Oxygen saturation recovery after 6-minute walk test in patients with idiopathic pulmonary fibrosis.

BACKGROUND: The six-minute walk test (6MWT) is widely used to assess functional capacity and prognosis in patients with idiopathic pulmonary fibrosis (IPF). However, studies on oxygen saturation recovery after the 6MWT in patients with IPF are rare. In our study, we investigated the relationship between oxygen saturation recovery time and dyspnea, fatigue, quality of life, prognostic markers and pulmonary hypertension (PH). METHODS: In this cross-sectional study, IPF patients diagnosed according to current guidelines and followed up in our Interstitial Lung Disease Outpatient Clinic between 2021 and 2022 were included. Demographics, data from spirometry, diffusion capacity measurement, arterial blood gas analysis, transthoracic echocardiography and the 6MWT were recorded. The oxygen saturation recovery time, distance saturation product (DSP), gender-age-physiology (GAP) index and composite physiological index (CPI) scores were calculated. Dyspnea severity was assessed by the modified Medical Research Council (mMRC) and Dyspnoea-12 (D-12) scales, fatigue severity by the Multidimensional Fatigue Inventory (MFI-20) and quality of life by the St George's Respiratory Questionnaire (SGRQ). RESULTS: Fifty IPF patients (34 men, 16 women, age: 66.8 ± 7.3 years) were included in the study. The mean FVC was 77.8 ± 19.3%, the DLCO was 52.9 ± 17.1%, the 6-minute walk distance (6MWD) was 385.7 ± 90.6 m, the GAP index was 3.5 ± 1.5, and the CPI was 43.7 ± 14.1. Oxygen saturation after the 6MWT reached pretest values at an average of 135.6 ± 73.5 s. The oxygen saturation recovery time was longer in patients with higher GAP index scores (Rs = 0.870, p < 0.001), CPI scores (Rs = 0.906, p < 0.001), desaturation (Rs = 0.801, p < 0.001), FVC%/DLCO% (Rs = 0.432, p = 0.002), sPAP (Rs = 0.492, p = 0.001), TRV (Rs = 0.504, p = 0.001), mMRC (Rs = 0.913, p < 0.001), MFI-20 (Rs = 0.944, p < 0.001), D-12 scale (Rs = 0.915, p < 0.001) and SGRQ scores (Rs = 0.927, p < 0.001); lower FVC (%) (Rs=-0.627, p < 0.001), DLCO (%) (Rs=-0.892, p < 0.001), PaO2 (Rs=-0.779, p < 0.001), DSP (Rs=-0.835, p < 0.001), and 6MWD (Rs=-0.763, p < 0.001). A total of twenty patients (40%) exhibited an increased risk of PH. According to our multiple regression analysis, oxygen saturation recovery time was independently associated with the GAP index (p = 0.036), the lowest oxygen saturation occurring during the 6MWT (p = 0.011) and the SGRQ score (p < 0.001). CONCLUSIONS: Our results showed that oxygen saturation recovery time is associated with dyspnea, fatigue, quality of life, increased risk of PH and prognostic markers in IPF. Therefore, we recommend continuous measurement of oxygen saturation after 6MWT until pretest values are reached.

Asthma-chronic obstructive pulmonary disease overlap: Results from a national-multicenter study.

Introduction: Patients with asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) have a greater disease burden than those with COPD or asthma alone. In this study, it was aimed to determine the prevalence, risk factors, and clinical features of ACO because there are limited national data in Türkiye. Materials and Methods: The study was conducted in a cross-sectional design in nine tertiary-care hospitals. The patients followed with a diagnosis of asthma or COPD for at least one year were enrolled in the study. The frequency of ACO and the characteristics of the patients were evaluated in the asthma and COPD groups. Result: The study included 408 subjects (F/M= 205/203, mean age= 56.24 ± 11.85 years). The overall prevalence of ACO in both groups was 20.8% (n= 85). The frequency was higher in the COPD group than in the asthma group (n= 55; 33.3% vs. n= 22; 9.8%), respectively (p= 0.001). Patients with ACO had similarities to patients with COPD in terms of advanced age, sex, smoking, exposure to biomass during childhood, being born in rural areas, and radiologic features. Characteristics such as a history of childhood asthma and allergic rhinitis, presence of chronic sinusitis, NSAID hypersensitivity, atopy, and high eosinophil counts were similar to those of patients with asthma (p<0.001). The annual decline in FEV1 was more prominent in the ACO group (mean= -250 mL) than in the asthma (mean change= -60 mL) and COPD (mean change= -230 mL) groups (p= 0.003). Conclusions: This study showed that ACO was common among patients with asthma and COPD in tertiary care clinics in our country. ACO should be considered in patients with asthma and COPD who exhibit the abovementioned symptoms.

Interstitial lung disease in patients with systemic lupus erythematosus: a cohort study.

BACKGROUND: Systemic lupus erythematosus (SLE) is an autoimmune disease with a variety of organ/system involvement. Respiratory system involvement is common in these patients and usually manifests itself by disorders of the lung parenchyma, pleura, pulmonary vasculature or diaphragm. In this study, we sought to determine the frequency of interstitial lung disease (ILD) in patients with SLE and associated risk factors. METHODS: Three hundred randomly chosen patients with SLE were included. Chest x-ray (CXR), lung spirometry and carbon monoxide diffusion test (DLCO) were performed. High-resolution thorax computed tomography (HRCT) was performed for a definite diagnosis of ILD. . RESULTS: Of 300 patients, 16% had ILD. At the start of the study, the prevalence obtained from the patients' records showed that 4% had ILD. The median age, mean duration of disease, and follow-up time were significantly higher and longer in patients with ILD compared to patients without (p < 0.05). Forced expiratory volume (FEV1), forced vital capacity (FVC), DLCO and total lung capacity (TLC) were significantly lower in patients with ILD (p < 0.001). Patients with ILD had a significantly higher frequency of arthritis, serositis, Raynaud's phenomenon, myositis, and anti-Scl70 positivity (p = 0.01, 0.001, 0.02, 0.004, and 0.001, respectively). A significantly higher number of patients had stopped using hydroxychloroquine (HCQ) in the ILD group (p = 0.04).

Respiratory Muscle Endurance in Obesity Hypoventilation Syndrome.

BACKGROUND: An increase in respiratory work load and resistance to respiration cause a decrease in respiratory muscle endurance (RME) in patients with obesity hypoventilation syndrome (OHS). We aimed to evaluate and compare RME in subjects with OHS and a control group using an incremental load test and compare the RME of subjects with OHS in whom noninvasive ventilation (NIV) was and was not used. METHODS: Forty subjects with OHS (divided according to body mass index [BMI] as group I: 30-40 kg/m2; and group II: ≥ 40 kg/m2) and 20 subjects with obesity (control group: 30-40 kg/m2) were included in the study. RME was evaluated using the incremental load test, and respiratory muscle strength (RMS) was evaluated using mouth pressure measurements. The 6-min walk test, Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Fatigue Severity Scale (FSS), EQ-5D Health-Related Quality of Life Questionnaire (EQ-5D), and the Obesity and Weight-Loss Quality of Life Instrument (OWLQOL) were performed. RESULTS: RME and RMS (%) in group I were lower than the control group (P = .001, P = .005, and P = .001, respectively). No significant difference was found between the 3 groups in terms of 6-min walk distance (6MWD) percentage predicted values (P = .98). RME in the NIV user group was higher than the non-user group (P = .006). ESS, total PSQI, and FSS scores in the control group were less than group I (P = .01, P = .009, and P = .005, respectively) and group II (P = .01, P < .001, and P < .001, respectively). The EQ-5D scores of the control group were higher than group II only (P = .005 and P = .005, respectively). There were no differences in OWLQOL between the groups (P = .053). CONCLUSIONS: RME was low in subjects with OHS but higher in those who used NIV. The incremental load test could be performed easily and safely in a clinic setting.

Validity and reliability of the Turkish version of "the Dyspnea-ALS-Scale (DALS-15)".

AIM: The aim of this study was to investigate the validity and reliability of the Turkish version of The Dyspnea-ALS-Scale (DALS-15). METHODS: Forward translation, back translation, and cross-cultural adaptation were used to ensure the equivalency of translated version of the scale. Then, patients with amyotrophic lateral sclerosis (ALS) who have dyspnea or orthopnea that develops with effort or at rest were evaluated using DALS-15 via online surveys. The respiratory subscale of ALS Functional Rating Scale-Revised (ALSFRS-R) and Modified Borg Dyspnea Scale (MBDS) was used to investigate the construct validity of the Turkish DALS-15. Reliability was assessed with Cronbach's α and inter-item correlation matrix (internal consistency). RESULTS: We have included 52 ALS patients in the study. Findings showed that Turkish version of DALS-15 was highly correlated with respiratory subscale of ALSFRS-R (r = - 0.668; p = < 0.0001) and MBDS (for upright position: r = 0.728; p = < 0.0001 and for supine: r = 0.78; p = < 0.0001). The scale did not show any ceiling or floor effect. Also, DALS-15 had a high level of Cronbach's α (0.95) and internal consistency (ICC: 0.949; 95%CI: 0.92-0.96). Test-re-test reliability of the questionnaire was (ICC: 0.909; 95% CI: 0.81-0.95). The standard error of measurement value was 2.76, whereas the minimal detectable change score was 7.66 points for the translated version of the scale. CONCLUSIONS: The Turkish version of DALS-15 possesses strong psychometric properties with excellent validity and reliability. It is shown to be useful for online self-assessment, outside of the clinical settings, especially in hard times such as a pandemic.

The Investigation of Falls and Balance from the Perspective of Activities of Daily Living in Patients with COPD.

The aim of this study was (1) to compare the activities of daily living (ADLs), perceived falling risk and balance in chronic obstructive pulmonary disease (COPD) patients with or without falling history and (2) to investigate the relationship between ADLs and balance. Fourteen patients with COPD with a history of falling whose mean falling frequency was 2.64 ± 0.74 times in the last 12-months (fallers) and 14 age and sex-matched patients with COPD with no history of falling (non-fallers) were included. The outcome measures were the London Chest Activity of Daily Living (LCADL) scale, Activities-Specific Balance Confidence (ABC) scale, Berg Balance Scale (BBS), 6-minute walking test, and quadriceps-femoris strength. Fallers reported increased dyspnoea perception in ADLs, decreased balance confidence, and disturbed balance compared with non-fallers (p < 0.05). A strong correlation was found between the LCADL scale item score (dressing the upper body) and the BBS total score (rho = -0.81, p = 0.001) in fallers. The LCADL scale item score (going out socially) was significantly correlated with the total score of the ABC scale (rho = -0.61, p = 0.001). Moderate correlations were found between the LCADL scale item scores (dressing the upper body, washing hair, and walking up stairs) and the BBS total score (p < 0.003). This study demonstrated that increased severity of dyspnoea perception during ADLs is associated with impaired balance and poor balance confidence, regardless of functional capacity and peripheral muscle strength in patients with COPD. The balance confidence was low in functional mobility-based activities in patients with COPD with a history of falling.

Diaphragmatic dysfunction at the first visit to a chest diseases outpatient clinic in 500 patients with amyotrophic lateral sclerosis.

INTRODUCTION: In this study, we aimed to evaluate diaphragmatic dysfunction (DD) by using a practical approach in patients with amyotrophic lateral sclerosis (ALS) at the first visit to a chest diseases outpatient clinic. METHODS: Patients with ALS seen in our outpatient clinic for the past 5 y and followed up for at least 1 y, were retrospectively evaluated. Having at least one of the following three criteria was accepted as DD: (a) paradoxical abdominal movement (PAM), (b) sitting-supine forced vital capacity (FVC) difference ≥ 20%, (c) sitting-supine arterial oxygen saturation measured by pulse oximetry (SpO2 ) difference ≥ 4%. Respiratory symptoms, arterial blood gas analysis, sleep studies, noninvasive mechanical ventilation use, and mortality were recorded. RESULTS: Five-hundred patients with ALS were included (female/male: 220/280, age: 58.9 ± 11.3 y). Of the patients, 22.8% had daytime hypercapnia. DD was observed in 55% of the patients (PAM in 112, sitting-supine FVC difference ≥ 20% in 50, and sitting-supine SpO2 difference ≥ 4% in 113 patients). Of the patients with DD, 31.6% (n = 87) had no respiratory symptoms, 46.4% had FVC > 70% and 33.5% had FVC <50%. Nocturnal hypoxemia (sleep time spent with SpO2 < 90% ≥30%) was present in 59.7%, and all patients with nocturnal hypoxemia had DD. Obstructive sleep apnea (8 severe, 14 moderate, 39 mild) was detected in 55% of the patients with polysomnography (n = 61) or polygraphy (n = 50). During follow-up, 52.2% of the patients died. Mean survival time was shorter in patients with DD (P < .001). CONCLUSION: Paradoxical abdomimal movement (PAM), sitting-supine SpO2 difference ≥ 4% and sitting-supine FVC difference ≥ 20% are indicators of DD, which should be routinely evaluated at every outpatient visit.

Frequency of Obstructive Sleep Apnea in Stage I and II Sarcoidosis Subjects Who Had No Corticosteroid Therapy.

OBJECTIVES: The number of studies on the frequency of obstructive sleep apnea (OSA) in subjects with sarcoidosis is low. Therefore, we aimed to investigate the frequency and predictors of OSA in subjects with clinically stable stage I and II sarcoidosis who were not taking corticosteroid and/or immunosuppressive drugs. We also evaluated restless legs syndrome (RLS) and periodic leg movements in sleep (PLMS). MATERIALS AND METHODS: Subjects with clinically stable stage I and II sarcoidosis and not receiving corticosteroid and/or immunosuppressive therapy were included in the study. Upper airway examination, lung function tests (forced vital capacity [FVC], forced expiratory volume in 1 second [FEV1], diffusing capacity of the lungs for carbon monoxide [DLCO]), and polysomnography were performed on all subjects. In addition, subjects' Epworth Sleepiness Scale (ESS) scores and the Pittsburgh Sleep Quality Index (PSQI) were recorded. RESULTS: Of the total number of 46 sarcoidosis subjects (35 women, 11 men; age: 44.4±10.7 years; body mass index (BMI): 29.3±5 kg/m2), 28 (60.9%) were detected with OSA (67.8% mild OSA). The recorded ESS score of the subjects was low (2.6±3.2), whereas the sleep quality was poor in 36.9% of these subjects. Rapid eye movements (REM) related OSA was diagnosed in 14.2% of the OSA subjects. Age was the only factor related to OSA diagnosis in a logistic regression analysis (p=0.048). None of the subjects were diagnosed with RLS and PLMS. CONCLUSION: OSA is common in stage I and II sarcoidosis subjects who did not receive corticosteroid therapy. The frequency of OSA diagnosis increases as the age of the subjects increases. Therefore, sarcoidosis subjects should be evaluated for OSA throughout the follow-up.

Comparison of arterial and venous blood gases in patients with obesity hypoventilation syndrome and neuromuscular disease.

OBJECTIVES: Obesity hypoventilation syndrome (OHS) and some neuromuscular diseases (NMD) present with hypercapnic respiratory failure. Arterial blood gas (ABG) analysis is important in the diagnosis, follow-up, and treatment response of these diseases. However, ABG sampling is difficult in these patients because of excessive subcutaneous fat tissue, muscle atrophy, or contracture. The aim of this study is to investigate the value of venous blood gas (VBG), which is an easier and less complicated method, among stable patients with OHS and NMD. METHODS: The study included stable OHS and NMD patients who had been previously diagnosed and followed up between March 2017 and May 2017 in the outpatient clinic. ABG was taken from all patients in room air, and peripheral VBG was taken within 5 min after ABG sampling. RESULTS: Thirty-six patients with OHS and 46 patients with NMD were included in the study. There was a moderate positive correlation between arterial and venous pH values for all patients (r s = 0.590, P < 0.001). There were a strong and very strong positive correlations between arterial and venous pCO2 and HCO3 values (r s = 0.725 and r s = 0.934, respectively) (P < 0.001). There was no correlation between arterial and venous pO2 and saturation values. There was an agreement in Bland-Altman method for the values of ABG and VBG (pH, pCO2, and HCO3). CONCLUSIONS: There was a correlation between ABG and VBG values (pH, pCO2, and HCO3). VBG parameters (pH, pCO2, and HCO3) can be used safely instead of ABG parameters which have many risks, during treatment and follow-up of patients with OHS and NMD.

Are home sleep studies useful in diagnosing obstructive sleep apnea in children with down syndrome?

INTRODUCTION AND AIM: Obstructive sleep apnea syndrome (OSAS) is frequent in children with Down syndrome (DS) and polysomnography (PSG) is recommended for all children with DS. However PSG is not always available and alternative diagnostic methods are needed. The aim of the study was to evaluate the feasibility and validity of home polygraphy (HPG) in children with DS. METHODS: A national DS association was contacted and children aged 6 to 18 years who accepted to participate were recruited. Otorhinolaryngologic evaluation, in-lab PSG and HPG were performed. OSAS was diagnosed by PSG with an apnea-hypopnea index (AHI) more than or equal to 1. OSAS severity was classified as moderate-to-severe if AHI was more than or equal to 5. Receiver operating characteristic curves were calculated for HPG using PSG as the gold standard. RESULTS: Nineteen children (12 girls) completed the study. Median age was 11.3 years. Demographic and clinical characteristics were similar in children with and without OSAS. Eighty-nine percent of HPG studies were technically acceptable at the initial night and the success rate was 100% when two failed studies were repeated. PSG revealed OSAS in six (32%) children, two had mild and four had moderate-to-severe OSAS. All four patients with moderate-to-severe OSAS diagnosed with PSG have been diagnosed with the same severity on HPG. HPG had 100% sensitivity and 83% specificity when AHI ≥ 3 was set as diagnostic criteria. CONCLUSION: HPG is a feasible and reliable test of OSAS in children with DS and may be useful in diagnosis and treatment of patients with moderate-to-severe OSAS in this patient group.

Leptin and adiponectin levels in obstructive sleep apnea phenotypes.

Objective: To examine the serum levels of leptin and adiponectin in different obstructive sleep apnea (OSA) phenotypes. Methods: Obese patients who were admitted to our sleep laboratory were included. All patients underwent spirometry, daytime arterial blood gas analysis, polysomnography and transthoracic echocardiography. Serum levels of adiponectin and leptin were recorded. Results: Analysis included 146 OSA patients (81 females, 65 males, age: 49.8 ± 10.7 years, body mass index: 40.3 ± 4.9 kg/m2, 47.9% severe OSA, 42.5% severe obesity). Females had higher leptin and adiponectin levels (p < 0.001; p < 0.001, respectively). Leptin levels were higher in patients with severe obesity (p < 0.001). Severe OSA patients had lower leptin and adiponectin levels (p = 0.023; p = 0.035, respectively). Conclusion: Adipokine levels were different especially in OSA patients with severe obesity, female gender and severe OSA.

Turkish Thoracic Society Consensus Report: Interpretation of Spirometry.

ÖZET: Günümüzde spirometre ölçümlerinin uygulama ve yorumlama nitelik güvencesi "American Thoracic Society / European Respiratory Society" standartlari ile belirlenmistir. Dünyada oldugu gibi ülkemizde de birçok laboratuvar bu standartlari kullanmaktadir. Buna karsin, farkli laboratuvarlardan farkli degerlendirme sonuçlari görebilmek mümkündür. Bu rapor, ülkemizdeki solunum fonksiyon testi laboratuvarlarinda yapilan degerlendirmelerin standardizasyonunu saglamak amaci ile hazirlanmistir.

Serum endocan levels in patients with stable COPD.

BACKGROUND: Endothelial cell specific molecule-1, also called as endocan, is a dermatan sulfate proteoglycan, which is expressed by endothelial cells in alveolar walls of the lung and kidney. High endocan levels are found associated with endothelial dysfunction and inflammation. We hypothesize that endocan level is also high in COPD due to systemic inflammation and endothelial dysfunction. We aimed to investigate the expression of endocan in patients with stable COPD. MATERIAL AND METHODS: The study included patients with COPD and control subjects. COPD patients were classified according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017 criteria. Demographics, body mass index, smoking history, and comorbidities were recorded. Endocan levels of COPD patients and controls were compared. RESULTS: Totally, 88 subjects (47 stable COPD patients, 41 controls) were evaluated. Endocan levels were significantly higher in COPD patients than control group (860.1±259.8 vs 647.3±316.9 pg/mL, P=0.001). There was no relationship between GOLD COPD categories and endocan levels. Also endocan levels were similar between COPD patients with or without hypoxemia. CONCLUSION: Serum endocan level was significantly higher in patients with stable COPD. Further studies should be performed to better understand the relationship between endocan and COPD.

Pulmonary functions and sleep-related breathing disorders in lipid storage disease.

PURPOSE: Pulmonary function abnormalities and sleep-related breathing disorders (SRBD) are frequent in subjects with several neuromuscular diseases but there is no data about lipid storage diseases (LSD). Therefore, we aimed to evaluate pulmonary functions and SRBD in adults with LSD. METHODS: Pulmonary functions (forced expiratory volume (FEV1), forced vital capacity (FVC), supine FVC, upright-supine FVC% change, maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), peak cough flow (PCF)), arterial blood gases, and polysomnographic data of all subjects were evaluated. RESULTS: Twenty-five subjects with LSD were evaluated [17 males, 8 females; age 34.9 ± 15 years; BMI 26.5 ± 3.4 kg/m2]. MIP was - 72.2 ± 32.7 cmH2O (< - 80 cmH2O in 13 subjects), MEP was 80.9 ± 39.1 cmH2O (< 80 cmH2O in 9 subjects, < 40 cmH2O in 6 subjects), and PCF was 441.3 ± 190.9 L/min (< 360 L/min in 11 subjects). FVC was 87.8% ± 25.7 and 6 subjects had FVC < 80%. Seven subjects had diaphragm dysfunction (four upright-supine FVC% ≥ 15, three dyspnea in supine position with paradoxical abdominal respiration). Five subjects had hypoxemia (PaO2 < 80 mmHg) and 8 subjects had hypercapnia (PaCO2 > 45 mmHg). REM sleep had decreased in all subjects (10.2% ± 6.1). Obstructive sleep apnea (OSA) was found in 80% of the subjects (n = 20; 9 mild, 9 moderate, 2 severe). For subjects with OSA, apnea-hypopnea index (AHI) was 20.8 ± 15.9/h, oxygen desaturation index (ODI) was 11.9 ± 15.4/h, AHIREM was 30.6 ± 19.7/h, AHINREM was 19.7 ± 16.6/h, ODIREM was 27.2 ± 26.1/h, and ODINREM was 11.4 ± 15/h. Five subjects (20%) diagnosed as REM-related OSA. Nocturnal mean SpO2 was 94.9% ± 1.7, lowest SpO2 was 73.3% ± 13.9, and time spent with SpO2 < 90% was 2.4% ± 7.2. CONCLUSION: In subjects with LSD, pulmonary function impairment, daytime hypercapnia and hypoxemia, and OSA, especially REM-related OSA, are frequent. Therefore, pulmonary functions and polysomnography should be performed routinely.

The role of an activity monitor in the objective evaluation of patients with pulmonary hypertension.

INTRODUCTION: Patients with pulmonary hypertension (PH) show no symptoms at rest, but symptoms are triggered by physical activities. OBJECTIVES: The primary aim of our study was to assess physical activity of patients with PH by using an activity monitor. The secondary aim was to evaluate the correlation between the activity monitor parameters and 6-min walk distance (6MWD), activity of daily living (ADL), quality of life, WHO functional class and PH classification. METHODS: Thirty-eight patients with pulmonary arterial hypertension (PAH) and seven patients with chronic thromboembolic PH were included in the study. Physical activity was assessed using a SenseWear arm band. A 6-min walk test was performed. Daily living activities were assessed using the 'nottingham extended activity of daily living index' (NEADL). For quality of life assessments, 'Minnesota living with heart failure' (MLHF) and 'Short form-36' (SF-36) surveys were used. RESULTS: Physical activity, exercise capacity, quality of life and contribution to ADL were lower in patients with PH. These data were associated with the 6MWD, quality of life and ADL index scores. We also found weak and moderate correlations between activity monitor data and SF-36 sub-group scores, MLHF and NEADL scores (P < 0.05). For the group with PAH, idiopathic PAH patients had more exercise capacity and total energy expenditure compared with patients with scleroderma-associated PAH. CONCLUSION: Correlation between activity monitor data and 6MWD, most of SF-36 sub-group scores, MLHF scores and NEADL index scores suggest that activity monitor can be used in the evaluation of patients with PH.

Follow-up of 1887 patients receiving tumor necrosis-alpha antagonists: Tuberculin skin test conversion and tuberculosis risk.

OBJECTIVES: To evaluate the characteristics of patients who developed tuberculosis while receiving tumor necrosis factor-alpha (TNF-α) antagonists and the related factors with tuberculosis. METHODS: Patient's demographics, tuberculin skin test (TST), isoniazid prophylaxis and type of TNF-α antagonist were recorded. TST conversion (≥5 mm increase) was evaluated for patients who had baseline and 1-year TST. RESULTS: Files of 1887 patients who were receiving TNF-α antagonists between August 2005 and June 2015 were evaluated. TST significantly increased at the end of 1 year (n = 748 baseline:7.36 ± 7.2 mm vs. 1 year:9.52 ± 7.5 mm, P < 0.001). One-third of patients (31.2%) who had negative TST at baseline had positive TST at 1 year. Tuberculosis developed in 22 patients (1.16%). The annual incidence of tuberculosis was 423/100 000 patient-year. TNF-α antagonist indications were ankylosing spondylitis (n = 8), inflammatory bovel diseases (n = 7) and rheumatoid arthritis (n = 4). Ten (45.5%) patients received infliximab, six (27.3%) patients received etanercept and six (27.3%) patients received adalimumab. Nineteen (86.4%) patients were under isoniazid prophylaxis. Twelve patients had extrapulmonary tuberculosis (54.5%; four lymph node, three pleura, two periton, one pericarditis, one intestinal, one joint). Atypical mycobacterium was detected in one patient. Adalimumab treatment (9.5× increase), male sex (15.6× increase) and previous tuberculosis disease history (11.5× increase) were risk factors for active tuberculosis. Conversion of TST was not found related with tuberculosis. CONCLUSIONS: Despite the high proportion of isoniazid prophylaxis, the incidence of tuberculosis in our patients receiving TNF-α antagonist was higher than the literature. Adalimumab treatment, male sex and previous tuberculosis disease history were found as risk factors for tuberculosis.

Sleep quality and quality of life in patients with moderate to very severe chronic obstructive pulmonary disease.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is highly associated with obstructive sleep apnea (OSA). Poor sleep quality is found to be related with decreased quality of life (QoL) in patients with COPD but no study assessed this relationship on the basis of nocturnal sleep parameters. OBJECTIVES: The aim of this study is to explore the relationships between sleep quality, daytime sleepiness and QoL in patients suffering from moderate to very severe COPD with and without sleep apnea assessed objectively and to compare sleep quality, QoL and daytime sleepiness in patients suffering from COPD with and without sleep apnea. METHODS: Fifty-one patients with stable moderate to very severe COPD (mean age, 59.8 ± 8.1 years) included in the study. The parameters of polygraphic sleep studies (Stardust II, Philips-Respironics) were noted. Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), The Modified Medical Research Council Dyspnea and SF-36 Health Quality Survey were performed. RESULTS: The rate of OSA was 74.5% (Apnea-Hypopnea Index, >5). out of all the patients, 94% had poor sleep quality (PSQI, >5). Negative correlations were found between PSQI and physical role, social function and mental health of SF-36 subgroups (P < .05). There was no correlation between PSQI, ESS, SF-36, dyspnea and polygraphic parameters (P > .05). In the comparison of patients with or without OSA, the vitality of SF-36 subgroup was found lower in patients with OSA (P < .05). CONCLUSIONS: In conclusion, irrespective of OSA, patients with COPD are suffering from poor sleep quality and poor sleep quality negatively affects the QoL. Also, COPD and OSA association causes worsened vitality in the terms of health-related QoL.

Fractional Exhaled Nitric Oxide Measurement in Pulmonary Hypertension: A Follow-Up Study.

Pulmonary hypertension (PH) is a fatal disease although significant improvements in treatment are achieved. Easily implemented and noninvasive prognostic techniques are needed while following-up these patients. The aim was to investigate the role of fractional exhaled nitric oxide (FeNO) in follow-up for patients with PH. In this longitudinal study, patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic PH (CTEPH) who were seen in PH Outpatient Clinic, Istanbul Faculty of Medicine, Istanbul University, were enrolled in the study. Echocardiography, 6-minute walking test, brain natriuretic peptide, and FeNO measurements were performed, and World Health Organization functional class was evaluated to all patients at baseline, and third, and sixth months. Right-heart catheterization and pulmonary function tests at the time of diagnosis were recorded. The study comprised 31 patients (23 women, 8 men; mean age: 53.4 ± 17.1 years) with PAH (n = 19) and CTEPH (n = 12) and 80 healthy controls. Patients with PH had lower FeNO values than the control group (16.5 ppb vs 19.8 ppb; P < .05). Fractional exhaled nitric oxide values did not change during follow-up and did not correlate with other follow-up measures except tricuspid annular plane systolic excursion values. Fractional exhaled nitric oxide was higher in the idiopathic PAH subgroup at baseline and at third month than patients with PAH associated with other diseases. Fractional exhaled nitric oxide did not change in patients who had clinical deterioration. As a conclusion; Patients with PH had lower FeNO values than healthy controls, but FeNO did not change significantly during follow-up. Large-scale studies with prolonged follow-up periods are needed to understand the role of FeNO in the follow-up of the patients with PH.

The Predictors of Obesity Hypoventilation Syndrome in Obstructive Sleep Apnea.

BACKGROUND: As obesity increases, the frequency of obstructive sleep apnea and obesity hypoventilation syndrome increases also. However, obesity hypoventilation syndrome frequency is not known, as capnography and arterial blood gas analysis are not routinely performed in sleep laboratories. AIMS: To investigate the frequency and predictors of obesity hypoventilation syndrome in obese subjects. STUDY DESIGN: Retrospective clinical study. METHODS: Obese subjects who had arterial blood gas analysis admitted to the sleep laboratory and polysomnography were retrospectively analyzed. Subjects with restrictive (except obesity) and obstructive pulmonary pathologies were excluded. Demographics, Epworth-Sleepiness-Scale scores, polysomnographic data, arterial blood gas analysis, and spirometric measurements were recorded. RESULTS: Of the 419 subjects, 45.1% had obesity hypoventilation syndrome. Apnea hypopnea index (p<0.001), oxygen desaturation index (p<0.001) and sleep time with SpO2<90% (p<0.001) were statistically higher in subjects with obesity hypoventilation syndrome compared to subjects with eucapnic obstructive sleep apnea. The nocturnal mean SpO2 (p<0.001) and lowest SpO2 (p<0.001) were also statistically lower in subjects with obesity hypoventilation syndrome. Logistic regression analysis showed that the lowest SpO2, oxygen desaturation index, apnea hypopnea index and sleep time with SpO2 <90% were related factors for obesity hypoventilation syndrome. CONCLUSION: Obesity hypoventilation syndrome should be considered when oxygen desaturation index, apnea hypopnea index and sleep time with SpO2 <90% are high.

Does Obstructive Sleep Apnea Increase the Risk for Periodontal Disease? A Case-Control Study.

BACKGROUND: A possible association between periodontitis and obstructive sleep apnea (OSA) has been suggested. The aim of this study is to compare periodontitis prevalence between controls and patients with OSA by assessing clinical periodontal parameters and gingival crevicular fluid (GCF) levels of interleukin (IL)-1ß, tumor necrosis factor (TNF)-α, and high-sensitive C-reactive protein (hs-CRP); serum hs-CRP was also sampled. METHODS: A case-control study was performed that included 163 individuals: 83 individuals (18 females and 65 males) with OSA and 80 non-OSA individuals (23 females and 57 males) as controls. The test group was classified according to OSA severity. Clinical periodontal measurements were recorded, and GCF samples were collected. GCF hs-CRP, IL-lß, and TNF-α levels were analyzed using an enzyme-linked immunosorbent assay method. Serum hs-CRP was measured by latex-enhanced immunoturbidimetric assay. RESULTS: Prevalence of periodontitis in the OSA group (96.4%) was significantly higher than in the control group (75% [P <0.001]). Severe periodontitis prevalence was higher in the OSA group than control group. All periodontal clinical parameters and GCF IL-lß concentrations were significantly higher in patients with OSA than in controls (P = 0.001). No significant differences were found between the mild OSA and moderate-to-severe OSA groups. Additionally, there was no significant difference in GCF TNF-α and hs-CRP levels between the groups (P >0.05). Serum hs-CRP levels were significantly higher in patients with OSA. A significant correlation was found between GCF IL-1ß and all clinical parameters. CONCLUSIONS: Results demonstrated higher prevalence of periodontitis and higher levels of GCF IL-1ß and serum hs-CRP in patients with OSA. However, there is still a need for randomized clinical trials testing oral care interventions.