Zeynep Pınar Önen

Health-Related Quality of Life in Patients with Sleep-Related Breathing Disorders: Relationship with Nocturnal Parameters, Daytime Symptoms and Comorbid Diseases

Background: Sleep-related breathing disorders (SRBD) are frequently encountered health problems in the general population. Habitual snoring and obstructive sleep apnea/hypopnea syndrome (OSAHS) constitute most SRBD diagnoses. Although the decrease in quality of life is a well-known entity in SRBD patients, there is not enough data regarding the underlying pathophysiological mechanisms to explain this deterioration. Objectives: The aim of this study was to investigate which parameters were affecting the quality of life in patients with SRBD. Methods: Medical Outcome Survey – Short Form 36 (SF-36) and Epworth Sleepiness Scale were used in 135 patients with SRBD (69 patients with OSAHS and 66 patients with habitual snoring), and Charlson comorbidity index was calculated. Acquired data were compared with leading symptoms and polysomnographic findings in these patients. Results: All SF-36 scores were significantly decreased in SRBD patients. However, there were no significant differences in the SF-36 scores of these patients. Also, no significant correlation was found between the severity of OSAHS and the SF-36 scores. Similarly, none of the polysomnographic parameters was found significantly correlated with SF-36 scores. In contrast, all SF-36 scores were influenced by body mass index, Epworth Sleepiness Scale score, mean nocturnal saturation and the presence of coexisting diseases. Conclusions: According to the results of multiple variance analysis, we concluded that the quality of life depends on a number of collaborative factors such as obesity, mean nocturnal saturation, symptoms related to SRBD and the presence of comorbid diseases, rather than only on one independent parameter in the patients with SRBD.

Uso precoz de la ventilación mecánica no invasiva en pacientes con insuficiencia respiratoria hipercápnica aguda ingresados en una sala de neumología: estudio prospectivo

BACKGROUND In recent years, the optimal location for noninvasive mechanical ventilation (NIMV) has been a matter of debate. Our aim was to detect the effectiveness of NIMV in acute hypercapnic respiratory failure (AHRF) in respiratory ward and factors associated with failure. METHODS 69 patients treated with NIMV in respiratory ward were prospectively evaluated. The success of NIMV was defined as absence of need for intensive care unit (ICU) transfer with patients discharge from hospital (group 1), failure of NIMV was defined as need for ICU transfer (group 2). RESULTS The mean age was significantly higher in group 2. The cause of respiratory failure was COPD in 51 patients, obesity-hypoventilation syndrome in 14 and kyphoscoliosis in 4 patients. NIMV was successful in 55 patients and unsuccessful in 14. There was no significant difference between the two groups for pretreatment pH, PaCO₂ and PaO₂/FiO₂. After 1h and 3h of NIMV there was significant improvement in group 1. After 3h of NIMV, in group 1 respiratory rate was significantly decreased. The pretreatment APACHE II score, respiratory rate, frequency of pneumoniae, associated complication and comorbid disease was significantly higher in group 2. The success rate was higher in patients with good compliance to NIMV. CONCLUSION NIMV can be successfully applied in patients with AHRF in respiratory ward. The associated factors with NIMV failure are absence of early improvement in blood gases and respiratory rate, bad compliance to NIMV, older age, presence of associated complication, comorbid disease, pneumonia and high baseline respiratory rate.

[Early use of noninvasive mechanical ventilation in patients with acute hypercapnic respiratory failure in a respiratory ward: a prospective study].

Background: In recent years, the optimal location for noninvasive mechanical ventilation (NIMV) has been a matter of debate. Our aim was to detect the effectiveness of NIMV in acute hypercapnic respiratory failure (AHRF) in respiratory ward and factors associated with failure. Methods: 69 patients treated with NIMV in respiratory ward were prospectively evaluated. The success of NIMV was defined as absence of need for intensive care unit (ICU) transfer with patients dishcarge from hospital (group 1), failure of NIMV was defined as need for ICU transfer (group 2).

Assessing the knowledge in primary health care following an educational course structured in the context of gard chronic airway diseases national control program

Introduction Chronic obstructive pulmonary diseases are common causes of disease in the community and account for considerable percent of the caseload in primary health care facilities. For this reason, it is important to question and improve the knowledge of primary health care physicians. This study is designed to assess the level of knowledge for bronchial asthma and COPD of the primary healthcare physicians, both before and immediately after an educational course structured in the context of GARD Chronic Airway Diseases National Control Program. Materials and Methods The participating physicians attended an intensive educational course on asthma and COPD. Twenty five item questionnaires for asthma and COPD were administered to the participants both before and immediately after the end of the course. Contribution of education to the level of knowledge was investigated by comparing the percentages of the correct answers in the pre-and post-test. Result From 11 different cities, 1817 and 1788 primary health care physician were attended to the asthma and COPD educations, respectively. The accuracy rate of ≥ 75% was obtained from only 4 questions in pre-test asthma questionnaire. On the contrary, in 15 questions the accuracy rate was < 50%. The mean accuracy rate for the whole asthma test was 45.8%, and this rate raised to 69.6% after education course. The accuracy rate of ≥ 75% could not be obtained from any of the questions in pre-test COPD questionnaire. On the contrary, in 19 questions the accuracy rate was < 50%. The mean accuracy rate for the whole asthma test was 42.0%, and this rate raised to 71.3% after education course. Conclusions It has been shown that, in primary care settings, the level of knowledge in asthma and COPD should be enhanced and that this increase can be achieved with an education course.

Comparison of Polysomnography Variables in Obstructive Sleep Apnea Patients with or without Excessive Daytime Sleepiness

ABS TRACT Ob jec ti ve: Excessive daytime sleepiness (EDS) is a common symptom in patients with obstructive sleep apnea (OSA), and the reason for this could not be fully elucidated. The aim of this study was to compare polysomnographic and demographic features of patients with OSA with or without EDS according to Epworth Sleepiness Scale (ESS). Material and Methods: A total of 82 adult patients who were diagnosed with OSA with polysomnography were retrospectively divided into 2 groups in terms of having EDS (ESS>10) or not (ESS≤10) according to ESS score. Results: Forty six patients had an ESS score >10. Patients with OSA suffering from sleepiness were younger (p=0.010), more obese (p=0.039), had higher arousal index (p=0.051) and apnea hypopnea index (AHI) (p=0.036) on polysomnography. There was no gender difference between two groups (p=0.423). Polysomnographic findings revealed that there were no differences in total sleep time, sleep efficiency or overall distribution of sleep stages (N1,N2, N3, REM), or nocturnal mean and minimum saturation (p=0.516, p=0.790, p=0.674, p=0.852, p=0.677, p=0.137, p=0.286, p=0.353, respectively). On multivariate regression analysis, arousal index, total AHI, and age were effective in determination of ESS score (p<0.001). Conclusion: OSA patients with EDS were younger and more obese when compared to OSA patients with no EDS. No single factor was effective for detection of EDS with ESS score. Rather, factors such as severity of OSA, arousal index, and age were collectively decisive.