Is there a relationship between hematological parameters and duration of respiratory events in severe OSA

Association between Red Blood Cell Distribution Width and Obstructive Sleep Apnea Syndrome: A Systematic Review and Meta-Analysis

Although polysomnography is the gold standard method to diagnose obstructive sleep apnea syndrome (OSAS), there is an ongoing quest for simpler and relatively inexpensive biomarkers of disease presence and severity. To address this issue, we conducted a systematic review of the potential diagnostic role of the red blood cell distribution width (RDW), a routine hematological parameter of red blood cell volume variability, in OSAS. A total of 1478 articles were initially identified in the databases PubMed, Web of Science, Scopus, Embase, and Google Scholar, from their inception to February 2023, and 20 were selected for final analysis. The RDW was significantly higher in OSAS than in non-OSAS subjects (SMD = 0.44, 95% CI 0.20 to 0.67, p < 0.001; low certainty of evidence). In univariate meta-regression, the mean oxygen saturation (SpO₂) was significantly associated with the effect size. No significant between-group differences were observed in subgroup analyses. Notably, in OSAS subjects, the RDW SMD progressively increased with disease severity. In conclusion, these results suggest that the RDW is a promising biomarker of OSAS (PROSPERO registration number: CRD42023398047).

Serum bicarbonate level improves specificity of Berlin Sleep Questionnaire for obstructive sleep apnea

Several questionnaires have been developed to assist the diagnostic process in obstructive sleep apnea syndrome (OSAS). Berlin Sleep Questionnaire (BSQ) represents a validated screening tool for OSAS. Totally 450 patients admitted to the Sleep Center at Dicle University Medical Faculty were included prospectively. A risk analysis was performed for presence of OSAS using the BSQ. Arterial blood gas measurements were performed including bicarbonate (HCO3) level. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of BSQ for presence of OSAS and severe OSAS were determined. In patients with arterial HCO₃ >24.94 mEq/L; sensitivity, specificity, PPV and NPV, of the BSQ were 93.04, 57.1, 98.3, and 23.5%, respectively. The addition of arterial HCO₃ value increased the sensitivity of the BSQ in detecting OSAS patients. Although the cost of sleep studies is high for false positives from the BSQ plus arterial HCO3 level, this cost should be compared with the loss of work efficiency and severe healthcare costs of undiagnosed cases in the future. Therefore, finding possible OSAS cases in primary care health centers is important and adding serum HCO3 value to BSQ questionnaire may contribute to this topic.

Prognostic factors in elderly patients admitted to the intensive care unit with community-acquired pneumonia

OBJECTIVE

We aimed to determine the clinical, radiological and laboratory findings that may indicate poor prognosis in severe community acquired pneumonia (CAP) requiring intensified care to reduce the risk of death.

METHODS

The medical histories, demographic characteristics and laboratory values of over 65 years old patients admitted to the intensive care unit (ICU) and diagnosed with CAP were recorded.

RESULTS

Total of 86 patients were included in the study. Among those patients 39 were discharged from the ICU with health but 47 were expired. Diastolic blood pressure was significantly lower in expired patients (p = 0.044). In multivariate analysis, older age (>78 years) (p = 0.004), at admission elevated blood glucose (>108 mg/dL) levels (p = 0.048), decreased serum albumin (<3.5 g/dL) levels (p = 0.043), elevated serum procalcitonin levels (>0.63 μg/L) (p = 0.034) and in blood gas analysis decreased pH (<7.35) (p = 0.042)and increased lactate (>2mmol/L) (p = 0.001) were the significant risk factors for in-ICU mortality.

CONCLUSIONS

At old age, blood glucose and procalcitonin levels increased at the time of admission, serum albumin levels decreased, pH decreased in blood gas analysis and lactate levels increased, and significant mortality determinants in CAP patients over 65 years of age who applied to the intensive care unit.