Geriatric patients with known acute kidney injury and normal renal function at the time of admittance to the intensive care unit/assessment of RRT requirement and mortality: retrospective case-control study.

BACKGROUND: The objective of our study was to investigate the renal functions on admittance, chronic disease status, the diagnosis on admittance to the intensive care unit (ICU), need for mechanical ventilation and medication groups and their impact over mortality and renal replacement treatment (RRT) requirement in geriatric patients with and without known acute kidney injury (AKI) at the time of admittance. METHODS: A total of 168 patients over 65 years of age having been monitored for more than 24 h in our Respiratory ICU and were assessed retrospectively. Factors influencing the RRT requirement and the mortality rates of patients with known AKI and normal renal function at the time of admittance were reviewed. RESULTS: Of 80 patients, 8 (10 %) without AKI at the time of admittance to the ICU required RRT during the follow-up, however, 72 of those (90 %) completed the follow-up without developing AKI. Of 88 patients, 29 (33 %) with AKI at the time of admittance to the ICU required RRT, however, 59 of those (67 %) completed the follow-up without any need for RRT. CONCLUSIONS: Presence of known AKI in the geriatric population at the time of their admittance to the respiratory ICU remarkably increased both the need for RRT and the mortality with respect to the geriatric population with normal renal functions. After having assessed the reasons justifying RRT and increasing the mortality during the intensive care, gastrointestinal bleeding and hypotension which necessitate the combined use of dopamine and noradrenaline were concluded to be prominent.

COPD: an underdiagnosed disease at hospital environment.

BACKGROUND AND AIM: Chronic obstructive pulmonary disease (COPD) is a serious disease with morbidity and mortality due to delayed diagnosis until significant symptoms arise. We aimed to assess the utility of spirometry and COPD Assessment Test (CAT) in detecting undiagnosed COPD patients in a localized area. MATERIAL AND METHODS: People who came to the hospital for patient visit or examination with a smoking history of > 10 pack-years (> 40 years old), and with no known chest disease were invited to study. The participants completed a questionnaire and performed spirometry. Spirometry was performed according to ATS/ERS Task Force on spirometry. COPD was defined as according to the Global Initiative for Chronic Obstructive Lung Disease guidelines. RESULTS: There were 800 subjects screened, and 648, capable of performing spirometry, were included to the study. The mean age was 48.3 ± 9.0 and 38 % of the study population was male. Post-bronchodilator FEV1/FVC ratio was lower than 0.70 in 17 % of the subjects. Median (25-75 percentiles) total CAT scores and among the questions of CAT; cough, phlegm, chest tightness and breathlessness scores for COPD and non-COPD subjects were; 15(9-22) vs 12(6-18) (p = .004), 2(1-3) vs 1(0-2) (p < .001), 2(0-3) vs 1(0-3) (p = .004), 3(1-4) vs 2(0-3) (p > .001), 4(3-5) vs 3(2-4) (p = .001), respectively. Symptom prevalence was as follows: exertional dyspnea 91 %, dyspnea 80.9 %, cough 56.3 % and phlegm 58.3 % in COPD. CONCLUSION: Our study showed that spirometric screening together with the CAT questionnaire may improve the awareness of disease and may determine undiagnosed patients.

Does hormonal control obviate positive airway pressure therapy in acromegaly with sleep-disordered breathing?

INTRODUCTION: Acromegaly is a disease in which uncontrolled release of growth hormone occurs after closure of epiphyseal plates, causing changes in the body that can lead to sleep disordered breathing (SDB). No definite guidelines regarding the treatment of SDB in acromegaly are available. In this study, we aimed to investigate the prevalence of SDB in acromegaly and whether hormonal control alters the necessity of positive airway pressure (PAP) therapy in acromegaly patients with SDB. METHODS: Forty-two acromegaly patients were included in the study and divided into two groups according to disease status, i.e., active or well controlled. All patients underwent polysomnography. Fourteen patients with active acromegaly were diagnosed with SDB and were evaluated for PAP therapy with polysomnography both before and 6 months after disease control was achieved. RESULTS: Sleep-disorder breathing was diagnosed in 22 of 42 patients, 7 of 20 patients with controlled-disease and 15 of 20 patients with active diseases. There were significant reductions in respiratory disturbance index (RDI), apnea index, desaturation index, central apnea number, and rapid eye movement-phase RDI at the control polysomnography. Initially, PAP therapy was indicated in 12 of 14 patients and PAP therapy indication held in 11 patients after acromegaly control was achieved. CONCLUSION: Our study revealed that over half of patients with acromegaly had SDB. Furthermore, SDB severity decreases with acromegaly treatment; however, this decrease does not change the indication for PAP therapy; therefore, PAP therapy should not be delayed in acromegalic SDB patients.

[Relationship between symptoms of obstructive sleep apnea syndrome and traffic accidents in the city drivers]. / Sehir içi araç kullanan soförlerde obstrüktif uyku apne sendromu semptomlari ve trafik kazasi iliskisi.

INTRODUCTION: There is a high tendency for traffic accidents in patients with obstructive sleep apnea syndrome (OSAS). Thus it's recommended to investigate OSAS symptoms before certification of professional drivers. However, to what degree OSAS symptoms predict traffic accidents is not clear. We aimed to investigate the relationship between OSAS symptoms and traffic accidents. MATERIALS AND METHODS: Five hundred twenty bus drivers working at Istanbul Electricity, Tramway and Tunnel (IETT) general management were randomly selected. Berlin questionnaire was applied which included demographic data, accident ratios, total duration in profession, duration of working in a day and OSAS symptoms. Epworth sleepiness score (ESS) test was applied to assess day time slepiness. RESULTS: All drivers were male. Snoring were present in 324 (65.7%) of participants. Traffic accident history were present in 259 (49.7%) of drivers. Significant relationship was present between traffic accident and only daytime sleepiness among the OSAS symptoms. The mean of accident/year ratio of all participants were 0.092. Mean of ESS was 7.3 ± 3.2 for all participants. There is a positive correlation between ESS and accident/year ratio (r= 0.57, p= 0.012). CONCLUSION: Only daytime sleepiness among OSAS symptoms is related with traffic accident. The questioning of OSAS symptoms alone is inadequate to estimate traffic accident risk. Thus further consideration more than symptom questioning is needed at phase of authorization of professional drivers to detect OSAS.

[The frequency and properties of REM related obstructive sleep apnea among the patients with mild related obstructive sleep apnea]. / Hafif obstrüktif uyku apneli hastalarda REM ile iliskili obstrüktif uyku apne sikligi ve özellikleri.

INTRODUCTION: The question if REM related obstructive sleep apnea (OSA) is a specific clinical entity or if it is an early sign of severe sleep disordered breathing as there is high occurrence of REM OSA in mild and moderate cases, recently have attracted the investigators. In this study, we aimed to see the frequency of REM related OSA among patients with mild OSA; and also to evaluate relation between apnea and daytime sleepiness among REM related OSA patients. MATERIALS AND METHODS: One hundred thirty four patients with mild OSA [Apnea hipopnea index (AHI)= 5-15] among 1267 patients with polysomnography examination at sleep laboratory of Bezmialem University Hospital between 1st August 2010 and 29th February 2012 were retrospectively evaluated. Patients having REM AHI/non-REM AHI ≥ 2 and non-REM AHI < 15 are considered as REM related OSA. RESULTS: Eighty (59%) of 134 patients with mild OSA were considered as REM related OSA. When REM related OSA and non REM OSA are compared for age, gender, daytime sleepiness, body mass index, neck surround and aditional diseases; mean age of REM related OSA group was found only significantly lower. Number of AHI in REM was over 15 at 87.3% of REM related OSA group and over 30 at 39.3% of them. There was no relation between REM AHI and daytime sleepiness symptom (p= 0.81). CONCLUSION: We may consider the result of lower mean age in REM related OSA group as a supporting result for early sign of severe sleep disordered breathing. We consider to follow up this group of patients to answer the question about subject.

Clinical and polysomnographic features of a large Turkish pedigree with restless leg syndrome and periodic limb movements.

PURPOSE: Restless leg syndrome (RLS) and periodic limb movements (PLMS) are common neurological diseases often associated with insomnia. A familial aggregation in RLS has been identified since it was first described; however, inheritance patterns of RLS/PLMS are poorly understood and their exact pathophysiology is not well-known. We have identified a Turkish pedigree with RLS/PLMS, which is a rare condition, in five generations of a family, including nine affected family members. METHODS: A detailed clinical evaluation of the family was conducted with the help of polysomnographic recording, electrophysiological findings, and biochemical parameters. RESULTS: The proband is a 38-year-old male member of the family who first started to show symptoms at the age of 29. All the patients from this family have been diagnosed with RLS, according to the criteria of the International RLS Study Group. Disease onset was early in all cases and even earlier in the younger generation. Three affected individuals also had PLMS on polysomnographic recordings. CONCLUSION: To our knowledge, this is the first Turkish family in which nine individuals in five generations are affected. We suggest an important effect of anticipation and genetic impact of the diseases and describe specific clinical features. Further investigation of clinical, genetic, and biochemical similarities between PLMS and RLS may yield important clues, adding to our understanding of the pathophysiology of these common diseases.