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Normal solunum paterninde değişiklikler ve anatomik hava yolu darlıkları uyku ile ilişkili solunum bozukluklarında sıklıkla görülen durumlardır. Uyku ile ilişkili solunum bozukluklarına horlama, üst solunum yolu direnci ve obstrüktif uyku apnesi örnek verilebilmektedir. Bununla birlikte uyku ile ilişkili solunum bozuklukları ileride gelişebilecek metabolik, kardiyovasküler, psikolojik, nörolojik bozukluklar ve davranış bozukluklarıyla da ilişkilendirilmektedir. Diş hekimleri uyku ile ilişkili solunum bozukluğu bulunan hastaların tanısı ve tedavisinde önemli bir rol oynamaktadırlar. Uyku ile ilişkili solunum bozukluğu bulunan çocuklarda birtakım semptomlar ve kraniyofasiyal anomaliler bulunabilmektedir. Diş hekimlerinin uykuda ile ilişkili solunum bozukluklarının belirtileri hakkında farkındalığının arttırılması ve hastaların erken dönem tedavilerinin hızlı bir şekilde yapılabilmesi ile hastaların hayat kalitesinin arttırıldığı bildirilmektedir. Bu şekilde çocuklarda ileriki dönemlerde gelişebilecek rahatsızlıkların ve kişide oluşabilecek sekellerin önüne geçilebilmektedir. Diş hekimlerinin klinikte rahatlıkla kullanılabilen ve uyku ile ilişkili solunum bozukluklarının teşhisinde kullanılabilecek invaziv olmayan yöntemler ve anketler hakkında bilgi sahibi olması, hastalarını doğru yönlendirmesi konusunda bilgilendirilmesi büyük önem taşımaktadır., Changes in the normal breathing pattern and anatomical airway stenosis are common conditions in sleep disordered breathing. Snoring, upper airway resistance and obstructive sleep apnea are examples of sleep disordered breathing. In addition, sleep disordered breathing is also associated with metabolic, cardiovascular, neurological, psychological and behavioral problems that may develop in the future. Dentists play an important role in the diagnosis and treatment of patients with sleep disordered breathing. Especially with the dentist's awareness of craniofacial problems and other risk factors for sleep disordered breathing in children, it is possible to provide an early treatment and maintain a healthy respiration. Early diagnosis and treatment of sleep disordered breathing prevent future problems and morbidity in children. It is of great importance that dentists should be informed about non-invasive methods and questionnaires that can be used easily in the clinic and these questionnaires can be used in the diagnosis of sleep disordered breathing.

Obstrüktif Uyku apne sendromu (OUAS), yetişkin popülasyonda oldukça sık görülen önemli bir halk sağlığı problemidir. Obezite bu send-romun gelişimi için en önemli risk faktörüdür. OUAS şiddeti beden kitle indeksi (BKİ), uyku evresi, pozisyonu ve cinsiyete göre değişiklik göstermektedir. Bu çalışmada OUAS şiddetine BKİ, uyku evresi, uyku pozisyonu yanında cinsiyetin etkisinin değerlendirilmesi amaçlanmıştır. Çalışmaya polisomnografi incelemesi sonrasında OUAS tanısı alan 93 (%61,58) erkek, 58 (%38,41) kadın olmak üzere toplam 151 hasta alınmıştır. Hastaların demografik özellikleri, polisomnografi parametreleri ve risk faktörleri retrospektif olarak kaydedilmiştir. OUAS tanısı üçüncü Uluslararası Uyku Bozuklukları Sınıflama Klavuzuna göre koyulmuştur. Kadın cinsiyette yaş, BKİ, diabet ve hipertansiyon gibi kardiyovasküler risk faktörleri erkek cinsiyete göre anlamlı yüksek bulunmuştur (p=0,001, p=0,001, p=0,034, p=0,001). Buna rağmen OUAS şiddeti erkek cinsiyette anlamlı bulunmasa da daha yüksek bulunmuştur (p>0,05). Bu yükseklik sırtüstü pozisyonda istatistiksel olarak anlamlı bulunmuştur (erkeklerde AHİSIRT: 44,34±28,07/saat, kadınlarda AHİSIRT: 35,09±26,76/saat, p=0,048). REM uyku evresinde ise OUAS şiddeti kadınlarda fazla bulunmuştur (p=0,016). Bu çalışmada OUAS risk faktörlerinden olan yaş, BKİ, hipertansiyon ve diabet mevcudiyeti, kadın cinsiyette erkek cinsiyete göre istatistiksel olarak anlamlı yüksek bulunmuştur. Buna rağmen OUAS şiddeti erkek cinsiyette daha yüksek bulunmuştur. Bu yükseklik sırtüstü pozisyonda istatistiksel olarak anlamlı bulunmuştur. REM uyku evresinde ise OUAS şiddeti kadın cinsiyette daha fazla bulunmuştur. Bu durum cinsiyetler arasında yağ dağılımındaki farklılıkları düşündürmekte ve genel bir obeziteden ziyade bölgesel yağ birikiminin OUAS için daha önemli bir prediktör olduğunu düşündürmektedir., Obstructive Sleep Apnea syndrome (OSAS) frequently seen in the adult population is an important public health problem. Obesity is an important risk factor of OSAS. Severity of sleep apnea syndrome may differ according to sleep position, sleep stage, gender and body mass ındex (BMI). Therefore, we aimed to evaluate the relationship between the severity of Obstructive Sleep Apnea Syndrome and sleep stage, sleep position with gender. One hundred fifty-one subjects (93 (61,58 %) men, 58 (38,41%) women) were analyzed. Recorded demographic features, over-night polysomnographic data and risk factors of the subjects were reviewed retrospectively. Diagnosis of OSAS was made according to the 3. edition of International of Sleep Disorders Classification. Famele subjects had signicantly higher age, BMI, diabetes and hypertension (p=0.001, p= 0.001, p= 0.034, p= 0.001). The severity of OSAS was higher in male subjects. It was significantly in supin position (AHI: 44.34±28.07/hour in males, AHI: 35.09±26.76/hour in females, p=0.048). The severity of OSAS in REM stage was higher in female subjects (p=0.016). Although age, BMI, hypertension and diabetes was signicantly higher in females than males in this study, OSAS severity in male patients was higher. The difference was significantly in supin position in sleep. The severity of OSAS in REM sleep stage was higher in females than males. This condition suggests that regional fat accumulation is a more important predictor for OSAS than general obesity due to differences in fat distrubution by gender.

Sleep has marked effects on learning, neurocognitive functions, integration of information, and quality of life during childhood. Many pediatric diseases may impair both quality of sleep and quality of life of children.. Diseases with chronic or progressive nature, requiring regular drug use or long term follow-up, causing somatic complaints like pain may effect sleep qualitatively or quantitatively. A better understanding of the effects of these diseases on sleep will have a positive effect on the neurocognitive and physical development of patients. Sleep disorders could be an etiologic factor for cardiovascular, neurocognitive and endocrinological disorders as well. Diabetes, childhood cancers, diseases with chronic pain, neurological diseases and airway pathologies may cause sleep disorders in childhood. Further understanding and better treatment of sleep disorders may contribute to the general well-being of the patients.

research Amaç: Bu çalışmada tıkayıcı uyku apnesi sendromu (TUAS) hastalarında hastalık şiddetinin ve sürekli pozitif havayolu basıncı (SPHB) titrasyonunun evre 3 ve REM (rapid eye movement) uykusu üzerine etkisi araştırıldı.Hastalar ve Yöntemler: Çalışmaya polisomnografi (PSG) ile orta veya ağır TUAS tanısı konulan 114 hasta (87 erkek, 27 kadın, ort. yaş 51.1±10.5 yıl; dağılım 34-66 yıl) dahil edildi. Apne hipopne indeksi ve uyku evrelerinin yüzde değerleri ayrı ayrı istatistiksel olarak karşılaştırıldı. Sürekli pozitif havayolu basıncı titrasyonu sırasında hesaplanan uyku evrelerinin yüzde değerleri tespit edildi ve ilk PSG ile karşılaştırıldı.Bulgular: Polisomnografi sonucuna göre 114 hastanın 41'i orta (30 erkek, 11 kadın; ort. yaş 49.8±10.2 yıl), 73'ü ağır (57 erkek, 16 kadın; ort. yaş 51.8±10.8 yıl) TUAS idi. Apne hipopne indeksi arttıkça evre 2 uykusu artarken, evre 3 ve REM uykusu azaldı; değişimler istatistiksel olarak anlamlı idi (p

Sleep-disordered breathing is one of the important factors contributing to the development and/or progression of heart failure (HF). This condition is related to recurring attacks of apnea, hypopnea, and hyperpnea, sleep disruptions, arousals, intermittent hypoxemia, hypocapnia, and hypercapnia, and intrathoracic pressure changes. Obstructive sleep apnea (OSA) is characterized by recurrent upper airway obstruction (apnea and hypopnea), increased breathing effort against totally or partially occluded upper airway, and sleep disruptions. Cardiovascular consequences are the most serious complications of OSA and include acute myocardial infarction, heart failure, left/right ventricular dysfunction, arrhythmias, stroke, and systemic and pulmonary hypertension. Cheyne-Stokes respiration and central apneas may also occur in patients with HF. This article reviews the most recent information on the physiopathology, diagnosis, and treatment modalities of obstructive and central apneas in patients with HF.

The morbidity and mortality of obstructive sleep apnea (OSA) are related principally to its cardiovascular complications. Metabolic syndrome (MBS) is recognized as raising the risk of cardiovascular disease. In this study, we analysied the diagnostic value of MBS to predict the diagnosis of severe OSA. Eight-seven subjects (54 males and 33 females) without any cardiac or pulmonary disease referred for evaluation of OSA, had overnight polysomnography. MBS were diagnosed according to NCEP criteria. According to apnea-hypopnea index (AHI), subjects were divided into two groups: severe OSA (AHI ≥ 30, 26 males, 15 females) and non-severe OSA (AHI < 30, 28 males, 18 females). Ages were similar in both OSA groups for both genders. In the severe OSA group, number of patients with MBS was especially higher (in females n= 13, 86.6%; in males n= 19, 73%) than non-severe OSA (in females 6, 33%, in males 9, 32%). The mean values of the five diagnostic criteria of MBS were significantly higher in severe OSA than non-severe groups in both genders. Analysis of diagnostic value (criteria ≥ 3) of MBS for predicting the diagnosis of severe OSA in males and females revealed the sensitivity 73% and 86.6%, the specificity 67.8% and 94.4%, positive predictive value 67.9% and 86.7%, negative predictive value 73% and 85.7% respectively. Especially in female patients referred to the sleep clinics, evaluation of MBS criteria may play an important role in predicting severe OSA with high sensitivity and negative predictivity. Furthermore, the presence of MBS in OSA patients might increase cardiovascular complications.

Objectives: We investigated the effect of nasal continuous positive airway pressure (CPAP) on blood pressure (BP) and left ventricular structure in male patients with severe obstructive sleep apnea (OSA). Study design: Thirty-three male patients with severe OSA underwent CPAP treatment for six months. Compliance was defined as the use of CPAP for at least 3.5 hours per night during treatment; thus, 25 patients (mean age 47.9±8.2 years) were compliant with a mean of 5.3±1.9 hours, and eight patients (mean age 48.6±8.4 years) were noncompliant with a mean of 1.0±0.8 hours. Before and after CPAP, echocardiographic assessments were made to determine left ventricular structure (interventricular septum thickness, left ventricular posterior wall thickness, left ventricular mass, and left ventricular mass index) and function (E/A ratio, isovolumic relaxation time, mitral deceleration time, and velocity of mitral flow propagation), and systolic and diastolic blood pressures were measured. In the compliant group, 20 patients had hypertension, 22 patients had diastolic dysfunction, and 16 patients had left ventricular hypertrophy (LVH). All noncompliant patients were hypertensive, four had diastolic dysfunction, and four had LVH. Results: Systolic and diastolic BPs significantly decreased after CPAP treatment, the decreases being more pronounced in the compliant group (p

In obstructive sleep apnea syndrome (OSAS), repetitive episodes of apnea cause increased sympathetic nerve activity, increased surges in arterial blood pressure, swings in intrathoracic pressure, oxidative stres, hypoxia and hypercapnia. The association of OSAS with some diseases, having endothelial dysfunction in their physiopathology, such as hypertension, diabetes mellitus, obesity, coronary artery diseases, stroke and heart failure is common. Increased sympathetic nerve activity and also endothelial dysfunction which are the results of hypoxia, have important roles in vascular complications of OSAS. When compared with healthy population, an important endothelial dysfunction in OSAS patients and relationship between OSAS severity and endothelial dysfunction have been shown. In this review, the relationship between OSAS and endothelial dysfunction was overviewed.

Kardiyak X sendromu, anjina pektoris, stres testi esnasında miyokard iskemisine işaret eden ST segment depresyonu ve normal koroner anjiyogram ile karakterizedir. Bu hastalık hastaların bazılarında gösterilen mikro-dolaşım bozuklukları nedeniyle mikrovasküler anjinanın eşdeğeri olarak düşünülmüştür. Bu sendrom, daha ziyade altta yatan çeşitli mekanizmaların bulunduğu heterojen bir hastalıktır. Kardiyak X sendromunun altında yatan patofizyoloji ortaya konamamıştır. Kardiyak X sendromu olan hastaların prognozu, mortalite ve miyokard enfarktüsü insidansı açısından iyidir. Metabolik Sendrom, hipertansiyon, hiperglisemi, rdperinsulinemi, hipertrigliseridemi ve düşük plazma HDL kolesterol değerleri ile karakterize bir tablodur. Bu hastalık, obezite ateroskleroz ve koroner kalp hastalığı açısından önde gelen bir risk faktörüdür. Günümüzde bu bilgiler ışığında kardiyovasküler hastalığın tedavisi açısından tam entegre yaklaşım kabul görmektedir En sık karşılaşılan uyku apne türü Obstrüktif Uyku Apne Sendromu olarak adlandırılır. Uyku apnesi solunumun kesilmesi olarak bilinir. Bu hastalık, uyku sırsında oluşan üst hava yolu obstrüksiyonun tekrarlayıcı dönemleri ile karakterize olup genellikle kan okisjen saturasyonunda azalma ile beraberdir. Başka bir deyişle, havayolu birkaç bölgede tıkanır. Üst hava yolu, hava yolundaki doku fazlalığı ile büyük toniller, büyük dil ile tıkanabilir. Genellikle uykuda, havayolunda bulunan kasların gevşemesi ve kollapsı sonucunda olur. Nasal pasajlarda obstrükte olabilir. Bazan çenenin ve havayolunun yapısı uyku apne için faktör olabilir. OSAS erişkin dönemdeki en yaygın uykusuzluk nedenidir. Bu çalışmaya Eylül 2004 ile Temmuz 2005 tarihleri arasında Kardiyoloji polikliniğine göğüs ağrısı nedeniyle başvuran 11 'İ erkek 9'u kadın toplam 20 sendrom x hastası ile 12'si kadın 8'i erkek toplam 20 metabolik sendrom hastası alındı. Yapılan analizinde metabolik sendromlu hastalarda AHİ indeksi ile sadece sistolik kan basıncı arasında pozitif korelasyon var iken, kardiyak sendrom x'li hastalarda pozitif korelasyona rastlayamadık, fakat sub gurup analizlerde, AHİ indeksi 10'un üzerinde olan, metabolik sendromlu hastalarda, trigliserit ve sistolik kan basıncı (SKB) ile pozitif korelasyon var iken, AHİ indeksi 10'un üzerinde olan kardiyak sendrom x'li hastalarda HDL ile negatif korelasyon ve SKB ile pozitif korelasyon saptandı, kardiyak sendrom x hastalan ile metabolik sendromlu hastalarda, olası kardiyak strüktürel anomalileri, ekokardiyografik olarak araştırdık, kontrol gurubu ile, karşılaştırdık. Kardiyak sendrom x hastalarında, sağ atrium çaplan, kontrol gurubuna göre daha yüksek, mEv/mAv oranı OSAS' lu hastalarda anlamlı olarak azalmış, LV izovolümik relaksasyon zamanı anlamlı olarak artmıştı, MPİ anlamlı olarak düşüktü. 62 Sonuç olarak; Kardiyak sendrom x ve Metabolik sendrom birçok kardiyovaskuler risk parametrelerinim içermektedir, çalışmamızda, kardiyovaskuler komplikasyonlara neden olan, OSAS'unu, bu iki gurup hastada normal populasyona göre anlamlı derecede yüksek saptadık. Anahtar kelimeler: Kardiyak sendrom x, metabolik sendrom, Obstruktif uyku apne sendromu. 7.SUMMARY Cardiac syndrome X is characterized by angina pectoris, ST segment depression which pointed myocard iskemia during treadmill test and normal coroner angiogram. This illness is thought as an equivalence of microvascular angina because of micro-circulation disturbances are seen in the some of patients. This syndrome especially is a heterogen illness which underlies various mechanisms. Cardiac syndromes X pathophysiology's is not clear. The patients' prognosis, incidence of myocard enfarction and mortality that have cardiac syndrome X are good. Metabolic Syndrome is characterized by hypertension, hyperglycemia, hyperinsulinemia, hypertriglyceridemia and lower levels of plasma HDL. This illness is a risk factor for obesity, coroner heart diseases, and atherosclerosis. At the present for treatment of cardiovascular diseases in the light of mis knowledges complete integration opinion is accepted. The most common kind of sleep apnea is called Obstructive Sleep Apnea Syndrome. Sleep apnea means "cessation of breath." It is characterized by repetitive episodes of upper airway obstruction that occur during sleep, usually associated with a reduction in blood oxygen saturation. In other words, the airway becomes obstructed at several possible sites. The upper airway can be obstructed by excess tissue in the airway, large tonsils, a large tongue and usually includes the airway muscles relaxing and collapsing when asleep. Another site of obstruction can be the nasal passages. Sometimes the structure of the jaw and airway can be a factor in sleep apnea. In adults the most common reason is sleepless. Total 20 (1 1 women, 9 men) syndrome X patients and 20 (12 women, 8 men) metabolic syndrome patients were enrolled in this trial between september-2004 and july-2005. As a result of, we have determined OSAS in the 55% of syndrome X patients and 39% of metabolic syndrome patients. Eventually, cardiac syndrome X and metabolic syndrome include many cardiovascular risk parameters, m our study, we determined that OSAS which is responsible for cardiovascular complication, is higher in this two groups than normal population. Key words: Cardiac syndrome, metabolic syndrome, sleep apnea syndrome Cardiac syndrome X is characterized by angina pectoris, ST segment depression which pointed myocard iskemia during treadmill test and normal coroner angiogram. This illness is thought as an equivalence of microvascular angina because of micro-circulation disturbances are seen in the some of patients. This syndrome especially is a heterogen illness which underlies various mechanisms. Cardiac syndromes X pathophysiology's is not clear. The patients' prognosis, incidence of myocard enfarction and mortality that have cardiac syndrome X are good. Metabolic Syndrome is characterized by hypertension, hyperglycemia, hyperinsulinemia, hypertriglyceridemia and lower levels of plasma HDL. This illness is a risk factor for obesity, coroner heart diseases, and atherosclerosis. At the present for treatment of cardiovascular diseases in the light of mis knowledges complete integration opinion is accepted. The most common kind of sleep apnea is called Obstructive Sleep Apnea Syndrome. Sleep apnea means "cessation of breath." It is characterized by repetitive episodes of upper airway obstruction that occur during sleep, usually associated with a reduction in blood oxygen saturation. In other words, the airway becomes obstructed at several possible sites. The upper airway can be obstructed by excess tissue in the airway, large tonsils, a large tongue and usually includes the airway muscles relaxing and collapsing when asleep. Another site of obstruction can be the nasal passages. Sometimes the structure of the jaw and airway can be a factor in sleep apnea. In adults the most common reason is sleepless. Total 20 (1 1 women, 9 men) syndrome X patients and 20 (12 women, 8 men) metabolic syndrome patients were enrolled in this trial between september-2004 and july-2005. As a result of, we have determined OSAS in the 55% of syndrome X patients and 39% of metabolic syndrome patients. Eventually, cardiac syndrome X and metabolic syndrome include many cardiovascular risk parameters, m our study, we determined that OSAS which is responsible for cardiovascular complication, is higher in this two groups than normal population. Key words: Cardiac syndrome, metabolic syndrome, sleep apnea syndrome

Obstructive sleep apnea hypopnea syndrome (OSAHS) is characterized by repetitive upper airway obstruction during sleep and it is commonly seen in the adult population, 4% in the men, 2% in the women. The most common nocturnal symptom is snoring while the most common daytime symptom is excessive daytime sleepiness. The gold standard in the diagnosis is polysomnography. Nasal continuous positive airway pressure is the most efficient therapy in the treatment and prevention of the disease. The OSAHS may cause cardiovascular complications in long-term, including systemic hypertension, pulmonary hypertension, congestive heart failure, arrhythmias, stroke and myocardial infarction. All these complications increase the morbidity and mortality of OSAHS. In this paper, effects of OSAHS on cardiovascular system were reviewed.