Objective: This study focuses on evaluating the relationship between physical findings, particularly collar size and Body Mass Index (BMI), and polysomnographic parameters in male patients seen at a Sleep Disorders Laboratory, suspected to have Obstructive Sleep Apnea (OSA).    Methods: Design: Cross-sectional study Setting: Academic tertiary private hospital Participants:  Charts of 149 adult male patients referred for polysomnography between July 1, 2005 and June 30, 2006 were reviewed.  Height, weight, and external neck circumference measurements were obtained.  The data from polysomnography results were noted and correlated with the physical measurements.    Results: The mean collar size for the OSA group was 42.03 cm with a mean BMI of 29.14 while the mean collar size for the normal group was 39.05 cm with a mean BMI of 25.36.  A significant difference was noted in both the collar size and body mass index (BMI) between the OSA group and the normal group (p<0.005).  Results showed a significant correlation between collar size and BMI.  Collar size and BMI measurements were also correlated with increasing severity of sleep apnea in the OSA group.  The ³40 cm collar size among male adults with symptoms of OSA was 80% sensitive and 67% specific with a positive predictive value of 94% in predicting true OSA.   Conclusion: This study suggests that the external neck circumference and the degree of obesity determined through BMI measurement may be important predictors of sleep apnea in adult Filipino males suspected to have OSA.  Given the high probability of having true OSA in symptomatic male adults with a collar size ³ 40 cm, outright definitive management may be opted for in these patients, while those with a collar size < 40 cm may need to undergo further confirmatory tests.     Keywords: obstructive sleep apnea, external neck circumference, collar size, body mass index, polysomnography, obesity

Objective: To describe a rare case of Kimura’s disease initially misdiagnosed as malignancy then tuberculosis.Methods:     Design: Case report     Setting: Tertiary Private Hospital     Patient: OneResults: A 30-year-old male with a 6-year history of gradually-enlarging right infra-auricular mass revealed an enlarged mass in the right infraauricular area and multiple cervical lymphadenopathies on physical examination. Initial fine-needle aspiration biopsy was interpreted as pleomorphic adenocarcinoma but succeeding work-ups and imaging studies led to treatmentfor tuberculosis. Subsequent biopsies finally led to the proper histopathologic diagnosis of Kimura’s disease and the patient was shifted to appropriate treatment with oral prednisone.Conclusion: Kimura’s disease is rare and may be confused with other diseases such as malignancyor tuberculosis. Histopathologic diagnosis is necessary as its treatment differs from tuberculosisand other diseases.Keywords: Kimura’s disease, parotid gland tumor, angiolymphoid hyperplasia with eosinophilia

This contribution aims to integrate findings of our recently reported three brain imaging studies on young narcolepsy-cataplexy patients [1][2][3]. All brain images were acquired using 3.0 Tesla MRI. In our prior study of a voxel-based morphometry [1], narcoleptic patients showed gray matter (GM) deficits in the hypothalamus and fronto-limbic areas. Hypothalamic GM deficits correlated with severity of narcolepsy. In our diffusion tensor imaging study that assessed global white matter (WM) integrity [2], narcoleptic patients had decreased WM integrity especially in fronto-limbic areas, which were associated with sleepiness and attention deficit. Prefrontal metabolite concentration was measured in a proton magnetic resonance spectroscopy [3]. Narcoleptic patients had higher GABA levels in the medial prefrontal areas. This is potentially related to the compensation of nocturnal sleep disturbance. Hypothalamus seems to be a key structure in narcoleptic symptoms. However, both GM and WM abnormalities of fronto-limbic areas were also related to narcolepsy and its symptoms. Compensatory alteration of GABA was also found in the areas. Taken together, our reports suggest that fronto-limbic area, as well as hypothalamus, may be implicated in narcolepsy. References[1] Gray matter deficits in young adults with narcolepsy. Acta Neurol Scand 2009;119:61-7. [2] Decreased fractional anisotropy values in brains of young narcoleptic patients. 2009; presented in APSS. [3] Increased GABA levels in medial prefrontal cortex of young adults with narcolepsy.Two types of monoamine oxidase (MAO), type A (MAO-A) and type B (MAO-B), have been identified. Generally, MAO-A is highly expressed in noradrenergic/adrenergic neurons such as the locus coeruleus, whereas MAO-B is highly expressed in serotonergic and histaminergic neurons and distinct populations of glia such as tanicytes. On the other hand, it has been reported that non-catecholaminergic neurons also express MAOs in an adult rat brain. Extracellular serotonin (5-HT), norepinephrine / epinephrine (NE/E), and dopamine (DA) appear to be removed by a reuptake mechanism; subsequently, they are metabolized by intracellular MAO activity. In the hypothalamus, 5-HT and DBHpositive varicosities densely distribute around hypothalamic nucleus, likely MAO activity affecting the neuronal functions. In the present study, we investigated the distribution of MAOs and the anatomical relation to the neuropeptide-expressing neurons in the rat hypothalamus. We performed enzyme histochemistry for MAO-A or MAO-B, and use specific antibodies for MAO-A and MAO-B. In the result, we found moderate MAO-A enzyme activities in the distinct neuronal populations, and strong MAO-B activity in some glial cells including tanicytes. MAO-A-immunoreactivities (IR) were found in the varicosities of noradrenergic/adrenergic neurons and in the cell bodies of some neuropeptides-expressing neurons in the lateral hypothalamus. Especially, orexin neurons robustly express MAO-A, but not MAO-B. Objective:We have elucidated the p...

Objective: To determine whether excessive daytime sleepiness (EDS) as assessed by the Epworth Sleepiness Scale (ESS) is significantly correlated with body mass index (BMI) and Apnea-Hypopnea Index (AHI) in patients suspected of OSAS and whether obesity as assessed by BMI is associated with AHI. Methods: Study Design:            Non-Concurrent Cohort Study Setting:                       Tertiary Private Hospital Population:                The charts of 389 patients suspected to have sleep disorders and referred for polysomnography (PSG) at the Center for Snoring and Sleep Disorders in year 2009 were reviewed. Inclusion criteria were patients aged 19 and above with complete data. A total of 238 patient charts were included in the study. Results:The study included a total of 238 patient charts. Results showed no significant association between ESS and AHI (p-value >0.05), even when correlated with the different severities of OSAS (p-value>0.05). Sensitivity and specificity of ESS was found to be 54% and 57%, respectively, indicating that ESS is not a sensitive and specific tool to predict the presence of OSAS. These findings suggest that ESS may not be able to significantly identify patients with OSAS. However, BMI showed a significant association with ESS (p-value<0.05), representing more patients with EDS belonging to the obese category. Conversely, obese patients were twice more likely to have EDS, represented by ESS scores of ³10. BMI wasalso significantly associated with AHI using one-way Anova test. Conclusion: This report concludes that the ESS alone is insufficient to identify patients with OSAS. Nevertheless, questionnaires like the ESS supplement relevant history to help diagnose patients with sleep disorders, particularly OSAS. On the other hand, the ESS showed a significant association with BMI, representing more obese patients had excessive daytime sleepiness. The likelihood ratio of having excessive daytime sleepiness is 2 times more for obese patients. BMI was also significantly associated with AHI, which confirms the well established relationship of obesity with OSAS, and shows that obese patients are at higher risk for severe OSAS. Keywords:obstructive sleep apnea syndrome, daytime sleepiness, Epworth sleepiness scale, polysomnography, apnea-hypopnea index,  body-mass index.