Microalbuminuria in obstructive sleep apnea syndrome.

OBJECTIVES: Microalbuminuria is an important risk factor for cardiovascular diseases. Microalbuminuria may be seen due to intermittent hypoxemia in patients with obstructive sleep apnea syndrome (OSAS). In this study, we investigated the prevalence and relationship of microalbuminuria with clinical and physiological parameters in patients with OSAS. METHOD: Ninety-eight patients with OSAS and 26 nonapneic snoring subjects upon polysomnography were included in this study. The urinary albumin-to-creatinine ratio (UACR) was calculated according to a previously described formula. The severity index of chronic diseases was evaluated by using the modified cumulative illness rating scale (MCIRS). Insulin resistance (IR) method was analyzed by homeostasis assessment model (HOMA-IR). Subjective sleepiness was assessed using the Epworth sleepiness scale (ESS). RESULTS: Body mass index (BMI), MCIRS, and UACR were higher in patients with OSAS than nonapneic snoring subjects. In linear regression model, there was a negative relationship between UACR and minimal O2, and there was a significantly positive relationship between UACR and desaturation index. CONCLUSION: Microalbuminuria may be seen in patients with OSAS, depending on the severity of disease and hypoxemia. Microalbuminuria in patients with OSAS should be examined in regular periods for risk of cardiovascular morbidity or mortality.

Personality profiles in patients with obstructive sleep apnea.

OBJECTIVE: The Minnesota Multiphasic Personality Inventory (MMPI) responses between snorers and obstructive sleep apnea (OSA) may be different. Thus, we compared the MMPI responses between snorers and OSA. DESIGN: A clinical-based cross-sectional survey. PARTICIPANTS: This is a survey of 94 treatment-naive sleep-disordered breathing (SDB) subjects. METHOD: Clinical information, body mass index (BMI), 36-item Short Form Health Survey, the Turkish version of the MMPI, Epworth sleepiness scale (ESS), fatigue scale, attention-deficit scale, and polysomnography were collected. All patients with OSA and snorers was accepted as individuals with SDB (AHI > 0 events/h). The threshold of five apnea and hypopnea per hour of sleep was chosen to define both OSA and snorers. Disability profile is consisting of four or more MMPI clinical scale elevations. RESULTS: OSA patients compared to snorers have significantly higher absolute scores on hypochondriasis (Hs) (65.0 ± 12.0 vs 58.4 ± 7.9, p = 0.01, respectively). OSA patients compared to snorers have significantly higher rate of clinical elevation on both psychopathic deviance (13.0 vs 0 %, p = 0.03, respectively) and Hs (26.1 vs 3.3 %, p = 0.01, respectively). People with disability profile has lower the quality of life, a higher score for inattention, a higher fatigue scores, and higher sleepiness scores. The quality of life and attention deficit and daytime sleepiness scores were associated with total MMPI absolute score in individuals with SDB in bivariate analyses. CONCLUSION: Present study indicated that patients with OSAS compared to snorers displayed significantly more hyopchondriasis and psychopathic deviance personality characteristics. The daytime functions in individuals with sleep-disordered breathing may be influenced by the severity of psychopathology.

Attention deficit/hyperactivity disorder in adults with sleep apnea.

AAttention deficit hyperactivity disorder (ADHD) is a common childhood illness. In some patients, this illness may persist into adulthood and an association between ADHD and Obstructive Sleep Apnea (OSA) has been found in childhood. However, it is unclear how OSA and ADHD coincide in adulthood. Therefore, to explore the relationship between OSA and adult ADHD the current investigation utilized a clinically-based cross-sectional survey. Subjects consisted of 81 treatment-naïve OSA patients and 32 controls. Measures included each patient completed a questionnaire regarding sleep, Adult ADHD scale. Clinical information, body mass index, 36-item Short Form Health Survey (SF-36), Epworth Sleepiness Scale (ESS), Hospital Anxiety and Depression Scale, and polysomnography.The subjects with Apnea-Hypopnea Index (AHI) ≥ 5 events/h were defined as patients with OSA. The control group was accepted as individuals with AHI > 0 events/h. The prevalence of adult ADHD was not different between the patients with OSA and the control group [(7.4 % (6/75) vs. 6.3 % (2/30), p = 0.8, respectively]. OSA patients with ADHD, as compared with those without, had higher anxiety scores and poorer physical component scores of quality of life and higher ESS scores. ADHD scores in patients with OSA were associated with anxiety and depression scores and SF36 physical and mental component scores in bivariate analyses. Thus, in our sample ADHD was not a frequent illness in adult patients with OSA. However, in patients with OSA and ADHD higher levels of anxiety and daytime sleepiness and poorer quality of life was found.

Case of round pneumonia: pulmonary infarct and a rare situation that is similar with the lung cancer.

BACKGROUND AND AIMS: Round pneumonia (RP) is a rare radiological presentation of a subtype of lobar pneumonia that arises because of a developmental defect in connective tissues (pores of Köhn and channels of Lambert). The round appearance on chest X-ray (CXR) is thought to occur from an infectious process that spreads from small peripheral alveoli centrifugally through interalveolar channels via the pores of Kohn and the canals of Lambert. This explains the nonsegmental distribution and shape of RP. The pathogenesis of RP is unknown. An alternative theory holds that RP in children occurs because of underdeveloped pores of Kohn and the absence of canals of Lambert, limiting the spread of the organism and resulting in a focal, round mass seen on radiographs. As a result of this developmental defect, dissemination of infection remains in a limited area. While this is a well-known entity in childhood, it has been described infrequently in adults. Lesions of RP are not necessarily round; oval lesions can also be seen. It is a radiological subtype of the pneumonia subtype and presents as a solitary nodule or a mass lesion in CXR. METHODS: We presented two cases of RP. One mimicked and was mistaken for pulmonary infarction because of triangular pleural-based density and the other mimicked pulmonary malignancy because of a homogeneous triangular opacity based on the pleura on the posteroanterior radiography and computed tomography. CONCLUSION: These cases were presented because of RP's importance, and RP should be considered a part of differential diagnosis of pulmonary infarct and lung tumor.

Low Cognitive Ability in Subjects With Bronchiectasis.

BACKGROUND: Bronchiectasis may change cognitive function. The mechanism responsible for cognitive dysfunction in COPD may be neuronal damage caused by hypoxia. Cognitive function in patients with bronchiectasis is also likely to be affected by similar mechanisms. The goal of this study was to determine the frequency and determinants of low cognitive ability in subjects with stable bronchiectasis. METHODS: Thirty subjects with stable bronchiectasis and 25 healthy volunteers underwent a cognitive ability assessment using the Wechsler Adult Intelligence Scale. Bronchiectasis was diagnosed by high-resolution computed tomography of the chest. Age, body mass index, the Hospital Anxiety and Depression Scale, and pulmonary function were assessed. Perceived intensity of dyspnea after exercise (after climbing 3 flights of stairs) was estimated using a modified Borg scale. RESULTS: Mean scores on the verbal and performance tests and full-scale IQ scores were significantly lower in subjects with bronchiectasis than in healthy volunteers. Low cognitive ability in subjects with bronchiectasis was associated with higher depression scores, lower oxygen saturation, and poor lung function after adjusting for potential confounders in multivariate analysis. Borg scores after exercise in subjects with bronchiectasis and low cognitive ability were higher than those in subjects with bronchiectasis and high cognitive ability, despite similar PaO2 and FEV1 in both groups. CONCLUSIONS: Low cognitive ability in subjects with bronchiectasis may be associated with reduced lung function, more serious hypoxemia, and higher depressive symptoms. Subjects with bronchiectasis and low cognitive ability feel more intense dyspnea than do those with high cognitive ability.