Arterial stiffness in obstructive sleep apnoea: Is there a difference between daytime and night-time?

BACKGROUND AND OBJECTIVE: Obstructive sleep apnoea syndrome (OSAS) is a common chronic systemic disease in the general population, with known associated cardiovascular outcomes. We aimed to investigate arterial stiffness in OSAS patients and compare daytime and night-time values with control subjects. METHODS: A total of 104 patients undergoing investigation for OSAS with polysomnography also underwent pulse wave velocity (PWV) and augmentation index (AIx) measurements with Mobil-O-Graph for 24 h. Eighty-two patients were found to have OSAS and 22 did not have OSAS and acted as controls. RESULTS: PWV values of the 82 OSAS patients during the 24-h period, both daytime and night-time, were significantly higher than that of the control subjects. Moreover, night-time levels of AIx were significantly higher in OSAS patients than control subjects (P = 0.025). PWV during night-time was higher than daytime measurements in OSAS patients (P = 0.012). Apnoea hypopnoea index (AHI) was significantly correlated with PWV and AIx over 24 h (P = 0.0001, r = 0.412; P = 0.002, r = 0.333, respectively). Positive correlations were also found between oxygen desaturation index (ODI) with PWV and AIx during the night (P = 0.0001, r = 0.480; P = 0.002, r = 0.325, respectively). However, daytime AIx was not significantly correlated with ODI (P = 0.052, r = 0.205). CONCLUSION: OSAS patients, without known cardiovascular disease, have increased PWV, indicating an increased arterial stiffness, compared with control subjects and correlations between AHI and arterial stiffness indices suggest increased arterial stiffness with increased disease severity. Therefore, arterial stiffness should be considered as a possible cause for cardiovascular complications in OSAS patients.

Effects of nondipping pattern on systemic inflammation in obstructive sleep apnea.

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is a highly prevalent chronic systemic disease in the general population with high morbidity and mortality. Nondipping pattern-failure to drop blood pressure levels in nighttime-is also seen in OSAS patients. We aim to investigate dipping and nondipping patterns of OSAS patients and to compare inflammatory markers. MATERIALS AND METHODS: Patients with the confirmed diagnosis of OSAS with polysomnography underwent ambulatory blood pressure monitoring. During monitoring, patients with decreased nighttime mean systolic blood pressures 10 % or more were defined as dippers, and the patients without this amount of decrease were defined as nondippers. Peripheral venous blood samples were collected for the analysis of IL-2, IL-6, IL-8, IL-10, IL-12, and TNF-α. Results were compared with convenient statistical tests. RESULTS: According to monitoring results, 34 of 62 OSAS patients were dipper and 28 of 62 patients were nondipper. Demographic characteristics, OSAS severity, and Apnea Hypopnea Index were similar in both groups. When inflammatory markers were compared between two groups, IL-2 levels were found to be significantly different (p = 0.014). CONCLUSION: In conclusion, nondipping pattern appears to be associated with increased serum IL-2 levels indicating the increased inflammatory response independently from OSAS severity, and this pattern should be evaluated carefully for possible cardiovascular complications.

Assessment of inflammatory biomarkers and oxidative stress in pulmonary thromboembolism: follow-up results.

Instability in circulation, hypoperfusion, hypoxia, and ischemia in pulmonary thromboembolism (PTE) may occur as a result of failure in pulmonary circulation. All these conditions cause inflammation and oxidative stress. We aimed to investigate inflammatory markers, asymmetric dimethylarginine (ADMA) levels, and the oxidant-antioxidant balance in patients with PTE. This study was conducted as a prospective case-control study. Thirty-eight patients with PTE enrolled to the study. Age- and gender-matched 38 healthy subjects without risk factors for pulmonary embolism were selected as control group. Venous blood samples were obtained from the PTE patients during the initial diagnosis and at the first month of treatment and from the control subjects. Interleukine-6 (IL-6), tumor necrosis factor alpha (TNF-α), total antioxidant status (TAS), total oxidant status (TOS), and ADMA levels were measured for all the samples. The results of patients and healthy subjects were compared. The mean age of the control group was 51.81 ± 15.18 years, and the mean age of the patients was 52.90 ± 18.22 years (p = 0.770). Deep venous thrombosis was present in 68 % of the patients. While we found significant differences between the patient and control groups in terms of IL-6, TAS, TNF-α, ADMA and oxidative stress index (OSI) values (p = 0.001, p = 0.011, p = 0.038, p = 0.028, and p = 0.024, respectively), the TOS value was not different between the groups (p = 0.080). The ADMA, TNF-α, TAS, TOS, and OSI values of the patients during the initial diagnosis and at the first month of treatment were not different (p > 0.05). The results of this study indicate an increased inflammation, endothelial damage, and oxidative stress in PTE. No difference at the first month of therapy suggests ongoing processes. We consider that these markers may be useful in the diagnosis and follow up of PTE.

Diagnostic utility of flexible bronchoscopy in elderly patients.

BACKGROUND: In the elderly population, diagnosis and initial treatment should be considered as soon as possible because of high disease incidence and complications. We aimed to evaluate the findings of flexible bronchoscopy (FB) and determine the diagnostic utility of FB in patients 65 years old and older. METHOD: We retrospectively evaluated FB results. Demographic data, clinical and bronchoscopic findings, diagnostic procedures during FB and incidence of accurate diagnosis with FB both in patients 65 years old and older and in younger patients were determined. RESULTS: A total of 745 patients [younger patients (<65 years, n = 378, F/M: 120/258) and older patients (≥65 years, n = 367, F/M: 88/279)] who underwent FB at our clinic between 2009 and 2012 were included. The mean age of older patients was 72.6 ± 5.8 years, while the mean age of younger patients was 50.9 ± 11.7 years. Overall, 188 older patients (51.2%) had an accurate diagnosis with the procedures used during bronchoscopy, and 179 younger patients (47.3%) had a final diagnosis with these procedures. The diagnostic utility of FB did not differ significantly between study groups (P = 0.291). During FB, 326 older patients (88.8%) had no complication, and 343 younger patients (90.7%) had no complications. No statistically significant difference was found between older and younger patients in terms of complications during FB (P = 0.389). CONCLUSION: The results of this study indicate the high diagnostic value of FB together with low complication rates in patients aged 65 years and older.

Predictive value of Berlin Questionnaire and Epworth Sleepiness Scale for obstructive sleep apnea in a sleep clinic population.

INTRODUCTION: The Berlin Questionnaire (BQ) and Epworth Sleepiness Scale (ESS) are two of the widely used screening instruments for subjects suffering from sleep disorders. OBJECTIVES: To determine the predictive accuracy of the BQ and ESS in the subjects who were admitted to our sleep clinic, using overnight polysomnography as the 'gold standard'. METHODS: The BQ and ESS were performed to 1450 subjects hospitalized in our sleep clinic for polysomnographic evaluation. RESULTS: One thousand two hundred thirty of 1450 subjects (84.8%) had apnea-hypopnea index (AHI) ≥ 5, and 70.5% of them were classified as being at high risk of sleep apnea with BQ and 45.9% of them were classified as having excessive daytime sleepiness with ESS. Being in the high-risk group with the self-reported, BQ predicted an AHI ≥ 5 with a sensitivity of 0.73 and a specificity of 0.44, vs a sensitivity of 0.46 and a specificity of 0.60 with the self-reported ESS. Sensitivity of BQ (0.80) was highest when we selected the cut-off value of AHI as 30. When we evaluated the predictive accuracy of BQ and ESS together, specificity of both instruments as 0.72 at AHI cut-off value of 5 was found. AHIs were significantly correlated with the scores in each category and the total scores of BQ (P < 0.0001). CONCLUSIONS: The BQ is a poor predictor of obstructive sleep apnea (OSA) in subjects admitted to our sleep clinic. BQ and ESS together may be used to detect patients with low risk for OSA.

Can platelet indices predict obstruction level of pulmonary vascular bed in patients with acute pulmonary embolism?

INTRODUCTION: Computed tomography pulmonary arterial obstruction index ratio (CTPAOIR) is related with the severity of pulmonary embolism (PE). Platelet indices including mean platelet volume (MPV), platelet distribution width (PDW) are reported to be increased in acute PE. OBJECTIVE: In this study, we aimed to evaluate the relationship between CTPAOIR and platelet indices and the utility of these parameters in the determination of PE severity. MATERIALS AND METHODS: We retrospectively analysed the demographic data, clinical probability scores, laboratory data and echocardiographic findings of 63 acute PE patients who were diagnosed by pulmonary arterial computed tomography angiography. RESULTS: The hospital records of 38 (60.3%) male and 25 (39.7%) female patients with acute PE and 29 (58%) male and 21 (42%) female healthy control were evaluated (P = 0.803). The mean value of MPV, PDW levels, platelet counts and red cell distribution width levels were higher in PE groups than in control subjects (P < 0.05). Massive PE was present in 33.3% of PE patients. There were statistically significant differences in terms of hospital length of stay (HLS), mean value of MPV, CTPAOIR and systolic pulmonary arterial pressure (sPAP) in addition to systolic arterial pressure between massive and submassive PE patients (P < 0.05 for all). CTPAOIR was positively correlated with HLS, clinical probability scores, D-Dimer level, MPV, PDW levels and sPAP. CONCLUSION: Platelet indices, MPV and PDW, can be used for the determination of disease severity, and lead to therapeutic strategies for PE patients.

Inflammatory processes and effects of continuous positive airway pressure (CPAP) in overlap syndrome.

We aimed to compare serum levels of the inflammatory mediators including C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), and asymmetric dimethylarginine (ADMA) in chronic obstructive pulmonary disease (COPD), obstructive sleep apnea syndrome (OSAS), and their coexistence called overlap syndrome (OVS). In addition, we planned to investigate changes of these mediators with the treatment of continuous positive airway pressure (CPAP) in OSAS and OVS. CRP, TNF-α, and ADMA levels were analyzed by ELISA method from blood samples withdrawn from patients with COPD (N = 25), OVS (N = 25), and moderate- to severe-stage OSAS (N = 25). First blood samples were taken in the morning after polysomnography application, and second blood samples were taken from OSAS and OVS patients who underwent regular CPAP treatment. In comparison of three groups prior to CPAP treatment, ADMA level in OSAS were significantly lower than in COPD (p = 0.009), but CRP and TNF-α were similar among groups. When we compared the parameters before and after CPAP treatment, the level of CRP in both OSAS and OVS decreased significantly (p = 0.02, p = 0.04), whereas TNF-α and ADMA levels did not display any significant differences. A decrease of serum CRP level in OVS and OSAS groups following effective CPAP treatment shows that CPAP is an effective treatment method for systemic inflammation.