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    Evaluation of primary and accessory respiratory muscles and their influence on exercise capacity and dyspnea in pulmonary arterial hypertension
    (Mosby-Elsevier, 2023) Durdu, Habibe; Demir, Rengin; Zeren, Melih; Basturk, Pinar; Arabaci, Hidayet Ozan; Sinan, Umit Yasar; Kucukoglu, Mehmet Serdar
    Background: Skeletal and respiratory muscle disfunction has been described in pulmonary arterial hypertension (PAH), however, involvement of accessory respiratory muscles and their association with symptomatology in PAH is unclear. Objectives: To assess the primary and accessory respiratory muscles and their influence on exercise tolerance and dyspnea. Methods: 27 patients and 27 healthy controls were included. Serratus anterior (SA), pectoralis muscles (PM) and sternocleidomastoid (SCM) muscle strength were evaluated as accessory respiratory muscles, maximal inspiratory (MIP) and expiratory pressures (MEP) as primary respiratory muscles, and quadriceps as peripheral muscle. Exercise capacity was evaluated with 6-min walk test (6MWT), dyspnea with modified Medical Council Research (MMRC) and London Chest Activity of Daily Living (LCADL) scales. Results: All evaluated muscles, except SCM, and 6MWT were decreased in patient group (p < 0.01). SA was the most affected muscle among primary and accessory respiratory muscles (Cohen's-d = 1.35). All evaluated muscles significantly correlated to 6MWT (r = 0.428-0.525). A multivariate model including SA, SCM and MIP was the best model for predicting 6MWT (R = 0.606; R-2 = 0.368; p = 0.013) and SA strength had the most impact on the 6MWT (B =1.242; beta = 0.340). None of the models including respiratory muscles were able to predict dyspnea, however PM and SA strength correlated to LCADL(total) (r =-0.493) and MMRC (r =-0.523), respectively. Conclusion: SCM may be excessively used in PAH since it retains its strength. Considering the relationship of accessory respiratory muscles with exercise tolerance and dyspnea, monitoring the strength of these muscles in the clinical practice may help providing better management for PAH. (C) 2022 Elsevier Inc. All rights reserved.
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    Sleep Quality and Its Predictors among Dyspnea, Fatigue and Exercise Capacity in Pulmonary Arterial Hypertension
    (Taiwan Soc Cardiology, 2024) Ceylan, Raziye; Demir, Rengin; Zeren, Melih; Sinan, Umit Yasar; Kucukoglu, Mehmet Serdar
    Background: Poor sleep quality is an overlooked symptom in patients with pulmonary arterial hypertension (PAH), however it may significantly contribute to disease burden. Objectives: The aim of this study was to assess the sleep quality of patients with PAH and investigate its association with dyspnea, fatigue, and exercise capacity. Methods: Forty-five patients were included. Sleep quality of the patients was assessed by the Pittsburgh Sleep Quality Index (PSQI), dyspnea levels were assessed by the UCSD-Shortness of Breath Questionnaire (UCSD-SOBQ), Baseline Dyspnea Index (BDI), Modified Medical Research Council (MMRC) dyspnea scale and Modified Borg Dyspnea scale, fatigue levels were evaluated with the Fatigue Severity Scale and Borg Rating of Perceived Exertion, and functional exercise capacity was evaluated with the 6-minute walk test (6MWT). Results: Among the patients with PAH, 64% had poor sleep quality (PSQI > 5). PSQI score was significantly correlated with MMRC scale (r = -0.561), UCSD-SOBQ (r = 0.497), BDI (r = -0.468), and 6MWT (r = -0.412) (p < 0.05). There was no significant relationship between sleep quality and fatigue. A regression model including MMRC and 6MWT could explain 32% of variance in PSQI (p < 0.05), and MMRC score was an independent predictor for PSQI (p < 0.05). In addition, MMRC score had a greater influence on PSQI than 6MWT ((3 = 0.548 vs. 0.019). Conclusions: Poor sleep quality is common in patients with PAH and is associated with poor exercise capacity and dyspnea. Patients with severe dyspnea are particularly at higher risk of poor sleep quality. Consideration of sleeprelated complaints and underlying mechanisms when planning symptomatic treatments for these patients may help provide better management for PAH.