Extensive Exposure to Tear Gases in Ankara.

OBJECTIVES: The most common chemical substances used as mass control agents are chloroacetophenone, chlorobenzylidene malononitrile, and oleoresin capsicum. These agents not only have local and rapid effects but also have systemic and long-term effects. The aim of the present study was to discuss the patterns of tear gas exposure and to investigate its effects on respiratory functions. MATERIALS AND METHODS: A face-to-face survey was conducted in 86 individuals who had been exposed to tear gas indoor and outdoor during the public protests in June 2013. RESULTS: The most frequently reported respiratory complaints included cough, dyspnea, phlegm, and chest pain. Spirometry measurements including forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) were also performed. Indoor exposers have lower mean % predicted FVC and FEV1 values than outdoor exposers. All complaints and signs were more common in indoor exposure to tear gas than in outdoor exposure. CONCLUSION: Safety of the chemicals used as mass control agents during protests is doubtful as these agents are associated with several health risks.

The efficacy of Watch PAT in obstructive sleep apnea syndrome diagnosis.

Polysomnography is currently considered as the gold standard for the diagnosis of obstructive sleep apnea syndrome (OSAS). But high expense and the backlog of the sleep centers have resulted in a search for an alternative method of diagnosis. The aim of this study is to assess the efficacy and reliability of Watch PAT as an alternate option in OSAS diagnosis. The patients have worn a Watch PAT(®) 200 device in the sleep laboratory during a standard polysomnography. The correlation in REM and Non-REM AHI scores, sleep periods and the mean O2 saturation percentage between Watch PAT and PSG sleep studies were assessed. There was a statistically significant very strong correlation between PSG and Watch PAT AHI scores (Spearman's rho = 0.802 p < 0.001). The mean recording time with PSG and Watch PAT was 463.06 ± 37.08 and 469.33 ± 72.81 min, respectively, and there was no statistically significant difference (p = 0.068). However, there was a statistically significant difference between two methods regarding the average sleep time and REM sleep period. No statistically significant difference was revealed in the mean O2 saturation percentage (p < 0.001). Watch PAT is an efficient device and is considered to be an adjunctive diagnostic method for PSG in diagnosis of OSAS.

The prevalence of obstructive sleep apnea in patients with difficult-to-treat asthma.

OBJECTIVES: Obstructive sleep apnea (OSA) occurs more commonly in asthma patients than in the general population and can complicate asthma management. The aim of this study was to evaluate the presence of OSA in patients with difficult-to-treat asthma (DTA) and to investigate the sleep quality in these patients. METHODS: Patients with DTA were recruited from the adult allergy clinic of a tertiary care hospital. After completing the Sleep Questionnaire and Epworth Sleepiness Scale, all participants underwent overnight polysomnography. The demographic and asthma severity assessments included the following measures: the age at diagnosis, duration of illness, smoking and atopy status, results of pulmonary function tests, number of asthma control medications used, and number of hospitalizations and emergency room visits because of asthma and analgesic hypersensitivity according to apnea-hypopnea index (AHI) scores. RESULTS: We analyzed 47 (M:9/F:38) DTA patients with a mean age of 48.74±9.45 years. The mean duration of asthma was 9.17±6.5 years. Twenty-four (51.1%) patients were atopic. The analgesic hypersensitivity rate was 27.7%. Fourteen patients (29.8%) were former smokers and 2 patients were current smokers. Sleep quality was impaired in all patients. Thirty-five patients (74.5%) had OSA, 11 of whom had mild OSA, and 24 patients had moderate-severe OSA. The presence of OSA was not statistically correlated with asthma characteristics. CONCLUSION: The study showed that there is a remarkably high prevalence of OSA in DTA. Although no statistically significant relationship between the presence of OSA and clinical asthma characteristics was identified, all DTA patients should be assessed for OSA.

The relationship between high-sensitivity C-reactive protein levels and the severity of obstructive sleep apnea.

BACKGROUND AND OBJECTIVE: There is an increased risk of cardiovascular and cerebrovascular events in patients with obstructive sleep apnea (OSA). High-sensitivity C-reactive protein (hs-CRP) is a marker that predicts atherosclerotic complications. However, there are contradictory results about the correlation between serum hs-CRP levels and OSA severity. The purpose of this work was to evaluate the relationship between hs-CRP levels and the severity of OSA in newly diagnosed OSA patients. METHODS: The study group was composed of 76 patients with clinical suspicion of OSA. Subjects with body mass indexes (BMI) ≥30 kg/m(2) were classified as obese. Full-night polysomnography (PSG) was performed on all patients. Patients with an apnea-hypopnea index (AHI) ≥5 were considered to have OSA, and patients with an AHI <5 were accepted as the control group. Blood samples were taken from all patients to analyze serum hs-CRP levels the morning after PSG. RESULTS: The serum hs-CRP levels were significantly higher in the OSA group (4.03 ± 3.58 mg/L) than in the control group (2.41 ± 1.95 mg/L) (p = 0.013). This high level was positively correlated with BMI (r = 0.376, p = 0.001) and with AHI (r = 0.280, p = 0.014). In multiple regression analysis, elevated hs-CRP levels were associated with AHI (F = 3.293, p = 0.033), which was independent of obesity. CONCLUSIONS: Patients with OSA have elevated serum levels of hs-CRP, a marker for inflammation and an independent risk predictor for cardiovascular morbidity. The severity of OSA is responsible for the elevation of hs-CRP.

The diagnostic role of capnography in pulmonary embolism.

The aim of this study was to evaluate the diagnostic contribution of alveolar dead space fraction (AVDSf) measured using capnography in patients admitted with suspected pulmonary embolism (PE). A total of 58 patients who were admitted to our hospital with suspected PE between October 2006 and January 2008 were included in this study. All patients were assessed using the Wells clinical score, capnography, computed tomographic pulmonary angiography, D-dimer measurement, lower-extremity venous Doppler ultrasonography, and V/Q scintigraphy. Forty patients (69%) had PE based on computed tomographic pulmonary angiography findings. The AVDSf value with the highest sensitivity and specificity, which was at the same time statistically significant, was 0.09. This value was consistent with the AVDSf value obtained using receiver operating characteristic analysis. In our study, the sensitivity of capnography was 70%, with a specificity of 61.1%, positive predictive value of 80%, and negative predictive value of 47.8%. The use of AVDSf in combination with any of the several scoring systems that evaluate clinical likelihood of PE and D-dimer levels resulted in higher sensitivity and specificity rates for the diagnosis of PE.

[Split-night versus full-night polysomnography: comparison of the first and second parts of the night]. / Polisomnografía de parte de la noche y polisomnografía de toda la noche: comparación entre la primera y la segunda partes de la noche.

BACKGROUND AND OBJECTIVE: In a split-night study, the first part consists of standard polysomnography (PSG) for the diagnosis of obstructive sleep apnea syndrome while the second part is used to establish a suitable level of continuous positive airway pressure. The aim of our study was to compare the sleep and respiratory parameters during the first 3 hours of the night with the values found during the remainder of sleep and during the whole night. PATIENTS AND METHODS: Forty-five patients were included in the study. Each patient underwent a standard full-night PSG and the PSG data for each patient were divided into 2 periods: PSG1, defined as the initial 3 hours of the total sleep time and PSG2, defined as the remaining period. Sleep and breathing data from PSG1 and PSG2 were then separately computed and compared with each other and with data for the total sleep time (PSGt). RESULTS: The percentage of total sleep time in stage III-IV and the apnea-hypopnea index (AHI) were significantly higher and the percentage of time in rapid eye movement (REM) sleep was significantly lower during PSG1 than during PSG2 (P< .001). Similarly, the percentage of time in stage III-IV sleep was significantly higher and the percentage of REM sleep was significantly lower during PSG1 than during PSGt (P< .001), but there was no significant difference in the AHI between PSG1 and PSGt. CONCLUSION: The diagnosis for the first 3 hours of the night will give a reliable reflection of the whole night. In addition, optimal positive airway pressure titrated during the second half of the night is also optimal for the first half of the night.

[Relationship between the severity of obstructive sleep apnea and hypertension]. / Obstrüktif uyku apne sendromu siddeti ile hipertansiyon arasindaki iliski.

OBJECTIVE: Obstructive sleep apnea syndrome (OSAS) is a syndrome defined frequently by decrease in arterial oxygen saturation and repeated upper airway obstruction episodes during sleep. The most important complications of OSAS patients belong to cardiovascular system. Systemic arterial hypertension (43-60%), pulmonary hypertension (20-30%), coronary artery disease (20-30%) and congestive heart failure (5-10%) are among OSAS associated cardiovascular disease spectrum. In this study, we investigated the frequency of hypertension (HT), which is the most common cardiovascular disease seen in patients admitted with OSAS suspicion. METHODS: Overall 263 consecutive patients with possible OSAS were included in this cross-sectional study. Diagnostic polysomnography (PSG) was performed in all patients with 44-channel polysomnograph (Compumedics E series, Australia) one whole night. Sleep stages and respiratory events were manually scored. Patients with apnea hypopnea index (AHI) <5 were diagnosed as OSAS negative, patients with AHI between 5-14 were diagnosed as mild OSAS, patients with AHI between 15-29 were diagnosed as moderate OSAS, patients with AHI >or=30 were diagnosed as severe OSAS. Relation of OSAS and presence of HT was statistically analyzed with Chi-square test. RESULTS: According to PSG records of the patients who were assessed with OSAS suspicion, 54 (20.5%) patients were assessed as OSAS negative, 26(9.9%) - mild OSAS, 45 (17.1%) - moderate OSAS, and 138 (52.5%) were diagnosed as severe OSAS. Hypertension was present in 4 (7.4%) of 54 OSAS negative patients and 56 (36.8%) of 209 patients with OSAS, the difference was significant (p=0.001). When we assessed mild OSAS patients and moderate-severe OSAS patients in terms of HT frequency, HT was present in a lower rate in mild OSAS patients as compared with patients with moderate-severe OSAS (3/26 versus 53/183; p=0.044). When we compared OSAS negative patients with moderate-severe OSAS patients, HT was less frequently found in OSAS negative patients (4/54 versus 53/183, p=0.001). CONCLUSION: It is determined that hypertension was more frequently seen in patients with OSAS than in patients without OSAS and that HT frequency increased in parallel to the severity of OSAS.

Erythrocyte deformability, plasma viscosity and oxidative status in patients with severe obstructive sleep apnea syndrome.

BACKGROUND AND PURPOSE: In patients with severe obstructive sleep apnea syndrome (OSAS), diurnal changes of plasma viscosity and erythrocyte deformability were measured to elucidate the possible mechanism of cardiovascular diseases in OSAS patients. PATIENTS AND METHODS: Plasma viscosity and erythrocyte deformability was determined in 11 OSAS patients and 11 healthy subjects matched by sex and age. Plasma viscosity was measured by a cone-plate viscometer, and erythrocyte deformability was determined by filtration technique. Whole blood counts were performed and oxidative status of the patients' plasma and erythrocytes were evaluated. RESULTS: OSAS patients had higher plasma viscosity than controls, both in the morning (1.74+/-0.3 vs. 1.36+/-0.2 mPas, P<0.002) and evening (1.55+/-0.2 vs. 1.27+/-0.1 mPas, P<0.002), and morning plasma viscosity was significantly higher than the evening level (P<0.05). Morning plasma viscosity of patients was inversely correlated with their mean nocturnal SaO(2). Morning plasma malonyldialdehyde level was significantly higher in the patients than in the controls (69.7+/-30.5 vs. 45.5+/-11.0 nmol/l, P<0.005). Erythrocyte deformability of the patients was slightly lower. CONCLUSIONS: We have observed that plasma viscosity is high both in the morning and in the evening in severe OSAS patients. This elevation may predispose OSAS patients to myocardial infarction and stroke by increasing blood viscosity. Low nocturnal mean SaO(2) may be responsible for the high plasma viscosity in these patients.

Effect of nasal continuous positive airway pressure in uncontrolled nocturnal asthmatic patients with obstructive sleep apnea syndrome.

The mechanisms of nocturnal asthma are intimately related to circadian rhythms, which influence inflammatory cells and mediators, hormone levels and cholinergic tone. Nocturnal airway narrowing in asthma is sometimes associated with sleep disorders, such as obstructive sleep apnea syndrome (OSAS). The aims of this study were to evaluate the association of nocturnal asthma and OSAS, and investigate the influence of continuous positive airway pressure (CPAP) therapy to improve nighttime symptoms in asthmatic patients with OSAS. Forty-three asthmatic patients who had nocturnal symptoms in spite of the optimal medical treatment according to the Global Initiative for Asthma guidelines and associated with snoring were studied. Pulmonary function tests (PFTs), asthma nighttime symptom scores, and polysomnography were performed on all patients. We treated the patients with an apnea-hypopnea index (AHI) 15 (moderate-severe OSAS) (n=16) with CPAP during 2 months. After 2 months, PFT, asthma nighttime symptom scores were reperformed. There was no significant difference in PFT values before and after CPAP treatment in OSAS patients. Asthma nighttime symptom scores were improved significantly (P<0.05) after CPAP treatment. In conclusion, in some patients with nocturnal asthma, OSAS may be responsible disease for nocturnal symptoms. In this condition, CPAP improves nocturnal symptoms without amelioration in PFT abnormalities.

[Upper airway resistance syndrome]. / Ust solunum yolu rezistansi sendromu.

Upper Airway Resistance Syndrome (UARS) is characterized with daytime sleepiness and cardiovascular disturbances, because of the repetitive increase of upper airway resistance leading to arousals. UARS, can easily be overlooked because the conventional polysonographic measurements are not sensitive enough to diagnose this syndrome, therefore the prevalence and morbidity of this syndrome is not known. Measuring the increased inspiratory effort by an esophageal balloon during the rising upper airway resistance is the gold standard technique for the diagnosis. Treatment of UARS is similar with Obstructive Sleep Apnea Syndrome (OSAS). In this article the clinical picture, diagnosis, and management of the UARS is reviewed.