Prevalence and Risk of Obstructive Sleep Apnea and Arterial Hypertension in the Adult Population in Poland: An Observational Subset of the International Prospective Urban Rural Epidemiology (PURE) Study.

Obstructive sleep apnea (OSA) is a common breathing disorder affecting millions of people worldwide. The disorder is connected with serious consequences including hypertension, myocardial infarction, arrhythmias, coronary disease, cardiac insufficiency, stroke, transient ischemic attack, and cognitive decline. Epidemiological data assessing the prevalence of OSA in different countries vary in methodology, size, and characteristics of population chosen and thus are hardly comparable. There are very few reports on the prevalence of OSA and on the diagnostic accuracy of sleep questionnaires available in Poland. In this report we present the analysis of the prevalence of, and risk factors for OSA in the Polish adult population consisting of 613 community-based subjects (227 men and 386 women). The study was based on the STOP-BANG questionnaire, a validated Screening Tool for OSA in primary care. It is a part of Polish subset of the Prospective Urban Rural Epidemiology (PURE) study, an ongoing population cohort study of individuals from urban and rural communities from 21 countries. We took into account age, gender, body mass index (BMI), and antihypertensive treatment. The findings are that over one half of the Polish population investigated had a moderate to high risk of OSA (66.5% of men and 60.1% of women). After the adjustments for age, gender, and BMI we noticed a dose-response relationship between arterial blood pressure behavior and OSA. The association was significant among women, but not men. Based on previous studies we can assume that one half of this high risk group would be further diagnosed for OSA. This study, the first large scale screening for OSA in Poland, shows a substantial, much higher than previously appreciated, prevalence of risk for OSA in the population at large.

Effectiveness of Bronchofiberoscopy in Diagnosis of Lung Lesions.

Lung cancer is the most common cause of cancer-related deaths. A short survival rate often results from belated diagnosis made in advanced stages. Therapy individualization requires the collection of a viable material for histopathological examination, which often brings difficulties. This study was performed in a group of 110 patients suspected of malignancy in chest computed tomography. All subjects underwent bronchofiberoscopy. Bronchoalveolar lavage (BAL) and endobronchial brushing were performed in all cases, whereas forceps tissue biopsy was taken if mucous membrane abnormalities were observed. In case of a negative result of bronchofiberoscopy invasive methods were implemented. A malignant neoplasm was diagnosed in 106 cases. Overall, cancer cells (positive result) were found in 45 patients (42.0%) subjected to bronchofiberoscopy. Cytology was positive in 38 (35.8%) and histopathological examination in 30 (28.3%) specimens. Eleven samples of BAL (10.3%) were positive. Endobronchial brushing was more effective, with 27 positive samples (25.5%). Forceps tissue biopsy was performed in 33 cases with 90% sensitivity. The most frequent cancer subtype found was squamous cell carcinoma. No severe complications of bronchofiberoscopy were observed. We conclude that bronchofiberosocpy is a safe diagnostic procedure for lung lesions, but its sensitivity and specificity are low. Only when there are mucous macroscopic changes observed, a precise diagnosis is possible.

Is elevated ENA-78 serum level a link between obstructive sleep apnea and atherosclerosis?

Obstructive sleep apnea (OSA) is a risk factor for cardiovascular disease, inflammation, and oxidative stress. This study compared serum levels of different factors in patients with carotid artery stenosis and with or without coexisting OSA. It also aimed to identify a molecule that may be crucial for the inflammatory process correlated with intermittent hypoxia. Sixty-eight subjects scheduled for surgical treatment of carotid artery stenosis were enrolled. Polygraphy was performed the night before the surgery. Morning levels of proinflammatory cytokines and chemotactic and angiogenic factors were measured. The most profound differences between the groups were found for ENA-78 serum concentration. However, as many factors could affect the results, further studies are needed to investigate the role of ENA-78 in atherosclerosis in patients suffering from OSA.

Malignant melanoma of the lung: case series.

Extracutaneous locations of primary malignant melanoma are rare. In the respiratory system most melanomas present as metastatic tumors. For the diagnosis of primary lung melanoma, strict histopathological and clinical criteria should be met. In this paper we present three cases of malignant melanoma which showed in the respiratory system. The first 2 case studies present primary lung melanomas, while the last one shows late lung metastasis of tumor originated from vaginal mucosa. The treatment of choice for localized disease as well as single metastasis is surgical excision.