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Objective: In modern society, the number of people working night shifts is increasing. The aim of the study was to investigate effects of shift work on obstructive sleep apnea syndrome (OSAS) and oxygen desaturation index (ODI) during daytime and nighttime sleep in patients with OSAS., Methods: Twenty-nine male and two female shift workers (SW) with OSAS were investigated. Their mean age was 47±10years, BMI 32±4kg/m(2). The control group consisted of 10 male patients with OSAS, matched for age, BMI, and hours of night sleep, not working on shifts. Nocturnal and diurnal after night shift or sleep deprivation polysomnographies (PSG) were performed in all subjects., Results: Comparison of diurnal and nocturnal PSG recordings in the SW group demonstrated a significantly higher AHI in diurnal PSG after the night shift vs. nocturnal PSG (50±27 vs. 32±22, P<0.05). During daytime sleep SW OSAS patients demonstrated higher AHI than sleep-deprived controls (49.7±26.6 vs. 30.1±21.9, P<0.05) and higher ODI (44.1±25.1 vs. 21.6±18.5, P<0.05)., Conclusions: Significantly higher severity of OSAS during daytime sleep after night shift may intensify unfavorable health effects of OSAS. Patients with OSAS if not effectively treated should avoid nighttime work., (Copyright © 2010 Elsevier B.V. All rights reserved.)

Unlabelled: Obstructive sleep apnea (OSA) is one of the most often sleep disturbance. Not treated patients have 2-3 times more risk for death because of the cardiovascular diseases. Leptin and homocysteine are the risk factors for cardiovascular diseases. Treatment by nCPAP has positive influence for health care and reduction of hypertension in this group. The aim of this study was to evaluate an effect of 3 weeks nCPAP therapy on a serum leptin and homocysteine concentrations in patients with OSA., Materials and Methods: The study group consisted of 48 male patients in the age x=51,2?7,5 years old, OSA was diagnosed by polisomnographic study The leptin concentration was evaluated by RIA methods (HUMAN LEPTIN RIA KIT), the homocysteine concentration was evaluated byAxis Homocysteine EIA test. Patients were treated by nCPAP during 3 weeks. Only 29 patients were effectively treated for this time. The compliance was: 5.07 +/-1.81 h, Results: In the group of 29 patients the serum leptin and homocysteine concentration before and after treatment were 11,05+/-5,59 ng/mL vs 11,07+/-7,16 ng/mL i 10,98+/-2,79 micromol/L vs 10,34+/-2,99 micromol/L. In the all study group the statistical important correlation between leptin and AHI, mean and minimal saturation overnight, fibrinogene concentration, BMI, WHR, waist circumference, heart rate and between homocysteine and heart rate were observed., Conclusions: 3 weeks therapy does not have any effect on leptin and homocysteine concentrations in the studied group of patients with OSA. Serum leptin concentration correlates with AHI, TMB90, as well as with mean and minimal saturation during a sleep. This indicates a potentially higher risk of cardiovascular diseases in the studied group.

The aim of the study was to compare the incidence of obstructive sleep apnoea syndrome (OSAS) symptoms in relatives of subjects with OSAS and in relatives without OSAS but with clinical symptoms of this disease. The study group consisted of 186 relatives of patients with OSAS and 117 relatives of patients with symptoms of OSAS in whom the disease was not confirmed by polysomnography. They were all mailed a questionnaire with questions concerning anthropometric data, the presence of symptoms typical for OSAS and the presence of concomitant diseases. Analysis of the obtained data revealed an increased frequency of snoring, sleep apnea and nycturia in the relatives of patients with OSAS when compared to relatives of patients without OSAS, but the difference was not statistically significant. The incidence of daytime OSAS symptoms was significantly higher in the group of relatives of patients with OSAS. No differences in the incidence of arterial hypertension, ischaemic heart disease and diabetes mellitus were found.

Unlabelled: The prevalence of OSA rises with age, however it is also diagnosed in patients below the age of 35 years. Aim of the paper was the camparison of the severity and clinical features of OSA in young and elderly subjects. The study was a retrospective analysis of 561 subjects aged > 65 yrs and 319 subjects aged < 35 yrs who were investigated in our Sleep Laboratory between 1992-2005 due to snoring or daytime sleepiness. They all underwent full polisomnography or a limited recording. In patients with diagnosed OSA (AHI > 10) we initiated CPAP therapy., Results: OSA was diagnosed in 383 (63,3%) older patients and in 144 (45,1%) younger patients. BMI was significantly higher in younger subjects than in older (32,2+/-6,9 vs 28,9+/-5,1 kg/m2). The prevalence of OSA among women was significantly higher in older patients than in younger (26,4 vs 5,8%). Younger patients with OSA had a significantly higher AHI (42,7+/-32,1 vs 32,2+/-18,4) and a longer duration of apneas expressed as percentage of total sleep time spent in apnea (31,6+/-23,2 vs 26,5+/-17,7%). CPAP therapy was initiated in 185 older patients and 41% of them continue therapy. In younger group patients CPAP therapy was started in 51 patients and 47% of them continue therapy. The mean therapeutic pressure was significantly higher in younger patients with OSA (9,2+/-2,2 vs 8,2+/-2,2 cmH2O)., Conclusions: 1/ OSA is more frequent in elderly patients ; 2/ in young patients OSA is more severe and requires higher pressures in CPAP therapy; 3/ OSA among women is four time more frequent in older patients than in younger.

Unlabelled: The aim of the study was to determine the factors which influence the decision to initiate nCPAP therapy in patients with OSA. 184 patients with OSA were enrolled to the study. They were divided into two groups: group "T" ("treated") which consisted of 112 patients who were being treated with nCPAP and group "R" (resigned") which consisted of 68 patients who refused nCPAP therapy. The main causes of their refusal were: the possibility of surgical treatment, nCPAP intolerance and high costs associated with the purchase of a nCPAP device. The mean age of the patients was comparable in both groups (49.2 +/- 8.7 vs 50.5 +/- 10.6 yrs). Patients from group T had a significantly higher body weight and BMI than the patients from group R (106.6 +/- 2.1 kg vs 94.1 +/- 20.9 kg, p < 0.0001 and 35.0 +/- 6.3 kg/m2 vs 31.1 +/- 6.3 kg/m2, p < 0.00005 respectively). The patient evaluation included physical examination, a questionnaire concerning symptoms related with OSA and OSA assessment by poly-MESAM, polysomnography (PSG) before and with nCPAP trial therapy., Results: the following parameters obtained in the poly-MESAM recording differed significantly (p < 0.001) between group T and group R: RDI (54.6 vs 41.7), HRV index (24 vs 11), SaO2 min (67.0 vs 75% and SaO2 mean (84 vs 88%). Analysis of the baseline PSG did not reveal differences in sleep structure in both groups. We found a significantly higher AHI in group T (63.6 vs 44.9, p < 0.00005). PSG confirmed a significantly lower SaO2 min and SaO2 mean in group T (67.0 vs 75.0%, p < 0.001 and 89.0 vs 92%, p < 0.00002 respectively) and also revealed a significantly longer total sleep time with SaO2 < 90% in this group (183.0 vs 55.0 min, p < 0.0005). We did not find any differences between both study groups in the parameters obtained in PSG with nCPAP trial therapy., Conclusions: OSA patients who decide to be treated with nCPAP are more obese, have a higher BMI and demonstrate a more severe disease assessed by PSG.

Aim: to evaluate usefulness of serum homocysteine concentration in assessing the risk of atherosclerosis in patients with OSAS., Materials and Methods: 47 patients (mean age 50.6+/-10.3 years, mean BMI 31.52+/-6.04 kg/m2), with OSAS confirmed by polisomnography and 12 healthy snoring subjects (mean age 42.8 +/-16.8 years, mean BMI 26.9+/-2.95 kg/m2) were enrolled to the study. OSAS patients were divided into two groups - subjects with normal blood pressure (group A, n=32, mean age 51.3+/-10.3 years, mean BMI 30.6+/-4.4 kg/m2) and subjects with arterial hypertension (group B, n=15, mean age 52.7+/-9.8 years, mean BMI 31.4+/-5.0 kg/m2). None of the study subjects was treated with statins or fibrates. Serum concentration ofhomocysteine, uric acid, glucose level and lipid profile was evaluated in all subjects., Results: We found significant abnormalities in the lipid profile in all the study groups. The mean concentrations of cholesterol (mg/dL), triglycerides (mg/dL) and homocysteine (micromol/L) were as follows: 215.0+/-34.2, 200.0+/-173.0, 8.2+/-2.9 in group A, 216.5+/-43.1, 189.3+/-138.8, 8.40+/-1.67 in group B. 195.0+/-32.9, 154.3+/-133.0, 9.3+/-2.1 in the control group. No significant correlation between the homocysteine concentration and level of cholesterol or triglycerides was found., Conclusions: the serum concentration of homocysteine seems not to be a good marker in the evaluation of the risk of atherosclerosis in patients with OSAS.

Unlabelled: The aim of the study was to compare intensity of sleep disordered breathing in standard nocturnal polisomnography (PSG) and diurnal PSG after night shift in shift workers with obstructive sleep apnea syndrome., Methods: 25 shift workers (24 M, 1 F), aged 45,4 +/- 9,1 yrs, of mean BMI 31,9 +/- 4,02 kg/m2 were studied. Nocturnal PSG and diurnal PSG after night shift were performed in all participants., Results: The mean apnea/hypopnea index (AHI) in diurnal PSG was higher than AHI in nocturnal PSG, 47,8+/- 27,4/h vs 38,0 +/-24,1/h respectively, (p<0,05). Not significant tendency towards higher oxygen desaturation index (ODI) in diurnal PSG was observed, 40,4 +/-25,5/h vs 31,9 +/-25,8/h respectively., Conclusion: The study demonstrated that there is a significant increase in AHI in diurnal PSG after night shift compared to standard night PSG in shift workers with OSAS. This may negatively influence diagnosis and treatment.

In 52 patients with Obstructive Sleep Apnea Syndrome (OSAS) and nasal obstruction due to nasal septum deformation, hypertrophy of inferior nasal concha or posttraumatic external nose deformity the evaluation of the day somnolence using the Epworth Scale was carried out. The patients were randomly divided in to two groups. The first group consisted of 40 patients who were subjected to appropriate corrective surgery of the nasal obstruction. The remaining 12 patients constituted the control group. After 3 month each of the patients was asked to fill in the same questionnaire. Among the patients who underwent the surgical procedure day somnolence intensity was decreased approximately 2 times whereas in the control group no significant changes were observed. Results of this study could be crucial for the discussion concerning the complex influence of the nasal obstruction on the pathomechanism and symptomatology of obstructive breathing disorders during sleep.

Unlabelled: Hypertension, coronary heart diseases, obesity, diabetes mellitus are often present in patients with obstructive sleep apnea (OSA). The aim of the study was to estimate the serum leptin concentration and sympathetic activity in patients with obstructive sleep apnea and in control group., Investigated Group: 51 persons (F6, M45) were included into the study. The control group (GK) consisted of 15 snoring person (15 M) in the age x = 44.19 +/- 14.60, study group (GB) consisted of 36 patients with OSA (6F, 30M) in the age 5 1.47 +/- 8.95 years., Methods: Leptin was measured by RIA methods using the HUMAN LEPTIN RIA KIT (LINCO Research, Inc).: adrenaline and noradrenaline were measured in the serum by HPLC methods (BIO-RAD)., Results: The serum concentrations of leptin (ng/mL), adrenaline and noradrenaline (pg/mL) in patients with OSA compared with control group were respectively 15.55 +/- 11.26 : 61.2 +/- 27.4: 523.2 +/- 165.1 vs 10.34+/- 6.86 : 47.7 +/- 27.3: 447.9 +/- 102.6. There was positive significant correlation between leptin concentration and BMI (r = 0,34) and serum leptin and adrenalin concentration (r = 0,34). The serum leptin concentration was significantly higher in the female group. In the male group there was tendency to increase leptin concentration together with degree of OSA grade estimated by AHI and AHI <50 leptin concentration 12.23+/- 6.96 ng/mL vs AHI>50 and leptin concentration 13.35 +/- 3.54ng/ml., Conclusions: 1. In the group of patients with OSA the serum concentrations of leptin, adrenaline and noradrenaline were higher then in control group. 2. There are positive statistical significant correlation between serum leptin levels and BMI and serum adrenaline concentration in the study group. 3. The serum leptin concentration was higher in the female group. 4. There was tendency to increased leptin concentration in the study group together with degree of OSA grade estimated by AHI. 5. Our results confirm correlation between leptin and sympathetic activity and their influences on obesity and degree of OSA grade in studied group.

Unlabelled: Obstructive sleep apnea (OSA) affects approximately 450,000 people in Poland. Use of nasal continuous positive airway pressure (nCPAP) devices and laryngeal surgery are widely accepted OSA treatment methods. In 1995 ASDA approved oral devices for treatment of OSA patients. The aim of the study was to determine efficiency of mandibular advancement devices (MAD) in OSA therapy., Material and Methods: The study group included 20 patients with OSA, all of whom did not tolerate nCPAP and did not have indications or did not agree for surgical treatment., Results: Control polysomnography was carried out in 11 patients using MAD. In 64% of patients AHI was lower then 10. No correlation between MAD use and AHI values was found. 45% of patients declared improvement of sleep quality and life comfort., Conclusions: Use of mandibular advancement devices is an important alternative therapy of OSA.

To assess the autonomic system in obstructive sleep apnea syndrome (OSAS), the sympathetic skin response (SSR) and the R-R interval variation (RRIV) tests were studied in 34 OSAS patients and in 32 healthy controls. The aim of the study was to evaluate the sympathetic and parasympathetic system function in OSAS, to define the pattern of autonomic abnormalities found in SSR and RRIV in patients, and to analyze the usefulness of both tests in paraclinical assessment of the dysautonomia, compared with clinical symptoms and signs of autonomic nervous system involvement. The correlations between both autonomic tests results were also studied. In OSAS patients, SSR test results were abnormal in about 44% and RRIV results were abnormal in about 21% of patients. The mean values of parameters studied in SSR were significantly different in OSAS patients and controls (P < 0.05), whereas the differences between RRIV results were less important. The SSR and RRIV results in patients with mild apnea (Apnea/ Hypopnea Index (AHI) < 15) were more frequently within normal limits if compared with those of patients with severe apnea, but without reaching statistical significance. The clinical studies results (according to the Autonomic Symptoms Questionnaire) were related to the SSR results (p < 0.05 on chi and Fisher exact test). According to these results, SSR and RRIV are simple paraclinical electrophysiologic tests that confirm clinical dysautonomia. They may be useful as screening tests for assessment of dysautonomia in OSAS.

Unlabelled: Obstructive sleep apnea (OSA) is often accompanied by cardiovascular and metabolic disorders. The renin-angiotensin system plays an important role of the cardiovascular regulation. The activity of the angiotensin converting enzyme is genetically determined. The aim of the study was to estimate the relation between angiotensin converting gene polymorphism and cardiovascular diseases or familial history in patients with obstructive sleep apnea. 63 patients with OSA were enrolled to the study. Arterial hypertension was diagnosed in 30 cases, ischaemic heart disease in 5 cases and 10 patients suffered from both mentioned diseases., Result: The observed ACE genotype frequencies in the study group were II: ID: DD: 23.81: 47.62: 28.57%, in the hypertension subgroup II: ID: DD--30.0: 46.6: 23.3%. No differences in the study group were observed in relation to familial history :DI:II--30.43: 43.48: 26.09% vs 25.64: 48.72: 25.4%., Conclusions: 1. In the study group there was no association between ACE polymorphism and OSA. 2. There were also no association between the polymorphism of ACE and cardiac diseases or familial history of cardiac diseases in OSA group. 3. The polymorphism of ACE is not a risk factor for OSA.

The authors describe the case of survival for the period of 10 years after brain metastasis surgery and removal of the left lung upper lobe due to adeno-squamous cells carcinoma. Surgery did not generate any complications. Within 8 years after the surgery the radiological examination showed infiltrations resembling changes typical for tuberculosis. Microbiological analysis showed a culture of Mycobacterium kansasi leading to diagnosis of mycobacteriosis. Hence the antituberculous treatment was extended to 12 months to be interrupted due to liver damage. Two years later the patient experienced incident of haemoptysis. Detailed examination and assessment of the respiratory tract condition revealed COPD without features of renewal of the neoplastic process or infection by Mycobacterium tuberculosis or mycobacterium other than tuberculosis. This case demonstrates that aggressive surgical approaches to lung cancer with solitary cerebral metastasis significantly improve patient survival and justifies its widespread use.

The aim of our study was to determine correlation between bronchoscopically visible lesions and histopathologic classification and whether cytology and histopathology can complement each other in diagnosis of pulmonary neoplasm. Fibroptic flexible bronchoscopy was performed in 208 patients who where suspected of having lung cancer--abnormal chest x-ray or hemoptysis. Material for histopathologic examination was obtained from bronchial brushings, bronchial forceps biopsy and bronchial washings. Positive results were classified as non--small cell or small cell carcinomas. All patients were questioned about smoking history. In 165 patients there were visible signs of neoplasm in bronchoscopic examination: tumor, necrosis, infiltration, compression. Histopathology was positive in 90 cases:small cell carcinoma 32%, non-small cell carcinoma 68%. In 23 cases material for histopathologic examination was obtained from both bronchial brushings and foceps biopsies: results were compatible in 78%. Bronchial brushings identified neoplasm in three additional cases. In analysed group of 208 patients cancer cells were found in 43%. Examination of bronchial brushings coplements forceps biopsy in diagnosing and typing lung neoplasms and could be performed more frequently in patients undergoing fiberoptic bronchoscopy.

The aim of study was to present clinical and electrophysiological methods of assessment of dysautonomia and to evaluate usefulness of these methods. We evaluated clinical symptoms of dysautonomia by Questionnaire of Autonomic Disorders, which allows the qualitative and quantitative analysis of clinical dysautonomia. We used two noninvasive methods of electrophysiological evaluation: R-R interval variation test (RRIV) and sympathetic skin response (SSR). In assessment by our questionnaire all patients studied had clinical symptoms and signs of dysautonomia. We examined 15 patients with clinical conditions accompanied by dysautonomia. The SSR were abnormal in 4 patients (increased latency or absence of response from one limb or increased latency in upper and lower limb). The results of RRIV were abnormal in 8 patients at rest and during deep breathing. Both, SSR and RRIV, were abnormal in 3 patients. The clinical examination and electrophysiological tests are useful for the assessment of the involvement of autonomic nervous system: The battery of tests is necessary for a complete evaluation of dysautonomia in different diseases.

Examination of the sympathetic skin response (SSR), a non-invasive method of studying conduction in the sympathetic nervous system was performed in 15 male patients with obstructive sleep apnea syndrome (OSAS) evaluated by polysomnography who were compared with 7 non-apneic snorers and 26 controls. The aim of the study was to assess sympathetic nervous system function in OSAS, to compare the results with those found in non-apneic heavy snorers, to define the pattern of abnormalities and to study the correlations between SSR results and polysomnographic parameters. In the OSAS group the mean hand latency was significantly longer than in non-apneic snorers and healthy subjects. The most characteristic pattern of abnormalities was an absence of a foot response found in 12 of 15 OSAS patients. There were no correlations between SSR abnormalities and polysomnographic parameters. The SSR method seems to be useful in assessment of the sympathetic nervous system, especially of those parts related to sudomotor function, in OSAS.