Abnormal respiratory event detection in sleep: A prescreening system with smart wearables.

Sleeping is an important activity to monitor since it has a crucial role in the overall health and well-being of the people and society. In order to diagnose the problems in sleep, different monitoring systems are developed in the literature. The unobtrusiveness, reduced cost, objectiveness, protection of privacy and user-friendliness are the main design considerations and the proposed system design achieves those objectives by utilizing smart wearables, smart watch and smart phone. The accelerometer and heart rate monitor sensors on smart watch and the sound level sensor on the smart phone are activated. The experiments with this system are performed with 17 subjects in a sleep clinic. The data collected from these subjects is used to generate various combinations by employing varied feature extraction, feature selection and sampling approaches. Five different machine learning algorithms are implemented and the classification results are generated using the various combinations of data, training and scoring strategies. The system performance is measured in two ways, the accuracy rate of distinguishing abnormal respiratory events is 85.95% and the classification success of subjects according to the problems in their respiration is one misclassification among 17 subjects. With all the methodology utilized in this study, the proposed system is a novel prescreening tool which recognizes the severity of problems in respiration during sleep.

A polysomnographic and clinical study of sleep disorders in patients with Behçet and neuro-Behçet syndrome.

Brainstem is the most common site of involvement in neuro-Behçet syndrome (NBS). On the other hand, the critical importance of this anatomical region in the regulation of sleep has been disregarded in the literature. We aimed to investigate the microstructure of sleep in patients with Behçet syndrome (BS) and NBS. Patients were allocated to 2 groups: (1) BS without any neurological involvement and (2) NBS with brainstem lesions only. A control group was also enrolled in this study. The comparison of polysomnographic parameters between all patients (BS and NBS) with the control group showed that sleep onset was longer (p = 0.006), the duration of superficial NREM sleep stage (N2) was significantly longer (p = 0.018), and the respiratory disturbance index was significantly higher (p = 0.034) in patients. Sleep apnea and restless legs syndrome are more commonly observed in BS and NBS. Our findings emphasize the importance of questioning the quality of sleep and its disorders in patients with BS in order to better handle the common somatic complaints in these patients, such as fatigue or daytime sleepiness

[Early results of treatment with expandable intramedullary nails in femur shaft fractures]. / Femur saft kiriklarinda genisleyebilir intramedüller çivilerle erken dönem tedavi sonuçlari.

OBJECTIVES: We evaluated the use of expandable intramedullary nails, their efficacy, and short-term results in the treatment of femur shaft fractures. METHODS: The study included 20 patients (10 females, 10 males; mean age 31 years; range 15 to 75 years) who were treated with expandable intramedullary nails (Fixion intramedullary femur nail) for femur shaft fractures. All the fractures were closed and were rated as type 32 A or B according to the AO classification. The mean duration from injury to surgery was three days (range 4 hours to 8 days). The results were evaluated using the Thoresen criteria. The mean follow-up was 26 months (range 9 to 38 months). RESULTS: The mean operation time was 79 minutes (range 45 to 120 min). Union was achieved in all the patients in a mean of 12.8 weeks (range 10 to 20 weeks). According to the Thoresen criteria, the results were excellent in 15 patients, good in one patient, fair in three patients, and poor in one patient. The results in all type A middle diaphyseal fractures were excellent. Of four patients with A2-3 distal metadiaphyseal fractures, one patient had a good result with a valgus of 5 degrees , and three patients had a fair result with a valgus ranging from 8 degrees to 10 degrees , one of which also had 8-mm shortening. Delayed union, early or late infections, compartment syndrome, or bone necrosis were not seen. Of six patients who completed a follow-up of two years, the nails were removed in five patients, whereas removal was not possible in one patient due to a break in the upper part. CONCLUSION: Expandable intramedullary nails offer advantages in terms of ease of application and are less invasive than static nails and reamed applications. However, they may not provide adequate stability in metadiaphyseal regions and in fractures with fragments greater than 50%.

Nocturia in sleep-disordered breathing.

BACKGROUND AND PURPOSE: Nocturia is a common complaint in sleep-disordered breathing (SDB), but there is no study demonstrating the prevalence and frequency of nocturnal urination in a large number of SDB patients. To determine the prevalence and frequency of nocturnal urination among patients with SDB of different severities and to discover the factors related to nocturia. METHOD: A retrospective chart review was conducted among 1970 SDB patients. Nocturia was assessed using a standard questionnaire. Four groups of SDB patients were compared with regard to frequency of nocturnal urination and additional demographic, clinical, and polysomnographic (PSG) variables, by analysis of variance (ANOVA) with Tukey's honest significant difference (HSD) post-hoc comparisons. Partial correlation analysis was performed to detect the relationships between frequency of nocturnal urination and PSG and demographic variables. Logistic regression analysis was employed to examine the independent predictors of nocturia. RESULTS: Significant correlations were found between the frequency of nocturnal urination and mean age, body mass index (BMI), respiratory disturbance index (RDI), apnea-hypopnea index (AHI), respiratory effort index (REI) and lowest oxygen saturation. The frequency of nocturnal urination showed significant differences between four groups of individuals with SDB (P<0.001). Nocturnal urination of more than three episodes per night was reported significantly more by severe SDB patients (P<0.001). CONCLUSION: Age, BMI, hypertension (HT), AHI, and REI were found to be significantly associated with nocturia.

[Early results of treatment with expandable intramedullary nails in tibia shaft fractures]. / Tibia saft kiriklarinda genisleyebilir intramedüller çivilerle erken dönem tedavi sonuçlari.

OBJECTIVES: We evaluated the use of expandable intramedullary nails, their efficacy, and short-term results in the treatment of tibia shaft fractures. METHODS: The study included 19 patients (8 females, 11 males; mean age 38 years; range 17 to 65 years) who were treated with expandable intramedullary nails (Fixion) for tibia shaft fractures. All the fractures were closed. Four patients had associated injuries. According to the AO classification, the fractures were type 42-A, B, or C. The mean duration from injury to surgery was 2.8 days (range 6 hours to 14 days). The results were evaluated using the Johner-Wruhs criteria. The mean follow-up was 23 months (range 9 to 39 months). RESULTS: The mean operation time was 47 minutes (range 25 to 53 min). Union was achieved in all the patients in a mean of 11.5 weeks (range 8 to 18 weeks). According to the Johner-Wruhs criteria, the results were excellent in 17 patients (89.5%) and good in two patients (10.5%). Treatment of fragmented-oblique fractures of the distal metadiaphysis (42-B2) resulted in a valgus angulation of 5 degrees in two patients, and extremity shortening of 5 mm in one patient, both of whom had good results. Complications such as delayed union, early or late infections, or bone necrosis did not occur. The range of motion of the knee and ankle reached that of the contralateral side in all the patients. CONCLUSION: Expandable intramedullary nails offer advantages in terms of ease of application and are less invasive than static nails and reamed applications. However, they may not provide adequate stability in fractures with fragments greater than 50%.

Does frequency of nocturnal urination reflect the severity of sleep-disordered breathing?

Nocturia is an often-described symptom of sleep-disordered breathing (SDB). The aim of our study was to determine the frequency of nocturnal urination among patients with different severity of SDB and to find out whether frequency of nocturnal urination reflects the severity of disease. A retrospective chart review was conducted among 1075 subjects of suspected SDB. Nocturia was assessed using standard questionnaire evaluating a frequency of nocturnal urination. Subjects were divided into four groups of SDB based on the polysomnographic evaluation. In primary snoring group, 51% subjects did not complain nocturia, 28% subjects reported one time, 16% subjects reported two to three times and 5% subjects reported more than three times urination per night. Among patients with mild obstructive sleep apnea syndrome (OSAS), nocturnal urination was not reported by 36% and was reported one time by 34%, two to three times by 15%, more than 3 times by 15%. The corresponding frequencies among patients with moderate OSAS were 40, 31, 17 and 12%, and with severe OSAS were 23, 22, 23 and 32%, respectively. The severe OSA group was significantly different from other groups as regards the frequency of nocturnal urination (P < 0.001) while other OSA groups did not show any significance. Nocturnal urination of more than three times was significantly more reported by severe OSA patients ( P < 0.001) (positive predictive value = 0.71, negative predictive value = 0.62).

The effects of trazodone on sleep in patients treated with stimulant antidepressants.

BACKGROUND AND PURPOSE: To evaluate the effects of trazodone on subjective and objective measures of sleep in depressed insomnia patients treated with selective serotonin reuptake inhibitors (SSRIs). SSRIs can exacerbate or cause new insomnia while alleviating other symptoms of depression. Trazodone has been reported to be an effective hypnotic for patients with antidepressant-associated insomnia. PATIENTS AND METHODS: Twelve female patients were given either 100 mg trazodone or placebo for 7 days in a double-blind crossover design with a 7-day washout period. Polysomnographic recordings were repeated on the 3rd, 9th and 17th, 23rd nights after treatment with trazodone or placebo. Sleep was assessed by Pittsburgh sleep quality index (PSQI) at the beginning and end of the study. Psychological evaluation was done by Hamilton depression rating scale (HDRS). RESULTS: Trazodone significantly increased total sleep time, percentage of stages 3+4, sleep efficiency index, sleep continuity index and decreased percentage of stage 1, number of awakenings, stage shifts compared to the baseline. This improvement was also obtained after 7 days of treatment. The PSQI score was reduced to 5+/-1.6 at the end of the study. HDRS was reduced to 11.5+/-4.5 with trazodone and to 12.2+/-3 with placebo. CONCLUSION: Trazodone is effective in the treatment of antidepressant-associated insomnia.

Childhood onset of narcolepsy-cataplexy syndrome in Turkey: clinical and genetic study.

Narcolepsy is a disabling sleep disorder characterized by excessive daytime sleepiness and abnormal manifestations of rapid eye movement (REM) sleep including cataplexy, sleep paralysis and hypnagogic hallucinations. It is known to be complex disorder in which both genetic predisposition and environmental factors play a role. In humans, susceptibility to narcolepsy is tightly associated with a specific HLA allele, DQB1*0602. In this report, we took advantage of the ongoing genetic study in Turkish narcoleptic patients to document clinical and genetic data of eight patients whose onset of symptoms were in the childhood period.