Anxiety and depression levels of healthcare workers during Covid-19 pandemic.

Background: Coronavirus disease 2019 (covid-19), which causes a pandemic in the world, has started to appear in turkey since march 2020. Healthcare workers are at the top of the groups most at risk for covid-19 infection, which can have a negative impact on psychological state. Objectives: It was aimed to evaluate anxiety and depression levels among healthcare workers. Methods: this cross-sectional study performed via an online survey in april 2020. Participants answered questions about sociodemographic features, personal views and experiences about covid-19 and the hospital anxiety and depression scale (hads). Results: A total of 300 healthcare workers,193 men and 107 women, participated in the survey. According to hads, 44.6% of participants scored above anxiety and 68.2% scored above depression cut-off points. Being younger than 50 and taking care of covid-19 patients in hospitals were independently associated with anxiety risk. Female gender, young age (less than 50) and having comorbidity were independent risk factors for depression. Conclusion: Healthcare workers were at high risk of anxiety and depression during covid-19 outbreak. For this reason, psychological support should be given, especially to the group with high risk.

The effects of vitamin D supplemantation on prognosis in patients with mild obstructive sleep apnea syndrome

Background/aim: The aim of this study was to investigate the effect of vitamin D on the disease prognosis and biochemical parameters in patients with mild obstructive sleep apnea syndrome (OSAS). Materials and methods: Nineteen adult male individuals (18­65 years) who were diagnosed with mild OSAS after polysomnography and had low vitamin D levels were included in the study. Each week, patients took 50.000 IU Vitamin D3 supplementation for 8 weeks. Polysomnography, biochemical parameters FBG (fasting blood glucose), lipid profile (TG, TC, LDL-C, HDL-C, VLDL-C), calcium, phosphorus, parathormone, calcitonin, serum 25(OH)D, insulin, CRP, TNF-α, IL-6, and IL-10 of patients were evaluated at the beginning of study and at the end of the study. All assessments, including polysomnography, were repeated after 8 weeks. Results: Serum vitamin D levels were initially 19.5 ± 5.01 ng/mL and increased to 41.8 ± 10.51 ng/mL (p < 0.001) at the end of the study. FBG, TC and HOMA-IR of the patients were significantly decreased (p < 0.05). CRP, TNF-α, IL-6, and IL-10 levels were also correlated with serum vitamin D levels (p < 0.05). There was a significant decrease in number of obstructive apneas, apneas a nd hypopneas, apnea index, hypopnea index, and apnea hypopnea index of the patients (p < 0.05). Conclusion: As a result, it is thought that vitamin D supplementation may have a positive effect on the disease prognosis of mild OSAS.

[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.

Is NREM-predominant obstructive sleep apnea syndrome a different clinical entity?

Background/aim: This study aimed to evaluate whether NREM-predominant obstructive sleep apnea syndrome (OSAS) patients (NREM AHI < REM AHI) have distinct clinical and polysomnographic features compared to REM-predominant OSAS patients (REM AHI > NREM AHI). Materials and methods: A total of 342 patients (93 females and 249 males) who were admitted to the Sleep Disorders Unit at the Gazi University Faculty of Medicine and underwent polysomnography between January 2011 and April 2016 were retrospectively reviewed. Patient data, symptoms related to OSAS, Epworth Sleepiness Scale (ESS) scores, and polysomnographic findings were recorded. The patients were divided into two groups according to the apnea-hypopnea index (AHI) as patients with NREM-predominant OSAS and patients with REM-predominant OSAS. Results: The total AHI in the NREM-predominant group was significantly higher than in the REM-predominant group (P < 0.001). The patients with severe OSAS constituted the majority in both groups, and the rate of patients with severe OSAS was significantly higher in the NREM-predominant group than in the REM-predominant group (P < 0.001). Arousal index and sleep time spent under 90% SaO2 was higher in the NREM-predominant group (P = 0.005, P = 0.001), whereas nocturnal mean and minimum O2 saturation values were lower in the NREM-predominant group compared to patients with REM-predominant OSAS (P < 0.001, P = 0.013). In evaluating systemic disorders, the prevalence of coronary artery disease was significantly higher in the NREM-predominant OSAS group (P < 0.001). Conclusion: Our results showed that patients with NREM-predominant OSAS had a more severe course than patients with REMpredominant OSAS. However, we found no significant difference in sleep-specific symptoms, suggesting that the two groups represented distinct entities.

Neurocognitive disorders and sleep in children with primary ciliary dyskinesia.

BACKGROUND: Primary ciliary dyskinesia (PCD) patients have higher incidence of sleep disordered breathing which lead neurocognitive impairments such as attention-deficit/hyperactivity disorder (ADHD). It may effect academic performance of children and may cause impairment in emotional relationships. This study aim to evaluate hyperactivity and attention deficiency in PCD patients and investigate the relationship between sleep and hyperactivity and attention deficiency in PCD patients. METHOD: Fifteen PCD patients aged 8-18 years and 31 age-matched healthy controls were compared. Ear, nose, and throat examination and home sleep testing were performed in PCD patients. Pediatric sleep questionnaire, Conners' Parents and Teacher scale and Stroop test were applied in both groups in order to investigate the relation between sleep disordered breathing and ADHD in PCD children. RESULTS: PCD patients had chronic rhinosinusitis (100%), tonsillar hypertrophy (80%) and adenoidal hypertrophy (60%). FEF25-75 was low in pulmonary function test. Sixty percent of the PCD patients had mild obstructive sleep apnea syndrome in home sleep testing. Mean AHI was 1.54 ± 0.27. Compared with the controls PCD patients had higher PSQ scores. Hyperactivity scores on Conners' Parents scale and inattention findings in Stroop test were higher in PCD patients than the healthy controls (P < 0.05). CONCLUSION: Most of PCD children had mild obstructive sleep apnea syndrome. Hyperactivity and inattention findings were higher in PCD patients. Sleep disordered breathing assessment should be a routine part of PCD patients management and these patients should be carefully monitored in terms of hyperactivity and inattention.

Effect of semi-rapid maxillary expansion in children with obstructive sleep apnea syndrome: 5-month follow-up study.

BACKGROUND: The purpose of this study was to investigate the effect of semi-rapid maxillary expansion (SRME) orthodontic treatment on biomarkers and respiratory parameters in children with obstructive sleep apnea syndrome (OSAS) and maxillary transverse deficiency. METHODS: Thirty children with OSAS were included in this study. Fifteen children were enrolled as control, and 15 children were subjected to SRME orthodontic treatment method for 5 months. Beside respiratory parameters, pharyngeal area, dental arch, and postero-anterior widths and the levels of OSAS biomarkers in serum and urine were measured. RESULTS: Pharyngeal airway space, dental arch, and postero-anterior widths were increased after SRME treatment. Sleep tests showed a decrease in the apnea-hypopnea index (AHI) after 5-month control/treatment duration. Serum kallikrein (KLK)1 levels decreased significantly in the treatment group. There was a significant increase in serum orosomucoid (ORM)2 levels and a decrease in urine perlecan levels in the control group after a 5-month follow-up. A significant negative correlation between serum ORM2, perlecan, gelsolin, and KLK1 levels and intercanin width, as well as between serum ORM2 and KLK1 levels and intermolar width, was observed. CONCLUSIONS: SRME treatment can be considered as a useful approach in children with OSAS. A further investigation of OSAS-related biomarkers and their relationship with sleep and orthodontic parameters is needed for providing easier and reliable modulatory strategies in the treatment of OSAS.

The effect of obstructive sleep apnea syndrome on the central auditory system

Background/aim: Obstructive sleep apnea syndrome (OSAS) is a disease characterized by repeated hypoxia attacks during sleep. The effect of hypoxia on the central nervous system is a well-known entity. In this study we aimed to investigate the effect of OSAS on the central auditory system. Materials and methods: Twenty-one OSAS patients diagnosed by polysomnography (PSG) and 10 control subjects were included in the study. After a thorough otorhinolaryngology examination, all subjects underwent pure tone audiometry (250 to 8000 Hz frequency). The subjects with normal otoscopic examination and hearing threshold were included in the study. All participants underwent speech discrimination analyses and auditory time processing and sequencing tests, i.e. frequency pattern test (FPT) and duration pattern test (DPT). Results: Although hearing was normal in the OSAS patients, significant loss was observed in the speech discrimination rates compared to the control group (P < 0.05). Significant disruption was also detected in the FPT and SPT in the OSAS patients (P < 0.05). Conclusion: Repeated hypoxic episodes in OSAS resulted in statistically significant impairments in the central auditory pathways, even if the hearing threshold was within normal limits.

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.

Does nasal congestion have a role in decreased resistance to regular CPAP usage?

Nasal obstruction is known to cause resistance to continuous positive airway pressure (CPAP) therapy in obstructive sleep apnea syndrome (OSAS). In this paper, short- and long-term nasal congestion in OSAS patients receiving CPAP treatment were evaluated with acoustic rhinometry (AR). A total of 36 patients with moderate-to-severe OSAS, diagnosed with polysomnography were included in the study. Ten healthy subjects without OSAS constituted the control group. Pre-treatment nasal patency were measured with AR in all participants. 26 patients used the recommended CPAP treatment. Ten patients did not accept CPAP treatment. The AR test was repeated for all the subjects after 1 and 3 months except the 3rd month's measurements of the control group. There was no statistically significant difference between the initial minimum cross-sectional area (MCA) measurements of OSAS patients, using or not using CPAP, and the control group (P > 0.05). However, the first month MCA measurements of patients receiving CPAP were found to be significantly decreased compared with the initial values (P < 0.001). There was no significant change in the first and third months MCA values in the control group and patients who did not use CPAP (P > 0.05). No significant difference revealed in the 3rd month MCA measurements of the patients using CPAP compared with the initial values (P > 0.05). In this study, the increased nasal congestion, which is thought to be the cause of CPAP resistance, was objectively demonstrated in OSAS patients using CPAP. In addition, the nasal congestion developing at the first month was shown to disappear over time, supporting the opinion that patient compliance in CPAP treatment is expected to increase after regular device usage.

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".

[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.

Home sleep study characteristics in patients with mucopolysaccharidosis.

BACKGROUND: Mucopolysaccharidoses (MPS) are a group of inherited lysosomal storage disorders caused by the deficiency of hydrolases involved in the degradative pathway of glycosaminoglycans. In MPS, upper airway obstruction may result from multiple causative factors which may impact severely upon morbidity and mortality. METHODS: We evaluated upper airway obstructive disease and related clinical findings through home sleep study in 19 patients (11 with MPS VI, 4 with MPS I, 4 with MPS II) with MPS followed at Gazi University Pediatric Metabolic Unit. Patients underwent home-based sleep measurements, and sleep respiratory problems were asked in a detailed clinical history. Measurements of apnea, apnea-hypopnea index (AHI), hypopnea index, oxygen desaturation index, and minimal oxygen saturation were obtained through home sleep study. RESULTS: For 19 children, the disorder was normal in 1, mild (AHI=1.5-5/h) in 5, moderate (AHI=5-10/h) in 2, and severe (AHI>10/h) in 11. The prevalence of OSA was 94.7 % (18/19) in patients with MPS. Snoring, witnessed apnea, pectus carinatum, and macroglossia were the main clinical findings. Echocardiograms showed evidence of pulmonary hypertension in 13 patients. CONCLUSION: Home sleep study is a quick and accessible screening test to determine the abnormalities of breathing during sleep and enables clinicians to take necessary action for patients with severe manifestations.

Obstructive sleep apnea syndrome is related to the progression of chronic kidney disease.

BACKGROUND AND AIM: Obstructive sleep apnea syndrome (OSAS) is an independent risk factor for the development of cardiovascular events and hypertension. The possible causes are oxygen desaturation due to hypopnea, increased cytokine levels and insulin resistance. All these risk factors also have a role in the progression of chronic kidney disease (CKD). The aim of this study was to determine the relationship between OSAS and the severity of CKD. MATERIALS AND METHODS: We retrospectively evaluated the medical records of 175 subjects who were admitted for the polysomnography study. OSAS was diagnosed by polysomnography if Apnea-Hypopnea Index (AHI) > 5 and glomerular filtration rate (GFR) was calculated with Cockcroft-Gault formula. According to AHI, individuals with AHI < 5 were recruited as group 1 (OSAS negative group), those with AHI = 5-15 group 2 (mild OSAS group), those with AHI = 15-30 group 3 (moderate OSAS group), and those with AHI > 30 group 4 (severe OSAS group). RESULTS: Of the subjects, 117 (67%) were men, 58 (33%) were women and the mean age was 54.0 ± 12.1 years. There were 28 (14.3%), 18 (10.3%), 35 (20.0%) and 97 (55.4%) patients in groups 1, 2, 3 and 4 respectively. The prevalence of diabetes mellitus and hypertension and body mass index was significantly higher in severe OSAS group (P < 0.05). A significant decrease in GFR was detected when the severity of OSAS increased (group 1 = 50.0 ± 11.8, group 2 = 44.8 ± 15.9, group 3 = 40.8 ± 14.7, group 4 = 38.8 ± 16.0; P for trend < 0.001). CONCLUSION: In the light of the present study, we speculate that OSAS is an independent risk factor for the progression of chronic kidney disease, which is a growing health problem. Further randomized-multicenter prospective studies are warranted to evaluate this relationship.

Consequences of hypoxia-reoxygenation phenomena in patients with obstructive sleep apnea syndrome.

BACKGROUND AND OBJECTIVES: Obstructive sleep apnea syndrome (OSAS) is a common disorder characterized by numerous episodes of absence of respiratory flow during sleep, which can be followed by a decrease in SaO2, which is rapidly normalized when ventilation resumes. We hypothesize that this hypoxia-reoxygenation phenomena may affect the generation of vascular endothelial growth factor (VEGF), erythropoietin (EPO), endothelin-1 (ENDO-1), and inducible nitric oxide synthase (iNOS). DESIGN AND SETTING: Prospective, patients referred to sleep disorders center. PATIENTS AND METHODS: The presence and severity of OSAS were determined using the standard overnight polysomnography. Diagnosis of OSAS was made when the apnea-hypopnea index (AHI) was ≥15, independent of the appearance of symptoms. Serum levels of VEGF, EPO, ENDO-1, and nitrite-nitrate were measured after overnight fasting in 69 patients with OSAS and in 17 healthy control subjects. Serum levels of VEGF and nitrite-nitrate were measured again after 12 weeks of treatment with continuous positive airway pressure (CPAP) in OSAS patients. RESULTS: Serum VEGF levels were found to be significantly higher and nitrite-nitrate levels were found to be significantly lower in OSAS patients than in controls (P=.003, .008, respectively), but no differences in EPO and ENDO-1 levels were found between the groups. We demonstrated that in OSAS patients, the serum VEGF levels were decreased and nitrate levels were increased after 12 weeks of CPAP treatment (P=.001, .002, respectively). CONCLUSION: According to our data, it is likely that hypoxia-reoxygenation phenomena affect the VEGF and nitrite-nitrate levels, which may be pathogenic factors in generating cardiovascular complications in OSAS.

Serum gamma-glutamyl transferase activity is an independent predictor for cardiovascular disease in obstructive sleep apnea syndrome.

Gamma glutamyl transferase (GGT) is a new marker for predicting myocardial infarction, stroke, cardiac death and inflammation. There is also a strong relationship between Obstructive Sleep Apnea Syndrome (OSAS) and cardiovascular disease. This study was designed to investigate the association between serum GGT levels and cardiovascular disease in patients with OSAS, and relationship between severity of OSAS and serum GGT level. We evaluated the medical records of 166 subjects who were admitted for sleep study. OSAS was diagnosed by polysomnography if Apnea-Hypopnea Index (AHI) > 5. According to AHI, individuals in whom AHI< 5 were recruited as group 1 (OSAS negative group), AHI = 5-15: group 2 (mild OSAS group), AHI = 15-30: group 3 (moderate OSAS group), AHI >30: group 4 (severe OSAS group). Cardiovascular disease was defined if the patients had heart failure, coronary artery disease or arrhythmia. Of the subjects, 112 (67.5%) were male and the mean age was 54.3 ± 12.2 years. There were 22 patients (13.2%), 17 patients (10.2%), 34 patients (20.4%) and 93 patients (56.2%) in group 1, 2, 3 and 4, respectively. There is a significant increase in serum GGT levels while AHI score increases (group 1 = 28.0 ± 10.1, group 2 = 33.8 ± 13.2, group 3 = 35.2 ± 8.5, group 4 = 40.0 ± 22.0; p for trend = 0.024). However, serum C-reactive protein (CRP), alanine aminotransferase and aspartate aminotransferase levels were similar in all groups (p > 0.05). There was a significant independent association between serum GGT levels and the severity of OSAS. Moreover, serum GGT levels were significantly high in patients with cardiovascular disease compared with patients without cardiovascular disease in severe-moderate-mild OSAS (p < 0.05) and OSAS negative groups while CRP levels were not. This was a significant independent association. The present study suggests that high serum GGT level, regardless of the other traditional risk factors, is an independent predictor of cardiovascular disease in patients with OSAS. The results should be confirmed with other randomized prospective studies.

[Sleep disorders in end-stage renal failure]. / Son dönem böbrek yetersizliginde uyku bozukluklari.

Sleep disorders are common in patients with end-stage renal disease. Daytime sleepiness, restless legs syndrome, periodic limb movement disorder, insomnia, sleep apnea syndrome are the most disturbances. Usually, sleep-related complaints are attributed to uremia because of similar symptoms, and this may cause to delayed diagnosis. Sleep disorders are negative effect on quality of life and compliance to treatment of patients as well as cause increased mortality and morbidity. Therefore, sleep disorders should be evaluated as a different clinical entity in patients with chronic kidney failure or receiving renal replacement therapy. In this article, we aimed to review of etiology, pathogenesis and treatment of common sleep disorders in end-stage renal failure in sight of related literature information.

Role of nitric oxide synthase gene intron 4 and exon 7 polymorphisms in obstructive sleep apnea syndrome.

The objective of our study was to assess the association of eNOS4 and eNOS296 polymorphisms of endothelial nitric oxide synthase (eNOS) gene with obstructive sleep apnea syndrome (OSAS). Forty-eight patients with OSAS and 181 healthy volunteers were included in the study. Genotype analyses were performed for eNOS intron 4 VNTR and exon 7, Glu298Asp (G --> T) polymorphisms. There was no significant difference between the patients and controls regarding eNOS4 polymorphism (P > 0.05). There was a significant difference between the patients and controls regarding eNOS296 polymorphism. Glu/Asp variant was more frequent whereas Glu/Glu variant was less frequent in the patients compared to controls (P < 0.001). There was no relationship between eNOS4 and eNOS296 polymorphisms and polysomnography parameters, apnea-hypopnea index, age, gender, body weight and height, body mass index, hypertension, coronary artery disease, arrhythmia, diabetes mellitus, hypercholesterolemia and smoking (P > 0.05). The eNOS4 polymorphism of NOS gene is not associated with OSAS. However, eNOS296 polymorphism of NOS gene is associated with occurrence of OSAS, but not with severity of OSAS.

Comparison of serum adiponectin and tumor necrosis factor-alpha levels between patients with and without obstructive sleep apnea syndrome.

BACKGROUND: The obstructive sleep apnea syndrome (OSAS) is closely associated with cardiovascular and metabolic disorders. OBJECTIVES: The aim of this study was to evaluate the influence of OSAS on plasma adiponectin levels independent of obesity in our study group. We also investigated the association between plasma adiponectin, plasma tumor necrosis factor-alpha (TNF-alpha), obesity, cardiovascular disease (CVD) and OSAS. METHODS: The patients were classified into controls or OSAS patients according to the apnea-hypopnea index (AHI): patients with an AHI <5 constituted the control group (n = 32) and patients with an AHI > or =5 constituted the OSAS group (n = 106). Plasma TNF-alpha and adiponectin levels were measured in both groups. RESULTS: Plasma adiponectin levels were negatively correlated with AHI, body mass index (BMI) and SpO(2) <90% and positively correlated with minimum oxygen saturation. The plasma levels of TNF-alpha were positively correlated with SpO(2) <90%, BMI and fasting plasma glucose levels. In addition, there was a significant negative correlation between plasma TNF-alpha and adiponectin levels in theOSAS group. Compared with thenon-obese OSAS group, subjects with obesity and OSAS had lower adiponectin levels and SpO(2) <90%, and higher TNF-alpha levels. Obese OSAS patients had higher rates of CVD with lower plasma adiponectin levels when compared with obese control subjects. CONCLUSION: Serum adiponectin is significantly lower in patients with OSAS and it is independent of obesity. This might explain the high incidence of CVD and metabolic syndrome in patients with OSAS.