Obesity and obstructive sleep apnea syndrome.

OBJECTIVES: to investigate the association of sleep apnea severity with insulin resistance, leptin, adipose-fatty acid binding protein (A-FABP) and visfatin levels and to evaluate the confounding role of obesity. STUDY DESIGN: prospective study. METHODS: the study included obese patients who were referred to the sleep laboratory. Patients were divided into two main groups according to their Apnea-Hypopnea Index (AHI). Measurements of body weight, height, blood pressure, waist circumference (WC), and neck circumference (NC) were taken on the night of the sleep study. Blood samples were taken after polysomnography. Insulin resistance was estimated with the homeostasis model assessment (HOMA) index. RESULTS: group A included 34 patients with obstructive sleep apnea syndrome (OSAS) and group B included 19 patients without OSAS. OSAS patients had significant higher visfatin levels; however, other parameters were similar. Leptin and A-FABP were significantly correlated with body mass index (BMI) in both groups. OSAS patients had significant higher NC and WC despite a BMI similar to that of group B, and strong correlations of these two variables were found with HOMA. Group A had higher visfatin levels than did group B. CONCLUSIONS: insulin resistance was not directly associated with BMI and/or AHI, but it was aggravated by nocturnal hypoxemia owing to apnea severity. NC was also a good predictor for insulin resistance and should not be ignored during the treatment selection for the patients with OSAS. Visfatin may have a potential role as a screening marker for OSAS.

Results of primary ossiculoplasty and prognostic factors in canal wall-down tympanoplasty.

The ideal goals of chronic middle ear surgery should be the permanent removal of disease and the preservation of good hearing function. The postoperative outcome of hearing and the status of middle ear after canal wall-down tympanoplasty with primary ossiculoplasty were studied in 192 ears with chronic middle ear disease. Cholesteatoma was present in 121 (63.0%) of 192 cases; in the remaining 71 cases (27.0%), there was middle ear mucosa disease without cholesteatoma. The stapes superstructure was present in 142 (73.9%) of 192 cases. The results of preoperative and postoperative pure-tone averages were 55.12 (SD, 4.92) and 35.81 (SD, 4.84) dB, respectively. The preoperative and postoperative air-bone gaps in 192 cases were 32.70 (SD, 5.18) and 21.16 (SD, 5.09) dB, respectively. The mean hearing gain of the 192 ears was 19.17 (SD, 6.09) dB. The presence of stapes superstructure positively affects hearing status. Also, better hearing results were obtained in cholesteatoma cases presented. Recurrences of disease were seen rarely compared with literature. It was revealed that the postoperative outcome of primary canal wall-down tympanoplasty with ossicular chain reconstruction is suitable for safe ear and hearing ear.