Leptin levels in children with obstructive sleep apnea syndrome.

INTRODUCTION: The aim of this study is to assess the effect of obstructive sleep apnea syndrome (OSAS) severity on leptin levels in children. PATIENTS AND METHODS: Children with habitual snoring underwent overnight polysomnography. Fasting venous blood samples were obtained between 8 AM and 9 AM, following the night of the sleep study. Children with an apnea-hypopnea index of ≥ 5/h were included in the moderate-to-severe OSAS group while those with an apnea-hypopnea index of < 5/h formed the mild OSAS/primary snoring group. RESULT: 47 children (51% male and 49% female; mean age 7.8 ± 2.6 years) were recruited. Twenty seven participants were diagnosed with moderate-to-severe OSAS, and twenty children who had AHI < 5 were included in the mild OSAS/primary snoring. The two groups did not differ regarding age, gender and body mass index z score (p> 0.05). Furthermore there were no differences in log serum leptin levels (p= 0.749). Log serum leptin levels correlated with the BMI z score in the whole study group (p= 0.001; r= 0.499) but they were not associated with apnea-hypopnea index, mean and lowest oxygen saturation during sleep. CONCLUSIONS: Serum leptin levels are affected by adiposity but not by OSAS severity among children with habitual snoring.

Prognostic value of serum procalcitonin and C-reactive protein levels in critically ill patients who developed ventilator-associated pneumonia.

INTRODUCTION: Ventilator-associated pneumonia (VAP) is an important cause of mortality and morbidity in critically ill patients. We sought to determine the prognostic value of procalcitonin (PCT) and C-reactive protein (CRP) kinetics in critically ill patients who developed VAP. METHODS: Patients who were admitted to the intensive care unit (ICU) and developed VAP were eligible. Patients were followed for 28 days after the pneumonia diagnosis and blood samples for PCT and CRP were collected on the day of the pneumonia diagnosis (D0), and days 3 (D3) and 7 (D7) after the diagnosis. Patients were grouped as survivors and non-survivors, and the mean PCT and CRP values and their kinetics were assessed. RESULTS: In total, 45 patients were enrolled. Of them, 22 (48.8%) died before day 28 after the pneumonia diagnosis. There was no significant difference between the survivor and non-survivor groups in terms of PCT on the day of pneumonia diagnosis or CRP levels at any point. However, the PCT levels days 3 and 7 were significantly higher in the non-survivor group than the survivor group. Whereas PCT levels decreased significantly from D0 to D7 in the survivor group, CRP did not. A PCT level above 1 ng/mL on day 3 was the strongest predictor of mortality, with an odds ratio of 22.6. CONCLUSION: Serum PCT was found to be a superior prognostic marker compared to CRP in terms of predicting mortality in critically ill patients who developed VAP. The PCT level on D3 was the strongest predictor of mortality in VAP.

Investigation of obstructive sleep apnoea syndrome prevalence among long-distance drivers from Zonguldak, Turkey.

BACKGROUND: The aim of this study was to assess the prevalence of Obstructive sleep apnoea syndrome (OSAS) in long-distance drivers located in the Zonguldak area and to show the correlation between OSAS and traffic accidents. METHODS: In this study, 241 long-distance drivers who were residents of Zonguldak province were interviewed face-to-face and a questionnaire regarding OSAS symptoms, occupational histories, and numbers of accidents was administered. Body mass measurements were also taken from participants. Patients who exhibited evidence of OSAS underwent polysomnography (PSG). RESULTS: Snoring was detected in 56% out of all participants, daytime sleepiness was observed in 26.6% and apnoea in 11.6%. All-night PSG was applied to 42 participants who had a high probability of clinical OSAS. Among these, eight had an apnoea-hypopnoea index (AHI) < 5. The prevalence of OSAS was 14.1%. There was a significant relationship between the ratio of traffic accidents per professional years and AHI (r = 0.571; p < 0.005). CONCLUSIONS: OSAS prevalence was higher among long-distance drivers in the Zonguldak region. Disease severity was directly proportional to traffic-accident risk, and thus represents a serious social problem.

Evaluation of atrial electromechanical delay and left atrial mechanical function in patients with obstructive sleep apnea : Cardiac involvement in patients with OSA.

OBJECTIVE: The aim of this study was to evaluate atrial electromechanical delay measured by tissue Doppler imaging and left atrial mechanical function in patients with obstructive sleep apnea (OSA). MATERIALS AND METHODS: Fourty-seven moderate-to-severe OSA patients who were newly diagnosed by polysomnography (Apnea-hypopnea index ≥ 15 events/h, 32 males, mean age 49.4 ± 11.5) and 30 patients who had no OSA in polysomnography (Apnea-hypopnea index < 5 events/h, 21 males, mean age 45.4 ± 9.1) were included in the study. Using tissue Doppler, diastolic functions, atrial electromechanical coupling were measured from the lateral mitral, septal, and tricuspid annulus. Inter, intra, and left atrial electromechanical delay were calculated (lateral-tricuspid, septum-tricuspid, lateral-septal). Left atrial volumes (maximal, minimal, and presystolic) were measured by the method of discs in the apical four-chamber view and were indexed to body surface area. Mechanical function parameters of the left atrium were also calculated. RESULTS: Interatrial, intraatrial, and left atrial electromechanical delays were significantly higher in the OSA group compared to the control group. Passive emptying fraction was significantly decreased, volume at the beginning of atrial systole and active emptying volume were significantly increased in OSA patients compared to the controls. The apnea-hypopnea index was significantly associated with interatrial and intraatrial electromechanical delay, passive emptying fraction, and conduit volume. CONCLUSIONS: Electromechanical delay was markedly prolonged and left atrial electromechanical function was impaired in untreated OSA patients. These impairments worsen with increasing severity of OSA.

Clinical factors affecting the direct cost of patients hospitalized with acute exacerbation of chronic obstructive pulmonary disease.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a disease of increasing significance in terms of economic and social burden due to its increasing prevalence and high costs. Direct costs of COPD are mostly associated with hospitalization expenditures. In this study, our objective was to investigate the costs of hospitalization and factors affecting these costs in patients hospitalized due to acute exacerbation of COPD (AECOPD). METHODS: A total of 284 patients hospitalized AECOPD were included in the study. Data were examined retrospectively using the electronic hospital charts. RESULTS: Mean duration of hospitalization was 11.38 ± 6.94 days among study patients. Rates of admission to the intensive care unit, initiation of non-invasive mechanical ventilation (NIMV) and invasive mechanical ventilation (MIV) were 37.3% (n=106), 44.4% (n=126) and 18.3% (n=52) respectively. The rate of mortality was 14.8% (n=42). Mean cost of a single patient hospitalized for an AECOPD was calculated as $1765 ± 2139. Mean cost of admission was $889 ± 533 in standard ward, and $2508 ± 2857 in intensive care unit (ICU). The duration of hospitalization, a FEV1% predicted value below 30%, having smoked 40 package-years or more, the number of co-morbidities, NIMV, IMV, ICU, exitus and the number of hospitalizations in the past year were among the factors that increased costs significantly. Hospital acquired pneumonia, chronic renal failure and anemia also increased the costs of COPD significantly. CONCLUSION: The costs of treatment increase with the severity of COPD or with progression to a higher stage. Efforts and expenditures aimed at preventing COPD exacerbations might decrease the costs in COPD.

The benefit of expiratory-phase quantitative CT densitometry in the early diagnosis of chronic obstructive pulmonary disease.

PURPOSE: We aimed to compare the inspiratory and expiratory quantitative computed tomography (CT) densitometric data of healthy volunteers, individuals with chronic obstructive pulmonary disease (COPD) risk, and COPD patients to aid in the early diagnosis of COPD. MATERIALS AND METHODS: Of the study patients, 14 were healthy volunteers (Group I), 12 were patients at risk for COPD (Group II), and 13 were COPD patients (Group III). The high-resolution CT was performed at three levels (the upper, middle, and lower parts of the lungs). All images were evaluated with a specific program for the segmentation of pulmonary parenchyma. The mean lung density (MLD) was measured, and the emphysema index (EI) was calculated using this program. RESULTS: Both MLD values and calculated EI ratios showed significant differences between Groups I and III, and Groups II and III in both expiratory and inspiratory phases (P < 0.05). However, in the comparison of healthy volunteers and patients at risk for COPD (Group I and II), only expiratory-phase MLD values showed statistically significant difference (P < 0.001). CONCLUSION: In patients at risk for COPD, expiratory-phase MLD measurements can be used as an early diagnostic method.

Serum asymmetric dimethylarginine, nitrate, vitamin B(12), and homocysteine levels in individuals with pulmonary embolism.

We aimed to analyze the pre- and posttreatment serum asymmetric dimethylarginine (ADMA), nitrate (NO(3)), vitamin B(12) and homocysteine levels in pulmonary embolism (PTE) patients and to determine the prognostic value of these variables in predicting chronic thromboembolic pulmonary hypertension (CTEPH). This study was conducted in 64 patients. The patients were classified into the two groups: patients with normal pulmonary artery pressure (PAP) (group I) and patients with high PAP with persistent lung perfusion defects or who died at the end of 3 months of therapy (group II). We found statistically significant differences between two groups with respect to the partial oxygen pressure, the oxygen saturation, and the PAP, but there was no difference between the two groups with respect to the pretreatment ADMA, NO(3), or homocysteine levels. The vitamin B(12) levels were higher in group II. The NO(3) levels increased and the ADMA and vitamin B(12) levels decreased with treatment in both groups. These results suggest that these parameters are not predictive of the development of CTEPH.

The results of computed tomography guided tru-cut transthoracic biopsy: complications and related risk factors.

INTRODUCTION: Transthoracic biopsy (TTB) is a well-defined and effective method used for pathologic sampling in the diagnosis of the pulmonary lesions. It is less invasive in comparison to surgical procedures. In addition, diagnostic rate of tru-cut biopsy is higher than that of fine needle aspiration biopsy (FNAB) especially for benign lesions. In this study, we presented tru-cut transthoracic biopsy (TTB) procedure results and the frequency of TTB complications with related risk factors. MATERIAL AND METHODS: A total of 102 patients were evaluated by CT scan guided tru-cut TTB in the diagnosis of lung lesions between January 2003 and December 2007. The complications due to tru-cut TTB were recorded. The factors such as the lesion depth, the lesion size, and the emphysematous changes that accompany the lesion were evaluated through χ(2) test. RESULTS: Among the samples, 51% malignancy and 49% benign pathology were observed. Pneumothorax developed in 15.7% of the 102 procedures. It was found that the lesion's distance from the pleura, the size of the lesion, and emphysematous changes around the lesion significantly increased the risk of pneumothorax. DISCUSSION: The tru-cut biopsy complications are similar to those of FNAB. In the centers where cytologic examination is insufficient in the diagnosis of lung lesions, tru-cut biopsy should be routinely performed as it is a reliable biopsy technique compared to FNAB.

Working conditions and pneumoconiosis in Turkish coal miners between 1985 and 2004: a report from Zonguldak coal basin, Turkey.

In Turkey, bituminous coal mining is performed only in Zonguldak coal basin since 1940. Pneumoconiosis surveillance programs and dust control measures are in effect, but published pneumoconiosis data from this area is lacking. In this study, we aimed to evaluate the change in prevalence and case detection between 1985 and 2004 and assess the correlation between the dust concentration in workplaces and the prevalence of pneumoconiosis. Data on respirable dust concentrations and number of workers diagnosed as pneumoconiosis between 1985 and 2004 were obtained from Turkish Coal Enterprises authorities. Mean respirable dust concentrations in workplaces underground and on the ground were 1.66 mg/m(3) and 0.73 mg/m(3) respectively. Total number of workers decreased from 38.231 in 1985 to 12.261 in 2004 including 8932 underground workers. In this period, pneumoconiosis has not been reported in the ground workers. Incidence of pneumoconiosis ranged between 0.17-2.8 percent and prevalence ranged between 1.23-6.23 percent between 1985 and 2004. Radiologic opacities compatible with pneumoconiosis were predominantly small opacities. This is the first report about the incidence and prevalence rate of coal worker's pneumoconiosis in the main coal mining area of Turkey. Dust measurement and screening standards should be improved and adapted to international standards and we conclude that surveillance data should be closely monitored in this region and further epidemiologic studies in this area are warranted.

Prevalence of major obstructive sleep apnea syndrome symptoms in coal miners and healthy adults.

Obstructive sleep apnea syndrome obstructive sleep apnea syndrome is associated with symptoms including habitual snoring, witness apnea and excessive daytime sleepiness. Also obstructive sleep apnea syndrome is related to some occupations which are needed attention for work accident. We aimed to determine the prevalence of snoring, witnessed apnea and excessive daytime sleepiness in coal workers and healthy adults in Zonguldak city center, and also evaluate the differences between these groups. This study consisted of 423 underground coal workers and 355 individuals living in centre of Zonguldak. Study and comparison group were chosen by nonstratified randomized sampling method. Data were collected by a questionnaire that included information regarding snoring, witnessed apnea and excessive daytime sleepiness. Mean age was 43.3 ± 6.05 years in miners and 44.3 ± 11.8 years in comparison group. In miners, snoring frequency was determined as 42.6%, witnessed apneas were 4.0%, and daytime sleepiness were 4.7%. In comparison group, these symptoms were 38.6%, 4.8% and 2.8% respectively. There were no statistical differences between coal workers and comparison group in these symptoms. Also snoring prevalence was higher in smoker miners. We found that major symptoms of obstructive sleep apnea syndrome in coal workers are similar to general population in Zonguldak. Further studies that constucted higher populations and with polysomnography are needed to evaluate these findings.

Giant bulla mimicking tension pneumothorax.

In the chest X-ray, we observe tension pneumothorax (TPX) as wide radiolucent view in a hemithorax and pushing the mediastinal structures contralateral. Giant bulla may mimic TPX with wide radiolucent view and mediastinal shift. The present report includes giant pulmonary bulla in 35-year-old woman. The giant bulla was diagnosed as a TPX in emergency, and chest tube was performed. The differentiation between TPX and a giant bulla may be very difficult. The therapies of these two similar entities are completely different. So that, we must be careful about anamnesis, physical examination and radiology for true diagnosis.

Lung clearance of 99mTc-DTPA in ankylosing spondylitis.

The association of ankylosing spondylitis (AS) and lung parenchyma abnormalities has been shown in previous studies by radiological and pulmonary function tests. Technetium-99m diethylene triamine pentaacetic acid ((99m)Tc-DTPA) dynamic lung scanning is an easy, noninvasive method to assess alveolar-capillary barrier permeability. We aimed to study the abnormalities in pulmonary clearance of (99m)Tc-DTPA in patients with AS, and the presence of any correlation between this clearance and the radiological and pulmonary function tests. We studied twenty-one nonsmoker patients with AS who were compared to 21 age and sex matched healthy volunteers. All subjects underwent pulmonary function tests and pulmonary scintigraphy with (99m)Tc-DTPA to evaluate pulmonary clearance. Clearance half time (T(1/2)) of (99m)Tc-DTPA through the lungs was calculated by placing a monoexponential fit on the 30 min activity curves. High resolution CT and pulmonary function tests were performed for each patient. Our results showed the following: Spirometric parameters of forced vital capecity (FVC) and theratio of forced expiratory value in 1sec/FVC (FEV1%) scores were worse in patients compared to the control group (P<0.005 and P<0.05, respectively). Clearance half time was longer in AS group than in the control group (58.45+/-7.59 and 51.62+/-4.79 min, respectively; P<0.05). There was a negative correlation between T(1/2) value and FEV1% (r=-0.876, P< 0.01), of AS patients and the control group. Additionally, there were moderate positive correlation between T(1/2) and FVC (r=0.705, P<0.001), weak positive correlation between T(1/2) and FEF2575 (r=0.493, P<0.05), and T(1/2) and DLCO (r=0.444, P<0.05). A positive correlation was found between the duration of the disease and T(1/2) (r=0.44, P<0.05). In conclusion, longer T(1/2) values and lower FVC values in nonsmoker AS patients may suggest not only the pulmonary involvement in AS but also the duration of the disease.

Effect of adenoidectomy and/or tonsillectomy on cardiac functions in children with obstructive sleep apnea.

BACKGROUND/AIMS: We aimed to determine the effects of adenoidectomy and/or tonsillectomy (AT) on cardiac functions in children with adenoid and/or tonsillary hypertrophy and obstructive sleep apnea syndrome (OSAS) by using echocardiography with tissue Doppler imaging facility (TDI). METHODS: Twenty-nine children with adenoid and/or tonsillary hypertrophy and OSAS and 26 children with primary snoring entered the study. Cardiac functions were assessed by echocardiography with TDI in both groups. Tests were repeated in the OSAS group 6 months after treatment with AT. RESULTS: Echocardiography showed a decrease in estimated pulmonary artery systolic pressure from 31 +/- 4.2 to 13.1 +/- 2.3 (p < 0.001). In TDI, tricuspid E(m) and E(m)/A(m) increased from 11.0 +/- 2.7 to 13.5 +/- 2.7 cm/s (p < 0.001), and 1.46 +/- 0.52 to 1.82 +/- 0.53 (p = 0.004), respectively, following AT, indicating improvement in right ventricular diastolic dysfunction. Similarly, mitral E(m) and E(m)/A(m) increased from 12.3 +/- 2.1 to 16.3 +/- 2.7 cm/s, and from 1.65 +/- 0.51 to 2.30 +/- 0.54, respectively (p < 0.001). There was no significant difference between postoperative values and control group values. CONCLUSION: TDI is a technique able to detect diastolic dysfunction unnoticeable by conventional echocardiography. Following AT, we observed improvement in both left and right ventricular diastolic functions using TDI.

Examination of lung toxicity, oxidant/antioxidant status and effect of erdosteine in rats kept in coal mine ambience.

Occupational exposure to coal dust causes pneumoconiosis and other diseases. Reactive oxygen species (ROS) have been implicated in the pathogenesis of coal dust-induced lung toxicity. In this experimental study, we investigated the oxidant/antioxidant status, nitric oxide (NO) and hydroxyproline (HP) levels in lungs and blood of rats exposed to coal dust in mine ambience. In addition, we also investigated the attenuating effects of erdosteine. At the end of the experiment processes, tissue levels of HP, malondialdehyde (MDA) and NO, as well as the activities of superoxide dismutase, glutathione peroxidase, catalase, xanthine oxidase (XO), myeloperoxidase (MPO) and proinflammatory cytokines (IL-6 and TNF-α) were evaluated in the lung tissues, plasma samples or erythrocytes of rats. Exposure to coal dust resulted in a significant increase in the oxidant parameters (MDA, NO levels, and XO activity) and HP levels, as compared to the controls. A decrease in activities of antioxidant enzymes, and an increase in MPO activity were found in the study group, compared to the controls. Increased NO levels of lung were found in the study groups, that were significantly reduced by erdosteine. Our studies provide evidence that supports the hypothesis for ROS mediated coal workers' pneumoconiosis. Erdosteine may be beneficial in the coal dust-induced lung toxicity via antioxidant and free radical scavenger properties.

Sleep disturbance in patients with lichen simplex chronicus and its relationship to nocturnal scratching: A case control study.

BACKGROUND: Lichen simplex chronicus (LSC) is a common pruritic disorder resulting from repeated rubbing and scratching. Nighttime pruritus is a common feature in LSC and may disrupt the sleep pattern. The aim of this study is to determine whether there are sleep abnormalities in patients with LSC. PATIENTS AND METHODS: Fifteen patients with LSC and 15 age-, sex- and body mass index-matched control subjects were enrolled in the study. No participant had any other medical or psychiatric illness. All subjects were evaluated by overnight polysomnography, scratch electrodes, Epworth sleepiness scale and a general questionnaire for demographic data and sleep problems. RESULTS: There were no significant differences in the groups for total sleep time, sleep efficiency, sleep latency, rapid eye movement (REM) latency, percentage of stage 1 non-REM sleep and REM sleep. The percentage of stage 2 non-REM sleep was higher (P < 0.05) and the percentage of slow wave sleep (stages 3 and 4) was lower in the study group (P < 0.05) than in the controls. The patient group had a mean of 15.9 +/- 7.5 arousal index and 22.8 +/- 14.1 awakenings compared with 9.5 +/- 3.1 and 10.4 +/- 3.9, respectively, in the controls (P < 0.05, P < 0.01, respectively). Arousals of patients were mainly observed in non-REM sleep. The number of scratching bouts ranged from 6 to 20 per night. Scratching episodes were observed frequently during stage 2 non-REM sleep. CONCLUSION: Polysomnographic findings of patients with LSC demonstrated that sleep structure is disturbed by arousals and awakenings related to scratching bouts during sleep.

Color Doppler evaluation of the ocular arterial flow changes in chronic obstructive pulmonary disease.

PURPOSE: To evaluate the hemodynamic changes in the extraocular orbital vessels of the patients with chronic obstructive pulmonary disease (COPD), using color Doppler ultrasonography (CDU) technique, and to compare the results with those of healthy control subjects. METHODS: Forty-five patients with COPD and 17 healthy control subjects were included in this study. Patients with COPD were classified according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD). Fifteen patients of stage I COPD (mild airflow limitation), stage II COPD (worsening airflow limitation) or stage III COPD (severe airflow limitation) were enrolled into Group I, II and III, respectively. End tidal carbon dioxide (EtCO(2)), peripheral oxygen saturation (SpO(2)), pulse rate (PR) and respiratory rate (RR) were measured by using capnograph/pulse oximeter in all patients. Measurements were performed in only one randomly chosen eye of each participant. The peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistance index (RI) were measured in the ophthalmic artery (OA), central retinal artery (CRA), lateral short posterior ciliary artery (LPCA) and medial short posterior ciliary artery (MPCA), using CDU technique. RESULTS: The PSV measurements of the OA were significantly higher in Groups II and III compared to control group (p < 0.01, p < 0.001, respectively). The RI values from OA and CRA were significantly higher in Group II and III than the control group (p < 0.05). The RI values of LPCA and MPCA were also significantly higher in Group II than the control subjects (p < 0.05). When RI values were compared, mean values of LPCA and MPCA were significantly lower in Group III than in Group II (p < 0.05). There were no significant differences between Group I and control patients about PSVs, EDVs and RI values of all arteries Statistically significant correlations were found for the EtCO(2) with PSV (r = 0.53, p < 0.01) and EDV (r = 0.51, p < 0.01) of the OA. Statistically significant correlations were also found for the SpO2 with RI (r = -0.34, p < 0.05) in the OA. CONCLUSION: We concluded that COPD is associated with impaired retrobulbar hemodynamics, especially in the ophthalmic artery. Moreover, central retinal and posterior ciliary arteries with increased resistance are also found to be affected when compared with healthy control eyes.

Evaluation of nasal mucociliary functions with rhinoscintigraphy in coal workers' pneumoconiosis.

OBJECTIVE: To compare nasal mucociliary clearance (NMC) functions in coal workers with pneumoconiosis, coal workers without pneumoconiosis and healthy controls by using technetium-99m-labeled macroaggregated albumin rhinoscintigraphy. METHODS: Sixty-five of the 86 coal workers were clinically documented as suffering from coal workers' pneumoconiosis (CWP group). CWP workers were divided into two groups according to smoking status: 44 smokers (CWP-S) and 21 nonsmokers (CWP-NS). Twenty-one workers without pneumoconiosis (NCWP group) were similarly divided into two groups: 12 smokers (NCWP-S) and 9 nonsmokers (NCWP-NS). Thirty-three healthy male volunteers were selected for the control group [15 smokers (control-S), 18 nonsmokers (control-NS)]. The half-time (t1/2) value for the clearance of the radiopharmaceutical was calculated for each patient. RESULTS: Mean t1/2 values for CWP-S, CWP-NS, NCWP-S, NCWP-NS, control-S and control-NS were 25.10 +/- 7.75, 10.97 +/- 3.24, 14.68 +/- 4.98, 9.17 +/- 3.71, 19.15 +/- 5.04 and 15.08 +/- 5.11, respectively (p < 0.001, Kruskal-Wallis variance analysis). Further, mean t1/2 values of smokers versus nonsmokers in CWP, NCWP and control groups were compared, and it was found that although smoking prolonged nasal transport time in all three groups, the difference was significant only in the CWP group (p < 0.001, p < 0.023 and p < 0.027, respectively, Bonferroni-adjusted Mann-Whitney test). CONCLUSION: Our findings demonstrated a synergistic detrimental effect of smoking with coal dust exposure on nasal transport time.

Prevalence of obstructive sleep apnea syndrome and associated symptoms in 3--11-year-old Turkish children.

Our objective was to investigate the prevalence of sleep-disordered breathing (SDB) and obstructive sleep apnea syndrome (OSAS) in 3-11-year-old Turkish children. A cross-sectional study was conducted in Zonguldak, northwestern Turkey. Symptomatic children were identified by using a self-administered questionnaire and were classified into three groups: nonsnorers, occasional snorers, and habitual snorers. All habitual snoring children were invited to undergo polysomnography (PSG). Nine hundred fifty-four children (79.5%) were nonsnorers, 205 (17.2%) were occasional snorers, and 39 (3.3%) were habitual snorers. There was no significant relationship between gender and habitual snoring (male, 3.4%; female, 3.1%; P > 0.05; odds ratio (OR), 1.13; 95% confidence interval (CI), 0.59-2.14). There was a statistically significant relationship between habitual snoring and allergic rhinitis (OR, 4.23; 95% CI, 2.14-8.35). Four children who snored every night, and who had apnea spells and/or troubled sleep, underwent adenoidectomy and/or tonsillectomy before polysomnographic evaluation because of clinical detoriation. Twenty-eight of 39 children with habitual snoring participated in PSG evaluation. PSG revealed that 11 children (0.9% of the total population) had OSAS. When 4 operated children were added to these 28 children, we found the minimum prevalence of OSAS to be 1.3% in our study group. There was a significant correlation between OSAS and troubled sleeping (P <0.001; OR, 4.37; 95% CI, 1.33-14.3). We found the prevalence of habitual snoring to be 3.3% in Turkish children by using self-administered questionnaires. Allergic rhinitis was significantly correlated with habitual snoring. Minimum estimated prevalence of OSAS was found to be 1.3%.

Comparison of early and late pleuropulmonary findings of ankylosing spondylitis by high-resolution computed tomography and effects on patients' daily life.

Ankylosing spondylitis (AS) is a multisystemic disease and extra-articular features may develop as pleuropulmonary involvement. We aimed to show and compare the early and late pleuropulmonary findings of AS and its effects on patients' daily life by causing dyspnea. The study consisted of 38 patients (33 male, 5 female). All patients met the New York criteria for AS. Patients were divided into two groups for comparison of early (disease duration <10 years and normal chest X-ray, 18 patients) and late (disease duration >/=10 years and normal or abnormal chest X-ray, 20 patients) manifestations. All patients underwent high-resolution computed tomography (HRCT) and pulmonary function tests. A questionnaire was completed to measure perceived shortness of breath (dyspnea score) with activities of daily living such as dressing, shaving or walking. HRCT findings were abnormal in 27 of the 38 patients (73%). Pulmonary involvement was high in early AS (61.1%). The number of findings in early and late AS found were as follows: mosaic pattern (9/10), parenchymal micronodules (2/3), parenchymal bands (5/9), bronchial wall thickening (2/10), ground-glass opacity (7/7), and interlobular septal thickening (6/10). A moderate correlation was obtained between presence of mosaic pattern and forced midexpiratory flow rate (FEF(25-75)) values indicating small airway obstruction (r=0.346, p=0.019). The dyspnea score was statistically higher in patients with AS having pulmonary involvement than those without involvement. Pulmonary involvement is common in early AS compared to late AS. The involvement of small airways was found frequently as interstitial lung disease in early and late AS. This study also suggests that AS with pulmonary involvement may affect patients' daily life by causing dyspnea, which is why early detection of pulmonary lesions may have clinical importance and should be studied in a large cohort.

Evaluation of carotid artery wall thickness with high-resolution sonography in obstructive sleep apnea syndrome.

PURPOSE: An increased intima-media thickness (IMT) in the carotid arteries is a marker of generalized atherosclerosis, and it has been associated with a high risk of stroke. The aim of this study was to investigate whether patients with obstructive sleep apnea syndrome (OSAS) have an increase in atherosclerotic indicators in the carotid arteries. METHODS: We studied 30 men with severe OSAS who had an apnea-hypopnea index (AHI) of at least 20. IMT measurement and the presence of stenotic occlusive lesions in the carotid arteries (right common carotid artery [RCCA], right bulb [Rbulb], right internal carotid artery [RICA], left common carotid artery [LCCA], left bulb [Lbulb], and left internal carotid artery [LICA]) were investigated by high-resolution sonography. Results of the sonographic examinations were compared with those for a group of 20 subjects with mild OSAS (AHI <20) and 20 healthy subjects. RESULTS: The mean IMT of the carotid arteries of patients with severe OSAS was significantly higher than those of patients with mild OSAS and control subjects (RCCA 0.81 versus 0.63 versus 0.58, p <0.01; Rbulb 0.96 versus 0.87 versus 0.65, p <0.001; RICA 0.77 versus 0.69 versus 0.61, p <0.05; LCCA 0.97 versus 0.78 versus 0.67, p <0.01; Lbulb 1.01 versus 0.89 versus 0.72, p <0.01; LICA 0.91 versus 0.75 versus 0.65, p <0.001). CONCLUSIONS: This study shows that the carotid arteries' IMT is increased in patients with severe OSAS. This increase may predispose the patients to cerebrovascular disease. Additionally, the findings support the hypothesis that patients with OSAS are at risk of developing cerebrovascular disease regardless of the presence or absence of other vascular risk factors (eg, hypercholesterolemia, diabetus mellitus, and hypertension).