Uyku apnesi tedavisinde kullanılan cihazlar kilo almaya eğilimi arttırıyor olabilir mi?

Year 2015, Volume: 5 Issue: 3, 113 - 118, 14.01.2016

Seçkin Ulusoy Nurdoğan Yavuz Mehmet Emre Dinç Mustafa Acar

Abstract

Amaç: Bu çalışma ile tıkayıcı uyku apnesi sendromu (TUAS) hastalarının tedavisinde kullanılan cihazların kilo değişiklikleri üzerine etkilerinin araştırılması planlandı.

Yöntem: Çalışmaya horlama ve uyku apnesi şikayetleriyle başvurup polisomnografi (PSG) tetkiki istenen 256 hasta dahil edildi. Hastalar apne hipopne indeksleri (AHI) ve cihaz kullanım durumlarına göre aşağıdaki şekilde gruplandırıldı: Grup 1 TUAS tanısı konularak tedavi amaçlı cihaz kullananlar (n=101), Grup 2 TUAS tanısı konularak tedavi amaçlı önerilen cihaza uyum sağlayamayanlar (n=76) ve Grup 3 PSG ile basit horlama teşhisi konulup TUAS olmayanlar (n=79). Grup 1; CPAP, Auto CPAP veya BiPap kullanan hastalardan oluşmaktadır. Her üç grup hastanın da vücut kitle indeksi (VKİ) ve boyun çevresi (BÇ) ölçümleri kayıtlarına PSG merkezinden ulaşıldı (başlangıç değerleri); bu hastalar tekrar ölçüm ve kontrol için Kulak Burun Boğaz polikliniğine çağırılarak değerlendirildiler (kontrol değerleri).

Bulgular: Grup 1 hastalarında; başlangıç değerleri ile kontrol değerleri karşılaştırıldığında: VKİ ve BÇ istatistiksel olarak anlamlı derecede yüksekti (p<0.05), Grup 2 ve 3 için VKİ ve BÇ’de istatistiksel olarak anlamlı bir fark saptanmadı (p>0.05). Grup 1 de farklı cihaz türlerini kullanan (CPAP, Auto CPAP veya BiPap) hastalar için VKİ ve BÇ açısından anlamlı farklılık göstermedi (p>0.05).

Sonuç: Uyku apnesi hastalarını tedavi etmek için kullanılan cihazlar kilo almaya eğilimi arttırmaktadırlar. Bu hastaların ileride kısır döngüye sebep olmamak için obezite açısından yakın takipleri ve gerekli önlemlerin alınması gerekir.

Anahtar sözcükler: Uyku apnesi, CPAP, Auto CPAP, BiPap, vücut

kitle indeksi, boyun çevresi.

Keywords

Uyku apnesi, CPAP, Auto CPAP, BiPap, vücutkitle indeksi, boyun çevresi

Can the devices used to treat obstructive sleep apnoea syndrome increase the tendency to gain weight?

Abstract

Objective: This study investigated the effects of device treatments on
weight changes in obstructive sleep apnoea syndrome (OSAS)
patients.
Methods: The study included 256 patients who underwent
polysomnography to evaluate snoring and suspected OSAS. They
were grouped according to the apnoea hypopnoea index (AHI) and
device usage for OSAS as follows: Group 1 included patients who
were established with OSAS diagnosis and used device for treatment
purpose (n=101); Group 2 included patients who were established
with OSAS diagnosis but could not adapt to the devices recommended for medical purposes (n=76); and Group 3 included patients who
were established with ordinary snoring diagnosis but did not have
OSAS, (n=79). Group 1 used CPAP, Auto CPAP, or BiPap. For all
groups, BMI and neck circumference data were obtained from sleep
centre records (baseline values) and invited to visit again for followup measurements in otolaryngology outpatient clinic (control values).
Results: In Group 1, both BMI and neck circumference were
increased at follow-up compared with the baseline measurements
(p<0.05) while no significant change was detected in the other two
groups (p>0.05). The BMI and neck circumference did not differ
among the devices used in Group 1 (CPAP, Auto CPAP, and BiPap)
(p>0.05).
Conclusion: Devices used to treat OSAS tend to enhance weight
gain. Such patients should be closely monitored and the required
measures should be taken in terms of obesity. 

Keywords

Auto CPAP, body mass index, BiPap, continuous positive airway pressure (CPAP), neck circumference, obstructive sleep apnoea syndrome (OSAS)

References

• Fritscher LG, Mottin CC, Canani S, Chatkin JM. Obesity and obstructive sleep apnea-hypopnea syndrome: the impact of bariatric surgery. Obes Surg 2007;17:95–9.
• Malhotra A, White DP. Obstructive sleep apnoea. Lancet 2002; 360:237–45.
• Strollo PJ Jr, Rogers RM. Current concepts: obstructive sleep apnea. N Engl J Med 1996; 334:99–104.
• Caples SM, Gami AS, Somers IK. Obstructive sleep apnea. Ann Intern Med 2005;142:187–97.
• Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993;328:1230–5.
• Palmer LJ, Buxbaum SG, Larkin E, et al. A whole-genome scan for obstructive sleep apnea and obesity. Am J Hum Genet 2003; 72:340–50.
• Gami AS, Caples SM, Somers VK. Obesity and obstructive sleep apnea. Endocrinol Metab Clin North Am 2003;32:869–94.
• Peppard PE, Young T, Palta M, Dempsey J, Skatrud J. Longitudinal study of moderate weight change and sleep-disor- dered breathing. JAMA 2000;284:3015–21.
• Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993;328:1230–5.
• Loube DI, Loube AA, Erman MK. Continuous positive airway pressure treatment results in weight loss in obese and overweight patients with obstructive sleep apnea. J Am Diet Assoc 1997;97: 896–7.
• Owens RL, Shafazand S. Effects of CPAP and weight loss on OSA outcomes. J Clin Sleep Med 2014;10:1365–7.
• Redenius R, Murphy C, O’Neill E, Hamwi MA, Zallek SN. Does CPAP lead to change in BMI? J Clin Sleep Med 2008;4:205–9.
• Quan SF, Budhiraja R, Clarke DP, et al. Impact of treatment with continuous positive airway pressure (CPAP) on weight in obstruc- tive sleep apnea. J Clin Sleep Med 2013;9:989–93.
• World Medical Association (WMA). Declaration of Helsinki. Ethical principles for medical research involving human subjects. 59th WMA General Assembly, Seoul, Republic of Korea, October 2008.
• Fletcher EC. Invited review: physiological consequences of inter- mittent hypoxia: systemic blood pressure. J Appl Physiol (1985) 2001;90:1600–5.
• Punjabi NM, Sorkin JD, Katzel LI, Goldberg AP, Schwartz AR, Smith PL. Sleep-disordered breathing and insulin resistance in middle-aged and over weight men. Am J Respir Crit Care Med 2002;165:677–82.
• Ojeda E, Lopez S, Rodriguez P, et al. Prevalence of sleep apnea syndrome in morbidly obese patients. Chest 2014;145(3 Suppl): 601A.
• Kumar AR, Guilleminault C, Certal V, Li D4, Capasso R, Camacho M. Nasopharyngeal airway stenting devices for obstruc- tive sleep apnoea: a systematic review and meta-analysis. J Laryngol Otol 2015;129:2–10.
• Shinohara E, Kihara S, Yamashita S, et al. Visceral fat accumula- tion as an important risk factor for obstructive sleep apnoea syn- drome in obese subjects. J Intern Med 1997;241:11–8.
• Maeda K, Okubo K, Shimomura I, Funahashi T, Matsuzawa Y, Matsubara K. cDNA cloning and expression of a novel adipose specific collagen-like factor, apM1 (adipose most abundant gene transcript 1). Biochem Biophys Res Commun 1996;221:286–9.
• Arita Y, Kihara S, Ouchi N, et al. Paradoxical decrease of an adi- pose-specific protein, adiponectin, in obesity. Biochem Biophys Res Commun 1999;257:79–83.
• Nakagawa Y, Kishida K, Kihara S, et al. Nocturnal reduction in circulating adiponectin concentrations related to hypoxic stress in severe obstructive sleep apnea–hypopnea syndrome. Am J Physiol Endocrinol Metab 2008;294:E778–84.
• Zamarrón C, Riveiro A, Gude F. Circulating levels of vascular endothelial markers in obstructive sleep apnoea syndrome. Effects of nasal continuous positive airway pressure. Arch Med Sci 2011;6:1023–8.
• Ridker PM, Hennekens CH, Roitman-Johnson B, Stampfer MJ, Allen J. Plasma concentration of soluble intercellular adhesion molecule-1 and risks of future myocardial infarction in apparently healthy men. Lancet 1998;351:88–92.
• Jiang H, Cao H, Wang P, Liu W, Cao F, Chen J. Tumour necro- sis factor-α/interleukin-10 ratio in patients with obstructive sleep apnoea hypopnoea syndrome. J Laryngol Otol 2015;129:73-8.
• Ouchi N, Kihara S, Arita Y, et al. Novel modulator for endothelial adhesion molecules: adipocyte-derived plasma protein adiponectin. Circulation 1999;100:2473–6.
• Garcia JM, Sharafkhaneh H, Hirshkowitz M, Elkhatib R, Sharafkhaneh A. Weight and metabolic effects of CPAP in obstructive sleep apnea patients with obesity. Respir Res 2011;12: 80. doi: 10.1186/1465-9921-12-80.
• Giles TL, Lasserson TJ, Smith BJ, White J, Wright J, Cates CJ. Continuous positive airways pressure for obstructive sleep apnoea in adults. Cochrane Database Syst Rev 2006;(1):CD001106.
• Povitz M, Bolo CE, Heitman SJ, Tsai WH, Wang J, James MT. Effect of treatment of obstructive sleep apnea on depressive symp- toms: systematic review and meta-analysis. PLoS Med 2014;11(11): e1001762.
• Harris M, Glozier N, Ratnavadivel R, Grunstein RR. Obstructive sleep apnea and depression. Sleep Med Rev 2009;13:437–44.
• This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported (CC BY
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• Please cite this article as: Ulusoy S, Yavuz N, Dinç ME, Acar M. Can the devices used to treat obstructive sleep apnoea syndrome increase the tendency
• to gain weight? ENT Updates 2015;5(3):113–118.