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Öğe Carbonic Anhydrase IX as a Marker of Disease Severity in Obstructive Sleep Apnea(Mdpi, 2022) Geckil, Aysegul Altintop; Kiran, Tugba Raika; Berber, Nurcan Kirici; Otlu, Onder; Erdem, Mehmet; In, ErdalBackground and Objectives: Carbonic anhydrase (CA) enzymes are a family of metalloenzymes that contain a zinc ion in their active sites. CA enzymes have been implied in important situations such as CO2 transport, pH regulation, and oncogenesis. CA-IX is a transmembrane glycoprotein and stimulates the expression of hypoxia-inducible factor-1 (HIF-1) CA-IX. This study aimed to determine serum CA-IX levels in OSA patients in whom intermittent hypoxia is important and to investigate the relationship between serum CA-IX levels and disease severity. Materials and Methods: The study included 88 people who applied to Malatya Turgut Ozal University Training and Research Hospital Sleep Disorders Center without a history of respiratory disease, malignancy, and smoking. Patients were divided into three groups: control (AHI < 5, n = 31), mild-moderate OSA (AHI = 5-30, n = 27) and severe OSA (AHI > 30, n = 30). The analysis of the data included in the research was carried out with the SPSS (IBM Statistics 25, NY, USA). The Shapiro-Wilk Test was used to check whether the data included in the study had a normal distribution. Comparisons were made with ANOVA in multivariate groups and the t-test in bivariate groups. ANCOVA was applied to determine the effect of the CA-IX parameter for OSA by controlling the effect of independent variables. The differentiation in CA-IX and OSA groups was analyzed regardless of BMI, age, gender, and laboratory variables. ROC analysis was applied to determine the parameter cut-off point. Sensitivity, specificity, and cut-off were calculated, and the area under the curve (AUC) value was calculated. Results: Serum CA-IX levels were 126.3 +/- 24.5 pg/mL in the control group, 184.6 +/- 59.1 pg/mL in the mild-moderate OSA group, and 332.0 +/- 39.7 pg/mL in the severe OSA group. Serum CA-IX levels were found to be higher in the severe OSA group compared to the mild-moderate OSA group and control group and higher in the mild-moderate OSA group compared to the control group (p < 0.001, p < 0.001, p < 0.001, respectively). In addition, a negative correlation between CA-IX and minimum SaO(2) and mean SaOI(2) (r = -0.371, p = 0.004; r = -0.319, p = 0.017, respectively). A positive correlation between CA-IX and desaturation index (CT90) was found (r = 0.369, p = 0.005). A positive correlation was found between CA-IX and CRP (r = 0.340, p = 0.010). When evaluated by ROC curve analysis, the area under the curve (AUC) value was determined as 0.940 (95% CI 0.322-0.557; p < 0.001). When the cut-off value for CA-IX was taken as 254.5 pg/mL, it was found to have 96.7% sensitivity and 94.8% specificity in demonstrating severe OSA. Conclusions: Our study found that serum CA-IX value was higher in OSA patients than in control patients, and this elevation was associated with hypoxemia and inflammation. CA-IX value can be a fast, precise, and useful biomarker to predict OSA.Öğe Coexistence of obstructive sleep apnea syndrome and fibromyalgia(Turkish Assoc Tuberculosis & Thorax, 2022) Geckil, Aysegul Altintop; Baykara, Rabia AydoganIntroduction: Fibromyalgia is characterized by pain all over the body, whose diagnosis and treatment are not fully understood. Obstructive sleep apnea syndrome (OSAS) is a disease that causes apnea, hypopnea and oxygen desaturation due to collapse in the upper respiratory tract and is characterized by excessive daytime sleepiness, fatigue and lack of attention. Symptoms and signs of OSAS and fibromyalgia are similar. In our study, we aimed to compare the association of fibromyalgia in female OSAS patients in terms of polysomnography and laboratory parameters. Materials and Methods: We aimed to examine the association of fibromyalgia in patients with female OSAS. A total of 190 female OSAS patients were included in the study. The patients were divided into two groups according to the presence of fibromyalgia: 88 (46.3%) patients in the fibromyalgia group and 102 (53.7%) patients in the control group. Statistical Package for the Social Sciences (SPSS) program was used for the evaluation of demographic data, polysomnography parameters and laboratory tests of the patients, and values with p< 0.05 were considered statistically significant. Results: Mean age of the patients was 52.1 +/- 11.9 years and mean body mass index (BMI) was 35.1 +/- 7.2. There was no difference between age and BMI (p= 0.971, p= 0.716, respectively). Periodic leg movements (PLMS) were higher in the fibromyalgia group (p= 0.02). The desaturation index (CT90) was found to be high in the fibromyalgia group (p= 0.043). The minimum SaO(2 )value was found to be low in the fibromyalgia group (p= 0.022). Sleep latency was found to be higher in the fibromyalgia group (p= 0.031). Hemoglobin and hematocrit values were found to be statistically significantly higher in the fibromyalgia group (p= 0.020, p= 0.027, respectively). Triglyceride level was found to be high in the fibromyalgia group (p= 0.043). Conclusion: We recommend clinical evaluation of female patients with fibromyalgia and we suggest polysomnography, especially in patients with excessive daytime sleepiness. Early diagnosis and treatment of concomitant OSAS will contribute to quality of fibromyalgia patients' life.Öğe The effects of disease severity and comorbidity on oxidative stress biomarkers in obstructive sleep apnea(Springer Heidelberg, 2024) Kiran, Tugba Raika; Otlu, Onder; Erdem, Mehmet; Geckil, Aysegul Altintop; Berber, Nurcan Kirici; In, ErdalPurposeIschemia-modified albumin (IMA), total oxidant status (TOS), and total antioxidant status (TAS) are biomarkers used to evaluate oxidative stress status in various diseases including obstructive sleep apnea (OSA). In this study, we investigated the effects of disease severity and comorbidity on IMA, TOS and TAS levels in OSA.MethodsPatients with severe OSA (no-comorbidity, one comorbidity, and multiple comorbidities) and mild-moderate OSA (no-comorbidity, one and multiple comorbidities), and healthy controls were included in the study. Polysomnography was applied to all cases and blood samples were taken from each participant at the same time of day. ELISA was used to measure IMA levels in serum samples and colorimetric commercial kits were used to perform TOS and TAS analyses. In addition, routine biochemical analyses were performed on all serum samples.ResultsA total of 74 patients and 14 healthy controls were enrolled. There was no statistically significant difference between the disease groups according to gender, smoking status, age, body mass index (BMI), HDL, T3, T4, TSH, and B12 (p > 0.05). As the severity of OSA and comorbidities increased, IMA, TOS, apnea-hypopnea index (AHI), desaturation index (T90), cholesterol, LDL, triglyceride, AST, and CRP values increased significantly (p < 0.05). On the other hand, TAS, minimum desaturation, and mean desaturation values decreased significantly (p < 0.05).ConclusionsWe concluded that IMA, TOS, and TAS levels may indicate OSA-related oxidative stress, but as the severity of OSA increases and with the presence of comorbidity, IMA and TOS levels may increase and TAS levels decrease. These findings suggest that disease severity and presence/absence of comorbidity should be considered in studies on OSA.Öğe The effects of PAP therapy on energy metabolism in patients with obstructive sleep apnea syndrome(Turkish Assoc Tuberculosis & Thorax, 2019) Geckil, Aysegul Altintop; Yetkin, OzkanIntroduction: In this study, changes in energy metabolism before and after treatment were compared in obstructive sleep apnea syndrome (OSAS) patients who received positive airway pressure therapy. Materials and Methods: Thirty-nine patients (22 male, 17 female) were admitted to study. Patients for PAP therapy who had moderate to severe in polysomnography were included. Values of energy metabolism were recorded during three days via metaboic holter device, before and after PAP therapy. Results: The mean age of the patients was 51.53 +/- 11.16 year. In 15 (38.46%) of the patients BPAP, and in 24 (61.54%) of the patients CPAP treatment started. Three days after using metabolic holter device: the total daily energy consumption of the patients was found to be 482,4 +/- 296.1 kcal/day before treatment and 524.5 +/- 343.1 kcal/day after treatment (p < 0.0001); patients' daily physical activity was 7867 +/- 3319 steps/day before treatment and 12.416 +/- 1451 steps/day after treatment, which was considered statistically significant (p < 0001); the total daily resting period of the patients was 7.90 +/- 1.36 hours/day before treatment and 7.44 +/- 1.42 hours/day after treatment, considered statistically significant (p < 0001); the total sleep duration of the patients was 5.50 +/- 1.88 hours/day before treatment and 5.87 +/- 1.20 hours/day after treatment, considered statistically significant (p < 0001). Conclusion: In our study, we found that daily physical activity and energy consumption increased with PAP treatment. With PAP treatment, obesity, diabetes and hypertension can be controlled. In our study, since PAP treatment was effective with effective sleep, the immobilization time was decreased and therefore the duration of daytime physical activity was prolonged. With these effects, patients' compliance with treatment increases. In conclusion, PAP treatment should be recommended in patients with moderate and severe OSAS.Öğe Efficacy of copeptin in distinguishing COVID-19 pneumonia from community-acquired pneumonia(Wiley, 2021) Kuluozturk, Mutlu; In, Erdal; Telo, Selda; Karabulut, Ercan; Geckil, Aysegul AltintopThe clinical symptoms of community-acquired pneumonia (CAP) and coronavirus disease 2019 (COVID-19)-associated pneumonia are similar. Effective predictive markers are needed to differentiate COVID-19 pneumonia from CAP in the current pandemic conditions. Copeptin, a 39-aminoacid glycopeptide, is a C-terminal part of the precursor pre-provasopressin (pre-proAVP). The activation of the AVP system stimulates copeptin secretion in equimolar amounts with AVP. This study aims to determine serum copeptin levels in patients with CAP and COVID-19 pneumonia and to analyze the power of copeptin in predicting COVID-19 pneumonia. The study consists of 98 patients with COVID-19 and 44 patients with CAP. The basic demographic and clinical data of all patients were recorded, and blood samples were collected. The receiver operating characteristic (ROC) curve was generated and the area under the ROC curve (AUC) was measured to evaluate the discriminative ability. Serum copeptin levels were significantly higher in COVID-19 patients compared to CAP patients (10.2 +/- 4.4 ng/ml and 7.1 +/- 3.1 ng/ml; p < .001). Serum copeptin levels were positively correlated with leukocyte, neutrophil, and platelet count (r = -.21, p = .012; r = -.21, p = .013; r = -.20, p = .018; respectively). The multivariable logistic regression analysis revealed that increased copeptin (odds ratio [OR] = 1.183, 95% confidence interval [CI], 1.033-1.354; p = .015) and CK-MB (OR = 1.052, 95% CI, 1.013-1.092; p = .008) levels and decreased leukocyte count (OR = 0.829, 95% CI, 0.730-0.940; p = .004) were independent predictors of COVID-19 pneumonia. A cut-off value of 6.83 ng/ml for copeptin predicted COVID-19 with a sensitivity of 78% and a specificity of 73% (AUC: 0.764% 95 Cl: 0.671-0.856, p < .001). Copeptin could be a promising and useful biomarker to be used to distinguish COVID-19 patients from CAP patients.Öğe Efficacy of serum apelin and galectin-3 as potential predictors of mortality in severe COVID-19 patients(Wiley, 2023) Berber, Nurcan Kirici; Geckil, Aysegul Altintop; Altan, Nazife Ozge; Kiran, Tugba Raika; Otlu, Onder; Erdem, Mehmet; In, ErdalApelin is a cardioprotective biomarker while galectin-3 is a pro-inflammatory and profibrotic biomarker. Endothelial dysfunction, hyperinflammation, and pulmonary fibrosis are key mechanisms that contribute to the development of adverse outcomes in Coronavirus disease 2019 (COVID-19) infection. This study aims to analyze the prognostic value of serum apelin and galectin-3 levels to early predict patients at high risk of mortality in patients hospitalized for severe COVID-19 pneumonia. The study included 78 severe COVID-19 patients and 40 healthy controls. The COVID-19 patients were divided into two groups, survivors and nonsurvivors, according to their in-hospital mortality status. Basic demographic and clinical data of all patients were collected, and blood samples were taken before treatment. In our study, serum apelin levels were determined to be significantly lower in both nonsurvivor and survivor COVID-19 patients compared to the control subjects (for both groups, p < 0.001). However, serum apelin levels were similar in survivor and nonsurvivor COVID-19 patients (p > 0.05). Serum galectin-3 levels were determined to be higher in a statistically significant way in nonsurvivors compared to survivors and controls (for both groups; p < 0.001). Additionally, serum galectin-3 levels were significantly higher in the survivor patients compared to the control subjects (p < 0.001). Positive correlations were observed between galectin-3 and age, ferritin, CK-MB and NT-proBNP variables (r = 0.32, p = 0.004; r = 0.24, p = 0.04; r = 0.24, p = 0.03; and r = 0.33, p = 0.003, respectively) while a negative correlation was observed between galectin-3 and albumin (r = -0.31, p = 0.006). Multiple logistic regression analysis revealed that galectin-3 was an independent predictor of mortality in COVID-19 patients (odds ratio [OR] = 2.272, 95% confidence interval [CI] = 1.106-4.667; p = 0.025). When the threshold value for galectin-3 was regarded as 2.8 ng/ml, it was discovered to predict mortality with 80% sensitivity and 57% specificity (area under the curve = 0.738, 95% CI = 0.611-0.866, p = 0.002). Galectin-3 might be a simple, useful, and prognostic biomarker that can be utilized to predict patients who are at high risk of mortality in severe COVID-19 patients.Öğe Impact of rem-related obstructive sleep apnea therapy on anxiety, depression and daytime sleepiness(Bayrakol Medical Publisher, 2022) Geckil, Aysegul Altintop; Ermis, HilalAim: Obstructive Sleep Apnea (OSA) is characterized by repetitive episodes of complete or partial upper airway obstruction during sleep. Patients who slept at least 30 minutes in REM sleep, total apnea-hypopnea index (AHI)>5 and REM AHI/NREM AHI>2 are defined as REM-related OSA. We investigated the efficacy of treatment on anxiety, depression and daytime sleepiness in REM-related OSA. Material and Methods: A total of 110 patients with REM-related OSA participated in the study. Patients were divided into two groups; the treatment group consisted of patients who received treatment (n:38) and the non-treatment group who refused to receive treatments (n:72). Of the 38 patients treated, 33 had mild disease and 5 had moderate disease. Sixty-seven of the 72 patients who did not receive treatment had mild disease and 5 had moderate disease. Both groups completed the HADS (Hospital Anxiety-Depression Scale), ESS (Epworth Sleepiness Scale) questionnaires. SPSS was used for data analysis. Results were expressed as mean and standard deviation. T-test and chi-square tests were performed to compare cases. A p-value <0.05 was considered statistically significant. Results: There was no statistically significant difference between the groups, in terms of age, gender, height, weight, and body mass index (BMI). No statistically significant difference was found between the two groups in terms of polysomnography parameters AHI, REM AHI, arousal index, periodic leg movement (PLM) index, sleep latency, REM latency, minimum oxygen saturation (SPO2), and cumulative percentage of time spent at saturation below 90%. HADS- Anxiety, HADS- Depression and ESS scores were significantly higher in the non-treatment group in comparison to the treatment group (p=0.011, p=0.016, p=0.005, respectively). Discussion: The results of our study showed that treatment has positive effects on anxiety, depression and daytime sleepiness, which are indicative of the quality of life in patients with REM-related OSA.Öğe Is There a Relationship between Voice Quality and Obstructive Sleep Apnea Severity and Cumulative Percentage of Time Spent at Saturations below Ninety Percent: Voice Analysis in Obstructive Sleep Apnea Patients(Mdpi, 2022) Yaslikaya, Serhat; Geckil, Aysegul Altintop; Birisik, ZehraBackground and Objectives: Apnea hypopnea index is the most important criterion in determining the severity of obstructive sleep apnea (OSA), while the percentage of the total number of times which oxygen saturation is measured below 90% during polysomnography (CT90%) is important in determining the severity of hypoxemia. As hypoxemia increases, inflammation will also increase in OSA. Inflammation in the respiratory tract may affect phonation. We aimed to determine the effects of the degree of OSA and CT90% on phonation. Materials and Methods: The patients were between the ages of 18-60 years and were divided into four groups: normal, mild, moderate, and severe OSA. Patients were asked to say the vowels /alpha:/ and /i:/ for 5 s for voice recording. Maximum phonation time (MPT) was recorded. Using the Praat voice analysis program, Jitter%, Shimmer%, harmonics-to-noise ratio (HNR), and f0 values were obtained. Results: Seventy-two patients were included. Vowel sound /alpha:/; there was a significant difference for Jitter%, Shimmer%, and HNR measurements between the 1st and the 4th group (p < 0.001, p < 0.001, and p < 0.001, respectively) and a correlation between CT90% and Shimmer% and HNR values (p < 0.001 and p < 0.021, respectively). Vowel sound /i:/; there was a significant difference in f0 values between the 1st group and 2nd and 4th groups (p < 0.028 and p < 0.015, respectively), and for Jitter%, Shimmer%, and HNR measurements between the 1st and 4th group (p < 0.04, p < 0.000, and p < 0.000, respectively), and a correlation between CT90% and Shimmer% and HNR values (p < 0.016 and p < 0.003, respectively). The difference was significant in MPT between the 1st group and 3rd and 4th groups (p < 0.03 and p < 0.003, respectively). Conclusions: Glottic phonation can be affected, especially in patients whose AHI scores are >= 15. Voice quality can decrease as the degree of OSA increases. The increase in CT90% can be associated with the worsening of voice and can be used as a predictor in the evaluation of voice disorders in the future.Öğe Leukocyte albumin ratio as an early predictor of mortality in critical COVID-19 patients(Bayrakol Medical Publisher, 2022) Geckil, Aysegul Altintop; In, Erdal; Berber, Nurcan Kirici; Kasapoglu, Umut Sabri; Karabulut, Ercan; Ozdemir, CengizAim: The aim of this study is to analyze the effectiveness of the leukocyte albumin ratio (LAR) in predicting mortality in critical COVID-19 patients. Material and Methods: In this retrospectively-designed study, we evaluated a total of 98 critical patients who were hospitalized in the intensive care unit. Patients were divided into two groups according to hospital mortality as survivors (n=43) and non-survivors (n=55). Results: The non-survivors group was statistically significantly older (67.3 +/- 9.7 versus 62.5 +/- 10.9; p=0.023). HT and DM were detected more in the non-survivors group than in the survivors group (p=0.031, p=0.018, respectively). Mean LAR values were significantly higher in non-survivors than in survivors (5.9 +/- 3.5 versus 3.3 +/- 1.4; p<0.001). LAR values was positively correlated with urea (r=0.43, p<0.001), LDH (r=0.35, p<0.001), ferritin (r=0.25, p=0.015), procalcitonin (r=0.34, p<0.001), and pro-BNP (r=0.24, p=0.015) levels. A cut-off value of 3.71 ng/mL for LAR predicted mortality with a sensitivity of 76% and a specificity of 70% (AUC:0.779 95% Cl:0.689-0.870; p<0.001). Multivariable logistic regression analysis revealed that older age (OR:1.114, 95% CI:1.020-1.218; p=0.017) and increased ferritin (OR:1.003, 95% CI:1.001-1.004; p=0.002) and LAR (OR:1.583, 95% CI:1.073-2.337; p=0.021) values were independent predictors of mortality in patients with critical COVID-19. Discussion: LAR can be a useful and prognostic marker that can be used to predict mortality in COVID-19 patients admitted to the intensive care unit.Öğe May viral load detected in saliva in the early stages of infection be a prognostic indicator in COVID-19 patients?(Elsevier, 2021) Aydin, Sukru; Benk, Isilay Gokce; Geckil, Aysegul AltintopObjective: This study aimed to investigate the prognostic value of viral load detected in the saliva of COVID-19 patients in the early stage of infection. Study design: Oro-nasopharyngeal swab and saliva samples were collected from all patients simultaneously in the early stage of COVID-19. Viral loads were determined by extracting viral RNAs from saliva samples of patients whose ONP swabs were positive for SARS-CoV-2 by RT-qPCR. The demographic information, comorbidities, cycle threshold values, and one-month clinical courses were recorded and compared. Results: The patients' clinical course was evaluated for one month; 56 % of patients had mild disease, 26.4 % had moderate disease, 9.6 % had severe disease, and 8% had a critical/mortal disease. The average cycle threshold values of SARS-CoV-2 in saliva and ONP samples were measured as 22.28 and 24.19, respectively. Cycle threshold value of saliva was found to be significant in predicting disease severity (Eta coefficient 0.979). A statistically significant relationship was found between the disease's severity and the mean of ONP samples' Ctvalues (p < 0.05). Gender, age, body mass index, and co-morbidities were compared with the severity of the disease; no statistically significant difference was found. Conclusion: Viral load detected in saliva in the early period of COVID-19 infection may have a prognostic value in showing the disease's course in patients over 45-year-old. Saliva is an easily obtainable, reliable material for COVID-19 screening.Öğe MTU-COVNet: A hybrid methodology for diagnosing the COVID-19 pneumonia with optimized features from multi-net(Elsevier Science Inc, 2022) Kavuran, Gurkan; In, Erdal; Geckil, Aysegul Altintop; Sahin, Mahmut; Berber, Nurcan KiriciPurpose: The aim of this study was to establish and evaluate a fully automatic deep learning system for the diagnosis of COVID-19 using thoracic computed tomography (CT). Materials and methods: In this retrospective study, a novel hybrid model (MTU-COVNet) was developed to extract visual features from volumetric thoracic CT scans for the detection of COVID-19. The collected dataset consisted of 3210 CT scans from 953 patients. Of the total 3210 scans in the final dataset, 1327 (41%) were obtained from the COVID-19 group, 929 (29%) from the CAP group, and 954 (30%) from the Normal CT group. Diagnostic performance was assessed with the area under the receiver operating characteristic (ROC) curve, sensitivity, and specificity. Results: The proposed approach with the optimized features from concatenated layers reached an overall accuracy of 97.7% for the CT-MTU dataset. The rest of the total performance metrics, such as; specificity, sensitivity, precision, F1 score, and Matthew Correlation Coefficient were 98.8%, 97.6%, 97.8%, 97.7%, and 96.5%, respectively. This model showed high diagnostic performance in detecting COVID-19 pneumonia (specificity: 98.0% and sensitivity: 98.2%) and CAP (specificity: 99.1% and sensitivity: 97.1%). The areas under the ROC curves for COVID-19 and CAP were 0.997 and 0.996, respectively. Conclusion: A deep learning-based AI system built on the CT imaging can detect COVID-19 pneumonia with high diagnostic efficiency and distinguish it from CAP and normal CT. AI applications can have beneficial effects in the fight against COVID-19.Öğe The relationship between anxiety, depression, daytime sleepiness in the REM-related mild OSAS and the NREM-related mild OSAS(Springer Heidelberg, 2020) Geckil, Aysegul Altintop; Ermis, HilalIntroduction Obstructive sleep apnea syndrome (OSAS) is a common form of sleep-related respiratory disease characterized by recurrent blockages in the upper airway. Rapid eye movement (REM)-related OSAS is a condition in which apneas and hypopneas are more common during REM sleep. We investigated whether there was any difference between REM-related mild OSAS group and NREM-related mild OSAS group in terms of anxiety, depression, and daytime sleepiness. Methods A total of 166 patients with mild OSAS (72 patients with REM-related and 94 NREM-related OSAS) participated in the study. Hospital Anxiety-Depression Scale (HADS) and Epworth Sleepiness Scale (ESS) questionnaires were completed by both groups. Results Anxiety and depression scores were significantly higher in patients with REM-related OSAS in comparison to the NREM-related OSAS group (p = 0.01, p = 0.02 respectively). There was no statistically significant difference between the two groups in terms of ESS scores (p = 0.60). Conclusion The results of our study suggest that patients with REM-related OSAS have higher rates of depression and anxiety compared to non-REM-related OSAS patients and this may adversely affect quality of life. It may be possible to prevent psychiatric complications, such as depression and anxiety, by administering treatments that reduce REM sleep duration and intensity in patients with REM-related OSAS.
