Study of leptin and adiponectin as disease markers in subjects with obstructive sleep apnea.

BACKGROUND: Published studies showed conflicting results of the associations between adiponectin and leptin levels and obstructive sleep apnoea (OSA). In obese patients, plasma leptin is elevated and adiponectin is decreased, and we postulate that these adipokines could be potential markers of clinical and metabolic perturbations in patients with OSA. METHODS: 147 patients with suspected OSA had polysomnography to determine the Respiratory Disturbance Index (RDI). We measured fasting plasma glucose (FPG), fasting serum insulin, plasma leptin, adiponectin, and full lipid profile. Patients were classified on the basis of the RDI, degree of adiposity, and insulin resistance (IR) (homeostasis model assessment of insulin resistance (HOMAIR)). RESULTS: 28.6% of subjects had normal polysomnography, 34.8% had mild OSA, 19.6% had moderate OSA, and 17% had severe OSA. Obesity was more prevalent in subjects with moderate-severe OSA (47%). Adiponectin decreased significantly (P = 0.041) with increasing severity of OSA. Though BMI was significantly higher in subjects with severe OSA, paradoxically, leptin was lowest in those subjects independent of gender dimorphism. CONCLUSIONS: Adiponectin is an independent marker of disease severity in patients with OSA. The paradoxical decrease in circulating leptin, which suggests impaired secretion, deserves further studies as a potential marker of severe OSA.

Familial occurrence of pulmonary alveolar microlithiasis in 3 siblings.

Pulmonary alveolar microlithiasis (PAM) is a rare disease of unknown etiology characterized by intra-alveolar calcium deposits. More than 500 cases were reported in the literature. The disorder affects people at every age beginning from the early childhood. It occurs probably as a result of autosomal recessive transmission. Familial occurrence is often found with family history of the disease being present in up to 50% of the reported cases. We report PAM in 3 siblings.

Prevalence, risk factors and impact on daytime sleepiness and hypertension of periodic leg movements with arousals in patients with obstructive sleep apnea.

STUDY OBJECTIVE: To determine the prevalence, risk factors, and impact on daytime sleepiness and hypertension of periodic leg movements of sleep (PLMS) with associated arousals in patients with obstructive sleep apnea (OSA). METHODS: A single-center retrospective case series of 798 consecutive patients who underwent diagnostic overnight polysomnography for suspected OSA. We performed discriminant function analysis using clinical and polysomnographic variables to examine the relationship between PLMS (periodic leg movement arousal index > or =5 per hour) and potential risk factors, including OSA. RESULTS: Mean +/- SD age was 50 +/- 12 years, body mass index 32 +/- 8 kg/m2, Epworth Sleepiness Scale (ESS) score 11 +/- 5, and apnea-hypopnea index 31 +/- 26 per hour. Sixty-eight percent were men, 30% had systemic hypertension, and 19% were smokers. Ninety-two percent had OSA (apnea-hypopnea index +/- 5); 47% had PLMS; 44% had both OSA and PLMS; and among patients with OSA, 48% had PLMS. Significant predictors of PLMS, in order of importance, were number of predisposing medical conditions, age, number of predisposing medications, obesity, and OSA. Medical conditions that significantly predicted PLMS were depression, fibromyalgia, and diabetes mellitus. The ESS score and hypertension status were no different between those with both OSA and PLMS and those with OSA alone. CONCLUSIONS: One in 2 patients investigated for OSA has PLMS. Risk factors for PLMS include preexisting medical conditions-particularly depression, fibromyalgia, and diabetes mellitus-increasing age, predisposing medications, obesity, and OSA. The combination of OSA and PLMS results in no greater subjective daytime sleepiness or prevalence of hypertension than OSA alone.

Aspergillus-related lung disease.

Aspergillus is a ubiquitous dimorphic fungus that causes a variety of human diseases ranging in severity from trivial to life-threatening, depending on the host response. An intact host defence is important to prevent disease, but individuals with pre-existing structural lung disease, atopy, occupational exposure or impaired immunity are susceptible. Three distinctive patterns of aspergillus-related lung disease are recognized: saprophytic infestation of airways, cavities and necrotic tissue; allergic disease including extrinsic allergic alveolitis, asthma, allergic bronchopulmonary aspergillosis, bronchocentric granulomatosis and chronic eosinophilic pneumonia; and airway and tissue invasive disease -- pseudomembranous tracheobronchitis, acute bronchopneumonia, angioinvasive aspergillosis, chronic necrotizing aspergillosis and invasive pleural disease. A broad knowledge of these clinical presentations and a high index of suspicion are required to ensure timely diagnosis and treatment of the potentially lethal manifestations of aspergillus-related pulmonary disease. In the present report, the clinical, radiographic and pathological aspects of the various aspergillus-related lung diseases are briefly reviewed.

Demographic pattern and clinical characteristics of patients with smear- positive pulmonary tuberculosis in kuwait.

OBJECTIVE: The aim of this study was to document various clinical factors that are likely to be of help in the control of tuberculosis in Kuwait. SUBJECTS AND METHODS: Details of patients with sputum positive for acid-fast bacilli in the period from January 1998 to December 2000 were collected retrospectively from the case records and population statistics from government sources. The data were then tabulated and analyzed. RESULTS: Of the 526 cases, 83.5% were expatriates and 16.5% Kuwaiti; 373 (70.9%) were male. Of the expatriates, 66.7% were from Asia and the Far East, 5.7% were > or =60 years. The annual incidence was 8.34 per 100,000 population. The lowest incidence was observed in the Jahrah governorate with an overall incidence of 5 (2.0 among Kuwaitis and 6.4 among expatriates) per 100,000 population. The highest incidence overall (10.2) and among Kuwaitis (4.1) was observed in the Farwaniya governorate, while the highest incidence among expatriates was seen in the Capital governorate (13.4). Radiologically, 94 (19.5%) had minimal, 246 (51.5%) had moderately advanced and 141 (29.3%) far-advanced disease. The majority of the patients (72%) had only + status for AFB in the smear. Hypercalcemia (25.7%), hyponatremia (22.15%) and hyperglycemia (29.9%) were common in the patients. Mean serum albumin was low (28.7 +/- 5.5 g/l). Two hundred and forty-seven (47.2%) were declared cured while 116 (22.2%) completed treatment. Comparison between nationals and expatriates showed a significant difference only for age, smoking status, defaulter rate and place of residence. CONCLUSION: The lowest regional incidence was found in the Jahrah governorate. Both biochemical abnormalities and radiologically advanced presentations were common. Disease pattern and response to treatment was purely individual and did not differ with respect to nationality or race.