Hikmet Fırat

The evaluation of sleep quality and response to anti-tumor necrosis factor α therapy in rheumatoid arthritis patients

Poor sleep quality (SQ) is increasingly recognized as giving rise to decreased quality of life, and raising pain perception. Our aim is to evaluate the SQ in rheumatoid arthritis (RA) patients treated with anti-tumor necrosis factor alpha (anti-TNF-α) therapy. This was a prospective observational and open-label study of RA patients. A total of 35 patients with RA were enrolled in this study. Of the 35 patients, 22 had high disease activity (DA), and 13 were in remission. High DA group was initiated an anti TNF-α therapy. Clinical and objective parameters of SQ were assessed by using the Pittsburgh Sleep Quality Index (PSQI) and polysomnography (PSG). The total PSQI score and the frequency of poor SQ were high in 60xa0% of the RA patients. The median PSQI score was significantly higher in the high DA group than in the remission group (Pxa0=xa00.026). Following an anti-TNF-α therapy initiation, significant improvements were observed in the high DA group by PSQI test (Pxa0=xa00.012). However, no statistically significant difference was found by PSG (Pxa0>xa00.05). Although an improvement in DA with anti-TNF-alpha therapy did not provide an amelioration in laboratory parameters, we found a significant improvement in SQ by subjective PSQI test. These findings may support that sleep disorders in RA are likely to be associated with a complex pathophysiology.

Five Year Compliance to Positive Airway Pressure in Patients with Sleep Apnea Syndrome

Study objectives: Compliance is the adherence of the patient to CPAP therapy after his/her decision to start treatment. The aim of this study is to evaluate the compliance to PAP therapy in a large patient population and the results were presented after 5 years of follow-up period in order to emphasize longterm compliance with CPAP treatment in the light of the literature. nMethods: Patients who could not afford CPAP device or attend regular controls were excluded from the study and the remaining 174 patients were included in the study. At the end of 5 years, the patients were called back. A total of 110 patients met the eligibility criteria for the study110 patients (79 males, 31 females) whose charts were reviewed nResults: Fifty of 110 study participants (45.5%) regularly used PAP device for ≥4 hours and the remaining 60 (54.5%) patients did not use PAP device regularly. At the end of 5 years, we found that 36.4% of the patients used the device 4 hours a night. AHI severity does not affect adherence to the device and compliance rates (χ2=2.743; p=0.254) nConclusion: The patients compliance rates with their PAP devices was found in accord with the literature. This study conveys greater importance than other relevant studies in the literature and it encompasses a larger patient population follow up for a long period.

The Quantitative Analysis of Uvulopalatal Flap Surgery

Amaç: Bu çalışmada, uvulopalatal flap cerrahisinin kantitatif analizi için sinyal işleme tekniklerine dayanan yeni bir metodoloji önerilmektedir. Uvulopalatal flap ameliyatı ile ilgili klinik değerlendirme çalışmaları, doktorların muayenesine bağlı olmakla birlikte, hastanın subjektif geribildirimini de içermektedir. Kantitatif ve objektif değerlendirme çalışması literatürde halen eksiktir. Gereç ve Yöntem: Ameliyat öncesinde ve sonrasında 21 hastanın tüm gece uyku kayıtları analiz edilmiştir. Önerilen algoritma, iki bağımsız bölümden oluşmaktadır. Birinci bölümde, kalp hızı değişkenliği ve elektrokardiyogramın karmaşıklığı hesaplanmıştır. İkinci bölüm ise, elektroensefalogram alt bantlarının enerjilerinin hesaplanmasını içerir. Ardından, klinik ve deneysel parametreler arasındaki ilintinin belirlenmesi için istatistiksel yöntemler uygulanmıştır. Bulgular: Düşük frekans/yüksek frekans oranı ve beta dalgasının alt bant enerjisi, ameliyat sonrası delta uyku süresi düşük olan hastalar için anlamlıdır. Ayrıca, hem ameliyat sonrası delta uyku süresi hem de kan gazında ölçülen O2 satürasyonu (SaO2) parametresi yüksek olanlar için alfa ve beta dalgalarının ve teta dalgasının alt bant enerjileri anlamlıdır. Ameliyat sonrası solunum bozukluğu endeksi ve SaO2 parametresi düşük olan hastalarda karmaşıklık anlamlıdır ve solunum bozukluğunun horlama indeksi ile ilintisi bulunmaktadır. Sonuç: Ameliyat öncesi ve sonrasındaki klinik bulgulara göre anlamlı olmayan solunum bozukluğu indeksinin karmaşıklık özelliği ile doğrudan ilişkili olduğu bulunmuştur. Bu çalışmanın en önemli sonucu, ameliyat öncesi karmaşıklık özelliğinin solunum bozukluğu ve horlama indeksi ile ilintili olmasıdır. Bu, karmaşıklık özelliğinin cerrahiden önce bir öngörü parametresi olabileceği anlamına gelmektedir. Anahtar Kelimeler: Uyku bozuklukları, obstrüktif uyku apnesi, uvulopalatal flap cerrahisi, karmaşıklık, Hjorth parametreleri Objective: In this work, a new methodology based on signal processing techniques for the quantitative analysis of uvulopalatal flap surgery is proposed. Clinical assessment studies of uvulopalatal flap surgery are based on not only the physician’s examination, but also the patient’s subjective feedback. Quantitative and objective evaluation studies are still lacking in the literature. Materials and Methods: Full night sleep records were analyzed for 21 patients before and after the surgery. The proposed algorithm consists of two independent parts. In the first part, the heart rate variability and complexity of the electrocardiogram were calculated. The second part includes calculating the electroencephalogram sub-band energy. Afterwards, the statistical methods were applied in order to determine the correlation of clinical and experimental parameters. Results: The low frequency/high frequency ratio and the sub-band energy of beta wave were significant for the patients having low postoperative delta sleep duration. Moreover, the sub-band energies of both alpha and beta waves, and theta wave were significant for the patients who had high post-operative delta sleep duration and blood oxygen saturation (SaO2)-parameter. Complexity was significant for the patients with low postoperative respiratory disturbance index and SaO2 parameter, and respiratory disturbance is correlated with snoring index. Conclusion: Respiratory disturbance index, which is not significant according to the preand post-operative clinical findings, was found to be directly related to the complexity feature. The most important result of this work is that the pre-operative complexity feature is correlated with respiratory disturbance and snoring index. This means that complexity feature can be a predictor prior to surgery.

The Presence of Conjunctivochalasis in Obstructive Sleep Apnea Patients.

Objectives: The aim of our study was to detect the presence of conjunctivochalasis (CCh) in obstructive sleep apnea (OSA) patients. Methods: We included 54 subjects (41 OSA patients and 14 control subjects) in the study. All the patients were assessed regarding the presence and stage of CCh. Results: The patients were grouped according to their apnea-hypopnea index as determined during nocturnal polysomnography in our laboratory as mild (12 patients), moderate (16 patients), and severe (13 patients) OSA. The CCh rate was 87.8% in the OSA group and 57.1% in the control group (P=0.022). Mean CCh stage was 1.58±1.24, 2.38±0.88, and 2.15±0.98 in the mild, moderate, and severe OSA groups, respectively, and 0.71±0.72 in the control group (P=0.0001). Conclusions: The moderate and severe OSA groups were associated with higher rates and more advanced stages of CCh. We believe that detailed conjunctival assessment is necessary for patients with complaints such as burning, stinging, and foreign body sensation, which we frequently confront in daily practice. In particular, young patients diagnosed with CCh must be carefully assessed regarding sleep apnea. In light of the above findings, we suggest that patients with ocular surface symptoms that are not relieved by topical medical treatment should be assessed for CCh and OSA. Longitudinal studies monitoring the response of CCh to OSA treatment are needed to clarify the relationship between CCh and OSA.