The Effect of Type-2 Diabetes Mellitus on Sleep Architecture and Sleep Apnea Severity in Patients With Obstructive Sleep Apnea Syndrome.

INTRODUCTION: Obstructive sleep apnea syndrome (OSAS) is a severe condition that is characterized by recurrent partial or complete breathing interruptions during sleep, leading to insulin resistance, microvascular complications, and cardiovascular complications. It is of great importance to know the impact of type 2 diabetes mellitus (DM), which is prevalent in the world and in our country, Turkey, leads to significant mortality and morbidity, significantly affects the quality of life, and requires continuous follow-up, on sleep in patients with OSAS and to raise awareness on this issue. In this study, we aimed to determine the effects of diabetes on sleep duration and sleep architecture in patients with OSAS and to investigate the relationship between OSAS severity and DM control. METHODS: Fifty diabetic and 42 non-diabetic patients diagnosed with OSAS at the Sleep Disorders Center of Süreyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey, between October 2022 and March 2023 were included in the study. Polysomnographic and biochemical parameters of the two groups were compared. The effect of OSAS severity and sleep architecture on diabetes control was investigated. RESULTS: No significant difference was found between diabetic and non-diabetic patients in terms of total sleep duration, sleep efficiency, and sleep latency, whereas REM (rapid eye movement) latency was prolonged and REM sleep duration and percentage were significantly lower in diabetic patients. The severity of OSAS was found to be greater in diabetic patients and they spent significantly more time below 90% saturation during sleep. No correlation was found between the groups in the glycated hemoglobin (HbA1c) parameter, which we examined in terms of diabetes control, sleep architecture, and OSAS severity. CONCLUSION: The presence of diabetes aggravates the severity of OSAS, prolongs the transition to REM sleep, and leads to a decrease in REM duration. Sleep is essential for both mental and physical well-being. In this regard, it is of utmost importance to examine diabetic patients for OSAS and to perform polysomnography in appropriate patients.

Gene Expression Profiles of Tumor Necrosis Factor-α and Endothelin-1 in Obstructive Sleep Apnea.

BACKGROUND/AIMS: The aim of this study was to observe the relationship between the gene expression profiles of tumor necrosis factor (TNF)-α and endothelin (EDN)-1 and obstructive sleep apnea (OSA). METHODS: A prospective, cross-sectional study performed at a tertiary-care academic center; 108 patients with snoring and day-time sleeplessness were included in this study carried out in the Otolaryngology Department. All patients were evaluated with 1-night polysomnography (PSG). There were 63 patients with OSA and 45 patients without OSA. In the OSA group, the median apnea hypopnea index (AHI) was 29.1; in the non-OSA group, the median AHI was 2.1. Blood samples were obtained from all 108 patients for the genetic analysis of the expression of TNF-α and EDN-1. PSG findings and gene expression levels were evaluated in both groups. RESULTS: The median (range) age was 46 (20-81) years, BMI 24.9 (15-49), EDN-1 gene expression 0.45 (0.02-67.88) pg/µL, and TNF-α gene expression 1.71 (0.08-59.52) pg/µL. We found that EDN-1 and TNF-α gene expression levels were significantly higher in the OSA group than in the control group (p = 0.009 vs. p < 0.001). CONCLUSION: EDN-1 and TNF-α gene expression levels were associated with the occurrence of OSA.

Increased Exhaled 8-Isoprostane and Interleukin-6 in Patients with Helicobacter pylori Infection.

BACKGROUND: Helicobacter pylori (H. pylori) infection triggers both local inflammation, usually in gastric mucosa, and chronic systemic inflammation. It is assumed that this local and systemic inflammation is caused by extracellular products excreted by H. pylori. The aim of this study was to investigate the possible association between H. pylori infection and a local inflammatory response in the airway by using exhaled breath condensate technique. MATERIALS AND METHODS: This study includes 41 H. pylori seropositive patients who have gastric symptoms and 27 healthy control subjects. Pulmonary function tests (PFT), chest X ray, and physical examination were performed in all patients and interleukin-6 (IL-6), 8-isoprostane and nitrotyrosine levels were measured in exhaled breath condensate. RESULTS: Levels of IL-6 and 8-isoprostane in exhaled breath condensate (EBC) were significantly higher in H. pylori positive patients than control subjects (p < 0.05). Nitrotyrosine levels were also higher in H. pylori positive patients but the difference was not statistically significant. Both groups had similar leukocyte counts, C-reactive protein (CRP) levels and PFT parameters. CONCLUSION: H. pylori infection causes an asymptomatic airway inflammation which can be detected by exhaled breath condensate. The clinical importance of this inflammation remains unclear.

Airway inflammation and tiotropium treatment in stable COPD patients.

BACKGROUND/AIM: Chronic obstructive pulmonary disease (COPD) is an inflammatory disease of the lung associated with progressive airflow limitation. The aim of this study is to assess the influence of tiotropium treatment on airway inflammation and symptoms in stable COPD patients. MATERIALS AND METHODS: Inflammatory markers were measured in the expired breath condensate fluid (EBC) before starting tiotropium treatment and at the end of the first month. RESULTS: Twenty-two patients (81% men) with a mean age of 65.4 ± 10.1 years completed the study. The mean nitrotyrosine and 8-isoprostane levels for oxidative stress markers in EBC before and after treatment were 4.5 ± 2.3, 3.5 ± 1.9 pg/mL (P = 0.06) and 7.3 ± 10.8, 8.1 ± 11.7 pg/mL (P = 0.28), respectively. The mean interleukin-6 and tumor necrosis factor-alpha levels for inflammation markers in EBC before and after treatment were 1.03 ± 1.1, 0.77 ± 0.8 pg/mL (P = 0.41) and 27.8 ± 2.6, 29.2 ± 5.7 pg/mL (P = 0.36) respectively. The mean symptom scores decreased significantly with tiotropium and a mean increase of 124.6 ± 0.86 mL was observed in a lung function test (FEV1). CONCLUSION: Although a 4-week treatment with tiotropium did not modify any of the inflammatory or oxidative stress markers in EBC fluid, tiotropium treatment helps to control symptoms in COPD.

Influence of CPAP treatment on airway and systemic inflammation in OSAS patients.

AIM: Obstructive sleep apnea syndrome (OSAS) is characterized by recurrent respiratory disorders in the upper airways during sleep. Although continuous positive airway pressure (CPAP) has been accepted to be the most effective treatment for OSAS, its role on inflammation remains debatable. In this study, our aim was to examine the influence of 3 months of CPAP treatment on tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), 8-isoprostane, and peroxynitrite levels in exhaled breathing condensates (EBC) and serum. METHODS: Thirty-five patients who were newly diagnosed as moderate or severe OSAS with full night polysomnography and used CPAP therapy regularly for 3 months were included in the study. Polysomnography, spirometric tests, fasting blood samples, and EBC were ascertained on entry into the study and after 3 months of treatment. All patients were assessed monthly for treatment adherence and side effects. RESULTS: We found that all polysomnographic parameters were normalized after CPAP therapy in the control polysomnogram. Also, all markers in EBC and nitrotyrosine and 8-isoprostane levels in serum were decreased significantly with CPAP treatment. Sedimentation rate, C-reactive protein, IL-6, and TNF-α remained unchanged in serum after treatment. We found that baseline nitrotyrosine levels were significantly correlated with apnea-hypopnea index, oxygen desaturation index, and percent time in SpO2 < 90 % (p < 0.01). CONCLUSIONS: CPAP therapy has primarily a relevant impact on airways, and nitrotyrosine levels correlated well with severity of OSAS. This treatment decreases both inflammation and oxidative stress levels in airways in OSAS patients. Also, this treatment helps to decrease systemic oxidative stress levels in serum.

Interaction of metabolic syndrome with asthma in postmenopausal women: role of adipokines.

The increasing prevalence of both asthma and obesity are major health problems. Recent studies established a possible link between obesity and asthma; however, the underlying mechanism is not clear. The aim of the study was to analyze the prevalence of metabolic syndrome in postmenopausal subjects with asthma and search the interactions between adipokines, metabolic syndrome, and asthma. A total of 45 female patients (57.5 ± 13.9 years) with asthma and 30 healthy subjects (59.6 ± 12.8 years) in postmenopausal status were enrolled in this study. For the diagnosis of metabolic syndrome, modified World Health Organization diagnostic criteria were used. Blood levels of glucose, lipid profile, HbA1c, insulin, CRP, leptin, adiponectin, tumor necrosis factor-alpha, interleukin (IL)-6, IL-8 and plasminogen activator inhibitor-1 (PAI-1) were measured. The mean body mass index was 29.6 ± 5.4 for asthma patients and 28.2 ± 5.3 for the control group. The incidence of metabolic syndrome was found as 26 % for both groups. Insulin resistance as calculated by homeostasis model assessment (HOMA-IR) and fasting insulin levels were significantly higher in asthma patients (p < 0.001 for both parameters). Leptin levels were significantly higher (p = 0.001) and adiponectin levels were lower (p = 0.029) in asthma patients compared to controls. We concluded that although incidence of obesity and metabolic syndrome was not higher in postmenopausal asthma patients than controls, there was an impairment of glucose metabolism and altered adipokine levels in asthma patients.

Effect of resveratrol on treatment of bleomycin-induced pulmonary fibrosis in rats.

Resveratrol has a preventive potential on bleomycin-induced pulmonary fibrosis in prophylactic use; however, it was not studied in the treatment of the fibrosis. This study investigated the role of resveratrol on the treatment of bleomycin-induced pulmonary fibrosis. Intratracheal bleomycin (2.5 mg/kg) was given in fibrosis groups and saline in controls. First dose of resveratrol was given 14 days after bleomycin and continued until sacrifice. On 29th day, fibrosis in lung was estimated by Aschoft's criteria and hydroxyproline content. Bleomycine increased the fibrosis score (3.70 ± 1.04) and hydroxyproline levels (4.99 ± 0.90 mg/g tissue) as compared to control rats (1.02 ± 0.61 and 1.88 ± 0.59 mg/g), respectively. These were reduced to 3.16 ± 1.58 (P = 0.0001) and 3.08 ± 0.73 (P > 0.05), respectively, by resveratrol. Tissue malondialdehyde levels in the bleomycin-treated rats were higher (0.55 ± 0.22 nmol/mg protein) than that of control rats (0.16 ± 0.07; P = 0.0001) and this was reduced to 0.16 ± 0.06 by resveratrol (P = 0.0001). Tissue total antioxidant capacity is reduced (0.027 ± 0.01) by bleomycine administration when compared control rats (0.055 ± 0.012 mmol Trolox Equiv/mg protein; P = 0.0001) and increased to 0.041 ± 0.008 (P = 0.001) by resveratrol. We concluded that resveratrol has some promising potential on the treatment of bleomycin-induced pulmonary fibrosis in rats. However, different doses of the drug should be further studied.

Subcutaneous fat tissue thickness of the anterior neck and umbilicus in patients with obstructive sleep apnea.

OBJECTIVE: To investigate the differences in thickness of subcutaneous fat tissue of the anterior neck and umbilicus of patients with and without obstructive sleep apnea (OSA), the relationship between thickness of subcutaneous fat tissue of the anterior neck and umbilicus and polysomnographic findings, and the influence of body mass index (BMI), anthropometric findings, and gender. STUDY DESIGN: Cross-sectional study. SETTING: Tertiary care university hospital. SUBJECT AND METHODS: Seventy-three patients with OSA and 24 non-OSA patients were evaluated with polysomnography for 1 night. Anthropometric parameters and BMI were also investigated. Subcutaneous fat tissue thickness of anterior neck and umbilicus was assessed using ultrasound. The thickness of subcutaneous fat tissue adjacent to the submandibular gland, isthmus, hyoid, suprasternal notch, and umbilicus was measured with ultrasound. Data analysis was performed using SPSS. RESULTS: Apnea-hypopnea index (AHI) was significantly and positively correlated with age (P = .016, r (2) = 0.244), BMI (P < .001, r (2) = 0.416), and anthropometric findings (waist circumference P < .001, r (2) = 0.337; hip circumference P = .008, r (2) = 0.269; neck circumference P = .002, r (2) = 0.309). Minimum oxygen saturation was significantly, negatively correlated with age (P = .002, r (2) = -0.310), BMI (P < .001, r (2) = -0.404), and anthropometric findings (waist circumference P = .005, r (2) = -0.281, hip circumference P < .001, r (2) = -0.353, neck circumference P = .010, r (2) = -0.261). There were no significant differences between the OSA and non-OSA groups with respect to age (P = .178), gender (P = .189), or ultrasonographic findings for subcutaneous fat tissue thickness adjacent to the submandibular gland (P = .480), thyroid isthmus (P = .311), suprasternal notch (P = .950), umbilicus (P = .691), or hyoid (P = .159). Neck circumference (P = .039) and BMI (P = .014) were significantly higher in the OSA group. CONCLUSION: These indicate that anterior neck and umbilical subcutaneous fat tissue thickness may not contribute to the severity of OSA.

Influence of preemptive analgesia on pulmonary function and complications for laparoscopic cholecystectomy.

Pain and diaphragmatic dysfunction are the major reasons for postoperative pulmonary complications after upper abdominal surgery. Preoperative administration of analgesics helps to reduce and prevent pain. The objective of this study was first to research the rate of pulmonary complications for laparoscopic cholecystectomy (LC) and then analyze the influence of preemptive analgesia on pulmonary functions and complications. Seventy patients scheduled for elective LC were included in our double-blind, randomized, placebo-controlled, prospective study. Randomly, 35 patients received 1 g etofenamate (group 1) and 35 patients 0.9% saline (group 2) intramuscularly 1 h before surgery. All patients underwent physical examination, chest radiography, lung function tests, and pulse oxygen saturation measurements 2 h before surgery and postoperatively on day 2. Atelectasis was graded as micro, focal, segmental, or lobar. With preemptive analgesia, the need for postoperative analgesia decreased significantly in group 1. In both groups mean spirometric values were reduced significantly after the operation, but the difference and proportional change according to preoperative recordings were found to be similar [29.5 vs. 31.3% reduction in forced vital capacity (FVC) and 32.9 vs. 33.5% reduction in forced expiratory volume in 1 s (FEV(1)) for groups 1 and 2, respectively]. There was an insignificant drop in oxygen saturation rates for both groups. The overall incidence of atelectasia was similar for group 1 and 2 (30.2 vs. 29.2%). Although the degree of atelectesia was found to be more severe in the placebo group, the difference was not statistically significant. We concluded that although preemptive analgesia decreased the need for postoperative analgesia, this had no effect on pulmonary functions and pulmonary complications.

Influence of obesity on bone mineral density in postmenopausal asthma patients undergoing treatment with inhaled corticosteroids

OBJECTIVES: The etiology of osteoporosis in asthma is complex as various factors contribute to its pathogenesis. The purpose of our study was to investigate the effects of obesity and inhaled steroids, as well as the severity and duration of asthma, on osteoporosis in postmenopausal asthma patients as compared to healthy controls. METHODS: A total of 46 patients with asthma and 60 healthy female controls, all postmenopausal, were enrolled in our study. Bone mineral density was assessed at the lumbar spine and hip using a Lunar DPX-L densitometer. RESULTS: Bone mineral density (BMD) scores were comparable between the asthmatic and control groups, with average scores of 0.95 ± 0.29 and 0.88 ± 0.14 g/cm², respectively. Likewise, osteoporosis was diagnosed in a similar percentage of patients in the asthmatic (39.1 percent) and control (43.3 percent) groups. Bone fracture was identified in four patients with asthma (8.6 percent) and in six patients from the control group (10 percent). We could not detect any relationship between BMD and duration of asthma, asthma severity, inhaled steroids or body mass index (BMI). There was no difference between the two groups with respect to age or years since menopause. Although asthma patients were more likely to be overweight and presented higher BMD scores on average than the control subjects, these differences were not statistically significant. CONCLUSIONS: There is a slight positive protective effect of high BMI against osteoporosis in asthma patients, but this effect is overcome by time and menopause status. Therefore, the protective effect of obesity against osteoporosis in asthma patients seems to not be significant.

Breast tuberculosis.

Tuberculosis is the most widespread and persistent human infection in the world. Tuberculosis of the breast is an uncommon disease with an incidence range between 0.1-3%, for all the breast diseases treated surgically. We present a case with primary breast tuberculosis. The diagnosis was made based on result of pathological examination of incision biopsy and cure had been obtained with anti-tuberculosis therapy with 4 drugs. Especially for patients from the areas where tuberculosis is endemic, tuberculosis must be considered in differential diagnosis of breast lesions.

Active pulmonary tuberculosis with vertebra and rib involvement: case report.

Multifocal skeletal tuberculosis is defined as osteoarticular lesions that occur simultaneously at two or more locations and is generally associated with disseminated disease. Although involvement of bones accounts for 1 to 5% of all tuberculosis cases, multifocal involvement of the skeleton is extremely rare. We present a case of active pulmonary tuberculosis (TB) with vertebral and rib involvement and multiple hypodense lytic lesions accompanied by a paravertebral mass lesion. In the differential diagnosis, metastases, lymphoma, multiple myeloma, chordoma sarcoidosis and rare spinal infections such as brucellosis and fungal disease were considered. The diagnosis was established by surgical biopsy, taken by video-assisted thoracoscopic surgery. Especially for patients from TB-endemic areas, tuberculosis must be considered in the differential diagnosis and treatment should be started without delay.

Complicated parapneumonic effusion and empyema thoracis: microbiologic and therapeutic aspects.

Patients with pleural infections have a high risk of morbidity and mortality with prolonged hospitalization. The best methods for treating pleural infections remain debatable. Although the increasing drainage volume effect of streptokinase adjunctive to chest-tube, is well known, its effect on clinical outcomes like duration of hospitalization and need for further surgery, remains controversial. The aim of this study was to analyze the etiological and microbiological factors for pleural infections, and assess the effect of streptokinase adjunctive to chest tube for clinical outcomes. Charts of patients with a chest disease department discharge diagnosis of complicated parapneumonic effusion or empyema were retrospectively reviewed. Of the 107 patients (85 male), the mean age was 47.9+/-17.1 years. The most frequently shown bacteriological agent was Staphylococcus aureus. Drainage with thoracentesis was used in 44 patients (group 1); chest tube was performed in 44 patients (group 2) and intrapleural streptokinase was given after chest tube insertion in 19 patients (group 3). Mean hospitalization time in group 1 was shorter than the other two groups (P<0.05), but there was no significant difference between group 2 and 3. Our mortality rate was 8.4%. Success rates were 95.4%, 65.9% and 78.5% in groups 1, 2, and 3, respectively (P>0.05). Intrapleural streptokinase is a safe procedure but it did not effect the duration of hospitalization, mortality and success rate. Mortality remains especially high in patients with concomitant disease.

Smoking habit among the relatives of patients with serious smoking-related disorders.

OBJECTIVE: To assess smoking habit and awareness of smoking as a potential cause of disease among relatives of patients with serious smoking-related disorders. DESIGN AND SETTING: A survey using a face-to-face interview-assisted questionnaire at the Ege University Hospital between October 1998 and March 1999. SUBJECTS: We interviewed 242 relatives of patients with serious smoking-related disorders, of whom 56.6% were female and 43.4% male. The mean age was 41.2 +/- 13.2 years (15-75). One relative per patient completed the questionnaire and the chosen relative took care of the patient during his illness and accompanied him during hospital visits. MAIN OUTCOME MEASURES: We assessed the relationship between smoking habit and the perception of smoking as a potential cause of illness by the relatives. Statistical analysis was performed by chi(2) test. RESULTS: The prevalence of smoking among relatives was 37.6% [49.5% males (n = 105) and 28.5% females (n = 137), p = 0.0003] and an additional 20.2% were ex-smokers. Of the relatives, 86.4% knew that the diseases were directly related to smoking, and 37.8% of these people were smokers and 21.5% ex-smokers. Only 7.2% reported that they had quit smoking after being influenced by the diseases of the patients. The decision to quit was statistically unrelated to the awareness of smoking as the cause of disease. Of all the relatives, 69.2% had tried to quit at least once, 86.8% considered quitting, and 89.0% considered using professional help for smoking cessation. CONCLUSION: The findings show that even though this group of smokers is aware of the harmful effects of smoking they cannot successfully quit smoking; however, the majority reconsider quitting and receiving professional help.