Results of Polysomnographies and Treatment Strategies in Elderly Patients with Symptoms of Obstructive Sleep Apnea Syndrome.

OBJECTIVES: In this study, we evaluated data regarding the management of geriatric patients with symptoms of obstructive sleep apnea syndrome (age, >65 years) who were admitted to our sleep clinic. MATERIAL AND METHODS: Symptoms and sleep data of the patients were retrospectively evaluated, and the patients were reevaluated after treatment. RESULTS: A total of 85 patients with a median age of 69 years were included. Snoring and fatigue were the most common symptoms. Cardiovascular diseases were the most frequently listed comorbidity. The median Epworth sleepiness scale was 10, and based on Berlin sleep questionnaire findings, 63.5% of the participants were in the high-risk group. Eighty-seven percent were diagnosed with obstructive sleep apnea (2/3 of them were positional), and moderate-to-severe obstructive sleep apnea was observed more in women than in men. Only one patient was diagnosed with central sleep apnea. There were positive and linear correlations between increased age and the apnea-hypopnea index, arousal index, Epworth sleepiness scale, and being in a high-risk group according to the Berlin sleep scale; however, there was no correlation between increased age and the number of hypopnea and apnea events. There were also positive and linear correlations between the apnea-hypopnea index and the Epworth sleepiness scale, being in a high-risk group according to the Berlin sleep questionnaire, an increased number of known medical conditions, and increased body mass index. We were able to contact 72 of the 85 patients via phone calls. Patients who adjusted to treatment had positive feedbacks. CONCLUSION: Sleep disorders are observed more in the elderly, and an increasing age is an independent factor for sleep disorders. Besides the usual signs and symptoms of sleep disorders, it should be considered in elderly who have cognitive dysfunction and dementia.

Effects of biomass smoke on pulmonary functions: a case control study.

BACKGROUND: Biomass smoke is the leading cause of COPD in developing countries such as Turkey. In rural areas of Turkey, females are more exposed to biomass smoke because of traditional lifestyles. AIM: The aim of this study was to determine the adverse effects of biomass smoke on pulmonary functions and define the relationship between duration in years and an index (cumulative exposure index) with altered pulmonary function test results. PARTICIPANTS AND METHODS: A total of 115 females who lived in the village of Kagizman (a borough of Kars located in the eastern part of Turkey) and were exposed to biomass smoke were included in the study. The control group was generated with 73 individuals living in the same area who were never exposed to biomass smoke. RESULTS: Twenty-seven (23.8%) females in the study group and four (5.5%) in the control group had small airway disease (P=0.038). Twenty-two (19.1%) females in the study group and ten (13.7%) in the control group had obstruction (P=0.223). Twenty (17.3%) females in the study group who were exposed to biomass smoke had restriction compared with ten (13%) in the control group (P=0.189). The duration needed for the existence of small airway disease was 16 years, for obstructive airway disease was 17 years, and for restrictive airway disease was 17 years. The intensity of biomass smoke was defined in terms of cumulative exposure index; it was calculated by multiplying hours per day, weeks per month, and total years of smoke exposure and dividing the result by three. CONCLUSION: Exposure to biomass smoke is a serious public health problem, especially in rural areas of developing countries, because of its negative effects on pulmonary functions. As the duration and the intensity of exposure increase, the probability of having altered pulmonary function test results is higher.

Timing of noninvasive ventilation failure: causes, risk factors, and potential remedies.

BACKGROUND: Identifying the predictors of noninvasive ventilation (NIV) failure has attracted significant interest because of the strong link between failure and poor outcomes. However, very little attention has been paid to the timing of the failure. This narrative review focuses on the causes of NIV failure and risk factors and potential remedies for NIV failure, based on the timing factor. RESULTS: The possible causes of immediate failure (within minutes to <1 h) are a weak cough reflex, excessive secretions, hypercapnic encephalopathy, intolerance, agitation, and patient-ventilator asynchrony. The major potential interventions include chest physiotherapeutic techniques, early fiberoptic bronchoscopy, changing ventilator settings, and judicious sedation. The risk factors for early failure (within 1 to 48 h) may differ for hypercapnic and hypoxemic respiratory failure. However, most cases of early failure are due to poor arterial blood gas (ABGs) and an inability to promptly correct them, increased severity of illness, and the persistence of a high respiratory rate. Despite a satisfactory initial response, late failure (48 h after NIV) can occur and may be related to sleep disturbance. CONCLUSIONS: Every clinician dealing with NIV should be aware of these risk factors and the predicted parameters of NIV failure that may change during the application of NIV. Close monitoring is required to detect early and late signs of deterioration, thereby preventing unavoidable delays in intubation.

Clinical, radiologic, and functional evaluation of 304 patients with bronchiectasis.

BACKGROUND: Bronchiectasis continues to be one of the major causes of morbidity and mortality in developing countries, with a probably underestimated higher prevalence than in developed countries. OBJECTIVE: To assess the clinical profile of adult patients with bronchiectasis. METHODS: We retrospectively reviewed the clinical, radiologic, and physiologic findings of 304 patients with bronchiectasis confirmed by high-resolution computed tomography. RESULTS: Mean age of participants (45.7% males, 54.3% females) was 56 ± 25 years and 65.8% of them were lifetime non-smokers. Most common identified causes of bronchiectasis were childhood disease (22.7%), tuberculosis (15.5%), and pneumonia (11.5%). The predominant symptoms were productive cough (83.6%), dyspnea (72%), and hemoptysis (21.1%). The most common findings on chest examination were crackles (71.1%) and rhonchi (28.3%). Types of bronchiectasis were cylindrical in 47%, varicose in 9.9%, cystic in 45.1%, and multiple types in 24.3%. Involvement was multilobar in 75.3% and bilateral in 62.5%. Of 274 patients, 20.8% displayed normal pulmonary function test results, whereas 47.4%, 8% and 23.7% showed obstructive, restrictive, and mixed pattern, respectively. Patients with cystic disease had a higher frequency of hemoptysis (42%) and a greater degree of functional impairment, compared to other types. CONCLUSION: In patients with bronchiectasis from southern Turkey, generally presenting with recurrent productive cough, hemoptysis, dyspnea, and persistent bibasilar rales, the etiology remains mainly idiopathic. Post-infectious bronchial destruction is one of the major identified underlying pathological processes. The clinical picture and the deterioration of the pulmonary function test might be more severe in patients with cystic type bronchiectasis.