Obstrüktif Uyku Apne Sendromu OUAS Saptanan Hastalarda Vasküler Fonksiyon Bozukluğu ve Ateroskleroz Riskinin Değerlendirilmesi

Elçin Aydın; Cihan Altın; Birsen Şahin Satılmış; Erkan Eşki; Mustafa Agah Tekindal; Muhteşem Ağıldere

EN TR

Investigation of Endothelial Dysfunction and The Risk of Atherosclerosis In Patients With Obstructive Sleep Apnea Syndrome

Abstract

Purpose: To investigate endothelial dysfunction and pre-atherosclerosis in patients with Obstructive Sleep Apnea Syndrome OSAS by using several parameters including Brachial Artery Flow-Mediated Vasodilation BAFMV , Carotid Intima-Media Thickness CIMT , Mean Platelet Volume MPV and Epicardial Fat Thickness EFT . Patients with OSAS were classified according to the Apnea-Hypopnea Index AHI . Patients and Methods: OSAS patients who have 5 or more AHI score were enrolled in the study. Patients with hypertension, hyperlipidemia, diabetes mellitus and cardiovascular diseases were excluded. Patients were classified as mild 5-10 , moderate 16-30 and severe >30 according to AHI. These groups were compared to each other in terms of endothelial dysfunction and pre-atherosclerosis markers including BAFMV, CIMT, MPV and EFT. Groups were compared statistically by using either Student’s T-Test or Mann Whitney–U test. Results: Our study population consists of 23 patients with OSAS 16 male, 7 female with the mean age of 46.30±9.51 years ranging from 31-65 years. There were no significant differences in all parameters between the mild 5-10 , moderate 16-30 and severe >30 groups according to AHI. Conclusion: It is well known that patients with OSAS have an increased cardiovascular risk. In our study, no differences were shown between the progression of the disease and endothelial dysfunction and pre-atherosclerosis markers.

Keywords

Endothelial dysfunction,pre-atherosclerosis,obstructive sleep apnea syndrome

Obstrüktif Uyku Apne Sendromu OUAS Saptanan Hastalarda Vasküler Fonksiyon Bozukluğu ve Ateroskleroz Riskinin Değerlendirilmesi

Öz

Amaç: Obstrüktif Uyku Apne Sendromu OUAS saptanan hastalarda vasküler endoteliyel işlev bozukluğu ve preaterosklerozis; brakial arter akım aracılı vazodilatasyon BAAV , karotis arter intima-media kalınlığı KIMK , mean platelet volume MPV ve epikardiyal yağ dokusu EYD ölçümü yapılarak değerlendirildi. OUAS hastaları Apne-hipopne indekslerine AHI göre gruplara ayrılarak kıyaslandı. Hastalar ve Yöntem:Hastanemize uyku bozukluğu nedeni ile başvuran ve polisomniografi ile yapılan değerlendirmede AHİ değeri 5 ve üstünde bulunan, hiperlipidemi, hipertansiyon, diyabetes mellitus ve bilinen kalp-damar hastalığı olmayan, yaşları 30-70 arası, kadın ve erkeklerden oluşan hastalar çalışmaya dahil edildi. Bu hastalar AHI derecelerine göre hafif-orta ve şiddetli şeklinde gruplandırıldı. Preateroskleroz KIMK, EYD kalınlığı ve MPV ile vasküler fonksiyon ve endotel hücre vazodilatasyonu ise BAEF bakılarak değerlendirildi. İstatistik olarak iki grup arasındaki farklılıklar değerlendirilmek istendiğinde parametrik test ön şartlarını sağladığı durumda “Student’s t Test”; sağlamadığında ise “Mann Whitney–U testi” kullanıldı. Bulgular: 23 hastanın 16 tanesi erkek, 7 tanesi kadındır. Yaş ortalaması 46,30+9,51 31-65 yaş arası . Hastalar AHI indekslerine göre hafif:5-15, orta:16-30, şiddetli >30 olarak gruplandırıldığında karşılaştırma için kullanılan parametrelerde anlamlı farklılık saptanmadı. Sonuç: OUAS hastalarında kardiyovasküler riskin arttığı bilinmektedir. Çalışmamızda bu hastalarda hastalığın şiddeti ile preateroskleroz ve endotel fonksiyonun bozulması arasında bağlantı bulunmamıştır

Anahtar Kelimeler

Obstrüktif uyku apne sendromu,pre-ateroskleroz,endotel fonksiyon bozukluğu

References

Karadağ M, Yavuz Z. Uyku Apne Sendromu. Erişim: http:// uykubozuklugu.uludag.edu.tr/literatur1.htm
Köktürk O. Uykuda solunum bozuklukları. Tarihçe, tanımlar, hastalık spektrumu ve boyutu. Tüberküloz Toraks Derg 1998;46:187–92.
Carlson JT, Hedner JA, Ejnell H, Peterson LE. High prevelance of hypertension in sleep apnea patients independent of obesity. Am J Respir Crit Care Med 1994;150:72–7. [CrossRef]
Linberg E, Janson C, Gislason T, Svärdsudd K, Hetta J, Boman G. Snoring and hypertension: a 10 year follow up. Eur Respir J 1998;11:884–9. [CrossRef]
Nieto FJ, Young TB, Lind BK, Shahar E, Samet JM, Redline S, et al. Association of slep-disordered breating, sleep apnea, and hypertension in large community based study. JAMA 2000;283:1829– 36. [CrossRef]
Lavie P, Herer P, Hoffstein V. Obstructive sleep apnea syndrome as a risk factor for hypertension: population study. BMJ 2000;320:479– 82. [CrossRef]
Silverberg DS, Oksenberg A. Essential hypertension and abnormal upper airway resistance during sleep. Sleep 1997;20:794–806. [CrossRef]
Andreas S, Schul R, Werger G, Kreuzer H. Prevalence of obstructive sleep apnea in patients with coronary artery disease. Cor Artery Dis 1996;7:541–5.

Schafer H, Koahler U, Ploch T, Peter JH. Sleep-related myocardial ischemia and sleep structure in patients with obstructive sleep apnea and coronary heart disease. Chest 1997;111:387–93. [CrossRef]
Quan SF, Howard BV, Iber C, Kiley JP, Nieto FJ, O’Connor GT, et al. The Sleep Heart Healty Study: Design, rationale, and methods. Sleep 1997;20:1077–85. [CrossRef]
Peker Y, Hedner J, Norum J, Kraiczi H, Carlson J. Increased Incidens of Cardiovascular Disease in Middle-aged Men with Obstructive Sleep apnea: A 7-year Follow-up. Am J Respir Crit Care Med 2002;166:159– 65. [CrossRef]
Mooe T, Rabben T, Wiklund U, Franklin KA, Eriksson P. Sleep- disordered breathing in men with coronary artery disease. Chest 1996;109:659–63. [CrossRef]
Chung S, Yoon IY, Shin YK,, Lee CH, Kim JW, Lee T, et al. Endothelial Dysfunction and C-Reactive Protein in Relation with the Severity of Obstructive Sleep Apnea Syndrome. Sleep 2007;30:997–1001. [CrossRef]
Simon A, Gariepy J, Chironi G, Megnien JL, Levenson J. Intima-media thickness: a new tool for diagnosis and treatment of cardiovascular risk. J Hypertens 2002;20:159–69. [CrossRef]
American Diabetes Association. Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 2010;33:S62–9. [CrossRef]
Poredos P. Intima-media thickness: indicator of cardiovascular risk and measure of the extent of atherosclerosis. Vasc Med 2004;9:46– 54. [CrossRef]
Lim TK, Lim E, Dwivedi G, Kooner J, Senior R. Normal value of carotid intima-media thickness: a surrogate marker of atherosclerosis: quantitative assessment by B-mode carotid ultrasound. J Am Soc Echocardiogr 2008;21:112–6. [CrossRef]
Sarioglu N, Demirpolat G, Erel F, Kose M. Which Is the Ideal Marker for Early Atherosclerosis in Obstructive Sleep Apnea (OSA)- Carotid Intima-Media Thickness or Mean Platelet Volume? Med Sci Monit 2017;23:1674–81. [CrossRef]
Coretti MC, Anderson TJ, Benjamin EJ, Celermajer D, Charbonneau F, Creager MA, et al. Guidelines for the ultrasound assessment of endothelial-dependent flow mediated vasodilation of the brachial artery: a report of the international brachial artery reactivity task force. J Am Coll Cardiol 2002;39:257–65. [CrossRef]
Kostopoulos K, Alhanatis E, Pampoukas K, Georgiopoulos G, Zourla A, Panoutsopoulos A, et al. CPAP therapy induces favorable short- term changes in epicardial fat thickness and vascular and metabolic markers in apparently healthy subjects with obstructive sleep apnea-hypopnea syndrome (OSAHS). Sleep Breath 2016;20:483–93. [CrossRef]
Ciccone MM, Scicchitano P, Mitacchione G, Zito A, Gesualdo M, Caputo P, et al. Is there a correlation between OSAS duration/severity and carotid intima-media thickness? Respir Med 2012;106:740–6. [CrossRef]
Del Ben M, Fabiani M, Loffredo L, Polimeni L, Carnevale R, Baratta F, et al. Oxidative stress mediated arterial dysfunction in patients with obstructive sleep apnoea and the effect of continuous positive airway pressure treatment. BMC Pulm Med 2012;12:36. [CrossRef]
Ohike Y, Kozaki K, Iijima K, Kojima T, Ohga E, Santa T, et al. Amelioration of vascular endothelial dysfunction in obstructive sleep apnea syndrome by nasal continuous positive airway pressure-possible involvement of nitric oxide and asymmetric NG, NG-dimethylarginine. Circ J 2005;69:221–6. [CrossRef]
Ip MSM, Lam B, Chan LY, Zheng L, Tsang KWT, Fung PCW, Lam WK. Circulating nitric oxide is suppressed in obstructive sleep apnea and is reversed by nasal continuous positive airway pressure. Am J Respir Crit Care Med 2000;162:2166–71. [CrossRef]
Joannides R, Haefeli WE, Linder L, Richard V, Bakkali EH, Thuillez C, Lüscher TF. Nitric oxide is responsible for flow-dependent dilatation of human peripheral conduit arteries in vivo. Circulation 1995;91:1314–19. [CrossRef]
Cooke JP. Flow, NO and atherogenesis. Proc Natl Acad Sci U S A 2003;100:768–70. [CrossRef]
Wang Y, Xu H, Qian Y, Guan J, Yi H, Yin S. Patients with Obstructive Sleep Apnea Display Decreased Flow-Mediated Dilatation: Evidence from a Meta-Analysis. Med Sci Monit 2017;23:1069–82. [CrossRef]
Parish JM, Somers VK. Obstructive sleep apnea and cardiovascular disease. Mayo Clin Proc 2004;79:1036–46. [CrossRef]
Ryan S, Taylor CT, McNicholas WT. Systemic inflammation: a key factor in the pathogenesis of cardiovascularcomplications in obstructive sleep apnoea syndrome? Thorax 2009;64:631–6. [CrossRef]
Olson LJ, Olson EJ, Somers VK. Obstructive sleep apnea and platelet activation: another potential link between sleep disordered breathing and cardiovascular disease. Chest 2004;126:339–41. [CrossRef]
Kario K. Obstructive sleep apnea syndrome and hypertension: mechanism of the linkage and 24-h blood pressure control. Hypertens Res 2009;32:537–41. [CrossRef]
Suzuki T, Nakano H, Maekawa J, Okamoto Y, Ohnishi Y, Yamauchi M, Kimura H. Obstructive sleep apnea and carotid-artery intima-media thickness. Sleep 2004;27:129–33. [CrossRef]
Kaynak D, Göksan B, Kaynak H, Degirmenci N, Daglioglu S. Is there a link between severity of sleep-disorder breathing and atherosclerotic disease of the carotid arteries? Eur J Neurol 2003;10:487–93. [CrossRef]
Kanbay A, Tutar N, Kaya E, Buyukoglan H, Ozdogan N, Oymak FS, et al. Mean platelet volume in patients with obstructive sleep apnea syndrome and its relationship with cardiovascular diseases. Blood Coagul Fibrinolysis 2013;24:532–6. [CrossRef]
Varol E, Ozturk O, Gonca T, Has M, Ozaydin M, Erdogan D, Akkaya A. Mean platelet volume is increased in patients with severe obstructive sleep apnea. Scand J Clin Lab Invest 2010;70:497–502. [CrossRef]
Kurt OK, Yildiz N. The importance of laboratory parameters in patients with obstructive sleep apnea syndrome. Blood Coagul Fibrinolysis 2013;24:371–4. [CrossRef]
Sökücü S N, Özdemir C, Dalar L, Karasulu L, Aydın Ş, S Altın. Is Mean Platelet Volume Really a Severity Marker for Obstructive Sleep Apnea Syndrome without Comorbidities? Pulmonary Med 2014:754839. [CrossRef]

Details

Primary Language

Turkish

Subjects

-

Journal Section

-

Authors

Elçin Aydın

Cihan Altın

Birsen Şahin Satılmış

Erkan Eşki

Mustafa Agah Tekindal

Muhteşem Ağıldere

Publication Date

December 1, 2019

Submission Date

-

Acceptance Date

-

Published in Issue

Year 2019 Number: 4

IZ

https://izlik.org/JA73MR69GL

Cite

RIS / Bibtex

EndNote

Aydın E, Altın C, Şahin Satılmış B, Eşki E, Tekindal MA, Ağıldere M (December 1, 2019) Obstrüktif Uyku Apne Sendromu OUAS Saptanan Hastalarda Vasküler Fonksiyon Bozukluğu ve Ateroskleroz Riskinin Değerlendirilmesi. Acıbadem Üniversitesi Sağlık Bilimleri Dergisi 4 627–633.