The effect of sleep apnea severity on cardiac autonomic activity during night time in obstructive sleep apnea patients / O efeito da gravidade da apneia do sono sobre atividade cardíaca autonômica durante o período noturno em pacientes com apneia obstrutiva do sono

ABSTRACT CONTEXT AND OBJECTIVE: Impaired autonomic cardiac function is an important consequence of obstructive sleep apnea (OSA). This impairment is mainly due to intermittent hypoxia episodes following apneas. However, the impact of apnea severity on autonomic cardiac function remains unclear. The aim of this study was to evaluate the relationship between the severity of sleep apnea and heart rate turbulence (HRT) and heart rate variability (HRV) in OSA. DESIGN AND SETTING: Observational cross-sectional study conducted in the Departments of Cardiology and Pulmonary Diseases, Afyon Kocatepe University, Turkey. METHODS: 106 patients with OSA and 27 healthy volunteers were enrolled. Based on apnea hypopnea index (AHI) values, obstructive sleep apnea severity was classified as follows: mild OSA (AHI ≥ 5 and < 15), moderate OSA (AHI ≥ 15 and ≤ 30) and severe OSA (AHI > 30). HRV and HRT parameters were assessed via 24-hour digital Holter electrocardiogram recordings for all subjects. RESULTS: HRV and HRT results were significantly lower among OSA patients than among control subjects (P < 0.05). However, there were no significant differences in HRT and HRV between the three patient subgroups. Correlations did emerge between AHI and the NN-interval parameter RMSSD and between oxygen desaturation and turbulence slope (respectively: r = -0.22, P = 0.037; and r = -0.28, P = 0.025). CONCLUSION: HRT and HRV results deteriorate in OSA. Correlations between apnea severity and these parameters seem to be present.

RESUMO CONTEXTO E OBJETIVO: Função autonômica cardíaca prejudicada é consequência importante da apneia obstrutiva do sono (AOS). Este prejuízo deve-se principalmente a episódios de hipóxia intermitente após apneias. No entanto, o impacto da gravidade da apneia na função cardíaca autonômica permanece obscuro. O objetivo deste estudo foi avaliar a relação entre gravidade da apneia do sono com turbulência da frequência cardíaca (TFC) e variabilidade da frequência cardíaca (VFC) em pacientes com AOS. DESENHO E LOCAL: Estudo observacional transversal conduzido nos Departamentos de Cardiologia e Doenças Pulmonares, Afyon Kocatepe University, Turkey. MÉTODOS: 106 pacientes com AOS e 27 voluntários saudáveis foram recrutados. Com base nos valores do índice de apneia-hypopneia (IAH), a gravidade da apneia obstrutiva do sono foi classificada assim: AOS leve (IAH ≥ 5 e < 15), AOS moderada (IAH ≥ 15 e ≤ 30) e AOS grave (IAH > 30). Parâmetros da VFC e TFC foram avaliados por meio de gravações de eletrocardiograma digital Holter de 24 horas para todos os sujeitos. RESULTADOS: Os resultados da VFC e TFC foram significativamente menores nos pacientes com OSA, em comparação com indivíduos controle (P < 0,05). No entanto, não houve diferenças significativas em VFC e TFC, entre os três subgrupos de pacientes. Correlações surgiram entre IAH e o parâmetro do intervalo-NN, RMSSD, e entre dessaturação de oxigênio e declive da turbulência (respectivamente; r = -0,22, P = 0,037; e r = -0,28, P = 0,025). CONCLUSÃO: Os resultados da VFC e TFC deterioram em AOS. Parece haver relação entre a gravidade da apneia e tais parâmetros.

Assessment of indoor air fungi in Western-Anatolia, Turkey.

This study was conducted to determine fungal spores in the indoor air of the houses in the city of Afyon, Western-Anatolia, Turkey. We investigated the seasonal properties of mould spores in 10 houses of Afyon over a period of one year. Viable moulds were recovered from all 10 houses. Twenty seven different moulds were isolated and identified from the indoor air of the houses. The most common genus was Cladosporium spp. (31.9%), followed by Aspergillus spp. (18.6%), Penicillium spp. (15.5%), Altemaria spp. (13.0%) and other species (21.0%). The mould concentration was higher in the kitchens than in other parts of the houses such as the living rooms and bedrooms (p < 0.05). The fungal flora of the air in the Afyon city region has a seasonal variation. All fungal species had their highest prevalence in summer and their lowest in winter, but only Aspergillus spp. had a significant seasonal variation (p = 0.012). Viable moulds are common in the houses of Afyon. Reducing these indoor fungi is necessary to improve the health of individuals with fungal-induced diseases like asthma.

Molds in the homes of asthmatic patients in Isparta, Turkey.

This study was planned in order to determine the fungal spores in the air of inside the homes of asthmatic patients living in Isparta (from southwest region of Turkey). The seasonal properties of mold spores in the air of homes of 24 asthmatic and 14 control subjects living in the city of Isparta over a period of one year were investigated. Viable molds were recovered from all 38 houses. Twenty different molds were isolated and identified from the indoor air of the houses in which asthmatic patients and controls lived. The most common isolated genera were Penicillium spp. (27.9%), followed by Cladosporium spp. (26.3%), Aspergillus spp. (14.7%) and Alternaria spp. (13.1%) in the indoor air of the houses of asthmatic patients. No differences in colony numbers were observed between asthmatics and control groups. The percentage of molds was higher in kitchens than other parts of the houses such as living rooms and bedrooms (p < 0.05). A seasonal variety of the fungal flora in Isparta city region was observed. It is concluded that viable molds are common in houses in Isparta. Reducing indoor molds may improve the health of individuals with fungal-induced diseases like asthma.

The prevalence of asthma among secondary school students in Afyon, Turkey.

Ethnic origin has been reported to affect the prevalence of atopic diseases in several studies in different parts of the world. The aim of this study was to determine the current and cumulative prevalence of asthma, allergic rhinitis, atopic dermatitis and reactivities to allergen skin prick tests (SPT) among secondary school students in Afyon, Turkey. The data of the first stage were collated through the application of the European Community Respiratory Health Survey Questionnaire on 1,400 students (1,366 were properly completed) registering at various schools in Afyon-Turkey, in the academic year 2000-2001. At the second stage, a physical examination and SPT were performed on 121 students. Of the students within the study group, 53 (3.9%) had experienced an asthma attack within the previous 12 months, 49 (3.6%) had a past history of asthma attacks and 167 (12.2%) reported wheezing attacks within the previous 12 months. The cumulative prevalence of asthma, rhinoconjunctivitis and dermatitis were found to be 7.46%, 8.10% and 3.5%, respectively. A positive SPT reaction to at least one allergen was found in 15.7% of the students. SPT positivity was 11.13% in symptomless students and 20.3% in asthmatic students. In analysis of logistic regression, a history of atopy, as determined in the questionnaire, was seen to be significantly correlated with SPT positivity. The prevalence of self-reported asthma and/or asthma-like symptoms was shown to be lower in students living in Afyon than other countries. Asthma and asthma-like symptoms were found to be significantly more prevalent among students who smoked.