ABSTRACT
BACKGROUND AND OBJECTIVES: Sleep disturbances and excessive daytime sleepiness (EDS) are the major symptoms of obstructive sleep apnea (OSA). This study aimed to investigate clinical implications of insomnia and EDS in patients with OSA using the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). MATERIALS AND METHOD: We evaluated 131 subjects with suspected OSA who were undergoing polysomnography (PSG) and performing the PSQI and ESS surveys. OSA was diagnosed when the apnea-hypopnea index was five or more. EDS was defined when ESS score was 11 points or higher. Detailed history and questionnaire were used to categorize insomnia. We compared clinical variables and PSG results in subgroups with or without insomnia and EDS. RESULTS: There were no significant differences of PSQI and ESS score between controls and OSA. OSA with insomnia had significantly increased total score (p < 0.001) and decreased total sleep time (p=0.001) and sleep efficiency (p=0.001) on the PSQI compared to those without insomnia. OSA with EDS showed significantly increased PSQI score (p=0.022) and decreased total sleep time (p=0.018) on PSG compared to those without EDS. Neither PSQI nor ESS score had a correlation with respiratory variables such as AHI and oxygen saturation. Total sleep time had a significant effect on both insomnia and EDS in patients with OSA. CONCLUSION: Decreased total sleep time had important effects on subjective symptoms of OSA and comorbid insomnia. Therefore, restoration of decreased sleep time is important in the management of OSA.
Subject(s)
Humans , Methods , Oxygen , Polysomnography , Sleep Apnea, Obstructive , Sleep Initiation and Maintenance DisordersABSTRACT
IgG4-related sclerosing disease was first discovered when researching autoimmune pancreatitis. It is an autoimmune disease that causes fibrosis on the pancreas, bile duct, gall bladder, salivary glands, and lungs. It is rarely reported in the nasal cavity. The diagnosis of IgG4-related sclerosing disease is based on biopsy findings demonstrating the characteristic histopathologic findings and immunohistochemical staining. IgG4-related sclerosing disease shows good response to high-dose steroid therapy. However, some patients do not respond to this treatment. Azathioprine or rituximab can be helpful in such case. We report our experience with IgG4-related sclerosing disease treated with azathioprine for 2 years, along with a related literature review.
Subject(s)
Humans , Autoimmune Diseases , Azathioprine , Bile Ducts , Biopsy , Diagnosis , Fibrosis , Immunoglobulins , Lung , Nasal Cavity , Pancreas , Pancreatitis , Plasma Cells , Rituximab , Salivary Glands , Urinary BladderABSTRACT
Immunoglobulin G4 (IgG4)-related sclerosing disease is characterized by a systemic involvement of tumor-like lesions with IgG4-positive plasma cell. This disease can occur in the salivary, lacrimal and pituitary gland in the head and neck region. The involvement of IgG4-related sclerosing disease at nasopharynx is extremely rare, so it is hard to make an accurate diagnosis. Recently, we have experienced two cases of IgG4-related sclerosing disease arising from the nasopharynx. Diffusely enhancing mass with surrounding bony erosion and increased 18-F fludeoxyglucose uptake was found at the nasopharynx, suggesting malignancy. But the cases were finally confirmed as IgG4-related sclerosig disease by punch biopsy and the symtoms improved with glucocorticoid therapy. We report our experiences with a literature review.