Red blood cell distribution width in Obstructive Sleep Apnea Syndrome and its association with cardiovascular disease.

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is associated with cardiovascular disease (CVD). Red blood cell distribution width (RDW) is reported as a novel marker of cardiovascular disease (CVD) risk. We aimed to investigate the correlation of RDW level with the severity of Obstructive Sleep Apnea Syndrome (OSAS) defined with the apnea-hypopnea index (AHI) and to study the relationship between RDW and CVD in OSAS. METHODS: From retrospective analyses of patients admitted to our department for polygraphy between January 2018 and January 2020, OSAS patients with complete medical records and hemogram analyses were evaluated. RESULTS: The study population consisted of 160 patients (101 females/59 males). The mean age was 52.32 ± 10.83 years. RDW correlated positively with the apnea hypopnea index (AHI) (r=0.392; p < 0.0001) and C-reactive protein (CRP) (r = 0.3, p < 0.001). RDW and CRP were significantly higher in patients with CVD than whom without CVD (p < 0.0001). In multivariate analysis, the independent predictors of CVD in OSAS were RDW (p < 0.0001; OR=3.095; CI: 1.69-5.66), CRP (p=0.046; OR=1.136; CI: 1.002-1.287) and age (p=0.013; OR=1.085; CI: 1.017- 1.157). The cut-off level for RDW with optimal sensitivity and specificity was calculated as 14.45 with sensitivity of 81% and specificity of 75%. CONCLUSIONS: The findings of this study suggest that RDW, a simple, relatively inexpensive and universally available marker could have the ability to predict CVD in OSAS.

Unusual Neurological Manifestation of Langerhans Cell Histiocytosis in an Adult.

Langerhans Cell Histiocytosis is a rare disorder characterized by an abnormal proliferation of Langerhans cells in one or multiple organs. It rarely presents with a central vestibular involvement. We report a case of a multisystem Langerhans Cell Histiocytosis with mucosal, hepatic, and neurological involvement, presenting with dizziness and balance disorders. A 39-year-old woman with a histopathologically confirmed mucosal palatal Langerhans Cell Histiocytosis presented with a history of dizziness for a year. Vestibular examination revealed a saccadic eyes pursuit, an up beating spontaneous nystagmus, a bilateral gaze nystagmus and a prolonged positional nystagmus, in the supine roll test. Pure tone audiometry showed a slight left sensorineural hearing loss at the 8000 Hz frequency. Computed tomography (CT) scan showed a bilateral maxillary sinus fullness and a peripheral osteosclerosis of the surrounding bony walls. Hepatic magnetic resonance imaging (MRI) showed a typical hepatic involvement with a hepatomegaly with countless cysts. Temporal bone CT scan and MRI were normal. Cerebral MRI showed an hyperintense nodular signal at T2 FLAIR weighted images lateral to the right pons, at the level of the left middle cerebellar peduncle and at the left mesencephalon. Balance disorders can rarely present a sign of a degenerative neurological cerebellar involvement. Such a rare manifestation can present in different neurological disorders such as Langerhans' cell Histiocytosis.