Comparison of Awareness of Symptoms and Illness Between Patients with Obstructive Sleep Apnea and Simple Snoring / 수면정신생리

BACKGROUND AND OBJECTIVES: Obstructive sleep apnea (OSA) is often undiagnosed but is an important risk factor affecting the health of an individual. The level of awareness of the illness among patients with OSA is low and is not correlated with severity of the illness. This study was conducted to compare awareness of OSA symptoms and illness between patients with OSA and simple snorers. MATERIALS AND METHODS: Two hundred eighty-two patients who were suspected of having OSA participated in this study. All subjects underwent overnight polysomnography. Those with an apnea-hypopnea index (AHI) ≥ 5 were classified as the OSA group, while those with an AHI < 5 were classified as the simple snoring group. A sleep questionnaire, which included items on awareness of the illness, OSA, and sleep symptoms, was administered to all subjects and their bed-partners. RESULTS: Simple snorers were much more aware of their symptoms such as snoring, irregular breathing, and apnea than were patients with OSA. Bed-partners of simple snorers were also more aware of the participants' sleep symptoms than were partners of patients with OSA. However, the duration of OSA symptoms was longer in the OSA group. In the correlation analysis, the level of awareness of OSA symptoms was negatively correlated with AHI, age, body mass index, and Epworth Sleepiness Scale score. Among the sleep questionnaire and polysomnography results, only Pittsburgh Sleep Quality Index was positively correlated with level of awareness of OSA symptoms. The minority of the respondents had heard about the treatment methods of continuous positive airway pressure and oral appliance and preferred them as treatment options. CONCLUSION: This study suggests that simple snorers are more aware of their symptoms than are patients with OSA. A higher severity of OSA, represented by a higher AHI, is correlated with lower awareness of one's OSA symptoms.

The Significance of Monocyte Chemoattractant Protein-1 and Interleukin-6 in Maintenance Hemodialysis Patients with Arteriovenous Fistula Obstruction / 대한신장학회잡지

Dysfunction of vascular access remains a leading cause of morbidity in patients receiving maintenance hemodialysis, accounting for 10-25% of their hospitalization. The main cause of vascular access dysfunction is thrombosis which is related to venous stenosis. The pathogenetic mechanism of venous stenosis includes cytokines, coagulation factors, growth factors and adhesion molecules. Two such cytokines, monocyte chemoattractant protein-1(MCP-1) and interleukin-6(IL-6), are known to be important in vascular smooth muscle cell proliferation. MCP-1 secreted by vascular endothelial cells, suppresses vascular smooth muscle cell proliferation. In contrast, IL-6 is secreted by monocytes, and it stimulates vascular smooth muscle cell proliferation. The followings are the results of our investigation into the plasma levels of MCP-1 and IL-6, as well as the clinical features of 70 patients currently receiving hemodialysis. 1) The patients were divided into two groups, a group with a history of vascular access obstruction (obstructed group) and a group with no such history (non-obstructed group). The mean age of the patients in the obstructed group was 48.1+/-14.2 years and that of the non-obstructed group, 53.2+/-13.7 yerars. The male-to-female ratios were 12 : 8 and 25 : 25 respectively. The average number of obstructions was 1.5+/-0.7. 2) The average duration of dialysis treatment was 17.2+/-42.2 months for the obstructed group and 28.5+/-35.2 months for the non-obstructed group. The dosage of heparin and erythropoietin given during dialysis, the amount of ultrafiltration, average blood pressure, hematocrit, platelet count, and the levels of albumin, total cholesterol, triglyceride, calcium, phosphorus, glucose, iPTH and creatinine were analysed, but there was no meaningful statistical difference between the two groups, There was, however, a statistically significant(p<0.05) difference in the levels of HDL-cholesterol between the two groups : In the obstructed group, an average level of HDL-cholesterol was 34.4+/-8.5 mg/dL whereas in the non-obstructed group, was 41.3+/-13.7 mg/dL. 3) The obstructed group had a MCP-1 level of 403.2+/-233.9 pg/mL and the non-obstructed group had a level of 271.8+/-124.1pg/ml, which is a meaningful statistical difference(p<0.01). Although the IL- 6 level was 10.3+/-24.3 pg/mL in the obstructed group and 5.0+/-8.1 pg/mL in the non-obstructed group, there is not significant difference because the distri bution of the sample values was widely scattered. In conclusion, MCP-1 levels showed higher levels in the group that had a history of vascular access obstruction perhaps as a result of over-secretion stimulated by A-V fistula obstruction. The higher IL-6 levels(without statistical meaning) in the same group may have relevance to vasclar access obstruction, but additional studies with a larger population are needed to clarify any relationship.

Clinical Features of Stroke in Patients Undergoing Maintenance Dialysis / 대한신장학회잡지

Cardiovascular and cerebrovascular diseases are important causes of death in patients receiving maintenance dialysis. Stroke occurred in high rate with the tendency to worsen prognosis. Also many patients with chronic renal failure(CRF) showed a high risk for stroke. From March 1985 to March 1999, at Wonju Christian Hospital, we investigated retrospectively risk factors, clinical appearance and prognosis for stroke in 20 patients with CRF who undergoing maintenance dialysis. The stroke occurred in nine male and eleven female with a mean age of 49.95+/-9.19 years. Seventeen patients underwent hemodialysis and three patients underwent peritoneal dialysis. Mean duration of dialysis was 50.05+/-34.68 months. Causes of CRF were as follows : 55% glomerulonephritis, 20% diabetes mellitus, 5% polycystic kidney and 20% unknown origin. At the time of stroke, serum protein level was 6.68+/-0.86mg/dL, albumin 3.38+/-0.87g/dL, cholesterol 160.25+/-43.34mg/dL, HDL-cholesterol 41.41+/-11.86mg/dL. All patients were on antihypertensive medication. Mean systolic blood pressure was 197+/-45mmHg, diastolic blood pressure 114+/-23mmHg. Systolic blood pressure of fourteen cases were more than 180mmHg. During hemodialysis, heparin dosage was an average 2425+/-371.48 IU. The types of stroke were intracerebral hemorrhage (ICH, 75%), subdural hematoma(10%), cerebral infarction(15%). One case developed both cerebral hemorrhage and subarachnoid hemorrhage. The sites of hematoma were basal ganglion-thalamus(60%), and subcortex(33.3%). Of these, nine cases had subsequent intraventricular hemorrhage(IVH). One case involved IVH only. The mean volume of hematoma was 66.42+/-29.92mL. Three cases of cerebral infarction developed in midcerebral arterial territory. Prognoses were as follows : Sixteen patients with cerebral hemorrhage died during hospitalization and one case has been monitored via outpatient department. One patient with cerebral infartion died during hospitalization and two have been discharged after symptom was improved. In conclusion, CRF patients undergoing maintenance dialysis showed higher incidence of ICH, unlike the recent studies which showed a higher rate of cerebral infarction to ICH in the general population. There was a higher incidence of stroke in patients whose blood pressure were poorly controlled. The most common site of ICH was basal ganglia and thalamus which was the same as in the general population. In many cases, it accompanied IVH and showed a higher mortality rate. Therefore, it is thought that aggressive blood pressure control is indicated to reduce mortality caused by stroke during maintenance dialysis.