Determination of new prediction formula for nasal continuous positive airway pressure in Turkish patients with obstructive sleep apnea syndrome

Background

Race/ethnicity may play an important role in determining body size, severity of obstructive sleep apnea syndrome (OSAS), and effective continuous positive airway pressure (CPAP) (Peff). Turkey is composed of different ethnic groups. Therefore, the aims of this study were to determine new prediction formula for CPAP (Ppred) in Turkish OSAS patients, validate performance of this formula, and compare with Caucasian and Asian formulas.

Methods

Peff of 250 newly diagnosed moderate-to-severe OSAS patients were calculated by in-laboratory manual titration. Correlation and multiple linear regression analysis were used to model effects of ten anthropometric and polysomnographic variables such as neck circumference (NC) and oxygen desaturation index (ODI) on Peff. New formula was validated in different 130 OSAS patients and compared with previous formulas.

Results

The final prediction formula was $ {\text{Ppred}} = \left( {0.{148} \times {\text{NC}}} \right) + \left( {0.0{38} \times {\text{ODI}}} \right) $ . When Peff of control group was assessed, it was observed that mean Peff was 8.39?±?2.00?cmH₂O and Ppred was 8.23?±?1.22?cmH₂O. Ppred was within ±3?cmH₂O of Peff in 96.2% patients. Besides, Peff was significantly correlated with new formula, and prediction formulas developed for Caucasian and Asian populations (r?=?0.651, p?<?0.001, r?=?0.648, p?<?0.001, and r?=?0.622, p?<?0.001, respectively).

Conclusions

It is shown that level of CPAP can be successfully predicted from our prediction formula, using NC and ODI and validated in Turkish OSAS patients. New equation correlates with other formulas developed for Caucasian and Asian populations. Our simple formula including ODI, marker of intermittent hypoxia, may be used easily in different populations.     

Gender differences in clinical and polysomnographic features of obstructive sleep apnea: a clinical study of 2827 patients

Purpose

Obstructive sleep apnea (OSA) is underdiagnosed in females due to different clinical presentation. We aimed to determine the effect of gender on clinical and polysomnographic features and identify predictors of OSA in women.

Methods

Differences in demographic, clinical, and polysomnographic parameters between 2052 male and 775 female OSA patients were compared.

Results

In female OSA patients, age (56.1 ± 9.7 vs. 50.4 ± 11.6 years, p < 0.0001) and body mass index (36.3 ± 8.6 vs. 31.8 ± 5.9 kg/m², p < 0.0001) were increased, whereas men had higher waist-to-hip ratio and neck circumference (p < 0.0001). Hypertension, diabetes mellitus, thyroid disease, and asthma were more common in females (p < 0.0001). Men reported more witnessed apnea (p < 0.0001), but nocturnal choking, morning headache, fatigue, insomnia symptoms, impaired memory, mood disturbance, reflux, nocturia, and enuresis were more frequent in women (p < 0.0001).

The indicators of OSA severity including apnea-hypopnea index (AHI) (p < 0.0001) and oxygen desaturation index (p = 0.007) were lower in women. REM AHI (p < 0.0001) was higher, and supine AHI (p < 0.0001) was lower in females. Besides, women had decreased total sleep time (p = 0.028) and sleep efficiency (p = 0.003) and increased sleep latency (p < 0.0001). In multivariate logistic regression analysis, increased REM AHI, N3 sleep, obesity, age, morning headache, and lower supine AHI were independently associated with female gender.

Conclusions

These data suggest that frequency and severity of sleep apnea is lower in female OSA patients, and they are presenting with female-specific symptoms and increased medical comorbidities. Therefore, female-specific questionnaires should be developed and used for preventing underdiagnosis of OSA.

     

Evaluation of the GeneXpert MTB/RIF assay for rapid diagnosis of tuberculosis and detection of rifampin resistance in pulmonary and extrapulmonary specimens

Mycobacterium tuberculosis remains one of the most significant causes of death from an infectious agent. The rapid diagnosis of tuberculosis and detection of rifampin (RIF) resistance are essential for early disease management. The GeneXpert MTB/RIF assay is a novel integrated diagnostic device for the diagnosis of tuberculosis and rapid detection of RIF resistance in clinical specimens. We determined the performance of the MTB/RIF assay for rapid diagnosis of tuberculosis and detection of rifampin resistance in smear-positive and smear-negative pulmonary and extrapulmonary specimens obtained from possible tuberculosis patients. Two hundred fifty-three pulmonary and 176 extrapulmonary specimens obtained from 429 patients were included in the study. One hundred ten (89 culture positive and 21 culture negative for M. tuberculosis) of the 429 patients were considered to have tuberculosis. In pulmonary specimens, sensitivities were 100% (27/27) and 68.6% (24/35) for smear-positive and smear-negative specimens, respectively. It had a lower sensitivity with extrapulmonary specimens: 100% for smear-positive specimens (4/4) and 47.7% for smear-negative specimens (21/44). The test accurately detected the absence of tuberculosis in all 319 patients without tuberculosis studied. The MTB/RIF assay also detected 1 RIF-resistant specimen and 88 RIF-susceptible specimens, and the results were confirmed by drug susceptibility testing. We concluded that the MTB/RIF test is a simple method, and routine staff with minimal training can use the system. The test appeared to be as sensitive as culture with smear-positive specimens but less sensitive with smear-negative pulmonary and extrapulmonary specimens that include low numbers of bacilli.     

Nursing students' immunisation status and knowledge about viral hepatitis in Turkey: a multi-centre cross-sectional study

Yamazhan T., Durusoy R., Tasbakan M.I., Tokem Y., Pullukcu H., Sipahi O.R., Ulusoy S. & Turkish Nursing Hepatitis Study Group (2011) Nursing students' immunisation status and knowledge about viral hepatitis in Turkey: a multi‐centre cross‐sectional study. International Nursing Review 58 , 181–185 Background: The aims of this multi‐centre cross‐sectional survey were to detect Turkish nursing students' level of knowledge on viral hepatitis, to evaluate their rates of exposure to blood and to find out their hepatitis A (HAV), hepatitis B (HBV) vaccination status. Methods: This multi‐centre cross‐sectional study was conducted in 14 nursing schools located in the seven geographical regions of Turkey. A questionnaire composed of 47 questions on socio‐demographic factors, level of knowledge on HAV, HBV, hepatitis C (HCV) immunisation status, exposure history and attitudes was applied to the study group. Results: A total of 1491 third‐ and fourth‐year nursing students participated with an 89% response rate. The mean age of the participating students was 21.4 ± 1.3. Their mean knowledge score was 23.7 ± 4.6 (71/100) and was significantly higher in fourth‐year students than third‐year students. There were significant differences in mean scores among nursing schools. Among the participants, 85.3% had received HBV vaccine and 9.1% had received HAV vaccine. The percentage of students who signify themselves at increased risk of acquiring viral hepatitis was 97.3%. Of the students, 28.1% had sustained a needle‐stick injury and 5.4% had experienced conjunctival exposure to blood. Conclusions: Curriculum differences among nursing schools have a significant effect on nursing students' level of knowledge. For this reason, nursing schools should organize HBV immunisation programmes for their students to increase vaccination coverage.     

The features of infectious diseases departments and anti-infective practices in France and Turkey: a cross-sectional study

The aim of this study was to assess the infectious diseases (ID) wards of tertiary hospitals in France and Turkey for technical capacity, infection control, characteristics of patients, infections, infecting organisms, and therapeutic approaches. This cross-sectional study was carried out on a single day on one of the weekdays of June 17–21, 2013. Overall, 36 ID departments from Turkey (n?=?21) and France (n?=?15) were involved. On the study day, 273 patients were hospitalized in Turkish and 324 patients were followed in French ID departments. The numbers of patients and beds in the hospitals, and presence of an intensive care unit (ICU) room in the ID ward was not different in both France and Turkey. Bed occupancy in the ID ward, single rooms, and negative pressure rooms were significantly higher in France. The presence of a laboratory inside the ID ward was more common in Turkish ID wards. The configuration of infection control committees, and their qualifications and surveillance types were quite similar in both countries. Although differences existed based on epidemiology, the distribution of infections were uniform on both sides. In Turkey, anti-Gram-positive agents, carbapenems, and tigecycline, and in France, cephalosporins, penicillins, aminoglycosides, and metronidazole were more frequently preferred. Enteric Gram-negatives and hepatitis B and C were more frequent in Turkey, while human immunodeficiency virus (HIV) and streptococci were more common in France (p?相似文献   

Quality of life in obstructive sleep apnea is related to female gender and comorbid insomnia

Purpose

Obstructive sleep apnea (OSA) is a common sleep disorder affecting health-related quality of life (QoL), and OSA severity is not a reliable indicator for QoL. The aim of this study was (1) to evaluate the impact of gender on QoL and (2) to identify the predictors of QoL in OSA patients.

Methods

World Health Organization Quality of Life Scale short form (WHOQOL-Bref) was used for evaluating QoL in OSA patients undergoing polysomnography in sleep laboratory of a university hospital.

Results

Out of 197 patients (age 50.4?±?12.1 years, AHI 38.5?±?28.4/h), 139 (70.6%) were men and 79.2% had moderate-to-severe OSA. Female gender, increased BMI, higher Epworth sleepiness score (ESS), and lower oxygen saturations were associated significantly with poor QoL in terms of all domains (physical, psychological, social relationship, and environmental) of WHOQOL-Bref questionnaire. The indicators of OSA severity (AHI and ODI) correlated negatively only with the physical domain. The subjects with comorbid insomnia and OSA had lower physical and social scores than subjects with no insomnia, and women with insomnia had significantly worse QoL scores in all domains than the others. In the multivariate linear regression analysis, female gender, comorbid insomnia, increased sleepiness, and higher BMI were significantly associated with poor QoL.

Conclusions

Female gender, comorbid insomnia, and daytime sleepiness were the outstanding factors affecting health-related QoL negatively in OSA. Besides, the impact of OSA on QoL may be explained by the presence of daytime sleepiness rather than OSA severity.