Browsing by Author "Avci, Aynur Yilmaz"

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Association between Hypoxia Parameters with White Matter Hyperintensity and Silent Cerebral Infarcts on Brain Magnetic Resonance Images in Patients with Obstructive Sleep Apnea
(2016) Avci, Aynur Yilmaz; Avci, Suat; Lakadamyali, Huseyin; Lakadamyali, Hatice; Can, Ufuk; 0000-0003-2155-8014; 0000-0001-9004-9382; 0000-0001-8689-417X; O-3636-2018; F-6770-2019; AAJ-2999-2021
Objective: This study evaluated the association between hypoxia parameters with white matter hyperintensity (WMH) and silent cerebral infarcts (SCI) on brain magnetic resonance (MR) images of patients with obstructive sleep apnea (OSA). Methods: In this retrospective study, the study group was composed of 453 patients who were evaluated by overnight polysomnography (PSG). Data on hypoxia parameters, such as total sleep duration with oxygen saturation < 90% (ST90), percentage of cumulative time with oxygen saturation < 90% (CT90), and the lowest oxygen saturation (min SaO(2)), were obtained from PSG. The presence of WMH and SCI was evaluated in all participants using brain MR images. Results: Hypoxia parameters, such as ST90, CT90, and min SaO(2), were significantly associated with WMH (P < 0.001). The multiple regression analysis showed that CT90 was independently associated with SCI (P = 0.038). In addition, when participants were divided into two groups according to CT90 < 10% and CT90 = 10%, age (P = 0.002), sex (P = 0.015), body mass index, Apnea-Hypopnea Index score, Epworth Sleepiness Scale score, and the presence of WMH, hypertension, and diabetes mellitus were significantly higher in the CT90 = 10% group compared with the CT90 < 10% group (P < 0.001 for all parameters). CT90 = 10% increased the risk of WMH 2.34-fold (95% confidence interval, 1.44-3.85; P = 0.006). Conclusion: The severity of nocturnal intermittent hypoxia may contribute to the pathogenesis of WMH and SCI in patients with OSA.
Association Between Mitral Valve Prolapse, Migraine, and White Matter Hyperintensities on Magnetic Resonance Imaging
(2018) Avci, Aynur Yilmaz; Toprak, Munire Kilinc; Lakadamyali, Liatioe; Akinci, Sinan
Objective: Migraine is linked with an elevation in vascular risk factors, ischemic stroke, and a variety of constitutional brain lesions. However, the pathogenesis of this relationship is still inexplicit. The link between cardiac diseases and comorbid migraine-ischemic stroke might be a vascular disease involving both heart and brain. In this study, an association between mitral valve prolapse (MVP), migraine, and the presence of brain white matter hyperintensities (WMHs) were evaluated among adult subjects with migraine headache devoid of any traditional vascular risk factors. Materials and Methods: Four hundred subjects (200 subjects with migraine headache, 200 healthy controls; age range 18-50 years) were incorporated in the retrospective study. Existence of a headache compatible with migraine was diagnosed according to the International Headache Society-2 criteria. The participants were devoid of any known comorbid diseases, vascular risk factors or inflammatory diseases. All patients, both those with migraine and controls were screened with echocardiography to assess for MVP and with brain magnetic resonance imaging co evaluate the presence of any WMHs. Results: The prevalence of MVP was found to be higher in the migraine group (p<0.011). The odds ratio (OR) for the presence of MVP in patients with migraine compared with controls was 2.44 [95% confidence interval (CI): 1.25-4.74; p=0.0086]. The OR for the presence of WMHs in patients with migraine compared with controls was 5.88 (95% CI: 3.42-10.10; p<0.0001). After modifying for confounding factors, multiple linear regression analyses revealed that migraine was independently and positively associated with MVP (p=0.044), tricuspid regurgitation (p=0.003), and WMHs (p<0.001), and mitral regurgitation and migraine was independently and positively connected with WMHs (p<0.005 and p<0.001, respectively). Conclusion: MVP is found CO be independently associated with migraine when compared with controls. Therefore, we suggest that MVP might have an association with migraine. Nevertheless, we could not demonstrate any correlation between MVP and WMHs. Hence, we suggest that MVP might nor be involved in the evolution of WMHs in migraine
Correlation of changes in the red blood cell distribution width with the response to continuous positive airway pressure in patients with obstructive sleep apnea
(2019) Lakadamyali, Huseyin; Kivanc, Tulay; Avci, Aynur Yilmaz
It is recently found that the red blood cell distribution width (RDW) is independently associated with cardiovascular disease in patients with obstructive sleep apnea (OSA).The goal of this study is to investigate the correlation of RDW with the severity of OSA and whether RDW could be used to monitor the response to continuous positive airway pressure (CPAP) therapy in OSA patients. The study enrolled 70 participants. Control group (n=24) consisted of patients with normal polysomnography and OSA group (n=46) comprised patients with OSA of varying severity. RDW was measured before polysomnography in both groups. In addition, RDW was measured in the OSA group following 3months of CPAP therapy. The RDW was significantly higher in the OSA group (p<0.001), and this difference remained after adjusting for age and body mass index (p=0.001). The RDW was approximately twofold greater in the OSA group (OR 2.126, 95% confidence interval 1.32-3.41; p=0.002). On univariate analysis, the RDW was significantly correlated with hypoxia parameters, which was persistent with multivariate analysis. Furthermore, CPAP therapy reduced RDW (p=0.002), and the change in the severity of 3% ODI by CPAP was correlated with the change in the RDW (r=0.416, p=0.013). The high RDW may be related to the pathophysiology of OSA. The high RDW in OSA may be associated with hypoxia. Therefore, treating OSA with CPAP could improve the RDW.
High sensitivity C-reactive protein and cerebral white matter hyperintensities on magnetic resonance imaging in migraine patients
(2015) Avci, Aynur Yilmaz; Lakadamyali, Hatice; Arikan, Serap; Benli, Ulku Sibel; Kilinc, Munire; 25595197
Migraine is a common headache disorder that may be associated with vascular disease and cerebral white matter hyperintensities (WMHs) on magnetic resonance imaging (MRI) scan. High sensitivity C-reactive protein (hs-CRP) is a marker of inflammation that may predict subclinical atherosclerosis. However, the relation between migraine, vascular risks, and WMHs is unknown. We evaluated hs-CRP levels and the relation between hs-CRP level and WMHs in adult migraine patients. This case-control study included 432 subjects (216 migraine patients [without aura, 143 patients; with aura, 73 patients]; 216 healthy control subjects without migraine; age range 18-50 y). Migraine diagnosis was determined according to the International Classification of Headache Disorders II diagnostic criteria. The migraine patients and control subjects had no known vascular risk factors, inflammatory disease, or comorbid disease. The presence and number of WMHs on MRI scans were determined, and serum hs-CRP levels were measured by latex-enhanced immunoturbidimetry. Mean hs-CRP level was significantly greater in migraine patients (1.94 +/- 2.03 mg/L) than control subjects (0.82 +/- 0.58 mg/L; P a parts per thousand currency signaEuro parts per thousand.0001). The mean number of WMHs per subject and the presence of WMHs was significantly greater in migraine patients (69 patients [31.9%]; 1.68 +/- 3.12 mg/dL) than control subjects (21 subjects [9.7%]; 0.3 +/- 1.3; P a parts per thousand currency signaEuro parts per thousand.001). However, there was no correlation between hs-CRP level and WMHs in migraine patients (r = 0.024; not significant). The presence of WMHs was increased 4.35-fold in migraine patients (odds ratio 4.35, P a parts per thousand currency signaEuro parts per thousand.001). High hs-CRP level may be a marker of the proinflammatory state in migraine patients. However, the absence of correlation between hs-CRP level and WMHs suggests that hs-CRP is not causally involved in the pathogenesis of WMHs in migraine patients. The WMHs were located mostly in the frontal lobe and subcortical area.
Hypoxia and Inflammation Indicate Significant Differences in the Severity of Obstructive Sleep Apnea within Similar Apnea-Hypopnea Index Groups
(2017) Avci, Aynur Yilmaz; Avci, Suat; Lakadamyali, Huseyin; Can, Tfuk; 0000-0001-9004-9382; 0000-0003-2155-8014; 0000-0003-2155-8014; 28271327; F-6770-2019; O-3636-2018; O-3636-2018
Purpose We determined whether hypoxia parameters are associated with C-reactive protein (CRP), mean platelet volume (MPV), white matter hyperintensity (WMH), and the severity of obstructive sleep apnea (OSA), and also evaluated whether hypoxia parameters, CRP, MPV, and WMH differ in patients with similar apnea-hypopnea index (AHI) scores. Methods A total of 297 patients, who were evaluated using Polysomnography, were assessed retrospectively. The measured hypoxia parameters included total sleep time with oxygen saturation <90% (ST90), percentage of cumulative time with oxygen saturation <90% (CT90), and lowest oxygen saturation (min SaO(2)). The patients were divided into subgroups according to their CT90 values, and patients with different AHI severities were divided into subgroups according to their ST90 and min SaO(2) levels. Results Hypoxia parameters are associated with CRP, MPV, WMH, and the severity of OSA (P < 0.05). The hypoxia parameters differed in all subgroup analyses of similar AHI groups (P < 0.001), and CRP differed only in severe OSA (P < 0.008, P < 0.001). In subgroup analyses of similar AHI groups, MPV and. WMH were not significantly different (P > 0.05). Above the hypoxia threshold (CT90 >= 10%) of CRP, MPV increased significantly and the presence of WMH increased twofold. Conclusions These data suggest that increased hypoxia severity may mediate increased inflammation and activation of platelets and contribute to the pathogenesis of WMH in patients with OSA. In addition, patients with severe OSA may show significant variability in inflammation and vascular risk. Further prospective data are needed.
Hypoxia parameters, physical variables, and severity of obstructive sleep apnea
(2016) Avci, Suat; Avci, Aynur Yilmaz; Lakadamyali, Huseyin; Aydin, Erdinc; 0000-0001-9004-9382; 0000-0001-6864-7378; 0000-0003-2155-8014; F-6770-2019; AAJ-2379-2021; O-3636-2018
Objective: To determine the relation between hypoxia and physical parameters in patients who had different levels of severity of obstructive sleep apnea (OSA). Methods: This was a retrospective, cross-sectional study of 259 men who were evaluated with overnight polysomnography. Severity of OSA was graded based on the apnea-hypopnea index (AHI): normal/simple snoring (n=31); mild OSA (n=70); moderate OSA (n=63); severe OSA (n=95). Patients with different severity were divided into subgroups, based on having the lowest or highest values of the total sleep time with oxygen saturation <90% (ST90) or minimum oxygen saturation (min SaO(2)). Results: Median AHI was 20.4 events/hour. Univariate analysis showed that ST90 was correlated with AHI (r=0.772; p <= 0.001) and Epworth sleepiness scale (ESS) (r=0.344; p <= 0.001), and min SaO(2) was inversely correlated with AHI (r=-0.748; p <= 0.001) and ESS (r=-0.319; p <= 0.001). Multivariate linear regression showed that ST90 was independently associated with AHI, ESS, and neck circumference, and min SaO(2) was independently inversely associated with AHI, ESS, and body mass index (BMI). In patients who had severe OSA, the subgroups which had lowest and highest min SaO(2) differed significantly in BMI, modified Mallampati score, neck and waist circumferences, and ret-roglossal Muller grade. In patients with percentage of sleep time with oxygen saturation below 90% (CT90) <10%, the upper limit of ST90 was 36 minutes and corresponded to 70% lower limit of min SaO(2). Conclusion: Hypoxia parameters show significant variation in OSA severity categories. None of the physical parameters had clinically useful relations with hypoxia parameters in OSA patients except patients who had severe OSA.
Late onset hirayama disease: Characteristic magnetic resonance imaging features hirayana disease
(2020) Haberal, Kemal Murat; Avci, Aynur Yilmaz; Bayramoglu, Mert; Agildere, Ahmet Muhtesem; 0000-0002-8211-4065; 0000-0003-4223-7017; 0000-0001-9004-9382; R-9398-2019; AAB-5802-2020; F-6770-2019
Hirayama Disease is a rare benign lower motor neuron disorder which is primarily affecting young males. It is characterized by the progressive weakness of the distal upper extremities followed by spontaneous stabilization of the symptoms. In this paper, we describe a 58 year- old female patient with a complaint of weakness in the right hand and forearm. Magnetic resonance imaging of the cervical spine established the final diagnosis of Hirayama disease. Hirayama disease when detected and intervened at an early stage of the disease process, can have a good prognosis. Clinicians and radiologists should be aware of the clinical features, as well as suspicious findings on neutral-position MR imaging and an additional neck-flexion MR imaging study should be arranged to confirm the diagnosis.
Migraine and Subclinical Atherosclerosis: Endothelial Dysfunction Biomarkers and Carotid Intima-Media Thickness: A Case-Control Study
(2019) Avci, Aynur Yilmaz; Akkucuk, Mehmet Husamettin; Torun, Ebru; Arikan, Serap; Can, Ufuk; Tekindal, Mustafa Agah; https://orcid.org/0000-0001-9004-9382; https://orcid.org/0000-0003-4569-1143; https://orcid.org/0000-0001-5752-3812; https://orcid.org/0000-0001-8689-417X; https://orcid.org/0000-0002-4060-7048; 30645751; F-6770-2019; AAJ-2828-2021; AAJ-1289-2021; AAJ-2999-2021; U-9270-2018
Background Migraine is a common neurovascular disease associated with vascular risks, especially in young adult females, but the mechanism underlying these associations remains unknown. This study evaluated the relationships between plasma endothelial dysfunction biomarkers and carotid intima-media thickness (IMT) in young adult females with migraine. Methods This case-control study included 148 female patients (age range: 18-50years). Migraine was diagnosed according to the International Headache Society-IIIb criteria. Endothelial dysfunction biomarkers, such as von Willebrand factor (vWF), C-reactive protein (CRP), homocysteine, total nitrate/nitrite concentration, and thiobarbituric acid-reactive substances (TBARS), were evaluated in plasma. Carotid IMT was measured by a radiologist with sonography. Results The CRP, TBARS, vWF, and IMT levels were increased in the migraine compared with the control group (p<0.001, p=0.02, p<0.001, and p<0.001, respectively). After adjusting for confounders, multiple linear regression analysis revealed that systolic arterial blood pressure, CRP, vWF, TBARS, and right and left internal carotid artery (ICA) IMT were independently positively correlated with migraine (p<0.01, p=0.004, p=0.023, p=0.024, p=0.032, and p=0.048, respectively). Multiple logistic regression analysis revealed that right ICA IMT was independently associated with ergotamine and triptan and left ICA IMT was independently associated with ergotamine (p=0.013, p=0.026, and p=0.017, respectively). In addition, significant correlations were found between LDL lipoprotein and carotid IMT in the migraine group (p<0.05). Conclusions Carotid IMT enhancement and elevated TBARS, vWF, and CRP levels in migraine subjects during a migraine attack could be regarded as consequences of migraine attack pathophysiology. The independent associations between triptan and ergotamine consumption and enhanced carotid IMT suggest that repeated use of these vasoconstrictive antimigraine agents may have additional effects on carotid IMT.
Peripheral Nerve Function Changes Due to Hypoxia in Obstructive Sleep Apnea
(2019) Avci, Aynur Yilmaz; Avci, Suat; 0000-0001-9004-9382
Introduction: Chronic hypoxia is known to be one of the risk factors for peripheral neuropathy. However, the effect of intermittent hypoxia on peripheral nerves is not fully understood. This study evaluated the relation between intermittent hypoxia and peripheral nerve function in Obstructive Sleep Apnea (OSA) patients. Materials and Methods: In this retrospective study, 86 patients who underwent polysomnography (PSG) and electroneuromyography were enrolled. Participants with diseases affecting peripheral nerves and lung function were excluded from the study. Hypoxia parameters were obtained from the PSG study. Lower extremity motor and sensory nerve conduction studies of all patients were evaluated. Results: In patients with OSA, peroneal nerve distal motor latency and sural sensory nerve action potential amplitude was low and velocity was significantly slower than controls (p<0.001, p<0.04, p<0.001, respectively). After adjustment for age and body mass index, the results remained significantly (p<0.001, p<0.01, p<0.001, respectively). The nerve conduction results were significantly correlated with the hypoxia parameters. After adjustment for confounding factors, logistic regression analyses revealed that hypoxia parameters were independently associated with nerve conduction results. Conclusion: OSA and intermittent hypoxia may affect both motor and sensory nerve conduction, which suggests that subclinical sensorimotor peripheral neuropathy is associated with OSA. The related intermittent hypoxia and OSA may be a cause of axonal and demyelinating neuropathies.
The relationship between clinical and laboratory findings and duration of sleep where oxygen saturation remains below 90-95% in obstructive sleep apnea
(2016) Avci, Suat; Avci, Aynur Yilmaz; Yagbasan, Berna Devrim; Gunizi, Huseyin
Objective: The aim of the present study was to determine correlations between CT90 and CT95 values and physical examination parameters, chronic metabolic diseases, smoking, mean platelet volume, cerebral magnetic resonance imaging (MRI), presence and number of hyperintense foci in obstructive sleep apnea (OSA). Methods: A total of 1154 patients who underwent polysomnography in our sleep laboratory between 2011 and 2014 were screened retrospectively. Among them, 72 cases who underwent ear, nose and throat examinations, cerebral MR, CBC and biochemical tests were included in the study. All patients underwent a detailed anamnesis together with (1) measurements of BMI (body mass index) (2) circumferences of neck and abdomen, (3) examination of oropharynx, (4) Muller maneuver with the aid of fiberoptic endoscope, (5) estimation of Epworth sleep scale scores, (6) and polysomnographic (PSG) tests. Results: According to the severity of OSA, the patients had simple snoring (22.2%), mild (19.4%) and severe OSA (38.9%). In multivariate regression analysis, body mass index (BMI) (p=0.026) and apnea/hypopnea index (AHI) (p=0.013) were seen as independent variables affecting CT90 (R-2=49%). Multivariate linear regression analysis demonstrated that independent variables of smoking (p=0.001), AHI (p=0.003) and number of hyperintense foci (p=0.013) affected CT95 (R-2=%47.9), while relationships between diabetes, BMI and CT95 were not statistically significant. Conclusion: Since CT95 values are affected by smoking without any statistically significant correlation with retropalatal and retroglossal Muller stages, we think that consideration of CT90 value will be more appropriate in the evaluation of the severity of chronic intermittent hypoxia in patients with obstructive sleep apnea. However, the correlation between CT90 value and AHI is closer to the value indicated in the literature, but not stronger.