Obstructive sleep apnea (OSA) has been definitively shown to be a risk factor for the development of cardiovascular disease and mortality. Recent reports have indicated that obstructive sleep apnea is associated with insulin resistance and impaired glucose metabolism, also have type 2 diabetes. The potential mechanisms leading to the development of type 2 diabetes in OSA patients are likely to be various. Reduced physical activity resulting from daytime somnolence, sympathetic nervous system activation, intermittent hypoxia, sleep fragmentation and sleep loss, dysregulation of the hypothalamic-pituitary axis, alteration in adipokine profiles, and activation of inflammatory pathways have been proposed. Based on the current evidence, clinicians should assess the risk of OSA in patients with type 2 diabetes and, conversely, consider that possibility of glucose intolerance in patients with OSA. Further large-scale and long-term follow-up studies in patient populations with selected by reliable but inexpensive diagnostic measures, controlled for potential confounder factor, are needed.
Adipokines ; Anoxia ; Axis, Cervical Vertebra ; Cardiovascular Diseases ; Glucose ; Glucose Intolerance ; Humans ; Insulin Resistance ; Motor Activity ; Risk Factors ; Sleep Apnea, Obstructive ; Sleep Deprivation ; Sympathetic Nervous System

OBJECTIVES: The Berlin Questionnaire (BQ) has been used to help identify patients at high risk of having sleep apnea in primary care. But it has not been validated in a sleep clinic for Korean patients. The aim of this study is to evaluate the usefulness of the BQ as a screening tool for obstructive sleep apnea (OSA) for Korean patients in a sleep clinic. METHODS: The BQ was prospectively applied to 121 subjects with OSA suspicion who visited to our sleep clinic. All subjects performed overnight polysomnography. OSA was defined as an apnea-hypopnea index (AHI) > or =5. We investigated the sensitivity, specificity, positive and negative predictive values of the BQ according to severity by AHI. RESULTS: In 121 subjects, 73.6% were males, with a mean age of 48.8+/-13.0 years. Twenty-five (20.6%) patients did not have OSA (AHI<5), 30 (25%) patients had mild OSA (AHI> or =5 and <15), 26 (21.4%) had moderate (AHI> or =15 and <30), and 40 (33%) had severe OSA (AHI> or =30). The BQ identified 69.4% of the patients as being at high risk for having OSA. The sensitivity and specificity of the BQ were 71.9% and 40%, for AHI> or =5, 75.8% and 38.2% for AHI> or =15, 77.5% and 34.6% for AHI> or =30, respectively. The positive and negative predictive values of the BQ were 82.1% and 27.0% for AHI> or =5, respectively. Positive and negative likelihood ratios were 1.2 and 0.7, and the overall diagnostic accuracy of the BQ was 65.3%, using an AHI cut-off of 5. CONCLUSION: Due to modest sensitivity and low specificity, the BQ does not seem to be an appropriate tool for identifying patients with obstructive sleep apnea in a sleep clinic population.
Berlin ; Humans ; Male ; Mass Screening ; Polysomnography ; Primary Health Care ; Prospective Studies ; Surveys and Questionnaires ; Sensitivity and Specificity ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive

OBJECTIVES: The percentage of positional sleep apnea in obstructive sleep apnea (OSA) varies in different reports from 9% to 60%. If there is a positional dependency in patients with OSA, positional therapy alone could be successful in treating about 50% of all OSA cases. The aim of this report is to compare anthropomorphic and polysomnographic data between the positional sleep apnea group and non-positional sleep apnea group with OSA whose conditions were diagnosed in our sleep clinic. METHODS: This is a retrospective study of anthropomorphic and polysomnographic data of patients with OSA who was performed a nocturnal polysomnography. Positional sleep apnea was defined as having a supine apnea-hypopnea index (AHI) of twice or more compared to the AHI in the non-supine position. The patients were divided in the positional sleep apnea group and the non-positional sleep apnea group. RESULTS: In 101 patients with OSA, 81 were male, and the mean age was 49.2+/-11.9 years. Seventy-six (75.2%) were diagnosed as the positional sleep apnea. Waist to hip ratio and body mass index (BMI) were significantly higher in non-positional sleep apnea group. The frequency of severe OSA was significantly higher in this group. In the positional sleep apnea group, nocturnal sleep quality was better preserved, and consequently these patients were less sleepy during daytime. AHI was significantly lower and minimal arterial oxygen saturation during sleep was significantly higher in this group. CONCLUSION: The percentage of positional sleep apnea in OSA was 75.2%. AHI, BMI, and waist to hip ratio were lower in the positional sleep apnea group. These patients have less severe breathing abnormalities than the non-positional sleep apnea group in polysomnography.
Body Mass Index ; Dependency (Psychology) ; Humans ; Male ; Oxygen ; Polysomnography ; Respiration ; Retrospective Studies ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive ; Waist-Hip Ratio

OBJECTIVES: Several studies suggest that nocturia may be related to obstructive sleep apnea syndrome (OSAS). The mechanism by which OSAS develops nocturia has not been determined. The present study aimed to determine the prevalence of nocturia among adults with OSAS and to identify factors that may be predictive in this regard. METHODS: Retrospective review of clinical and polysomnographic data obtained from patients evaluated at the sleep clinics of the St. Paul's Hospital between 2009 and 2012. The urinary symptoms were assessed on the basis of the International Prostate Symptom Score (IPSS). Pathologic nocturia was defined as two or more urination events per night. OSAS was defined as apnea-hypopnea index (AHI) > or =5. A multivariate analysis using logistic regression was performed to examine the relationship between polysomnographic variables and the presence of pathologic nocturia, while controlling for confounding factor. RESULTS: A total of 161 men >18 years of age (mean age 46.7+/-14.1), who had been referred to a sleep laboratory, were included in the present study. Among these, 27 patients with primary snoring and 134 patients with obstructive sleep apnea were confirmed by polysomnography. Nocturia was found in 53 patients with OSAS (39.6%) and 8 patients with primary snoring (29.6%). The AHI was higher in patients with nocturia than in those without nocturia (p=0.001). OSAS patients with nocturia had higher arousal index (p=0.044), and lower nadir oxyhemoglobin saturation (p=0.001). Multiple regression analysis showed that age (beta=0.227, p=0.003), and AHI (beta=0.258, p=0.001) were associated with nocturia, and that the presence of pathologic nocturia was predicted by age (OR 1.04 ; p=0.004) and AHI (OR 1.02 ; p=0.001). CONCLUSION: Nocturia is common among patients with OSAS. The strongest predictors of nocturia are age and AHI in patients with OSAS.
Adult ; Arousal ; Humans ; Logistic Models ; Male ; Multivariate Analysis ; Nocturia* ; Oxyhemoglobins ; Polysomnography ; Prevalence* ; Prostate ; Retrospective Studies ; Sleep Apnea, Obstructive* ; Snoring ; Urination

A beta-glucan synthase gene was isolated from the genomic DNA of polypore mushroom Sparassis crispa, which reportedly produces unusually high amount of soluble beta-1,3-glucan (beta-glucan). Sequencing and subsequent open reading frame analysis of the isolated gene revealed that the gene (5,502 bp) consisted of 10 exons separated by nine introns. The predicted mRNA encoded a beta-glucan synthase protein, consisting of 1,576 amino acid residues. Comparison of the predicted protein sequence with multiple fungal beta-glucan synthases estimated that the isolated gene contained a complete N-terminus but was lacking approximately 70 amino acid residues in the C-terminus. Fungal beta-glucan synthases are integral membrane proteins, containing the two catalytic and two transmembrane domains. The lacking C-terminal part of S. crispa beta-glucan synthase was estimated to include catalytically insignificant transmembrane alpha-helices and loops. Sequence analysis of 101 fungal beta-glucan synthases, obtained from public databases, revealed that the beta-glucan synthases with various fungal origins were categorized into corresponding fungal groups in the classification system. Interestingly, mushrooms belonging to the class Agaricomycetes were found to contain two distinct types (Type I and II) of beta-glucan synthases with the type-specific sequence signatures in the loop regions. S. crispa beta-glucan synthase in this study belonged to Type II family, meaning Type I beta-glucan synthase is expected to be discovered in S. crispa. The high productivity of soluble beta-glucan was not explained but detailed biochemical studies on the catalytic loop domain in the S. crispa beta-glucan synthase will provide better explanations.
Agaricales ; Cell Wall ; Classification ; Clone Cells* ; Cloning, Organism* ; DNA ; Efficiency ; Exons ; Glycogen Synthase ; Humans ; Introns ; Membrane Proteins ; Open Reading Frames ; RNA, Messenger ; Sequence Analysis

Central sleep apnea (CSA) is a highly prevalent comorbidity in patients with heart failure and may present in 25 to 40 percent of heart failure patients. Continuous positive airway pressure (CPAP) is the primary therapeutic option and effective in treatment of obstructive sleep apnea (OSA). In heart failure patients with CSA, several trials of CPAP showed a number of positive effects in heart failure treatment. A 58-year-old male visited the hospital because of dyspnea and he was diagnosed as heart failure with ischemic heart disease. He underwent coronary angiography and received percutaneous coronary intervention due to stenosis at the middle of left anterior descending coronary artery. However, dyspnea was not completely improved after treatment with percutaneous coronary intervention. The patient also experienced snoring and sleep apnea which worsened with symptom of dyspnea in the recent year. We suspected CSA and the patient underwent polysomnography to confirm whether sleep apnea was present. During the polysomnography, CSA with Cheyne-Stokes respiration (CSR) was observed and apnea-hypopnea index was 45.9/hr. The patient was treated with CPAP. After CPAP treatment, hypoxemia and CSA were resolved and dyspnea was improved with reducing NYHA class. We report a case successfully treated with clinical improvement by presuming CSA in a patient with heart failure.
Anoxia ; Cheyne-Stokes Respiration ; Comorbidity ; Constriction, Pathologic ; Continuous Positive Airway Pressure* ; Coronary Angiography ; Coronary Vessels ; Dyspnea ; Heart Failure* ; Heart* ; Humans ; Male ; Middle Aged ; Myocardial Ischemia ; Percutaneous Coronary Intervention ; Polysomnography ; Sleep Apnea Syndromes ; Sleep Apnea, Central* ; Sleep Apnea, Obstructive ; Snoring

No abstract available.
Intensive Care Units ; Sepsis ; Critical Illness ; Chronic Disease ; Hospital Mortality

BACKGROUND: Aging is a significant issue worldwide, and Korea is one of the most rapidly aging countries. Along with the demographic transition, the age structure of intensive care unit (ICU) patients changes as well. METHODS: The aim of this study was to analyze the change in age distribution of the ICU patients over the last 10 years and its effect on clinical outcomes. Single-center, retrospective analysis of all patients aged ≥18 years admitted to either the medical or surgical ICU at St. Paul's Hospital, The Catholic University of Korea, between January 2005 and December 2014 was conducted. For clinical outcome, in-hospital mortality, duration of ICU stay, and hospital stay were analyzed. Cost analysis was performed to show the economic burden of each age strata. RESULTS: A total of 10,366 ICU patients were admitted to the chosen ICUs during the study period. The proportion of elderly patients aged ≥65 years increased from 47.9% in 2005 to 63.7% in 2014, and the proportion of the very elderly patients aged ≥80 years increased from 12.8% to 20.7%. However, this increased proportion of elderly patients did not lead to increased in-hospital mortality. The percent of ICU treatment days attributable to elderly patients increased from 51.1% in year 2005 to 64.0% in 2014. The elderly ICU patients were associated with higher in-hospital mortality compared to younger age groups. CONCLUSIONS: The proportion of elderly patients admitted to ICUs increased over the last decade. However, overall in-hospital mortality has not increased during the same period.
Age Distribution ; Aged* ; Aging ; Costs and Cost Analysis ; Critical Care* ; Hospital Mortality ; Humans ; Intensive Care Units* ; Korea* ; Length of Stay ; Mortality ; Population Dynamics ; Retrospective Studies*

BACKGROUND: Recent research demonstrates a strong association between smoking-related behaviors and genetic variation. We investigated the clinical features and genetic effects of dopamine receptors and a serotonin transporter on smoking cessation in Koreans. METHODS: Smokers (n=51) wanting to quit smoking were included as the study population. They were genotyped for polymorphisms in dopamine D2 receptor (DRD2) (TaqI and -141C), dopamine D4 receptor (DRD4), and a serotonin transporter (5-HTT). We defined abstinence as stopping smoking at six months after enrollment. RESULTS: Eighteen patients (35.3%) stopped smoking at six months. The abstinence group had a higher rate of alcohol use whereas the non-abstinence group had more coughing. However, there were no significant differences in average smoking rate, starting age of smoking, gender, nicotine dependence, and forced expiratory volume in one second between the two groups. As for the genes in the dopamine pathway, the polymorphisms of DRD2 TaqI (A1 allele) and DRD2 -141C (Ins C allele) were not genotypically different between the two groups (P=0.245 and 0.409, respectively). The genetic variation in the DRD4 variable number of tandem repeats (VNTR) also showed a similar distribution in the two groups. Regarding the polymorphisms of 5-HTT, there was no difference in the long allele between the two groups (P=0.852). CONCLUSIONS: This study suggests that the genetic variations of DRD2 TaqI, DRD2 -141C, DRD4 VNTR, and 5-HTT might have little influence on smoking cessation in Korean smokers.
Alleles ; Cough ; DNA ; Dopamine ; Forced Expiratory Volume ; Genetic Variation ; Humans ; Minisatellite Repeats ; Polymorphism, Genetic ; Receptors, Dopamine ; Receptors, Dopamine D2 ; Receptors, Dopamine D4 ; Serotonin Plasma Membrane Transport Proteins ; Smoke ; Smoking ; Smoking Cessation ; Tobacco Use Disorder

BACKGROUND: A randomized, multicenter, open-label, parallel group study was performed to compare the effects of remifentanil and morphine as analgesic drugs on the duration of weaning time from mechanical ventilation (MV). METHODS: A total of 96 patients with MV in 6 medical and surgical intensive care units were randomly assigned to either, remifentanil (0.1-0.2 mcg/kg/min, n = 49) or morphine (0.8-35 mg/hr, n = 47) from the weaning start. The weaning time was defined as the total ventilation time minus the sum of controlled mode duration. RESULTS: Compared with the morphine group, the remifentanil-based analgesic group showed a tendency of shorter weaning time (mean 143.9 hr, 89.7 hr, respectively: p = 0.069). Secondary outcomes such as total ventilation time, successful weaning rate at the 7th of MV day was similar in both groups. There was also no difference in the mortality rate at the 7th and 28th hospital day. Kaplan-Meyer curve for weaning was not different between the two groups. CONCLUSIONS: Remifentanil usage during the weaning phase tended to decrease weaning time compared with morphine usage.
Analgesics ; Humans ; Critical Care ; Morphine* ; Mortality ; Respiration, Artificial* ; Ventilation ; Ventilator Weaning ; Weaning*