Browsing by Author "Kivanc, Tulay"

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Approach of pulmonologists in Turkey to noninvasive mechanical ventilation use in acute respiratory failure
(2016) Ugurlu, Aylin Ozsancak; Kivanc, Tulay; Dogrul, Ilgaz; 26963304
Introduction: Noninvasive mechanical ventilation (NIV) has been increasingly used worldwide for acute respiratory failure (ARF), especially in patients with chronic lung disorders. We aimed to define the approach of pulmonologists in Turkey to NIV use for ARF management. Materials and Methods: A 38-question survey, developed and tested by authors, was distributed by e-mail to a total of 2.205 pulmonologists in Turkey. Results: Response rate was 27% (n=596). Seventy-one percent of responders were practicing NIV in clinic. NIV use was found to be associated with responder's academic title, age, duration of medical license, type of physician's hospital and its region, patient load, NIV experience during residency, and duration of NIV and intensive care unit (ICU) experience (p<0.001). Based on sub-group analysis of responders using NIV, median number of NIV patients followed-up per week was 4 [interquartile range (IQR): 2-6]. Most of the NIV users reported employment of wards (90%) and/or ICUs (86%) to follow-up patients, while 8.4% of the responders were applying NIV only in ICU's. Chronic obstructive lung disease (COPD) (99.5%), obesity hypoventilation syndrome (93.7%) and restrictive lung disease (89.4%) were the most common indications. Majority of NIV users (87%) were applying NIV to > 60% of patients with COPD, and success rate in COPD was reported as over 60% by 93% of users. Oronasal mask (median and IQR 90, 80-100%, respectively) and home care NIV ventilators (median and IQR 50, 10-85%, respectively) were the most commonly utilized equipment. Conclusion: NIV use in ARF varies based on hospital type, region and, especially, experience of the physician. Although consistent with guidelines and general practice, NIV use can still be improved and increased.
Carotid intima-media thickness in chronic obstructive pulmonary disease and survival: A multicenter prospective study
(2019) Lakadamyali, Huseyin; Kivanc, Tulay; 30942958
Introduction Chronic obstructive pulmonary disease (COPD) is associated with increased cardiovascular morbidity and mortality. Carotid intima-media thickness (CIMT) is a noninvasive method assessing atherosclerosis. Objective It was aimed to determine relationship and survival between COPD and CIMT. Methods CIMT was measured using Doppler ultrasound (USG) in 668 stable COPD patients at 24 centers. Patients were followed-up for 2 years. Results There were 610 patients who completed the study. There were 200 patients CIMT with <0.78 mm (group 1), and 410 with CIMT >= 0.78 mm (group 2). There was a significant difference at the parameters of age, gender, smoking load, biomass exposure, GOLD groups and degree of airway obstruction (FEV1) between groups 1 and 2. Our results revealed positive correlations between mean CIMT and age, smoking load (pack-years), biomass exposure (years), exacerbation rate (last year), duration of hypertension (years) and cholesterol level; negative correlations between CIMT and FEV1 (P < 0.05). According to logistic regression model, compared with group A, risk of CIMT increase was 2.2-fold in group B, 9.7-fold in group C and 4.4-fold in group D (P < 0.05). Risk of CIMT increase was also related with cholesterol level (P < 0.05). Compared with infrequent exacerbation, it was 2.8-fold in the patients with frequent exacerbation (P < 0.05). The mean survival time was slightly higher in group 1, but not significant (23.9 vs 21.8 months) (P > 0.05). Conclusion This study is the first regarding CIMT with combined GOLD assessment groups. It has revealed important findings supporting the increase in atherosclerosis risk in COPD patients. We recommend Doppler USG of the carotid artery in COPD patients at severe stages.
Conscious Sedation : Clues for Diagnosing Obstructive Sleep Apnea Syndrome
(2016) Unler, Gulhan Kanat; Gokturk, Huseyin Savas; Dogan, Rusina; Kivanc, Tulay; Karakoca, Aydin; 0000-0003-0182-002X; 0000-0001-6503-3872; 27821023; AAG-3273-2020
Background and aims: The use of anesthetic agents for endoscopic sedation has recently increased. However, sedation introduces additional risks in patients with obstructive sleep apnea syndrome (OSAS). The presence of sleep apnea is not often enough questioned in clinical practice. The purpose of this study was to determine whether patients with sedation-induced snoring and decreased arterial oxygen saturation during gastroscopy are more likely to have OSAS. Methods: This study considered 600 consecutive patients undergoing elective outpatient upper gastrointestinal endoscopy under conscious sedation for evaluation of dyspepsia. Ten patients with observed snoring and decreased arterial saturation during the gastroscopy procedure were enrolled in the study. The control group was comprised of 13 patients matched by sex, age, and body mass index (BMI) who did not snore and had a more stable oxygen saturation under conscious sedation during an elective outpatient gastroscopy for the evaluation of dyspepsia and were selected using a computer-generated randomized sequence. Patients were monitored and an overnight polysomnography was performed in the study group. Statistically significant differences between groups were assessed using the nonparametric Wilcoxon and independent-samples t-tests. Results: There was no significant difference in age or BMI between the two groups (p>0,05) Mean minimum oxygen saturation was significantly different between the two groups (p=0.011). In the study group, 7 patients were found to have moderate OSAS necessitating a continuous positive airway pressure device. Conclusion: Patients with hypoxia and snoring, under conscious sedation are more likely to have OSAS. "Out-of-operating-room" sedoanalgesia is therefore critical.
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.
The Evaluation and Management of Sleep Disordered Breathing During Perioperative Period
(2015) Kivanc, Tulay; Lakadamyali, Huseyin
Obstructive sleep apnea (OSA) is a syndrome defined frequently by decrease in arterial oxygen saturation, repeated upper airway obstruction episodes, increases in sympathetic output and tone, and repetitive arousals during sleep. OSA is the most common form of sleep-disordered breathing. In the United States, it has been estimated that 4% of middle aged males and 2% of middle aged females have OSA. Nevertheless the majority of patients who affect from OSA are undiagnosed and untreated. All these evidences imply that a prominent portion of OSA patients who undergo surgery will not be diagnosed and that the physicians must screen patients suspected of having sleep-disordered breathing to customize the anesthetic care and start necessary evaluations and therapy.
Evaluation of Choroidal Thickness Using Spectral-Domain Optical Coherence Tomography in Patients with Severe Obstructive Sleep Apnea Syndrome: A Comparative Study
(2014) Karalezli, Aylin; Eroglu, Fatma Corak; Kivanc, Tulay; Dogan, Rasina; https://orcid.org/0000-0003-3003-0756; 25540760; D-5308-2015
AIM: To assess choroidal thickness in patients with severe obstructive sleep apnea syndrome (OSAS) and compare them with healthy controls, using spectral domain optical coherence tomography (OCT). METHODS: In this observational, cross-sectional study, choroidal thicknesses of 23 newly severe OSAS patients and 23 body mass index- age- and sex-matched healthy subjects were measured using a high -speed, high resolution frequency domain-OCT device (lambda=840 nm, 26 000 A -scans/s, 5 pm axial resolution). All patients underwent a complete ophthalmic examination before the measurements. OCT measurements were taken at the same time of day (9:00 a.m.), in order to minimize the effects of diurnal variation. RESULTS: There was a statistically significant difference in median choroidal thickness between the OSAS patients (201 pm; range 145 -237 pm) and the controls (324 pm; range 296 -383 mu m; P <0.001). There were significant differences at all measurement points (P <0.001 for all). The apnea -hypopnea index (AHI) values were more than 30 in all OSAS patients and the mean AHI was 48.57 +/- 6.54. The interexaminer intraclass correlation coefficient (ICC) for the mean choroidal thickness was 0.938 (95%CI, 0.908-0.985) and ICC was greater than 0.90 for all measurement points. CONCLUSION: The decreased choroidal thickness of patients with severe OSAS might be related to the the autonomic disregulation associated with this disease. Further studies are needed to evaluate the etiopathologic relationship between choroidal thickness and OSAS.
Importance of laboratory parameters in patients with obstructive sleep apnea and their relationship with cardiovascular diseases
(2018) Kulaksizoglu, Sevsen; Kivanc, Tulay; Lakadamyali, Huseyin; Eyuboglu, Fusun; 0000-0002-7613-2240; 0000-0002-5525-8207; 28345811; AAI-8932-2021; AAR-4338-2020
BackgroundOstructive sleep apnea (OSA) is an independent risk factor for the development of cardiovascular events. Platelet activation and inflammation are the mechanisms involved in the association between OSA and cardiovascular disease (CVD). The markers of platelet activation and inflammation are the mean platelet volume (MPV), platelet-lymphocyte ratio (PLR), red cell distribution width (RDW), neutrophil- lymphocyte ratio (NLR). We aimed to define the association of NLR, PLR, RDW, and MPV with the severity of disease and the presence of CVD. MethodsThis study consisted of 300 patients who were admitted to the sleep laboratory. The patients were classified according to their apnea- hypopnea index (AHI) scores as OSA negative (Group A: AHI<5), mild (Group B: AHI: 5-15), moderate (Group C: AHI=15-30), and severe OSA (Group D: AHI >30). ResultsThere were no significant differences in the NLR, PLR, and MPV among the groups (P>.05); only RDW differed significantly (P=.04). RDW was significantly higher in patients with than without risk factors for CVD [15.6% (15.4-15.7) vs 15.3% (15.1-15.3), respectively; P=.02]. ConclusionsNLR, PLR, MPV, and RDW are widely available and easily obtained from a routinely performed hemogram. Among these laboratory parameters, only RDW can demonstrate the reverse consequences of OSA-associated comorbidities, because vascular damage due to systemic inflammation is an important underlying mechanism in these diseases. RDW might be used as a marker of the response and patient compliance with continuous positive airway pressure treatment.
Relation Between Pulmonary Hypertension and Health-Related Quality of Life in Patients Undergoing Hemodialysis
(2016) Kivanc, Tulay; Kal, Oznur; Ciftci, Ozgur; Akcay, Sule; 0000-0002-7751-4961; 0000-0002-8360-6459; 27805514; AAJ-7586-2021; AAB-5175-2021
Objectives: Pulmonary hypertension has been reported to occur in a considerable proportion of patients with end-stage renal disease. End-stage renal disease affects the health-related quality of life of patients. There is a lack of specific information on the relation between pulmonary hypertension and health-related quality of life in patients with end-stage renal disease in the literature. We aimed to evaluate this relation in patients undergoing hemodialysis. Materials and Methods: This prospective case-control study included 68 patients treated with hemodialysis and 30 healthy participants as controls. Group 1 comprised hemodialysis patients with pulmonary hypertension, group 2 comprised patients without pulmonary hypertension, and group 3 were healthy subjects. Each patient's health-related quality of life was measured with the Medical Outcomes Study 36-Item Short Form health survey. Doppler echocardiography was performed to determine pulmonary artery pressure in all patients. The groups were compared with respect to health-related quality of life. Results: Pulmonary hypertension was found in 47.1% of patients (mean systolic pulmonary artery pressure of 48.9 +/- 11.8 mmHg). Significant differences were observed among the 3 groups regarding the physical function, physical role, bodily pain, general health, vitality, social function, emotional role, mental health, and physical component summary (P =.001). There was no significant correlation between pulmonary artery pressure and health survey scores. Conclusions: Hemodialysis patients had significantly lower quality of life scores than healthy subjects. There were no significant differences in terms of health survey domains between the hemodialysis patients with and without pulmonary hypertension. This may be due to the severe adverse effects of end-stage renal disease on health-related quality of life. We conclude that, because end-stage renal disease has so many adverse effects on health-related quality of life, the additional effects of pulmonary hypertension on health-related quality of life could not be revealed.
Serum YKL-40/chitinase 3-Like Protein 1 Level Is an Independent Predictor of Atherosclerosis Development in Patients with Obstructive Sleep Apnea Syndrome
(2015) Bakirci, Eftal Murat; Unver, Edhem; Degirmenci, Husnu; Kivanc, Tulay; Gunay, Murat; Hamur, Hikmet; Buyuklu, Mutlu; Ceyhun, Gokhan; Topal, Ergun; Coban, Taha Abdulkadir; 26142786
Objective: The inflammatory process plays an important role in the development of cardiovascular complications in patients with obstructive sleep apnea syndrome (OSAS). YKL-40/chitinase 3-like protein 1 is a novel biomarker of systemic inflammation. This study aimed to investigate whether carotid intima-media thickness (CIMT), a useful marker for early atherosclerosis, is associated with serum YKL-40/chitinase 3-like protein 1 levels in patients with normotensive and nondiabetic OSAS. Methods: The study included 40 OSAS patients and 40 agesex- and body mass index-matched healthy controls. Serum YKL-40 levels were detected by enzyme-linked immunosorbent assay. CIMT was measured by B-mode ultrasound. Results: The patients with OSAS had significantly increased CIMT and higher YKL-40 and high sensitivity C-reactive protein (hsCRP) levels than those of the controls. CIMT was strongly correlated with serum YKL-40 levels (r=0.694, p<0.001), hsCRP (r=0.622, p<0.001), age (r=0.525, p=0.001), and weakly correlated with apnea-hypopnea index (AHI) (r=0.365, p=0.021) and the percentage of recording time spent (PRTS) of oxygen saturation <90% (r=0.488, p=0.001). Moreover, it was detected that serum YKL-40 levels were strongly correlated with AHI (r=0.617, p<0.001), and weakly correlated with SaO 2 <90% of PRTS (r=0.394, p=0.012) and hsCRP (r=0.486, p=0.001). In multiple regression analyses, age and serum levels of YKL-40 and hsCRP were found to be independent predictors of CIMT. Conclusion: In patients with OSAS, CIMT was increased. This increase was associated with serum YKL-40 level. Increased serum level of YKL-40 may be an early predictor of atherosclerosis development in patients with OSAS.