Evaluation of comorbid diseases in obstructive sleep apnea syndrome

SUMMARY OBJECTIVE: It is known that obstructive sleep apnea syndrome affects many systems due to hypoxemia and hypercarbia. We aimed to demonstrate with the utilization of well-standardized questionnaire tools and electrophysiological tests that cognitive impairment, depression, autonomic dysfunction, and metabolic syndrome may occur in association with obstructive sleep apnea syndrome. METHODS: The electrophysiological examination protocol of autonomic nervous system functions was performed with sympathetic skin response and R-R Interval. Patients were administered Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, Montreal Cognitive Assessment, and Hamilton Depression Rating Scale by physicians in face-to-face interviews. RESULTS: This study included 148 participants, consisting of 73 patients and 75 controls. There was a statistically significant difference between the patient group and control group with regard to sympathetic skin response, R-R Interval, post-hyperventilation R-R Interval, and R-R Interval variation (p<0.001). A statistically significant difference was observed between the patient group and control group in terms of median Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, and Montreal Cognitive Assessment scores. It was observed that the control group achieved significantly better scores than the patient group in delayed recall (p<0.001) and language (p<0.05) categories. CONCLUSION: Obstructive sleep apnea syndrome patients should be screened for diseases, especially in the cardiovascular system, that cause serious morbidity and impair functionality such as dementia and depression. We believe that many comorbid diseases encountered in obstructive sleep apnea syndrome patients can be prevented with early diagnosis and continuous positive airway pressure treatment.

Evaluation of comorbid diseases in obstructive sleep apnea syndrome.

OBJECTIVE: It is known that obstructive sleep apnea syndrome affects many systems due to hypoxemia and hypercarbia. We aimed to demonstrate with the utilization of well-standardized questionnaire tools and electrophysiological tests that cognitive impairment, depression, autonomic dysfunction, and metabolic syndrome may occur in association with obstructive sleep apnea syndrome. METHODS: The electrophysiological examination protocol of autonomic nervous system functions was performed with sympathetic skin response and R-R Interval. Patients were administered Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, Montreal Cognitive Assessment, and Hamilton Depression Rating Scale by physicians in face-to-face interviews. RESULTS: This study included 148 participants, consisting of 73 patients and 75 controls. There was a statistically significant difference between the patient group and control group with regard to sympathetic skin response, R-R Interval, post-hyperventilation R-R Interval, and R-R Interval variation (p<0.001). A statistically significant difference was observed between the patient group and control group in terms of median Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, and Montreal Cognitive Assessment scores. It was observed that the control group achieved significantly better scores than the patient group in delayed recall (p<0.001) and language (p<0.05) categories. CONCLUSION: Obstructive sleep apnea syndrome patients should be screened for diseases, especially in the cardiovascular system, that cause serious morbidity and impair functionality such as dementia and depression. We believe that many comorbid diseases encountered in obstructive sleep apnea syndrome patients can be prevented with early diagnosis and continuous positive airway pressure treatment.

Too bad to treat? Predicting clinical outcome after mechanical thrombectomy in octogenarians.

OBJECTIVES: We aimed to reveal the effect of the totaled health risk in vascular events (THRIVE) score and the radiological parameters of the Alberta stroke program early computed tomography score (ASPECTS), the Van Swieten Scale (VSS) score, and the Evans Index on clinical outcomes in patients over 80 years of age who underwent endovascular thrombectomy (EVT). MATERIALS AND METHODS: We retrospectively analyzed anterior ischemic stroke (AIS) patients over 80 years of age who underwent EVT between May 2017 and April 2022. Good functional outcome was accepted as a 90-day modified Rankin Scale (mRS) score of 0-2. We constructed three models to compare to the mRS (model 1: THRIVE, CTA-ASPECT; model 2: THRIVE, CTA-ASPECT, Evans Index; model 3: THRIVE, CTA-ASPECT, Evans Index, VSS). RESULTS: A total of 39 octogenarian patients with thrombolysis in cerebral infarction (TICI) 2c-3 recanalization were selected, and their 90-day mRS scores were compared. Of these, 19 patients (48%) showed good outcomes. In multivariable receiver operating characteristic (ROC) analyses, the AUC of model 1 was 0.797 (95% confidence interval [CI], 0.638-0.909), the AUC of model 2 was 0.862 (95% CI, 0.714-0.951), and the AUC of model 3 was 0.905 (95% CI, 0.768-0.975). CONCLUSIONS: Evaluation of the THRIVE score, which measures vascular disease burden and stroke severity, together with the radiological parameters of ASPECTS score, VSS score, and the Evans Index, provides useful guidance in predicting the clinical outcomes of elderly AIS patients after EVT.

The role of ASPECTs in patient selection for endovascular therapy - CTA source images versus noncontrast CT.

The Alberta Stroke Program Early Computed Tomography Score (ASPECTs) on noncontrast CT (NCCT) is widely used for the decision of endovascular therapy (ET) in randomized controlled trials. CT angiography source images (CTA-SI) is another method to evaluate ischemic brain damage. We aimed to evaluate the association between pretreatment ASPECTs on CTA-SI and post-treatment clinical and radiological outcomes in acute stroke patients treated with ET. The association between both scores along with final infarct and outcome were analyzed. A total of 90 patients with successful recanalization were included in the study. The mean age was 59 ±â€¯11.8. According to the results, CTA-SI ASPECTs was better correlated with final infarct than NCCT ASPECTs (p < 0.001). In univariate analyzes, factors associated with good outcome were age, baseline NIHSS score, and presence of diabetes mellitus (p = 0.001, p = 0.002, p = 0.034, respectively). On the other hand, when an analysis differentiating patients by age was performed, 40 patients below 60 years of age had significantly better outcomes despite having higher baseline NIHSS scores (p = 0.002). Finally, in multivariate analyzes, only age and baseline NIHSS score were found to be independent predictors of good outcome (p = 0.003 for both). In conclusion, CTA-SI ASPECTs in patient selection for ET seems to be more useful than NCCT ASPECTs. However, both scoring modalities were not found to be independent predictors of good outcome. Outcomes are changeable for the younger population who could continue their lives with mild or no deficits despite having a relatively low initial ASPECTs.