Altay Sahin

Reliability and validity studies of the Turkish version of the Epworth Sleepiness Scale

The Epworth Sleepiness Scale (ESS) is a self-administered eight-item questionnaire that is widely used in English speaking countries for assessment of daytime sleepiness in adults. The aim of this study was to investigate the reliability and validity of the ESS in the Turkish language. The Turkish version of the ESS (ESStr) was applied to 194 healthy controls and 150 consecutive subjects attending the sleep centre with symptoms of sleep-disordered breathing. Test–retest reliability of the ESStr was tested in a separate group of 30 subjects. The ESStr scores of 60 subjects with mild to severe obstructive sleep apnoea (OSA) were compared with the ESStr scores of 60 healthy controls matched for age, gender, and body mass index (BMI). Concurrent validity with the Functional Outcomes of Sleep Questionnaire (FOSQtr) was also assessed in 12 subjects. The questionnaire had a high level of internal consistency as measured by Cronbach’s alpha (≥0.86). The test–retest intraclass correlation coefficient was r  = 0.81 (95% confidence interval: 0.64–0.90) (p < 0.001) and Spearman’s correlation coefficient was r = 0.80 (p = 0.01). The control group had lower ESStr scores than subjects with sleep-disordered breathing (3.6 ± 3 vs 12.6 ± 6, respectively; p < 0.001). Subjects with mild sleep-disordered breathing also had lower scores of the ESStr than those with moderate and severe sleep-disordered breathing (10 ± 6.2 vs 14 ± 5. and 10 ± 6.2 vs 16 ± 5.4, respectively; both p < 0.05), but there were no significant differences between moderate and severe subjects with sleep apnoea. There were significant correlations between the ESStr and total FOSQtr and its subscales (r  = −0.22 to r = −0.92; all p  = 0.05). Factor analysis of item scores showed that the ESStr had only one factor. The ESStr is a reliable and valid measure of daytime sleepiness. These features and the simplicity of the ESStr make it a valuable measure for clinical management and research.

Prevalence of asthma and allergic diseases in primary school children in Ankara, Turkey: two cross-sectional studies, five years apart.

The prevalence of allergic diseases is reported to have increased worldwide. Two questionnaire surveys, five years apart, were conducted to evaluate the trend of prevalence rates and possible risk factors among primary school children in Ankara, Turkey. A previous survey in 1992 revealed the lifetime prevalences of asthma, wheezing, allergic rhinitis and atopic dermatitis were 17.4%, 23.3%, 28% and 6.1%, and the prevalences for the preceding 12 months were 8.3%, 11.9%, 15.4% and 4%, respectively. The survey was repeated with the same questionnaire in the same age group (6–13 years) of the same school in May 1997. The parents of 358 boys and 380 girls completed the questionnaire. The lifetime and last 12 months’ prevalences of asthma, wheezing, rhinitis and atopic dermatitis were 16.8%, 22.5%, 18.7%, 6.5%, and 9.8%, 13.3%, 14.1%, 4.3%, respectively. There was a significant change only for the lifetime prevalence of rhinitis (p < 0.001). The rate of indoor smoking had declined from 73.9% to 64%, and pet ownership had risen from 7.9% to 22.9% (p < 0.001 for both). Atopic family history was the most prominent risk factor for all types of allergic disorders. Male gender was a significant risk factor for current asthma and wheezing [odds ratio (OR) = 1.80 and 1.59; 95% confidence intervals (CI) = 1.09–2.98 and 1.01–2.48, respectively], and passive smoking affected the occurrence of allergic rhinitis (OR = 1.84; CI = 1.13–3.00). The prevalence rates of allergic diseases among primary school children in Ankara stabilized during a 5‐year period for all diseases other than allergic rhinitis. However, there are changing behavior patterns, i.e. indoor smoking and keeping pet animals, which that may have affected these rates.

Body fat composition: a predictive factor for obstructive sleep apnea.

Objective: To investigate body fat composition, measured by bioelectrical impedance assay (BIA), for predicting the presence and severity of obstructive sleep apnea‐hypopnea syndrome (OSAHS). Body fat composition was also compared with other well‐known OSAHS predictors such as body mass index (BMI), neck circumference, and abdominal visceral fat.

P-wave duration and dispersion in patients with obstructive sleep apnea

AIM P-wave dispersion (Pd) has been reported to be associated with inhomogeneous and discontinuous propagation of sinus impulses. The purpose of this study was to investigate Pd in patients with obstructive sleep apnea (OSA) and to determine its relationship with severity of the disease. METHODS The study population included 67 patients referred to sleep laboratory. The Apnea-Hypopnea Index (AHI) was defined as the number of apneas and hypopneas per hour of sleep. Of the sixty-seven patients, 48 had AHI5 and were diagnosed as OSA. Nineteen of the patients had AHI<5 and were diagnosed as OSA (-) (Group 1), 32 of the patients had AHI between 5-30 (mild and moderate, group 2), 16 of the patients had AHI>30 (severe, group 3). The P-wave duration was calculated in all leads of the surface electrocardiogram. The difference between the maximum (Pmax) and minimum P (Pmin) wave duration was calculated and was defined as the P-wave dispersion (Pd). Echocardiographic examination was also performed. RESULTS Pmax was longer in group 3 compared to group 2 and group 1 (p=0.002, p<0.001 respectively). Pmax was longer in group 2 compared to group 1 (s<0.001). Pd was greater in group 3 compared to group 2 and group 1 (p<0.001 for both comparison). Pd was greater in group 2 compared to group 1 (p<0.001). Pmin did not differ between the groups. In patients with OSA, Pd was positively correlated with AHI (r=0.56, p<0.001), BMI (r=0.43, p=0.03), and mitral early diastolic to late diastolic velocity (E/A) ratio (r=0.37, p=0.01). Multiple linear regression analysis showed that only AHI was independently associated with Pd (beta=0.39, p=0.02). CONCLUSION Pd was found to be greater in patients with OSA than patients without OSA and to be associated with severity of the disease.

Survey of the allergic status of patients with bronchial asthma in Turkey: a multicenter study

Patients diagnosed with bronchial asthma (BA) were prospectively enrolled to assess their allergen spectra and atopic status. The patients came from five major cities (Ankara. Ízmir, Samsun. ElazíǵC, and Adana) in different regions of Turkey. Atopic status, total IgE levels, and allergen speelra were determined in 1149 patients and 210 controls who were spouses of the patients sharing the same environment hut not consanguinity with the patients. Total IgF. levels were significant higher in the asthmatic patients. For both groups, total IgE. levels were higher in both alopic and male subjects. Atopy rates were 42% in asthmatics and 26.1% in controls, declining notably by age in both groups. The most common allergen in both groups was house‐dust mite (RDM), which was more frequency detected in coastal regions (Samsun. Izmir, and Adana). Allergen spectra of the patients included HDM. pollens, cockroach, pet animals, and molds in decreasing order of frequency. Phleum praiensi: and Artemisia vulgam were the most common pollens in all regions, whereas Olea europaea was the most common in Izmir. Pollen sensitivity was least frequent in hlazig. For all of the regions, pet sensitivity was less common than, and mold sensitivity was comparable to, that of Western countries. In conclusion. BA patients in Turkey displayed significant differences in their allergen spectra and total IgE levels from control subjects and BA patients in Western countries.

Early myocardial functional alterations in patients with obstructive sleep apnea syndrome.

Background: There is limited information regarding myocardial alterations in patients with obstructive sleep apnea syndrome (OSAS) in the absence of pulmonary and cardiac comorbidity. In this study, we aimed to evaluate potential myocardial alterations of these patients and investigate the possible effects of OSAS‐related pathological variations on left and right ventricular functions. Methods: We studied 107 consecutive patients who were referred to our sleep laboratory for clinically suspected OSAS and 30 controls without any history or symptoms of sleep‐related disorders. Severity of OSAS was quantified by polysomnography. Patients with apnea–hypopnea index (AHI) < 5 were included in the OSAS (−) group (Group 1, n = 22). Subjects with AHI ≥ 5 were considered as OSAS and classified according to their AHI as mild‐to‐moderate (AHI ≥ 5 and AHI < 30) (Group 2, n = 45) and severe (AHI ≥ 30) OSAS groups (Group 3, n = 40). Conventional M‐mode, 2D, and Doppler mitral inflow parameters, tissue Doppler velocities, myocardial peak systolic strain, and strain rate values of various segments were measured and compared between groups. Results: Patients with OSAS displayed impairment of left ventricular diastolic function compared with controls. There were no significant differences between groups regarding parameters reflecting left ventricular systolic function. Myocardial strain analysis demonstrated significant decrement regarding apical right ventricular longitudinal peak systolic strain and strain rate values between groups in relation to the severity of OSAS. Conclusions: Patients with OSAS display a regional pattern of right ventricular dysfunction correlated with the severity of disease.

Clinical and Radiological Study in Sepiolite Workers

Radiological findings were evaluated on a mass survey (70 mm films) in four villages where mining and processing of sepiolite have occurred for more than 100 yr, together with a clinical and radiological study in 63 sepiolite trimming workers in Eskisehir, Turkey. Mineral fiber-related pleural diseases were not detected in those people who were exposed to sepiolite dust. Although pulmonary fibrosis was encountered in 10 of 63 workers, no relationship between pulmonary fibrosis and sepiolite inhalation could be established. In contrast, all fibrotic patients were smokers and came from dusty rural regions where tremolite (asbestos) and zeolites are present. Three of them had also worked in dusty fields.

Peritoneal mesothelioma: Sonographic findings in nine cases

Ultrasonographic findings in nine cases of peritoneal mesothelioma are presented. The most common findings were sheetlike or nodular peritoneal thickening, soft tissue masses, fixation of the intestinal loops, mesenteric thickening, and minimal ascites which was disproportional to the degree of tumor dissemination. The authors found that abdominal sonography, using 3.75–7.5 MHz transducers, is a useful imaging method for diagnosis of peritoneal mesothelioma in high-risk groups.

Experience of 10 years with Churg-Strauss syndrome: An accompaniment to or a transition from aspirin-induced asthma?

Churg-Strauss syndrome is a rare, idiopathic, eosinophilic vasculitis appearing in concurrence with asthma which is often severe. Aspirin-induced asthma is a special clinical syndrome existing in nearly 10 % of adult asthmatics. After leukotriene antagonists had been marketed there has been marked increase in Churg-Strauss syndrome reports among the patients who had been followed up with asthma. This syndrome seems to be more frequent among the patients with aspirin-induced asthma. The role of leukotriene antagonists on the conversion from aspirin-induced asthma to Churg-Strauss syndrome has aroused attention and been questioned. Here we report 7 cases of Churg-Strauss syndrome where three had aspirin induced asthma which we have diagnosed in the last 10 years and where only one of them seems to be related to antileukotriene drug use.

Treatment of Echinococcus granulosus Cysts

dOSL,\. The major ohstack in the treatment of hydntid diseases in Turkey is the lack of patient compliance. Needless to say. the presence of only I00 mg tablet\ of mebendazole in Turkey and thc difficulty of swallowing 60 to 120 tablets at one time every day contrihutcs to the outcome. We have no experience with alhcndazole which is not ;tvailable in Turkey. We have observed complications rno\tly due to perforation of the cysts during treatment in these paticnts. Pneurnothorax. hemoptysis. fever and superimposed hacterial infection in the hydatid cyst caviiy have occurred in 11 small nurnher of patient\. Side effects due to mebendazole were infrcqucnt and consisted of throinhocytopeni;i. g;istrointestin;il irritation and alopecia. All these sidc effects were rever\ible. We have not observed allergic reactionc during treatment or after perforation of the cysts in any of the patients. Wc assume that thc follow-up of the patientc after cyst rupture is a very important part of the treatment schedule. It should he emphasized that rigid or flexible hronchoscopy may be valuable for extraction of the hydatid membrane in o ionnl patients (2 of the 43 patient.; in our series. unpublished data). Pcrcutancous aspiration of the hydatid cyst lesions in the liver and lung in conjunction with mclxml;rzolc chemotherapy is currently under investigation in our institution. Preliminary results suggest that it is ii rather simple. inexpensive and useful method Longterm results are awaited.