Ayhan Sogut

Role of Adipokines and Hormones of Obesity in Childhood Asthma

Purpose The aim of this study was to evaluate serum levels of leptin, ghrelin, and adiponectin in obese and non-obese children with asthma and in healthy non-asthmatic children, and analyze their relationships with clinical outcomes. Methods This study enrolled 40 obese and 51 non-obese children with asthma and 20 healthy children. Body mass index and serum leptin, ghrelin, and adiponectin levels were determined in all children. Asthma symptom scores and lung function test results were recorded for subjects with asthma. Results Serum leptin levels (11.8±7.9, 5.3±6.8, and 2.1±2.4 ng/mL in the obese asthmatic, non-obese asthmatic, and control groups, respectively) and adiponectin levels (12,586.2±3,724.1; 18,089.3±6,452.3; and 20,297.5±3,680.7 ng/mL, respectively) differed significantly among the groups (P<0.001 for all). Mean ghrelin levels were 196.1±96.8 and 311.9±352.8 pg/mL in the obese and non-obese asthmatic groups, respectively, and 348.8±146.4 pg/mL in the control group (P=0.001). The asthma symptom score was significantly higher in the obese children with asthma than in the non-obese children with asthma (P<0.001). Leptin and adiponectin levels were correlated with the asthma symptom score in non-obese children with asthma (r=0.34 and r=-0.62, respectively). Conclusions Obesity leads to more severe asthma symptoms in children. Moreover, leptin, adiponectin, and ghrelin may play important roles in the inflammatory pathogenesis of asthma and obesity co-morbidity.

Relationship of sleep quality and quality of life in children with monosymptomatic enuresis

BACKGROUNDnHealth-related quality of life (QoL) in children with monosymptomatic nocturnal enuresis might be influenced by impaired quality of sleep. The aim of this study was to evaluate possible deteriorations in QoL and sleep quality and the association between these parameters in children with monosymptomatic nocturnal enuresis.nnnMETHODSnThe study consisted of 44 children with monosymptomatic nocturnal enuresis and 27 healthy controls aged 6-15 years. KINDL QoL and Pittsburgh Sleep Quality Index (PSQI) were applied to all children.nnnRESULTSnMean total KINDL scores in enuresis and control groups were 65.1 +/- 11.0 vs. 67.4 +/- 13.7, respectively (P = 0.44). PSQI scores were not significantly different between the groups (P > 0.05l). In the enuresis group, age showed significant negative correlation with self-esteem domain of KINDL (r = -0.39, P = 0.01) and positive correlation with sleep duration sub-score of the PSQI (r = 0.37, P = 0.03). Duration of enuresis showed significantly negative correlation with total KINDL score and self-esteem domain (r = -0.32 and r = -0.39, P = 0.04 and P = 0.01, respectively). There was significant correlation between physical well-being sub-score of KINDL with daytime dysfunction and total scores of PSQI (r = -0.53, P = 0.001 and r = -0.41, P = 0.02, respectively). Daytime dysfunction sub-score of PSQI was significantly correlated with friends sub-score of KINDL (r = -0.33, P = 0.04).nnnCONCLUSIONSnAs age of the child and duration of enuresis increase, self-esteem domain of QoL worsens. Moreover, there is a significant correlation of physical well-being and friends domains of QoL score and total and daytime dysfunction scores of PSQI. These findings necessitate global evaluation of QoL and sleep quality in children with monosymptomatic nocturnal enuresis to increase efficacy of health care.

Sleep quality and depression–anxiety in mothers of children with two chronic respiratory diseases: Asthma and cystic fibrosis

BACKGROUNDnSleep quality and psychological well being of parents are expected to be influenced by the childs health and disease status. The aim of this study was to compare sleep quality and depression-anxiety parameters in mothers of children with cystic fibrosis (CF) asthma and healthy controls.nnnMETHODSnThe study included mothers of 62 children with asthma, 21 children with CF and 35 healthy children. All mothers filled in the Pittsburgh Sleep Quality Index (PSQI) questionnaire and hospital anxiety depression scale (HADS).nnnRESULTSnComparison of the three groups with Kruskall Wallis analysis demonstrated that subjective sleep, sleep efficiency and total PSQI scores were significantly different between the groups (p=0.02, p=0.01 and p=0.04 respectively). Comparisons of the groups in pairs with Mann Whitney U test with Bonferroni correction revealed that subjective sleep quality scores in mothers of children with asthma were significantly higher than the ones in the control group (1.0+/-0.9 vs 0.6+/-0.7, p=0.015). The other PSQI scores as well as the anxiety and depression scores were higher in CF and asthma groups when compared to the control group but did not reach statistical significance. Anxiety and depression scores were significantly correlated with PSQI total score in CF (rho=0.54 and 0.49 respectively) and asthma groups (rho=0.45 and 0.60 respectively) but not in the control group.nnnCONCLUSIONnIn conclusion, presence of a chronic respiratory disease in a child may be associated with disturbed sleep quality and increased depression and anxiety in mothers.

Attention Deficit and Hyperactivity Symptoms in Children with Asthma

Background. Asthma that is chronic may influence childrens behavioral health and quality of life (QoL) negatively. Objective. To evaluate the frequency of attention deficit and hyperactivity symptoms in children with asthma and to determine if these symptoms are associated with a deterioration of QoL. Methods. Mothers of 62 children with moderate asthma and those of 38 healthy children aged between 7–12 years were included in the study. Conners Parent Rating Scale-48 (CPRS), a 48-item multiple-choice questionnaire, was completed by the mothers to identify attention deficit and hyperactivity symptoms in children. The Pediatric Asthma Quality of Life Questionnaire (PAQLQ) was filled in by children to measure QoL. Results. Mean age was 9.2 ± 1.5 years for asthmatic children (37 male, 25 female) and 10.1 ± 1.3 years for control group (20 male, 18 female). The two groups were similar regarding age and sex. Attention deficit score in the asthma group was significantly higher than that in the control group (p = 0.01). The frequency of hyperactivity was higher in the asthmatic group but the difference between the groups was not significant (p = 0.36). Attention deficit and hyperactivity scores of Conners-P were not correlated with PAQLQ scores (regarding total, activity, emotional and symptom domains). Conclusion. Increased rates of attention deficit symptoms in children with asthma, as reported by mothers, might reflect the negative impact of asthma on neurobehavioral health. Asthmatic children, especially the ones who display attention deficit symptoms, must be considered for further evaluation regarding attention deficit hyperactivity disorder.

Sleep actigraphy evidence of improved sleep after treatment of allergic rhinitis

BACKGROUNDnChildren with allergic rhinitis (AR) are reported to have disturbed sleep and daytime fatigue due to nasal obstruction.nnnOBJECTIVEnTo evaluate sleep impairment in children with AR using actigraphic evaluation.nnnMETHODSnFourteen children aged 7 to 16 years with grass pollen-sensitized seasonal AR were enrolled. They completed the Total 4-Symptom Score (T4SS) scoring system for AR symptom score and the Pittsburgh Sleep Quality Index (PSQI) questionnaire for sleep quality, and they underwent actigraphy for 3 days in the pretreatment period. After topical corticosteroid and antihistaminic treatment for 8 weeks, actigraphy, the T4SS, and the PSQI were repeated. Fourteen healthy children aged 8 to 16 years underwent actigraphy and completed the PSQI questionnaire as controls.nnnRESULTSnThere were no significant age or sex differences between the AR and control groups. Pretreatment PSQI and actigraphy scores were worse in the AR group vs the control group. After treatment, sleep quality improved, and there were no differences in actigraphy and PSQI scores between the 2 groups. Before treatment, the T4SS was significantly correlated with the sleep efficiency, daytime napping episodes, and total nap duration variables of actigraphy (r = -0.53, P = .004; r = 0.43, P = .02; and r = 0.39, P = .04, respectively). The T4SS was correlated with the total PSQI score (r = 0.67, P < .001).nnnCONCLUSIONSnSleep can be compromised in children with AR. There is a significant correlation of clinical symptom score with the actigraphic and PSQI variables. Therefore, actigraphy may be used as an objective tool to evaluate sleep disturbance in children with AR.

Prevalence of habitual snoring and symptoms of sleep-disordered breathing in adolescents ☆

OBJECTIVEnSleep-disordered breathing is an important public health problem in adolescents. The aim of this study was to investigate the prevalence and risk factors of habitual snoring and symptoms of sleep-disordered breathing in adolescents.nnnMETHODSnA cross-sectional study was conducted with children from primary schools and high schools that the ages ranged from 12 to 17 years. Data were collected by physical examination and questionnaires filled in by parents regarding sleep habits and possible risk factors of snoring. According to answers, children were classified into three groups: non-snorers, occasional snorers, and habitual snorers.nnnRESULTSnThe response rate was 79.2%; 1030 of 1300 questionnaires were fully completed and analyzed. The prevalence of habitual snoring was 4.0%. Habitual snorers had significantly more nighttime symptoms including observed apneas, difficulty breathing, restless sleep and mouth breathing during sleep compared to occasional and non-snorers. Prevalence of habitual snoring was increased in children who had had tonsillar hypertrophy, allergic rhinitis, and maternal smoking.nnnCONCLUSIONnWe found the prevalence of habitual snoring to be 4.0% in adolescents from the province of Manisa, Turkey which is low compared to previous studies. Habitual snoring is an important problem in adolescents and habitual snorers had significantly more nighttime symptoms of sleep-disordered breathing compared to non-snorers.

Regulatory-T, T-helper 1, and T-helper 2 cell differentiation in nasal mucosa of allergic rhinitis with olive pollen sensitivity.

Background: Allergic rhinitis (AR) is a disease in which T-helper (Th)2 response is predominant and its pathogenic mechanism is still poorly understood. Aim: To evaluate the possible role of Th1, Th2 and regulatory-T (Treg) cells in the pathogenesis of AR. Methods: This case-control study enrolled 41 patients with seasonal AR (10–62 years old), sensitive to olive pollens, and 15 healthy controls (18–60 years old). Nasal biopsy was performed and specimens of nasal lavage fluid were obtained from all participants. The levels of interleukin (IL)-4, IL-10, interferon (IFN)-γ and transforming growth factor-β (TGF-β) were measured in nasal lavage fluid specimens. The expression of FOXP3, GATA-3 and T-bet was measured by immunohistochemical methods in the nasal biopsy specimens. Results: The levels of IFN-γ in the group with AR were significantly lower than those in the control group (p = 0.008). The levels of IL-4, IL-10 and TGF-β did not differ between the two groups. The expression of FOXP3 and T-bet in patients with AR was significantly lower than that in the control group (both p = 0.001). Expression of GATA-3 in the nasal mucosa was similar between the groups (p = 0.2). The ratios of T-bet/GATA-3 and FOXP3/GATA-3 in the AR group were significantly lower than those in the control group (p = 0.001). Conclusion: Insufficient Treg and Th1 cells may be associated with the allergic inflammation that may be attributed to the Th2 immune response in patients suffering from AR who are sensitive to olive pollen.

Correlation of quality of life with clinical parameters and eosinophilic cation protein levels in children with allergic rhinoconjunctivitis.

Background: Systemic and mucosal roles of eosinophils in the pathogenesis of allergic rhinoconjunctivitis (AR) are known. The aim of this study was to investigate the relationship of clinical parameters and quality of life with eosinophilic cationic protein (ECP) in grass pollen-sensitive children with seasonal AR. Methods: This study included 31 children with AR and 18 healthy controls aged between 5 and 15 years. ECP levels in nasal lavage fluid and serum were measured. AR symptom scores were calculated and the pediatric rhinoconjunctivitis quality of life questionnaire (PRQLQ) was filled in for all patients. Results: Mean serum and nasal ECP levels (ng/ml) were significantly higher in the patient group (p < 0.05 for both). In the AR group, the mean clinical symptom score was 7.3 ± 2.2, while the total PRQLQ score, activity limitation, symptoms and emotional function domains were 2.5 ± 0.9, 3.0 ± 1.1, 2.5 ± 1.2 and 2.6 ± 1.1, respectively. The total clinical symptom score and disease duration showed a significant correlation with the total PRQLQ score (p = 0.00 and 0.003, respectively). However, neither nasal lavage nor serum ECP levels were significantly correlated with symptom score, duration of disease, PRQLQ total score or domains (p > 0.05 for all). Conclusion: These results may indicate the absence of a correlation between clinical status and quality of life and levels of ECP in tissues with allergic inflammation.

Influence of Ambulatory Inhaled Treatment with Different Devices on the Duration of Acute Asthma Findings in Children

Background. Efficacy of bronchodilator treatment in children with asthma depends on the proper use of inhalation devices. The aim of this study was to compare the efficacy of inhaled bronchodilator treatment with a spacer and a nebulizer in children with acute asthma findings. Methods. Fifty-eight children with acute asthma findings who received ambulatory inhaled bronchodilator treatment with a nebulizer and 39 with a spacer were enrolled in the study. Duration of asthma, inhaled steroid treatment and the number of exacerbations during the previous year were recorded. Duration of current acute symptoms, exacerbation severity score and duration of respiratory findings after initiation of treatment were also recorded. Results. Children in both groups were similar in age (76.5 ± 30.3 months using a nebulizer vs 83.1 ± 25.1 in spacer group, p = 0.26). Duration after diagnosis of asthma, initiation of inhaled steroid treatment and exacerbation symptoms were similar between groups (p = 0.15, 0.76 and 0.93, respectively). Exacerbation severity score in the nebulizer group was not significantly different from the spacer group (2.6 ± 0.7 vs 2.8 ± 0.7 respectively, p = 0.19). Number of exacerbations in the previous year was not different (2.0 ± 1.2 in the nebulizer group vs 1.6 ± 0.9 in the spacer group, p = 0.08). Duration of acute asthma findings after initiation of inhaled bronchodilator treatment was similar between the two groups (6.5 ± 2.9 vs 7.2 ± 4.6 p = 0.34). Conclusion. Nebulizers and spacers have similar influence on the duration of acute asthma findings in children when used in ambulatory home bronchodilator treatment.