NoSAS score predicts cardiovascular disease in patients with obstructive sleep apnea.

PURPOSE: The Lausanne NoSAS (Neck circumference, Obesity, Snoring, Age, Sex) score is a new tool for the identification of high-risk patients for obstructive sleep apnea (OSA). Up to now, no study has attempted to determine the role of NoSAS score in cardiovascular morbidity of patients with OSA. We aimed to investigate the relationships between NoSAS scores and CVD and also between severity of OSA, polysomnographic parameters, and NoSAS scores in patients with OSA. METHODS: Patients with diagnosis of OSA by full-night polysomnography were recruited in the study. Based on apnea-hypopnea index (AHI) scores, the patients were categorized as OSA-negative (AHI < 5), mild OSA (5 ≤ AHI < 15), moderate OSA (15 ≤ AHI < 30), and severe OSA (AHI ≥ 30). The definition of cardiovascular diseases (CVD) included the presence of any of the diseases such as hypertension, coronary artery disease, heart failure, or arrhythmia. RESULTS: A total of 1514 patients including cases with 199 OSA-negative, 391 mild, 342 moderate, and 582 severe OSA were enrolled in the study. NoSAS scores were significantly different between mild, moderate, and severe OSA groups. NoSAS scores were negatively correlated with minimum oxygen saturation values and positively with AHI and ODI (oxygen desaturation index) values (P < 0.001). NoSAS scores were significantly higher in patients with CVD, diabetes mellitus, and cerebrovascular disease compared with those without (P < 0.005). NoSAS cut-off values for hypertension (14), congestive heart failure (8.5), coronary artery disease (9), cerebrovascular event (11), and diabetes mellitus (10) were also determined. CONCLUSION: NoSAS scores are associated with CVD and the severity of OSA. NoSAS scores may be useful to predict CVD in patients with OSA.

Potential Use of SGLT-2 Inhibitors in Obstructive Sleep Apnea: A new treatment on the horizon.

BACKGROUND: Obstructive sleep apnea (OSA) is characterized by hypoxic episodes due to collapse of the airway during sleep and is frequently associated with obesity, type 2 diabetes mellitus (T2DM) and cardiovascular diseases (CVD). There is currently no pharmacological agent approved for the treatment of OSA. Sodium-glucose cotransporter-2 (SGLT2) inhibitors have the potential to both increase life expectancy and quality of life of these patients making them promising agents for this role. There are relatively few studies investigating this possible beneficial relationship between these drugs and OSA. METHOD: We aimed to increase awareness on the potential benefits of SGLT2 inhibitors in OSA patients by describing the current evidence on the effectiveness of these inhibitors in both overall and cardiovascular morbidity and mortality. We performed a literature search for articles reporting on the use of SGLT2 inhibitors in patients with OSA and T2DM. RESULTS: We identified 4 manuscripts studying the use of SGLT2 inhibitors in 475 OSA patients with T2DM. Among them, 332 patients were administered SGLT2 inhibitors, and 143 patients were in a control group. SGLT2 inhibitors have many potential positive impacts on OSA patients by targeting various mechanisms involved in OSA pathogenesis. CONCLUSION: SGLT2 inhibitors are prime pharmacological candidates for the treatment of OSA, and additional studies are needed to better explore mechanisms and outcomes unique to this population. Additionally, patients with OSA often have multiple comorbidities that are clinical indications for SGLT2 inhibitor therapy. Physicians should recognize and encourage the use of these agents in such patients.

Kidney transplantation: a possible solution to obstructive sleep apnea in patients with end-stage kidney disease.

INTRODUCTION: Obstructive sleep apnea (OSA) is frequently reported among patients with chronic kidney disease resulting in considerable morbidity and mortality. OSA may cause repetitive stimulation of the sympathetic nervous system and elevations in pulmonary artery pressure leading to an elevated risk of cardiac and vascular complications in patients with chronic kidney disease. Furthermore, OSA is associated with progressive worsening of kidney injury and loss of renal function. METHODS: In this systematic review and meta-analysis, we evaluated the effect of renal transplantation on the progression of OSA in patients with end-stage kidney disease. RESULTS: The meta-analysis included eight studies with a total of 401 patients. Findings showed that kidney transplantation does not lead to a statistically significant effect on the apnea-hypopnea index (MD 2.6 events/hr, 95% CI -3.2 to 8.3, p = 0.21), total sleep time (MD 14.7 min/night, 95% CI -8.4 to 37.8, p = 0.76), sleep efficiency (MD 2.5%, 95% CI -1.4 to 6.3, p = 0.57), slow wave sleep (MD 0.4% of total sleep time, 95% CI -7.5 to 8.4, p = 0.05), and rapid eye movement sleep (MD 0.6% of total sleep time, 95% CI -2.2 to 3.3, p = 0.98). There was no statistically significant effect of kidney transplantation on OSA in patients with chronic renal disease.

The effect of tocilizumab on severe COVID-19 infection: Review of current evidence.

The COVID-19 outbreak that spread in December 2019 has caused the death of millions of people in a short time. Many studies published recently have shown that many cytokines (interleukin (IL) IL-1, IL-2, IL-6, TNF and IFN-) are significantly increased in COVID-19 patients with pneumonia, and especially IL-6 in combination with other cytokines has shown to be the main cause of the cytokine storm. Since IL-6 level is associated with clinical worsening in COVID-19 patients, anti-IL-6 therapy is seen as a promising treatment. Tocilizumab, a widely used IL-6 antagonist, was approved by the FDA in 2017 for Cytokine Storm Syndrome (CSS). Its addition to the treatment in COVID19 patients with increased blood IL-6 levels and oxygen saturation.

Immunogenicity of SARS-CoV-2 mRNA vaccine in dialysis and kidney transplant patients: A systematic review.

Kidney transplant recipients and dialysis patients constitute a risk group for severe COVID-19. They are highly advised to get vaccinated according to the current guidelines. However, data on antibody response, cell responses and protection from events, and factors that might alter this response after a routine full series of vaccination remain incomplete for these populations. The aim of this article was to analyze the antibody responses after a full series of mRNA-based SARS-CoV-2 vaccination in kidney transplantation and dialysis patients and to define the factors that alter seroconversion status in these populations. In this systematic review, 18 studies investigating the antibody response to full vaccination with two doses of COVID-19 mRNA vaccines in hemodialysis, peritoneal dialysis, and kidney transplant patients were included. Kidney transplant and dialysis patients have a lower seroconversion rate after mRNA-based SARS-CoV-2 vaccination than the healthy population: 27.2% for kidney transplantation, 88.5% for dialysis patients while all healthy control in these studies seroconverted. Moreover, anti-S antibody titers were lower in seroconverted kidney transplantation or dialysis patients than in healthy control in all studies that assessed this variable. Older age and dialysis vintage, immunosuppressive or chemotherapy treatment, and lower serum albumin, white blood cell, lymphocyte and hemoglobin counts were associated with lower/no antibody response to vaccination. Dialysis patients and kidney transplant recipients have lower seroconversion rates after a full series of mRNA-based SARS-CoV-2 vaccination than the general population. Several factors are associated with an altered antibody response. A third dose could be considered in this patient group.

A new predictor to determine the exacerbation and treatment of chronic obstructive pulmonary disease: eosinophil/neutrophil ratio.

INTRODUCTION: COPD is an inflammatory disease characterized by persistent respiratory symptoms and airflow limitation. Currently, it has been demonstrated in some studies that eosinophil and T helper-2 mediated inflammation play a role in the pathophysiology of COPD. MATERIALS AND METHODS: It was planned to evaluate eosinophilia, eosinophil/ neutrophil ratio (ENR), distribution of ENR according to GOLD groups, number of exacerbations in last year, relationship between ENR and the rate of ICS use in COPD patients, and the ENR cut-off value that predicts eosinophilic COPD. This study was planned prospectively in stable COPD patients between July 2017 and December 2017. All patients were divided into two groups as eosinophilic and non-eosinophilic group. Eosinophilia was considered to be > 2% of peripheric blood eosinophils. RESULT: A total of 206 stable COPD patients (127 eosinophilic and 79 noneosinophilic) were included. Age, gender, BMI, smoking history, mMrc score were statistically similar while average pack-year of smoking was significantly higher in eosinophilic group. ENR was significantly higher in eosinophilic group as expected (p<0.001). High positive correlation was found between ENR and eosinophilic COPD (r= 0.8, p<0.001). In Group D, the number of eosinophilic COPD patients is significantly higher than the non-eosinophilic group while the distribution of patients in group A, B, C was similar. Although the PFT findings were similar in both groups, the use of ICS was significantly lower and the number of exacerbations was significantly higher in eosinophilic group. In the ROC analysis, the ENR cut-off value that predicts eosinophilic COPD was found to be 0.32 in all COPD patients (Sens: 93.7%, Specif: 92.4%, AUC= 0.97, p<0.001). CONCLUSIONS: Based on these findings, it is considered that more priority should be given to the use of ICS in COPD patients with high ENR and it can be used as a marker for predicting COPD exacerbation as COPD exacerbations are higher in patients with ENR.

A rare but a serious complication: gemifloxacin induced tendinopathy.

We present a case of tendon rupture and subcutaneous bleeding after administration of gemifloxacin for the treatment of lower respiratory tract infection. Fluoroquinolone-induced tendinopathy is a rare but increasingly acknowledged adverse effect of this group of antibiotics. Most of the cases occur in the Achilles tendon and can lead to tendon rupture. Possible predisposing risk factors include steroid use, patients with renal failure or kidney transplantation, old age and being an athlete.

Pathological features of COVID-19 infection from biopsy and autopsy series.

Novel coronavirus disease 2019 (COVID-19) which is caused by severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) was first identified in December 2019 in Chinese town Wuhan and considered as a pandemic by World Health Organization. The disease has variety of symptoms including fever, shortness of breath, cough, fatigue, loss of smell and taste and diarrhea. While the majority of cases have mild symptoms, some progress to viral pneumonia, multi-organ failure, or cytokine storm and mortality is mostly caused by hypoxemic respiratory failure. Until now, more than 3.5 million people worldwide were infected and more than 240.000 mortality has been occurred. Thus, there is now evidence the disease may affect variety of organs according to accumulating biopsy and autopsy studies. Such pathological studies have potential role on the understanding of clinical outcomes and in the development of novel targeted therapeutic approaches. Given these aforementioned data, in the current manuscript we have summarized the pathological features of COVID-19 derived from biopsy and autopsy series.

COVID-19 and acute kidney injury.

The Coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) started in December 2019 and has affected millions of lives worldwide, while many aspects of the illness are still unknown. Current data show that many hospitalized COVID-19 patients suffer from kidney damage, in the form of proteinuria, hematuria or acute kidney injury (AKI). AKI is especially prevalent among severe and critically ill COVID-19 patients and is a predictor of mortality. The pathophysiology of AKI in COVID-19 is unclear. Early reports of histopathologic examination from autopsied kidney tissue show SARS-CoV-2 viral particles in renal tubular cells and podocytes, suggesting direct viral infection, as well as findings of acute tubular necrosis, while rhabdomyolysis-associated AKI and glomerulopathies may also occur. As of today, only remdesivir has been authorized to treat COVID-19. Ongoing research investigates potential of anti-viral and anti-inflammatory agents along with safety and efficacy of commonly prescribed drugs such as renin-angiotensin-aldosterone system blockers. This review discusses the prevalence of AKI and its association with outcome, while highlighting possible mechanisms of AKI and suggesting organ protective measures to prevent the development of kidney damage.

[Determination of anthropometric measurements in obstructive sleep apnea syndrome in Turkish population]. / Türk popülasyonunda obstrüktif uyku apne sendromunda rol oynayan antropometrik ölçümlerin belirlenmesi.

INTRODUCTION: In this study, we aimed to determine the values of anthropometric measurements and rates used in the evaluation of obstructive sleep apnea syndrome (OSAS) in our country. MATERIALS AND METHODS: Twenty accredited sleep centers in thirteen provinces participated in this multicenter prospective study. OSAS symptoms and polysomnographic examination and apnea-hypopnea index (AHI) ≥ 5 cases OSAS study group; patients with AHI < 5 and STOP-Bang < 2 were included as control group. Demographic characteristics (age, sex, body mass index-BMI) and anthropometric measurements (neck, waist and hip circumference, waist/hip ratio) of the subjects were recorded. RESULT: The study included 2684 patients (81.3% OSAS) with a mean age of 50.50 ± 0.21 years from 20 centers. The cases were taken from six geographical regions of the country (Mediterranean, Eastern Anatolia, Aegean, Central Anatolia, Black Sea and Marmara Region). Demographic characteristics and anthropometric measurements; age, neck, waist, hip circumference and waist/ hip ratios and BMI characteristics when compared with the control group; when compared according to regions, age, neck, waist, hip circumference and waist/hip ratios were found to be statistically different (p< 0.001, p< 0.001, p< 0.05, respectively). When compared by sex, age, neck and hip circumference, waist/hip ratio, height, weight and BMI characteristics were statistically different (p< 0.001, respectively). Neck circumference and waist/hip ratio were respectively 42.58 ± 0.10 cm, 0.99 ± 0.002, 39.24 ± 0.16 cm, 0.93 ± 0.004 were found in women. CONCLUSIONS: The neck circumference was lower than the standard value in men, but higher in women. The waist/hip ratio was above the ideal measurements in both men and women. In this context, the determination of the country values will allow the identification of patients with the possibility of OSAS and referral to sleep centers for polysomnography.

The Relationship between Hypomagnesemia and Pulmonary Function Tests in Patients with Chronic Asthma.

OBJECTIVE: To investigate the relationship between serum values of magnesium and the parameters of the pulmonary function tests (PFT) in patients with chronic asthma. SUBJECTS AND METHODS: This study recruited 50 patients with chronic stable asthma and 40 healthy individuals as a control group. Data on age, sex, severity of asthma, PFT, and details of drug therapy were obtained from each group. Serum magnesium, potassium, phosphorus, calcium, and sodium levels were also measured. To evaluate differences between groups, the Student t test or Mann-Whitney U test was performed for continuous variables, and the χ2 test for categorical variables. RESULTS: In the asthma group, 10% (n = 9) of the patients had hypomagnesemia and 5.5% (n = 5) had hypophosphatemia. Patients with asthma were divided into two groups: the hypomagnesemic group (n = 9) and the normomagnesemic group (n = 41). Forced expiratory volume in 1 s (FEV1), FEV1%, peak expiratory flow (PEF), and PEF% were lower in the hypomagnesemic group than in the normomagnesemic group (p = 0.02). Multiple logistic regression analysis revealed a statistically significant association between hypomagnesemia and PFT in the hypomagnesemic asthmatic group. The correlations of age with FEV1, FEV1%, PEF, and PEF% were as follows: p = 0.00, r = 0.29; p = 0.00, r = 0.43; p = 0.03, r = 0.22; p = 0.00, r = 0.38; and p = 0.03, r = 0.22, respectively. The correlation of serum magnesium levels with PFT (FEV1, FEV1%, PEF, PEF%) were as follows: p = 0.001, r = 0.29; p = 0.001, r = 0.43; p = 0.03, r = 0.22; and p = 0.001, r = 0.38, respectively. The other electrolytes were within the normal range in both groups. CONCLUSION: In this study, hypomagnesemia and hypophosphatemia were found to be the most common electrolyte abnormalities in patients with chronic stable asthma. FEV1, FEV1%, PEF, and PEF% were significantly lower in asthmatic patients with hypomagnesemia compared to asthmatic patients with normomagnesemia.

Obstructive sleep apnea is a risk factor for osteoarthritis.

INTRODUCTION: Obstructive sleep apnea (OSA) syndrome is closely associated with cardiovascular and metabolic disorders. Recent studies reported that osteoarthritis (OA) is associated with cardiovascular disease as well as inflammation defined as "metabolic disorder". Due to the strong association of metabolic disorders with both OA and OSA, we aimed to investigate the association between severity of OSA and osteoarthritis grade based on X-Ray. MATERIALS AND METHODS: Patients who underwent polysomnography due to suspicion of OSA were recruited in a cross-sectional study. Included patients were grouped according to apnea-hypopnea index (AHI) as mild (AHI between 5 and 14.9), moderately (AHI between 15 and 29.9), and severe OSA (AHI ≥ 30). Patients with AHI p< 5 served as the control group. Kellgren-Lawrence scoring system was used to express OA severity, which was graded as Grade 0, 1, 2, 3 and 4. RESULT: One hundred twenty patients were enrolled into the study. Mean age was 52.4 ± 11.5 years and 56% (68/120) of the patients were male. A strong correlation was present between severity of OSA and severity of OA. Among those with Grade 4 OA group (33 patients), all patients had severe OSA and this association was independent from body-mass index. In the Grade 1 OA group, none of the patients had severe OSA (p< 0.05). A positive correlation was also seen between severity of OSA, OA and hs-CRP. CONCLUSIONS: There is a strong association between OSA and OA. OSA might be a novel risk factor for the development OA. Further studies should evaluate the effect of OSA treatment on OA.

Unique Case of Pseudomembranous Aspergillus Tracheobronchitis: Tracheal Perforation and Horner's Syndrome.

Pseudomembranous aspergillus tracheobronchitis is an uncommon form of invasive pulmonary aspergillosis, and it is generally seen in immunocompromised patients. We report about a mildly immunocompromised case with pseudomembranous aspergillus tracheobronchitis, which caused tracheal perforation, and Horner's syndrome. A 44-year-old female with uncontrolled diabetes mellitus, complaining of fever and dyspnea, was admitted to the hospital. She was hospitalized with community-acquired pneumonia and diabetic ketoacidosis. Insulin infusion and empirical antibiotics were firstly commenced. Bronchoscopy showed left vocal cord paralysis with extensive whitish exudative membranes covering the trachea and the main bronchi. Liposomal amphotericin B was added due to the probability of fungal etiology. Mucosal biopsy revealed aspergillus species. Second bronchoscopic examination demonstrated a large perforation in the tracheobronchial system. Despite all treatments, respiratory failure developed on the 25th day and the patient died within 2 days. Pseudomembranous aspergillus tracheobronchitis is fatal in about 78 % of all cases despite appropriate therapy. Early diagnosis and efficient antifungal therapy may improve the prognosis.

Effect of obstructive sleep apnea syndrome on corneal thickness.

Obstructive sleep apnea syndrome (OSAS) might be a risk factor for the development of eye disorders. The aim of the study was to evaluate the effect of OSAS on central corneal thickness (CCT). A total of 195 patients were enrolled in the study, and underwent polysomnography. Patients were divided according to their apnea-hypopnea index (AHI) scores into control group (AHI < 5), mild (AHI, 5-15), moderate (AHI, 15-30), and severe OSAS (AHI > 30) groups. In ophthalmological examinations, CCT, auto refractometer measurement, tear break-up time, and Schrimer's test results were evaluated. Central corneal thickness was significantly decreased in patients with OSAS compared to the control group (542.14 ± 31.21 vs. 569.92 ± 13.46, p < 0.001). As the severity of OSAS increased, CCT decreased (mild OSAS = 567.48 ± 23 mm, moderate OSAS = 530.21 ± 30.2 mm, and severe OSAS = 557.97 ± 16.52 mm, respectively, p < 0.001). The mean values of auto refractometer, tear break-up time, and Schrimer's test were similar between the groups (p > 0.05). CCT was negatively correlated with AHI, oxygen desaturation index, desaturation percentages, and positively correlated with minimum oxygen saturation values (p < 0.05). This study showed that central corneal thickness is inversely correlated with the severity of OSAS. OSAS affects all organ systems particularly cardiovascular and neurological mechanisms. Further studies are warranted to evaluate the effect of OSAS treatment on CCT.

[Where do we perform sleep test: In the laboratory or at home?] / Uyku testi nerde yapilmali; laboratuvarda mi, evde mi?

Obstructive sleep apnea syndrome (OSAS) is an important public health problem seen in 14.3% of male, and 5% of female population which leads to higher morbidity, and mortality rates because of its outcomes effecting many organ systems including cardiovascular, and cerebrovascular systems. Despite its higher prevalence in community, sleep laboratories both in our country, and in the world remain incapable of diagnosing these patients, and 80-90% of the cases with OSAS can not be diagnosed. As an alternative to gold standard polysomnographic examinations this desperate condition revived the use of more practical, and less expensive portable monitorization devices which can be used at home without the need for help of a technician. In this article we will discuss whether application of sleep test on a patient with suspect OSAS in the laboratory or at home will be more appropriate regarding effectiveness, and reliability of the test in the light of the scientific data.

Platelet-lymphocyte ratio is an independent predictor for cardiovascular disease in obstructive sleep apnea syndrome.

There is a strong relationship between obstructive sleep apnea syndrome (OSAS) and cardiovascular disease (CVD). Chronic intermittent hypoxia, inflammation, oxidative stress, and endothelial dysfunction may constitute etiologic mechanisms, linking OSAS to CVD. Inflammation play an important role in the development of CVD. Platelet-lymphocyte ratio (PLR) is a new biomarker showing inflammation. No previous study has ever investigated the association between PLR, CVD and OSAS severity in patients with OSAS. This study was designed to investigate the association between PLR and CVD in patients with OSAS, and relationship between severity of OSAS, polysomnographic parameters and PLR. This was a cohort study in which patients who had undergone a full night polysomnoraphy for diagnosis of OSA were recruited. Patients were divided according to their apnea-hypopnea index (AHI) scores into OSAS negative (Group 1: AHI < 5), mild (Group 2: AHI, 5-15), moderate (Group 3:AHI,15-30), and severe OSAS (Group 4: AHI > 30) groups. The presence of heart failure, coronary artery disease or arrhythmia was defined as CVD. A total of 424 patients were included in this study. There were 57, 93, 82, and 192 patients in Groups 1, 2, 3, and 4, respectively. PLR were significantly different between groups (Group 1: 87.38; Group 2: 95.07; Group 3: 97.01, Group 4: 126.9, P < 0.05). PLR were significantly correlated with AHI, oxygen desaturation index, average and minimum O2 saturation values (P < 0.05). Values of PLR were significantly higher in patients with CVD compared with those without. Multiple regression analysis demonstrated that PLR is an independent predictor of CVD. PLR cut-off value for demonstrating the presence of CVD is higher than 108.56. In the light oh findings, PLR is strongly associated with the severity of OSAS and cardiovascular disease in OSAS patients. PLR might be used as a biomarker to predict CVD in OSAS patients.

A new approach in the diagnosis of upper airway resistance syndrome (UARS): PAP method.

INTRODUCTION: Upper airway resistance syndrome (UARS) is characterized by repeated number of arousals at night, and excessive daytime sleepiness or somnolence (EDS). It is often missed in classical polysomnographic diagnostic approaches and misdiagnosed as simple snoring or idiopathic hypersomnia, thereby is often left untreated. We propose that positive airway pressure (PAP), which has shown to be effective against UARS, can be used as a diagnostic tool as well. The study designed to test whether patients with high titration pressures can be diagnosed for UARS, and whether this pressure can be used as the treatment pressure in UARS. MATERIALS AND METHODS: This study is a retrospective cohort study. The patients with the following selection criteria: apnea hypopnea index (AHI) < 5, respiratory effort related arousal (RERA) index > 20, excessive daytime sleepiness or somnolence (EDS) without nocturnal oxygen desaturation levels were included to the study. After diagnostic polysomnography (PSG), PAP titrarion was applied to diagnose and treatment. RESULTS: Fourteen (%46.7) of the patients were male, 16 (%53.3) were female, with a mean age of 46.4 ± 9.9 and mean body mass index (BMI) of 26 ± 3.3. The patiens had a mean Epworth sleepiness scale 15.3 ± 3.9, mean AHI: 2.3 ± 1.4 and average RERA: 26.1 ± 4.9. The mean CPAP titration pressure was 7.1 ± 1.1 cmH2O. CONCLUSION: In the light of current findings, during PAP titration patients required high pressures is the evidence of increased upper airway resistance in UARS. Using the from therapy to diagnosis protocol, the PAP protocol determines the individual therapeutic pressures needed by patients. Following up the clinical outcomes of these patients under the PAP treatment, and including a larger cohort will contribute greatly to treating this syndrome, defined as one of the "unresolved problems in years".

Obstructive sleep apnea syndrome and chronic kidney disease: a new cardiorenal risk factor.

Clinical and experimental studies revealed that sleep apnea might be an insidious risk factor for the progression of kidney disease and development of cardiovascular events by exacerbating well-known risk factors, namely hypertension, type 2 diabetes mellitus and obesity. Furthermore, sleep apnea also has a negative impact on endothelial function. Therefore, sleep apnea might be defined as a new cardiorenal risk factor. In this review, we aimed to summarize the evidences supporting the complex inter-relations between sleep apnea and development and progression of chronic kidney disease.

[An important concomitancy: interstitial lung diseases and sleep related breathing disorders]. / Önemli bir beraberlik: interstisyel akciger hastaliklari ve uyku iliskili solunum bozukluklari

Interstitial lung diseases (ILD), are a group of diseases which can involve pulmonary interstitium, small airways, and vessels, and diffusely affect pulmonary parenchyma as a consequence development of inflammation, and fibrosis leading to respiratory failure, and finally death. Obstructive sleep apnea syndrome (OSAS) is a disorder which courses with its systemic outcomes, and increasing morbidity, and mortality when accompanied with other respiratory system diseases. Concomitancy of OSAS with other lung diseases including chronic obstructive pulmonary disease, asthma, ILD, cystic fibrosis is termed as ''overlap syndrome''. Because of characteristic feature of OSAS ie. recurrent oxygen desaturations during night hours, ILD-OSAS concomitancy accelerates progression of underlying lung disease. Therefore, in cases with ILD, early diagnosis, and treatment of comorbid OSAS conveys vital importance in that this approach improves quality of life of the patients, and slows down progression of the disease. In this review ILD-OSAS concomitancy will be analyzed from its various aspects.

[The treatment of central sleep-apnea syndrome, updated information, and review of the literature]. / Santral uyku apne sendromu tedavisi, güncel bilgiler ve literatürün gözden geçirilmesi.

Central sleep-apnea syndrome (CSAS) is a disease state characterized by respiratory arrest as a result of decrease or lack of respiratory drive originating from respiratory center. Although it is seen in less than 5% of the casses who consult to the sleep disorders center, incidence of CSAS increases in the presence of congestive heart and/or renal failure, and central nervous system abnormalities. Treatment of CSAS which has been analyzed under six headings in the last version of International Classification of Sleep Disorders (ICSD-2), differs among each type of CSAS. In this review, our aim is to analyze treatment alternatives for CSAS in the light of currently updated information.