Screening the frequency of obstructive sleep apnea syndrome on obesity patients in family medicine

YÖK Tez No: 501312Obezite, yağ dokusunun olumsuz sonuçlar doğuracak ölçüde artması olarak tanımlanabilen kronik seyirli bir hastalıktır. Obeziteye bağlı Diyabet, Metabolik Sendrom, Dislipidemi, Hipertansiyon, Osteoartrit ve Obstrüktif Uyku Apne Sendromu sık görülmektedir. Obstrüktif Uyku Apne Sendromu toplumda görülme sıklığı en yüksek olan Uykuda Solunum Bozukluğudur. Obstrüktif Uyku Apne Sendromu sık görülmesiyle olduğu kadar yol açtığı hastalıklar nedeniyle de büyük önem taşımaktadır. Çalışmamıza vücut kitle indeksleri 30 ve üzerinde olan 314 (K: 280, E: 34) obez hasta ile vücut kitle indeksleri 30'un altında olan 133 (K: 97, E: 36) kontrol grubu olgusu aldık. Dışlama kriterleri arasında KOAH, Astım, Konjestif kalp yetmezliği, Diyabet, aktif sigara kullanımı gibi kronik ve metabolik hastalık durumu ile düzenli ilaç kullanım öyküsü olmaması yer almaktadır. Tüm olgulara Berlin Anketi, Pittsburgh Uyku Kalitesi Ölçeği, Epworth Uykululuk Skalası ve APNEIC Test uygulanmıştır. Olguların sosyodemografik özellikleri ile antropometrik ölçümleri ve biyokimyasal laboratuvar testleri yapılmıştır. Obez grup ile normal kilolu kontrol grubu arasında Obstrüktif Uyku Apne Sendromu riski açısından Berlin Testi (Obez Grup: %71 yüksek risk; Kontrol Grubu: %11,3 yüksek risk; p<0,001) gözlenmiştir. APNEIC Test ile de (Obez Grubu: %33,8 yüksek risk, %7 en yüksek risk; Kontrol grubu: %9 yüksek risk, %0,8 en yüksek risk; p<0,001) ile anlamlı düzeyde farklılık saptanmıştır. Pittsburgh Uyku Kalitesi Ölçeği ile obez olguların: %50,1'inde kötü uyku kalitesi görülürken, kontrol grubu olguların %50,4' ünde kötü uyku kalitesi görülmüştür (p=0,512). Epworth Uykululuk Skalası ile de (Obez Grup: %23,6 yüksek risk, Kontrol Grubu: %23,1 yüksek risk; p=0,615) değerlendirildiğinde bu iki grup arasında risk açısından anlamlı bir fark saptanmamıştır. Sonuç olarak obez bireylerde obez olmayan bireylere göre Obstrüktif Uyku Apne Sendromu açısından yüksek risk taşıma olasılığı daha fazla gözlenmiştir. Özellikle 1.basamak aile hekimliği pratiğinde Obstrüktif Uyku Apne Sendromu riski taşıyan olguların belirlenmesinde altın standart tanı testi olmasına rağmen polisomnografinin kullanımının zorluğu da göz önüne alınarak Berlin ve APNEIC testlerin kolay kullanımlı, prediktif değerlerinin de yüksek olması nedeniyle kullanılması önerilebilir. Pittsburgh ve Epworth ise uyku kalitesinin değerlendirilmesinde kullanılabilir olmasına rağmen Obstrüktif Uyku Apne Sendromunun değerlendirilmesinde kullanılmasının klinik açıdan bir yararı gözlenmemiştir.Obesity is a chronic disease can be defined as considerable increase of adipose tissue to lead negative consequences. Obesity-related diabetes, metabolic syndrome, dyslipidemia, hypertension, osteoarthritis and obstructive sleep apnea syndrome are common. Obstructive sleep apnea syndrome is the one of respiratory sleep disorders with highest incidence in society. Obstructive sleep apnea syndrome is important because of being seen commonly and also because of the diseases it caused. In our study, we get 314 (F: 280, M: 34) obese patients whose body mass indexes are equal or greater than 30 and 133 (F: 97, M: 36) control group cases whose body mass indexes are less than 30. Exclusion criteria include COPD, asthma, congestive heart failure, diabetes, and metabolic disease states such as chronic active smoking is located in the absence of regular drug use history. Berlin Questionnaire, the Pittsburgh Sleep Quality Scale, the Epworth Sleepiness Scale and APNEIC test were administered to all cases. Socio-demographic characteristics of the patients with anthropometric measurements and biochemical laboratory tests are done. Between the obese group and control group of normal weight Obstructive Sleep Apnea Syndrome risks in Berlin Test (obese Group: 71% high risk; control group: 11.3% high risk; p <0.001) were observed. With APNEIC Test (obese group: 33.8% high risk, the highest risk of 7%; control group: 9% higher risk of 0.8% the highest risk; p <0.001) significant differences were found. With Pittsburgh Sleep Quality Scale: 50.1% of obese patients and also 50.4% of the control group patients were observed to have poor sleep quality both (p = 0.512). When it was evaluated with Epworth Sleepiness Scale (obese group: 23.6% high risk, control group: 23.1% high risk, p = 0.615), no significant difference in risk were detected between two groups. As a result, obese individuals have a higher risk for obstructive sleep apnea syndrome in comparison ton on-obese individuals. Especially in first step family medicine practice, although it is the gold Standard diagnostic test in identifying patients' risk for obstructive sleep apnea syndrome; taking into consideration of difficulty of the use of polysomnography, Berlin and APNEIC tests can be advised because of easier use and higher predictive values. Despite being used of Pittsburgh and Epworth to evaluate sleep quality, no clinical benefit was observed in use for evaluation of obstructive sleep apnea syndrome

Evaluation of smoking cessation practice by physicians for hospitalized patients in a tertiary hospital

WOS: 000388621700009PubMed: 27924963Objective: To investigate physicians' smoking cessation practice, consultation for smoking intervention for hospitalised patients and its determinants. Methods: The cross-sectional study was conducted at Duzce University Hospital, Duzce, Turkey, from January to April 2013, and comprised hospitalised patients. The survey, including smoking habits and 5As (Ask, Advise, Assess, Assist and Arrange) steps of smoking intervention practiced by physicians was applied to those patients discharged from the hospital. SPSS 20 was used for statistical analysis. Results: Of the 502(31.6%) participants, 264(52.6%) were women and 238(47.4%) were men. The overall mean age was 52.8 +/- 18.2 years. Besides, 269(53.6%) respondents were at the level of elementary school education; 289(57.6%) had chronic disease; 119(23.7%) were current and 106(21.1%) were former smokers. The frequency of current smokers among men with chronic disease was significantly lower compared to those who did not have chronic disease (p = 0.017). In women, the factor was insignificant (p = 0.642). The physicians practiced the steps of "Ask, Advise, Assess, Assist and Arrange" on 354(70.5%), 240(47.9%), 194(38.7%), 88(17.6%) and 29(5.8%) patients for active smoking. Consultation during hospitalization significantly increased patient's effort to quit smoking after discharge (p = 0.012). Conclusion: Smoking intervention by physicians for hospitalised patients was associated with the status of patient's gender, education level and chronic disease

Smoking cessation practice of physicians for hospitalized patients in tertiary hospital

WOS: 000209370404186

Association of vitamin B12 with obesity, overweight, insulin resistance and metabolic syndrome, and body fat composition; primary care-based study

PubMed ID: 23892832Aim To investigate correlation of vitamin B12 with obesity insulin resistance, metabolic syndrome. Methods The cross-sectional and primary care-based study was carried out. Anthropometric, blood pressure measurements and bioelectric impedance analysis (BIA) were recorded. Vitamin B12, folic acid, hemogram, insulin, ferritin, iron, total iron binding capacity and other biochemical tests were assayed. The subjects were grouped as obesity, overweight, control, metabolic syndrome (MetS) and insulin resistance (IR). Correlation of vitamin B12 with body mass index (BMI), IR, age, and BIA was evaluated. Results The study enrolled 976 patients (obesity: 414, overweight: 212, and control: 351). The mean age in groups of obesity, overweight and control were 35.9 ± 8.7, 28.9 ± 6.3 and 33.1 ± 8.7, respectively (p = 0.142). Vitamin B12 level was significantly lower in patients with obesity and overweight than healthy individuals (178.9 ± 25.2; 219.8 ± 78.5, and 328.5 ± 120.5, p < 0.001, respectively). Vitamin B12 level was lower in patients with MetS (+/-) and IR (+/-), but insignificant (p = 0.075 and 0.058, respectively). Significant and negative correlation was observed between vitamin B12 and BMI (r =-0.221, p=0.001). No significant difference was observed between obese male and female patients (247.8 ± 89.1 versus 235.5 ± 89.3 pg/mL, respectively, p=0.090). Conclusion Low Vitamin B12 level was associated with obesity and overweight, but not with insulin resistance, metabolic syndrome and gender. Vitamin B12 was negatively correlated only with body mass index