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Öğe Can a Computer-Based Prescription of Free Medication Increase Smoking Cessation Rates Efficiently?(Aves, 2016) Salepci, Banu; Fidan, Ali; Caglayan, Benan; Parmaksiz, Elif Torun; Kiral, Nesrin; Comert, Sevda Sener; Gungor, Gulten AktinOBJECTIVES: In 2011, in the context of a research project, bupropion and varenicline were distributed to smoking cessation clinics by the Ministry of Health of Turkey to be prescribed free of charge by a computer-based system. In the present study, we compared smoking cessation rates between patients who were prescribed free medications during the period of the project and those who had to pay for their medication. MATERIAL AND METHODS: Six hundred four patients who applied during the project period were given either bupropion or varenicline, which were prescribed using an algorithm-based computer system. Three hundred sixteen patients who applied after that period were prescribed medicines deemed appropriate by the attending physician but had to pay for the medication on their own. Follow-up visits were arranged for one year. Carbon monoxide (CO) levels in the expired air were used as indicators of cessation. RESULTS: A total of 537 patients began treatment, of which 438 (81.6%) applied during the first period (group 1) and 99 (18.4%) applied during the second period (group 2). The mean age and concomitant disease presence were higher in the second-period patients (p < 0.05). Advanced age, comorbidities, pathological findings in spirometry, and chest X-ray were also higher in those who paid for the cost of their treatment (p= 0.009, 0.001, 0.006, 0.001, respectively). Smoking cessation rates were found to be 14.8% and 27.3% after six months (p= 0.008) and 10.7% and 18.2% after one year (p= 0.059), respectively, for group 1 and group 2. Age, dependence score, cigarettes smoked (as pack-years), and percentage of patients who paid for the treatment were found to be significantly higher (p< 0.001, 0.021, 0.018, 0.001, respectively) for those who quit smoking at the end of six months. For the patients who quit smoking at the end of one year, age was found to be significantly higher (p= 0.008), and the number of males was higher, although the difference was not statistically significant (p= 0.05). When logistic regression analysis was applied, age, dependence score, and paid treatment were found to be independent variables (p= 0.002, 0.008, 0.012, respectively) for those who quit smoking at the end of six months. Only age was found to be an independent variable for those who quit smoking at the end of one year (p= 0.029). CONCLUSION: More smokers could receive treatment by the distribution of free drugs. However, quitting rates at the end of six months were higher when patients had to pay for their treatment. On the other hand, quitting rates at the end of one year were not affected by whether the treatment was paid for or free of charge. The most important factor increasing quitting rates at the end of six months and one year was found to be advanced age.Öğe The effect of obstructive sleep apnea syndrome and snoring severity to intima-media thickening of carotid artery(Springer Heidelberg, 2015) Salepci, Banu; Fidan, Ali; Ketenci, Suhendan Cosan; Parmaksiz, Elif Torun; Comert, Sevda Sener; Kiral, Nesrin; Akturk, Ulku AkaIntima-media thickening (IMT), which is the early finding of carotid artery atherosclerosis, has been shown to be associated with obstructive sleep apnea syndrome (OSAS). In our study, we aimed to assess prospectively the effect of severity of OSAS and snoring on carotid artery IMT. A total of 102 patients who were admitted to sleep laboratory between May 2011 and May 2012 were included in the study. All patients were examined by polysomnography. Common carotid arteries (CCA) and internal carotid arteries (ICA) were evaluated for IMT by carotid Doppler ultrasonography. The mean age was 45.9 +/- 11.1, with 40 (39.2 %) women and 62 (60.8 %) men. Of 88 OSAS patients who had an apnea-hypopnea index (AHI) of > 5, 33 (37.5 %) had mild, 20 (22.7 %) had moderate, and 35 (39.8 %) had severe disease. Fourteen patients who had AHI < 5 were designated as the habitual snoring group. IMT was detected in 17 (16.7 %) of all patients. In patients with severe OSAS, CCA walls were thicker (p = 0.040) and IMT ratios were higher (p = 0.019) compared to mild/moderate OSAS patients. In patients with IMT, age, AHI, oxygen desaturation index (ODI), and snoring index were higher compared to patients without IMT (p < 0.05). Carotid artery IMT, which is an early finding of atherosclerosis, was found to be highly correlated with OSAS and snoring severity.Öğe Overnight Transcutaneous Carbon Dioxide Monitoring in Eucapnic Patients with Obstructive Sleep Apnea Syndrome(Aves, 2015) Salepci, Banu; Fidan, Ali; Caglayan, Benan; Parmaksiz, Elif; Akturk, Ulku; Kiral, Nesrin; Comert, Sevda SenerOBJECTIVES: We monitored increases in CO2 levels during sleep by measuring transcutaneous pCO(2) (PtcCO(2)) to determine its relationship with polysomnographic data in normocapnic patients with obstructive sleep apnea syndrome (OSAS). MATERIAL AND METHODS: Between October 2011 and December 2012, 139 patients underwent PtcCO(2) monitoring with polysomnography. All patients were evaluated with arterial blood gas (ABG) measurements and pulmonary function tests (PFTs). We excluded 13 patients with COPD and/or daytime hypercapnia and 29 patients whose PtcCO(2) records could not be evaluated. RESULTS: The patients' mean age was 46.8 +/- 10.3 years. Fifty-nine patients (60.8%) were male, and 38 (39.2%) patients were female. The mean overnight PtcCO(2) was <= 45 mm Hg in 84 (86.6%) patients and >45 mm Hg in 13 (13.4%) patients. In the group with PtcCO(2) >45 mm Hg, 10 patients had an apnea-hypopnea index (AHI) >15, and 3 patients had an AHI<15, without a statistically significant difference (p=0.078). The mean apnea and apnea/interapnea periods were similar. The mean PtcCO(2) values correlated with time spent when the SpO(2) was <90% (r=0.220, p<0.031). When we grouped the patients by AHI, 60 (61.8%) patients had an AHI>15 (moderate to severe OSAS), and 37 (37.2%) had an AHI<15 (mild OSAS). Of the former group, 16.7% had a mean PtcCO(2) >45 mm Hg, whereas this ratio was 8.1% in the latter group. The difference was not statistically significant (p=0.359). In the group with an AHI>15, the highest PtcCO(2) levels were significantly higher (p<0.05). CONCLUSION: We conclude that seemingly eucapnic OSAS patients may experience hypercapnia when sleeping, and PtcCO(2) monitoring may be useful in the early diagnosis of hypercapnia.
