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BACKGROUND: In the literature, novel physiotherapy and rehabilitation approaches are getting significant attention as a way to cope with secondary complications in the management of asthma. OBJECTIVE: To investigate the effectiveness of core stabilization exercises combined with the Asthma Education Program (AEP) and breathing exercises in patients with asthma. METHODS: The study sample consists of 40 asthmatic patients (age 52.25 ± 11.51 years) who were randomly divided into a Training Group (TG) (n= 20) and a Control Group (CG) (n= 20). All subjects were included in the AEP, and both groups were trained in breathing retraining exercises (2 times/wk, 6-week duration in the clinic). The core stabilization exercise program was also applied in the TG. Respiratory muscle strength (maximum inspiratory and expiratory pressures), physical activity level (International Physical Activity Questionnaire Short Form (IPAQ)), health-related quality of life (Asthma Quality of Life Questionnaire (AQOL)), functional exercise capacity (six-minute walking test (6MWT)), and dynamic balance (Prokin PK200) were assessed before and after the interventions. RESULTS: The TG showed more significant improvements in MIP (ΔTG:4.55 cmH2O, ΔCG:0.95 cmH2O), IPAQ (ΔTG:334.15 MET-min/wk., ΔCG:99 MET-min/wk.), 6MWT (ΔTG:24.50 m, ΔCG:11.50 m), and dynamic balance sub-parameters compared to the mean difference between the initial assessment and after a 6-week intervention program, which included twelve exercise sessions (p< 0.01). CONCLUSIONS: The findings present greater improvements in inspiratory muscle strength, physical activity level, functional exercise capacity, and dynamic balance when core stabilization exercises are included in the pulmonary rehabilitation program for the management of asthma.

INTRODUCTION In this study, we aimed to evaluate diaphragmatic dysfunction (DD) by using a practical approach in patients with amyotrophic lateral sclerosis (ALS) at the first visit to a chest diseases outpatient clinic. METHODS Patients with ALS seen in our outpatient clinic for the past 5 y and followed up for at least 1 y, were retrospectively evaluated. Having at least one of the following three criteria was accepted as DD: (a) paradoxical abdominal movement (PAM), (b) sitting-supine forced vital capacity (FVC) difference ≥ 20%, (c) sitting-supine arterial oxygen saturation measured by pulse oximetry (SpO2 ) difference ≥ 4%. Respiratory symptoms, arterial blood gas analysis, sleep studies, noninvasive mechanical ventilation use, and mortality were recorded. RESULTS Five-hundred patients with ALS were included (female/male: 220/280, age: 58.9 ± 11.3 y). Of the patients, 22.8% had daytime hypercapnia. DD was observed in 55% of the patients (PAM in 112, sitting-supine FVC difference ≥ 20% in 50, and sitting-supine SpO2 difference ≥ 4% in 113 patients). Of the patients with DD, 31.6% (n = 87) had no respiratory symptoms, 46.4% had FVC > 70% and 33.5% had FVC

WOS:000529333500019 Our study was conducted to determinethe role of parental smoking status on the European Medical Association Smoking or Health (EMASH) nicotine dependence scores. Records of patients aged >= 18. registered at the Smoking Cessation Outpatient Clinics, were reviewed. Data of three groups (group 1: mothers' smoking status; group 2: fathers' smoking status; group 3: both parents' smoking status) were compared. A total of 902 patient records were analyzed (54.8% male, 45.2% female, age: 43.79 +/- 12.47 years). The average number of cigarettes smoked was 23.98 +/- 9.94/day, and the age of smoking onset was 19.11 +/- 5.94 years. There were more individuals with low EMASH score in the subgroup in which mothers did not smoke than that where mothers smoked (p=0.038). The percentage of females was higher (p=0.018) and the average age was lower (p=0.005) in that where mothers smoked. There were more individuals with high EMASH score in the subgroup in which fathers smoked than that where fathers did not smoke (p=0.026). There were more individuals with low EMASH score in the subgroup in which none of the parents smoked than that where both parents smoked (p=0.013). We found a strong relationship between smoking patterns and parental smoking. Smoking Cessation Clinic We would like to thank all the staff (nurses, secretaries) who had helped in the organization of the Smoking Cessation Clinic. We are grateful for the support and guidance offered by the Ethical Committee of Istanbul Medical Faculty.

Background/aim: Our aim is to determine the caregiver burden of chronic obstructive lung disease (COPD) patient's caregivers, and to determine whether there is a workday loss. Materials and methods: 252 COPD patients and their caregivers were included. Disease information of the patients were recorded and a questionnaire was applied. Socio-demographic characteristics of the caregivers were recorded and a questionnaire consisting of 24 questions including COPD disease, treatment and loss of working days, and the Zarit Scale were used. Results: 128(50.8%) of the patients according to GOLD were group-D, 97(38.5%) of the patient's relatives were working, 62(24.7%) were not able to go to work for 1-14 days, and 125(57.1%) spent outside the home from 1-14 nights, because those accompanied to patients. In univariate analysis were detected modified medical research council (mMRC) (p < 0.001), CAT (p < 0.001), the number of comorbidities of patients (p = 0.027), forced expiratory volume in 1 FEV1cc (p = 0.009), FEV1% (p < 0.001), the presence of long term oxygen therapy (LTOT), and the number of comorbidities of the patient's relatives (p = 0.06) increased the care load. In multiple linear regression analysis, age (p = 0.03), COPD assessment test (CAT) score (p = 0.001), FEV1% (

Amaç: Bu çalışmada obez ve uyku ile ilişkili solunum bozuklukları (UİSB) olan olgularda serum ürik asit (ÜA) düzeyinin obstruktif uyku apne (OUA) şiddeti, nokturnal hipoksemi (NH) ve obezite hipoventilasyon sendromu (OHS) ile ilişkisi araştırıldı. Gereç ve Yöntem: Uyku laboratuarına başvuran vücut kitle indeksi (VKİ) ≥30 kg/m2 olan polisomnografi ile UİSB saptanan tüm olgular çalışmaya alındı. Demografik özellikler, antropometrik ölçümler ve serum ÜA düzeyleri kaydedildi. Apne-hipopne indeksi (AHİ) ve ODİ (oksijen desaturasyon indeksi) hesaplandı. AHİ 5-14 olay/sa hafif, 15-29 olay/sa orta ve ≥30 olay/sa ağır şiddette OUA olarak değerlendirildi. Nokturnal SpO245 mmHg ise OHS tanısı koyuldu. Bulgular: Çalışmaya 159 UİSB olan olgu (79 kadın, 80 erkek, yaş: 50,0±10,5 yıl, VKİ: 40,1±5,7 kg/m2) dahil edildi. Olguların 76'sında OHS ve 83'ün de saf OUA tanısı mevcuttu. NH %25,8'inde (n=41) saptandı. NH olanlarda ÜA düzeyi anlamlı olarak yüksekti (6,22±1,37 mg/dl, 5,67±1,51 mg/dl, p=0,008). OHS olgularında ÜA düzeyi saf OUA olguları ile benzerdi (5,91±1,25 mg/dl, 5,72±1,68 mg/dl, p=0,1). OUA şiddeti arttıkça ÜA düzeyi artmaktaydı (hafif: 5,03±1,41 mg/dl, orta: 5,46±1,55 mg/ dl, ağır: 6,19±1,8 mg/dl, p=0,039). Erkek OUA olgularında ÜA düzeyleri daha yüksekti (6,86±1,64 mg/dl, 4,84±1,10 mg/dl, p, Objective: We examined the serum uric acid (UA) levels among patients with sleep-related breathing disorders (SRBD) and the relationship between UA levels and obstructive sleep apnea (OSA) severity, nocturnal hypoxemia (NH) and obesity hypoventilation syndrome (OHS). Material and Method: Subjects with body mass index (BMI) ≥30 kg/m2 who, according to polysomnography results, have SRBD were included. Demographics, anthropometric measurements and serum UA were recorded. The apnea-hypopnea index (AHI) and oxygen desaturation index (ODI) were recorded. The OSA severity was graded as mild (AHI 5-14 events/hour), moderate (AHI 15-29 events/hour) or severe (AHI ≥30 events/hour). NH was considered when sleep time spent with SpO245 mmHg was considered OHS. Results: The study included 159 patients with SRBD (79 female, 80 males, age: 50.0±10.5 years, BMI: 40.1±5.7 kg/m2). Seventy- six had OHS and 83 had pure OSA. NH was detected in 25.8% of patients. UA levels were higher in subjects with NH (6.22±1.37 mg/dl, 5.67±1.51 mg/dl, p=0.008). UA levels were similar in patients with OHS and pure OSA (5.91±1.25 mg/dl, 5.72±1.68 mg/ dl, p=0.1). UA levels increased as OSA severity increased (mild: 5.03±1.41 mg/dl, moderate: 5.46±1.55 mg/dl, severe: 6.19±1.8 mg/dl, p=0.039). UA levels were higher in males with OSA (6.86±1.64 mg/dl, 4.84±1.10 mg/dl, p

Introduction: We investigated the frequency of granulomatous lung diseases (GLD) in patients with granulomatosis ocular pathologies who referred to our clinic for differential diagnosis. Methods: Diagnosis of sarcoidosis or definitive tuberculosis was made with microbiological and/or histopathological findings. Patients who did not respond to immunosuppressive treatments, and had latent tuberculosis infection proven with PPD and/or Quantiferon-TB test were considered as possible ocular tuberculosis and antituberculosis treatments were given to these patients. Treatment response was evaluated with vision tests and clinical response. Results: Totally 200 patients (58% female, 42% male, age:46±3.9years) included. Ocular pathologies were uveitis in 65.6%, choroiditis in 20%, vascular pathologies in 6.5% and others 8%. Immunosuppressive treatment were given to 132 (66%) cases; 56 (41%) of them received steroid treatment. PPD performed in 173 patients (PPD:16.6±7mm) and PPD was ≥15mm in 125 of them. Quantiferon-TB test was positive in 85.5% of 166 cases. Sarcoidosis was diagnosed histopathologically in 7.5% (n=15/200), tuberculosis was diagnosed microbiologically or pathologically in 2% (n=4/200). Eighty-nine cases were considered as possible tuberculosis with clinical-radiological findings and the presence of latent tuberculosis. Antituberculosis treatment was given to these patients and 50 of them (56%) responded well. Conclusion: Only 9.5% of cases with ocular granulomatosis disease diagnosed definitively tuberculosis or sarcoidosis. In cases who do not respond to immunosuppressive treatments and have latent tuberculosis infection; initiating anti-tuberculosis treatment can provide good results.

Kumbasar, Ozlem Ozdemir/0000-0003-4599-1461 WOS:000514100200008 PubMed ID: 32163363 OBJECTIVES: The aim of this study is to evaluate the approaches of Turkish pulmonologists to the diagnosis and treatment of idiopathic pulmonary fibrosis (IPF) in daily clinical practice. MATERIALS AND METHODS: A questionnaire containing 38 questions about the IPF diagnosis and treatment was given to pulmonologists between January 22 and 29, 2018, and the data of 158 physicians who responded to the questionnaire were evaluated. RESULTS: This survey showed that the mean number of patients that physicians followed up and managed annually was 8.3 and 5, respectively. The mean symptom duration before the diagnosis was 9-12 months. Patients were seen on average by three physicians prior to confirmed diagnosis. Almost 80% of the physicians have an opportunity to access a pathologist and radiologist specialized in IPF. However, only 26% of them have an opportunity to access regular multidisciplinary meetings. Although antifibrotics were the most commonly prescribed drugs, approximately 10% of patients were prescribed steroids, N-acetylcysteine, and immunosuppressants. Most of the physicians (81%) were aware of international guidelines; however, the Turkish Thoracic Society IPF Diagnosis and Treatment Consensus Report was read by only 41% of them. CONCLUSION: This survey may lead to the IPF awareness in Turkey, and it may help to close the gaps regarding the diagnosis and treatment.

WOS:000576587500002 PubMed ID: 33031719 OBJECTIVES: The number of studies on the frequency of obstructive sleep apnea (OSA) in subjects with sarcoidosis is low. Therefore, we aimed to investigate the frequency and predictors of OSA in subjects with clinically stable stage I and II sarcoidosis who were not taking corticosteroid and/or immunosuppressive drugs. We also evaluated restless legs syndrome (RLS) and periodic leg movements in sleep (PLMS). MATERIALS AND METHODS: Subjects with clinically stable stage I and II sarcoidosis and not receiving corticosteroid and/or immunosuppressive therapy were included in the study. Upper airway examination, lung function tests (forced vital capacity [FVC], forced expiratory volume in 1 second [FEV1], diffusing capacity of the lungs for carbon monoxide [DLCO]), and polysomnography were performed on all subjects. In addition, subjects' Epworth Sleepiness Scale (ESS) scores and the Pittsburgh Sleep Quality Index (PSQI) were recorded. RESULTS: Of the total number of 46 sarcoidosis subjects (35 women, 11 men; age: 44.4 +/- 10.7 years; body mass index (BMI): 29.3 +/- 5 kg/m2), 28 (60.9%) were detected with OSA (67.8% mild OSA). The recorded ESS score of the subjects was low (2.6 +/- 3.2), whereas the sleep quality was poor in 36.9% of these subjects. Rapid eye movements (REM) related OSA was diagnosed in 14.2% of the OSA subjects. Age was the only factor related to OSA diagnosis in a logistic regression analysis (p=0.048). None of the subjects were diagnosed with RLS and PLMS. CONCLUSION: OSA is common in stage I and II sarcoidosis subjects who did not receive corticosteroid therapy. The frequency of OSA diagnosis increases as the age of the subjects increases. Therefore, sarcoidosis subjects should be evaluated for OSA throughout the follow-up.

OBJECTIVES To evaluate the characteristics of patients who developed tuberculosis while receiving tumor necrosis factor-alpha (TNF-α) antagonists and the related factors with tuberculosis. METHODS Patient's demographics, tuberculin skin test (TST), isoniazid prophylaxis and type of TNF-α antagonist were recorded. TST conversion (≥5 mm increase) was evaluated for patients who had baseline and 1-year TST. RESULTS Files of 1887 patients who were receiving TNF-α antagonists between August 2005 and June 2015 were evaluated. TST significantly increased at the end of 1 year (n = 748 baseline:7.36 ± 7.2 mm vs. 1 year:9.52 ± 7.5 mm, P

Introduction Parameters related to prognosis in diffuse parenchymal lung disease (DPLD) have a decisive influence on treatment and follow-up processes. We aimed to define baseline characteristics and factors that effect the mortality of the group of patients with DPLD and to determine distinctions between subgroups. Materials and Methods Demographic characteristics, complaints, comorbidity, treatment, pulmonary function tests, echocardiographic findings, six minute walking test (6MWT), arterial blood gases analysis, radiological findings and survival time were collected from outpatient clinics database. Patients' survival time and mortality-related parameters were evaluated. Result This study consisted of 104 patients. Forty-four of them idiopathic pulmonary fibrosis (IPF), 34 scleroderma and 26 rheumatoid arthiritis (RA) with lung involvement. Mortality rates were similar for the groups but median survival was shorter in patients with IPF than scleroderma and RA (IPF: 35.1 ± 22.4 months, scleroderma: 61.1 ± 27.9 months, RA: 60.0 ± 52.1 months; p= 0.001, p= 0.016 respectively). Mortality was higher in patients who are > 60 years old (24/64 vs. 5/40, p= 0.007), had chronic obstructive pulmonary disease (COPD) (5/7 vs. 24/97, p= 0.017), gastroesophageal reflux (7/13 vs. 22/91 p= 0.043) and usual interstitial pattern (11/48 vs. 18/56, p= 0.054), low PaO2 (< 60 mmHg) at admission (6/8 vs. 8/32, p= 0.014), desaturation on 6MWT (13/28 vs. 1/18, p= 0.003), high reduction of DLCO/year (6/10 vs. 4/33, p= 0.023). COPD and 6 minute walking distance (6MWD) were found as independently related factors for mortality (p= 0.013, p= 0.02) for whole group. Conclusions As a result, 6MWD and COPD were found as independently related factors for mortality for all patients. In subgroup analysis for IPF, scleroderma, and RA; 6MWD is only independent factor for mortality.

A possible association between periodontitis and obstructive sleep apnea (OSA) has been suggested. The aim of this study is to compare periodontitis prevalence between controls and patients with OSA by assessing clinical periodontal parameters and gingival crevicular fluid (GCF) levels of interleukin (IL)-1β, tumor necrosis factor (TNF)-α, and high-sensitive C-reactive protein (hs-CRP); serum hs-CRP was also sampled.A case-control study was performed that included 163 individuals: 83 individuals (18 females and 65 males) with OSA and 80 non-OSA individuals (23 females and 57 males) as controls. The test group was classified according to OSA severity. Clinical periodontal measurements were recorded, and GCF samples were collected. GCF hs-CRP, IL-lβ, and TNF-α levels were analyzed using an enzyme-linked immunosorbent assay method. Serum hs-CRP was measured by latex-enhanced immunoturbidimetric assay.Prevalence of periodontitis in the OSA group (96.4%) was significantly higher than in the control group (75% [P0.001]). Severe periodontitis prevalence was higher in the OSA group than control group. All periodontal clinical parameters and GCF IL-lβ concentrations were significantly higher in patients with OSA than in controls (P = 0.001). No significant differences were found between the mild OSA and moderate-to-severe OSA groups. Additionally, there was no significant difference in GCF TNF-α and hs-CRP levels between the groups (P0.05). Serum hs-CRP levels were significantly higher in patients with OSA. A significant correlation was found between GCF IL-1β and all clinical parameters.Results demonstrated higher prevalence of periodontitis and higher levels of GCF IL-1β and serum hs-CRP in patients with OSA. However, there is still a need for randomized clinical trials testing oral care interventions.

Coccidioidomycosis caused by Coccidioides immitis or Coccidioides posadasii is a rare infectious disease except in endemic regions. In this report the third documented imported case of coccidioidomycosis in Turkey was presented. A thirty-year-old male patient was admitted to our hospital with fever and purulent drainage from his chest tube. He had worked in Arizona, USA, until 4 months before this presentation. While in Arizona, he experienced cough and hemoptysis and was diagnosed as pulmonary coccidioidomycosis. He was treated with itraconazole for two months and he had no symptoms for 3 years. He then returned to Turkey and 2 months after his return to Turkey, he was admitted to another hospital in Istanbul with dyspnea and diagnosed as hydro-pneumothorax, and pleural fluid obtained from the inserted chest tube was found to be purulent. One gram of BID amoxicillin-clavulanate was given. Physical examination on admission revealed a purulent drainage on the right side chest tube, a temperature of 38.5°C and decreased breath sounds on the right lung. Piperacillin-tazobactam 3 x 4.5 g intravenous and fluconazole 400 mg intravenous once daily were started. Human immunodeficiency virus test was negative. Gram-negative diplococci and rods, gram-positive cocci and septate hyphae were seen in the Gram stain of his pleural fluid. Pleural fluid culture revealed Moraxella catarrhalis after 24 hours incubation and a mold after 72 hours of incubation. Anti-coccidioidal antibodies were found positive in a titer of 1/2. Hydro-pneumothorax, atelectasis and a 3 mm nodules in the right lung were seen in his thorax CT. The patient's pleural fluid and the culture plates were sent to the Public Health Institute of Turkey, Mycology Reference Laboratory (PHIT-MRL), with a clinical suspicion of coccidioidomycosis. The specimen and plates were submitted to the PHIT-MRL Bio Safety Level-3 laboratory for mycological evaluation. The microscopic examination of 15% KOH preparations of pleural fluid specimens revealed septate hyphae which appear to be in the early stages of forming arthroconidia. The pleural fluid culture grew buff-white coloured colonies with aerial hyphae, which were suspected of being a Coccidioides spp. The strain was identified as C.immitis/posadasii by direct microscopy and culture, and subsequently confirmed by the FDA-approved DNA probe. DNA sequence analysis of the ITS and D1/D2 rDNA regions confirmed the isolate to be C.posadasii species [ITS 100% match to GenBank Accession No. AB232901 (630/630 base pair match), and D1/D2 100% match to GenBank Accession No. AB232884 (617/617 base pair match)]. ITS1 and ITS2 barcode analysis also confirmed the species to be C.posadasii, which is the species endemic in Arizona. Susceptibility testing was performed according to Clinical and Laboratory Standards Institute M38-A2 guidelines in the Fungus Testing Laboratory of the University of Texas Health Science Center at San Antonio and minimal inhibitory concentration values were; 0.125 µg/ml for amphotericin B, posaconazole and voriconazole, 0.5 µg/ml for itraconazole and 8 µg/ml for fluconazole. He had decortication of the pleura and was discharged from hospital after six weeks treatment with intravenous fluconazole which was continued orally for one year. Anti-coccidioidal antibodies were negative after two months of treatment. The patient is currently asymptomatic. The presented case is the third case reported from Turkey and provides additional contribution to the existing literature with regard to the appearance of arthroconidium, which is the unusual hyphal form, instead of the expected spherules in the infected tissue.

Pulmonary hypertension (PH) is a fatal disease although significant improvements in treatment are achieved. Easily implemented and noninvasive prognostic techniques are needed while following-up these patients. The aim was to investigate the role of fractional exhaled nitric oxide (FeNO) in follow-up for patients with PH. In this longitudinal study, patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic PH (CTEPH) who were seen in PH Outpatient Clinic, Istanbul Faculty of Medicine, Istanbul University, were enrolled in the study. Echocardiography, 6-minute walking test, brain natriuretic peptide, and FeNO measurements were performed, and World Health Organization functional class was evaluated to all patients at baseline, and third, and sixth months. Right-heart catheterization and pulmonary function tests at the time of diagnosis were recorded. The study comprised 31 patients (23 women, 8 men; mean age: 53.4 ± 17.1 years) with PAH (n = 19) and CTEPH (n = 12) and 80 healthy controls. Patients with PH had lower FeNO values than the control group (16.5 ppb vs 19.8 ppb; P < .05). Fractional exhaled nitric oxide values did not change during follow-up and did not correlate with other follow-up measures except tricuspid annular plane systolic excursion values. Fractional exhaled nitric oxide was higher in the idiopathic PAH subgroup at baseline and at third month than patients with PAH associated with other diseases. Fractional exhaled nitric oxide did not change in patients who had clinical deterioration. As a conclusion; Patients with PH had lower FeNO values than healthy controls, but FeNO did not change significantly during follow-up. Large-scale studies with prolonged follow-up periods are needed to understand the role of FeNO in the follow-up of the patients with PH.

Background: As obesity increases, the frequency of obstructive sleep apnea and obesity hypoventilation syndrome increases also. However, obesity hypoventilation syndrome frequency is not known, as capnography and arterial blood gas analysis are not routinely performed in sleep laboratories. Aims: To investigate the frequency and predictors of obesity hypoventilation syndrome in obese subjects. Study Design: Retrospective clinical study Methods: Obese subjects who had arterial blood gas analysis admitted to the sleep laboratory and polysomnography were retrospectively analyzed. Subjects with restrictive (except obesity) and obstructive pulmonary pathologies were excluded. Demographics, Epworth-Sleepiness-Scale scores, polysomnographic data, arterial blood gas analysis, and spirometric measurements were recorded. Results: Of the 419 subjects, 45.1% had obesity hypoventilation syndrome. Apnea hypopnea index (p

Introduction: Minor salivary gland biopsy is used as a minimally invasive method in the diagnosis of sarcoidosis. To date, a few studies have shown that minor salivary gland biopsy is an diagnostic tool in differentiating sarcoidosis from tuberculosis. In this study we evaluated the diagnostic yield of minor salivary gland biopsy in patients with sarcoidosis. Material and methods: The study included patients with sarcoidosis who were diagnosed during the last 10 years in Pulmonary Department of Istanbul Medical Faculty. Baseline diagnostic tests, histopathological results and clinical findings were recorded. Results: Totally, 354 patients (270 female, 84 male, mean age: 46.48) with sarcoidosis were analyzed. Radiologically, 7.3% was stage 0, 46.6% was stage I, 33% was stage II, 9% was stage III, and 3.9% was stage IV. Respiratory functions were normal in 70%, diffusion capacity was normal in 66% and 18.8% had obstructive pattern, 10.9% had restrictive pattern in spirometry. The most common extrapulmonary involvement was skin (%22.8) and eye (%16.9). Minor salivary gland biopsy was performed in 215 cases and 49.3% of them had findings compatible with sarcoidosis. In 13.8% of the cases, the diagnosis was based on only minor salivary gland biopsy and clinical-radiological findings. Conclusion: In our study, salivary gland biopsy was diagnostic in half of the cases, and in 13.8% of the cases was diagnosed without any other invasive procedure. Therefore, it can be used as a priority biopsy method in patients with clinical and radiological suspicion of sarcoidosis.

Objective: To examine the serum levels of leptin and adiponectin in different obstructive sleep apnea (OSA) phenotypes. Methods: Obese patients who were admitted to our sleep laboratory were included. All patients underwent spirometry, daytime arterial blood gas analysis, polysomnography and transthoracic echocardiography. Serum levels of adiponectin and leptin were recorded. Results: Analysis included 146 OSA patients (81 females, 65 males, age: 49.8 ± 10.7 years, body mass index: 40.3 ± 4.9 kg/m2, 47.9% severe OSA, 42.5% severe obesity). Females had higher leptin and adiponectin levels (p

OBJECTIVE: Nicotine is the main addictive agent present in tobacco and is principally metabolized by a cytochrome P450-mediated oxidation process. While smoking patterns differ widely among smokers, the metabolization rate of nicotine can also be affected by variations in rates of enzyme activity between individuals. Therefore, we aimed to investigate the significance of CYP2A gene variants in the smoking status in a Turkish population using next-generation sequencing (NGS). METHODS: This case–control study involved 64 subjects with Nicotine dependence (ND) and 36 Non-smoker (NS) subjects. Amplicants designed by “Primer-BLAST” programme were all sequenced using the “Illimuna-MiseqQ-platform”. RESULTS: It was found that there were five SNPs in the CYP2A6 gene (rs8192725, rs7248240, rs1809810, rs8192733 and rs28399435). CYP2A6 rs1809810 homozygous TT genotype and T allele were seen in lower percentages in ND group compared to the NS group (p =0.045; p =0.021). Individuals with CYP2A6 rs1809810 TT genotypes and T allele showed odds ratio of 4.760 and 5.360 for developing protective role ND, respectively. CYP2A6 rs8192733 CC genotype and C allele were both lower in ND group (respectively p =0.001, p =0.023) while GC genotype was higher in the ND group (p =0.004). CYP2A6 rs28399435 TT genotype and T allele were more common in the ND group (respectively p =0.001, p =0.001). CYP2A6 rs28399435 CC genotype was lower in the ND group than in the NS group (p =0.010). CONCLUSIONS:CYP2A6 rs1809810, rs8192733, rs28399435 could be genetic risk factors for ND in a Turkish population. © 2018, © 2018 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. 47815 This study was supported by Istanbul BAP-ONAP (47815) programme. This study was supported by Istanbul University BAP-ONAP (47815) programme. The authors would like to thank the ?Yedikule Smoking Cessation Study Group? for their contributions. Yedikule Smoking Cessation Study Group: Ay?e Bahad?r, Sibel Yurt, Efsun Gonca Ugur Chousein, Seda Tural Onur, Balma Akbaba Bagc?, Didem Gorgun Hattatoglu, M. Gonenc Ortakoylu, Bar?? Ac?kmese, ?ule Gul, Elif Tanr?verdi O. 2-s2.0-85057596434

WOS:000473683900005 PubMed ID: 31333769 OBJECTIVES: Obesity hypoventilation syndrome (OHS) and some neuromuscular diseases (NMD) present with hypercapnic respiratory failure. Arterial blood gas (ABG) analysis is important in the diagnosis, follow-up, and treatment response of these diseases. However, ABG sampling is difficult in these patients because of excessive subcutaneous fat tissue, muscle atrophy, or contracture. The aim of this study is to investigate the value of venous blood gas (VBG), which is an easier and less complicated method, among stable patients with OHS and NMD. METHODS: The study included stable OHS and NMD patients who had been previously diagnosed and followed up between March 2017 and May 2017 in the outpatient clinic. ABG was taken from all patients in room air, and peripheral VBG was taken within 5 min after ABG sampling. RESULTS: Thirty-six patients with OHS and 46 patients with NMD were included in the study. There was a moderate positive correlation between arterial and venous pH values for all patients (rs= 0.590, P < 0.001). There were a strong and very strong positive correlations between arterial and venous pCO2and HCO3values (rs= 0.725 and rs= 0.934, respectively) (P < 0.001). There was no correlation between arterial and venous pO2and saturation values. There was an agreement in BlanduAltman method for the values of ABG and VBG (pH, pCO2, and HCO3). CONCLUSIONS: There was a correlation between ABG and VBG values (pH, pCO2, and HCO3). VBG parameters (pH, pCO2, and HCO3) can be used safely instead of ABG parameters which have many risks, during treatment and follow-up of patients with OHS and NMD.

Aylin Pihtili,1 Zuleyha Bingol,2 Esen Kiyan2 1Department of Pulmonary Medicine, Bezmialem Vakif University, Faculty of Medicine, Istanbul, Turkey; 2Department of Pulmonary Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey Background: Endothelial cell specific molecule-1, also called as endocan, is a dermatan sulfate proteoglycan, which is expressed by endothelial cells in alveolar walls of the lung and kidney. High endocan levels are found associated with endothelial dysfunction and inflammation. We hypothesize that endocan level is also high in COPD due to systemic inflammation and endothelial dysfunction. We aimed to investigate the expression of endocan in patients with stable COPD.Material and methods: The study included patients with COPD and control subjects. COPD patients were classified according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017 criteria. Demographics, body mass index, smoking history, and comorbidities were recorded. Endocan levels of COPD patients and controls were compared.Results: Totally, 88 subjects (47 stable COPD patients, 41 controls) were evaluated. Endocan levels were significantly higher in COPD patients than control group (860.1±259.8 vs 647.3±316.9 pg/mL, P=0.001). There was no relationship between GOLD COPD categories and endocan levels. Also endocan levels were similar between COPD patients with or without hypoxemia.Conclusion: Serum endocan level was significantly higher in patients with stable COPD. Further studies should be performed to better understand the relationship between endocan and COPD. Keywords: chronic obstructive pulmonary disease, endothelial cell specific molecule-1, endothelial dysfunction, systemic inflammation

Introduction: Risk of recurrence and bleeding, play a role in considering the optimal duration of treatment. The aim of the study was to determine the frequency of recurrence, risk factors for recurrence and bleeding in cases with VTE. Material-methods:: Study included 412 VTE patients (164 male, 248 female, mean age: 53.5years, follow-up period: 25.3months). Patient9s demographics, risk factors, comorbidities, clinical data, treatment and complications were recorded. Results: There was at least one risk factor in 341 (82.7%) patients and 71 (17.2%) of them were idiopathic. In 76 (18.4%) of the cases VTE recurrence developed. There was no difference between recurrent and non-recurrent groups according to age and sex. There was no relationship between recurrence and mortality. Recurrence was higher in DVT and / or PTE+DVT groups than PTE group (24% vs 14.2%, p=0.007). Idiopathic VTE was higher in recurrent cases (26.3% vs 15.2%, p=0.028). D-dimer levels were higher in recurrent cases at first year control (p=0.034). Hereditary risk factors were higher in recurrent cases (p=0.031). During VTE treatment, 37 (8.9%) of cases had bleeding however major bleeding rate was 3.6%. Duration of anticoagulant was longer in patients who had bleeding (22months vs 12months p=0.047). Bleeding rate was higher in patients with massive PTE (p=0.001) and in elderly patients (≥75years) (p=0.036). Conclusion: In our study, presence of DVT, idiopathic VTE, hereditary risk factors and high D-dimer levels at first year were found as related factors of recurrence. Risk of bleeding increased in recurrent cases, in elderly cases and in cases whose treatment duration was longer in the first VTE event.

Introduction: Arterial blood gas (ABG) sampling is difficult in patients with obesity hypoventilation syndrome (OHS) and neuromuscular diseases (NMD). Our aim was to investigate the usability of venous blood gas (VBG) analysis, to replace ABG. Material and Methods: Study included stabilized OHS and NMD patients. ABG was taken from all of the cases in the room air and peripheral VBG samples were taken within 5 minutes after ABG analysis. Results: Totally 82 cases (female:33, male:49, mean age:46.9years) with OHS (n=36) and NMD (n=46) were included. For all patients, there was a moderate positive correlation between arterial and pH values (rs=0.590, p For NMD patienst; there was moderate positive correlation between arterial and venous pH and PCO2 values (rs=0.542, rs=0.540, p Conclusion: We found a relationship between ABG and VBG for the values of pH, PCO2 and HCO3. As a results, VBG values (pH, pCO2, HCO3) can be used safely during treatment and follow-up period of the patients with OHS and NMD, instead of ABG.

28th International Congress of the European-Respiratory-Society (ERS) -- SEP 15-19, 2018 -- Paris, FRANCE, WOS: 000455567105150, …, European Respiratory Soc

Introduction: Reactivation of tuberculosis (TB) suggests the inadequate treatment, while reinfection informs about the risk of infection in the community. This study investigated the rate of reactivation or re-infection in recurrent TB cases. Method: Fifty five recurrent TB cases in 12 districts of Istanbul between 2002 and 2015 were included. One of the cases was MDR-TB. All of them were treated successfully in the first episode (60% cured, 40% completed treatment). Fingerprints of strains obtained during the first and recurrent disease episodes were determined by spoligotyping method. Results: Of 55 cases with culture positive lung TB (44 male, 11 female, age:32.9±12.6 years), 39 (70.9%) were smear positive in the first episode. Thirty (54%) cases were smoking. Additional diseases such as; DM (n=2), COPD/asthma (n=3), and silicosis (n=1) were reported. All were treated with standard regimen for at least 6 months. INH resistance in 5 (9.1%), RIF resistance in 1 (1.8%), ETM resistance in 2 (3.6%), SM resistance in 7 (12.7%) were detected in the first episode. Directly observed treatment (DOT) was applied to 26 (47.3%) cases. Of 55 recurrent tuberculosis cases, 49 (89%) were reactivation and 6 (10.9%) reinfection. Mean time to reactivation was 3.6 years and reinfection was 2.83 years. DOT, smoking, completion of treatment or cure did not effect in cause of recurrence Conclusion: The cause of recurrence in lung TB was reactivation in Istanbul. This may be attributed to relatively low incidence of smear-positive TB disease in Istanbul, as well as the lack of therapeutic treatment quality.

The STOP-BANG questionnaire (SBQ) has never been studied in the context of its ability to predict obesity hypoventilation syndrome (OHS). Our aim was to evaluate the predictive performance of the original and modified SBQs for OHS in obese subjects with obstructive sleep apnea (OSA). Demographics, polysomnographic data, body mass index (BMI), Epworth Sleepiness Scale (ESS) scores, arterial blood gases, spirometric measurements, and SBQ scores were recorded. The modified SBQ was created by dividing BMI into ranges and adding the serum bicarbonate ranges. The study included 196 obese subjects, of whom 17 had normal polysomnography. Of the remaining subjects, 105 had pure OSA and 74 had OHS with OSA. Both the original and modified SBQs scores were higher for the OHS subjects than for those with pure OSA (p

Patients with chronic obstructive pulmonary disease (COPD) who have nocturnal oxygen desaturation (NOD) can be treated with nocturnal oxygen therapy (NOT) to avoid possible morbidity and mortality. Although there is no definite data recommending NOT alone, our aim is to evaluate the relationship between desaturation during the six-minute walk test (6MWT) and NOD in COPD. Fifty-five stable patients with COPD were enrolled in this study. The 6MWT and nocturnal oximetry were performed. Patients with comorbid diseases and respiratory failure were excluded. In total, 55 patients (49 males and 6 females, mean age: 65.8 ± 8.4 years) were analysed. Twenty-seven of the patients had moderate COPD and the remainder ( n = 28) had severe COPD. Three patients (11%) with moderate COPD and 12 patients (42.9%) with severe COPD desaturated during 6MWT ( p = 0.003). NOD was observed in five patients with severe COPD (17.9%). There were no patients with NOD in the moderate COPD group. Three (25%) of patients with severe COPD who desaturated during the 6MWT also had NOD. NOD was more common in patients with severe COPD and the patients with higher carbon dioxide levels ( p = 0.02 and p = 0.001). Three patients (11%) with moderate COPD desaturated during the 6MWT; however they did not have NOD. Although the sample size in this study was too small to be conclusive, NOD was more common in desaturators during the 6MWT particularly in patients with severe COPD.

Introduction: Impairment in pulmonary functions and sleep related breathing disorders in patients with lipid storage disease (LSD) are unknown. We aimed to evaluate impairment in pulmonary functions and sleep related breathing disorders in patients with LSD. Methods: Pulmonary functions (FEV1, FVC, upright-supine %FVC change, MIP, MEP, PCF), arterial blood gas analysis (ABG) and polysomnography of patients with LSD were evaluated. Results: Twenty-five patients with LSD are evaluated [17 male, 8 female; age:34.9±15.02years, BMI:26.5±3.4kg/m2(19-31kg/m2)]. MIP:72.2±32.7cmH2O ( 45mmHg). Obstructive sleep apnea (OSA) was found in 80% of patients (n=20; 9 mild, 9moderate, 2 severe). REM sleep had decreased in all patients (10.2%±6.1).For patients with OSA; apnea-hypopnea index (AHI):20.8±15.9/hour, apnea index:8.4±17.6/hour, hypopnea index:14.1±9/hour, REM AHI:30.6±19.7/hour, NREM AHI:19.7±16.6/hour, oxygen desaturation index (ODI):11.9±15.4/hour, REM-ODI:27.2±26.1/hour, NREM-ODI:11.4±15/hour. Nocturnal average SpO2: 94.9%±1.7, lowest SpO2:73.3%±13.9, time spent with SpO2 Conclusion: Pulmonary functions are adversely affected in LSD. Daytime hypercapnia, reduction in cough strength and OSA are frequent in LSD. ABG and polysomnography should be performed even pulmonary functions are normal in LSD.

Introduction Increased obstructive sleep apnea (OSA) incidence has been reported in sarcoidosis. However, no research has been conducted to determine the relation between OSA and pulmonary parenchymal involvement in sarcoidosis. Objectives We investigated OSA frequency and association between pulmonary parenchymal involvement and OSA in sarcoidosis. Additionally, relationship between lung functions and polysomnography data was assessed. Methods The study enrolled sarcoidosis subjects with or without pulmonary parenchymal involvement. Spirometry, diffusion capacity, 6-min walking test, arterial blood gases, chest X-ray, Epworth sleepiness scale (ESS) and polysomnography were performed. Subjects with body mass index (BMI) ≥30 or significant upper airway pathologies that might cause OSA were excluded. Results A total of 29 sarcoidosis subjects (15 with, 14 without parenchymal involvement) with mean age 43.8 ± 9.4 years were analyzed. Twenty-seven of them were female. BMI was 26.8 ± 4.2 kg/m2. Mean forced expiratory volume 1 s (FEV1) was 97.89% ± 20.21%, and forced vital capacity (FVC) was 102.86 ± 18.14%. ESS score was 4 ± 1.6. OSA was identified in 51.7% (n = 15) of subjects. Apnea-hypopnea index (AHI) was 16.16 ± 19/h and oxygen desaturation index (ODI) was 22.3 ± 25.99 among subjects with OSA. Sleep apnea related with rapid eye movement was present in 40% of OSA subjects. AHI and ODI were higher among sarcoidosis subjects with parenchymal involvement (P = 0.019, P = 0.026). OSA frequency was higher in the group with parenchymal involvement, but the difference was not statistically significant (n = 10/15, %66 vs n = 5/14, %35). FEV1 and FVC were not related with AHI and ODI. Conclusion We found a high rate of OSA in sarcoidosis. There was a trend of high OSA frequency in sarcoidosis subjects with parenchymal involvement.

INTRODUCTION: Body composition is an important parameter for patients with chronic obstructive pulmonary disease (COPD) whereas the association between asthma and obesity is not fully understood. The impact of diseases severity of asthma on fat free mass (FFM) has not been investigated. We aim to investigate the relationship between fat free mass and asthma control. METHODS: Patients with stable asthma referred to our outpatient clinic were evaluated. Demographics were noted. Asthma control test (ACT) was performed. Patients were divided into two groups according to ACT; ACT >19 (undercontrol) and ACT ≤19 (uncontrolled). Body composition assessment (using bioelectrical impendance analysis) was performed. RESULTS: One hundred- seventy two patients (F/M: 140/32, age: 53.7±12.6 years, BMI: 29.1±5.4kg/m2 with asthma were included the study. FMM was significantly higher in group under control than uncontrolled group (respectively; 49.8±8.2 vs. 46.7±4.9 p¬=0.002).Mean BMI wassimiliar in twogroups (respectively; 28.6±5.6 vs. 30.2±4.8 p=0.07).There was no difference in the frequency of obesity (BMI>30 kg / m2) between control and non-control patients. DISCUSSION AND CONCLUSION: FMM may be a more valuable finding in assesing asthma control than BMI and obesity. Further studies should be performed to beter understand the relationship between FFM and asthma control.

Introduction: Pulmonary hypertension (PH) is a chronic, progressive disease with a high morbidity and mortality. Its pathobiology involves interacting pathways of prostacyclin (PGI2), endothelin, and nitric oxide (NO). There are few studies which evaluated exhale NO levels in patients with PH. Aim of this study was to investigate the levels of exhaled NO in PH patients. Methods: Patients who were followed in Istanbul Faculty of Medicine, Pulmonary Hypertension Outpatient Clinic were enrolled in this study. Exhaled NO levels of patients with PH were compared to age and gender matched healthy controls. Results: Data of 38 patients with PH (28 females, 10 males, age:54.5±16.3years) were compared to 80 healthy controls (55 females, 25 males, age:49.8±14.4years). Etiologies of PH were pulmonary arterial hypertension (PAH, n=24) and chronic thromboembolic pulmonary hypertension (CTEPH, n=14). NYHA functional class of the patients were mostly II (68.4%). Thirteen of them (41.9%) were given PH specific treatment (prostacyclin derivatives, endothelin receptor antagonists, phosphodiesterase inhibitors). Estimated systolic pulmonary arterial pressure (PAP) by transthoracic echocardiography was 64.9±28.2mmHg and TAPSE was 1.88±0.48. ProBNP measured 1169.2±2858.9pg/ml. Right heart catheterization revealed systolic PAP 87.1±39.4mmHg, mean PAP 55.9±25.4mmHg, PVR 7.9±5.3wood. Exhaled NO levels were lower in patients with PH than healthy controls (16.7±6.8ppb vs 19.8±7.7ppb, p=0.036). Exhaled NO levels were not different between patients with PAH and CTEPH (16.7±6 vs 16.7±7.7, p=0.458). Conclusions: Our study showed a significant reduction in exhaled NO levels in PH patients.

Fatigue is one of the most important symptom of chronic respiratory diseases. However fatigue in patients with asthma has not been adequately investigated. The aim of this study was to determine the fatigue, exercise capacity, daily activities, anxiety and depression in patients with asthma and assess the relationships between these parameters. METHOD: Study were conducted in Istanbul University Faculty of Medicine, Department of Chest Diseases. Subjects with neurological problems, smokers and patients with cognitive impairment are not included in the study. The demographic characteristics of the participants were recorded. The “Fatigue Severity Scale (FSS)” and “Fatigue Impact Scale (FIS)” is used to assess fatigue. London Chest Activities of Daily Living Scale (LCADL) is used for the evaluation of daily activities, Hospital Anxiety and Depression Scale(HAD) are used for evaluate anxiety and depression. 6-minute walk test(MWT) is used to determine the exercise capacity. RESULT: Twenty subjects with asthma (52.8±9.9 years) and age matched 20 healthy volunteers participated the study. There was statistically significant difference found in fatigue impact and fatigue severity scales, LCADL and 6MWT (p CONCLUSION: Our study results showed the patients with asthma has low exercise capacity compared with healthy subjects and the possible reason of that is fatigue.Studies with larger sample size groups needed for further researches.

Aims: CYP2A6 and CYP2A13 genes are sub grouped in CYP2A gene cluster and have important role in nicotine detoxification mechanisms. We aimed to determine the variants of CYP2A6 and CYP2A13 in smokers and non-smokers. Material and Methods: 64 smokers and 36 non-smokers were included in the study. DNAs were isolated from 100 peripheral blood samples. The amplicants of genes using the primers which were designed by “Primer-BLAST” program were sequenced in “Illimuna-MiseqQ-platform. Results: Mean age was 47±13 for smokers, and 34±12 for non-smokers. The age and gender difference between smokers and non-smokers was significant (p Conclusion: The full genome sequence in CYP2A6 and CYP2A13 genes analysed for the first time in our study. CYP2A6 gene variants distrubition and numbers with the different haplotypes were significantly increased (5 and 6 in smokers, 3 and 10 in non-smokers) . CYP2A13 gene variants were increased in smokers compared to non-smokers. The result supports that the variant haplotypes could be effective in maintaining the smoking addiction. This study was supported by Istanbul Univesity, BAP-ONAP support program .

Objective: To investigate the level of endothelial cell specific molecule-1 (endocan) in obstructive sleep apnea (OSA). Methods: Study group included subjects with OSA. Control group included subjects who had no OSA on polysomnography and nonobese healthy subjects from population who had no OSA symptoms. Endocan levels of OSA and non-OSA subjects were compared. Results: Totally 106 individuals (63 OSA, 43 non-OSA) were included. Endocan levels were higher in OSA subjects than controls (1.25 ± 0.4 ng/ml vs 0.93 ± 0.3 ng/ml, p < 0.001). Endocan levels were correlated with BMI (r = 0.456, p < 0.001) and daytime PaO2 (r = -0.266, p < 0.042). In linear regression analysis there was no factor related to endocan level. Conclusion: Serum endocan is significantly higher in OSA. Further studies should be performed to better understand the relationship between endocan and OSA.

We herein report a patient case with familial amyloidotic polyneuropathy (FAP) who presented with vocal cord paralysis (VCP). A 60-year-old man with FAP (Gly89Gln) presented with hoarseness and snoring for the previous two years. A chest X-ray demonstrated cardiomegaly and bilateral diaphragmatic elevation. The findings of a restrictive pattern on spirometry and daytime hypercapnia were consistent with respiratory muscle weakness related to neuropathy [forced expiratory volume (FEV1): 38%, forced vital capacity (FVC): 39%, FEV1/FVC: 77, partial pressure of arterial oxygen (PaO2): 80 mmHg, partial pressure of carbon dioxide in arterial blood (PaCO2): 52 mmHg]. An ear-nose-throat examination showed VCP. Polysomnography revealed severe obstructive sleep apnea (OSA). FAP may cause OSA by VCP and hypercapnic respiratory failure by respiratory muscle weakness. Therefore, an ear-nose-throat examination, spirometry, arterial blood gases analysis and polysomnography are important for these patients.

We describe 2 unusual cases of tracheopathia osteochondroplastica (TPO), one of them presenting with lung carcinoma and the other at an uncommon age. A 74-year-old man presented with chronic bronchitis and a left lower lobe lesion as detected on chest computed tomography. Flexible bronchoscopy revealed multiple calcified nodular lesions involving the anterior-lateral walls of the trachea and main bronchi. Histologic analysis of the tracheal nodules confirmed the presence of TPO. Squamous cell carcinoma was diagnosed by transthoracic needle aspiration of the pulmonary nodule. The relevance of coexistence of these 2 conditions remains unknown. Our second case was in a young man who presented with persistent cough and a chest computed tomography scan revealing multiple tracheal nodules. Numerous hard tracheal nodules distributed around the lower trachea and main bronchi were observed at flexible bronchoscopy. When the cough and dyspnea persists despite conventional empiric treatment, uncommon tracheobronchial pathologies, such as TPO, should be considered.

Introduction: Ehlers-Danlos syndrome (EDS) is an uncommon cause of hemoptysis and spontaneous hemopneumothorax. We present a case with recurrent hemoptysis who had bronchial artery pathology and anomalous pulmonary venous return associated with EDS. Case: Twenty-years-old female presented with recurrent hemoptysis for two years. Thoracic tomography was normal. Six months of antituberculosis therapy were given due to M. tuberculosis growth in sputum cultures. Ear-nose-throat examination revealed lesions in bilateral nasal conchae and lesions were cauterized. As the hemoptysis persisted, a diagnostic bronchoscopy was performed and revealed an active source of bleeding at the orifice of superior segment of the right lower lobe. Bronchial artery ligation was performed via right thoracotomy. Echocardiogram revealed mitral and tricuspid valve prolapsed. Ophthalmologic examination was performed due to atypical localization of pupils. Bilateral coloboma, nistagmus and ectopia lentis were found. Patient history was positive for spontaneous ecchymosis, premature loss of teeth, increased joint laxity. Genetic physicians found these findings to be consistent with EDS type 6. Skin and subcutaneous tissue biopsies were performed and the definitive diagnosis was made using electron microscopy, fibroblast culture and mutation analysis. A hereditary transmission could not be demonstrated. Pulmonary angiography revealed a tortuous course in distal branches of bronchial arteries and early venous return consistent with arteriovenous fistula. Bilateral bronchial artery embolization was performed. Patient9s hemoptysis regressed. Conclusion: In this care, EDS was found as an uncommon cause of hemoptysis.

Introduction: Levels of adipokines in obstructive sleep apnea (OSA) and different OSA stages remains contraversial. Additionally adipokines levels in OSA with hypercapnia, pulmonary hypertension remains unknown. We examined serum levels of leptin and adiponectin in different subgroups of OSA. Methods: Obese subjects who were admitted to sleep laboratory were included. All subjects underwent spirometry, arterial blood gas analysis, polysomnography and transtoracic echocardiography. Serum levels of leptin and adiponectin were recorded. Results: Analysis included 146 OSA subjects (81 females, 65 males, age:49.8±10.7years, BMI:40.3±4.9kg/m 2 , 47.9% severe OSA). Of all subjects 37.7% had daytime hypercapnia, 61.6% had metabolic syndrome and 28.7% had pulmonary hypertension. Females had higher leptin and adiponectin levels (p 2 (p Discussion: Levels of adipokines were different especially in OSA subjects with malign obesity, female gender and severe disease.

Arterial blood gas (ABG) analysis is not a routine test in sleep laboratories due to its invasive nature. Therefore, the diagnosis of obesity hypoventilation syndrome (OHS) is underestimated. We aimed to evaluate the differences in subjects with OHS and pure obstructive sleep apnea (OSA) and to determine clinical predictors of OHS in obese subjects.Demographics, body mass index (BMI), Epworth Sleepiness Scale score, polysomnographic data, ABG, spirometric measurements, and serum bicarbonate levels were recorded.Of 152 obese subjects with OSA (79 females/73 males, mean age of 50.3 ± 10.6 y, BMI of 40.1 ± 5.6 kg/m(2), 51.9% with severe OSA), 42.1% (n = 64) had OHS. Subjects with OHS had higher BMI (P = .02), neck circumference (P.001), waist circumference (P.001), waist/hip ratio (P = .02), Epworth Sleepiness Scale scores (P = .036), ABG and serum bicarbonate levels (P.001), apnea-hypopnea index (P = .01), oxygen desaturation index (P.001), and total sleep time with S(pO2)90% (P.001) compared with subjects with pure OSA (n = 88). They also had lower daytime PaO2 (P.001), sleep efficiency (P = .032), mean S(pO2) (P.001), and nadir S(pO2) (P.001). Serum bicarbonate levels and nadir S(pO2) were the only independent predictive factors for OHS. A serum bicarbonate level of ≥ 27 mmol/L as the cutoff gives a satisfactory discrimination for the diagnosis of OHS (sensitivity of 76.6%, specificity of 74.6%, positive predictive value of 54.5%, negative predictive value of 88.9%). A nadir S(pO2) of80% as the cutoff gives a satisfactory discrimination for the diagnosis of OHS (sensitivity of 82.8%, specificity of 54.5%, positive predictive value of 56.9%, negative predictive value of 81.4%). When we used a serum bicarbonate level of ≥ 27 mmol/L and/or a nadir S(pO2) of80% as a screening measure, only 3 of 64 subjects with OHS were missed.Serum bicarbonate level and nadir saturation were independent predictive factors for the diagnosis of OHS.

Increased obstructive sleep apnea (OSA) incidence has been reported in sarcoidosis. However, no research has been conducted to determine the relation between OSA and pulmonary parenchymal involvement in sarcoidosis.We investigated OSA frequency and association between pulmonary parenchymal involvement and OSA in sarcoidosis. Additionally, relationship between lung functions and polysomnography data was assessed.The study enrolled sarcoidosis subjects with or without pulmonary parenchymal involvement. Spirometry, diffusion capacity, 6-min walking test, arterial blood gases, chest X-ray, Epworth sleepiness scale (ESS) and polysomnography were performed. Subjects with body mass index (BMI) ≥30 or significant upper airway pathologies that might cause OSA were excluded.A total of 29 sarcoidosis subjects (15 with, 14 without parenchymal involvement) with mean age 43.8 ± 9.4 years were analyzed. Twenty-seven of them were female. BMI was 26.8 ± 4.2 kg/m(2) . Mean forced expiratory volume 1 s (FEV1 ) was 97.89% ± 20.21%, and forced vital capacity (FVC) was 102.86 ± 18.14%. ESS score was 4 ± 1.6. OSA was identified in 51.7% (n = 15) of subjects. Apnea-hypopnea index (AHI) was 16.16 ± 19/h and oxygen desaturation index (ODI) was 22.3 ± 25.99 among subjects with OSA. Sleep apnea related with rapid eye movement was present in 40% of OSA subjects. AHI and ODI were higher among sarcoidosis subjects with parenchymal involvement (P = 0.019, P = 0.026). OSA frequency was higher in the group with parenchymal involvement, but the difference was not statistically significant (n = 10/15, %66 vs n = 5/14, %35). FEV1 and FVC were not related with AHI and ODI.We found a high rate of OSA in sarcoidosis. There was a trend of high OSA frequency in sarcoidosis subjects with parenchymal involvement.