Aylin Pihtili

Clinical Predictors of Obesity Hypoventilation Syndrome in Obese Subjects With Obstructive Sleep Apnea

BACKGROUND: Arterial blood gas (ABG) analysis is not a routine test in sleep laboratories due to its invasive nature. Therefore, the diagnosis of obesity hypoventilation syndrome (OHS) is underestimated. We aimed to evaluate the differences in subjects with OHS and pure obstructive sleep apnea (OSA) and to determine clinical predictors of OHS in obese subjects. METHODS: Demographics, body mass index (BMI), Epworth Sleepiness Scale score, polysomnographic data, ABG, spirometric measurements, and serum bicarbonate levels were recorded. RESULTS: Of 152 obese subjects with OSA (79 females/73 males, mean age of 50.3 ± 10.6 y, BMI of 40.1 ± 5.6 kg/m2, 51.9% with severe OSA), 42.1% (n = 64) had OHS. Subjects with OHS had higher BMI (P = .02), neck circumference (P < .001), waist circumference (P < .001), waist/hip ratio (P = .02), Epworth Sleepiness Scale scores (P = .036), ABG and serum bicarbonate levels (P < .001), apnea-hypopnea index (P = .01), oxygen desaturation index (P < .001), and total sleep time with SpO2 < 90% (P < .001) compared with subjects with pure OSA (n = 88). They also had lower daytime PaO2 (P < .001), sleep efficiency (P = .032), mean SpO2 (P < .001), and nadir SpO2 (P < .001). Serum bicarbonate levels and nadir SpO2 were the only independent predictive factors for OHS. A serum bicarbonate level of ≥ 27 mmol/L as the cutoff gives a satisfactory discrimination for the diagnosis of OHS (sensitivity of 76.6%, specificity of 74.6%, positive predictive value of 54.5%, negative predictive value of 88.9%). A nadir SpO2 of < 80% as the cutoff gives a satisfactory discrimination for the diagnosis of OHS (sensitivity of 82.8%, specificity of 54.5%, positive predictive value of 56.9%, negative predictive value of 81.4%). When we used a serum bicarbonate level of ≥ 27 mmol/L and/or a nadir SpO2 of < 80% as a screening measure, only 3 of 64 subjects with OHS were missed. CONCLUSIONS: Serum bicarbonate level and nadir saturation were independent predictive factors for the diagnosis of OHS.

Relationship between parenchymal involvement and obstructive sleep apnea in subjects with sarcoidosis.

Increased obstructive sleep apnea (OSA) incidence has been reported in sarcoidosis. However, no research has been conducted to determine the relation between OSA and pulmonary parenchymal involvement in sarcoidosis.

Evidence for the Efficacy of a Bioresonance Method in Smoking Cessation: A Pilot Study

Background: Since the 1970s, MORA bioresonance therapy has globally been applied in the context of complementary medicine for various indications. In this regard, practitioners also report successful application in smoking cessation. The present study aims to verify these reports in a controlled study setting. Methods: In order to achieve the aforementioned objective, we subjected the bioresonance method to a prospective, placebo-controlled, double-blind, parallel-group study involving 190 smokers. In both study groups (placebo n = 95; active bioresonance group; n = 95) the course of treatment and study conditions were standardized. Results: 1 week (77.2% vs. 54.8%), 2 weeks (62.4% vs. 34.4%), 1 month (51.1% vs. 28.6%), and 1 year (28.6% vs. 16.1%) after treatment, the success rate in the verum group differed significantly from the results in the placebo group. Also, the subjective health condition after treatment and subjective assessment of efficacy, polled after 1 week, were significantly more positive among participants in the active bioresonance therapy group than among those in the placebo group. Adverse side effects were not observed. Conclusion: According to the findings attained by this pilot study, bioresonance therapy is clinically effective in smoking cessation and does not show any adverse side effects.

The Predictors of Obesity Hypoventilation Syndrome in Obstructive Sleep Apnea

Background: As obesity increases, the frequency of obstructive sleep apnea and obesity hypoventilation syndrome increases also. However, obesity hypoventilation syndrome frequency is not known, as capnography and arterial blood gas analysis are not routinely performed in sleep laboratories. Aims: To investigate the frequency and predictors of obesity hypoventilation syndrome in obese subjects. Study Design: Retrospective clinical study. Methods: Obese subjects who had arterial blood gas analysis admitted to the sleep laboratory and polysomnography were retrospectively analyzed. Subjects with restrictive (except obesity) and obstructive pulmonary pathologies were excluded. Demographics, Epworth-Sleepiness-Scale scores, polysomnographic data, arterial blood gas analysis, and spirometric measurements were recorded. Results: Of the 419 subjects, 45.1% had obesity hypoventilation syndrome. Apnea hypopnea index (p<0.001), oxygen desaturation index (p<0.001) and sleep time with SpO2<90% (p<0.001) were statistically higher in subjects with obesity hypoventilation syndrome compared to subjects with eucapnic obstructive sleep apnea. The nocturnal mean SpO2 (p<0.001) and lowest SpO2 (p<0.001) were also statistically lower in subjects with obesity hypoventilation syndrome. Logistic regression analysis showed that the lowest SpO2, oxygen desaturation index, apnea hypopnea index and sleep time with SpO2 <90% were related factors for obesity hypoventilation syndrome. Conclusion: Obesity hypoventilation syndrome should be considered when oxygen desaturation index, apnea hypopnea index and sleep time with SpO2 <90% are high.

Serum endothelial cell specific molecule-1 (endocan) levels in patients with obstructive sleep apnea.

OBJECTIVE To investigate the level of endothelial cell specific molecule-1 (endocan) in obstructive sleep apnea (OSA). METHODS Study group included subjects with OSA. Control group included subjects who had no OSA on polysomnography and nonobese healthy subjects from population who had no OSA symptoms. Endocan levels of OSA and non-OSA subjects were compared. RESULTS Totally 106 individuals (63 OSA, 43 non-OSA) were included. Endocan levels were higher in OSA subjects than controls (1.25 ± 0.4 ng/ml vs 0.93 ± 0.3 ng/ml, p < 0.001). Endocan levels were correlated with BMI (r = 0.456, p < 0.001) and daytime PaO2 (r = -0.266, p < 0.042). In linear regression analysis there was no factor related to endocan level. CONCLUSION Serum endocan is significantly higher in OSA. Further studies should be performed to better understand the relationship between endocan and OSA.

Vocal Cord Paralysis and Hypercapnic Respiratory Failure in a Patient with Familial Amyloidotic Polyneuropathy.

We herein report a patient case with familial amyloidotic polyneuropathy (FAP) who presented with vocal cord paralysis (VCP). A 60-year-old man with FAP (Gly89Gln) presented with hoarseness and snoring for the previous two years. A chest X-ray demonstrated cardiomegaly and bilateral diaphragmatic elevation. The findings of a restrictive pattern on spirometry and daytime hypercapnia were consistent with respiratory muscle weakness related to neuropathy [forced expiratory volume (FEV1): 38%, forced vital capacity (FVC): 39%, FEV1/FVC: 77, partial pressure of arterial oxygen (PaO2): 80 mmHg, partial pressure of carbon dioxide in arterial blood (PaCO2): 52 mmHg]. An ear-nose-throat examination showed VCP. Polysomnography revealed severe obstructive sleep apnea (OSA). FAP may cause OSA by VCP and hypercapnic respiratory failure by respiratory muscle weakness. Therefore, an ear-nose-throat examination, spirometry, arterial blood gases analysis and polysomnography are important for these patients.

Daniel Kaiser - † Juli 2014

Daniel Kaiser ist nicht mehr. Im Juli setzte er seinem Leben ein Ende. Seine ganze Leidenschaft galt der Homöopathie. Von Studienzeiten an bis zu seinem Tod setzte er sich unermüdlich für diese Heilweise ein: für ihre Verbreitung unter den Medizinstudierenden, für die Verbesserung ihrer Lehre und ihrer praktischen Ausbildung, für die Fortbildungsliteratur – für jeden Aspekt, der die Homöopathie voranbringen konnte. Die Carstens-Stiftung «Natur und Medizin» hat ihm Großartiges zu verdanken. 1991/92 entwickelte er zusammen mit Bernhard Luft und der Stiftung das Konzept einer Kommunikationsund Fortbildungsplattform für die studentischen Arbeitskreise für Homöopathie, seit Herbst 1992 «Wilseder StudentInnen-Forum für Homöopathie» genannt, das bis heute zweimal im Jahr Vertreter der jeweils bestehenden studentischen Arbeitskreise um die Homöopathie versammelt. Diese Einrichtung, die ohne Daniel Kaiser nicht entstanden wäre, ist medizingeschichtlich längst als weltweit einzigartig gewürdigt worden. Die ersten Treffen lebten von seinem Schwung, seiner Leidenschaft, seiner frohen Ausstrahlung, seinen immer wieder neuen Impulsen. Gleich mit dem ersten Treffen im März 1992 gründete er die «Homöopathischen Flugblätter», ebenso neu und einmalig wie das Forum. Erst nach etwa 10 Jahren fielen sie dem elektronischen Zeitalter zum Opfer. Er war bescheiden genug, sich nach wenigen Treffen aus dem Forum zurückzuziehen und anderen den Vortritt zu lassen. Nun war jedoch ein Netzwerk junger leidenschaftlicher Homöopathen im Übergang vom Studium zum Arzt sein entstanden, das nach Kontinuität verlangte. So entstand auf Drängen Kaisers das «Alt-Wilseder Forum für Homöopathie», in dem sich bis heute einmal im Jahr diejenigen treffen, die dem Studentenforum entwachsen sind. Auch dieses Forum sucht seinesgleichen und wäre ohne Kaiser nicht entstanden. Im vergangenen Winter war er beim 20. Treffen dabei, das wegen des Jubiläums in Wilsede – dem namensgebenden Ursprungsort der ganzen Bewegung – in der Lüneburger Heide stattfand. Vollkommen neuartige Strukturen der Nachwuchsförderung in der Homöopathie, vom Studierenden bis zum Facharzt, gehen damit auf Kaiser zurück. Der Geist von Wilsede – Offenheit jenseits aller Schulen der Homöopathie, Offenheit für Wissenschaft und Forschung und ein freundschaftliches Miteinander – ist wesentlich durch ihn geprägt. Nicht nur die Carstens-Stiftung «Natur und Medizin», sondern die ganze homöopathische Gemeinschaft, insbesondere die mittlerweile mehreren Hundert Teilnehmer der Wilseder Foren, verneigen sich in Dankbarkeit vor Kaiser. Dem Entschluss, seinem Leben ein Ende zu setzen, kann man – bei aller Trauer – nur mit größtem Respekt begegnen. Sein schweres psychisches Leiden hat ihn schlussendlich in tiefer Verzweiflung zu Boden gedrückt.