Browsing by Author "Lakadamyali, Huseyin"

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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.
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.
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.
Effects of Three Month Nasal Continuous Positive Airway Pressure Treatment on Electrocardiographic, Echocardiographic and Overnight Polysomnographic Parameters in Newly Diagnosed Moderate/Severe Obstructive Sleep Apnea Patients
(2015) Cicek, Davran; Balcioglu, Akif Serhat; Lakadamyali, Huseyin; Muderrisoglu, Haldun; 25503651
The objective of the study was to determine the effects of nasal continuous positive airway pressure (nCPAP) therapy on left ventricular (LV) function and electrocardiographic parameters in newly diagnosed moderate/severe obstructive sleep apnea (USA) patients without cardiovascular comorbidities and medical treatments. We examined 44 patients who underwent overnight polysomnography together with 24-hour Ho lter electrocardiography, cardiopulmonary exercise testing including heart rate recovery at 1 minute (HRR-1), echocardiography, surface electrocardiography, and those who were diagnosed with moderate/severe USA apnea-hypopnea index >= 15. After 3 months of nCPAP treatment, the above-mentioned examinations were repeated. Forty-four patients completed the treatment period. Twelve weeks on effective nCPAP induced a significant increase in the mitral E/A ratio (P = 0.001), as well as reductions in isovolumic relaxation time (P = 0.001) and mitral deceleration time (DT) (P = 0.002). There were no significant differences in LV ejection fraction, LV mass index, and pulsed wave Doppler parameters. Mean heart rate was 79.2 +/- 12.5 pulses/minute, maximum P-wave duration 117.5 +/- 8.6 msec, P-wave dispersion (PWd) 54.6 +/- 10.2 msec, corrected QT interval (QTc) 436.5 +/- 40.5 msec, and QT dispersion (QTd) 46.3 +/- 7.1 msec, which significantly decreased to 70.4 +/- 9.6 pulses/minute (P <0.001), 111.5 +/- 8.7 msec (P <0.001), 51.6 +/- 8.9 msec (P <0.001), 418.4 +/- 31.2 msec (P <0.001), and 33.8 +/- 3.4 msec (P < 0.001), respectively. Exercise capacity at baseline determined as 10.5 +/- 2.2 metabolic equivalents (METS) and HRR-1 (20.6 +/- 11.7 bpm) significantly increased (12.1 +/- 1.5 METS and 27.4 +/- 8.6 bpm). There was no significant difference in aortic root parameters. Three-month nCPAP therapy significantly increased LV shortening fraction, with no effect on systolic function or aortic root diameters and a positive effect on heart rate, PWd, HRR-1, QTc and QTd time following nCPAP therapy.
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.
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.
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.
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.