Search

Background: Sleep apnea is linked with repetitive episodes of desaturation, disturbed sleep architecture, chronic stress, impaired melatonin regulation. Further knowledge on the physiology of melatonin secretion in sleep apnea, and the effect of possitive pressure treatment, could provide new therapeutic approach to the patients. Aim: The aim of the study is to examine the pattern of melatonin secretion in patients with sleep apnea, compared to healthy controls, and to evaluate the effect of BPAP therapy on melatonin levels. Materials and methods: this prospective study includes 76 individuals – 53 patients and 19 controls. Polysomnography was used to evaluate sleep architecture and disturbances in breathing. Melatonin direct saliva test was used in 31 patients and 15 controls to evaluate the pattern of melatonin secretion. Samples were taken at 2 a.m., 6 a.m., 2 p.m. and 22 p.m. Melatonin levels of 20 patients were followed up on the sixth month of therapy. Results: Melatonin levels in patients9 group are significantly higher in all investigated periods compared to the controls (figure 1). The pattern of melatonin secretion shows a higher peak during the night and does not reduce sufficiently in the morning. Melatonin levels in the afternoon are in correlation with the score on the daytime sleepines. 6-months therapy leads to reduction of melatonin levels and sleepiness to normal. Conclusion: BPAP therapy may lead to significant reduction of melatonin levels and influence daytime symptoms in sleep apnea.

A 42-year-old male patient was referred to hospital with symptoms of shortness of breath, wheezing and dry cough. The patient complains have begun four months ago. Due to them he was diagnosed previously with asthma, and treatment with fixed combination of inhaled corticosteroid and long-acting beta2 agonists was started, but without effect. Laboratory data and chest X-ray conducted in the hospital were normal. The spirometry showed normal FVC, FEV1 and significant reduction of PEF. The flow/volume loop was typically flattened during inspiration and expiration. It was the reason for decision that there is tracheal obstruction. The fibreoptic bronchoscopy showed an obturation, due to a tumor infiltrated the tracheal wall, and 80% stenosis of trachea. The histological result was adenoid cystic carcinoma. The patient was successfully undergoing surgical treatment. Malignant primary tumors of the trachea are very rare and adenoid cystic carcinoma is the second most common tracheal tumor. Due to its slow growth and non typical symptoms often it was misdiagnosed. The correct diagnosis and treatment is important for future survival of the patient.

Sleep-related breathing disorders could be accompanied by or caused by a variety of medical conditions. They are considered to be a significant medical and social problem. Together with excessive daytime sleepiness, patients with obstructive sleep apnea experience neuropsychological symptoms such as anxiety, attention deficits, cognitive impairment, depressive symptoms and other psychological disturbances leading to social adjustment difficulties. Patients diagnosed with obstructive sleep apnea demonstrate a decline in a wide spectrum of cognitive abilities, including memory, attention, psychomotor speed, executive, verbal and visual-spatial skills. The aim of this study is to investigate the cognitive functioning and affective disorders among patients with obstructive sleep apnea syndrome and to examine the frequency and severity of cases in comparison with a control group consisting of healthy volunteers. Our research has shown that there is a relation between sleep apnea and cognitive impairments and affective changes. This relation can be explained by the direct effect of the syndrome on the patient, where the main connecting factor is the severity and the distribution of excessive daytime sleepiness. Along with treatment of the somatic medical condition, it is extremely important that the patient's mental state is treated as well. Trial Registration: 57/2013, Medical University - Sofia, Bulgaria.

Normal circadian rhythm in Obstructive Sleep Apnea (OSA) is impaired by changes in various hormones and the Vitamin D level related with them: Aim: To evaluate parathyroid hormone (PTH) and 25-hydroxyvitamin D (25(OH) D) serum levels in patients with newly diagnosed OSA in the winter: Materials and Methods: From December 2015 to February 2016 50 people were included in a prospective study – 30 patients with OSA (24 men, 6 women), mean age 49.91 ± 14.15 years, and 20 healthy controls (12 men, 8 women; 53.54 ± 11.57 years). Polysomnography, assessment of daytime sleepiness, blood tests, including 25(OH) D and PTH, were performed: Results: There were no significant differences in the demographic data between both groups. Patients with OSA had significantly higher serum levels of PTH (5.93 ± 1.82 pmol/L), compared to controls (3.13 ± 0.97 pmol/L), p

The diagnosis of pulmonary embolism (PE) is usually determined by a combination of clinical investigations, D-dimer assay, and different imaging tests. The aim of this study was to compare the diagnostic value of perfusion lung scintigraphy in SPECT and low-dose CT (SPECT/CT), and Computed tomography pulmonary angiography (CTPA) for patients with suspected PE. Material and Methods: In a prospective one-year study 76 hospitalized patients suspected for PE were included. Clinical assessment, D –dimer assay, perfusion SPECT/CT and CTPA were carried out. Results: PE was diagnosed in 50 of 76 patients (66%) by perfusion SPECT/CT and 26 of 76 patients (34%) by CTPA. The sensitivity and specificity of perfusion SPECT/CT was 93%, respectively 64%. For CTPA they are 54%, respectively 93%. There is no significant difference regarding the diagnosis of PE at subsegmental and segmental level between both used methods. The sensitivity of perfusion SPECT/CT is significantly higher compared with CTPA, while the specificity is significantly higher at CTPA for diagnosis of PE. Conclusion: The perfusion SPECT/CT has an excellent diagnostic performance and should therefore be considered first-line imaging in the work up of PE in most cases.

Obstructive sleep apnea syndrome (OSAS) is associated with increased risk of different cardiovascular complications such as arterial hypertension, ischemic heart disease, rhythm disorders. Pericardial effusion (PE) is common condition in patients with OSAS, but usually in correlation with respiratory failure and pulmonary arterial hypertension (PAH). The aim of the study is to evaluate the presence of PE in OSAS patients without PAH and/or daily hypoxemia, and to assess the possible factors associated with it. 279 consecutive patients (162 men and 117 women, mean age 42.76 ± 12.44 years) with newly diagnosed OSAS were included. Different laboratory tests, 2-D echocardiography with Doppler-sonography to exclude other diseases that can lead to chronic PE were provided in all patients. PE was found in 102 (36.56%) of the patients.The mean effusion volume was small (150-250 ml). The PE significantly correlated with severity of OSA (r = 0.374, p Persistent pericardial effusion is common in patients with OSAS. Although it is usually not life-threatening condition, the PE could be very resistant to treatment. The exact mechanisms for the development of PE in many patients with OSAS are still unclear but the correlation with obesity and desaturation time during sleep show that PE may be as a result of chronic low-grade inflammation and elevated systemic oxidative stress.

Sleep-disordered breathing is connected with disturbed sleep architecture. Repetitive episodes of desaturation, chronic stress, inability of the brain to complete the full sleep cycle, impaired melatonin regulation, etc. are crucial mechanism. Further knowledge on the physiology of melatonin secretion, and related pathological phenomena, could provide new therapeutic approach to the patients. The aim of our study is to examine the pattern and of melatonin secretion in patients with sleep-disorder breathing and to compare them to those in healthy individuals in the control group. Our study includes 76 individuals divided into two groups – 53 patients and 19 controls. Polysomnography was used to evaluate sleep architecture and disturbances in breathing. Melatonin direct saliva test was used in 31 patients and 15 controls to evaluate the pattern of melatonin secretion. Samples were taken at 2 a.m., 6 a.m., 2 p.m. and 22 p.m. Daytime sleepiness in all of the participants was estimated with the Epworth Sleepiness Scale. Our results show that the melatonin levels in patients9 group are statistically significant higher in all investigated periods compared to the controls. The pattern of melatonin secretion shows a higher peak during the night and does not reduce sufficiently in the morning. Levels of melatonin in the afternoon are in correlation with the score on the Epworth sleepiness scale. Significant correlations were found between the levels of melatonin in the afternoon and the period of sleep spent with oxygen saturation below 90% and arousal index. Our study shows a direct link between daytime sleepiness and sleep-disordered breathing and the main connecting factor is the pattern of melatonin secretion.