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Mean platelet volume is increased in patients with severe obstructive sleep apnea

Abstract Increased platelet activation and aggregation which are closely related to cardiovascular complications have been reported in patients with obstructive sleep apnea (OSA). The aim of this study was to assess the mean platelet volume (MPV), an indicator of platelet activation in patients with OSA. The 95 subjects referred for evaluation of OSA underwent overnight polysomnography. Blood samples were taken for MPV determination. According to the apnea-hypopnea index (AHI), subjects were divided into three groups; group 1: control subjects without OSA (AHI < 5, n = 24), group 2: patients with mild to moderate OSA (AHI: 5–30, n = 42), and group 3: severe OSA (AHI > 30, n = 29). Body mass index (BMI) of patients with severe OSA was significantly higher than control subjects (31.5 ± 4.0 vs. 28.2 ± 5.0; p = 0.02). The MPV was significantly higher in patients with severe OSA than in the control group (8.9 ± 1.0 vs. 8.2 ± 0.7 fl; p = 0.01). Correlation analysis within 71 patients with OSA indicated that MPV was correlated with AHI (p < 0.001, r = 0.44) and DI (p = 0.001, r = 0.37). In multivariate regression analysis, when MPV was taken as independent with other study variables which are potential confounders such as age, gender and BMI, MPV was independently correlated with both AHI (β = 0.44, p < 0.001) and DI (β = 0.38, p < 0.001). We have shown that MPV was significantly higher in patients with severe OSA when compared with control subjects and MPV was correlated with AHI and DI.

Habitual Snoring in Primary School Children: Prevalence and Association with Sleep-Related Disorders and School Performance

Objectives: To determine the prevalence of habitual snoring (HS) and its association with both day- and nighttime symptoms, school performance and behavioral disturbances in a sample of primary school children. Subjects and Methods: A cross-sectional study was performed on 1,605 children (819 boys and 786 girls) aged 7–13 years from 9 randomly selected primary schools located within the city limits of Isparta, Turkey. HS and sleep problems were assessed using a 55-item multiple-choice questionnaire. Results: Of the 1,605 questionnaires, 1,164 were fully completed and returned, giving a response rate of 72.5%. The overall prevalence of snoring was 38.9%, while HS accounted for 3.5%. The prevalence of HS among boys (25, 3.0%) was higher than among girls (16, 2.0%; χ2 for trend: p < 0.001, OR: 1.92, 95% CI: 1.01–3.66). There was an association between younger age and HS, as children aged 7–8 years had the highest prevalence (χ2 for trend: 0.054, OR: 1.85, 95% CI: 0.81–4.22). Habitual snorers had more daytime and nighttime symptoms. Allergic symptoms, daytime mouth breathing, shaking the child for apnea, restless sleep and hyperactivity were significant and independent risk factors and sleep-related symptoms for HS. A significant and independent association was found between poor school performance and hyperactivity, nocturnal enuresis, tooth grinding and low parental/maternal education in multivariate analysis. Conclusion: Children with HS were more likely to have sleep-related daytime and nighttime symptoms. No significant associ- ation was determined between HS and poor school performance.

The Impact of Smoking Status on Antioxidant Enzyme Activity and Malondialdehyde Levels in Chronic Periodontitis

BACKGROUND The aim of this study is to investigate the impact of smoking status on the systemic and local superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and catalase (CAT) activities and malondialdehyde (MDA) levels in subjects with chronic periodontitis (CP). METHODS Sixty-five CP patients (23 smokers [CP-S], 23 former smokers [CP-FS], and 19 non-smokers [CP-NS]) and 20 periodontally healthy non-smoker controls (PH-NS) were included in the study. After the clinical measurements, serum and gingival tissue samples were collected. SOD, GSH-Px, and CAT activities and MDA levels in hemolysates and gingival tissue samples were spectrophotometrically assayed. RESULTS Blood MDA levels in all the periodontitis groups were higher than in the PH-NS group but only the difference between CP-FS and PH-NS groups was significant (P <0.01). Gingival tissue MDA levels in the periodontitis groups were significantly higher than that in the control group (P <0.01). However, the control group had the highest gingival SOD, GSH-Px, and CAT activities compared with all the periodontitis groups (P <0.01). The CP-S group had the highest gingival MDA levels and SOD, GSH-Px, and CAT activities among the periodontitis groups, whereas the lowest values were observed in the CP-NS group (P <0.01). The blood and gingival MDA levels in the CP-FS group were similar in the CP-NS group, whereas they were lower than in the CP-S group. CONCLUSIONS Systemic and local MDA levels are increased by smoking in addition to the impact of periodontitis. The decreased local SOD, GSH-Px, and CAT activities observed in periodontitis patients may increase with smoking.

The effects of continuous positive airway pressure therapy on mean platelet volume in patients with obstructive sleep apnea

Previous studies have reported increased platelet activation and aggregation in patients with obstructive sleep apnea (OSA). Continuous positive airway pressure (CPAP) treatment has been shown to decrease platelet activation. We aimed to study the effects of nasal CPAP therapy has on MPV values in patients with severe OSA. Thirty-one patients (21 men; mean age 53.8 ± 9.2 years) with severe OSA (AHI > 30 events/hour) constituted the study group. An age, gender and body mass index (BMI) matched control group was composed 25 subjects (14 men; mean age 49.6 ± 8.5 years) without OSA (AHI < 5 events/hour). We measured MPV values in patients with severe OSA and control subjects and we measured MPV values after 6 months of CPAP therapy in severe OS patients. The median (IQR) MPV values were significantly higher in patients with severe OSA than in control group (8.5 [8.3–9.1] vs. 8.3 [7.5–8.8] fL; p = 0.03). The platelet counts were significantly lower in patients with severe OSA than in control group (217.8 ± 45.9 vs. 265.4 ± 64.0 × 109/L; p = 0.002). The six months of CPAP therapy caused significant reductions in median (IQR) MPV values in patients with severe OSA (8.5 [8.3–9.1] to 7.9 [7.4–8.2] fL; p < 0.001). Six months of CPAP therapy caused significant increase in platelet counts when compared with baseline values (217.8 ± 45.9 to 233.7 ± 60.6 × 109/L; p < 0.001). We have found that the MPV values of patients with severe OSA were significantly higher than those of the control subjects and 6 months CPAP therapy caused significant reductions in the MPV values in patients with severe OSA.

C-Reactive Protein Levels in Patients with Chronic Obstructive Pulmonary Disease: Role of Infection

Objective: To investigate the value of C-reactive protein (CRP) as a marker of chronic obstructive pulmonary disease (COPD) exacerbations or specifically bacterial exacerbations and to evaluate a correlation between raised CRP levels and other markers of inflammation in patients with an acute exacerbation (AECOPD). Subjects and Methods: The medical records of patients with AECOPD were retrospectively analyzed. They were categorized according to the nature of sputum as mucoid or purulent and to the findings on chest radiographs as with pneumonia (PCOPD) or without pneumonia. Stable COPD (SCOPD) patients and a group of asymptomatic nonsmokers were also included in the study. Results: All COPD patients (SCOPD: 30; AECOPD: 51; PCOPD: 32) and control subjects (30) were male. The mean CRP levels and WBC counts of the groups were PCOPD: 108.1 ± 61.8 mg/l and 13.7 ± 6.8 × 109/l; AECOPD: 36.8 ± 43.9 mg/l and 11.4 ± 4.8 × 109/l; SCOPD: 3.9 ± 1.4 mg/l and 7.9 ± 1.9 × 109/l; control: 2.1 ± 0.9 mg/l and 7.7 ± 1.1 × 109/l. The mean CRP level of AECOPD was statistically different from those of PCOPD and SCOPD (p = 0.0001, p = 0.002, respectively). The sensitivity and specificity of CRP to determine an acute exacerbation were 72.5 and 100%, respectively. Among the patients with AECOPD, 25 had purulent sputum and a mean CRP level of 46.4 ± 48.6 mg/l, which is significantly higher than the CRP level (28.0 ± 44.5 mg/l) of the 18 patients with mucoid expectoration (p = 0.015). Among the mucoid-expectorating subgroup, the patients with leukocytosis had significantly higher CRP levels than the patients without leukocytosis (p = 0.034). Conclusion: A high serum CRP value may indicate an infectious exacerbation in COPD patients and it correlates with sputum purulence and increased serum WBC counts.

Influence of obstructive sleep apnea on left ventricular mass and global function: sleep apnea and myocardial performance index.

Obstructive sleep apnea (OSA) is associated with cardiovascular mortality and morbidity. It may predispose patients to left ventricular hypertrophy and heart failure. The aim of this study was to determine the left ventricular mass (LVM) and myocardial performance index (MPI) reflecting left ventricular global function in uncomplicated OSA patients. Sixty-four subjects without hypertension, diabetes mellitus, and any cardiac or pulmonary disease referred for evaluation of OSA underwent overnight polysomnography and complete echocardiographic assessment. According to the apnea hypopnea index (AHI), subjects were divided into three groups: group 1, control subjects with nonapneic snorers (AHI < 5, n = 18); group 2, patients with mild to moderate OSA (AHI: 5–30, n = 25); and group 3, severe OSA (AHI > 30, n = 21). Basic echocardiographic measurements, LVM, and LVM index were measured. Left ventricular MPI was calculated as (isovolumic contraction time+isovolumic relaxation time)/aortic ejection time by Doppler echocardiography. There were no significant differences in age, sex, body mass index, heart rate, and systolic and diastolic blood pressure among the three groups. Left atrium, interventricular septum, left ventricular posterior wall, left ventricular end-diastolic and end-systolic diameters, LVM mass, and LVM index were not significantly different among the three groups. Left ventricular MPI was significantly higher in severe OSA patients (0.64 ± 0.18) than in controls (0.49 ± 0.18; P < 0.05). There was no significant difference between controls (0.49 ± 0.18) and mild to moderate OSA (0.61 ± 0.16; P = 0.08) and between mild to moderate OSA (0.61 ± 0.16) and severe OSA (0.64 ± 0.18; P = 0.84). The present study demonstrates that patients with severe OSA have global left ventricular dysfunction.

The attitude toward tobacco dependence and barriers to discussing smoking cessation: a survey among Turkish general practitioners

ObjectivesTo evaluate the general attitude of a sample of Turkish general practitioners (GPs) toward tobacco dependence and to assess their knowledge and behavior regarding smoking cessation (SC).MethodsA self-administered questionnaire modified from WHO, Global Health Professional Survey was distributed to GPs, working in our district, Isparta.ResultsAs much as 41% of GPs were current smokers. Ever smokers were generally less likely to agree with statements that would change their freedom to smoke in certain places. While 46% of GPs frequently inquired about tobacco use in their patients, 13.5% did not advise any of their patients to quit smoking during the month preceding the questionnaire. The most common barriers reported by GPs to discussing SC with their patients were as follows: considering the discussion not to be effective (57.8%), having low confidence in knowledge (48.1%), having unpleasant personal experience or considering it a thankless task (46.1%).ConclusionsIt appears essential to reduce the number of GPs who smoke and to improve GP training on SC procedures for integrating SC treatment into primary care in Turkey.

Evaluation of patients followed up in a cigarette cessation clinic

Objectives:  The aim of this study was to evaluate the demographic characteristics and factors determining success in a smoking cessation clinic in smokers who completed a 1‐year follow up.

Effects of body weight supported treadmill training on cardiac and pulmonary functions in the patients with incomplete spinal cord injury.

We aimed to investigate the effects of body weight supported treadmill training (BWSTT) on cardio-pulmonary functions and on depression in subjects with incomplete spinal cord injury (SCI). Eight subjects (2 female, 6 male) with incomplete SCI participated in this study. Heart rate (HR), blood pressure (BP) and resting pulmonary function parameters were obtained from each subject at baseline and after BWSTT. The training programme was scheduled five times per week for six weeks. The psychological status was evaluated by Beck Depression Inventory (BDI). The post-BWSTT HR value was lower than the pre-training HR value (p< 0.05). In comparison of pre- and post-BWSTT pulmonary parameters, there were only significant improvement in FVC and IC (p< 0.05). The mean BDI score was lower after BWSTT compared to before BWSTT value. As a conclusion, 6 weeks BWSTT had positive effect on heart rate and limited effect on pulmonary functions. There was an improvement in depression level of the SCI subjects.

Thiol/disulfide homeostasis: A prognostic biomarker for patients with advanced non-small cell lung cancer?

Background: The aim of this study was to investigate oxidative stress and thiol/disulfide status with a novel automated homeostasis assay in advanced non-small cell lung cancer (NSCLC). Methods: Thirty-five patients with advanced NSCLC, who had been newly diagnosed and previously untreated, and 35 healthy subjects were chosen for the study. We measured plasma total thiol (–SH+–S–S–), native thiol (thiol) (–SH), and disulfide (–S–S–) levels in the patients with NSCLC and the healthy subjects. The thiol/disulfide (–SH/–S–S–) ratio was also calculated. Results: Statistically significant differences between the patient group and the control group were detected for the thiol/disulfide parameters. The mean native thiol, total thiol, and disulfide levels were significantly lower in the group with advanced stage NSCLC. The cut-off value was 313 and 13.8 for native thiol and disulfide, respectively. Median overall survival (OS) was significantly shorter in patients with low native thiol and disulfide levels according to the cut-off value (respectively, P = 0.001; P = 0.006). Native thiol, total thiol, and disulfide levels were correlated with Karnofsky performance status (KPS), OS, and age. Additionally, hierarchical regression analyses showed gender, KPS, lung metastases, and plasma native thiol levels were the determinants of OS in the final model. Conclusion: These results suggest that in advanced stage NSCLC, the native thiol, total thiol, and disulfide levels decrease, while the native thiol/disulfide ratio does not change. Low levels of thiol/disulfide parameters are related to tumor aggressiveness and may predict a poor outcome for patients with NSCLC.