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    Does AHI Value Enough for Evaluating the Obstructive Sleep Apnea Severity?
    (Springer India, 2015) Dundar, Yusuf; Saylam, Guleser; Tatar, Emel Cadalh; Ozdek, Ali; Korkmaz, Hakan; Firat, Hikmet; Ardic, Sadik
    Obstructive sleep apnea/hypopnea syndrome (OSAHS) is an important and more common public health problem with increasing incidence. Polysomonography (PSG) is the gold standard test in OSAHS diagnosis. Apnea-hypopnea index (AHI) is the main parameter of PSG, which is correlated with OSAHS severity. The main complaint of OSAHS patients is daytime sleepiness and the Epworth Sleepiness Scale (ESS) used for evaluation of disease severity. The correlation of AHI with daytime sleepiness and ESS is well known. But there are many patients, which have uncorrelated daytime sleepiness with AHI. This data calls this hypothesis; Are there any other parameters which may affect daytime sleepiness. 648 patients with complaining of snoring and apnea were evaluated by polysomnography and anthropometric measurements. The cut-off value of ESS was accepted 10 as an indicator of severe daytime sleepiness. Patients were divided to groups with the aim of homogenization, according to AHI values. The patients with similar AHI values were analyzed according to their ESS scores. BMI and neck circumference were elevated in daytime sleepiness patients. The nocturnal hypoxemia markers; apnea number/index, maximum duration of apnea, at least SO2 concentration, duration of SO2 less than 90 % were much effected in the group of daytime sleepiness. Beside the fact that our research, AHI is not enough for predicting the daytime sleepiness; anthropometric measurements and the nocturnal hypoxemia markers should be evaluated.
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    The evaluation of inflammatory process, endothelial dysfunction and oxidative stress in sleep apnea
    (Deomed Publ, Istanbul, 2014) Dundar, Yusuf; Tatar, Emel Cadalli; Saylam, Guleser; Korkmaz, Hakan; Selcuk, Omer Tarik; Ozdek, Ali; Ardic, Sadik
    Objective: To investigate the correlation of inflammatory process, endothelial dysfunction and oxidative stress with obstructive sleep apnea (OSA). Methods: In our prospective cross-sectional clinical study in a tertiary referral hospital, we evaluated 63 patients with newly diagnosed OSA and 9 simple snorers. Each patient was evaluated in terms of additional systemic diseases and laboratory tests. In addition to routine blood analysis; oxidative stress markers (leptine, RBP), vascular endothelial markers (ICAM-I, VCAM-I) and inflammatory markers (Crp, IL-6, TNF-alpha, isoprostane) were analyzed. Polysomnography test was performed and study population was divided into four groups depending on their AHI values. The levels of markers were analyzed and compared between the four groups. Results: There was a weak correlation between the isoprostane levels and mean apnea duration and also a mild correlation to the maximum apnea duration. A weak correlation was detected between leptine and VCAM levels to age and also a weak negative correlation was detected between CRP levels to age. The leptin levels were found to be mildly correlated to BMI and abdominal circumference. The ICAM levels were found to have a weak correlation to BMI and abdominal circumference. Conclusion: Our results indicate a correlation between sleep apnea and oxidative stress. These results may help to explain the association of comorbid diseases with OSAS. Further investigators should aim to explain key steps of inflammatory response in sleep apnea.
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    Evaluation of sleep quality in patients with ankylosing spondylitis and efficacy of anti-TNF- therapy on sleep problems: A polisomnographic study
    (Wiley, 2018) Karatas, Gulsah; Bal, Ajda; Yuceege, Melike; Firat, Hikmet; Gurcay, Eda; Ardic, Sadik; Cakci, Fatma Aytul
    IntroductionThis study was conducted to investigate the relationship between sleep quality (SQ) and disease activity (DA) in patients with ankylosing spondylitis (AS) and to evaluate the response to anti-tumor necrosis factor (anti-TNF-) therapy on sleep disorders. Materials and MethodsA total of 34 patients who met the modified New York classification criteria for AS were included in this prospective study. Patients were divided into two groups as follows: Group I (n=15) with high DA and receiving anti-TNF- therapy, and Group II (n=19) in remission. DA was assessed by the Bath AS Disease Activity Index. Pittsburgh Sleep Quality Index (PSQI) and polysomnography (PSG) were used to determine disorders and patterns of sleep, respectively, in both groups at baseline as well as at the third month of anti-TNF- therapy in Group I. ResultsBaseline evaluation revealed impaired SQ in 57.9% of all patients. PSG demonstrated obstructive sleep apnea syndrome, snoring and periodic leg movements in 73.7%, 74.4% and 26.3% of patients, respectively. Prior to anti-TNF- therapy, PSQI and snoring score were significantly higher in Group I (P=0.0001, P=0.012, respectively). Although there was a significant reduction in PSQI scores in Group I (P=0.005) at the third month of anti-TNF- therapy, no change was observed in PSG parameters (P>0.05). ConclusionSleep disorders increase in AS, particularly in patients with high DA. Anti-TNF- therapy has improved SQ without any improvement in PSG. Therefore, it may be concluded that PSG parameters might be more associated with disease pathogenesis rather than DA in patients with AS.