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

Acanthosis Nigricans in a Patient with Lung Cancer: A Case Report

Some skin lesions may accompany malignancies. Acanthosis nigricans, one such lesion, is a paraneoplastic dermatosis characterized by hyperpigmented and velvety verrucose plaques observed as symetric eruptions. With this report, we aim to present a rare case of concomitant lung cancer and acanthosis nigricans. Malignant acanthosis nigricans is most commonly associated with intra-abdominal malignancies. A 65-year-old patient who had hyperpigmented, hypertrophic and symmetric verrucose lesions at the flexor surfaces of the lower and upper extremities, face, palms and the axillary region. Thoracic computed tomography demonstrated a hypodense mass lesion with a dimension of 5 × 5.5 cm at the center of basal segment bronchi of the left pulmonary lobe. Fiberoptic bronchoscopy showed that the access to the lower left lobe was almost completely obstructed by the endobronchial lesion. The result of the histopathologic examination of the endobronchial tissue biopsy was reported as non-small cell (adenocarcinoma) lung cancer. Result of the histopathologic analysis of the punch biopsy of the skin lesions was reported as acanthosis nigricans .There are no pathognomonic dermatological findings for lung cancer. In conclusion, there are skin lesions that accompany lung cancer and we believe that these should be considered for differential diagnosis

Gender Difference in Clinical Presentation of Turkish Patients with Pulmonary Tuberculosis

The study was aimed to investigate the diagnostic differences between male and female patients in pulmonary tuberculosis in a tertiary 660 bedded Educational Respiratory Medicine Hospital, Istanbul, Turkey. A retrospective study was conducted with the new diagnosed, 50 men and 50 female pulmonary tuberculous patients. Age, symptoms, personal history, radiologic and sputum smear findings were collected from their files. 44 male and 42 female patients were enrolled to the study. Male patients tended to be older, smoke more, get alcohol more, lose weight more and have sputum smear positivity more than the female patients. Neither the time of diagnosis nor the radiologic appearance differed statistically. The radiologic appearance, not the clinic symptoms, help to diagnose tuberculosis in female patients; especially in those with no weight loss and sputum smear negativity

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

The utility of neck/thyromental ratio in defining low-risk patients with obstructive sleep apnea in sleep clinics

We aimed to evaluate the importance of neck/thyromental distance in the diagnosis of moderate to severe obstructive sleep apnea (OSA) in sleep clinics. 185 patients (122 males, 63 females) referred to our sleep clinic with OSA symptoms were enrolled to the study. The patients had level-1 polysomnography (PSG). The neck circumference (N), thyromental distance (T), and STOP test were recorded in all patients. Using an obstructive AHI > 15 event/h on PSG as the cut-off, the best N/T ratio to find patients with OSA was calculated with the receiver operator curve analyses. The best cut-off for N/T was chosen as 4.6. We used Modified STOP test: STO-NT test in which P (for hypertension item) was replaced with N/T ratio. N/T ratio > 4.6 was scored as positive. Two positives out of four questions in STO-NT were scored as high risk for OSA. The OSA prevalence was 60 % for AHI > 15. The mean ratio of N/T was significantly different between groups with AHI > 15 and AHI a parts per thousand currency sign 15. N and N/T ratio were moderately correlated with AHI. Sensitivity, specificity, negative predictive value, positive predictive value, and negative likelihood ratio of STOP test for AHI > 15 were 88.5, 28.4, 61.8, 65.4 % and 0.40, whereas 97.3, 23, 85, 65.9 % and 0.12 for STO-NT test, respectively. STO-NT test seems better than STOP test in determining patients who do not likely to have moderate to severe OSA in sleep clinics so can be preferred to decide on therapies other than CPAP in a short time

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