[Organ Manifestation and Subjective Sleep Quality in Sarcoidosis]. / Organmanifestation und subjektive Schlafqualität bei Sarkoidose.

BACKGROUND: Sleep disturbances are more common among sarcoidosis patients than in the general population. The influence of organ involvement on the subjective sleep quality was investigated in a large group of sarcoidosis patients. METHODS: In collaboration with the German Sarcoidosis Association, 1197 sarcoidosis patients were examined with a specially developed questionnaire with the Pittsburgh sleep quality index (PSQI) integrated into it. RESULTS: 91 % had pulmonary involvement, 65 % extra-pulmonary sarcoidosis. In 61 %, two or more organs were involved. Subjective sleep quality in PSQI declined significantly (p < 0.001) with the increase in the number of organs involved; there was a significant increase in the prevalence of known sleep apnea (p < 0.005), restless legs syndrome (RLS), percentage of women and comorbidities (all p < 0.001). In at least 33 % of patients with bone, muscle, nerve, kidney or heart involvement, the PSQI scores were > 10. CONCLUSIONS: In sarcoidosis patients with involvement of at least 2 organs, sleeping behaviour that includes RLS and sleep apnea should be evaluated.

Anxiety and depression in sarcoidosis: the influence of age, gender, affected organs, concomitant diseases and dyspnea.

BACKGROUND: Heightened degrees of anxiety and depression are often found in patients suffering from sarcoidosis, but the reasons for that are unclear. Furthermore, age and gender differences of anxiety and depression in sarcoidosis have not been reported with reference to normative data. OBJECTIVES: The aim was to test age and gender differences of anxiety and depression in a large sample, and to examine the influence of affected organs, concomitant diseases and dyspnea. METHODS: 1197 German patients diagnosed with sarcoidosis were examined, using the Hospital Anxiety and Depression Scale (HADS) and the MRC dyspnea scale. RESULTS: Patients suffering from sarcoidosis were significantly more anxious and depressed than the general population. This effect was especially strong in young age groups. The number of affected organs, the number of concomitant diseases and the degree of dyspnea significantly predicted anxiety and depression scores in univariate analyses. Among the affected organs, muscles, nerves, and bones most significantly contributed to depression. Sleep apnea, restless legs syndrome, and arterial hypertension were associated with anxiety as well as depression. In multivariate analyses including age and gender, however, only dyspnea and the number of concomitant diseases remained predictors of anxiety and depression scores. CONCLUSIONS: The analysis of mental distress should take into account comparisons with normative values. Young patients deserve special social support. Dyspnea proved to be an important symptom in the prediction of anxiety and depression.

Circulating endocannabinoids and N-acyl-ethanolamides in patients with sleep apnea--specific role of oleoylethanolamide.

OBJECTIVE: The endocannabinoid system promotes diverse effects on fat and glucose metabolism as well as on energy balance and sleep regulation. The role of N-acylethanolamides like oleoylethanolamide (OEA) and other endocannabinoids such as anandamide (AEA) and 2-arachidonyl-glycerol (2-AG) has not yet been investigated in patients with sleep apnea. DESIGN AND METHODS: We measured circulating OEA, AEA and 2-AG in patients with sleep apnea (n = 20) and healthy control subjects (n = 57). Respiratory distress index (RDI) as measured by polysomnography was used as a quantitative index of sleep apnea. RESULTS: In patients with sleep apnea OEA serum concentrations were significantly higher than in control subjects (8.4 pmol/ml (95% CI 6.9;9.9) vs. 4.0 (3.5;4.5); p<0.0001, adjusted for body mass index (BMI), fasting insulin, HDL and LDL cholesterol). In contrast, AEA (2.9 (95% CI 1.9;3.9) vs. 1.8 (1.4;2.1), p = 0.09) and 2-AG (20.0 (-14.5;54.5) vs. 32.8 (21.4;44.2), p = 0.56) were not significantly different between patients with sleep apnea and control subjects after adjustment. In the sleep apnea group, OEA serum concentrations were associated with RDI (r (2) = 0.28, p = 0.02) and BMI (r (2) = 0.32, p = 0.01). However, OEA was not associated with BMI in the control group (p = 0.10). CONCLUSIONS: These results indicate that among the three analyzed fatty acid derivatives, OEA plays a specific role in patients with sleep apnea. Together with animal data, the 2-fold elevation of OEA serum concentrations could be interpreted as a neuroprotective mechanism against chronic oxidative stressors and a mechanism to promote wakefulness in patients with nocturnal sleep deprivation and daytime hypersomnolence.

The exon 3-retaining and the exon 3-deleted forms of the growth hormone-binding protein (GHBP) in human serum are regulated differently.

Recently, two isoforms of the growth hormone-binding protein (GHBP), which is identical with the extracellular domain of the growth hormone receptor (GHR), have been described. One isoform contains the exon 3 (E3+GHBP) and one excludes the exon 3 (E3-GHBP). The distribution of both isoforms in peripheral blood and their functional relevance is so far unknown. To study the molecular distribution of both species we have analysed sera of 141 subjects with average weight, overweight and obesity by newly developed immunoassays. The relationship between the different molecular forms of GHBP and specific parameters of body composition as well as risk factors of metabolic disturbances, were then examined. The extracellular domain of the exon 3-retaining and -deleted isoforms of the GHR are released as E3+GHBP and E3-GHBP into the peripheral circulation. Furthermore, both molecular species do not show any correlation to each other (r = 0.67) and their relative proportion in blood is gender-dependent with a higher E3-GHBP proportion in females (P < 0.01). E3+GHBP appears to have a considerably stronger correlation to indicators (BMI, fat mass, waist circumference) and metabolic risk factors (fasting insulin, uric acid, triglycerides, apolipoprotein B, diastolic blood pressure) of adiposity than E3-GHBP, indicating differences in their functional significance. The availability of assays for the determination of GHBP isoforms may be very important for the study of the GH receptor and its soluble extracellular domain, GHBP.

Obstructive sleep apnoea syndrome: results and conclusions of a principal component analysis.

A cephalometric analysis according to Hasund, supplemented by special obstructive sleep apnoea syndrome (OSAS) parameters, was performed on 169 patients who had been referred from the sleep laboratory. Statistical analysis showed a correlation between specific cephalometric landmarks including posterior airway space (PAS), a soft palate length, hyoid position and posterior growth development of the mandible and OSAS severity. A principal component analysis differentiated between four subgroups of OSAS patients: (1) orthognathic obese subjects; (2) patients with a long soft palate and low-positioned hyoid; (3) retrognathic patients with narrow PAS; and (4) prognathic ones. Lateral cephalometry is an important contribution to OSAS diagnostics and oral and maxillofacial therapy procedures.

Disseminated mycosis due to Scedosporium prolificans in an AIDS patient with Burkitt lymphoma.

A case of fatal disseminated infection caused by the dematiaceous hyphomycete Scedosporium prolificans diagnosed post mortem is reported in a 60-year-old male patient with acquired immunodeficiency syndrome who additionally suffered from Burkitt's lymphoma. The patient was significantly granulocytopenic following aggressive chemotherapy and irradiation. He developed dyspnoea at rest and chest pain despite a normal chest radiograph. Fluconazole treatment was carried out empirically because no sign of a fungal infection was detected ante mortem, either by mycological cultivation or by serological investigation. First post-mortem examination revealed a disseminated fungal infection involving the central nervous system. Scedosporium prolificans was cultured from the kidney, spleen and myocardium. In vitro, the fungal isolate was found to be highly resistant to all available systemic antimycotics.

[Difficult patients in the sleep laboratory--nCPAP therapy in psychiatric patients with sleep apnea disorders]. / Schwierige Patienten im Schlaflabor--nCPAP-Therapie bei psychisch gestörten Patienten mit schlafbezogene Atmungsstörungen.

160 unselected patients under suspicion of sleep apnea were examined polysomnographically, 26 patients (16%) had relevant psychic disorders, which were classified according to ICD-10 by the psychiatric consultant. Affective-depressive disorders (n = 12) and neurotic disorders (n = 11) were diagnosed. Depression in 3 patients was primarily diagnosed in the sleep laboratory. A proper anamnesis can supply the doctor with helpful hints for psychic disorders. These disorders can complicate or prevent the diagnosis and therapy in the sleep laboratory.

[Severity of obstructive sleep apnea syndrome--correlation with cephalometric parameters]. / Schweregrad des obstruktiven Schlafapnoesyndroms (OSAS)--Zusammenhang mit kephalometrischen Parametern.

In 132 patients with polysomnographic records suffering from OSAS a cephalometric analysis according to Hasund supplemented by special OSAS-parameters was performed. The statistical analysis showed a correlation between severity of OSAS and width of posterior airway space, length of the soft palate, hyoid position and posterior growth development of the mandible. A principal component analysis showed four groups: 1) prognathic patients, 2) retrognathic patients with narrow PAS, 3) patients with long soft palate and low standing hyoid, and 4) orthognatic obese subjects. Lateral cephalometry is an important contribution to OSAS-diagnostics and should be performed on all OSAS patients in the course of interdisciplinary cooperation.