Background and Objectives: The Baveno classification represents a new approach to the assessment of the severity of OSA (Obstructive sleep apnea), which takes significant comorbidities into account: atrial fibrillation, arterial hypertension, heart failure, stroke, diabetes mellitus, and OSA symptoms expressed through the Epworth sleepiness scale (ESS). The authors believe that the Baveno classification facilitates a better stratification of patients with OSA and can be a good guide for deciding on the therapeutic approach and clinical monitoring of patients with OSA, compared to the AHI (apnea-hypopnea index) itself. The aim of this paper is to confirm the advantage of applying the Baveno classification to the evaluation of symptoms of anxiety and depression in the OSA patients compared to the application of the AHI as a single parameter. Materials and Methods: This research represents an observational retrospective study that was performed at the Pulmonology Clinic of the University Clinical Center in Kragujevac, Serbia. The study sample included 104 patients with diagnosed OSA. Patients were divided into four categories retrogradely according to the Baveno classification (A, B, C, and D). Statistical data processing was performed using the IBM SPSS Statistics version 25.0 program. Results: In our study, we proved that the Baveno classification is better at predicting the depressive disorder in OSA patients compared to the AHI itself, according to abnormal BDI-II (Beck Depression Inventory) score (value greater than ten) and HADS-D (Hospital anxiety and depression) scale (value greater than eight). The average AHI in the entire group of examined patients was 44.3 ± 19.8, while in category A the average AHI was 25.2 ± 10, in category B, 53.4 ± 20.6; in category C, 38.2 ± 18.5; and in category D, 48.1 ± 19.2. In the total sample, AHI did not correlate with the depressive episodes, but individually, the highest frequency of the depressive symptoms was precisely in the categories with the highest AHI (group D and B), where more than half of the subjects had an abnormal score. The frequency of the anxiety disorder (HADS-A) between the analyzed groups did not differ significantly, although the largest number of patients with significant anxiety were in category B, according to the Baveno classification. Conclusions: We proved that the Baveno classification is applicable in real life, and it is better at evaluating anxiety and depression using questionnaires and can identify new patients who need CPAP therapy, independently of other OSAS symptoms, primarily daytime sleepiness.

Introduction/Objective. The origin of depressive disorder in chronic obstructive pulmonary disease (COPD) patients is still not completely known and probably is caused by various factors. The aim of this study is to establish the most important characteristics of COPD patients who have depressive disorder. Methods. Eighty-nine COPD patients and 65 demographically-matched referents without COPD were included. All the patients underwent lung function examination, and gas exchange, nutritional status, dyspnoea level by the modified Medical Research Council (mMRC) scale and exercise tolerance were also assessed, as well as depressive disorder by Hospital Anxiety and Depression Scale (HADS) and Geriatrics Depression Scale (GDS) and quality of life by St. George?s Respiratory Questionnaire (SGRQ). Results. Depressive disorder has been found in 30.3% of COPD patients evaluated by HADS and 25.3% of COPD patients evaluated by GDS. When COPD subjects were stratified by forced expiratory volume in 1 second (FEV1) categorization, all subgroups were more likely to have depressive disorder, according to HADS and GDS, relative to referents with the odds ratio highest (3: 95% confidence interval 1.6?4.9) among those with the FEV1 < 30%. COPD patients with depressive disorder (HADS) compared to non-depressed patients had (differences in mean values) higher intensity of smoking [6.9 (0.5?10.1)], lower body mass index [-4.9 (-7.2?5.4)], lower value of FEV1% [-8.3 (-16.3?1.2)] , higher value of total lung capacity (%) [17.8 (2.3?28.4)], higher mMRC score (1.07 (-1?3.0), and higher SGRQ ? giving a total score of 32.9 (24.1?40.3). Conclusion. Evaluation of depressive disorder should be considered in every patient with COPD, especially in patients with greater degree of airflow limitation and lung hyperinflation, dyspnoea level and malnourished.

Background and Objectives: This paper aims to show whether obstructive sleep apnea (OSA) severity increases the level of systemic inflammation markers regardless of body mass index (BMI) and body composition. Materials and Methods: In total, 128 patients with OSA were included in the study. Examinees were divided into two groups: one with mild OSA (apnea–hypopnea index (AHI) < 15) and one with moderate and severe OSA (AHI ≥ 15). Nutritional status was assessed using body mass index, body composition by dual X-ray absorptiometry. Systemic inflammation was assessed on the basis of plasma concentrations of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and serum level of C-reactive protein (CRP). Results: We found elevated mean values of the evaluated systemic inflammation markers (CRP, TNF-α, IL-6) in a group with AHI ≥ 15, although there was no statistical significance. Our research found a significant positive correlation with BMI (r = 0.633, p < 0.001), as well as with body fat percentage (r = 0.450, p = 0.024) and serum CRP values. Significant correlation was found between the plasma IL-6 concentration and body fat percentage (FM%) (r = 0.579, p = 0.003) and lean body mass (r = −0.501, p = 0.013). Multivariate regression analysis did not show any independent predictor (parameters of OSA, nutritional status, body composition) of the systemic inflammation markers. Conclusions: Neither one tested parameter (nutritional status and body composition) of the severity of OSA was identified as an independent prognostic factor for the severity of systemic inflammation in patients with OSA.

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The female patient, 64 year old, was hospitalized in the intensive care unit of Clinic for Pulmonology, Clinical Center Kragujevac, due to fever, dry cough, dyspnea, fatigue and swelling of lower limbs. The symptoms started abruptly, 4 days before the admittance to the hospital. Upon admission, somnolence and signs of central cyanosis were noted. Auscultatory finding on the lungs was characterized by bilateral inspiratory crackles, while cardiac sound was silent, HR-120/min, TA-110/60mmHg. Analysis of arterial blood gases registered acute respiratory failure: pO2=5.1kPa, pCO2= 9.2kPa, pH=7.45, SAT=62%. Chest X-ray showed bilateral condensations in the lung parenchyma, predominantly in parahilar area. Cardiac shadow was enlarged. Laboratory tests showed increased value of pro-BNP (4086 pg/ mL) (reference values: < 125 pg/mL - negative; 125-400 pg/ mL - intermediate; > 450 pg/ml - heart failure). Echocardiographic exam upon admittance showed dilated cardiac cavities, global hypokinesis and ejection fraction of 35%. Noninvasive ventilation (NIV) treatment was started (BiLEVEL, IPAP 26cmH2O, EPAP 6cmH2O) at first continuously and then only during the night, with intense cardio-diuretic therapy. On the fifth day of hospitalization, the results of virology analyses confirmed influenza A (H1N1) infection. On the 6th day, gas exchange was normalized, complete radiological regression occurred, as well as normalization of echocardiographic exam finding. Our case shows that influenza A (H1N1) virus infection may be complicated by acute cardiac failure. If started on time, NIV treatment with simultaneous cardio-diuretic therapy, could have a positive impact on the resolution of acute heart failure during H1N1 virus infection.

Chronic obstructive pulmonary disease (COPD) is known to be characterized by inflammation both in the stable phase of the disease and during exacerbation. It has been shown that certain inflammatory mediators have a high level in systemic circulation, indicating systemic inflammation in COPD. The first recognized systemic effect of COPD is a disorder of the state of nourishment. Certain diseases, including COPD, can lead to cachexia where patients lose muscle mass despite adequate caloric intake. Inflammation in COPD also has an effect on increased protein catabolism, which leads to a decrease in body weight. Increased activity of enzymes matrix metalloproteinases family (MMP) in patients with COPD can lead to lung tissue destruction and the development of osteoporosis. It is considered that the most important role in the association between COPD and CVD disease is systemic inflammation. Low level of inflammation in small airways in COPD and Atherosclerotic plaques, may be a potential factor in the development of both pathological processes. Systemic manifestations of COPD include numerous endocrine disorders of the pituitary gland, thyroid gland, gonads, adrenal glands and pancreas. The mechanisms by which HOBP affects the endocrine function are not entirely clear, but are likely to include hypoxemia, hypercapnia, systemic inflammation, and the use of systemic glucocorticoids. Explanation for significant depressive disorder in more advanced stages in COPD can be expressive dyspnoea, decreased physical activity, worse exercise tolerance, frequent exacerbations and systemic inflammation which can lead to further physical activity decrease, social isolation, fear, and depression.