Ocular Surface in Patients With Obstructive Sleep Apnea Syndrome: Evaluation of Clinical Parameters and Impression Cytology.

PURPOSE: To evaluate the effect of obstructive sleep apnea syndrome (OSAS) on the ocular surface and conjunctival cytology and the relationship between the findings and disease severity. METHODS: One hundred six eyes of 106 patients (77 patients with OSAS and 29 control subjects) were included in the study. Twenty-three patients with an apnea-hypopnea index (AHI) of 5 to 15 were classified as mild OSAS (group 1), 27 patients with an AHI of 15 to 30 were classified as moderate OSAS (group 2), and 27 patients with an AHI≥30 were classified as severe OSAS (group 3). The following tests were used to evaluate the ocular surface: tear break-up time (TBUT), Schirmer I test, ocular surface disease index (OSDI), and conjunctival impression cytology (CIC). The results obtained from the tests were analyzed and compared between the groups. RESULTS: The mean value of the Schirmer I test was 15.03±10.16 (1-35) mm in the control group, whereas it was found as 13.39±8.80 (3-35) mm, 9.85±7.81 (1-30) mm, and 9.41±7.53 (2-35) mm in the mild, moderate, and severe OSAS groups, respectively, and the difference between the groups was significant ( P =0.002). Although the mean TBUT score was 9.83±5.03 (3-23) seconds in the control group, it was 11.04±6.22 (3-20), 6.26±3.48 (1-16), and 5.44±3.09 (1-10) in the mild, moderate, and severe OSAS groups, respectively, and the difference between the groups was significant ( P <0.001). Although the mean OSDI score was 12.76±14.84 (range, 0-41.65) in the control group, it was 11.52±12.95 (range, 0-44.40), 25.06±19.45 (range, 0-75), and 20.31±19.87 (range, 0-77.70) in the mild, moderate, and severe OSAS groups, respectively, and the difference between the groups was significant ( P =0.015). Although the mean CIC stage was 0.47±0.60 (0-2) in the control group, it was 0.89±0.74 (0-2), 1.52±0.75 (0-3), and 1.83±0.69 (1-3) in the mild, moderate, and severe OSAS groups, respectively, and the difference between groups was significant ( P <0.001). CONCLUSION: In addition to decreased tear production and TBUT, cytological changes including squamous metaplasia were detected between patients with OSAS and the control group.

Analysis of the relationship between tuberculosis-related mortality and nitrous oxide emission levels in the world with the environmental Kuznets curve method.

BACKGROUND: It was aimed to analyze the relationship between tuberculosis-related mortality and nitrous oxide emission levels in the world with the Environmental Kuznets Curve (EKC) Method. METHODS: WHO ICD-10 mortality list data and the World Bank Country Data (WBCD) were used between 1997 and 2017 for 12 countries. Cubic regression analysis was used for EKC Analysis. RESULTS: The difference between male and female deaths between 1996 and 1998 has increased sharply since 1999. Male deaths consistently occurred significantly more than female deaths. There was a significant and negative correlation between Nitrous oxide emissions (% change from 1990) and tuberculosis-related deaths, whereas there were significant and positive correlations between Nitrous oxide emissions in the energy sector (% of total) and tuberculosis-related deaths (p < 0.01). EKC analysis results showed that there is a U shaped between tuberculosis-related mortality and nitrous oxide emission levels in the world. DISCUSSION: Research results show that the relationship between nitrous oxide change and mortality is negative in the short term and positive in the long term. Therefore, although nitrous oxide gases cause respiratory diseases and mortality, it may be possible to transform a harmful environmental factor into a positive by developing devices or methods that will convert these gases into free radicals.

Evaluation of coagulation with TEG in patients diagnosed COVID-19.

BACKGROUND: A high D-dimer level may indicate the risk of coagulopathy and mortality in COVID-19 patients. T hromboelastography (TEG) is a test that evaluates clot formation and fibrinolysis in real-time, unlike routine coagulation tests. The study aimed to investigate the coagulation process with TEG in patients diagnosed with COVID-19. METHODS: The study was performed at our university hospital, chest diseases outpatient clinic as a cross-section study. A total of 51 patients with 23 high D-dimer levels group (HDG) and 28 low D-dimers group (LDG) were included in the study. TEG analysis was performed at the pretreatment evaluation in these two groups. RESULTS: D-dimer and fibrinogen levels of the HDG were higher than those of the LDG (550 vs. 90 ng/mL, p < 0.001; 521 vs. 269 mg/ dL, p < 0.001, respectively). In TEG analysis, HDG's R and K values were lower than LDG, and HDG's Angle, MA, and CI values were higher than LDG (p = 0.037; p < 0.001; p < 0.001; p < 0.001; p < 0.001, respectively). ROC curve analysis suggested that the optimum TEG parameters cut-off points for thrombosis risk were as below: for K was ≤2.1 min, for R was ≤6.1 min, for Angle was >62°, MA was 60.4 mm.

The investigation of levels of endothelial cell-specific molecule, progranuline, clusterin, and human epididymis protein 4 in the differential diagnosis of malignant pleural effusions.

BACKGROUND: Progranulin (PGRN), endothelial cell-specific molecule-1, clusterin (CLU), and human epididymis protein 4 (HE-4) are novel proteins reported to have diagnostic and prognostic potential in lung cancer. Here, we aimed to identify the markers with high sensitivity and specificity in distinguishing malignant pleural fluids from other pleural fluids. METHODS: This prospective, descriptive study was conducted at a medical faculty hospital between 2016 and 2019. The study population consisted of 90 patients <18 years of age with pleural effusion (PE). Levels of pleural fluids of PGRN, endothelial cell-specific molecule-1, CLU, and HE-4 were measured with enzyme-linked immunosorbent assay kits under the manufacturer's manual. RESULTS: Of 90 patients, 54 were men, and 36 were women (mean age 65 ±â€…16 years). Of pleural fluids investigated, 23 (25%) and 67 (74%) were transudates and exudates, respectively. Of exudates, while 27 (40%) and 19 (28%) were parapneumonic PE and tuberculous PE, respectively, 20 (29%) were malignant pleural effusion (MPE). Levels of all biomarkers in exudate fluids were found significantly higher than those of transudate fluids. CLU, HE-4, and PGRN levels in MPE were also found significantly higher than benign fluids (P < .05). Cutoff values were achieved by receiver operating characteristics analysis for CLU, HE-4, and PGRN to distinguish between malignant and benign groups. For diagnosis of MPE, the sensitivity and specificity values were found as 0.66 and 0.67 for a cutoff value of CLU of 18.29 mg/L (P = .00), as 0.76 and 0.76 for a cutoff value of HE-4 of 9.33 mg/L (P = .00), and as 0.66 and 0.67 for a cutoff value of PGRN of 105.91 mg/L (P = .001). CONCLUSION: HE-4 having high sensitivity and specificity can be a potential diagnostic marker in distinguishing between malignant and benign effusions, and these findings can constitute a basis for future research.

The Relationship between COVID-19 Severity and Bacillus Calmette-Guérin (BCG)/ Mycobacterium tuberculosis exposure history in healthcare workers: a multi-center study.

The COVID-19 pandemic has brought countries' health services into sharp focus. It was drawn to our group's attention that healthcare workers (HCWs) had a lower mortality rate against higher COVID-19 incidence compared to the general population in Turkey. Since risk of exposure to tuberculosis bacillus among healthcare workers are higher than the population, we aimed to investigate if there is a relationship between BCG and Mycobacterium tuberculosis exposure history with COVID-19 severity in infected HCWs. This study was conducted with 465 infected HCWs from thirty-three hospitals to assess the relationship between COVID-19 severity (according to their hospitalization status and the presence of radiological pneumonia) and BCG and Mycobacterium tuberculosis exposure history. HCWs who required hospital admission had significantly higher rates of chronic diseases, radiological pneumonia, and longer working hours in the clinics. Higher rates of history of contact and care to tuberculosis patients, history of tuberculosis, and BCG vaccine were observed in hospitalized HCWs. HCWs who had radiological pneumonia had a significantly increased ratio of history of care to tuberculosis patients and a higher family history of tuberculosis. The findings from our study suggest that the lower mortality rate despite the more severe disease course seen in infected HCWs might be due to frequent exposure to tuberculosis bacillus and the mortality-reducing effects of the BCG vaccine.

Effects of smoking on patients with obstructive sleep apnea syndrome.

OBJECTIVES: We aimed to investigate the relationship between the presence and severity of obstructive sleep apnea (OSAS) and smoking using pulmonary function tests and polysomnographic data. MATERIALS AND METHODS: This analytical cross-sectional study was done by retrospectively examining the files of patients who applied to the Meram Medical Faculty Chest Diseases Sleep Laboratory between 07.01.2016 and 30.12.2018. Three-hundred and thirty-three patients who were diagnosed with OSAS or simple snoring by polysomnography (PSG) were included in the study. RESULTS: Those involved in the study; 17.1% were simple snoring [apnea-hypopnea index (AHI) < 5]; 15.3% were mild OSAS (AHI: 5-15); 30.6% were moderate OSAS (AHI: 16-30); 36.9% were severe OSAS (AHI > 30), and 48.6% of the study participants never smoked. There was a significant correlation between the number of pack-years, minimum O2 saturation, mean O2 saturation, ratio of sleep time to total sleep time with oxygen saturation below 90%, %NREM 3 sleep time, Hb, HTC values, and FEV1/FVC values. According to the results of multiple linear regression analysis; the effect of package-year, age, and BMI on OSAS severity was found to be statistically significant (ß = 0.153 P = 0.004, ß = 0.123 P = 0.025, ß = 0.208 P < 0.001, respectively). CONCLUSION: It was revealed that patients with severe OSAS were heavy smokers, and increased smoking increased the OSAS severity both by increasing the AHI and by reducing the oxygen saturation overnight. One unit increase in the package-year results in a 15.3% increase in the AHI.

Frequency of sarcopenia and associated outcomes in patients with chronic obstructive pulmonary disease

Background/aim: We aimed to evaluate the prevalence of sarcopenia and associated outcomes in patients with chronic obstructive pulmonary disease (COPD). Materials and methods: This cross-sectional study was performed on 219 patients aged 50 years and over who were diagnosed with chronic obstructive pulmonary disease (COPD) according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. The study included 196 (89.5%) male and 23 (10.5%) female patients. The mean age of the patients was 66.9 ± 10.1 years. To diagnose sarcopenia, muscle function was determined by a gait speed test. Muscle strength was assessed with a hand dynamometer and muscle mass was measured with a bioelectrical impedance analysis device. Pulmonary function tests and six-min walking tests were also performed. The modified Medical Research Council (mMRC) dyspnoea scale was used to evaluate all the participants. Our sample consisted of sarcopenic patients at different stages (17 presarcopenic patients (7.8%), 32 patients with sarcopenia (14.6%), 65 patients with severe sarcopenia (29.7%), and 105 nonsarcopenic patients (47.9%). Results: Sarcopenia was significantly associated with age, BODE (body mass index (BMI), airflow obstruction, dyspnoea, and exercise capacity) index, GOLD spirometric classification, mMRC dyspnoea scale score, BMI, and educational status. Sarcopenia in COPD patients was firmly related to the severity of the disease and its prognosis. The prevalence of sarcopenia increased in severe and very severe COPD cases. The dyspnoea score was higher, and exercise capacities were lower in sarcopenic patients. Conclusions: Sarcopenia in COPD patients was closely related to the severity of COPD and a negative prognosis. The frequency of sarcopenia increased in severe and very severe COPD cases. Dyspnoea scores were higher and exercise capacities were lower in patients with sarcopenia. In patients with COPD, a diagnosis of sarcopenia should be considered, and preventive measures should be taken before irreversible changes develop.

Serum S100A12 and S100B proteins are independent predictors of the presence and severity of obstructive sleep apnea

Background/aim: Obstructive sleep apnea (OSA) is associated with serious cardiometabolic risks. Early diagnosis and treatment compliance are important. For this purpose, research is being carried out on biomarkers associated with the pathogenesis of the disease. We aimed to investigate whether serum S100A12 and S100B proteins could be used as biochemical markers in OSA patients to determine disease presence and severity. Materials and methods: A total of 60 (16 women, 44 men) patients with OSA and 50 (20 women, 30 men) controls were enrolled in this cross-sectional study. Each subject included in the study underwent full-night polysomnography (PSG). The presence and severity of OSA was assessed with the apnea­hypopnea index (AHI). In the OSA group, 17 cases were mild, 18 were moderate, and 25 were severe.The serum levels of S100A12 and S100B were measured using the enzyme-linked immunosorbent assay (ELISA) technique. These protein levels were compared using Student's t-test in the patient and control groups. Spearman's rho correlation coefficients and corresponding P-values were calculated to determine the correlations between these protein levels and polysomnographic parameters. For evaluating the association between OSA and biomarkers, as well as possible confounding factors with S100A12 and S100B, we employed multiple linear regression analyses for the patients with OSA Results: Serum levels of S100A12 and S100B were higher in patients than those in controls (P = 0.01 and P = 0.005, respectively), and a significant correlation was determined between S100A12 and S100B values and AHI (P = 0.0001; P = 0.0001), sleep time with SpO2 < 90% (P = 0.032; P = 0.01), minimum SpO2 during sleep (P = 0.019; P = 0.007), and oxygen desaturation index (ODI) (P = 0.001; P = 0.0001). In the linear regression analysis, AHI was independently related with both S100A12 (P < 0.0001) and S100B (P = 0.011). Receiving operating curves (ROC) identified patients with OSA: AUC for S100A12 = 0.643; AUC for S100B = 0.655 (P < 0.05). Conclusion: Serum levels of S100B and S100A proteins have high diagnostic performance in OSA and are independent predictors of OSA presence and severity.

Intact endobronchial hydatid cyst: an unexpected bronchoscopic challenge.

We describe a rare case of intact endobronchial hydatid cyst that posed a diagnostic challenge because of an unusual imaging manifestation (atelectasis) and unexpected bronchoscopic findings. Although the role of bronchoscopy in the management of pulmonary hydatid cyst is still controversial, 6 cases of complicated pulmonary hydatid cyst removed completely by suction through a fiberoptic bronchoscope have been reported so far. To the best of our knowledge, this is the first nonsurgically treated case of intact endobronchial hydatid cyst with an uneventful long-term follow-up.

Role of oxidative stress and serum lipid levels in stable chronic obstructive pulmonary disease.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) has been associated with increased oxidative stress or reduced antioxidant resources. The main goal of this study was to evaluate the levels of serum ischemia-modified albumin (IMA), oxidized low-density lipoprotein (ox-LDL), total oxidant status (TOS), and total antioxidant status in patients with stable COPD, compared with a control group. METHODS: This study was performed on 51 patients with stable COPD (42 men and 9 women; mean age 56.92 ± 3.0 years) and 45 healthy control participants (32 men and 13 women; 54.8 ± 3.8 years). The levels of serum lipids, IMA, total antioxidant status, TOS, and ox-LDL were measured in all participants. RESULTS: The levels of serum IMA, ox-LDL, and TOS were significantly higher in patients with COPD than those in control individuals. There was no difference between the levels of serum total antioxidant status, triglycerides, total cholesterol, and low-density lipoprotein cholesterol (LDL-C) of patients with COPD and those of control individuals. Serum high-density lipoprotein cholesterol levels were significantly lower in patients with COPD than in control individuals. CONCLUSION: Our study indicated that serum IMA, ox-LDL, and TOS may be increased as a result of chronic hypoxia, inflammation, and oxidative stress in patients with severe and very severe stable COPD. Our findings also revealed that IMA is higher in patients with Global Initiative for Chronic Obstructive Lung Disease Stages II, III, and IV, while TOS and ox-LDL are higher in patients with Global Initiative for Chronic Obstructive Lung Disease Stage IV. Measurements of serum IMA, TOS, and ox-LDL levels may be useful markers in the evaluation of stable COPD.

Impact of Continuous Positive Airway Pressure Treatment on Leptin Levels in Patients with Obstructive Sleep Apnea Syndrome.

BACKGROUND: There is growing evidence that leptin regulation is altered in obstructive sleep apnea syndrome (OSAS). Several potential mechanisms have been purported to explain how sleep apnea may alter leptin levels. We investigated whether repeated apneas, hypoxia, or excessive daytime sleepiness influenced the levels of leptin in OSAS patients. We also evaluated whether a 3-month continuous positive airway pressure (CPAP) treatment affected leptin levels in patients. METHODS: Randomly selected 31 untreated, otherwise healthy male, overweight [body mass index (BMI) >25 kg/m(2)] obstructive sleep apnea syndrome (OSAS) patients [apnea-hypopnea index (AHI) ≥15] and 25 control (AHI <5) were included in this study. To confirm the diagnosis, all subjects underwent standard polysomnography. Serum samples were taken at 07:00-08:00 a.m. after overnight fasting. The OSAS patients that had regular CPAP treatment (n=26) were re-evaulated 3 months later. RESULTS: Leptin levels (50.5±17.5 grams/L in OSAS and 56.3±25.5 grams/L in controls) and lipid profiles (TC, TGs, HDL-C, and LDL-C) between patient and control groups did not differ (P>0.05). Leptin levels were not correlated with the AHI, oxygen saturation, or excessive daytime sleepiness. CPAP treatment did not significantly change the (BMI), waist and neck circumference, or leptin levels in OSAS patients. Furthermore, we found no correlation between the decrease in serum leptin levels and parameters that were improved by CPAP treatment. CONCLUSION: Leptin levels and lipid profile of overweight subjects with and without OSAS were not different, and our results suggest that OSAS-related parameters and CPAP treatment do not play a significant role in the serum leptin levels.

Inherited and acquired immunodeficiencies underlying tuberculosis in childhood.

Tuberculosis (TB), caused by Mycobacterium tuberculosis (M.tb) and a few related mycobacteria, is a devastating disease, killing more than a million individuals per year worldwide. However, its pathogenesis remains largely elusive, as only a small proportion of infected individuals develop clinical disease either during primary infection or during reactivation from latency or secondary infection. Subacute, hematogenous, and extrapulmonary disease tends to be more frequent in infants, children, and teenagers than in adults. Life-threatening primary TB of childhood can result from known acquired or inherited immunodeficiencies, although the vast majority of cases remain unexplained. We review here the conditions conferring a predisposition to childhood clinical diseases caused by mycobacteria, including not only M.tb but also weakly virulent mycobacteria, such as BCG vaccines and environmental mycobacteria. Infections with weakly virulent mycobacteria are much rarer than TB, but the inherited and acquired immunodeficiencies underlying these infections are much better known. Their study has also provided genetic and immunological insights into childhood TB, as illustrated by the discovery of single-gene inborn errors of IFN-γ immunity underlying severe cases of TB. Novel findings are expected from ongoing and future human genetic studies of childhood TB in countries that combine a high proportion of consanguineous marriages, a high incidence of TB, and an excellent clinical care, such as Iran, Morocco, and Turkey.

The role of serum soluble urokinase-type plasminogen activator receptor in stable chronic obstructive pulmonary disease.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) results from an abnormal inflammatory response of the lungs to noxious particles or gases. Serum soluble urokinase-type plasminogen activator receptor (suPAR) is a glycoprotein secreted during infections and inflammation. The main goal of this study was to evaluate the serum suPAR level in stable COPD patients compared with a control group. METHODS: Forty-six stable COPD patients and 41 control subjects were included in the study. Blood samples were collected from 46 stable COPD patients (40 men, 6 women; mean [SD] age, 55.92 [7.91] years; the forced expiratory volume in 1 second, 45.32% [19.1%] of predicted). Forty-one healthy subjects were selected as control subjects and were matched to COPD patients with respect to age and body mass index. Serum suPAR and plasma fibrinogen levels were measured in stable COPD patients and control subjects. RESULTS: Serum suPAR levels of the COPD patients were significantly higher than those of the control subjects (4.94 [2.79] and 2.40 [2.01] ng/mL, respectively; P < 0.001). Plasma fibrinogen levels of the COPD patients were significantly higher than those of the control subjects (406.77 [172.6] and 336.53 [96.1] g/L, respectively; P < 0.05). CONCLUSIONS: Our study indicated that serum suPAR may play an important role in the inflammatory process of COPD, and this increase may be particularly large for patients in Global Initiative for Chronic Obstructive Lung Disease stages III and IV. Serum suPAR and plasma fibrinogen level measurements may be useful for the evaluation of stable COPD.

Relationships between Obstructive Sleep Apnea Syndrome, Continuous Positive Airway Pressure Treatment, and Inflammatory Cytokines.

The cardiovascular complications that frequently accompany obstructive sleep apnea syndrome (OSAS) are thought to develop as a result of inflammatory stress associated with cytokines such as IL-6 and TNF- α . We conducted the current study to compare levels of these cytokines in OSAS patients (n = 33) and nonapneic controls (n = 24). Furthermore, we investigated the impact of a three-month regime of continuous positive airway pressure (CPAP) on serum levels of IL-6 and TNF- α only in the OSAS patients. There were no significant differences in serum levels of either IL-6 (P = 0.782) or TNF- α (P = 0.722) or TNF- α (P = 0.722) between OSAS patients and nonapneic controls. Serum IL-6 levels correlated significantly with neck circumference in OSAS patients (P = 0.006). In OSAS patients, reduced levels of TNF- α and IL-6 correlated with increases in mean SaO2 after CPAP treatment (P = 0.020 and P = 0.051, resp.). However, neither of cytokine levels was significantly impacted by CPAP therapy (both P > 0.137). We have demonstrated that plasma cytokine levels are similar in both otherwise healthy subjects with OSAS and in nonapneic control, and we conclude that OSAS-related parameters and CPAP treatment do not play a significant role in altering cytokine levels.

The evaluation of retinal nerve fiber layer thickness in patients with obstructive sleep apnea syndrome.

Aim. To evaluate the retinal nerve fiber layer (RNFL) thickness in patients with obstructive sleep apnea syndrome (OSAS) by optical coherence tomography (OCT). Materials and Method. We studied 43 new diagnosed OSAS patients and 40 healthy volunteers. Patients underwent an overnight sleep study in an effort to diagnose and determine the severity of OSAS. RNFL analyses were performed using Stratus OCT. The average and the four-quadrant RNFL thickness were evaluated. Results. There was no difference between the average and the four-quadrant RNFL thickness in OSAS and control groups. There was no correlation between apnea-hypopnea index and intraocular pressure. Body mass index of patients with moderate and severe OSAS was significantly higher in patients with mild OSAS. Conclusion. Mean RNFL thickness did not differ between the healthy and the OSAS subjects, however, the parameters were more variable, with a larger range in OSAS patients compared to controls.

Complex sleep apnea syndrome in a child with Chiari malformation type 1.

There are few reports of a patient presenting with symptoms of obstructive sleep apnea syndrome (OSAS) as the sole manifestation of Chiari malformation type 1 (CM1). In the literature, complex sleep apnea syndrome (CompSAS) was also reported as a rare condition related to CM1 patients. We report the case of a 13-year-old patient with the complaint of snoring and difficulty in breathing during sleep, but otherwise healthy. After an initial polysomnography, the patient was diagnosed with OSAS and nocturnal continuous hypoxemia. The child underwent titration to pressure of continuous positive airway pressure (CPAP); obstructive apnea improved but central apnea (i.e., CompSAS) and nocturnal continuous hypoxemia persisted. Magnetic resonance imaging led to diagnosis of CM1. Her central apnea and nocturnal hypoxemia resolved following bi-level positive airway pressure-spontaneous-timed (S/T) (BiPAPS/ T) treatment. We emphasize that the CM1 cases can admit with only breathing problems during sleep without concomitant neurological findings, and this malformation can cause central apnea resistant to CPAP.

Lipid peroxidation and paraoxonase activity in nocturnal cyclic and sustained intermittent hypoxia.

PURPOSE: Obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) have been known to be associated with atherosclerosis and hypoxia which was suggested to have an important role in this process by the way of increased oxidative stress. In the present study, we aimed to evaluate the effects of nocturnal hypoxia pattern (intermittent versus sustained) on serum lipid peroxidation and paraoxonase (PON) activity. METHODS: Blood collections were performed in 44 OSA, 11 non-apneic, nocturnal desaturated COPD, and 14 simple snorer patients after full-night polysomnographic recordings. Nocturnal sleep and respiratory parameters, oxygen desaturation indexes, serum malondialdehyde (MDA) levels by measuring with the help of the formation of thiobarbituric acid reactive substances (TBARS), and PON activity were assessed in all subjects. RESULTS: OSA and COPD patients showed nocturnal hypoxemia, with a minimum oxygen saturation (SaO(2)) in ranges of 53-92 % and 50-87 %, respectively. The mean levels of TBARS was 15.7 ± 3.6 nmol and 15.3 ± 3.4 nmol malondialdehyde (MDA)/ml in OSA and COPD patients, respectively, while the mean level of the control group was 4.1 ± 1.2 nmol MDA/ml. The mean PON activity was found to be 124.2 ± 35.5 U/l in OSA patients and 124.6 ± 28.4 U/l in COPD patients. The mean PON activity of the control group was 269.0 ± 135.8 U/l. The increase in TBARS levels and the decrease in PON1 levels were statistically significant in both OSA and COPD patients according to controls (p < 0.001 for TBARS as well as PON1). CONCLUSION: The results of this study revealed that both OSA and non-apneic, nocturnal desaturated COPD patients showed increased levels of lipid peroxidation and decreased PON activity despite the differences in nocturnal hypoxia pattern.

Pneumothorax as an initial manifestation of obstructive sleep apnea syndrome.

CASE REPORT: A sixty-five-year-old man with bullous lung disease was admitted to emergency service with chest pain and dyspnea that developed during sleep. Pneumothorax was diagnosed both clinically and radiologically. After the chest drainage, the patient presented with a prolonged air leak that required thoracotomy. Further history and occurrence of pneumothorax during sleep suggested that obstructive sleep apnea might play a role in the development of pneumothorax. Nocturnal polysomnography later confirmed the diagnosis of severe obstructive sleep apnea syndrome. DISCUSSION: We hypothesized that obstructive sleep apnea may be a risk factor for pneumothorax especially in patients with bullous lung disease, and pneumothorax may be listed in the complications of obstructive sleep apnea syndrome.

A new approach to diagnosing of importance degree of obstructive sleep apnea syndrome: Pairwise AIRS and Fuzzy-AIRS classifiers.

Artificial Immune Recognition System (AIRS) classifier algorithm is robust and effective in medical dataset classification applications such as breast cancer, heart disease, diabetes diagnosis etc. In our previous work, we have proposed a new resource allocation mechanism called fuzzy resource allocation in AIRS algorithm both to improve the classification accuracy and to decrease the computation time in classification process. Here, AIRS and Fuzzy-AIRS classifier algorithms and one against all approach have been combined to increase the classification accuracy of obstructive sleep apnea syndrome (OSAS) that is an important disease that influences both the right and the left cardiac ventricle. The OSAS dataset consists of four classes including of normal (25 subjects), mild OSAS (AHI (Apnea and Hypoapnea Index) = 5-15 and 14 subjects), moderate OSAS (AHI < 15-30 and 18 subjects), and serious OSAS (AHI > 30 and 26 subjects). In the extracting of features that is characterized the OSAS disease, the clinical features obtained from Polysomnography used diagnostic tool for obstructive sleep apnea in patients clinically suspected of suffering from this disease have been used. The used clinical features are Arousals Index (ARI), Apnea and Hypoapnea Index (AHI), SaO2 minimum value in stage of REM, and Percent Sleep Time (PST) in stage of SaO2 intervals bigger than 89%. Even though AIRS and Fuzzy-AIRS classifiers have been used in the classifying multi-class problems, theirs classification performances are low in the case of multi-class classification problems. Therefore, we have used two classes in AIRS and Fuzzy-AIRS classifiers by means of one against all approach instead of four classes comprising the healthy subjects, mild OSAS, moderate OSAS, and serious OSAS. We have applied the AIRS, Fuzzy-AIRS, AIRS with one against all approach (Pairwise AIRS), and Fuzzy-AIRS with one against all approach (Pairwise Fuzzy-AIRS) to OSAS dataset. The obtained classification accuracies are 63.41%, 63.41%, 87.19%, and 84.14% using the above methods for 200 resources, respectively. These results show that the best method for diagnosis of OSAS is the combination of AIRS and one against all approach (Pairwise AIRS).

Pairwise ANFIS approach to determining the disorder degree of obstructive sleep apnea syndrome.

Obstructive sleep apnea syndrome (OSAS) is an important disease that affects both the right and the left cardiac ventricle. This paper presents a novel classification method called pairwise ANFIS based on Adaptive Neuro-Fuzzy Inference System (ANFIS) and one against all method for detecting the obstructive sleep apnea syndrome. In order to extract the features related with OSAS, we have used the clinical features obtained from Polysomnography device as a diagnostic tool for obstructive sleep apnea (OSA) in patients clinically suspected of suffering from this disease. The clinical features obtained from Polysomnography Reports are Arousals Index (ARI), Apnea and Hypoapnea Index (AHI), SaO2 minimum value in stage of REM, and Percent Sleep Time (PST) in stage of SaO2 intervals bigger than 89%. Since ANFIS has output with one class, we have extended the output of ANFIS to multi class by means of one against all method to diagnose the OSAS that has four classes consisting of normal (25 subjects), mild OSAS (AHI=5-15 and 14 subjects), middle OSAS (AHI<15-30 and 18 subjects), and heavy OSAS (AHI>30 and 26 subjects). The classification accuracy, sensitivity and specifity analysis, mean square error, and confusion matrix have been used to test the performance of proposed method. The obtained classification accuracies are 82.92%, 82.92%, 85.36%, and 87.80% for each class including normal, mild OSAS, middle OSAS, and heavy OSAS using ANFIS with one against all method with 50-50% train-test split, respectively. Combining ANFIS and one against all method that is firstly proposed by us was firstly applied for diagnosing the OSAS. The proposed method has produced very promising results in the detecting the obstructive sleep apnea syndrome.