The effect of hypoxia on hearing function

Background/aim: This study was conducted to determine the critical partial oxygen pressure (pO2) value that would impair hearing function by evaluating the effects of hypoxia on hearing function in subjects diagnosed with chronic obstructive pulmonary disease (CPOD). Materials and methods: The study included 25 male and 5 female patients referred to our clinic who were diagnosed with COPD, according to spirometry and PaO2 values, and who did not show pathology upon autoscopic examination. The control group consisted of 14 female and 16 male patients who had no lung disease and were in the same age range as the COPD group. Results: A statistically significant difference was found between the two groups for distortion-product otoacoustic emission (DPOAE) (P < 0.001). The COPD group was divided into two groups according to pO2 levels (pO2 ≤ 70 and pO2 > 70) in order to find a critical pO2 level which might cause significant change at a certain audiological extent. Conclusion: Hypoxia causes long-term decline in hearing thresholds, deterioration of DPOAE results, and prolongation of I­V interpeak latency in auditory brainstem response. However, the critical oxygen level that disrupts hearing function could not be determined.

Prevalence of insomnia and its clinical correlates in a general population in Turkey.

AIM: The prevalence of insomnia is influenced by environmental factors. This study aimed to investigate the prevalence of insomnia and its sociodemographic and clinical correlates in a general population-based survey in Turkey. METHODS: This population-based study included 4758 subjects among 5021 who participated in the Turkish Adult Population Epidemiology of Sleep Disorders study. Questionnaire items evaluating insomnia were adapted from the International Classification of Sleep Disorders II and the DSM-IV-TR. Subjects with restless legs syndrome were excluded. RESULTS: Insomnia was found to be associated with older age (18-24 years, 9.8%; 25-44 years, 11.7%; 45-64 years, 13.8%; 65 years or older, 13.9%), lower income level (<500 USD, 16.5%), time spent watching TV (6-8 h or more, 18.4%), tea consumption in the evening (≥6 glasses, 14.5%) and smoking status (current and ex-smoker, both 14.2%) in multiple logistic regression analysis. In respect to other medical disorders, insomnia was significantly associated with the presence of hypertension, diabetes and heart diseases after the adjustment for relevant risk factors for each disease, across all age and sex groups. CONCLUSIONS: Insomnia is a major health problem in our population, affecting subjects in the working age group and those of lower socioeconomic status. It should especially be screened in patients with chronic diseases. A relatively low proportion of insomnia diagnosed as a sleep disorder suggests that this condition and its clinical correlates are possibly under-recognized.

YKL-40: may be use as a new inflammatory biomarker in obstructive sleep apnea syndrome?

INTRODUCTION: YKL-40 [chitinase-3 like-1 (CHI3L1)] is a glycoprotein, has been implicated in inflammation, endothelial dysfunction, tissue remodelling and it is accepted as a noninvasive prognostic biomarker for inflammation. In this study, we aimed to underline usability of serum YKL-40 as an inflammatory biomarker in patients with obstructive sleep apnea syndrome (OSAS). PATIENTS AND METHODS: Two groups OSAS patients [Group I: Mild-moderate OSAS, n:43; median apnea-hypopnea index: AHI, /hour:18], Group II: Severe OSAS, n: 25; AHI:41.6] and healthy control group [n:25, AHI: 3.6] were included in the study. Serum YKL-40 level was tested in serum samples taken after polysomnography in OSAS patients and control group. In addition, the association of serum YKL-40 level with age, body mass index and polysomnografic parameters were analyzed in the OSAS patient groups. RESULTS: Median serum YKL-40 level was 20.30 ng/mL (range 8.01-73 ng/mL) in mild-moderate OSAS patients, and 22.58 ng/mL (9.17-99 ng/mL in severe OSAS patients, 18 ng/mL (range 7.36-88 ng/mL) in control group (p< 0.05). Serum YKL-40 level was found to be correlated with AHI in patient with mild-moderate OSAS patients (p< 0.05) and serum YKL-40 level was found to be correlated with age, total hypopnea time (minutes) in severe OSAS patients (p< 0.05). There was no relationship serum YKL-40 level with other studied variables (p> 0.05). CONCLUSION: At the end of this study, we found that serum YKL-40 level increase with severity of OSAS. The findings suggest that YKL-40 may be a useful biomarker for inflammation in patients with OSAS.

The utility of neck/thyromental ratio in defining low-risk patients with obstructive sleep apnea in sleep clinics.

We aimed to evaluate the importance of neck/thyromental distance in the diagnosis of moderate to severe obstructive sleep apnea (OSA) in sleep clinics. 185 patients (122 males, 63 females) referred to our sleep clinic with OSA symptoms were enrolled to the study. The patients had level-1 polysomnography (PSG). The neck circumference (N), thyromental distance (T), and STOP test were recorded in all patients. Using an obstructive AHI > 15 event/h on PSG as the cut-off, the best N/T ratio to find patients with OSA was calculated with the receiver operator curve analyses. The best cut-off for N/T was chosen as 4.6. We used Modified STOP test: STO-NT test in which P (for hypertension item) was replaced with N/T ratio. N/T ratio >4.6 was scored as "positive". Two positives out of four questions in STO-NT were scored as high risk for OSA. The OSA prevalence was 60 % for AHI > 15. The mean ratio of N/T was significantly different between groups with AHI > 15 and AHI ≤ 15. N and N/T ratio were moderately correlated with AHI. Sensitivity, specificity, negative predictive value, positive predictive value, and negative likelihood ratio of STOP test for AHI > 15 were 88.5, 28.4, 61.8, 65.4 % and 0.40, whereas 97.3, 23, 85, 65.9 % and 0.12 for STO-NT test, respectively. STO-NT test seems better than STOP test in determining patients who do not likely to have moderate to severe OSA in sleep clinics so can be preferred to decide on therapies other than CPAP in a short time.

Changes in serum levels of MDA and MMP-9 after UPF in patients with OSAS.

The aim of the study was to assess the markers of oxidant-antioxidant status in patients with obstructive sleep apnea syndrome (OSAS) who underwent uvulopalatal flap (UPF) surgery. Twenty-five patients who underwent UPF surgery participated in this study. Polysomnographic examinations were performed before and after the surgery to assess sleep apnea in all patients and to determine the success of the UPF surgery regarding the improvement in the apnea-hypopnea index (AHI). Descriptive factors (BMI, age, gender and neck thickness, etc.) of patients were recorded before operation. Blood samples were taken preoperatively, and repeated postoperatively at 6-month intervals to determine the changes in serum malondialdehyde (MDA) and matrix metalloproteinase-9 (MMP-9) levels. The mean age at surgery was 45.6 ± 9.9 years (range 25-63 years). There was a significant difference between preoperative and postoperative AHI, MDA and MMP-9 values (p < 0.05). There was no significant correlation between categorical variables. There was no correlation between postoperative ODI, MMP-9 and MDA. These results indicate that OSAS is associated with abnormal lipid peroxidation, which can be improved by UPF surgery. OSAS may increase risks of cardiovascular morbidity; however, UPF might be useful for decreasing these risks in patients with OSAS who are suitable candidates for UPF surgery.

Association of obstructive sleep apnea with homocystein, nitric oxide and total antioxidant capacity levels in patients with or without coronary artery disease.

INTRODUCTION: Obstructive sleep apnea (OSA) is associated with cardiovascular morbidity and mortality. Deficiency of nitric oxide (NO) and plasma levels of homocystein have been implicated in the pathogenesis of cardiovascular disease. OSA results in oxygen desaturation and arousal from sleep. Free oxygen radicals can be produced by hypoxia-reoxygenation. To test for the hypothesis that OSA is associated with cardiovascular morbidity, we investigated levels of homocystein, NO and total antioxidant capacity in OSA patients with and without coronary artery disease (CAD) in comparison with normal subjects and patients with CAD without OSA. MATERIALS AND METHODS: Polysomnography was performed in 27 patients who had a myocardial infarction and in 25 patients without evidence of CAD. Patients were grouped according their polysomnography results as OSA with CAD (group 1), OSA without CAD (group 2), CAD (group 3), and normal (group 4) . Levels of homocystein, NO and total antioxidant capacity were determined after an overnight fasting. Data were analysed with parametric and non parametric statistical tests. RESULTS: According to apnea-hypopnea index (AHI) 44.4% of CAD patients were OSA. After polysomnographic evaluation, the patients were re-distributed as follows: OSA with CAD (n= 12), OSA without CAD (n= 14), CAD (n= 15), and normal (n= 11). Homocystein levels were higher in 3 groups compared to controls. AHI, MDI and desaturation time was higher in three -vessel disease compared to one and two- vessel diseases (p< 0.05). NO levels were correlated with the period of oxygen desaturation (r: -0.45, p= 0.031). The antioxidant capacity did not differ between OSA and healthy groups. CONCLUSION: OSA is frequent in CAD. AHI, MDI and desaturation time are higher in patients with severe CAD. It is important to evaluate OSA patients for CAD.

Ocular surface assessment in patients with obstructive sleep apnea-hypopnea syndrome.

PURPOSE: The aim of this study was to assess the correlation between ocular surface changes and disease severity in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). METHODS: Two hundred eighty patients with OSAHS were compared with respect to the presence of a floppy eyelid syndrome (FES), Ocular Surface Disease Index (OSDI) questionnaire, the corneal fluorescein staining stages, the Schirmer I test, and tear film break-up time (TBUT) values. RESULTS: Based on the apnea-hypopnea index, the presence of FES was detected at the following rates: 23.1 % in non-OSAHS group (A), 41.7 % in mild group (B), 66.7 % in moderate group (C), and 74.6 % in severe group (D); severe and moderate stage of FES was found in groups C and D and mild stage of FES in group B (p < 0.01). OSDI questionnaire values were as follows: group A, 12.57 ± 17.64; group B, 22.90 ± 16.78; group C, 45.94 ± 22.03; and group D, 56.68 ± 22.85(p < 0.01). Schirmer values were as follows: group A, 10.76 ± 3.58 mm; group B, 9.83 ± 2.53 mm; group C, 7.73 ± 2.42 mm; and group D, 6.97 ± 2.15 mm (p < 0.01). The TBUT values were as follows: group A, 10.53 ± 3.64 s; group B, 9.46 ± 2.40 s; group C, 7.29 ± 2.13 s; and group D, 6.82 ± 2.20 s (p < 0.01). Corneal staining scores are as follows: 0.26 ± 0.60 in group A, 0.40 ± 0.71 in group B, 0.98 ± 0.72 in group C, and 1.14 ± 0.90 in group D, and the differences were statistically significant among the groups(p < 0.01). DISCUSSION: OSAHS, particularly the moderate and severe forms, is associated with low Schirmer and TBUT values and high scores in OSDI questionnaire and corneal staining pattern stage. The presence of FES is observed as a practically constant finding in OSAHS. If complaints such as burning, stinging, and itching which can be commonly observed in middle-aged patients are accompanied by FES, the patient should be evaluated for sleep disorders. We speculate that appropriate treatment of OSAHS may result in better control of these symptoms.

Chitinases and lung diseases.

Chitinase enzymes that hydrolize chitin and some articficial substrates are expressed in human despite lacking of the endogenous chitin within the body. Chitinases phatophysiological functions within human are not fully known. Recent evidence revealed that chitinases may have role into some processes of immune responses and inflammatory system. In this review, we discuss the role of chitinases in lung diseases based on the available information from the literature.

Proton magnetic resonance spectroscopy of periventricular white matter and hippocampus in obstructive sleep apnea patients.

BACKGROUND: The purpose of this study was to diagnose the hypoxic impairment by Magnetic resonance spectroscopy (MRS), an advanced MR imaging technique, which could not be visualised by routine imaging methods in patients with obstructive sleep apnea (OSA). MATERIAL/METHODS: 20 OSA patients and 5 controls were included in this prospective research. MRS was performed on these 25 subjects to examine cerebral hypoxemia in specific regions (periventricular white matter and both hippocampi). Polysomnography was assumed as the gold standard. Statistical analysis was assessed by Mann-Whitney U test and Receiver operating characteristics (ROC) curve for NAA/Cho, NAA/Cr and Cho/Cr ratios. RESULTS: In the periventricular white matter, NAA/Cho ratio in OSA patients was significantly lower than in the control group (p<0.05). There were no statistical differences between the OSA and the control group for NAA/Cho, NAA/Cr and Cho/Cr ratios for both hippocampal regions. Additionally, Cho/Cr ratio in the periventricular white matter region of OSA group was higher than in the control group (p<0.05). CONCLUSIONS: Hypoxic impairment induced by repeated episodes of apnea leads to significant neuronal damage in OSA patients. MRS provides valuable information in the assessment of hypoxic ischemic impairment by revealing important metabolite ratios for the specific areas of the brain.

The effects of CPAP treatment on nasal mucosa in patients with obstructive sleep apnea.

The aim of the study was to demonstrate the effects of nasal CPAP treatment on the morphology and function of nasal mucosa in patients with obstructive sleep apnea (OSA). Patients with complaints relevant to OSA underwent respiratory function tests, arterial blood gas analyses and polysomnography. Saccharine test and nasal biopsies were performed to assess the mucociliary transport time and to observe the histopathological changes in patients with apnea-hypopnea index ≥15 in whole night polysomnography. Tissue samples were obtained from middle and inferior turbinates and septal mucosa to observe the degree of inflammation and fibrosis by semiquantitative means. Biopsies and mucociliary transport test were performed before and 3 months after the initiation of CPAP treatment. A total of 25 patients with a mean age of 52 were enrolled in the study. While the pretreatment mucociliary transport time before and 3 months after the treatment were 10.50 and 11.50 min respectively. The difference between these values was statistically insignificant. Mean apnea-hypopnea index was 63.19, while mean partial oxygen pressure was 75.46 mmHg. Nasal CPAP treatment was introduced with a mean pressure of 9.54 cmH2O. The degree of inflammation and fibrosis was found to be significantly increased after CPAP treatment. Nasal CPAP leads to alterations in mucosa. Efforts should be directed to make CPAP treatment a safer method via protecting the morphologic and functional properties of the nasal mucosa.

Serum S100B protein: a useful marker in obstructive sleep apnea syndrome.

BACKGROUND AND PURPOSE: We aimed to underline the importance of serum S100B protein as a useful biochemical marker in patients with obstructive sleep apnea syndrome (OSAS). MATERIAL AND METHODS: Forty-three newly diagnosed patients with OSAS (median apnea-hypopnea index [AHI, events/ hour]: 37.5 [range 11.3-137]) and 25 subjects with AHI < 5 (median AHI: 4.4 [range 0.7-4.8]) were included in the study. Serum S100B protein level was tested in serum samples taken after polysomnography in both groups and the difference between OSAS patients and the control group regarding that level was assessed. In addition, the association of S100B protein serum level with age, body mass index, AHI, mean O2 saturation percentage during sleep, minimum O2 saturation value (%) at the end of the apneas, and the time spent at an O2 saturation less than 90% were analyzed in the OSAS patient group. RESULTS: Median serum S100B protein level was 133.7 pg/ mL (range 20.97-230.70 pg/mL) in patients with OSAS and 16.1 pg/mL (range 10.1-22.9 pg/mL) in the control group (p < 0.005). Serum S100B protein level did not correlate with any studied variable (p > 0.05 for each correlation coefficient). CONCLUSIONS: Serum S100B protein level is increased in patients with OSAS and may be a useful biochemical marker in those patients.

[Asymptomatic vena cava inferior aneurysm, case report]. / Asemptomatik inferior vena kava anevrizmali olgu.

Venous aneurysms are uncommon, whereas localized aneurysms of the inferior vena cava are extremely rare. Localized aneurysm of inferior vena cava was first publisheded in 1973 by Oh et al. Though venous aneurysms are generally asymptomatic, it is clinically important because of showing the symptoms of abdominal pain, gastrointestinal bleeding, acute venous obstruction, pulmonary embolism and even sudden death. Our case is also asymptomatic and localized aneurysm of the inferior vena cava is detected incidentally.

Tissue Doppler atrial conduction times and electrocardiogram interlead P-wave durations with varying severity of obstructive sleep apnea.

OBJECTIVES: Obstructive sleep apnea (OSA) has been reported to be associated with an increased risk of atrial fibrillation. The aim of this study was to investigate atrial electromechanical couplings in patients with OSA and the relationship between these parameters and P-wave dispersion (Pd). METHODS: One hundred twenty-six patients were enrolled in this study. All patients underwent polysomnographic examination. The apnea-hypopnea index (AHI) was defined as the number of apneas and hypopneas per hour of sleep. An AHI score of 5 or more was diagnosed as OSA, and an AHI score of less than 5 was diagnosed as OSA (-). Thirty-nine of the patients had an AHI score of less than 5 (group 1), 42 of the patients had AHI score between 5 and 30 (mild and moderate, group 2), 45 of the patients had an AHI score more than 30 (severe, group 3). Atrial electromechanical coupling (PA), intra-atrial, and interatrial electromechanical delay were measured with tissue Doppler imaging. P-wave dispersion was calculated from 12-lead electrocardiogram. RESULTS: Maximum P-wave duration was higher in group 3 compared with groups 2 and 1 (126.0 ± 16.7 vs 111.0 ± 12.5 [P < .001] and 126.0 ± 16.7 vs 99.9 ± 10.0 [P < .001], respectively). Maximum P-wave duration was higher in group 2 than in group 1 (111.0 ± 12.5 vs 99.9 ± 10.0, P < .001). P-wave dispersion was higher in group 3 compared with groups 2 and 1 (50.9 ± 11.5 vs 37.0 ± 8.6 [P < .001] and 50.9 ± 11.5 vs 27.9 ± 6.8 [P < .001], respectively). P-wave dispersion was higher in group 2 than in group 1 (37.0 ± 8.6 vs 27.9 ± 6.8, P < .001). Minimum P-wave duration did not differ between the groups. Atrial PA at the left lateral mitral annulus (lateral PA), septal mitral annulus (septal PA), and right ventricular tricuspid annulus (RV PA) were significantly higher in group 3 than in group 2 (P < .001, P = .001, and P = .009, respectively). Lateral PA, septal PA, and RV PA were higher in group 2 compared with group 1 (P < .001, P = .003, and P = .009, respectively). Interatrial electromechanical delay (lateral PA - RV PA) was significantly longer in group 3 compared with groups 2 and 1 (33.6 ± 12.1 vs 22.4 ± 9.4 [P < .001] and 33.6 ± 12.1 vs 14.9 ± 9.2 [P < .001], respectively). Interatrial electromechanical delay was longer in group 2 than in group 1 (22.4 ± 9.4 vs 14.9 ± 9.2, P = .001). There was a positive correlation between AHI and Pd, lateral PA, septal PA, RV PA, interatrial electromechanical delay, and left-sided intra-atrial electromechanical delay. CONCLUSION: Prolongation of electromechanical delay and increased Pd are associated with apnea-hypopnea index (AHI) and hence the severity of disease.

Bilateral multiple tumor-like endobronchial tuberculosis, diagnosed with bronchoscopic examination.

Endobronchial tuberculosis is defined as tuberculosis infection of tracheobronchial tree and it is not seen often in adult population. In the absence of parenchymal disease endobronchial tuberculosis is less well-recognized and can lead to difficulties in diagnosis. Our aim is to introduce a rare form of tuberculosis that is important because of high probability of developing severe bronchostenosis during its course. We report a 20-year-old woman who presented with two-month history of severe non-productive cough, shortness of breath, and hemoptysis. After clinical and radiological evaluation, flexible bronchoscopy showed bilateral multiple tumorous lesions that were seen from main carina down to the both main bronchus. The biopsy samples revealed EBTB diagnosis and antituberculosis therapy was given. At the second month of the therapy, rebronchoscopy revealed almost disappearance of the polypoid lesions. The patient healed without any stenosis. This case report is a reminder that endobronchial tuberculosis must take into consideration in differential diagnosis of endobronchial lesions. In patients with endobronchial tuberculosis healing without any complication could be achieved with timely diagnosis and commencement of early treatment.

The effectiveness of oropharyngeal exercises compared to inspiratory muscle training in obstructive sleep apnea: A randomized controlled trial.

BACKGROUND: Inspiratory muscle training (IMT) and oropharyngeal exercises (OE) have different advantages and disadvantages and a comparison of these modalities has been recommended. The aim of this study was to compare the effects of IMT and OE on important outcomes for patients with OSAS. METHODS: This was a randomized controlled clinical trial. Forty-one clinically stable OSAS patients not receiving CPAP therapy were randomly divided into three groups. Patients in the IMT group (n = 15) trained with a threshold loading device 7 days/week for 12 weeks. Patients in the OE group (n = 14) practiced exercises 5 days/week for 12 weeks. Twelve patients served as control group. Apnea-hypopnea index (AHI), respiratory muscle strength, snoring severity and frequency (Berlin Questionnaire), daytime sleepiness (Epworth Sleepiness Scale; ESS), sleep quality (Pittsburg Sleep Quality Index; PSQI), impact of sleepiness on daily life (Functional Outcomes of Sleep Questionnaire; FOSQ), and fatigue severity (Fatigue Severity Scale; FSS) were evaluated before and after the interventions. RESULTS: AHI and sleep efficiency did not change significantly in any of the groups. Significant decreases in snoring severity and frequency, FSS and PSQI total scores were found in the IMT and OE groups after the treatments (p < 0.05). There was a significant reduction in neck and waist circumference and significant improvement in respiratory muscle strength (MIP and MEP) in IMT group compared to control group (p < 0.05). The%MEPpred value and FOSQ total score significantly increased and ESS score reduced after the treatment in OE group compared to control group (p < 0.05). CONCLUSIONS: Our results indicate that both OE and IMT rehabilitation interventions are applicable in rehabilitation programs for OSAS patients who do not accept CPAP therapy. Our findings could lead to increase these methods' use among rehabilitation professionals and decrease in cost of CPAP treatment in OSAS.

Evaluation of upper airway in obstructive sleep apnea-hypopnea syndrome and habitual snorers.

OBJECTIVES: The purpose of this study was to evaluate upper airway in obstructive sleep apnea-hypopnea syndrome patients and habitual snorers, and to determine the correlation with apnea-hypopnea index. METHODS: 193 patients who applied to our Ear Nose Throat Clinic between years 2000 and 2002 with the complaint of witnessed snoring and/or apnea were included in the study. Each patient was evaluated by a complete head and neck examination and polysomnography. Physical examination included anterior rhinoscopy, nasal endoscopy, examination of oropharynx and hypopharynx and Muller maneuver. The correlation between the Ear Nose Throat examination parameters and the apnea/hypopnea index was investigated. RESULTS: Patients were distributed into two groups according to the apnea-hypopnea index: habitual snorers (34.3%) and obstructive sleep apnea-hypopnea (65.7%). There was a statistically significant correlation between apnea-hypopnea index and Muller maneuver, tongue base, lateral pharyngeal fold. There was a statistically significant correlation between body mass index, Muller maneuver and uvula. CONCLUSIONS: Obstructive sleep apnea-hypopnea patients results from changes in the upper airway. Anatomic and functional findings correlated with the apnea-hypopnea index. In the majority of patients with OSAHS, pharyngeal abnormalities and nasal obstruction were found to be statistically significant (Tab. 2, Fig. 1, Ref. 14).

[Vocal cord functions in patients with asthma attack]. / Astim atakli hastalarda vokal kord fonksiyonlari.

This study was planned to evaluate vocal cord functions and to establish underlying vocal cord dysfunctions (VCD) in patients with asthma attack. All patients admitted to emergency service of our hospital with asthma attack between February 01, 2007 and June 01, 2007 were included in the evaluation. After the evaluation, all patients regarded to have asthma attacks based on GINA 2006 guide were enrolled in the study. After first intervention, patients underwent endoscopic larynx examination for the evaluation of vocal cord functions. Twenty four (65.7%) male and 11 female (31.4%), overall 35 patients diagnosed with asthma and who did not have the history of another disease were included in the study. At endoscopic larynx examination carried out after first medical examination, at the moment of asthma attack, tongue, tongue base, epiglottis and arytenoid were observed to be within normal limits. In 9 (25.7%) patients, upper respiratory tract was hyperemic and in 2 (5.7%) odematous. One patient had nasal polyposis (p> 0.05). In the evaluation of vocal cord functions, restriction in adduction was observed in merely one patient. All other functions were normal. Rima opening width was established to be mean 8.34 + or - 0.725. VCD was deteced in none of the patients included in the study. Although we did not detect VCD in any patient, VCD should be borne in mind in cases which presents with the clinical picture of asthma and responds weakly to the treatment or in cases of unexplained shortness of breath. This may prevent many unnecessary procedures such as medication, entubation, tracheostomy and iatrogenic mortality. Further longutudial studies are required in order to shed light on the assocation of asthma with VCD.

Absenteeism and Delay to Work Due to Sleep Disorders in the Turkish Adult Population: A Questionnaire-Based National Survey.

Sleep problems may have negative effects on work-life balance, overall health, and safety. We aimed to investigate the association between sleep disorders and absenteeism and delay to work (being late or tardy) among the working adult population. The study was conducted by using data from a large survey of working adults who participated in the Turkish Adult Population Epidemiology of Sleep Study (TAPES) managed by Turkish Sleep Medicine Society (TSMS). Secondary analyses was employed to examine absenteeism and delay to work and their associations with sleep problems, including sleepiness by Epworth Sleepiness Scale (ESS), parasomnias, sleep apnea (by Berlin Questionnaire), sleep quality (by Pittsburgh Sleep Quality Index), and restless leg. History of any absenteeism and delay to work was observed in 276 (18%) and 443 (29%) out of 1,533 working adults, respectively. In the multivariate analyses, absenteeism was associated with younger age, female gender and poor sleep quality, while delay to work was associated with younger age, poor sleep quality, parasomnia, and sleepiness. In the presence of absenteeism and delay to work, sleep disorders including sleepiness, poor sleep quality, and parasomnia should be considered. Such evaluation may improve worker well-being and provide some additional benefits in terms of increasing productivity and lowering work-related costs.

Evaluation of sleep quality in patients with ankylosing spondylitis and efficacy of anti-TNF-α therapy on sleep problems: A polisomnographic study.

INTRODUCTION: This study was conducted to investigate the relationship between sleep quality (SQ) and disease activity (DA) in patients with ankylosing spondylitis (AS) and to evaluate the response to anti-tumor necrosis factor α (anti-TNF-α) therapy on sleep disorders. MATERIALS AND METHODS: A total of 34 patients who met the modified New York classification criteria for AS were included in this prospective study. Patients were divided into two groups as follows: Group I (n = 15) with high DA and receiving anti-TNF-α therapy, and Group II (n = 19) in remission. DA was assessed by the Bath AS Disease Activity Index. Pittsburgh Sleep Quality Index (PSQI) and polysomnography (PSG) were used to determine disorders and patterns of sleep, respectively, in both groups at baseline as well as at the third month of anti-TNF-α therapy in Group I. RESULTS: Baseline evaluation revealed impaired SQ in 57.9% of all patients. PSG demonstrated obstructive sleep apnea syndrome, snoring and periodic leg movements in 73.7%, 74.4% and 26.3% of patients, respectively. Prior to anti-TNF-α therapy, PSQI and snoring score were significantly higher in Group I (P = 0.0001, P = 0.012, respectively). Although there was a significant reduction in PSQI scores in Group I (P = 0.005) at the third month of anti-TNF-α therapy, no change was observed in PSG parameters (P > 0.05). CONCLUSION: Sleep disorders increase in AS, particularly in patients with high DA. Anti-TNF-α therapy has improved SQ without any improvement in PSG. Therefore, it may be concluded that PSG parameters might be more associated with disease pathogenesis rather than DA in patients with AS.

Usefulness of homocysteine as a cancer marker: total thiol compounds and folate levels in untreated lung cancer patients.

BACKGROUND: Apart from being a risk factor for atherosclerotic cardiovascular diseases, the latest research suggests homocysteine as a marker for cancer. We aimed to explore the clinical utility of plasma homocysteine levels as a marker in lung cancer. PATIENTS AND METHODS: Changes in serum total thiols and folate levels were investigated in newly diagnosed untreated lung cancer patients (n = 37) and compared with healthy controls (n = 26). Fluorometric HPLC methods were used for the determination of thiols. Other parameters were determined with commercial diagnostic kits. RESULTS: Increased total homocysteine (t-Hcy), decreased total glutathione (t-GSH) and folate levels were observed in lung cancer patients compared with healthy controls. Total levels of thiols and folate did not show any significant difference between SCLC and NSCLC patients. However, there were significantly higher t-Hcy, lower t-GSH and folate levels in the advanced-stage group compared with controls. Prevalence of hyperhomocysteinemia was 65% in lung cancer patients when 12 micromol/l were taken as a cut-off value for t-Hcy levels. CONCLUSION: Homocysteine is suggested as a marker for several types of cancer, but our result did not support this hypothesis for lung cancer. Although higher homocysteine levels were observed in the present study, further investigation in the larger cancer population would clarify the importance of homocysteine as a cancer marker.