclude a malignant disease and requires confirmation in microscopic examination of the extrauterine focus. The authors present a case of a 56-year-old woman with BML manifesting as bilateral multiple pulmonary nodules, with a tentative diagnosis of a disseminated malignant disease of mesenchymal origin. The patient underwent multiple diagnostic tests, which excluded malignancy. The definite diagnosis was established after the microscopic reevaluation of an excised pulmonary nodule. The patient is monitored with chest magnetic resonance. BML should be considered in the differential diagnosis of multiple pulmonary nodules in asymptomatic women. Patients with BML require long-term monitoring, therefore the selected imaging method should not carry the risk of cumulative side effects.

Serum levels of apoptosis-related markers (sFasL, TNF-a, p53 and bcl-2) in COPD patients

Introduction: Taking into account important role of apoptosis in COPD pathogenesis, we wanted to asses the serum levels of markers involved in apoptosis regulation, including apoptosis inducers such as TNF-a, sFasL or p53 protein and apoptosis inhibitor bcl-2 and, in addition, to compare these markers with selected COPD parameters. Material and methods: In 181 patients (60 women) with COPD (age was 62.2+ 9.37 years; FEV1% 55.2 + 19.98 %) and in 29 controls (11 women), serum levels of TNF-a, sFasL, p53 and bcl-2 were evaluated by the enzyme-linked immunosorbent assay (ELISA) method. Results: In COPD patients the mean sFasL level was 0.092 ± 0.077 ng/ml and mean TNF-a level was 2.911 ± 3.239 pg/ml. There were no differences in serum sFasL and TNF-a in COPD patients and control group. TNF-a and sFasL did not correlate with COPD parameters such as FEV1%, BMI, RV% (percentage of predicted value of residual volume) or BODE. Although we tried to evaluate bcl-2 and p53 protein serum levels with two different tests, measurable levels of bcl-2 were only detected in 15 patients and p53 in only 3 patients. Bcl-2 values were from 0.418 to 11.423 ng/ml and p53 from 90.772 to 994.749 pg/ml. Conclusions: We didn’t observe any differences in serum levels of pro- and antiapoptotic markers in COPD patients and the control group or correlations between the markers studied and COPD parameters

Korelacje pomiędzy rozdęciem miąższu płucnego mierzonego wskaźnikiem RV%TLC i składem ciała oraz profilem cytokinowym u chorych na przewlekłą obturacyjną chorobę płuc

Introduction: Body composition is an important prognostic factor in patients with COPD. The decrease in fat free mass (FFM), muscle mass (MM) and increase in visceral fat is associated with an elevated secretion of cytokines which promote systemic inflammation. The aim of the study was to evaluate body composition and the cytokine profile in patients with COPD in relation with the presence of hyperinflation.Material and methods: The study group consisted of 149 patients (61F, 88M) with stable COPD in all stages of severity aged 68 ± 8.8 yrs. All the patients underwent spirometry and bodypletysmography with bronchial reversibility testing. Hyperinflation was defined as RV%TLC > 48% and > 126% predicted. Body composition was analyzed by bioimpedance. The following serum inflammatory markers were evaluated: C-reactive protein, IL-6, IL-8, TNF-a, CC16, adiponectin and resistin.Results: Hyperinflation was found in 96 patients (group A) and it was more frequent in women than men (49/61 vs. 47/88, p < 0.001). BMI and age in this group were comparable to those in patients without hyperinflation (group B). Patients with hyperinflation have lover FFM, FFM index, MM and MM index and total body water and higher fat mass and fat mass index. We found significantly higher serum concentrations of inflammatory markers in group A: IL-6 – 6.4 ± 10.9 vs. 3.6 ± 4.2 pg/ml, resistin – 9.3 ± 4.2 vs. 7.6 ± 2.4 ng/ml, CRP 4.1 ± 2.3 vs. 2.9±2.1 mg/l, respectively.Conclusions: Patients with hyperinflation have a lower FFMI, TBW and MMI and a higher proportion of fat tissue. Hyperinflation is associated with elevated concentrations of inflammatory markers what may be associated with more severe disease. Body compositions abnormality and higher activity of systemic inflammation could therefore be a negative prognostic factor in COPD patients.Wstęp: Skład ciała jest ważnym czynnikiem prognostycznym u chorych na POChP. Spadek beztłuszczowej masy ciała (FFM), masy mięśni (MM) i wzrost masy trzewnej tkanki tłuszczowej jest związane ze wzrostem wydzielania cytokin odpowiedzialnych za systemowe zapalenie. Celem pracy była ocena wpływu hiperinflacji układu oddechowego na stan odżywienia i profilu cytokin u chorych na POChP.Materiał i metody: Grupa badana składała się z 149 chorych (61K, 88M), w stabilnym okresie POChP, którzy reprezentowali wszystkie stopnie ciężkości choroby, w wieku 68 ± 8,8 lat. Wszyscy chorzy mieli wykonaną spirometrię i pletyzmografię z próbą rozkurczową. Rozdęcie było definiowane, jako zwiększenie RV%TLC > 48% and > 126% wn. Skład ciała był mierzony metodą bioimpendancji. Wykonano pomiar następujących cytokin w surowicy: białko C-reaktywne (CRP), IL-6, IL-8, TNF-a, CC16, adiponektyna i rezystyna.Wyniki: Rozdęcie stwierdzono u 96 chorych (grupa A), było ono częstsze u kobiet niż mężczyzn (49/61 v. 47/88, p < 0,001). Indeks masy ciała i wiek były podobne do grupy chorych bez rozdęcia (grupa B). Grupa A miała niższe FFM i FFMI, MM i MMI i całkowitą masę wody oraz wyższą masę tłuszczową i indeks masy tłuszczowej. W grupie A stwierdzono istotnie statystycznie wyższe stężenie w surowicy markerów zapalenia: IL-6 — 6,4 ± 10,9 v. 3,6 ± 4,2 pg/ml, resistin — 9,3 ± 4,2 v. 7,6 ± 2,4 ng/ml, CRP 4,1 ± 2,3 v. 2,9 ± 2,1 mg/l.Wnioski: Chorzy, u których stwierdza się rozdęcie płuc mają niższe FFMI, TBW, MMI i więcej tkanki tłuszczowej. U chorych z rozdęciem płuc stwierdza się podwyższone stężenie markerów stanu zapalnego w porównaniu z chorymi bez rozdęcia, co może świadczyć o bardziej zaawansowanym procesie chorobowym. Zarówno zaburzenia w składzie ciała jak i wyższa aktywność zapalenia systemowego w grupie chorych z rozdęciem płuc może wskazywać na ich gorsze rokowani

The influence of 3 weeks therapy with continous positive airway pressure (nCPAP) on serum leptin and homocysteine concentration in patients with obstructive sleep apnea syndrom (OSAS)

Obstructive sleep apnea (OSA) is one of the most often sleep disturbance. Not treated patients have 2-3 times more risk for death because of the cardiovascular diseases. Leptin and homocysteine are the risk factors for cardiovascular diseases. Treatment by nCPAP has positive influence for health care and reduction of hypertension in this group. The aim of this study was to evaluate an effect of 3 weeks nCPAP therapy on a serum leptin and homocysteine concentrations in patients with OSA. Material and methods: The study group consisted of 48 male patients in the age x = 51, 2?7, 5 years old, OSA was diagnosed by polisomnographic study The leptin concentration was evaluated by RIA methods (HUMAN LEPTIN RIA KIT), the homocysteine concentration was evaluated by Axis Homocysteine EIA test. Patients were treated by nCPAP during 3 weeks. Only 29 patients were effectively treated for this time. The compliance was: 5.07 ± 1.81 h Results: In the group of 29 patients the serum leptin and homocysteine concentration before and after treatment were 11,05 ± 5,59 ng/mL vs. 11,07 ± 7,16 ng/mL i 10,98 ± 2,79 μmol/L vs. 10,34 ± 2,99 μmol/L. In the all study group the statistical important correlation between leptin and AHI, mean and minimal saturation overnight, fibrinogeneconcentration, BMI, WHR, waist circumference, heart rate and between homocysteine and heart rate were observed. Conclusions: 3 weeks therapy does not have any effect on leptin and homocysteine concentrations in the studied group of patients with OSA. Serum leptin concentration correlates with AHI, TMB90, as well as with mean and minimal saturation during a sleep. This indicates a potentially higher risk of cardiovascular diseases in the studied group. Pneumonol. Alergol. Pol. 2006, 74, 63-67

The interpretation of carbon monoxide diffusing capacity test depending of hemoglobin concentration

The carbon monoxide diffusion capacity (DLCO) is among others dependent of the hemoglobin value. The result of DLCO test in patients with anemia change when we adjust DLCO for hemoglobin (Hb) concentration. The aim of the study was to estimate if the differences between result of DLCO and DLCO/VA before and after adjust the Hb value can change the interpretation of the test in the group with normal and low value of Hb. The study group consist of 25 patients with normal level of Hb (group A) and 21 ones with anemia (group B). All studied have been done spirometry, bodypletyzmografy and DLCO test. All tests were made on the SensorMedics. The DLCO test was made in the single breath diffusing capacity program Results. The values of the Hb in the group A were above 13g/dl for female and 14g/dl for man. In the group B the Hb value were less then 10g/dl. In the group A the middle Hb concentration was 14,49 &plusmn; 1,36g/dl. DLCO and DLCO/VA before and after Hb value adjusted were 91,4 &plusmn; 17,98 vs. 90,7 &plusmn; 17,58 % i 101,5 &plusmn; 19,46 vs. 100,7 &plusmn; 18,65% (p > 0,05) In the group B the middle Hb concentration was 8,77 &plusmn; 0,97g/dl. DLCO and DLCO/VA before and after Hb value adjusted were: 57,05 &plusmn; 17,55 vs.72,19 &plusmn; 25,27% i 67,57 &plusmn; 11,18 vs. 84,66 &plusmn; 14,62% (p < 0,05) Conclusions: 1.The were non statistically important change in the DLCO test results after consideration on Hb level in the studied group without anemia, so in the patients with normal level of Hb the DLCO test result doesn't change the interpretation of the test after the consideration on Hb concentration 2. In patients with anemia we shout adjust the Hb value to the DLCO test because the results with out this can completely change the interpretation of the test and clinical diagnosis

Novel High Capacity Oligomers for Low Cost CO2 Capture

The novel concept of using a molecule possessing both physi-sorbing and chemi-sorbing properties for post-combustion CO2 capture was explored and mixtures of aminosilicones and hydroxyterminated polyethers had the best performance characteristics of materials examined. The optimal solvent composition was a 60/40 blend of GAP-1/TEG and a continuous bench-top absorption/desorption unit was constructed and operated. Plant and process models were developed for this new system based on an existing coal-fired power plant and data from the laboratory experiments were used to calculate an overall COE for a coal-fired power plant fitted with this capture technology. A reduction in energy penalty, from 30% to 18%, versus an optimized 30% MEA capture system was calculated with a concomitant COE decrease from 73% to 41% for the new aminosilicone solvent system

Three month continuous positive airway pressure (CPAP) therapy decreases serum total and LDL cholesterol, but not homocysteine and leptin concentration in patients with obstructive sleep apnea syndrome (OSAS)

Wstęp: Leczenie za pomocą CPAP zmniejsza zachorowalność i umieralność z przyczyn sercowo-naczyniowych u chorych na OBPS. Homocysteina i leptyna mogą odgrywać rolę w rozwoju choroby niedokrwiennej serca (ChNS) u tych pacjentów. Celem pracy była ocena wpływu 3-miesięcznego leczenia za pomocą CPAP na czynniki ryzyka ChNS u chorych na OBPS bez współistniejącej ChNS (OBPS bez ChNS) oraz na OBPS i ChNS. Materiał i metody: Leczenie za pomocą CPAP rozpoczęto u 42 chorych na OBPS bez ChNS oraz u 23 chorych na OBPS i ChNS. Przed i po 3-miesięcznym leczeniu oznaczano stężenie homocysteiny, leptyny, CRP, fibrynogenu oraz lipidogram i parametry określające otyłość brzuszną. Wyniki: Po 3-miesięcznym leczeniu nie stwierdzono istotnych zmian stężenia homocysteiny, leptyny, fibrynogenu oraz CRP w żadnej z grup. W grupie OBPS i ChNS nie stwierdzono zmian parametrów lipidowych, a także stopnia otyłości. W grupie OBPS bez ChNS stwierdzono istotne zmniejszenie stężenia cholesterolu całkowitego oraz cholesterolu frakcji LDL (202,5 &#177; 38,5 mg/dl v. 186,7 &#177; 33,5 mg/dl, p = 0,001 oraz 127,3 &#177; 32,9 mg/dl v. 116,4 &#177; 26,9 mg/dl, p = 0,02). Podczas obserwacji nie uległy istotnie zmianie BMI (30,4 &#177; 3,8 v. 30,6 &#177; 3,6 kg/m2, p = 0,5), ilość tkanki tłuszczowej wisceralnej (obwód w pasie 108,5 &#177; 8,0 cm v. 107,0 &#177; 7,5 cm, p = 0,09) ani WHR (1,03 &#177; 0,04 v. 1,01 &#177; 0,03, p = 0,07). Wnioski: Trzymiesięczne leczenie CPAP nie wpłynęło na stężenie homocysteiny i leptyny we krwi u chorych na OBPS, ale w istotny sposób obniżyło stężenie parametrów lipidowych w surowicy krwi u chorych na OBPS bez współistniejącej ChNS, co potwierdza korzystny wpływ tej metody leczenia na czynniki ryzyka ChNS. Pneumonol. Alergol. Pol. 2011; 79, 3: 173-183Introduction: In OSAS patients CPAP therapy decreases cardiovascular morbidity and mortality. Homocysteine and leptin may play a role in development of ischaemic heart disease (IHD) in patients with OSAS. The aim of the study was to assess the influence of 3 month CPAP therapy on cardiovascular risk factors in patients with OSAS without IHD (pure OSAS) and with OSAS and IHD. Material and methods: Therapy with CPAP was started in 42 OSAS without IHD (pure OSAS) and 23 OSAS and IHD patients. Plasma concentration of homocysteine, serum concentration of leptin, C-reactive protein (CRP), fibrinogen, lipids, and markers of visceral adiposity (MVA) were measured before and after treatment. Results: There were no significant changes in homocysteine, leptin, fibrinogen and CRP concentrations in neither group. In OSAS and IHD no change in serum lipids and MVA were found. In pure OSAS group total cholesterol and LDL cholesterol concentrations significantly decreased (202.5 &#177; 38.5 mg/dl v. 186.7 &#177; 33.5 mg/dl, p = 0.001 and 127.3 &#177; 32.9 mg/dl v. 116.4 &#177; 26.9 mg/dl, p = 0.02, respectively). Triglycerides did not significantly change (p = 0.09). There were no significant changes in BMI (30.4 &#177; 3.8 v. 30.6 &#177; 3.6, p = 0.5), waist circumference (108.5 &#177; 8.0 cm v. 107.0 &#177; 7.5 cm, p = 0.09) and waist to hip ratio (1.03 &#177; 0.04 v. 1.01 &#177; 0.03, p = 0.07). Conclusions: Three month CPAP therapy did not change homocysteine and leptin concentration in neither group. However, it significantly decreased serum lipids concentration in patients with pure OSAS, but not in patients with OSAS and IHD, suggesting beneficial effects of CPAP therapy on cardiovascular risk factors. Pneumonol. Alergol. Pol. 2011; 79, 3: 173-18