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    Impact of patient admission source on respiratory intensive care unit outcomes
    (BMC, 2025) Durak, B; Güngör, G; Guengoer, S; Durak, I; Yılmaz, B; Dönmez, GE; Tuncay, E; Şekerbey, HG; Moçin, ÖY; Adıgüzel, N; Karakurt, Z
    Background Research is limited in describing the association between admission source and mortality in critically ill patients. Therefore, this study investigated how intensive care units (ICUs) admission source (emergency department (ED) or ward) correlates with mortality rates. Methods This retrospective observational cross-sectional study was conducted in a tertiary pulmonology teaching hospital's ICU from January 1, 2018, to December 31, 2019. Patients were ICU patients admitted for acute respiratory failure. Demographic, comorbidities, diagnoses, APACHE II score, ICU admission (ED or ward), mechanical breathing support (invasive or noninvasive), length of stay, and mortality were recorded. Comparisons of ICU admission sources and mortality factors were established. Results A total of 2,173 ICU patients were studied; 1,011 (46%) were admitted from the ED and 1,162 (54%) from the ward. Their mean age was 70 years, and 66% of them were men. Pneumonia was the leading cause of ICU admission at 60% and Chronic Obstructive Pulmonary Disease (COPD) was the most common comorbidity at 54%. When both groups were evaluated in terms of respiratory support, non-invasive mechanical ventilation use was higher in patients admitted from the emergency room (ED: 50% vs. Ward: 35%), invasive mechanical ventilation was more frequently required in patients admitted from the ward compared to those admitted from the emergency department (ED: 17% vs. Ward: 25%). Length of ICU stay (2 vs. 3 days P < 0.001) and ICU mortality (odds ratio: 1.66, 95% confidence interval 1.297-2.124, P < 0.001) were higher in patients admitted from the ward than in patients admitted from the emergency department. In addition, pneumonia patients and those with malignancies, interstitial lung disease, or noninvasive mechanical ventilation (NIV) failure were associated with higher mortality. Conclusion Our study suggests that ward-to-ICU patients had higher mortality rates compared to ED-to-ICU patients. Triage protocols to better identify potentially critically ill patients in the ED may improve outcomes by avoiding delays in care and better assignment of admission location.
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    Predictors of Depression among Individuals with OSAS: A Cross-Sectional Study from Turkiye
    (WOLTERS KLUWER MEDKNOW PUBLICATIONS, 2025) Durak, B; Özol, D; Saraç, S
    Background:Obstructive sleep apnea syndrome (OSAS) has been increasingly associated with mood disturbances, particularly depression, through mechanisms involving neuroinflammation, altered neurotransmitter activity, and impaired sleep quality. It has been suggested that changes in sleep patterns may serve as effective biomarkers of depression.Aim:To assess the frequency of depressive symptoms and their association with excessive daytime sleepiness (ES), sleep quality, and hypoxemia in individuals diagnosed with OSAS.Methods:The study population included all consecutive individuals who were newly diagnosed with OSAS in the Sleep Disorders Center between April and June 2024. All 150 patients included in the study sample underwent polysomnography (PSG) and were administered the Epworth Sleepiness Scale (ESS), the Geriatric Depression Scale, Long Form (GDS-LF), and the Pittsburgh Sleep Quality Index (PSQI). Hypoxemia burden was determined primarily based on the time spent with oxygen saturation below 90% during the night (TST 90).Results:The mean age of the study participants was 54.8 +/- 7.7 years, and 33.3% were females. About 84% of the study participants had poor sleep quality, and 45.3% and 38% had depressive symptoms. In univariate analysis, female gender (P = 0.002), higher PSQI score (P < 0.001), higher oxygen desaturation index (P = 0.040), and lower AHI (P = 0.048) were associated with depression. In multivariate analysis, male gender (OR: 0.307, 95% CI: 0.133-0.708, P = 0.006) and higher PSQI score (OR: 1.290, 95% CI: 1.146-1.453, P < 0.001) remained significant independent predictors of depression, whereas AHI and hypoxemia burden were not significantly associated.Conclusions:Poor sleep quality and female gender are independent predictors of depression in OSAS patients, while AHI and hypoxemia burden do not appear to have a significant effect. These findings highlight the importance of assessing and addressing sleep quality, particularly in female OSAS patients, to improve mental health outcomes.