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Öğe A Case of Secondary Narcolepsy Presenting with Obstructive Sleep Apnea Symptoms(Galenos Publ House, 2016) Genc, Sebahat; Bilgic, Hatice Kayim; Okuyucu, Emine Esra; Dikmen, Nursel; Duman, TaskinObstructive sleep apnea syndrome (OSAS) and narcolepsy are two diseases causing excessive daytime sleepiness (EDS). As they are often confused, these two disorders can also coexist. Therefore there is need to distinguish these disorders in patients with EDS. We would like to present a case on a patient who sent to our sleep laboratory with a preliminary diagnosis of OSAS and suspicion of narcolepsy in detailed history. The case is a 24 year-old male. He was diagnosed with OSAS and narcolepsy while being investigated for OSAS. Neurological examination revealed an additional diagnosis of multiple sclerosis. In this case report, we emphasize that in patients with EDS, particularly if EDS cannot be explained with OSAS, investigation for narcolepsy should also be done. In addition, when narcolepsy is detected; neurological examination is actually necessary considering the possibility of secondary narcolepsy.Öğe Evaluation of right heart functions by echocardiography and tissue Doppler imaging echocardiography in obese and non-obese patients with obstructive sleep apnea(Cukurova Univ, Fac Medicine, 2020) Dikmen, Nursel; Genc, Sebahat; Akcay, Adnan BurakPurpose: The aim of our study was to compare the right ventricular systolic and diastolic functions and pulmonary artery pressure (PAP) in obese and non-obese patients with obstructive sleep apnea syndrome (OSAS) by tissue Doppler imaging (TDI) echocardiography. Materials and Methods: This study was conducted with 69 patients, 34 obese and 35 non-obese, diagnosed moderate or severe OSAS by an overnight polysomnographic sleep study. In all patients, LV (left ventricle) and RV (right ventricle) size, left atial (LA) and RA (right atrial) dimensions, LV and RV systolic and diastolic functions and systolic PAPs were measured by M-mode, two-dimensional analysis, color flow Doppler and TDI. Results: RV diastolic dysfunction was detected in both groups; this impairment was significantly higher in the obese group (lateral tricuspid late diastolic myocardial annular zone velocity A'a: 0.13 +/- 0.03 in non-obese patients and 0.11 +/- 0.04 in obese patients). The mean systolic PAP was significantly higher in obese patients (31.2 +/- 5.6, 27.1 +/- 5.8, respectively) Conclusion: Obstructive Sleep Apnea Syndrome increases cardiovascular morbidity and mortality. In our study,left ventricul and right ventricul diastolic dysfunction was determined by tissue Doppler imaging in patients with moderate and severe Obstructive Sleep Apnea Syndrome. Obesity contributes to this impairment regardless of Obstructive Sleep Apnea Syndrome.Öğe Impaired Pulmonary Function in Patients with Psoriasis(Karger, 2016) Baki, Didem Didar; Celik, Ebru; Genc, Sebahat; Celik, Muhammet Murat; Inan, Mehmet UgurBackground: Psoriasis is associated with chronic obstructive pulmonary disease. There is no study on the spirometric pulmonary function testing in patients with psoriasis. Objective: The aim of this study was to compare the spirometric parameters in patients with psoriasis and controls. Methods: Ninety-six patients with psoriasis and 60 sex- and age-matched control subjects were included in this study. Spirometric pulmonary function testing, including percent forced vital capacity (FVC%), percent forced expiratory volume in the 1st second (FEV1%), forced expiratory flow at 25-75% of FVC (FEF25-75%), and FEV1/FVC ratio, was performed in all study subjects. Results: The mean FEV1/FVC ratio and FEF25-75% were significantly lower in the psoriasis patients than in the controls (82.4 +/- 6.3 vs. 90.7 +/- 10.7, p < 0.001, and 86.7 +/- 24.2 vs. 94.8 +/- 23.0, p = 0.04, respectively). Both FEV1/FVC ratio and FEF25-75% were significantly associated with the presence of psoriasis (p < 0.001 and p = 0.029, respectively). Conclusion: Psoriasis patients had lower mean FEV1/FVC ratios and FEF25-75%, compared with the control subjects. FEV1/FVC and FEF25-75% are independently associated with the presence of psoriasis. (C) 2017 S. Karger AG, BaselÖğe Investigation of serum bisphenol A, vitamin D, and parathyroid hormone levels in patients with obstructive sleep apnea syndrome(Springer, 2014) Erden, Ersin Sukru; Genc, Sebahat; Motor, Sedat; Ustun, Ihsan; Ulutas, Kemal Turker; Bilgic, Hatice Kayim; Oktar, SuleymanObstructive sleep apnea syndrome (OSAS) is a common health problem, and associated with obesity, metabolic syndrome (MetS), and diabetes. Growing evidence shows that 25-hydroxyvitamin-D-3 (25-OH-D) insufficiency and high parathyroid hormone (PTH) levels may be correlated to glucose intolerance, MetS, obesity, and cardiovascular abnormalities similar to OSAS. Bisphenol A (BPA) is an endocrine disruptor agent which exerts a wide variety of metabolic effects. It has estrogenic activity and its exposure may contribute to weight gain, obesity, impaired glucose metabolism, and the development of diabetes, also similar to OSAS. The aim of this study is to investigate the relationships between OSAS and serum BPA, 25-OH-D, and PTH levels. This study enrolled 128 subjects, with all of the OSAS patients having been diagnosed by polysomnography. The 128 subjects were divided into three groups: a control (n = 43), a moderate OSAS (n = 23) (AHI = 15-30), and a severe OSAS groups (n = 62) (AHI > 30). The serum BPA, 25-OH-D, and PTH levels for each subject were analyzed. 25-OH-D was lower in both OSAS groups, and PTH was higher in the OSAS groups than in the control subjects. The BPA levels were higher in the severe OSAS group than the moderate OSAS and control. There was a positive correlation between the BPA and body mass index, and a negative correlation between the 25-OH-D and BPA levels in all of the individuals. OSAS is related to high BPA and PTH levels, and low vitamin D levels. There is a positive association between BPA levels and OSAS, and the severity of OSAS. These results suggest that the BPA levels may have a role in the pathogenesis of OSAS.Öğe THE RELATIONSHIP BETWEEN DISEASE SEVERITY AND PREDICTORS OF DIFFICULT INTUBATION IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA SYNDROME(Carbone Editore, 2015) Akkurt, Buket Cagla Ozbakis; Dogru, Sibel; Koyuncu, Onur; Davarci, Isil; Genc, SebahatObjectives: The objective of our study was to identify clinical and polysomnographic predictors of difficult intubation, through the correlation between commonly used measurements to predict difficult intubation. Methods: Consecutive patients diagnosed with moderate or severe obstructive sleep apnea syndrome (OSAS) using polysomnography (PSG), and sex and age matched normal controls were included in the study. The patient group was divided into two subgroups as mild/moderate and severe desease groups. Body mass index (BMI), neck circumference (NC), abdominal circumference (AC), Epworth Sleepiness Scale (ESS) score, Apnea/Hypopnea Index (AHI), Arousal Index (AI) were recorded. Predictive tests for difficult intubation were recorded for each subject. Records were compared between all groups. Results: Forty OSAS patients and 39 control subjects were enrolled in the study. Class III-IV Modified Mallampati Test (MMT) score was found in 37 (%92.5) OSAS patients, while in 10 (25.6 %) of the control subjects. There was statistically significant difference between two groups in terms of NC, AC, interincissor distance (IID). There was a significant inverse correlation between sternomental distance (SMD) and AHI in patients with OSAS. Conclusion: AHI is a reliable predictor of difficult intubation in patients with OSAS and is correlated with the sternomental distance.Öğe The relationship between disease severity and predictors of difficult intubation in patients with obstructive sleep apnea syndrome(Acta Medica Mediterranea, 2015) Akkurt, Buket Cagla Ozbakis; Dogru, Sibel; Koyuncu, Onur; Davarci, Isil; Genc, SebahatObjectives: The objective of our study was to identify clinical and polysomnographic predictors of difficult intubation, through the correlation between commonly used measurements to predict difficult intubation. Methods: Consecutive patients diagnosed with moderate or severe obstructive sleep apnea syndrome (OSAS) using polysomnography (PSG), and sex and age matched normal controls were included in the study. The patient group was divided into two subgroups as mild/moderate and severe desease groups. Body mass index (BMI), neck circumference (NC), abdominal circumference (AC), Epworth Sleepiness Scale (ESS) score, Apnea/Hypopnea Index (AHI), Arousal Index (AI) were recorded. Predictive tests for difficult intubation were recorded for each subject. Records were compared between all groups. Results: Forty OSAS patients and 39 control subjects were enrolled in the study. Class III-IV Modified Mallampati Test (MMT) score was found in 37 (%92,5) OSAS patients, while in 10 (25.6 %) of the control subjects. There was statistically significant difference between two groups in terms of NC, AC, interincissor distance (IID). There was a significant inverse correlation between sternomental distance (SMD) and AHI in patients with OSAS. Conclusion: AHI is a reliable predictor of difficult intubation in patients with OSAS and is correlated with the sternomental distance.Öğe The role of molds in the relation between indoor environment and atopy in asthma patients(Isfahan Univ Med Sciences, 2013) Ceylan, Emel; Doruk, Sibel; Genc, Sebahat; Ozkutuk, Ayse Aydan; Karadag, Fisun; Ergor, Gul; Itil, Bahriye OyaThe effect of mold fungi to allergic sensitization is not well-known. We aimed to evaluate the role of molds in the relation between indoor environment and atopy in asthmatics. Materials and Methods: The air samples obtained from 66 stable asthmatics and 35 control subject's houses were sprayed into Sabouraud dextrose agar. Allergy skin testing were performed in both groups. The temperature and humidity of each house were measured. Results: The incidence of atopy was similar in cases (59.1%) and controls (51.4%). The average amount of mold was 35.9 CFU/m3 and 34.3 CFU/m3, respectively. The number of household residents was positively correlated with the amount of molds. There was no difference in the amount of mold with respect to dosage of inhaler corticosteroids as well as symptom levels in asthmatics. The most frequently encountered allergens were Dermatophagoides farinae/Dermatophagoides pteronyssinus, grass/weeds and molds. Spending childhood in a village was more common among atopics. Conclusion: Living environment during the childhood might affect atopy and asthma. Based on the identification of molds as the second most frequent allergen after mites in our study population, assessment of mold sensitization as well as in forming patients about ways to avoid them seem likely to contribute to the effective management of uncontrolled asthma.Öğe Treatment Emergent Central Sleep Apnea: Should We Repeat Titration?(Galenos Publ House, 2016) Genc, Sebahat; Bilgic, Hatice Kayim; Tapan, Ozge OralMost patients with Obstructive sleep apnea syndrome are treated with continuous positive airway pressure (CPAP). However, in some patients central apnea arises during CPAP titration. This clinical condition is defined as treatment-emergent central sleep apnea (CSA). Here, we would like to present a case who was diagnosed with treatment-emergent CSA during the first titration study, however CSA was lost in the second titration. Before the diagnosis of treatment-emergent CSA, factors of titration should be reviewed and if it is not found satisfactory, procedure should be repeated. In most cases CPAP therapy eliminates CSA. However, in some cases bilevel positive airway pressure-spontaneous/timed or adaptive servo ventilator is needed. Repeated titration could be useful tool to predict whether the patient needs CPAP or advanced therapies.Öğe WHAT IS THE CLINICAL SIGNIFICANCE OF MIXED APNEA IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA: A RETROSPECTIVE STUDY(Carbone Editore, 2014) Genc, Sebahat; Tuncel, Ertan; Savas, Nazan; Demirkose, Mesut; Dikmen, NurselAim: Mixed apnea is defined as absent inspiratory effort in the initial portion of apnea, followed by resumption of inspiratory effort in the second portion. However, the pathophysiological and clinical significance of mixed apnea has not been well defined. This study investigated the likely clinical importance of mixed apnea. Materials and methods: Patients diagnosed with severe obstructive sleep apnea (OSA) in polysomnographic studies were enrolled. Those with a mixed-apnea index value of 5/h or higher were grouped as mixed-OSA (Group 1), and those with a mixed-apnea index value below 1/h were grouped as pure-OSA (Group 2). The patients' demographics, symptoms, clinical and polysomnographic findings, and laboratory examination results were reviewed retrospectively. Results: Groups 1 and 2 contained 24 and 42 patients, respectively. The mean age was significantly lower in Group I than those in Group 2 (47.4 +/- 10.4 vs 52.2 +/- 8.3, respectively, p<0.05). The patients in Group I displayed significantly higher apnea / hypopnea index (AHI) values (p <0.001). Sleep duration, arousal index, and duration of apneas were significantly higher in Group 1 (p=0,006, p=0.013, p=0.008, respectively). While minimum oxygen saturation and mean oxygen saturation levels were significantly lower (p<0.001), mean oxygen desaturation percentages were significantly higher in Group 1 than those in Group 2 (p=0,001). Conclusions: These findings suggest that mixed apnea is not just a subtype of obstructive apnea, and OSA with mixed apnea can be referred as a different fenotype of OSAS. Although there are studies about the alterations in neurochemical control of respiration, pathophysiology is not yet clear. So new studies are needed to investigate the underlying pathophysiology and and clinical outcome.Öğe What is the clinical significance of mixed apnea in patients with obstructive sleep apnea: A retrospective study(Acta Medica Mediterranea, 2014) Genc, Sebahat; Tuncel, Ertan; Savas, Nazan; Demirkose, Mesut; Dikmen, NurselAim: Mixed apnea is defined as absent inspiratory effort in the initial portion of apnea, followed by resumption of inspiratory effort in the second portion. However, the pathophysiological and clinical significance of mixed apnea has not been well defined. This study investigated the likely clinical importance of mixed apnea. Materials and methods: Patients diagnosed with severe obstructive sleep apnea (OSA) in polysomnographic studies were enrolled. Those with a mixed-apnea index value of 5/h or higher were grouped as mixed-OSA (Group 1), and those with a mixedapnea index value below 1/h were grouped as pure-OSA (Group 2). The patients' demographics, symptoms, clinical and polysomnographic findings, and laboratory examination results were reviewed retrospectively. Results: Groups 1 and 2 contained 24 and 42 patients, respectively. The mean age was significantly lower in Group 1 than those in Group 2 (47.4±10.4 vs 52.2±8.3, respectively, p<0.05). The patients in Group 1 displayed significantly higher apnea / hypopnea index (AHI) values (p <0.001). Sleep duration, arousal index, and duration of apneas were significantly higher in Group 1 (p=0,006, p=0.013, p=0.008, respectively). While minimum oxygen saturation and mean oxygen saturation levels were significantly lower (p<0.001), mean oxygen desaturation percentages were significantly higher in Group 1 than those in Group 2 (p=0,001). Conclusions: These findings suggest that mixed apnea is not just a subtype of obstructive apnea, and OSA with mixed apnea can be referred as a different fenotype of OSAS. Although there are studies about the alterations in neurochemical control of respiration, pathophysiology is not yet clear. So new studies are needed to investigate the underlying pathophysiology and and clinical outcome.
