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Ghrelin, leptin, adiponectin, and resistin levels in sleep apnea syndrome: Role of obesity.

AIM: The aim of this study was to investigate the relationship among plasma leptin, ghrelin, adiponectin, resistin levels, and obstructive sleep apnea syndrome (OSAS). METHODS: Fifty-five consecutive newly diagnosed OSAS patients and 15 age-matched nonapneic controls were enrolled in this study. After sleep study between 8:00 AM and 9:00 AM on the morning, venous blood was obtained in the fasting state to measure ghrelin and adipokines. RESULTS: Serum ghrelin levels of OSAS group were significantly (P < 0.05) higher than those of the control group. No significant difference was noted in the levels of leptin, adiponectin, and resistin in OSAS group when compared to controls. There was a significant positive correlation between ghrelin and apnea–hypopnea index (AHI) (r = 0.237, P < 0.05) or the Epworth sleepiness scale (ESS) (r = 0.28, P < 0.05). There was also a significant positive correlation between leptin and body mass index (r = 0.592, P < 0.0001). No significant correlation was observed between leptin, adiponectin, resistin, and any polysomnographic parameters. CONCLUSION: Our findings demonstrated that serum ghrelin levels were higher in OSAS patients than those of control group and correlated with AHI and ESS. Further studies are needed to clarify the complex relation among OSAS, obesity, adipokines, and ghrelin.

Association between serum neopterin, obesity and daytime sleepiness in patients with obstructive sleep apnea

OBJECTIVE Obesity and obstructive sleep apnea (OSA) and systemic inflammation may interact through biochemical pathways. Neopterin (NP) is a monocyte/macrophage activation marker produced by macrophages in response to interferon-gamma secreted by activated T-lymphocytes. This study examines the association between NP, obesity and OSA. PATIENTS AND METHODS The study included 22 newly diagnosed OSA (+) patients and 18 OSA (-) patients. Subjects with history of coronary artery disease, transplant patients, history of alcohol and drug abuse, history of HIV and any other significant medical illnesses such as active infections, autoimmune disease, malignancy, liver disease, pulmonary disease (COPD, asthma,...), neuromuscular disease, patients on immunomodulating therapy or HMG-CoA reductase inhibitors were excluded. RESULTS There were no significant differences in age, body mass index (BMI), and smoking habits of the OSA (+) patients and OSA (-) patients. Serum NP levels did not show any significant difference between the OSA (+) patients and OSA (-) patients, however, NP levels were positively correlated with BMI (r=0.320, p=0.044). There was no significant correlation between NP and any of the polysomnographic parameters. The result of stepwise regression analyses (r(2)=0.320, p<0.001) showed that high serum NP levels (p=0.004) and apnea-hypopnea index (AHI) were a risk factor for elevated Epworth sleepiness score, independent of BMI. CONCLUSION We suggest that serum NP levels correlate with BMI. There was a significant relationship between serum NP levels and excessive daytime sleepiness in OSA patients.

Catheter-Directed Therapy in Acute Pulmonary Embolism with Right Ventricular Dysfunction: A Promising Modality to Provide Early Hemodynamic Recovery

Background Catheter-directed therapy (CDT) for pulmonary embolism (PE) is considered as an alternative to systemic thrombolysis (ST) in patients with hemodynamically unstable acute PE who are considered at high bleeding risk for ST. We aimed to evaluate the efficacy and safety of CDT in the management of acute PE with right ventricular dysfunction (RVD). The primary outcomes were mortality, clinical success, and complications. Secondary outcomes were change in hemodynamic parameters in the first 24 hours following the procedure. Material/Methods Medical records of consecutive patients diagnosed as having acute massive or submassive PE with accompanying RVD treated by immediate CDT at our institution from January 2007 to January 2014 were reviewed. Patient characteristics, mortality, achievement of clinical success, and minor and major bleeding complications were analyzed in the overall study group, as well as massive vs. submassive PE subgroups. Change in hemodynamic parameters in the second, eighth, and 24th hours after the CDT procedure were also analyzed. Results The study included 15 consecutive patients (M/F=10/5) with a mean age of 54.2±16.6 years who underwent immediate CDT. Nine of the patients had submassive PE, and 6 had massive PE. In-hospital mortality rate was 13.3% (95% CI, 0.04–0.38). One major, but not life-threatening, bleeding episode was evident in the whole group. Hemodynamic parameters were stabilized and clinical success was achieved in 14/15 (93.3%; 95% CI, 70.2–98.8) of the patients in the first 24 hours. Notably, the hemodynamic recovery was significantly evident in the first 8 hours after the procedure. Conclusions CDT is a promising treatment option for patients with acute PE with RVD with no fatal bleeding complication. In experienced centers, CDT should be considered as a first-line treatment for patients with acute PE and RVD and contraindications for ST, with the advantage of providing early hemodynamic recovery.

Association between self reported snoring, STOP questionnaire and postoperative pulmonary complications in patients submitted to ortophaedic surgery

BackgroundObstructive sleep apnea (OSA) may increase perioperative complications. The aim of this study was to determine the relationship among postoperative pulmonary complication, snoring and STOP questionnaire in patients with ortophaedic surgery.Methods1,406 consecutive records of patients who had undergone elective ortophaedic surgery during the period January 2005-December 2008 were investigated retrospectively. Demographic information, sleep symptoms, STOP questionnaire, comorbidities and outcome data were collected.ResultsThere were 289 (20.5%) snorers and 1,117 (79.5%) non-snorers in the study group. There was no significant difference between snorer and non-snorer patients (p > 0.05) in the prevalence of pneumonia and respiratory failure. But in snorer patients the rate of postoperative atelectasis was significantly higher than in non-snorer group (p < 0.0001). The STOP Questionnaire was given to 1,406 patients and 147 (10.4%) out of them were classified at high risk of OSA. There was no significant difference in the prevalence of pneumonia and respiratory failure between low and high risk group (p > 0.05). However, in high risk patients the occurrence of postoperative atelectasis was significantly higher than in low risk group (p < 0.0001).ConclusionPostoperative atelectasis was significantly more prevalent in the high risk group according to STOP questionnaire.

The relationships of serum prealbumin levels with parameters that indicate severity of disease and emphysema pattern in patients with stable chronic obstructive pulmonary disease.

OBJECTIVE Malnutrition, which is a complication frequently observed in chronic obstructive pulmonary disease (COPD) and negatively affects prognosis, has become a parameter that must be monitored. Even though various methods are applied to assess malnutrition, biochemical parameters, especially serum prealbumin levels, are useful. MATERIALS AND METHODS The relationships between serum prealbumin levels, which we used as an indicator of malnutrition, with the severity of disease and the parameters predicting emphysema in stable COPD patients with no additional health problems were determined in this prospective study. RESULTS One hundred stable COPD patients were evaluated prospectively. Serum prealbumin levels had a negative correlation with the total number of hospitalizations due to acute exacerbation, total hospitalization time, and average number of annual hospitalizations, whereas it showed a positive correlation with FEV1 and FEV1/FVC% values. Serum prealbumin levels were positively correlated with the length of the line connecting the costophrenic sinus to the dome of the diaphragm, which is used to assess the presence of emphysema and was negatively correlated with retrosternal distance. Also, in COPD patients with low prealbumin levels, while the FEV1 and FEV1/FVC% values and the length of the line connecting the costophrenic sinus to the diaphragm dome significantly decreased, the retrosternal distance dramatically increased compared to COPD patients with normal prealbumin levels. CONCLUSION Serum prealbumin levels were convenient for monitoring malnutrition in COPD, were correlated with spirometric and anamnestic data indicating the severity of COPD, and were useful in distinguishing the subtype of COPD due to its decrease in the presence of emphysema.

Relationship between disease severity and D-dimer levels measured with two different methods in pulmonary embolism patients

Pulmonary embolism (PE) is diagnosed with increasing frequency nowadays due to advances in the diagnostic methods and the increased awareness of the disease. There is a tendency to use non invasive diagnostic methods for all diseases. D-dimer is a fibrin degradation product. We aimed to detect the relationship between disease severity and the D-dimer levels measured with two different methods. We compared D-dimer levels in cases of massive vs. non-massive PE. A total of 89 patients who were diagnosed between 2006 and 2008 were included in the study. Group 1 included patients whose D-dimer levels were measured with the immunoturbidimetric polyclonal antibody method (D-dimerPLUS®), while Group 2 patients made use of the immunoturbidimetric monoclonal antibody method (InnovanceD-DIMER®). In each group, the D-dimer levels of those with massive and non-massive PE were compared, using the Mann Whitney U test. The mean age of Group 1 (25 F/26 M) was 56.0 ± 17.9 years, and that of Group 2 (22 F/16 M) was 52.9 ± 17.9 years. There was no statistical difference in gender and mean age between the two groups (p > 0.05). In Group 1, the mean D-dimer level of massive cases (n = 7) was 1444.9 ± 657.9 μg/L and that of nonmassive PE (n = 34) was 1304.7 ± 350.5 μg/L (p > 0.05). In Group 2, the mean D-dimer level of massive cases (n = 6) was 9.7 ± 2.2 mg/L and that of non-massive PE (n = 32) was 5.9 ± 1.3 mg/L (p < 0.05). The mean D-dimer levels of massive cases as measured with the immunoturbidimetric monoclonal antibody method were significantly higher. Pulmonary embolism patients whose D-dimer levels are higher (especially higher than 6.6 mg/L) should be considered as possibly having massive embolism. Diagnostic procedures and management can be planned according to this finding.RiassuntoLa diagnosi di embolia polmonare (EP) viene posta oggi giorno con sempre maggiore frequenza grazie ai passi avanti della metodologia diagnostica e alla maggiore consapevolezza di malattia. In tutte le patologie si tende a ricorrere a metodi non invasivi per giungere alla diagnosi. Il D-dimero è un prodotto di degradazione della fibrina. Scopo di questo studio è valutare il rapporto tra gravità di malattia e livelli di D-dimero misurati con due metodiche differenti. Abbiamo comparato i livelli D-dimero in casi di EP massiva e in casi non gravi di EP. Sono stati selezionati 89 pazienti in cui è stata posta diagnosi di EP tra il 2006 e il 2008. Al Gruppo 1 sono stati allocati i pazienti ai quali il D-dimero era stato misurato mediante un metodo immunoturbidimetrico con anticorpi policlonali (D-dimer PLUS®), al Gruppo 2 i pazienti valutati mediante metodo immunoturbidimetrico con anticorpi monoclonali (InnovanceD-DIMER®). La comparazione tra i due gruppi è stata effettuata con il Mann Whitney U test. L’età media del gruppo 1 (25F/26M) era 56,0 ± 17,9 anni, nel Gruppo 2 (22F/16M) era 52,9 ± 17,9 anni. Non vi era una differenza statisticamente significativa tra i due gruppi per sesso o età (p > 0,05). Nei pazienti più gravi del gruppo 1 (n = 7) il livello medio di D-dimero era 1444,9 ± 657,9 μg/L, nei non gravi (n = 34) era 1304,7 ± 350,5 μg/L (p > 0,05). Nel gruppo 2 il livello medio di D-dimero nei gravi (n = 6) era 9,7 ± 2,2 mg/L e nei non-gravi (n = 32) era 5,9 ± 1,3 mg/L (p < 0,05). Il livello medio di D-dimero nei casi gravi in cui è stata utilizzata la metodica con anticorpo monoclonale è risultato significativamente più elevato rispetto ai pazienti meno gravi. Nei pazienti con embolia polmonare il cui D-dimero è più elevato (specie se superiore a 6,6 mg/L con la metodica ad anticorpi monoclonali) dovrebbe essere considerata la possibilità di una embolia massiva. I protocolli diagnostici e di gestione dei pazienti potrebbero perciò essere riformulati sulla base di questi risultati.

Serum CCL-18 level is a risk factor for COPD exacerbations requiring hospitalization

Introduction Chemokine (C-C motif) ligand 18 (CCL-18) has been shown to be elevated in chronic obstructive pulmonary disease (COPD) patients. This study primarily aimed to evaluate whether the serum CCL-18 level differentiates the frequent exacerbator COPD phenotype from infrequent exacerbators. The secondary aim was to investigate whether serum CCL-18 level is a risk factor for exacerbations requiring hospitalization. Materials and methods Clinically stable COPD patients and participants with smoking history but normal spirometry (NSp) were recruited for the study. Modified Medical Research Council Dyspnea Scale, COPD Assessment Test, spirometry, and 6-min walking test were performed. Serum CCL-18 levels were measured with a commercial ELISA Kit. Results Sixty COPD patients and 20 NSp patients were recruited. Serum CCL-18 levels were higher in COPD patients than those in NSp patients (169 vs 94 ng/mL, P<0.0001). CCL-18 level was significantly correlated with the number of exacerbations (r=0.30, P=0.026), although a difference in CCL-18 values between infrequent and frequent exacerbator COPD (168 vs 196 ng/mL) subgroups did not achieve statistical significance (P=0.09). Serum CCL-18 levels were significantly higher in COPD patients who had experienced at least one exacerbation during the previous 12 months. Overall, ROC analysis revealed that a serum CCL-18 level of 181.71 ng/mL could differentiate COPD patients with hospitalized exacerbations from those who were not hospitalized with a 88% sensitivity and 88.2% specificity (area under curve: 0.92). Serum CCL-18 level had a strong correlation with the frequency of exacerbations requiring hospitalization (r=0.68, P<0.0001) and was found to be an independent risk factor for hospitalized exacerbations in the multivariable analysis. Conclusion CCL-18 is a promising biomarker in COPD, as it is associated with frequency of exacerbations, particularly with severe COPD exacerbations requiring hospitalization, as well as with functional parameters and symptom scores.