[Determination of anthropometric measurements in obstructive sleep apnea syndrome in Turkish population]. / Türk popülasyonunda obstrüktif uyku apne sendromunda rol oynayan antropometrik ölçümlerin belirlenmesi.

INTRODUCTION: In this study, we aimed to determine the values of anthropometric measurements and rates used in the evaluation of obstructive sleep apnea syndrome (OSAS) in our country. MATERIALS AND METHODS: Twenty accredited sleep centers in thirteen provinces participated in this multicenter prospective study. OSAS symptoms and polysomnographic examination and apnea-hypopnea index (AHI) ≥ 5 cases OSAS study group; patients with AHI < 5 and STOP-Bang < 2 were included as control group. Demographic characteristics (age, sex, body mass index-BMI) and anthropometric measurements (neck, waist and hip circumference, waist/hip ratio) of the subjects were recorded. RESULT: The study included 2684 patients (81.3% OSAS) with a mean age of 50.50 ± 0.21 years from 20 centers. The cases were taken from six geographical regions of the country (Mediterranean, Eastern Anatolia, Aegean, Central Anatolia, Black Sea and Marmara Region). Demographic characteristics and anthropometric measurements; age, neck, waist, hip circumference and waist/ hip ratios and BMI characteristics when compared with the control group; when compared according to regions, age, neck, waist, hip circumference and waist/hip ratios were found to be statistically different (p< 0.001, p< 0.001, p< 0.05, respectively). When compared by sex, age, neck and hip circumference, waist/hip ratio, height, weight and BMI characteristics were statistically different (p< 0.001, respectively). Neck circumference and waist/hip ratio were respectively 42.58 ± 0.10 cm, 0.99 ± 0.002, 39.24 ± 0.16 cm, 0.93 ± 0.004 were found in women. CONCLUSIONS: The neck circumference was lower than the standard value in men, but higher in women. The waist/hip ratio was above the ideal measurements in both men and women. In this context, the determination of the country values will allow the identification of patients with the possibility of OSAS and referral to sleep centers for polysomnography.

Comparison of galactomannan, beta-D-glucan, and Aspergillus DNA in sera of high-risk adult patients with hematological malignancies for the diagnosis of invasive aspergillosis.

BACKGROUND/AIM: Invasive aspergillosis (IA) is a fatal infection that is difficult to diagnose in immunocompromised patients. In this study, Aspergillus-specific DNA was searched using real-time PCR (RT-PCR) in serum samples. Galactomannan (GM) and/or beta-D-glucan (BDG) tests were previously performed on these samples for 70 neutropenic patients with hematological malignancy. MATERIALS AND METHODS: The patients were categorized according to the criteria of the European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG). Among the patient serum samples, the first positive GM or BDG test sample and the median sample of GM or BDG test for negative patients were used to detect DNA levels by RT-PCR method (Light Cycler 480, Roche Molecular Biochemicals, Meylan, France) using a commercial kit (Way2Gene Fungi; Genmar, Izmir, Turkey). RESULTS: When the proven and probable IA group were considered as real patients, sensitivity of Aspergillus-specific DNA test was 90%, specificity was 73.3%, positive predictive value was 81.8%, and negative predictive value was 84.6%. CONCLUSION: This study found that searching for specific DNA by RT-PCR method has a sensitivity as high as the GM test. Although specificity was rather low, it was concluded that it can be used jointly with GM and BDG tests after decreasing contamination by severe laboratory applications.

Relief from sleep apnea after radiation and chemotherapy.

Superior vena cava syndrome (SVCS) can result from extrinsic compression by a primary tumor, mediastinal lymph nodes metastases, benign lesions, or intraluminal thrombosis. The association between obstructive sleep apnea and SVCS has not been extensively evaluated. To our knowledge, only 5 cases of obstructive sleep apnea in SVCS have been reported in the literature. We presented a 53-year-old man who was admitted with dyspnea, edema of the face, and excessive daytime sleepiness. Chest radiography and computed tomography revealed lung cancer. A biopsy of the tumor revealed squamous cell carcinoma. Obstructive sleep apnea was diagnosed by polysomnography (apnea hypopnea index: 13 per hour). After radiation and chemotherapy, edema of the face, snoring, and daytime sleepiness were alleviated, and the patient's apnea hypopnea index decreased to 0.6 per hour. In conclusion, there is a relationship between obstructive sleep apnea and SVCS.

Low level of IGF-1 in obesity may be related to obstructive sleep apnea syndrome.

The aim of this study was to compare serum insulin-like growth factor (IGF-1) levels in patients with obstructive sleep apnea syndrome (OSAS) with those of nonapneic controls and to determine the risk factors of low IGF-1 levels in patients with OSAS. The study included 39 newly diagnosed moderate-to-severe OSAS patients and 36 nonapneic controls. Overnight polysomnography (PSG) was performed in all patients. The circulating levels of IGF-1 in the OSAS group were significantly lower than those of the control group (p < 0.05). There was a significant negative correlation between IGF-1 and logarithmic transformation (Ln) of the apnea-hypopnea index (AHI), duration of apnea-hypopnea, arousal index, average desaturation, and oxygen desaturation index (ODI). The result of stepwise regression analyses showed that OSAS (p = 0.001) was a risk factor for a low IGF-1 level, independent of age, gender, and body mass index (BMI). Our findings demonstrated that there was a significant negative correlation between IGF-1 and Ln AHI and that OSAS reduced the circulating levels of IGF-1.

Relationship between serum substance P levels and daytime sleepiness in obstructive sleep apnea syndrome.

OBJECTIVE: We hypothesized that intermittent hypoxia might influence serum substance P levels, and that this effect might in turn contribute in excessive daytime sleepiness (EDS) in patients with obstructive sleep apnea syndrome (OSAS). PATIENTS AND METHODS: Fifty-five patients with newly diagnosed OSAS and 15 age-matched nonapneic control subjects were enrolled in this study. Full polysomnography was performed in all patients. Single blood samples were drawn between 8:00 am and 9:00 am after the sleep study. Substance P levels were analyzed with a competitive enzyme immunoassay (substance P EIA kit; Cayman Chemical; Ann Arbor, MI). RESULTS: There were no significant differences in age, gender, body mass index, smoking habit, and snoring between the two groups. Serum substance P levels in the OSAS group were significantly lower than that in the control group (p < 0.0001). Serum substance P levels were positively correlated with rapid eye movement sleep (r = 0.330, p = 0.049) and slow-wave sleep (r = 0.324, p = 0.049) phases. Serum substance P levels were negatively correlated with Epworth sleepiness scale score (r = - 0.253, p = 0.048), number of total apneas during the night (r = - 0.247, p = 0.036), number of respiratory events during the night (r = - 0.266, p = 0.024), apnea-hypopnea index (r = - 0.287, p = 0.015), respiratory arousal index (r = - 0.267, p = 0.026), time spent in apnea and hypopnea (r = - 0.307, p = 0.01), average oxygen desaturation (r = - 0.265, p = 0.026), and oxygen desaturation index (r = - 0.254, p = 0.031). CONCLUSION: We concluded that EDS seen in some of the OSAS patients might be associated with various pathophysiologic mechanisms including substance P levels.

Can clinical factors be determinants of bone metastases in non-small cell lung cancer?

OBJECTIVE: The aim of this study was to investigate the correlations among symptoms, laboratory findings of bone metastasis and whole body bone scanning (WBBS) and the frequency of occurrence of bone metastases MATERIALS AND METHODS: Hundred and six patients who were diagnosed with non-small cell lung cancer (NSCLC) between June 2001 and September 2005 were investigated retrospectively. Bone pain, detection of bone tenderness on physical examination, hypercalcemia and increased serum alkaline phosphatase were accepted clinical factors of bone metastases. Presence of multiple asymmetric lesions in WBBS was also accepted as bone metastases. Subjects whose clinical factors and WBBS indicated doubtful bone metastases were evaluated with magnetic resonance and/or biopsy. RESULTS: Occurrence of bone metastases was 31.1% among all patients. Bone metastases were determined in 21 (52.5%) of 40 patients who had at least one clinical factor. Asymptomatic bone metastases without any clinical factors were established in 11.3% of all NSCLC patients and 15.3% of 26 operable patients. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the clinical factors of bone metastases were 63.6, 73.9, 52.5, 81.8 and 70.7% respectively. There was no significant relationship between histologic type and bone metastases. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of WBBS in detection of bone metastases were 96.9, 86.3, 76.2, 98.4, 89.6% respectively. CONCLUSION: Sensitivity and specificity of the clinical factors of bone metastases are quite low. Routine WBBS prevented futile thoracotomies. Therefore, routine WBBS should be performed in all NSCLC patients, even in the absence of bone-specific clinical factors.