A new perspective on OSAS cases with the Baveno classification.

OBJECTIVE/BACKGROUND: Since the apnea-hypopnea index (AHI), which is used in the diagnosis and grading of OSAS, does not adequately reflect the clinical perspective of the disease, the Baveno classification of OSA was developed, which allows multicomponent evaluation of OSAS patients. The aim of our study was to evaluate the application of the Baveno classification in clinical practice. PATIENTS/METHODS: A prospective study was performed on patients diagnosed with OSAS between January 2021 and June 2022. Patients were divided into 4 groups according to Baveno classification (Groups A-D) and three groups as mild, moderate, and severe OSAS according to AHI. RESULTS: A total of 378 patients (70% male, mean age 48.68 ± 11.81 years) were included in the study. The patients had mild (n: 75; 20%), moderate (n: 88; 23%), and severe (n: 215; 57%) OSAS. According to Baveno classification, patients were included in Groups A (n: 90; 24%), B (n: 105 (28%), C (n: 65; 17%), and D (n: 118; 31%). The mean AHIs of the Baveno groups were similar (p = 0.116). Oxygen desaturation index (ODI) was higher in Groups B and D compared to Group A. The duration of T90 desaturation was longer in Groups C and D compared to Groups A and B (p < 0.05). CONCLUSIONS: The Baveno classification divided our OSAS cases into equivalent groups. One out of every four patients with mild OSAS was in Group D. This data was noteworthy in that the Baveno classification allows for the identification of symptomatic and comorbid patients with mild OSAS according to AHI and for the application of more effective treatments to these patients. Patients with comorbidities experienced oxygen desaturation for a longer period of time at night, and oxygenation deteriorated in patients with prominent symptoms. Baveno classification was found to be a more reasonable and easily applicable approach in clinical practice.

Postintensive care syndrome: Development and psychometric validation of a knowledge test.

INTRODUCTION: Postintensive care syndrome (PICS) is a combination of short-, medium- and long-term morbidities that occur in patients discharged from the Intensive care unit (ICU). ICU professionals have a crucial role in managing and understanding the PICS. This study aimed to develop the PICS Knowledge Test (PICS-KT), which measures ICU professionals' awareness and knowledge levels regarding PICS, and to determine its validity and reliability. METHODS: The databases were searched in detail, scientific research related to PICS was analyzed, and the draft scale was created accordingly. A total of 117 doctors and nurses who had been working in the ICU for at least 6 months were included in the study. For the validity and reliability analysis of the test, content validity ratio, item difficulty index, item discrimination index values and Cronbach α were examined. RESULTS: The Cronbach's α reliability coefficient for the 46-item PICS-KT is 0.93, indicating high reliability. Scores range from 0 to 46, with 32 or higher considered successful, suggesting adequate knowledge of PICS among ICU professionals. Scores of 14 or less indicate minimal knowledge. Those with scores between 14 and 32 possess some knowledge but need improvement. PICS-KT assesses knowledge in four main areas: general information, risk factors/causes, symptoms and findings and interventions. ICU professionals show high awareness of interventions for preventing and treating PICS, as indicated by a high mean score in the interventions subdimension. CONCLUSION: The PICS-KT is crucial in assessing healthcare professionals' understanding of the various short-, medium- and long-term morbidities associated with PICS. The study ensures that the test is a robust and dependable instrument for evaluating ICU professionals' knowledge about PICS.

NoSAS score predicts cardiovascular disease in patients with obstructive sleep apnea.

PURPOSE: The Lausanne NoSAS (Neck circumference, Obesity, Snoring, Age, Sex) score is a new tool for the identification of high-risk patients for obstructive sleep apnea (OSA). Up to now, no study has attempted to determine the role of NoSAS score in cardiovascular morbidity of patients with OSA. We aimed to investigate the relationships between NoSAS scores and CVD and also between severity of OSA, polysomnographic parameters, and NoSAS scores in patients with OSA. METHODS: Patients with diagnosis of OSA by full-night polysomnography were recruited in the study. Based on apnea-hypopnea index (AHI) scores, the patients were categorized as OSA-negative (AHI < 5), mild OSA (5 ≤ AHI < 15), moderate OSA (15 ≤ AHI < 30), and severe OSA (AHI ≥ 30). The definition of cardiovascular diseases (CVD) included the presence of any of the diseases such as hypertension, coronary artery disease, heart failure, or arrhythmia. RESULTS: A total of 1514 patients including cases with 199 OSA-negative, 391 mild, 342 moderate, and 582 severe OSA were enrolled in the study. NoSAS scores were significantly different between mild, moderate, and severe OSA groups. NoSAS scores were negatively correlated with minimum oxygen saturation values and positively with AHI and ODI (oxygen desaturation index) values (P < 0.001). NoSAS scores were significantly higher in patients with CVD, diabetes mellitus, and cerebrovascular disease compared with those without (P < 0.005). NoSAS cut-off values for hypertension (14), congestive heart failure (8.5), coronary artery disease (9), cerebrovascular event (11), and diabetes mellitus (10) were also determined. CONCLUSION: NoSAS scores are associated with CVD and the severity of OSA. NoSAS scores may be useful to predict CVD in patients with OSA.

The role of anthropometric measurements in identifying cardiometabolic diseases in obstructive sleep apnea syndrome.

Anthropometric indices continue to be important measurements especially in predicting obesity and various diseases it causes. The fact that these measurements are very simple to apply and provide clinicians with important information especially in identifying cardiometabolic diseases cannot be overlooked. The use of these indices without the need for complex measurements or laboratory tests gives rapid results on the risks of chronic diseases. Obesity is an important risk factor in obstructive sleep apnea syndrome, and anthropometric measurements showing body fat distribution are of great importance. In addition to the diagnosis of the disease, it is extremely important that the measurements reflecting obesity which is directly related to weight should not be ignored in predicting additional cardiometabolic diseases in this patient group. An ever-increasing variety of anthropometric measurements that reflect abdominal obesity with objective data enables the diagnosis of the disease as well as the determination of cardiometabolic risks of patients with asymptomatic sleep apnea syndrome.

Adherence to Auto-CPAP and Age: A Stable Condition? Comment on Barroso et al. Influence of Age on Adherence to Auto-CPAP: Experience from a Sleep Center in Portugal. Adv. Respir. Med. 2022, 90, 143-147.

We have read with great interest the recent paper published by Barroso et al. [...].

Evaluation of pulmonary involvement in systemic rheumatic diseases with high resolution computed tomography and pulmonary function test: A single-center experience.

INTRODUCTION: The objective of this study was to investigate the clinical and radiological features and pulmonary function tests (PFTs) in patients with the pulmonary involvement of systemic rheumatic diseases (SRDs). MATERIALS AND METHODS: This study was conducted as a retrospective and single-center study. Patients diagnosed with an SRD and admitted/referred to the department of chest diseases of our hospital between January 2015 and June 2019 were enrolled. All patients were evaluated using High Resolution Computed Tomography (HRCT) and PFT. RESULT: This study included 68 patients (15 males, 53 females) with a mean age of 62.38 ± 12.4 years. Forty-one (60.2%) patients had diagnosis of rheumatoid arthritis (RA), 10 (14.7%) patients had sjögren's syndrome (SS), 8 (11.7%) patients had systemic lupus erythematosus (SLE), 6 (8.8%) patients had systemic sclerosis (SSc), and 3 (4.4%) patients had mixed connective tissue disease (MCTD). While RA, SLE, MCTD patients were more commonly symptomatic, most of the SS patients were asymptomatic. Overall, 30 (44.1%) patients had normal PFT. Although 30 (%44.1) patients were asymptomatic and 30 (%44.1) patients had normal PFTs, at least one imaging finding was found in all patients according to HRCT imaging. "Bronchiectasis" was the most common HRCT finding in RA, followed by "chronic fibrotic changes" and "peribronchial thickening". "Chronic fibrotic changes" and "peribronchial thickening" were the most common changes in SS. Similarly, "peribronchial thickening" was the most common radiologic finding in SLE. As for SSc, "chronic fibrotic changes", "interlobular septal thickening", and "pleural effusion" were the most common radiologic findings. CONCLUSIONS: Pulmonary involvement in systemic rheumatic diseases can occur with various radiological images even in asymptomatic patients. PFTs can be normal as well as an obstructive, restrictive or mixed pattern can be seen. Heterogeneous and combined HRCT findings can be seen in SRD patients.

The effect of tocilizumab on severe COVID-19 infection: Review of current evidence.

The COVID-19 outbreak that spread in December 2019 has caused the death of millions of people in a short time. Many studies published recently have shown that many cytokines (interleukin (IL) IL-1, IL-2, IL-6, TNF and IFN-) are significantly increased in COVID-19 patients with pneumonia, and especially IL-6 in combination with other cytokines has shown to be the main cause of the cytokine storm. Since IL-6 level is associated with clinical worsening in COVID-19 patients, anti-IL-6 therapy is seen as a promising treatment. Tocilizumab, a widely used IL-6 antagonist, was approved by the FDA in 2017 for Cytokine Storm Syndrome (CSS). Its addition to the treatment in COVID19 patients with increased blood IL-6 levels and oxygen saturation.

Importance of Anthropometric Measurements to Determine Cardiometabolic Diseases in Obstructive Sleep Apnea Syndrome.

OBJECTIVE: Obesity is considered a major risk factor for obstructive sleep apnea syndrome (OSAS). This study aimed to examine the correlation between anthropometric measurements, which have been recently defined and are indicative of abdominal obesity and cardiometabolic diseases, OSAS severity, and polysomnography (PSG) parameters in patients with OSAS. MATERIAL AND METHODS: This retrospective cohort study included patients who underwent all-night polysomnography with a prediagnosis of OSAS. These patients were categorized as having mild (5-15), moderate (15-30), and severe (>30) OSAS according to the apnea-hypopnea index (AHI). The anthropometric measurements used in the study consisted of waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), (waist/hip)-to-height ratio (WHHR), a body shape index (ABSI), body adiposity index (BAI), abdominal volume index (AVI), and conicity index (CI). RESULTS: A total of 410 individuals were enrolled in the study (31 control subjects and 129 with mild, 101 with moderate, and 149 with severe OSAS). A significant difference was observed between groups in terms of all anthropometric measurements (p<0.05). The difference between the groups was significant in terms of diabetes mellitus, hypertension, and cardiovascular disease (p<0.05). There was a significant correlation between each of the anthropometric measurements and the PSG parameters. In the receiver operating characteristic analysis, cutoff values that predicted severe OSAS were ABSI>0.08, BAI>28.29, AVI>25.54, and CI>1.37. Multiple regression analyses demonstrated that age, sex, and AVI were independent predictors that determine OSAS presence. CONCLUSION: Anthropometric parameters that are indicators of abdominal obesity were found to be robustly correlated with cardiometabolic diseases and the severity of OSAS.

Relationship between COVID-19 and obesity.

N/A.

Evaluation of Interleukin-6, Leukotriene B-4, and Nitric Oxide Levels in Exhaled Breath Condensate of Asymptomatic Obese Individuals: Are Obese Patients Under Risk of Developing Asthma?

OBJECTIVE: If systemic inflammation in relation with obesity causes asthma, the detection of increased airway inflammation among obese individuals who do not have any respiratory symptoms can be also beneficial in indentifying obese patients who are at risk of developing asthma. The aim of this study was to evaluate the systemic and airway inflammation of asymptomatic obese and non-obese individuals. MATERIALS AND METHODS: Obese and non-obese individuals with no respiratory symptoms were included. Inflammatory biomarkers such as C-reactive protein (CRP), exhaled breath condensate (EBC) interleukin-6 (IL-6), EBC leukotriene B-4 (LTB-4), and EBC nitric oxide (NO) levels of obese and non-obese individuals were determined. RESULTS: Forty-five obese individuals (body mass index [BMI]≥30) and 31 non-obese individuals (BMI≤25) as a control group were included in this study. The mean age of the obese group (38.7±11.4 years) was significantly higher than the one of the non-obese group (29.5±8.6 years; p<0.001). There was no significant relationship between gender and BMI (χ2 =1.471, p=0.225). CRP levels were significantly higher in the obese group (6.94±8.28) than the non-obese group (3.29±0.39; p<0.001). The levels of EBC IL-6 in obese and non-obese group were found as 22.61±12.53 and 21.08±14.39, respectively (p=0.624). There was no significant difference between EBC NO levels of the obese group and non-obese group (24.35±10.9 vs. 21.56±7.83; p=0.226). No significant difference was found between the EBC LTB-4 level in the obese group and the non-obese group (36.39±89.82 vs. 16.64±17.45; p=0.231). CONCLUSION: Increased systemic inflammation in obese individuals who had no respiratory symptoms might indicate the tendency of asthma. However, airway inflammation was not significantly different between groups. Therefore the relationship between obesity and asthma should be investigated in future large-scale studies determining the direct effects of adipokines on airways.

Ultrasonographic measurement of the diaphragm thickness in patients with obstructive sleep apnea syndrome.

PURPOSE: The aim of this study was to evaluate the diaphragm thickness in patients with obstructive sleep apnea syndrome (OSAS). METHODS: This prospective study included patients who underwent polysomnography evaluation for the first time with a clinical suspicion of OSAS. All patients underwent polysomnographic evaluation with a 55-channel Alice 6 computerized system (Respironics; Philips, IL). Diaphragm thickness was measured as the distance between the peritoneum and the pleura using electronic calipers with a 7-12-MHz linear probe (PHILIPS EPIQ 5G). RESULTS: A total of 108 patients (67 males, 41 females) were enrolled in the current study. The mean age of the patients was 48.92 ± 11.47 years. The diaphragm thicknesses were significantly higher in OSAS patients both at end-inspirium and end-expirium compared with the normal group (p < 0.05). No significant difference was observed regarding the change level and thickening ratio (%) (p > 0.05). When the patients were allocated into OSAS subtypes; diaphragm thicknesses at the end of inspirium and expirium on both sides were significantly higher in the severe OSAS group and OSAS+OHS group compared with the other groups of normal, mild OSAS, and moderate OSAS subgroups (p < 0.05 for all). There was no significant difference between the groups regarding the thickening ratio (p > 0.05 for all). There was a positive correlation between the severity of OSAS and diaphragm thickness. CONCLUSION: Diaphragm thickness seems to be increased in OSAS patients and the thickness correlates with the severity of OSAS. However, the thickness ratio of OSAS patients does not differ from that of normal subjects.

Association Between 25-Hydroxyvitamin D and Bone Mineral Density in People With Obstructive Sleep Apnea Syndrome.

The aim of this study was to evaluate the association between bone mineral density (BMD) and 25-hydroxyvitamin D [25(OH) D] levels in patients with obstructive sleep apnea syndrome (OSAS). This study was designed as a cross-sectional and observational study. Patients who underwent polysomnography evaluation were classified as normal, mild, moderate, severe, or position-dependent OSAS, and OSAS + obesity hypoventilation syndrome (OHS). BMD was measured with the dual-energy X-ray absorptiometry method at the femur and lumbar spine. The chemiluminescence microparticle immunoassay was used for the measurement of 25(OH) D levels. A total of 126 patients (73 males, 53 females) with a mean age of 48.55 ± 11.8 years were included. Body mass index was significantly higher in the OSAS + OHS group than in the other groups (p < 0.01). There was no statistically significant difference between the groups in terms of total BMD, T-scores and Z-scores of the lumbar spine, femural neck, and total femur (p > 0.05 for all). Post hoc analyses showed that OSAS + OHS subgroup had lower level of 25(OH) D compared to the normal subjects (p = 0.006). Yet no significant difference was observed between the other OSAS groups. No significant correlation was observed between the apnea hypopnea index, the Epworth Sleepiness Scale scores, desaturation index, and BMD parameters (all for p > 0.05). While 25(OH) D levels were lower in OSAS + OHS patients, there was no statistically significant relationship between OSAS and BMD values.

Association of Acromegaly and Central Sleep Apnea Syndrome.

Acromegaly is usually characterized by the excessive secretion of growth hormone (GH) after the closure of epiphyseal plaques, resulting from functional pituitary adenomas. The most common manifestations of acromegaly are acral and soft tissue overgrowth, diabetes mellitus, hypertension, and heart and respiratory failure. In patients, obstruction of the upper airway may develop due to enlargement of the tongue and thickening of the tissues of the larynx; consequently, obstructive sleep apnea syndrome (OSAS) occurs commonly in acromegaly. Previous studies have shown an association between acromegaly and central sleep apnea syndrome (CSAS). Some of these described patients described showed that an elevation in the GH level may cause a defect in the respiratory drive. Most systemic diseases seen in acromegaly require effective treatment. We believe that it is necessary to perform effective treatments by examining respiratory disorders in sleep.

Monocyte Count/HDL Cholesterol Ratio and Cardiovascular Disease in Patients With Obstructive Sleep Apnea Syndrome: A Multicenter Study.

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is an independent risk factor for cardiovascular disease (CVD). Although monocyte to high-density lipoprotein cholesterol ratio (MHR) is increasingly being implicated in cardiovascular morbidity and mortality, no study has attempted to determine the role of MHR in cardiovascular morbidity of patients with OSAS. We aimed to investigate the association between MHR and CVD in patients with OSAS and the relationship between severity of OSAS, polysomnographic parameters, and MHR. METHODS: In this cohort study, patients who had undergone a full-night polysomnography for the diagnosis of OSAS were recruited. Included patients were grouped according to the apnea-hypopnea index (AHI) as mild (5-15), moderate (15-30), and severe (>30) OSAS. Patients with AHI < 5 served as the control group. The presence of heart failure, coronary artery disease, or arrhythmia was defined as CVD. RESULTS: A total of 1050 patients were included (131 controls, 222 mild, 228 moderate, and 469 severe OSAS). The severe group had higher MHR compared with the control and other OSAS groups (9.99, 12.11, 13.65, and 20.67 in control, mild, moderate, and severe OSAS groups, respectively, P < .001). The MHRs were significantly correlated with AHI, oxygen desaturation index, and minimum O2 saturation values ( P < .001). Values of MHR were significantly higher in patients with CVD compared with those without ( P < .001). Multiple regression analysis demonstrated that MHR is an independent predictor of CVD. CONCLUSION: The MHR is strongly associated with CVD and the severity of OSAS and might be used as a biomarker to predict CVD in patients with OSAS.