Assessment of neural alterations in obstructive sleep apnoea syndrome: can apparent diffusion coefficient measurements be useful?

BACKGROUND AND AIMS: Our aim was to investigate whether neurological alteration in patients with obstructive sleep apnoea syndrome (OSAS) with apparently normal cerebral and cerebellar structures can be assessed by means of apparent diffusion coefficient (ADC) measurement and to investigate the association between OSAS severity and ADC values. METHODS: Following the acquisition of diffusion-weighted cranial magnetic resonance imaging, ADC measurements were performed in 24 different apparently normal cerebral and cerebellar structures, including the bilateral frontal and parietal cortices, insulae, cingulate gyri, hippocampi, frontal and parieto-occipital periventricular white matter (PWM), caudate nuclei, putamen, thalami, cerebellar hemispheres, pons and mesencephalon in 47 OSAS patients and 20 control subjects. The ADC values of the patients and the control group were compared. The association between the apnoea-hypopnoea index (AHI) and the ADC values of the patients were investigated. RESULTS: The ADC values in the bilateral frontal PWM were lower in the patient group than those in the control subjects (P < 0.05). The measurements in the right cingulate gyri of the OSAS patients exhibited significantly higher ADC values than those of the control group (P = 0.002). Bilateral thalamic ADC values in severe OSAS patients were significantly higher than those in mild and moderate OSAS patients (P < 0.05). CONCLUSION: The ADC measurement is a simple and effective technique to evaluate neural alteration of the brain in patients with OSAS. ADC measurements can also be useful in the evaluation of the association between the AHI and the degree of neural alteration in the central nervous system.

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.

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.

Neutrophil-to-lymphocyte ratio in chronic obstructive pulmonary disease: a retrospective study.

Chronic obstructive pulmonary disease (COPD) is a common chronic inflammatory disease of the lung with a high mortality and morbidity rate. Some of the inflammatory markers such as C-reactive protein (CRP), leukocyte count are associated with COPD. In this study, we aimed to evaluate the role of neutrophil-to-lymphocyte ratio (NLR) in COPD patients comparing with the other well-known inflammatory markers. We retrospectively enrolled the laboratory results of 269 COPD patients of which 178 patients at stable period and 91 patients during acute exacerbation and 50 sex- and age- matched healthy controls. We found that NLR values of the stable COPD patients were significantly higher than those of the controls (P < 0.001). During acute exacerbation of the disease there was a further increase compared to stable period (P < 0.001). NLR values were also positively correlated with serum CRP levels and red cell distribution width (RDW) and negatively correlated with mean platelet volume (MPV) in both COPD groups. In conclusion, NLR could be considered as a new inflammatory marker for assessment of inflammation in COPD patients with its quick, cheap, easily measurable property with routine complete blood count analysis.

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.

Association analyses of oxidative stress, aerobic capacity, daily physical activity, and body composition parameters in patients with mild to moderate COPD.

BACKGROUND/AIM: To investigate total oxidant and antioxidant status, maximal aerobic capacity, daily physical activity, pulmonary functions, and body composition changes, as well as the associations among these parameters, in patients with mild to moderate chronic obstructive pulmonary disease (COPD) versus healthy controls. MATERIALS AND METHODS: The study included 30 male patients newly diagnosed with COPD and 30 body mass index-matched, nonsmoker male controls. Maximal aerobic capacity, daily physical activity, total oxidant and antioxidant status, pulmonary function tests, body composition, and anthropometric parameters were measured. RESULTS: Maximal aerobic capacity and total antioxidant values were lower in patients with COPD compared to the controls. The total oxidant value, body fat percentage, and waist/hip ratio were higher in patients with COPD than in the healthy controls. There was a moderately negative correlation between the total oxidant value and the maximal aerobic capacity, while there was a moderately positive correlation between the total antioxidant values and maximal aerobic capacity in patients with COPD. CONCLUSION: Low aerobic capacity, increased oxidative stress, and adiposity are related to impaired pulmonary functions in patients with mild to moderate COPD and might have a role in the pathogenesis of COPD.

[Effects of COPD on cognitive functions: a case control study]. / KOAH'in kognitif fonksiyonlar üzerine etkisi: Bir olgu kontrol çalismasi

INTRODUCTION: Assessment of disease severity, effects of disease on health status and future events should be considered to direct treatment strategies in chronic obstructive pulmonary disease (COPD) management. Although extrapulmonary effects of COPD are well known, effects of COPD on cognitive functions have not been evaluated sufficiently. therefore we aimed to determine cognitive functions of copd patients in the present study. MATERIALS AND METHODS: 112 COPD patients with moderate, severe and very severe irreversible airway obstruction and 44 age matched healthy subjects without COPD and systemic diseases as control group were enrolled to the study. Mini mental state examination (MMSE) was performed to evaluate cognitive functions. MMSE results were compared between patient and control groups. Moreover relationship between exacerbation frequency and cognitive functions was evaluated. RESULTS: Total 156 subjects as 112 COPD patients and 44 healthy subjects were included to the study. Mean age of COPD patients was 65.03 ± 7.63 years, and mean age of control group was 63.63 ± 8.96 years (p= 0.364). Mean score of MMSE in COPD patients was 23.8 ± 4.39, and mean score of MMSE in control group was 26.7 ± 2.88. We determined a significant difference in terms of MMSE scores betweeen patient and control group (p< 0.0001). MMSE scores and FEV1 values were significantly different among patients with moderate, sevre and very severe airflow obstruction (p= 0.001; p< 0.0001 respectively). We found a significant negative correlation between MMSE results and exacerbation frequency during last year (p= 0.003; r= -0.239). CONCLUSION: Lower MMSE scores of COPD patients than subjects in control group indicates the impairment of cognitive functions in COPD patients. Moreover a negative relationship between MMSE scores with exacerbation frequency during last year suggests that prevention from exacerbation can decrease cognitive impairment in COPD patients. We believe that assessment of cognitive functions and preventive strategies should be considered in COPD management.

Anticancer effects of thymoquinone, caffeic acid phenethyl ester and resveratrol on A549 non-small cell lung cancer cells exposed to benzo(a)pyrene.

BACKGROUND: Phytochemical compounds are emerging as a new generation of anticancer agents with limited toxicity in cancer patients. The purpose of this study was to investigate the potential effcts of thymoquinone, caffeic acid phenylester (CAPE) and resveratrol on inflammatory markers, oxidative stress parameters, mRNA expression levels of proteins and survival of lung cancer cells in Vitro. MATERIALS AND METHODS: The A549 cell line was treated with benzo(a)pyrene, benzo(a)pyrene plus caffeic acid phenylester (CAPE), benzo(a)pyrene plus resveratrol (RES), and benzo(a)pyrene plus thymoquinone (TQ). Inflammatory markers, oxidative stress parameters, mRNA expression levels of apoptotic and anti-apoptotic proteins and cell viability were assessed and results were compared among study groups. RESULTS: TQ treatment up-regulated Bax and down-regulated Bcl2 proteins and increased the Bax/Bcl2 ratio. CAPE and TQ also up-regulated Bax expression. RES and TQ down-regulated the expression of Bcl-2. All three agents decreased the expression of cyclin D and increased the expression of p21. However, the most significant up-regulation of p21 expression was observed in TQ treated cells. CAPE, RES and TQ up-regulated TRAIL receptor 1 and 2 expression. RES and TQ down-regulated the expression of NF-kappa B and IKK1. Viability of CAPE, RES and TQ treated cells was found to be significantly decreased when compared with the control group (p=0.004). CONCLUSIONS: Our results revealed up-regulation of the key upstream signaling factors, which ultimately cause increase in their regulatory p53 levels affecting the induction of G2/M cell cycle arrest and apoptosis. Overall these results provide mechanistic insights for understanding the molecular basis and utility of the anti-tumor activity of TQ, RES and CAPE.