Anna Brzecka

Efficacy of Noninvasive Volume Targeted Ventilation in Patients with Chronic Respiratory Failure Due to Kyphoscoliosis

Severe kyphoscoliosis can cause chronic respiratory failure. Noninvasive mechanical ventilation (NIMV) is a new optional treatment for such patients. The aim of this study was to evaluate the effectiveness of average volume-assured pressure support (AVAPS) NIMV in patients with kyphoscoliotic chronic respiratory failure. The study was performed in 12 patients (mean age 49±11 years and body mass index 27.5±7.9 kg/m2) with advanced kyphoscoliosis complicated by severe respiratory failure (PaO2 6.68±0.34 kPa, SaO2 81.7±3.1%, PaCO2 9.51±1.08 kPa) treated by the NIMV. The short-term, after 5 days, and long-term, after 1 year of home treatment, efficacy of NIMV was evaluated. We found a significant improvement of diurnal PaO2 and PaCO2 on the 5th day of NIMV (an increase of 1.4±0.3 kPa and a decrease of 1.8±0.8 kPa, respectively; p<0.05) and after one year NIMV (an increase of 2.07±0.46 kPa and a decrease of 2.68±0.85 kPa, respectively; p<0.05). There was a significant increase of mean blood oxygen saturation during sleep on the 5th day (86.2±3.2%) and after 1 year of treatment (89.4±2.1%) compared with the baseline level (83.2±3.2%). The forced vital capacity also increased after 1 year (1,024±258 ml vs. the baseline 908±267 ml; p<0.05). The NIMV was well tolerated and no patient discontinued the treatment during the observation period. We conclude that AVAPS NIMV is an effective treatment option in kyphoscoliotic patients with chronic respiratory failure, resulting in a prompt and long-term improvement of daytime and nocturnal blood gas exchange.

Soluble Ligand CD40 and Uric Acid as Markers of Atheromatosis in Patients with Obstructive Sleep Apnea

The aim of the study was to evaluate the risk of atheromatosis in patients with obstructive sleep apnea (OSA), as based on the concentration of the pro-atherogenic soluble CD40L ligand (sCD40L) in relation to the level of uric acid. The serum levels of sCD40L and uric acid were measured in 79 OSA patients (mean apnea/hypopnea index - AHI 34.4 ± 20.9) and in 40 healthy controls. We found that sCD40L was higher in the OSA patients with hyperuricemia than that in the patients with uric acid in the normal range (sCD40L: 9.0 ng/ml vs. 8.0 ng/ml, respectively, p < 0.05). There was a positive association of sCD40L with AHI (p = 0.01) and a negative one with the mean minimal nocturnal SaO₂(p < 0.05). Uric acid correlated negatively with the mean and minimal SaO₂and positively with the oxygen desaturation index (p < 0.05). OSA patients with hyperuricemia also had a higher prevalence of hypertension and ischemic heart disease. We conclude that OSA patients with increased uric acid concentration have increased risk of atheromatosis, as indicated by a higher level of soluble pro-atherogenic ligand CD40, and a higher prevalence of cardiovascular adverse events.

Hypoxemia During Bilevel Positive Airway Pressure Treatment in Patients with Obstructive Sleep Apnea Syndrome and Chronic Respiratory Insufficiency

In patients with obstructive sleep apnea (OSA) syndrome and chronic respiratory insufficiency one of the options of treatment is bilevel positive airway pressure (BPAP) during sleep. The aim of the study was to find out what are the factors influencing the early results of BPAP treatment in such OSA patients. The study was carried out in 55 adult obese patients (mean body mass index 45 ± 7 kg/m(2)), severe OSA syndrome (mean apnea/hypopnea index 62 ± 19), and chronic respiratory insufficiency (mean PaCO(2) 54 ± 5.7 torr) who underwent polysomnography during BPAP treatment. In 31 patients (56%) the mean SaO(2) during sleep was <88% despite the optimal BPAP and oxygen titration: 83 ± 4% during NREM and 81 ± 7% during REM sleep vs. 91 ± 2% and 90 ± 3%, respectively, in the remaining 24 patients (p < 0.001). The patients with advanced hypoxemia during sleep and BPAP treatment had lower forced vital capacity (2.2 ± 0.9 vs. 2.7 ± 0.8 l, p < 0.05), lower diurnal PaO(2) (49 ± 8 vs. 54 ± 7 torr), higher diurnal PaCO(2) (57 ± 5 vs. 52 ± 5 torr, p < 0.01), and higher PaCO(2) during sleep (75 ± 13 vs. 59.5 ± 7.5 torr). In conclusion, in obese patients with severe OSA syndrome and chronic alveolar hypoventilation there is a risk of sleep hypoxemia during BPAP treatment, despite optimal pressure titration.

Pulmonary Function Impairment in Patients Undergoing Allogeneic Hematopoietic Cell Transplantation

Deterioration of pulmonary function can be the sole symptom of early stages of pulmonary complications following allogeneic hematopoietic cells transplantation (alloHCT). The aim of the study was to evaluate the prevalence and types of pulmonary function abnormalities in allogenic cells recipients. Twenty three (5 children and 18 adults) allogeneic hematopoietic cells recipients who underwent pulmonary function assessment before and 6-12 months after alloHCT were included in the study. Forced expiratory volume in 1 s (FEV(1)), forced vital capacity (FVC), total lung capacity (TLC), and lung diffusion capacity for carbon dioxide (D(L)CO) were determined. Values <80% of predicted were considered abnormal. We found significant reductions of FVC, D(L)CO, and TLC after alloHCT. The most important reduction was noted in D(L)CO (pre-alloHCT of 85%±15% vs. post- alloHCT of 60%  ±  21%, p<  0.05). Six patients (26%) presented with lung function impairment before alloHCT: obstructive lung disease (4%), restrictive lung disease (13%), and decreased D(L)CO (17%). In 19 patients (83%) pulmonary function abnormalities were demonstrated after alloHCT. The most common disturbance was a D(L)CO decrease that occurred in 16 patients (70%). In conclusion, frequency of pulmonary function abnormalities in patients after alloHCT is high. A diffusion capacity decrease and restrictive pattern of ventilation insufficiency develop in the majority of patients after alloHCT. It would be reasonable to include pulmonary function testing to standard periodic examination in patients qualified for, and after, alloHCT procedure.

Efficacy of Noninvasive Mechanical Ventilation in Obese Patients with Chronic Respiratory Failure

Chronic respiratory failure (CRF) develops in a minority of obese patients. Noninvasive mechanical ventilation (NIMV) is a new optional treatment for such patients. The aim of this study was to evaluate the effectiveness of NIMV in obese patients with CRF. The material of the study consisted of 34 obese patients (body mass index 47.3 ± 7.9 kg/m(2)) with CRF (PaO2 = 6.40 ± 0.93 kPa and PaCO2 = 8.67 ± 2.13 kPa) who were hypoxemic despite an optimal therapy. Thirteen patients had an overlap syndrome (OS) - chronic obstructive pulmonary disease (COPD) coexisting with obstructive sleep apnea syndrome (OSAS) and 21 patients had obesity-hypoventilation syndrome (OHS). Ventilation parameters were determined during polysomnography. The efficacy of NIMV was evaluated on the fifth day and after 1 years home treatment. We observed a significant increase in the mean blood oxygen saturation during sleep in all patients; the increase was greater in patients with OHS (92.6 ± 1.4 %) than in patients with OS (90.4 ± 1.8 %). There was a significant improvement of diurnal PaO2 and PaCO2 on the fifth day of NIMV (mean PaO2 increase 2.1 kPa and PaCO2 decrease 0.9 kPa) and also after 1 year of home NIMV (mean PaO2 increase 1.9 kPa and PaCO2 decrease 2.4 kPa). Only one patient stopped treatment because of lack of tolerance during the observation period (1-3 years). In conclusion, NIMV is an effective and well tolerated treatment option in obese patients with CRF resulting in a rapid relief of respiratory disorders during sleep and a gradual, long-term improvement of gas exchange during the day, particularly in patients with OHS.

Sleep Disorders Associated With Alzheimer's Disease: A Perspective

Sleep disturbances, as well as sleep-wake rhythm disturbances, are typical symptoms of Alzheimers disease (AD) that may precede the other clinical signs of this neurodegenerative disease. Here, we describe clinical features of sleep disorders in AD and the relation between sleep disorders and both cognitive impairment and poor prognosis of the disease. There are difficulties of the diagnosis of sleep disorders based on sleep questionnaires, polysomnography or actigraphy in the AD patients. Typical disturbances of the neurophysiological sleep architecture in the course of the AD include deep sleep and paradoxical sleep deprivation. Among sleep disorders occurring in patients with AD, the most frequent disorders are sleep breathing disorders and restless legs syndrome. Sleep disorders may influence circadian fluctuations of the concentrations of amyloid-β in the interstitial brain fluid and in the cerebrovascular fluid related to the glymphatic brain system and production of the amyloid-β. There is accumulating evidence suggesting that disordered sleep contributes to cognitive decline and the development of AD pathology. In this mini-review, we highlight and discuss the association between sleep disorders and AD.

Metachronous Lung Cancer: Clinical Characteristics and Effects of Surgical Treatment

The occurrence of a second lung tumor after surgical removal of lung cancer usually indicates a lung cancer metastasis, but sometimes a new lesion proves to be a new primary lung cancer, i.e., metachronous lung cancer. The goal of the present study was to conduct a clinical evaluation of patients with metachronous lung cancer and lung cancer metastasis, and to compare the early and distant outcomes of surgical treatment in both cancer types. There were 26 age-matched patients with lung cancer metastases and 23 patients with metachronous lung cancers, who underwent a second lung cancer resection. We evaluated the histological type of a resected cancer, the extent of thoracosurgery, the frequency of early postoperative complications, and the probability of 5-year survival after the second operation. The findings were that metachronous lung cancer was adenocarcinoma in 52% of patients, with a different histopathological pattern from that of the primary lung cancer in 74% of patients. In both cancer groups, mechanical resections were the most common surgery type (76% of all cases), with anatomical resections such as segmentectomy, lobectomy, or pneumectomy being much rarer conducted. The incidence of early postoperative complications in metachronous lung cancer and lung cancer metastasis (30% vs. 31%, respectively) and the probability of 5-year survival after resection of either cancer tumor (60.7% vs. 50.9%, respectively) were comparable. In conclusion, patients undergoing primary lung cancer surgery require a long-term follow-up due to the risk of metastatic or metachronous lung cancer. The likelihood of metachronous lung cancer and pulmonary lung cancer metastases, the incidence of postoperative complications, and the probability of 5-year survival after resection of metachronous lung cancer or lung cancer metastasis are similar.