Different polysomnographic patterns in military veterans with obstructive sleep apnea in those with and without post-traumatic stress disorder.

INTRODUCTION AND OBJECTIVES: Obstructive sleep apnea (OSA) is a prevalent disorder among military veterans. The goal of this study is to compare the polysomnographic patterns of OSA in military veterans who have a history of post-traumatic stress disorder (PTSD) with those of veterans who have not PTSD. MATERIALS AND METHODS: Seventy-two Iranian military male veterans were classified into two groups: those with PTSD (40 cases) and those without PTSD (32 cases). Each participant was diagnosed with OSA using an overnight polysomnography, during which sleep-related parameters such as sleep efficiency (SE) and apnea-related events were detected. The body mass index (BMI) and Epworth Sleepiness Scale (ESS) were also assessed. RESULTS: For the PTSD group, mean age was 53.83 ± 7.3 years, elapsed time since they participated in war was 28.3 ± 3.4 years, apnea-hypopnea index (AHI) was 41.2 ± 27, SE was 77.7 ± 17.55%, ESS was 7.93 ± 2.04, BMI was 26.5 ± 5.7, and PLM index was 12.725 ± 8.64. The above respective parameters for the non-PTSD group were 51.33 ± 5.9 years, 28.3 ± 3.4 years, 30.33 ± 14.7, 82.4 ± 15.65%, 10.08 ± 3.02, 31.5 ± 6.7, and 8.8 ± 3.54. The relationships of AHI with ESS and BMI were not significant in PTSD group. CONCLUSION: OSA in military veterans suffering from PTSD presents more often with insomnia than obesity or increased daytime sleepiness. These findings are different from those typically seen in non-PTSD veterans with OSA.

The correlation of anxiety and depression with obstructive sleep apnea syndrome.

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is a common sleep disorder characterized by repeated upper airway obstruction during sleep. While respiratory pauses followed by loud snoring and daytime sleepiness are the main symptoms of OSAS, the patients may complain from sleep disruption, headache, mood disturbance, irritability, and memory impairment. However, the association of sleep apnea with anxiety and depression is not completely understood. Adherence to continuous positive airway pressure (CPAP), the treatment of choice for OSAS, may be influenced by psychological conditions, especially claustrophobia. The aim of this study was to evaluate the association of OSAS with anxiety and depression symptoms. This study also investigated the association of anxiety with body mass index (BMI) and the severity of OSAS. MATERIALS AND METHODS: We conducted a cross-sectional study on 178 adult individuals diagnosed with OSAS at the sleep laboratory between September 2008 and May 2012. The participants were interviewed according to a checklist regarding both their chief complaints and other associated symptoms. The psychological status was assessed according to Beck anxiety inventory (BAI) and Beck depression inventory (BDI) scoring. The severity of breathing disorder was classified as mild, moderate, and severe based on apnea-hypopnea index (AHI) which was ascertained by overnight polysomnography. Daytime sleepiness was assessed by Epworth sleepiness scale (ESS). RESULTS: The mean (SD) age of participants was 50.33 years. In terms of sex, 85.5% of the study population were males and14.4% were females. We found no relation between sex and the symptoms of OSAS. Regarding the frequency of anxiety and depression symptoms, 53.9% of the individuals had some degree of anxiety, while 46.1% demonstrated depressive symptoms. In terms of OSAS severity, this study showed that OSAS severity was associated with the frequency of anxiety, chocking, and sleepiness (P : 0.001). According to polysomnographic results, we found that the majority of patients suffering from anxiety and chocking (66.7% and 71.4%, respectively) had severe OSAS, while only 23.1% of patients with sleepiness had severe OSAS. CONCLUSION: Our study showed that the frequency of anxiety in OSAS patients is higher than in the general population regardless of the gender. Furthermore, it is more likely that OSAS patients present with anxiety and depression than the typical symptoms.

Human chorionic gonadotropin increases ß-cleavage of amyloid precursor protein in SH-SY5Y cells.

Elevated levels of amyloid-ß (Aß) peptides, the main component of amyloid plaques in Alzheimer's disease, are the result of excessive ß- and γ-cleavage of the amyloid precursor protein (APP) and/or impaired Aß clearance in the brain. It has been suggested that high concentrations of luteinizing hormone (LH) in women contribute to increased Aß generation after menopause, but the mechanism for this is incompletely understood. We investigated the effect of human chorionic gonadotropin (hCG), an LH receptor agonist, on APP ß-cleavage in the SH-SY5Y neuroblastoma cell line. Treatment of these cells with hCG-induced elevated ß-cleavage in a dose-dependent manner: administration of 30 mIU but not 10 mIU/ml of hCG significantly increased sAPPß levels in the cell medium 1.7-fold as measured by ELISA. These results support the notion that LH contributes to elevated Aß levels at least in part by increasing ß-cleavage of APP by ß-site APP cleaving enzyme.

The effect of smoking by family members and friends on the incidence of smoking among high school students.

OBJECTIVE: Smoking is the most important preventable cause of death. According to the global youth tobacco survey (GYTS) presented by WHO, 25% of smokers smoked their first cigarette before the age of 10; hence, it is of great importance to investigate the effect of smoking of family members and friends on smoking incidence of adolescents. MATERIALS AND METHODS: This analytic cross-sectional study was conducted on the basis of GYTS questionnaire. The studied population consisted of 3000 high school students who were selected randomly. Data was collected by applying the questionnaires which were fulfilled by students anonymously without supervision of school authorities. The results were analyzed with SPSS 11.5 software employing chi-square test. RESULTS: The studied population included 1842 boys (61.4%) and 1158 girls (38.6%) with the mean age of 16.1 years. In terms of smoking habit, 827 students (27.6%) were occasional smokers, 122 students (4.2%) were regular smokers, 518 students (17.3%) used another type of tobacco, and 1533 students (51.1%) were non-smokers. In terms of gender, 77.6% of occasional smokers were males and 22.4% of them were females. At the same time, males and females made up 80.3% and 19.7% of regular smokers, respectively. Also, males and females made up 71.1% and 28.9% of students using another type of tobacco, respectively. In terms of smoker family members and friends, 1860 students (85.6%) of non-smoker students had no smoker in their families and only 313 (14.4%) had at least one smoker in family, while 61.5% of smoker students had at least one smoker family member (p <.001). Similarly, 50.3% of smoker students had a number of smoker friends, while only 13% of non-smoker students had smoker friends. In terms of economic status this study showed that 22.4% of smoker students and 20.7% of non-smoker ones had high pocket money. CONCLUSION: This study showed that the incidence of smoking among high school students significantly correlated with the incidence of smoking among their friendsandfamilymembers (p < 0.001). This study also showed that the economic status (based on the amount of pocket money) has little orno effect on the incidence of smoking among high school students (p value: 0.863).

Tumor necrosis factor alpha and high sensitivity C-reactive protein in diagnosis of exudative pleural effusion.

BACKGROUND: Differentiation between exudative and transudative pleural effusions is the initial step in assessment of pleural effusion. The aim of this study was to determine whether high sensitivity C-reactive protein (hsCRP) and tumor necrosis factor α (TNFα) are diagnostic utilities for exudative pleural effusion. METHODS: This experimental study assessed 79 patients with pleural effusion who underwent diagnostic evaluations at Imam Reza hospital, Mashhad, Iran in 2009-2010. The complete biochemical analysis of pleural fluid, pleural fluid culture, and pathological examination of pleural fluid and tissue were performed. Moreover, hsCRP and TNFα concentrations were measured in pleural fluid samples. The data was analyzed by student's t-test and Mann-Whitney test. RESULTS: According to Light's criteria, 50 patients (63.30%) had exudative effusions while 29 subjects (36.70%) had transudative effusion. The pleural fluid concentrations of hsCRP and TNFα were significantly higher in the exudative group than the transudative group (p < 0.05). At a cutoff value of 5 mg/L for hsCRP, the results showed 94% sensitivity and 96.6% specificity. Regarding TNFα, a cutoff value of 12.9 ng/dl represented 96% sensitivity and 93% specificity. CONCLUSIONS: HsCRP and TNFα levels may be considered as beneficial diagnostic factors for detecting exudative effusion in patients with pleural effusion.