Browsing by Author "Avci, Suat"

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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.
Cervicofacial and Mediastinum Emphysema Following Dental Intervention
(2015) Akkucuk, Mehmet Husamettin; Avci, Suat; Torun, Ebru; Gonullu, Hatice
Mediastinitis is a clinical case with high mortality and morbidity ratio. Thus, defining the causes beforehand is significantly important. A 65-year-old male patient present to the emergency care unit because of symptoms such as swelling of his face and neck. Crepitation is noted during palpation at the right lateral face and neck of patients, indicating that swelling occurred after medical intervention by the dentist using spray. Emphysema is seen on the face, neck, and mediastinum on X-ray and CT scans. Patients were hospitalized, and parenteral antibiotic therapy was applied in case of the possibility of serious infection, which may occur because of the use of air syringe, causing the permeation of oral flora to the neck and mediastinum via buccal mucosal ruptures during the patient's dental surgery. Because swellings disappeared and the patient did not have fever on the third day of hospitalization, the patient was discharged after oral antibiotics therapy. Physicians working at the emergency care unit will always keep in mind the risk of deep neck infections and mediastinitis occurrence that patients presenting with swelling symptoms on the neck and face may have following dental surgery.
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.
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.
Relationships among Retropalatal Airway, Pharyngeal Length, and Craniofacial Structures Determined By Magnetic Resonance Imaging in Patients with Obstructive Sleep Apnea
(2019) Avci, Suat; Lakadamyali, Hatice; Lakadamyali, Huseyin; Aydin, Erdinc; Tekindal, Mustafa Agah; https://orcid.org/0000-0003-2155-8014; https://orcid.org/0000-0001-6864-7378; https://orcid.org/0000-0002-4060-7048; 29728955; O-3636-2018; AAJ-2379-2021; U-9270-2018
BackgroundThe integration of anatomical and nonanatomical parameters will improve our ability to predict the outcomes of OSA treatment. Currently, no standardized, quantitative classification of upper airway anatomical traits is available. The retropalatal (RP) airway is the most important area to consider when planning anatomical treatment. However, current evaluation methods feature qualitative conventional endoscopy. Here, we describe a quantitative magnetic resonance imaging (MRI) method used to classify RP airway patterns.MethodsWe recruited 117 males; 20 simple snorers and 97 patients with OSA. Lateral/anteroposterior ratios were calculated in three parallel planes and RP patterns were classified accordingly. Lateral wall soft tissue structures, skeletal dimensions representing those planes, pharyngeal lengths, and skeletal and vertical axis ratios were also measured.ResultsBoth the cross-sectional area at the hard palate level and the RP lateral dimension were associated with OSA. OSA patients had longer pharynges than controls. The oblique pattern was associated with narrow lateral dimensions. The vertical pattern was associated with a narrow nasopharynx but a longer pharynx. The airway ratio at the hard palate level and the skeletal ratios of all three planes were negatively correlated with the vertical axis ratio and together explained 40.8% of the variance in the vertical axis ratio.ConclusionsThe data suggest that anatomical imbalances between the craniofacial skeletal and soft tissue structures affect pharyngeal airway morphology in all three dimensions. The dimensions of the nasopharynx, the cross-sectional area at the hard palate level, and pharyngeal length were associated not only with the RP patterns but also with OSA severity. This study affords insights into upper airway anatomy and RP patterns and may help diagnose OSA patients and aid in the selection of an appropriate therapy.
Sex differences in adult craniofacial parameters
(2015) Avci, Suat; Ergun, Tarkan; Aydin, Erdinc; Kansu, Leyla; 25935592
To compare normal male and female craniofacial parameters in adults and evaluate associations of sex and intercochlear distance with other craniofacial parameters. In 60 normal adults (30 men and 30 women) who had no otitis media, craniofacial parameters were measured retrospectively on two-dimensional reformatted computed tomography scans. Compared with women, men had significantly greater mean osseous auditory tube length, cartilaginous auditory tube length, mastoid length, intercochlear distance, sella to posterior nasal spine distance, sella to basion distance, and nasopharynx sagittal area. The intercochlear distance was significantly correlated with mastoid depth, midpoint of the pharyngeal opening distance, sella to nasion distance, and nasopharynx sagittal area and inversely with angle of the auditory tube. Most men and women had Korner septum present, and mean thickness of Korner septum was significantly greater in men than women. Some craniofacial parameters, especially vertical parameters, differ with sex. These differences begin in childhood and continue in adulthood. Sex must be considered when planning a craniofacial morphologic study, and results of a craniofacial morphologic study should be evaluated with caution when there is no sex matching of the patient and control groups.
Shrinkage of Nasal Mucosa and Cartilage During Formalin Fixation
(2017) Kansu, Leyla; Aydin, Erdinc; Akkaya, Hampar; Avci, Suat; Akalin, Nalan; 0000-0003-1707-7760; 0000-0001-6864-7378; 0000-0003-2155-8014; 0000-0002-7070-6901; 28552840; H-8232-2013; AAJ-2379-2021; ABG-2028-2020; O-3636-2018
Background: After resection, specimens are subjected to formalin fixation during histological processing. This procedure can result in tissue shrinkage, with the amount of shrinkage related to tissue composition and tissue type. Aims: To evaluate the shrinkage of nasal mucosa and cartilage tissue and compare differences in shrinkage after resection, after formalin fixation, and during microscopic examination to understand differences in the rate of shrinkage of different tissue types. Study Design: Animal experimentation. Methods: Fresh nasal septa were excised from sheep (10 mm diameter in 40 sheep and 20 mm diameter in 40 sheep). The mucosa was separated from one side of the cartilage, with the contralateral mucosa remaining attached to the cartilage. Specimen diameters were measured in situ, after resection, after fixation for 6 or 24 hours (10% formalin), and during microscopic examination. Results: There were no differences between the in situ and after resection diameters of any tissue components (free mucosa, mucosa attached to cartilage, and cartilage) of all nasal specimens (10-or 20-mm diameter and 6or 24-hour fixation). However, significant shrinkage occurred between resection and after-fixation. Regarding tissue specimens that were fixed for different durations (6 or 24 hours), we observed a significantly smaller mean tissue diameter in specimens fixed for 24 hours versus those fixed for 6 hours for mucosa attached to cartilage (in the 10-mm diameter after-fixation samples), free mucosa (in the 20-mm diameter after-fixation samples), mucosa attached to cartilage (in the 20-mm diameter after-fixation and microscopic measurement samples), and cartilage (in the 20-mm diameter after-fixation samples). Tissue shrinkage was greatest in free mucosal tissue and least in cartilage. Conclusion: These results should be considered when evaluating patients undergoing surgical procedures for nasal cavity and paranasal sinus malignancies. Surgical margins should be measured before fixation or evaluated if possible before fixation and shrinkage.