Magdalena Kostrzewska

Impulse oscillometry in the diagnosis of airway resistance in chronic obstructive pulmonary disease.

Spirometry is a standard lung function test for diagnosis and staging of chronic obstructive pulmonary disease (COPD). Impulse oscillometry (IOS) can be complementary to spirometry, especially in patients at advanced age and with physical or mental disorders who cannot be diagnosed through spirometry. The aim of this study was to compare IOS and spirometry in the assessment of airway obstruction in COPD. The study was conducted in 112 stable COPD patients, including 29 females and 83 males of the mean age of 69±11 years. The oscillometric evaluation included total (R5), peripheral (R5-R20), and negative reactance (X5), which were compared with the predicted forced expiratory volume in 1 s (FEV1%pred). The findings show a significantly negative correlation between FEV1%pred and the R5, R5-R20, and X5. COPD patients had increased R5, R5-R20, and X5. The severity of bronchial obstruction found by impulse oscillometry correlated well the spirometric assessment. IOS is a simple to perform test that may be helpful for functional examination of COPD patients.

Dietary and cardio-metabolic risk factors in patients with Obstructive Sleep Apnea: cross-sectional study

Background Little is known about the role of dietary intake in obstructive sleep apnea (OSA), which could prove important in improving clinical outcomes for people with obesity and/or cardiovascular disease within these populations. Reduction in energy intake typically results in weight loss, markedly improving metabolic parameters and ameliorating OSA severity. The aim of this study was to evaluate the association of dietary and cardio-metabolic risk factors with OSA severity. Methods This was a cross-sectional study. A total of 75 volunteers at risk of OSA were recruited from 153 patients suffering from sleep disturbance at the Department of Pulmonology, Allergology and Respiratory Oncology at the Poznan University of Medical Sciences. Polysomnography was used for OSA diagnosis. Sleep quality was assessed by the Pittsburgh Sleep Quality Index. Blood pressure, parameters of glucose (fasting glucose, glucose tolerance test) and lipid metabolism (TC, LDL-C, HDL-C, TG) were assessed using routine enzymatic methods. Dietary intake was evaluated by 24-hr dietary recalls and Food Frequency Questionnaire. Ordinal logistic regression models were used for association of background characteristics and dietary intake with OSA severity. All analyses were adjusted for age, sex, BMI, smoking and alcohol intake. Results A higher percentage of smokers were observed in patients with mild OSA, while alcohol intake was the highest in severe OSA patients. Approximately 60% of the studied patients were self-reported poor sleepers. Results from ordinal logistic regression models showed that higher intakes of alcohol intake were associated with increased odds of severe OSA; whereas higher HDL-C levels were associated with lower odds (OR 0.01; 95% CI [0.0003–0.55]). Significantly higher odds of high OSA severity were observed in patients with disturbed sleep stages and obstructive sleep apnea. Moreover, the investigation of nutrient intake in relation to OSA severity showed that a higher intake of dietary fiber was associated with decreased OSA severity (OR 0.84; 95% CI [0.71–0.98]). Conclusions The severity of OSA is related to higher alcohol consumption and disturbed sleep. The significantly lower dietary fiber intake in patients with severe OSA is of particular importance for dietary consulting in clinical practice, which may positively influence cardiometabolic outcomes.

Carotid Artery Intima-Media Thickness in Hypertensive Patients with Obstructive Sleep Apnea

In this study we determined the relationship between the severity of obstructive sleep apnea (OSA) and body mass index (BMI), systolic and diastolic blood pressure (SBP, DBP), and carotid intima-media thickness (cIMT) in 30 hypertensive male patients, aged 30-70, with newly diagnosed OSA (15 with moderate OSA - Group A, and 15 with severe OSA - Group B) and 20 non-OSA hypertensive individuals (Group C). We revealed significant differences in cIMT between Groups B and C (0.9 ± 0.3 vs. 0.6 ± 0.1 mm and 1.0 ± 0.4 vs. 0.6 ± 0.2 mm in the right and left common carotid arteries, respectively; p <0.05). Increased carotid intima-media thickness in severe OSA was accompanied by higher systolic and diastolic blood pressures compared with both moderate OSA and control subjects. We conclude that in severe OSA increased blood pressure goes in tandem with the thickness of carotid intima-media, which helps explain increased cardiovascular risk in these patients.

Clinical Utility of Berlin Questionnaire in Comparison to Polysomnography in Patients with Obstructive Sleep Apnea

The aim of this study was to assess the utility of the Berlin questionnaire (BQ) in adult patients at high risk of obstructive sleep apnea (OSA). The study consisted of 64 patients recruited for the polysomnography diagnostics of sleep respiratory disturbances. The anthropometric assessment included body weight, height, and body mass index (BMI), all related to the risk of OSA. The BQ consisted of the following three categories: 1 - snoring, 2 - daytime somnolence, and 3 - hypertension. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were evaluated. Likelihood ratio was used to assess the diagnostic accuracy. We found that patients were, on average obese; the mean BMI amounted to 31.9 ± 6.0 kg/m2. Polysomnography identified OSA in 73.4% of patients (AHI >5), where the BQ categorized 87.5% of patients at high risk of OSA. Sensitivity of the BQ was 87.2%, specificity 11.8%, PPV 73.2%, and NPV 25.0%. Diagnostic accuracy assessed by the likelihood ratio had a value of 1.00. The BQ had a false discovery rate of 31.2% and misclassification rate of 32.8%. We conclude that the BQ is a sensitive tool that should be used in clinical settings in which the benefit of high sensitivity outweighs the disadvantage of low specificity.

Obstructive sleep apnea and hormones – a novel insight

Obstructive sleep apnea (OSA), a disorder characterized by repetitive collapse of the upper respiratory tract during sleep, occurs in about 4% of middle-aged men and 2% of women. The incidence of the disorder is rising due to an increase in obesity and ageing of the population. Patients with obstructive sleep apnea are at elevated risk of some endocrinal and metabolic disorders, which may lead to serious consequences including shortening of life expectancy. The recognition and understanding of interactions between local upper airway dysfunction and its endocrinal consequences is therefore vital. In this review we will focus on the influence of OSA on bone metabolism and endocrine homeostasis.

Small Airway Obstruction in Chronic Obstructive Pulmonary Disease: Potential Parameters for Early Detection

The impulse oscillometry (IOS) is recognized as a complementary method to spirometry in the diagnostics of obstructive pulmonary disorders. The IOS enables to measure total respiratory resistance (R5) and proximal respiratory resistance (R20), with the R5-R20 difference reflecting small airway resistance. This study seeks to evaluate the usefulness of R5-R20, maximal mid-expiratory flow (MMEF), and forced expiratory volume in 3 s/forced vital capacity ratio (FEV3/FVC), in the assessment of small airway obstruction in chronic obstructive pulmonary disease (COPD). One hundred and six COPD patients and 43 control subjects, aged over 55, were investigated. Spirometry and IOS were used to assess pulmonary function. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) were evaluated. The findings demonstrate significant reductions in FEV3/FVC and MMEF, and an increase in R5-R20 difference in COPD patients; the changes that depended on the severity of airway obstruction. The sensitivity of R5-R20 in reflecting the MMEF was 84%, specificity 44.2%, PPV 72.4%, and NPV 61.3%. We conclude that the R5-R20 difference is superior to spirometry in the assessment of small bronchi obstruction. A high sensitivity of R5-R20 in reflecting the MMEF makes the IOS method particularly useful for detection of mild lung injury, while a high specificity of the spirometric FEV3/FVC ratio makes it useful to exclude obstruction of small airways. Both methods are thus complimentary.

Molecules of Damage-Associated Patterns in Bronchoalveolar Lavage Fluid and Serum in Chronic Obstructive Pulmonary Disease

Chronic exposure to detrimental environmental factors may induce immunogenic cell death of structural airway cells in chronic obstructive pulmonary disease (COPD). Damage-associated molecular patterns (DAMPs) is a family of heterogeneous molecules released from injured or dead cells, which activate innate and adaptive immune responses on binding to the pattern recognition receptors on cells. This study seeks to define the content of DAMPs in the bronchoalveolar lavage fluid (BALF) and serum of COPD patients, and the possible association of these molecules with clinical disease features. Thirty COPD in advanced disease stages were enrolled into the study. Pulmonary function tests, arterial blood gas content, 6-minute walk test, and BODE index were assessed. The content of DAMPs was estimated using the commercial sandwich-ELISA kits. We found differential alterations in the content of various DAMP molecules. In the main, BALF DAMPs positively associated with age, forced expiratory volume in one second (FEV1), and residual volume (RV); and inversely with PaO2, residual volume/total lung capacity (RV/TLC) ratio, and the disease severity staging. In serum, DAMPS positively associated with the intensity of smoking and inversely with age, PaO2, and TLC. In conclusion, DAMPs are present in both BALF and serum of COPD patients, which points to enhanced both local in the lung environment as well as systemic pro-inflammatory vein in this disease. These molecules appear involved with the lung damage and clinical variables featuring COPD. However, since the involvement of various DAMPs in COPD is variable, the exact role they play is by far unsettled and is open to further exploration.