Carotid intima-media thickness is not associated with homocysteine and vitamin D levels in obstructive sleep apnea.

Obstructive sleep apnea syndrome (OSA) is associated with increased vascular morbidity. Accelerated atherosclerosis might be one of the most important mechanisms linking OSA with the development of vascular disorders. Homocysteine (HCY) and vitamin D has been associated with atherogenesis. The aim of this study was to assess a possible association between the levels of HCY and vitamin D and the carotid intima-media thickness (cIMT), which is a known marker for subclinical atherosclerosis in patients with OSA. We prospectively enrolled 110 patients with the history of snoring, who underwent standard overnight polysomnography. Clinical characteristics of the population were recorded on admission and blood samples were obtained in the fasting condition following morning. Extracranial cIMT measurements were performed according to the standardized scanning protocol. A significant correlation was found between cIMT and apnea-hypopnea index (r = .276, p = .006), age (r = .486, p < .001), diabetes mellitus (r = .377, p < .001), coronary artery disease (r = .274, p = .006) and history of stroke (r = .251, p = .012). We failed to find any significant correlation between cIMT and the levels of HCY (r = .036, p = .724) or vitamin D (r = .027, p = .800). In conclusion, our data suggest that the association of cIMT with the severity of OSA can be influenced by multiple metabolic consequences of OSA including traditional and non-traditional risk factors. HCY and vitamin D do not seem to play a superior role in this process.

Multi-infarct dementia and Alzheimer disease, contribution of cerebral circulation ultrasonography to pathogenesis and differential diagnosis. Value of microembolisation.

OBJECTIVES: Dementias are one of the most serious health and socioeconomic issues. Multi-infarct dementia (MID) and Alzheimer´s type dementia (AD) exhibit differences in cerebrovascular blood flow velocity profiles and in presence of microemboli, detected by transcranial Doppler sonography. MATERIAL AND METHODS: A group of 77 persons was divided into 4 subgroups: 1. subgroup of patients with MID (n=19; 10 male and 9 female, mean age was 74.32±8.30 years); 2. subgroup of patients with AD (n=19; 11 male and 8 female, mean age was 70.37±87.85 years); 3. subgroup of patients with hypertension (n=19; 11 male and 8 female, age adjusted) and 4. sex and age adjusted control group (CG) of 20 persons without hypertension or other serious risk factors. The duplex ultrasonographic examination of extracranial and intracranial circulation was preceded by neurologic, neuropsychological and psychiatric examination. The presence of microemboli was determined using Multi Dop X2 device (maker DWL), 60 minutes monitoring. All patients underwent brain computer tomography (CT) or magnetic resonance imaging (MRI). RESULTS: We found significantly higher incidence (68.4%, p=0.5267) of asymptomatic microemboli in ACM in the group of patients with MID compared to the AD group, the group of patients with hypertension and CG. CONCLUSION: The occurrence of "asymptomatic" emboli in the middle cerebral artery in patients with multi-infarct dementia is higher in the current study. Although these microemboli do not cause immediate symptoms, the evidence suggests, that they may be a risk factor for cognitive impairment, especially for multi-infarct dementia.

Is nocturnal epilepsy cause of disturbed quality of sleep and elevated daytime sleepiness?

OBJECTIVES: Authors evaluated quality of sleep and daytime vigilance in patients with nocturnal epilepsy and compared it to those with daytime epilepsy. BACKGROUND: Nocturnal seizures are an important type of epilepsy. They can result in morbidity due to disruption of sleep architecture. Daytime sleepiness, as a serious consequence of nocturnal seizures, has negative influence on quality of life in patients with epilepsy. METHODS: Authors examined 100 patients with epilepsy. The occurrence of epileptic seizures in circadian rhythm, type of epilepsy and epileptic seizures, as well as aetiology of epilepsy were evaluated. Patients were divided in two groups, 17 patients with nocturnal epilepsy and 83 patients with epileptic seizures not related to sleep. All of them underwent overnight video-EEG-polysomnography and they filled in the Epworth Sleepiness Scale questionnaire (ESS) as well as The Pittsburgh Sleep Quality Index questionnaire (PSQI). RESULTS: Overnight video-EEG-polysomnography detected significant changes in the sleep architecture in patients with nocturnal epilepsy. Significant decrease of N3 stage of NREM sleep (14.31%±8.07 in the group of nocturnal epilepsy vs. 20.12%±9.24 in the group of daytime epilepsy, p=0.01). Concurrently, significantly poorer sleep quality according to PSQI (18.52±7.51 in the group of nocturnal epilepsy vs. 6.21±3.62 in the group of daytime epilepsy, p=0.01) and tendency to increased daytime sleepiness according to ESS was revealed in these patients. CONCLUSION: Remarkable changes in sleep architecture associated with poor quality of sleep and increased daytime sleepiness were detected in patients with nocturnal epilepsy. In conclusion, we emphasize the importance of sleep history taking in patients with epilepsy and their further evaluation in sleep laboratory.

Predictors of impaired endothelial function in obstructive sleep apnea syndrome.

OBJECTIVES: Obstructive sleep apnea syndrome (OSA) is associated with increased cardiovascular morbidity and mortality. Endothelial dysfunction (ED), accelerated atherosclerosis and autonomic dysfunction might be the key players responsible for development of vascular diseases in patients with OSA. In a population with suspected OSA and low burden of cardiovascular risk factors, we therefore aimed to investigate the association between potential cardiovascular risk factors including OSA-specific indices, ED and autonomic activity. METHODS: ED was investigated using reperfusion hyperaemia index (RHI). OSA was assessed using standard polysomnography, autonomic activity was assessed using baroreflex sensitivity (BRS). RESULTS: We enrolled 31 patients (42.1±11.7 years) with OSA. Significant inverse correlation was found between RHI and apnea-hypopnea index (AHI) (r=-0.550, p=0.001) and between RHI desaturation index (r=-0.533, p=0.002). Positive correlation was found between RHI and minimal nocturnal oxygen saturation (r=0.394, p=0.028). In a multiple regression model AHI was the only significant variable to predict RHI (ß=-0.522, p=0.003). We found no correlation between RHI and BRS. RHI in the population with severe OSA (AHI above 30) was significantly lower than RHI in the rest of the population (p=0.012). CONCLUSION: AHI was the only significant independent predictor of impaired endothelial function as expressed by RHI. RHI showed no association with BRS in patients with OSA.