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ABSTRACT: Obstructive sleep apnoea (OSA) is a risk factor for cardiovascular morbidity and mortality. The aim of this study was to assess relations between cardiovascular diseases (CVD) and age in OSA subjects.
Consecutive OSA subjects (AHI/RDI > 10, Epworth score > 9 points) were evaluated. The chest X-ray, spirometry, arterial blood gases, ECG, blood morphology and biochemistry were performed during trial treatment with autoCPAP.
We studied 533 consecutive OSA patients, mean age 55.6 +/- 10.3 years (range 24-81), with obesity (BMI 34.4 +/- 6.6 kg/m(2)) and severe OSA (AHI/RDI 37.8 +/- 21.8). To evaluate relations between CVD and age, patients were divided into three groups. Group 1 < 50 years (123 subjects, 23.1%), Group 2 aged 50-60 years (250 subjects, 46.9%) and Group 3 > 60 years (160 subjects, 30%). Subjects < 50 years were more obese and had higher AHI/RDI when compared to older groups. Incidence of arterial hypertension, coronary artery disease, atrial fibrillation, heart failure and stroke increased with age (higher in subjects > 60 years).
Cardiovascular diseases were prevalent in OSA patients > 60 years. However the youngest group presented with more severe obesity and higher AHI/RDI.
Pneumonologia i alergologia polska: organ Polskiego Towarzystwa Ftyzjopneumonologicznego, Polskiego Towarzystwa Alergologicznego, i Instytutu Gruzlicy i Chorob Pluc 01/2009; 77(3):235-41.
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ABSTRACT: Obstructive sleep apnea (OSA) is a well-recognized risk factor of cardiovascular disorders and is related to metabolic syndrome. The aim of this study was to evaluate the effect of BMI and AHI/RDI on metabolic disturbances in patients suspected of OSA.
Ninety-nine patients referred with suspected OSA underwent standard polysomnography or limited sleep study. AHI/RDI > or = 10/hour was considered relevant for OSA diagnosis. Subjects with AHI/RDI < 10 were considered as controls. We assessed apnea-hypopnea index or respiratory disturbances index (AHI/RDI), Epworth sleepiness scale (ESS), body mass index (BMI), C-reactive protein (CRP, mg/l), glycosylated haemoglobin (HbA1c, %), fasting serum total cholesterol, HDL-, LDL-cholesterol, triglycerides (TG), glucose (G), insulin (INS, IU/ml) and HOMA index.
Data are presented as mean +/- SD or median (interquartile range) for parametric and nonparametric data respectively. Twenty-two patients were included as controls (age 51.8 +/- 10 vs. 55 +/- 11 in OSA; p = NS). AHI/RDI in the OSA group was 23 (16-31.3) and 7 (3.8-8.1) in controls (p < 0.001). BMI in OSA 32.2 +/- 5.8 vs. 30.4 +/- 4.6 in controls (p = NS). Patients with OSA had higher TG (160 +/- 75.9 vs. 130.2 +/- 51.9 mg/dl, p = 0.046), G (5.04 +/- 0.6 vs. 4.47 +/- 0.6, p = 0.0037), HOMA (2.31 +/- 1.5 vs. 1.85 +/- 1.7, p = 0.046). G correlated best with AHI/RDI (p < 0.001, r = 0.41). Significant differences were observed in OSA patients between obese (51 pts, BMI 35.2 +/- 4.8) and non-obese (26 pts, BMI 26.61 +/- 1.9) pts in: HDL-cholesterol (50.8 +/- 13.2 vs. 60.9 +/- 18.4 mg/dl; p = 0.02), TG (178.7 +/- 69.9 vs. 124 +/- 75.3 mg/dl, p < 0.001), G (5.15 +/- 0.7 vs. 4.8 +/- 0.5 mmol/l, p = 0.01), INS (11.7 +/- 5.9 vs. 6.57 +/- 4.7, p < 0.001), HOMA (2.7 +/- 1.4 vs. 1.4 +/- 1.2, p < 0.001), HbA(1c) (5.89 +/- 0.9 vs. 5.4 +/- 0.8, p = 0.03), CRP (2.2 +/- 2.9 vs. 1.09 +/- 1.2, p = 0.01).
Our findings support the results of previous studies showing the influence of OSA alone on metabolic disturbances. However, BMI has major impact on metabolic variables.
Pneumonologia i alergologia polska: organ Polskiego Towarzystwa Ftyzjopneumonologicznego, Polskiego Towarzystwa Alergologicznego, i Instytutu Gruzlicy i Chorob Pluc 01/2008; 76(5):340-7.
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ABSTRACT: Obesity and male gender are the main risk factors for the development of obstructive sleep apnoea (OSA); however, some epidemiological data has shown that neck circumference (NC) > or = 43 cm is a better predictor of obstructive event frequency than body mass index (BMI). The aim of this study was to assess the relation between NC and BMI on OSA severity in males.
The subjects completed a sleep questionnaire and Epworth sleepiness scale before the sleep study (full polysomnography or PolyMesam study). Authors studied 133 consecutive males with confirmed OSA (AHI/RDI > 10, Epworth score > 9 points). Chest X-ray, spirometry, arterial blood gases, ECG, blood morphology and biochemistry were performed during treatment trial with autoCPAP.
Subjects presented with obesity--BMI = 35.8 +/- 6.1 kg/m2, NC = 46 +/- 3.4 cm and severe disease--AHI/RDI = 45.3 +/- 23.6. Mean age was 52.7 +/- 11.3 years. The majority of subjects had NC > or = 43 cm (116 pts, 87.2% - group 1), 17 pts (12.8% - group 2) had NC < 43 cm had 17 pts. Comparison of both groups showed significant differences only for BMI (group 1 - 36.8 +/- 5.7, group 2 - 28.6 +/- 3.7; p < 0.0001). Linear regression analysis revealed significant correlation between NC and AHI/RDI (R2 = 0.07, r = 0.26; p = 0.003); however, the correlation between BMI and AHI/RDI was stronger (R2 = 0.14, r = 0.37; p < 0.0001). In multiple linear regression analysis we found significant correlation between AHI/RDI and age (beta = -0.31, p = 0.003) and BMI (beta = 0.34, p = 0.02). Conclusions: The strongest correlation between AHI/RDI, younger age and BMI. Correlation between neck circumference and AHI/RDI was significant but less when compared to BMI.
Pneumonologia i alergologia polska: organ Polskiego Towarzystwa Ftyzjopneumonologicznego, Polskiego Towarzystwa Alergologicznego, i Instytutu Gruzlicy i Chorob Pluc 01/2008; 76(5):313-20.
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ABSTRACT: The aim of this study was to assess results of 6MWT in non-selected group of obstructive sleep apnoea (OSA) patients. In healthy adult subjects 6-minute walking distance (6MWD) range from 400 to 700 m. Obesity, the main symptom of OSA, is one of the factors associated with reduction of 6MWD (another common factors: older age, shorter height, female sex, pulmonary, cardiovascular and musculoskeletal diseases).
Subjects completed sleep questionnaire and Epworth sleepiness scale before sleep studies (full polysomnography [PSG] or PolyMesam study [PM]). Consecutive OSA subjects (AHI/RDI >10, Epworth score > 9 points) were evaluated. The 6MWT, chest X-ray, spirometry, arterial blood gases, ECG, blood morphology and biochemistry were performed during trial treatment with autoCPAP.
We studied 151 subjects (119 males - 78.8% and 32 females - 21.2%), mean age 53.4 +/- 10.5 years. Subjects were obese - BMI = 35.7 +/- 6.2 kg/m(2) and presented severe OSA - AHI/RDI = 42.4 +/- 23.2. To assess relations between 6MWD and AHI/RDI, BMI, age and concomitant diseases we divided subjects in two groups: 1(st) with 6MWD > or = lower limit of normal (LLN) (123 pts; 81.5%) and 2(nd) with 6MWD < LLN (28 pts; 18.5%). Significant differences between groups were found for BMI, FVC (% of predicted) and Borg dyspnea scale before and after 6MWT. In multiple linear regression analysis we found significant correlation between 6MWD and BMI (beta = 0.41, p < 0.0001) and arterial hypertension (beta = -0.16, p = 0.04). Females had significantly shorter 6MWD than males (401.1 +/- 83.6 m and 451.8 +/- 107 m, respectively; p = 0.01). Difference was significant after adjustment for BMI and age (analysis of covariance) - R = 0.61, R2 = 0.38 (p < 0.0001).
BMI, female sex, arterial hypertension and lower FVC (% of predicted) were related to shorter 6-minute walking distance in OSA patients.
Pneumonologia i alergologia polska: organ Polskiego Towarzystwa Ftyzjopneumonologicznego, Polskiego Towarzystwa Alergologicznego, i Instytutu Gruzlicy i Chorob Pluc 01/2008; 76(2):75-82.
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ABSTRACT: Prevalence of obstructive sleep apnoea (OSA) is higher in postmenopausal females. The aim of this study was to compare OSA severity in postmenopausal females (group E-) and females with preserved estrogen activity (premenopausal or on hormonal replacement therapy - group E+).
We studied 147 OSA females in mean age 58.1 +/- 9.4 years. Subjects presented obesity (BMI = 34 +/- +/- 7.9 kg/m2) and moderate or severe disease (AHI = 35.9 +/- 20.9), SaO(2) mean - 89.4 +/- 5.8%. Group (E-) consisted of 116 pts (75.5%) and group (E+) of 36 pts (24.5%).
Group (E+) presented more severe OSA (AHI/RDI = 42 +/- 26.6) and obesity (BMI = 37.6 +/- 10.1 kg/m(2)) when compared to group E- (AHI/RDI = 33.9 +/- 18.4; p = 0.04 and BMI - 32.8 +/- 6.7 kg/m(2); p = 0.001). In multiple linear regression analysis we found significant negative correlation between AHI and age (beta = -0.29, p = 0.03). After adjustment for BMI and age (analysis of covariance) significant difference was still present between both groups (R = 0.24, p = 0.03).
Majority of OSA females qualified to CPAP therapy were postmenopausal (75.5%). Severity of OSA (AHI/RDI) after adjustment for age and BMI was higher in group (E+).
Pneumonologia i alergologia polska: organ Polskiego Towarzystwa Ftyzjopneumonologicznego, Polskiego Towarzystwa Alergologicznego, i Instytutu Gruzlicy i Chorob Pluc 02/2007; 75(2):129-33.
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ABSTRACT: Nocturia (two or more urinations per night) is a common symptom in OSA subjects. Higher secretion of atrial natriuretic peptide, increased intra-abdominal pressure, diuretics, diabetes, excessive fluid intake, awakenings are responsible for nocturnal urination. The aim of this study was to evaluate incidence of nocturia in moderate and severe OSA.
We studied 171 consecutive OSA patients (135 males and 36 females) - means: age - 53.6 +/- +/- 10.8 years, AHI/RDI - 43.6 +/- 23.2, BMI - 35.8 +/- 6.3 kg/m(2).
To assess relations between nocturia and AHI/RDI, overnight saturation, BMI and daytime sleepiness we divided subjects in two groups: 1(st) - without nocturia - 60 pts; 35.1% (group N-) and 2(nd) - with nocturia - 111 pts; 64.9% (group N+). Group N+ presented with higher AHI/RDI, 48 +/- 22.8 vs. 35.4 +/- 21.7 (p = 0.0006), higher BMI, 36.8 +/- 6.5 vs. 34 +/- 5.5 kg/m(2) (p = 0.004), lower mean overnight SaO(2), 88.6 +/- 5.6 vs. 90.4 +/- 4.3% (p = 0.03) and daytime sleepiness, Epworth score - 14.4 +/- 5.1 vs. 11.3 +/- 5.5 points (p = 0.0002). Multiple linear regression analysis revealed significant correlation between nocturia and Epworth sleepiness score (beta = 0.26, p = 0.0009), coronary artery disease (beta = 0.23, p = 0.004) and AHI/RDI (beta = 0.21, p = 0.04).
Nocturia is frequent in OSA patients (64.9%). Nocturnal urination was related to severity of OSA, excessive daytime sleepiness and coronary artery disease.
Pneumonologia i alergologia polska: organ Polskiego Towarzystwa Ftyzjopneumonologicznego, Polskiego Towarzystwa Alergologicznego, i Instytutu Gruzlicy i Chorob Pluc 02/2007; 75(2):140-6.
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ABSTRACT: The aim of this study was to evaluate the effect of CPAP treatment on respiratory muscle strength and exercise tolerance in patients with obstructive sleep apnoea (OSA) and overlap syndrome (OS).
9 patients with OSA and 9 patients with OS were studied. Respiratory muscle assessment, 6 minute walking distance (6MWD) and cycloergometry exercise test were performed before and after six month period of CPAP treatment.
In OSA group exercise tolerance did not change after the treatment. Mean 6MWD was 571.8 +/- 76.6 m before and 554.0 +/- 125.5 m after treatment, mean W(max) was 142 +/- 41 W before and 139 +/- 38 W after treatment. PI(max) in OSA group did not change significantly, 140.4 +/- 32.0 cm H(2)O before and 155.9 +/- 31.5 after treatment (p = 0.14). PE(max) improved from 170.5 +/- 49.2 cm H(2)O, to 199.9 +/- 27.6 cm H(2)O (p = 0.067). Handgrip force in OSA group improved from 50.5 +/- 16.5 kg to 61.0 +/- 17.0 kg (left hand) (p = 0.05) and from 53.3 +/- 14.2 to 58.9 +/- 15.9 (right hand) (p < 0.05). In OS group exercise tolerance improved by 17% after CPAP treatment from W(max) = 81 +/- 33 W before to 95 +/- 38 W after. Mean 6MWD was at the same level before (504 +/- 144 m) and after treatment (492 +/- 108 m). PI(max) in OS group improved from 89.2 +/- 35.7 cm H(2)O to 106.3 +/- 31.4 cm H(2)O (p < 0.05). PE(max) in OS group did not change significantly, 159.9 +/- 45.8 cm H(2)O before and 184.2 +/- 45.0 cm H(2)O after treatment (NS). Handgrip force in OS group improved from 38.1 +/- 15.9 kg to 46.9 +/- 11.1 kg (left hand) (p < 0.05) and did not change in right hand (44.5 +/- 17.7 kg vs. 47.9 +/- 10.4 kg) (NS). Data analysis of the whole group (18 pts) showed clear tendency to improve strength of respiratory muscles in patients treated with CPAP. Mean PI(max) improved from 123 to 133 cm H(2)O (p = 0.006) and PE(max) improved from 168.1 to 192 cm H(2)O (p = 0.02).
CPAP treatment improved strentgh of respiratory and skeletal muscles in patients with OSA and OS and improved exercise tolerance in patients with OS.
Pneumonologia i alergologia polska: organ Polskiego Towarzystwa Ftyzjopneumonologicznego, Polskiego Towarzystwa Alergologicznego, i Instytutu Gruzlicy i Chorob Pluc 02/2007; 75(1):46-56.
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ABSTRACT: Severe complications of lower respiratory tract infection in a patient with hereditary glucose-6-phosphate dehydrogenase (G-6-PD) deficiency may occur. The case of a 68-year-old man with hereditary glucose-6-phosphate dehydrogenase (G6PD) deficiency who developed severe haemolysis after community-acquired pneumonia is presented. G6PD deficiency in our patient was diagnosed during childhood. We observed complications of community-acquired pneumonia: empyema, haemolytic crisis and renal failure. Videopleuroscopy and pleural drainage were successfully performed. Community-acquired streptococcal pneumonia may also lead to haemolysis in G6PD deficient patients. Acute haemolysis, severe anaemia and renal insufficiency secondary to haemoglobinuria can be observed. Severe purulent complications of pneumonia in G6PD deficient patients may suggest granulocyte function impairment.
Pneumonologia i alergologia polska: organ Polskiego Towarzystwa Ftyzjopneumonologicznego, Polskiego Towarzystwa Alergologicznego, i Instytutu Gruzlicy i Chorob Pluc 02/2007; 75(3):283-8.
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ABSTRACT: We studied 44-year old man with heart failure (ejection fraction -25%). Obesity, arterial hypertension, snoring and excessive daytime sleepiness suggested concomitant obstructive sleep apnoea. Limited polysomnography with Polymesam revealed typical Cheyne-Stokes respiration with mainly central apnoeas (RDI=48/hour). We did not find any obstructive episodes during sleep study. Patient responded to CPAP therapy and apnoea hypopnoe index decreased to 12/hour on 8 mbar pressure.
Pneumonologia i alergologia polska: organ Polskiego Towarzystwa Ftyzjopneumonologicznego, Polskiego Towarzystwa Alergologicznego, i Instytutu Gruzlicy i Chorob Pluc 01/2006; 74(4):426-30.
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Paweł Kuca,
Dariusz Kamiński,
Edward Campbell,
Jacek Kołakowski,
Anna Goljan-Geremek,
Elzbieta Puścińska, Przemysław Bieleń,
Adam Nowiński,
Emil Wojda,
Iwona Hawryłkiewicz,
Paweł Sliwiński,
Dorota Górecka
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ABSTRACT: Four patients with alpha-1 antitrypsin (alpha-1 AT) deficiency are presented: one woman with severe (phenotype PiZ) and 3 men with moderate (phenotype PiMZ) deficiency of alpha-1 AT. The variability of clinical presentation of hereditary emphysema is described. In all patients tobacco smoking history, spirometric and 6-minutes walking tests as well as HRCT of the lung were performed and compared. The influence of smoking on the functional status is underlined.
Pneumonologia i alergologia polska: organ Polskiego Towarzystwa Ftyzjopneumonologicznego, Polskiego Towarzystwa Alergologicznego, i Instytutu Gruzlicy i Chorob Pluc 02/2004; 72(9-10):420-3.
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ABSTRACT: Expiratory muscle recruitment is common in stable COPD patients. However, physiological significance of expiratory muscle recruitment in COPD remains unclear. The purpose of this study was to assess the effect of expiratory muscle contraction on force generating ability of the diaphragm in COPD patients breathing at rest. The force generating ability of the diaphragm was evaluated from its pressure swing (Pdi) for a given diaphragm electrical activity (Edi), where Edi was normalized as % of its maximal value [Pdi/(Edi/Edimax)]. Phasic expiratory muscle contraction was measured as the total expiratory rise in gastric pressure (Pgaexp.rise). Nineteen patients with severe COPD, participated in the study but only 10 exhibited phasic rise in Pga during expiration with a mean Pgaexp.rise of 1.91 +/- 0.89 cmH2O. Patients were divided into passive expiration (PE) and active expiration (AE) groups. There was no significant difference in lung function and breathing pattern parameters between the two groups. Pdi/(Edi/Edimax) was 0.63 +/- 0.07 and 0.54 +/- 0.07 cm cmH2O/% in PE and AE groups, respectively, and was not significantly different between each other. Compared with PE group, AE group not only recruited expiratory muscles, but also preferentially recruited inspiratory rib cage muscles and derecruited the diaphragm. In conclusion phasic contraction of expiratory muscles at rest in COPD patients do not improve the force-generating ability of the diaphragm.
Pneumonologia i alergologia polska: organ Polskiego Towarzystwa Ftyzjopneumonologicznego, Polskiego Towarzystwa Alergologicznego, i Instytutu Gruzlicy i Chorob Pluc 02/2002; 70(7-8):387-97.
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ABSTRACT: Several studies have demonstrated relatively moderate increase in Pdi during exhaustive exercise in COPD patients. The present study was designed to determine whether the small increase in Pdi is due to a central inhibition of respiratory drive, or an inability of the diaphragm to develop pressure. Diaphragm electrical activation (Edi) and transdiaphragmatic (Pdi) pressure were measured in 19 patients with severe COPD using an esophageal catheter. End-expiratory lung volume (EELV) was assessed by inspiratory capacity (IC) maneuvers. Maximal voluntary Edi (Edimax) was obtained during these maneuvers. EELV increased during exercise (p < 0.001) causing end-inspiratory lung volume to attain 98 +/- 5% of TLC at end-exercise. Pdi at rest was 8.4 +/- 2.6 cm H2O. Edi was 19 +/- 4% of Edimax at rest and increased progressively during exercise (p < 0.001) to reach 78 +/- 3% of Edimax at end-exercise. In conclusion, dynamic hyperinflation during exhaustive exercise in patients with COPD, reduces diaphragm pressure generating capacity, promoting near maximal levels of diaphragm activation without evidence of central inhibition.
Pneumonologia i alergologia polska: organ Polskiego Towarzystwa Ftyzjopneumonologicznego, Polskiego Towarzystwa Alergologicznego, i Instytutu Gruzlicy i Chorob Pluc 01/2002; 70(7-8):378-86.
