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OBJECTIVE: The first choice for treatment in severe and moderate obstructive sleep apnea syndrome (OSAS) is positive airway pressure (PAP) devices. However, despite proper titration, respiratory events may persist, while central respiratory events may increase or emerge for some patients. The primary aim of this study is to compare the clinical, demographic, and polysomnographic features of patients with different titration results. MATERIAL AND METHODS: The patients who underwent automatic PAP (APAP) titration with the nasal mask in our clinic due to moderate or severe OSAS in 2017 were included in the study. The clinical, demographic, and polysomnographic characteristics of patients with successful (good) titration, “unacceptable” APAP titration, and treatment-emergent central apnea syndrome (TECSA), were recorded retrospectively and evaluated comparatively with statistical methods. RESULTS: Out of 942 titration tests with APAP, 37 patients were diagnosed as TECSA (3.9%), while unacceptable (unsuccessful) titration results were seen only in 20 patients (2.1%). For the successful titration group, 44 consecutive patients were recruited. In the TECSA group, the central apnea index and minimum SpO(2) were higher during the diagnostic polysomnography (PSG). In the unacceptable titration group, the baseline minimum SpO(2) was lower. The lower sleep efficiency, lower stage N3 sleep, and longer rapid eye movement (REM) and sleep latencies were observed in the TECSA group during the titration test. The diagnostic accuracy of PAP device recordings was found to be moderate (kappa value: 0.533). CONCLUSION: The baseline polysomnographic features, including higher central apnea index and minimum SpO(2)(,) may raise suspicion for titration failures for which a laboratory-based titration can be scheduled.

Background This study was conducted to evaluate the relationship of age-adjusted D-dimer value with different coefficients in diagnosis of pulmonary embolism (PE) in geriatric patients. Methods The emergency admissions of the patients aged 65 and over with suspected PE during 2018 were reviewed retrospectively. The demographic characteristics, laboratory tests and radiologic findings of computed tomography pulmonary angiogram (CTPA) or single photon emission computed tomography ventilation/perfusion scintigraphy (V/Q) were recorded. The characteristics of the patients with PE were statistically compared with the patients without PE. The specificity and sensitivity for higher cut-off levels (age × 10-15) were presented. Results PE was detected in 39.2% (n = 246) of 628 patients aged 65 years and older included in the study. The multivariate analysis revealed that higher D-dimer level (OR = 1,00011; p 0.001) and BUN level (OR = 1.025; p = 0.013) were independent risk factors for PE diagnosis in elderly patients. Diagnostic statistics for D-dimer cut-off levels selected from ROC analysis and calculated values as 10-15 times of age showed that if the D-dimer cut-off value used is chosen higher, lower sensitivity rates are obtained. Our results also indicated that the patients with malignancy, renal failure, central PE on CTPA and PE with high probability on SPECT VQ were presented with higher D-dimer values. Conclusion Our results do not support the use of higher D-dimer cut-off levels such as 15 times the age in geriatric population. The impact of the location of PE and comorbidities on the outcomes of these patients must be clarified for determining cut-offs with higher specificity.

Background: Asthma control is defined as to what extent manifestations of asthma can be observed in a patient or have been reduced or removed by treatment. Regular use of asthma treatments, correct inhaler technique, adequate information provided about the patient's diseases and medicines, and patient‐clinician collaboration aid asthma control. Asthma shares risk factors and links in the pathogenesis with obstructive sleep apnea (OSA), and OSA may aggravate asthma symptoms. Objective: To assess the risk of OSA for asthma control. Methods: The study was carried out in subjects with asthma who were followed up at specific time points and who used asthma medication regularly and with an appropriate inhaler technique. An asthma control test and a questionnaire were used to determine the asthma control levels and OSA risk of the subjects. Results: With regard to the questionnaire scoring, 77 of 137 subjects with asthma had a low OSA risk and 60 had a high OSA risk. The proportion of the subjects with a high OSA risk (p < 0.001) and were smokers (p = 0.020) were significantly higher in the subjects with uncontrolled asthma than in those with controlled asthma. Logistic regression analysis showed that the variables that affect asthma control status were the risk of OSA and obesity. The subjects with a low OSA risk were more likely to have controlled asthma than those with a high OSA risk (odds ratio 7.896 [95% confidence interval, 2.902‐21.487]; p < 0.001). Conclusion: In the subjects with asthma and who adhered to therapy and used inhalers with the correct technique, a high risk of OSA was associated with poor control of their asthma. This association was independent of other factors, including rhinitis, gastroesophageal reflux, and smoking.

This study aimed to show the predictive value of simple polysomnographic parameters including latency of deep sleep (nREM3), latency of rapid eye movement sleep (REM), and minimum oxygen saturation (SpO2) for predicting failure of autoadjusting positive airway pressure (APAP) titration. Out of 1470 patients with moderate to severe obstructive sleep apnea syndrome (OSAS) who underwent APAP titration between July 1, 2016, and December 31, 2017, 22 patients with titration failure were enrolled in the study. The demographic and polysomnographic characteristics of this group were compared with 44 patients with an adequate APAP titration who were matched with the titration failure group by age, sex, and OSAS severity. The periods between the start of sleep and the start of REM and nREM3 stages were noted as REM latency and nREM3 latency, respectively. The between group differences in the parameters including nREM3 latency, REM latency, and minimum SpO2 during the titration test were statistically significant (p = 0.004, p = 0.008, p

Aim: This study aims to reveal the relationship between Pulmonary Function Tests (PFTs) parameters and polysomnographic parameters. It aims to determine the guiding values in treatment selection, with the hypothesis that easily accessible PFTs parameters can be useful in clinical evaluation for patients with restrictive or obstructive type disorders. Material and Method: One hundred and forty-six patients with obstructive and/or restrictive pulmonary dysfunction who underwent polysomnography in the sleep clinic of our hospital between June 2019 and December 2019 were included in the study. Polysomnography (PSG) parameters and PFTs results were obtained. Age, gender, body mass index (BMI), Epworth Sleepiness Scale (ESS) score, PFTs parameters, apnea-hypopnea index (AHI), nocturnal oxygen saturation, tolerable positive airway therapy modality, and pressures were recorded. Results: Of 146 patients 34.9% were women and most (92.5%) had an obstructive disorder in PFTs. Of the patients with the obstructive disorder, 71 were being followed up with a diagnosis of chronic obstructive pulmonary disease (COPD) and 64 with a diagnosis of asthma. Interstitial lung disease was observed in 5 out of 11 cases (7.5%) with restrictive type disorder, and obesity resulted in restrictive disorder for the remaining 6 cases. Simple snoring was observed in 5.5%. Mild OSAS was observed at a rate of 30.1%. Moderate-severe OSAS was detected in 64.4% of the patients. When the relationship between optimal inspiratory/ expiratory positive airway pressure (IPAP/EPAP) values determined by automatic bilevel positive airway pressure (ABPAP) titration and PFTs parameters were analyzed, a moderate negative correlation was observed between IPAP value and forced vital capacity (FVC) (L) (r=-0.432, p=0035) Discussion: The results of this study show that PFTs parameters can be used to predict polysomnographic findings for patients with obstructive/ restrictive disorders. Almost two-thirds of the patients with obstructive sleep apnea (OSA)-related symptoms in this group were observed to have moderate-severe obstructive sleep apnea syndrome (OSAS). Based on our results in ROC analysis, we believe that it would be appropriate to recommend titration with bilevel devices, especially for patients with forced expiratory volume in one second (FEV1)

Aim: Obstructive sleep apnea syndrome (OSAS) and chronic obstructive pulmonary disease (COPD) have common pathophysiological mechanisms affecting the prognosis of each other. This study aims to investigate the relationship between the presence of OSA risk and the severity of COPD and to determine the possible clinical features for OSA risk for COPD patients. Material and Method: The patients (n=181) who applied to the outpatient clinics of pulmonology between September - November 2019 with the diagnosis of COPD, were analyzed cross-sectionally. Demographic features, anthropometric measurements, comorbidities, smoking status, and severity of dyspnea, respiratory functions, and exacerbation frequency in the last year were evaluated. All patients were questioned with the Epworth sleepiness scale (ESS) for detecting excessive daytime sleepiness (EDS), and the STOP-Bang for determining the risk of OSA. Results: The rate of diabetes, waist and hip circumference measurements, median ESS score, and EDS ratio were found to be higher in patients with moderate/high OSA risk when compared to patients with low OSA risk. In the multivariate regression model; lower oxygen saturation (OR: 0.83; p=0.007) and higher ESS score (OR=1.28; p

Background and Objectives: It is known that the prevalence of obstructive sleep apnea (OSA) is increased in acromegaly. Craniofacial anomalies, macroglossia, and thickening of the laryngeal wall caused by the increase in soft tissue in these patients lead to OSA. Also, the increase in growth hormone can trigger central apnea by causing a decrease in respiratory drive. Determining the polysomnographic characteristics of acromegaly patients is important to reveal the effect of these mechanisms. Methods: The demographic and polysomnographic characteristics of 33 acromegaly patients who underwent polysomnography (PSG) with suspicion of sleep disorders between 2011 and 2018 in the sleep laboratory of our hospital were retrospectively analyzed. One of the patients was excluded from the analysis because PSG was performed in the postoperative period. The remaining 32 patients with active acromegaly were grouped according to their gender and the presence of OSA and compared with statistical methods in terms of polysomnographic and clinical features. Results: OSA (AHI>5) was detected in 78.1% of 32 active acromegaly patients (18 females, 14 males) who underwent PSG with suspicion of sleep-disordered breathing. Moderate-severe OSA (62.5%) was found in most patients, and there was no difference between the sexes in terms of OSA detection rate and OSA severity. Respiratory events appear to be predominantly obstructive hypopneas. Also, the polysomnographic features of female and male acromegaly patients with OSA were found to be similar. It is seen that the OSA group is similar to the group with simple snoring in terms of body mass index (BMI), but is statistically significantly older (p=0,007). A positive correlation was found between age and AHI in pairwise correlation analysis (r:0,426 p:0,015, respectively). Conclusion: Considering that the prevalence of OSA in the population is approximately 5%, our results show that the risk of OSA in acromegaly increases, and obstructive pathways are effective in this increase. The probability of OSA occurrence and polysomnographic features between the genders are similar. Although the median BMI of the patients with and without OSA was similar, the median age was higher in the group with OSA, middle-aged acromegaly patients should be evaluated in terms of OSA even if there is no obvious obesity. doi: https://doi.org/10.12669/pjms.37.4.4229 How to cite this:Celik D, Duyar SS, Aksu F, Firat S, Ciftci B. Evaluation of Acromegaly patients with sleep disturbance related symptoms. Pak J Med Sci. 2021;37(4):1161-1165. doi: https://doi.org/10.12669/pjms.37.4.4229 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The Lung Science Conference (LSC) and the Sleep and Breathing Conference (SBC) are two conferences organised by the European Respiratory Society (ERS), the latter held in association with the European Sleep Research Society. This year, the LSC and SBC were both held in a virtual format with the participation of researchers and clinicians from around the world. The participation of Early Career Members (ECMs) was notable in both events: 216 of 363 (60%) delegates attending the LSC were under 40 years old, and 315 of 920 (34%) delegates were ≤40 years of age at the SBC. Both conferences included outstanding talks on the most recent advances in respiratory medicine and science, oral/poster communication sessions on novel research, exciting opportunities to network with peers, and much more!, This article provides a brief description of some of the most remarkable sessions of the @EuroRespSoc Lung Science Conference and the Sleep and Breathing Conference 2021 and presents the new incoming members of the ECMC (@EarlyCareerERS) https://bit.ly/2RSDP40

Objectives: The most common opinion about apnea/hypopnea formation in restrictive pulmonary diseases is based on decreased lung volumes causing upper airway collapse. This study targets to reveal some evidence for this pathophysiological pathway in patients with idiopathic pulmonary fibrosis (IPF) and obstructive sleep apnea (OSA). Methods: The clinical, demographical, and polysomnographic characteristics of 19 patients with OSA and IPF who underwent all-night polysomnography (PSG) were retrospectively evaluated for investigating the correlations between lung volumes calculated on the images of high-resolution computed tomography (HRCT) and polysomnographic findings. Supine HRCT images performed at the time of diagnosis of IPF were used for the calculation of total lung volume and low attenuation areas of the lung (LAA). The results were compared with the results of the PSG and pulmonary function tests (PFT). Results: The study group comprised 19 patients (3 female, 16 male) with a median apnea-hypopnea index (AHI) of 23.5/h. AHI in this IPF cohort was not correlated with body-mass index, neck circumference, age, or PFT. However, overall AHI and non-rapid eye movement (non-REM) AHI had a trend of positive correlation with LAA. We also showed a positive correlation between the LAA and forced vital capacity (FVC) (r=0.682 and, p = 0.003). Conclusions: The severity of OSAS in IPF patients is well correlated with LAA. This result supports the gravitational and the volumetric effect of the lung in apnea-hypopnea formation.

Aim: To assess relationship between obstructive sleep apnea (OSA) risk and uncontrolled asthma. Methods: Asthma control test (ACT) and Berlin Questionnaire (BQ) was performed on subjects with asthma who had regular inhaler use with appropriate technique and did not have an exacerbation in the last 8 weeks. Demographic and clinical characteristics and OSA-risk of subjects were compared between controlled and uncontrolled asthmatics. Association between asthma control and OSA risk was assessed. Results: Asthmatics aged 44.5 ± 11.5 years (male/female=37/100) were included in the study. Asthma was under control (ACT ≥20) in 77 (56.2%) and was uncontrolled (ACT Conclusion: The findings of the study reveal that obstructive sleep apnea is a determinant of asthma control independent of smoking, reflux and rhinitis underlying the importance of evaluation of asthmatics with uncontrolled disease in terms of OSA risk.

OBJECTIVES: Coincidance of idiopathic pulmonary fibrosis (IPF) and the obstructive sleep apnea syndrome (OSA) may have important effects on the pathogenesis of each other. Our aim is to define clinical characteristics of patients with IPF and OSA and to identify a combined index to determine the severity of both diseases together. MATERIALS AND METHODS: The clinical and polysomnographic characteristics of 22 patients with OSA and IPF who underwent nocturnal polysomnography (NPSG) were retrospectively evaluated and compared with 23 OSA patients without any other pulmonary comorbidities. RESULTS: We demonstrated high frequency of OSA within our study group (94,7%) all of whom had at least one of the majör symptoms of OSA. Lower AHI, lower neck circumference, higher percentage of deep sleep (nREM3) and less comorbidities were observed in the study group when compared to OSA with no other pulmonary comorbidities (p

The aim of this study was to compare olfactory functions pre- and post-CPAP treatment in patients with moderate to severe OSA, and to evaluate the factors that cause changes in olfactory functions. Twenty-two patients who had completed regular usage of CPAP treatment for 2 months were included in this prospective study. Olfactory tests using Sniffin’ Sticks were performed pre- and post-treatment. The mean age of the subjects was 47.6 ± 9.5 years. We did not find a significant change in olfactory functions after 2 months of CPAP treatment in our study group. When the patients were divided into two groups—those whose olfactory functions showed improvement and those whose functions did not—it was found that the mean age of the patients whose olfactory functions did not improve was significantly higher statistically. A significant adverse correlation was found between age and post-treatment olfactory functions, specifically in odour threshold and odour identification scores. Increased age adversely affects the therapeutic effect of CPAP treatment for olfactory functions.

Background/aim: Alpha-methylacyl-CoA racemase (AMACR), an intracellular enzyme involved in lipid metabolism, has emerged as an immunohistochemical marker for many types of cancer. Recent studies about the role of lipid metabolism in pathogenesis of mesothelioma have brought up some positive results. This study was conducted to investigate AMACR expression in the diagnosis of malignant pleural mesothelioma (MPM) and the correlation of this marker with clinical characteristics and survival. Materials and methods: The clinicopathologic characteristics and resection materials of 71 patients were reviewed retrospectively. AMACR expression was evaluated immunohistochemically. The correlations among AMACR expression, clinicopathologic factors, and survival were investigated. Results: AMACR expression was detected in 42.3% of the study group. The specificity and sensitivity of AMACR immunostaining in detecting mesothelioma were 41.1% and 42.3%, respectively. AMACR-positive and negative groups were similar for age, sex, smoking history, tumor diameter, lymph node involvement, differentiation, T-N factor, and stage. Overall survival was not significantly different between the groups, either. Conclusion: The sensitivity of immunostaining was not high enough to use AMACR as a diagnostic tool in MPM. AMACR expression did not have a prognostic value in MPM, either.