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1.  Obstructive Sleep Apnea and Postoperative Complications in Patients Undergoing Coronary Artery Bypass Graft Surgery: A Need for Preventive Strategies 
Obstructive sleep apnea (OSA) is very frequent and often unrecognized in surgical patients. OSA is associated with perioperative complications. We evaluated the effects of OSA on postoperative complications and hospital outcomes in patients undergoing coronary artery bypass graft (CABG) surgery.
Candidates of elective CABG were evaluated by the Berlin questionnaire for OSA. After surgery, patients were assessed for postoperative complications, re-admission to the Intensive Care Unit (ICU), duration of intubation, re-intubation, days spent in the ICU and the hospital.
We studied 61 patients who underwent CABG from which 25 (40.9%) patients had OSA. Patients with OSA had higher body mass index (29.5 ± 3.9 vs. 26.0 ± 3.7 kg/m2, P = 0.003) and higher frequency of hypertension (68.0% vs. 30.5%, P = 0.003), dyslipidemia (36.0% vs. 5.5%, P = 0.004), and pulmonary disease (16.0 vs. 2.7%, P = 0.08). Regarding the surgical outcomes, OSA patients had longer intubation duration (0.75 ± 0.60 vs. 0.41 ± 0.56 days, P = 0.03).
Obstructive sleep apnea is frequent, but unrecognized among patients undergoing CABG. In these patients, OSA is associated with prolonged intubation duration. Preventing these problems may be possible by early diagnosis and management of OSA in cardiac surgery patients. Further studies with larger sample of patients and longer follow-ups are required in this regard.
PMCID: PMC4274552  PMID: 25538841
Cardiac surgery; coronary artery bypass grafting; coronary artery disease; obstructive sleep apnea
2.  Pulmonary function tests in ulcerative colitis 
Pulmonary impairment in patients suffering ulcerative colitis (UC) has been suggested by several investigators using standard pulmonary function tests (PFTs). This changes in pulmonary function associated with minimal respiratory symptoms have been documented, especially in patients with active disease. The aim of this prospective study was to determine airway resistance and lung volumes in patients with UC who have no respiratory symptoms in comparisons to a healthy control group.
Materials and Methods:
We evaluated a total of 30 patients with UC by means of spirometry, body plethysmography, and impulse oscillometry. The patients were not complaining of any pulmonary symptoms and did not present any history of previous respiratory diseases. As controls we examined 30 healthy subjects matched for gender, age, and smoking status. The relationship between PFT, lung volume, and airway resistance; and the activity, localization, and duration of the UC disease were analyzed.
There was a significant difference between airway resistances (kPa/L/s) measured by body plethysmography in patients with UC and those of the controls (R5hz; 0.60 ± 0.44 vs. 0.39 ± 0.13; P < 0.001) and R20hz (0.37 ± 0.19 vs. 0.29 ± 0.1, P = 0.02). There were no correlation between PFT, airway resistance and site and scoring activity (P > 0.05).
Despite the lack of pulmonary symptoms, increased airway resistance was found in UC patients. We also have not found correlation between PFT, lung volume and airway resistance values and scoring of UC activity.
PMCID: PMC4214017  PMID: 25364358
Body plethysmography; impulse oscillometry; ulcerative colitis
3.  Berlin questionnaire study in surgical patient in Alzahra Hospital in year 2010 
To examine the prevalence of high-risk subjects of obstructive sleep apnea (OSA) and its predictive factors in patients undergoing elective surgery by using the Berlin Questionnaire.
Materials and Methods:
300 surgical ASA physical status I, II, III, and IV patients were surveyed. Patients were screened with the Berlin questionnaire for obstructive sleep apnea. Data of sex, age, BMI and HTN also evaluated. Data were analyzed by Chi-square test and P < 0.05 was meaningful.
The Berlin questionnaire identified 25.3% (76/300) of patients as being at high risk of sleep apnea (95% confidence interval, 20%-28%). This group consisted of 195 (65%) males and 105 (35%) females. The prevalence of high-risk subjects in men were more significantly than women (P = 0.001). High-risk subjects also were increasing with age (P = 0.000) and increasing with obesity (P = 0.000) and arterial hypertension (P = 0.000).
Predictors of high risk for OSA-related symptoms were female sex, age more than 50 years, and body mass index.
PMCID: PMC3732883  PMID: 23930261
Berlin questionnaire; preoperative; sleep apnea
4.  Validation of the Persian Version of Berlin Sleep Questionnaire for Diagnosing Obstructive Sleep Apnea 
Obstructive sleep apnea (OSA) is a common but usually under-diagnosed sleep disorder. Objective diagnosis is based on polysomnography, which is an expensive test. We assessed the reliability and diagnostic accuracy of the Berlin questionnaire (BQ) in diagnosis of OSA in Iranian sleep clinic patients.
A cross-sectional linguistic validation study was conducted on consecutive Iranian patients with Persian language attending one sleep clinic in Isfahan (Iran) were studied. Patients completed the Persian BQ (contains 10 questions in 3 categories), developed by forward-backward translation method. The patients underwent an overnight polysomnographic study at the clinic. Apneas/hypopnea index of >5/Hour was considered for diagnosis of OSA.
One hundred and fifty seven patients (55.4% male, mean age = 52.3 ± 13.6 years) were evaluated. Sleep study confirmed OSA diagnosis in 91.7% of the studied patients. The reliability analysis of the BQ categories showed alpha Cronbach's as 0.70 and 0.50 for category 1 and category 2, respectively. BQ categories 1-3 were positive respectively in 88.5%, 67.5%, and 66.9% of the patients. The BQ and sleep study were in agreement for 82.1% of the cases. The sensitivity, specificity, positive and negative predictive values, and positive, and negative likelihood ratio of the BQ were calculated as 84.0%, 61.5%, 96.0%, 25.8%, 2.18%, and 0.26% respectively.
BQ is useful as a screening test for diagnosing OSA in Iranian patients with sleep complaints; however, the test cannot be used for rolling out the OSA. Further studies on editing, modifying, and applying the BQ in a larger sample of patients are warranted in our society.
PMCID: PMC3634173  PMID: 23626891
Apnea hypopnea index; Berlin questionnaire; obstructive sleep apnea; Persian version of Berlin questionnaire; reliability and validity
5.  Sleep Quality in Patients on Maintenance Hemodialysis and Peritoneal Dialysis 
Sleep disturbances are common among uremic patients; however, limited data are available on predictors of sleep quality in this population. We assessed sleep quality in patients on hemodialysis (HD) and peritoneal dialysis (PD) and investigated predictors related to sleep quality.
Patients on maintenance HD and PD were consecutively included from two medical centers in Isfahan city (Iran). They completed the Pittsburgh sleep quality index (PSQI) and hospital anxiety and depression scale. Laboratory tests were done for iron state, kidney function, and electrolytes. Univariate and multivariate analyses were performed to find predictors of sleep quality.
About 90 patients were evaluated (53 males, age = 54.2 ± 15.2 years, disease duration = 5.3 ± 4.5 years). Poor sleep quality was frequent in 86.6% of the cases in each group of HD and PD patients. Patients on HD had poorer sleep quality in terms of total PSQI scores and two dimensions of sleep latency and sleep efficiency (P < 0.05). Anxiety (β = 0.232, P = 0.027), depression (β = 0.317, P = 0.004), and being on HD (β = 2.095, P = 0.009) were independent predictors of overall poor sleep quality.
Poor sleep quality is highly frequent in patients on maintenance dialysis and mood disorders and being on HD are predictive factors. Further studies are required for better understanding of risk factors associated with poor sleep quality and thus possible treatments in these patients.
PMCID: PMC3604848  PMID: 23543042
End-stage renal disease; hemodialysis; peritoneal dialysis; risk factors; sleep disorders
6.  Gas transfer and pulmonary function tests in women with disseminated lupus erythematosus 
ARYA Atherosclerosis  2012;8(2):76-78.
Systemic lupus involves different body organs including lungs. However, there is limited information on the systemic lupus without respiratory symptoms. The aim of this study was to investigate the diffusing capacity of the lung for carbon monoxide in women with disseminated lupus erythematosus and to compare it with a control group.
This prospective study was conducted during 2005 in the Rheumatology Clinic of Alzahra Hospital, Isfahan, Iran. The diffusing capacity of the lung for carbon monoxide and pulmonary parameters were measured using the unrelated samples in 76 female patients with systemic lupus.
Mean diffusing capacity of the lung for carbon monoxide in patients with lupus was lower than the control group (P ≤ 0.001). The amount of corrected volumetric capacity of carbon monoxide in lungs of patients was significantly different from the control group (P ≤ 0.001). Residual volume and total capacity of lungs in the female patients with lupus were higher than the control group (P ≤ 0.001).
Decreased diffusing capacity for carbon monoxide in lungs of females with systemic lupus without respiratory symptoms is prevalent. It indicates alveolar capillary membrane involvement in these patients. Increased residual volume and total capacity of lungs in these patients can be caused by bronchiolitis.
PMCID: PMC3463991  PMID: 23056107
Lupus Erythematosus; Transfer Capacity; Carbon Monoxide in Lungs; Total Capacity of Lungs
7.  Sleep Apnea Symptoms in Diabetics and their First Degree Relatives 
Sleep apnea is associated with increased risk of diabetes mellitus. However, no studies have compared sleep apnea symptoms in diabetic patients and their first degree relatives. The purpose of our study was to investigate high risk for sleep apnea syndrome, in diabetics and their first degree relatives for prevention of diabetes in family.
As a part of a cohort study, all of diabetic and their first degree relatives who came for glucose control in diabetes clinic were invited to take part in the survey. Two thousand, four hundred and sixty-two individuals (82% of invited) agreed to fill out the Berlin and Epworth sleep questionnaire. Participants consisted of 2462 subjects of 15–70 years of age, both males and females with diabetes and family history of type 2 diabetes mellitus. A total of 1234 participants had diabetes and 11,231 were relatives of diabetic patients. High risk for sleep apnea regarding Berlin questionnaire and Epworth sleepiness scale, diabetic and relative were analyzed.
Prevalences of high risk for sleep apnea were higher among diabetics than relatives (P-value<0.001). In a multiple regression analysis, “age, body mass index, education, high blood pressure” were risk factor for sleep apnea symptoms while isolated blood glucose level was not by Berlin questionnaire. By Epworth sleep scale only education level was a risk factor for sleep apnea symptoms while isolated blood glucose level was not risk factor.
Sleep apnea symptoms may not have significant difference between diabetics and their relatives. We need more study on sleep apnea in the family of diabetic patients. We hope that more studies on mentioned field may help prevention of diabetes in their family.
PMCID: PMC3278886  PMID: 22347605
Diabetes; first degree relatives; Iran; sleep apnea
8.  Correlation between chronic obstructive pulmonary disease and obstructive sleep apnea syndrome in a general population in Iran* 
The aim of this study was to evaluate epidemiological relationship between chronic obstructive pulmonary disease and sleep apnea syndrome in a sample of Persian population.
As a part of a population-based cross-sectional study, 3900 randomly selected individuals aged 15 years or older were invited to take part in the survey; 3770 individuals (96.6%) agreed to fill out the respiratory and sleep questionnaire. Those subjects suspected to have either chronic obstructive pulmonary disease and/or obstructive sleep apnea underwent spirometry and polysomnography test if indicated. Spirometric measurements were performed on 420 invited responders. Polysomnography measurements were performed on 25 of the responders.
Prevalence rates for sleep apnea, chronic obstructive pulmonary disease and current asthma were 4.98%, 5.7% and 3.1%, respectively. Logistic regression showed independent associations between sleep apnea and chronic obstructive pulmonary disease. There was no significant independent association between sleep apnea symptoms and current asthma and wheeze ever.
These observations indicated relationship between chronic obstructive pulmonary disease and obstructive sleep apnea. These observations indicated the necessity of further studies to explain the possible common pathogenic mechanisms involved in two disease entities.
PMCID: PMC3263100  PMID: 22279455
Chronic Obstructive Pulmonary Disease; Sleep Apnea Syndrome; Iran
9.  Effects of adenoidectomy on markers of endothelial function and inflammation in normal-weight and overweight prepubescent children with sleep apnea 
This trial study aimed to assess the effects of adenoidectomy on the markers of endothelial function and inflammation in normal-weight and overweight prepubescent children with obstructive sleep apnea (OSA).
This trial study was conducted in Isfahan, Iran in 2009. The study population was comprised of 90 prepubescent children (45 normal-weight and 45 overweight children), aged between 4-10 years old, who volunteered for adenoidectomy and had OSA documented by validated questionnaire. The assessment included filling questionnaire, physical examination, and laboratory tests; it was conducted before the surgery and was repeated two weeks and six months after the surgery.
Out of the 90 children evaluated, 83 completed the 2-week evaluation and 72 patients continued with the study for the 6-month follow up. Markers of endothelial function, i.e., serum adhesion molecules including endothelial leukocyte adhesion molecule (E-selectin), intercellular cell adhesion molecule-1 (ICAM-1), and vascular cell adhesion molecule-1 (sVCAM-1), and the markers of inflammation, i.e., interleukin-6, and high-sensitive C-reactive protein (hsCRP) decreased significantly in both normal-weight and overweight children after both two weeks and six months. After six months, the total and LDL-cholesterol showed a significant decrease in the overweight children.
The findings of the study demonstrated that irrespective of the weight status, children with OSA had increased levels of the endothelial function and inflammation markers, which improved after OSA treatment by adenoidectomy. This might be a form of confirmatory evidence on the onset of atherogenesis from the early stages of the life, and the role of inflammation in the process. The reversibility of endothelial dysfunction after improvement of OSA underscores the importance of primordial and primary prevention of chronic diseases from the early stages of the life.
PMCID: PMC3252780  PMID: 22247723
Sleep; Endothelial Function; Inflammation; Child; Prevention
10.  Comparison of Impulse Osillometry System and Spirometry for Diagnosis of Obstructive Lung Disorders 
Tanaffos  2011;10(1):19-25.
Obstructive lung disease is a growing health problem, especially in developed countries. This study aimed to compare Impulse Osillometry System (IOS) and Spirometry for evaluation of Chronic Obstructive Pulmonary Disease and asthma.
Materials and Methods
The study groups contained 87 healthy people, 87 asthmatic patients and 56 COPD patients. Spirometry (FVC, FEV1, FEV1/FVC) and IOS (R5, R20, X5) measurements were performed for all the healthy subjects and patients. The results of IOS were compared with spirometric results.
Significant differences were detected among the 3 groups (control, COPD and asthma) in terms of all the spirometric parameters (FVC, FEV1, FEV1/FVC) and some parameters of IOS (R5,R20,X5) measurements (p<0.05). Among COPD patients, sensitivity for X5 (the best value of IOS measurements in the COPD group) was 76%. Also, in asthmatic patients, sensitivity for R20 (the best value of IOS measurements in the asthma group) was 77%. We found a correlation between R5, R20 and X5 with FEV1 in asthmatic patients, but only R5 had this correlation with FEV1 in COPD patients.
We concluded that IOS can be an alternative for spirometry in the diagnosis of obstructive lung disease in patients with minimal cooperation. R5 can represent COPD severity.
PMCID: PMC4153135  PMID: 25191346
Impulse Osillometry System (IOS); Spirometry; Asthma; COPD
11.  Sample Survey of Chronic Obstructive Pulmonary Disease and Associated Risk Factors in Isfahan, Iran 
Tanaffos  2011;10(3):32-36.
The purpose of this cross-sectional study was to estimate the number of individuals with chronic bronchitis and/or chronic obstructive pulmonary disease in Isfahan. Our study results were compared with those of previous studies in Iran and similar studies in other countries.
Materials and Methods
As a part of a population-based, cross-sectional study, 2,200 randomly selected individuals aged 40 years or older were asked to take part in the survey; among whom, 1308 individuals (59.45%) agreed to fill out the respiratory questionnaire. This group consisted of 636 (48.6%) males and 672 (51.4%) females.
Spirometric measurements were performed in 279 cases. COPD was defined by the “Global Initiative for Obstructive Lung Disease” criteria.
One hundred-seven individuals (8.1%) fulfilled the clinical criteria for chronic bronchitis as the main sign of COPD. Multivariate analysis revealed that age and smoking were independent predictors for chronic obstructive pulmonary disease.
It is concluded that the prevalence of chronic bronchitis symptoms is approximately the same in our population as compared with western countries. The frequency of clinical chronic bronchitis has risen in comparison to a previous study in Isfahan.
PMCID: PMC4153154  PMID: 25191373
Chronic obstructive pulmonary disease; Epidemiology; Prevalence; Iran; Isfahan

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