Aylin Pihtili

Insomnia symptoms are frequently reported by patients with obstructive sleep apnoea (OSA). We aimed to estimate the prevalence of co‐occurring insomnia symptoms and OSA and to characterize its clinical, comorbidity and polysomnographic profile in a nationwide sleep clinic population. We analysed data from 12,715 adults enrolled in the multicentre Turkish Sleep Apnoea Database (TURKAPNE). All participants underwent full‐night laboratory‐based polysomnography and completed standardized symptom questionnaires. Participants were categorized into four groups: OSA with co‐occurring insomnia symptoms, OSA only, insomnia symptoms only and a reference group with neither OSA nor insomnia symptoms. Multivariable logistic regression analyses were performed to evaluate symptom associations across groups. Of 12,715 participants, 8142 (64.0%) had OSA only, 3275 (25.8%) had OSA with co‐occurring insomnia symptoms, 388 (3.1%) had insomnia symptoms only and 910 (7.2%) constituted the reference group. Compared with the reference group, OSA with co‐occurring insomnia symptoms was strongly associated with nocturnal dyspnoea (aOR 3.94, 95% CI 3.07–5.04), morning headache (aOR 3.31, 95% CI 2.46–4.44) and depressed mood (aOR 3.01, 95% CI 2.20–4.13). Polysomnography demonstrated respiratory disturbance together with prolonged sleep latency and a higher arousal index in participants with OSA and co‐occurring insomnia symptoms. To conclude, in this large national sleep clinic cohort, OSA with co‐occurring insomnia symptoms was common and associated with greater clinical complexity and combined respiratory and sleep‐continuity disturbances. Systematic assessment of insomnia symptoms in patients evaluated for OSA may improve clinical characterization and support more integrated management approaches. Trial Registration: NCT02784977

Background/Aims: Idiopathic inflammatory myopathies (IIMs) can cause respiratory muscle weakness, leading to diaphragm weakness (DW) and sleep-related breathing disorders (SRBD). We aimed to investigate clinical findings of DW and SRBD in patients with IIMs. Materials and Methods: In patients with biopsy-confirmed IIMs, demographics, respiratory symptoms, single-breath counting (SBC), arterial blood gas, upright/supine SpO2 and spirometry, diffusing capacity for carbon monoxide (DLCO), maximal inspiratory and expiratory pressure (MIP, MEP), peak cough flow (PCF), and polysomnography parameters were prospectively evaluated. Epworth Sleepiness Scale (ESS), STOP-BANG, and Mallampati scores were recorded. The presence of at least one of two findings was considered suggestive of DW: (1) paradoxical abdominal movement (PAM), (2) upright-supine forced vital capacity (FVC) difference of ≥20%. Results: Sixteen patients (12 female/4 male, mean age: 54.4 ± 11.2/y, 9 dermatomyositis [DM], 6 polymyositis [PM], 1 inclusion body myositis [IBM]) were evaluated. Findings consistent with DW were observed in 25% of patients, and all of them had DM. MIP, MEP, and PCF were reduced in the majority of patients. Supine FVC% and supine SpO2 were significantly lower in patients with DW (P < .001 and P = .003, respectively). PaO2, SaO2, SBC, and PCF were lower, and the upright–supine SpO₂ difference was greater in patients with DW, although these differences were not statistically significant. Polysomnography was performed in 68.8% (n = 11) of patients. All 11 patients who underwent polysomnography had obstructive sleep apnea (OSA) (2 severe, 4 moderate, 5 mild). Conclusion: Findings suggestive of DW were observed in 25% of patients with IIM and exclusively in those with DM, while OSA was identified in all patients who underwent polysomnography. These findings may support the clinical evaluation of both diaphragm involvement and sleep-related breathing disorders in patients with IIM. Cite this article as: Özduygu G, Kıyan E, Pıhtılı A, Tekçe HD, Cakar A. Diaphragm Weakness and Sleep-Related Breathing Disorders in Patients with Idiopathic Inflammatory Myopathy. ArchRheumatol. Published online October 14, 2026. doi: 10.5152/ ArchRheumatol.2026.26450.

Background: Comorbid insomnia and obstructive sleep apnea (COMISA) is increasingly recognized as a clinically important sleep disorder phenotype with potential cardiometabolic consequences. However, its association with diabetes mellitus (DM) remains insufficiently characterized. Methods: This cross-sectional analysis included 12,715 adults with suspected obstructive sleep apnea (OSA) from the nationwide multicenter TURKAPNE cohort who underwent full-night polysomnography. Insomnia symptoms were assessed using standardized questionnaire items, and OSA was defined as apnea–hypopnea index (AHI) ≥ 5 events/hour. COMISA was defined as the coexistence of insomnia symptoms and OSA. DM was identified based on self-reported physician diagnosis or use of antidiabetic medications. Multivariable logistic regression was performed to evaluate independent variables associated with COMISA. Results: COMISA was present in 3,275 patients (25.7%). DM was significantly more prevalent among patients with COMISA compared with those without COMISA (22.8% vs. 15.4%, p < 0.001). Overall, COMISA was observed in 33.9% of diabetic individuals and 24.1% of non-diabetic individuals. In multivariable analysis adjusted for age, sex, body-mass-index, smoking status, education level, and comorbidities, DM remained independently associated with COMISA (adjusted OR 1.17; 95% CI 1.05–1.31; p = 0.006). Among COMISA patients, those with DM exhibited greater sleep fragmentation and more severe sleep-disordered breathing, including higher AHI (30.0 vs. 24.0 events/h) and oxygen desaturation index (26.0 vs. 20.0 events/h) ( p < 0.001). Conclusions: DM is independently associated with COMISA and with more severe sleep and respiratory disturbances within this phenotype. These findings highlight the need for integrated screening of sleep disorders in individuals with DM. Trial registration: ClinicalTrials gov (NCT02784977).

Background: Heart failure with preserved ejection fraction (HFpEF) is closely linked to aging and cardiometabolic risk factors and frequently coexists with obstructive sleep apnea (OSA). We aimed to investigate the prevalence and clinical correlates of an HFpEF‐like phenotype in a revascularized coronary artery disease (CAD cohort), focusing on OSA and its severity. Methods: A total of 435 patients with preserved left ventricular ejection fraction from the RICCADSA cohort were included. OSA was defined as apnea–hypopnea index (AHI) ≥ 15 events/h. HFpEF‐like phenotype was defined by ≥ 2 of the following: elevated filling pressures (E/e′ ≥ 15), left atrial enlargement, increased left ventricular mass index, elevated pulmonary artery systolic pressure (≥ 35 mmHg), and elevated NT‐proBNP (≥ 125 pg/mL). Multivariable logistic regression analyses included age, sex, obesity, hypertension, diabetes, and OSA status. Additional models evaluated AHI and oxygen desaturation index (ODI) as continuous variables and assessed the impact of excluding body mass index (BMI). Results: Mean age was 63.6 ± 8.6 years and BMI 28.1 ± 4.1 kg/m ² ; 69.9% met HFpEF‐like criteria. Age and obesity were independently associated with HFpEF‐like phenotype, whereas categorical OSA was not. AHI and ODI were not independently associated after adjustment; however, in models excluding BMI, both AHI (OR 1.019, 95% CI 1.005–1.033) and ODI (OR 1.030, 95% CI 1.010–1.050) were significant predictors. Conclusions: HFpEF‐like phenotype is highly prevalent in CAD and primarily associated with aging and adiposity. The relationship between OSA severity and cardiac remodeling appears dependent on obesity, underscoring the interplay between cardiometabolic and sleep‐related factors. Pre‐registered Clinical Trial Number: The RICCADSA trial is registered at ClinicalTrials.gov (NCT00519597) and in the Swedish national research registry (FoU i Sverige—Research and Development in Sweden; registration no. VGSKAS‐4731; April 29, 2005).

Clinical Characteristics of Moderate-to-Severe Obstructive Sleep Apnea: A Cross-sectional Analysis of 12,715 Adults from the TURKAPNE Cohort - Thoracic Research and Practice

Background: Obstructive sleep apnea (OSA) is associated with increased cardiovascular morbidity; however, its relationship with subclinical coronary atherosclerosis detected incidentally on routine chest computed tomography (CT) remains incompletely defined. We aimed to evaluate the association between questionnaire-based OSA risk and moderate-to-severe coronary artery calcification (CAC) in patients without known cardiac disease undergoing non-contrast chest CT for non-cardiac indications. Methods: In this prospective cross-sectional study, 268 consecutive adults undergoing routine non-contrast chest CT were included. OSA risk was assessed using the Berlin Questionnaire (BQ) and a modified BQ (mBQ), excluding hypertension and obesity components. CAC was quantified using the Agatston method on non-gated CT images, and moderate-to-severe CAC was defined as a score > 100. Multivariable logistic regression models were adjusted for age, sex, smoking status, alcohol use, obesity, lung disease, diabetes mellitus and hypertension. Results: Moderate-to-severe CAC was substantially more prevalent among patients at high risk for OSA than among those at low risk (43.1% vs. 12.0%, p < 0.001). In unadjusted analyses, high-risk OSA was strongly associated with CAC > 100. After multivariable adjustment, BQ-defined high-risk OSA remained independently associated with moderate-to-severe CAC (adjusted odds ratio [OR] 2.74, 95% confidence interval [CI] 1.29–5.78, p = 0.008). Similar results were observed with the mBQ (adjusted OR 2.62, 95% CI 1.27–5.41, p = 0.009). Increased snoring intensity was also independently associated with CAC > 100 (adjusted OR 2.25, 95% CI 1.07–4.72, p = 0.032). Conclusions: Questionnaire-defined high-risk OSA is independently associated with moderate-to-severe incidental CAC detected on routine chest CT. These findings support the integration of sleep-related risk assessment into opportunistic cardiovascular imaging frameworks and highlight the potential role of thoracic CT in multidimensional cardiovascular risk stratification.

Purpose Neuromuscular diseases (NMDs) are reported to have increased obstructive apnoea/hypopnoea during rapid eye movement (REM) sleep; however, the prevalence of REM-related obstructive sleep apnoea (OSA) and its clinical correlates in NMD remain undefined. We evaluated REM sleep, REM-related OSA frequency, and associated with demographic and clinical factors. Methods We retrospectively evaluated patients with NMDs who underwent polysomnography (PSG) between 2015 and 2024. Demographic data, morning arterial blood gases, spirometry and PSG data were collected. REM-related OSA required AHI ≥ 5 events/hour, REM-to-non-REM (NREM) AHI ≥ 2, and REM ≥ 30 min; REM-isolated additionally required NREM AHI < 5 events/hour. Patients with OSA who did not meet the criteria for REM-related OSA were classified as having NREM-related OSA. Results Among 290 patients, OSA was present in 87.6% (254/290). REM sleep duration was markedly reduced (11.8 ± 8.0%; 46.8 ± 32.2 min), and 30.0% of patients had REM duration < 30 min. Among OSA with REM ≥ 30 min (n = 182), 54.4% had REM-related OSA; 25.3% were REM-isolated. Compared with NREM-related OSA, the REM-related group exhibited more frequent female sex (p = 0.015), hypertension (p = 0.020), and depression (p = 0.025). In multivariable analysis, REM-related OSA was independently associated with morning hypercapnia (aOR 4.889; 95%CI 1.885–12.680), forced vital capacity (FVC) < 50% and/or ≥ 20% upright-to-supine decline (aOR 3.847; 95%CI 1.085–13.642), and mild OSA (aOR 3.461; 95%CI 1.509–7.937). Conclusions Despite the marked reduction in REM sleep in NMDs, OSA, and particularly REM-related OSA, is common. In the REM-related OSA group, morning hypercapnia and FVC decline were more frequent. These observations suggest that REM-stage characteristics may be predictive of subsequent chronic respiratory failure.

REM-related OSA, with events mainly in REM sleep, is increasingly recognised as a distinct phenotype. Its relationship with systemic comorbidities remains unclear. This study aimed to evaluate the prevalence of cardio-metabolic, respiratory and psychiatric comorbidities in REM- versus non-REM-related OSA. Subjects undergoing polysomnography were included, excluding those with incomplete data, sleep efficiency < 60%, no OSA or other sleep disorders, REM sleep < 30 min, uncontrolled malignancy, prior upper airway surgery, severe lung disease, sedative use, or ongoing positive airway pressure/oral appliance therapy. Demographics, comorbidities, Epworth Sleepiness Scale (ESS) and polysomnographic data were recorded. A total of 2240 OSA patients were analysed (1541M/699F; mean age 49.9 ± 11.6 years; BMI 31.6 ± 5.7 kg/m²): 32.6% mild, 31.1% moderate, 36.3% severe. REM-related OSA was identified in 18.3%. It showed lower apnoea–hypopnoea index and oxygen desaturation index, the percentage of sleep time with SpO₂ < 90% but higher mean and nadir nocturnal oxygen saturation (all p < 0.001). REM-related OSA patients were younger, more often female (p = 0.002, p < 0.001) and had more comorbidities. In multivariable logistic regression adjusting for age, sex, ESS, OSA severity, and comorbidities, REM-related OSA was independently associated with hypertension, coronary artery disease, hypothyroidism, and asthma (p = 0.001, p = 0.003, p < 0.001, p < 0.001 respectively). REM-related OSA is a distinct clinical entity marked by a higher prevalence of comorbidities despite lower standard measures of disease severity. Clinicians should consider alternative screening and lower treatment thresholds for high-risk groups, including young women and those with comorbidities.

Streptococcus pyogenes (Group A Streptococcus) is an aerobic, gram-positive bacterium responsible for various infections such as pharyngitis, cellulitis, erysipelas, and necrotizing fasciitis. Though it rarely affects the lower respiratory tract, it can, in uncommon cases, cause community-acquired pneumonia. This study presents a rare case of rapidly progressing pneumonia caused by S. pyogenes, complicated by empyema. A 52-year-old woman presented to the emergency department with symptoms of cough, yellow sputum, night sweats, and left-sided chest pain. Initial empirical treatment with piperacillin-tazobactam was escalated to meropenem and vancomycin due to increased inflammatory markers and positive blood cultures. Blood and sputum cultures identified S. pyogenes using matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS). Susceptibility testing confirmed sensitivity to penicillin-class antibiotics, leading to targeted therapy with ceftriaxone, ampicillin-sulbactam, and later, oral amoxicillin-clavulanate. Despite appropriate antibiotics and tube thoracostomy, no significant clinical improvement was observed. Intrapleural fibrinolytic therapy was initiated, and a favorable response was achieved through the combination of antibiotics, drainage, and fibrinolytics. The patient was ultimately discharged in good condition. In conclusion, although S. pyogenes is an uncommon cause of community-acquired pneumonia, it should be considered in cases with rapid progression and empyema complications.