Obstrüktif uyku apne sendromlu hastalarda eritrosit dağılım genişliği, ortalama trombosit hacmi ve trombosit dağılım aralığı karşılaştırılması

Year 2019, Volume: 3 Issue: 10, 734 - 739, 01.10.2019

Hakan Çelikhisar , Gülay Daşdemir İlkhan

https://doi.org/10.28982/josam.622377

Cited By: 1

Abstract

Amaç: Obstrüktif uyku apne sendromunda (OUAS) intermitant hipoksiye bağlı gelişen kronik inflamasyonun PAP tedavisine yanıtını değerlendirmede kullanılacak güvenilir belirteçlere ihtiyaç vardır. Bu çalışmada, pozitif havayolu basıncı tedavisinin uzun dönem sonuçlarının hemogram parametreleri üzerine etkisini ve OUAS'lı hastalarda inflamasyon ve hastalığın ciddiyeti ile ilişkisini araştırmayı amaçladık.

Yöntemler: Çalışma prospektif kohort tipi çalışma olarak planlandı. Polisomnografi (PSG) sonuçlarına göre OUAS saptanmayan 61 katılımcı (%35.1) kontrol grubu olarak alındı. OUAS saptanan 113 hasta (%64,9) çalışma grubu olarak alındı. Çalışma grubunun (%31,6)’sı orta OUAS, 58'i (%33,3) şiddetli OUAS idi. Hastaların MPV, PDW, RDW, hemoglobin, hemotokrit, trombosit değerleri değerlendirildi ve altı ve on iki ay arayla karşılaştırıldı. 

Bulgular: Yaşları 33 ile 62 arasında değişen, toplam 174 hasta çalışmaya alındı. Başlangıçta hemoglobin, hematokrit ve MPV değerleri çalışma grubunda kontrol grubuna göre anlamlı derecede yüksek (sırasıyla P=0,008, P=0,007, P=0,004), her iki grupta da 6 ve 12 aydaki düşüşler istatistiksel olarak anlamlıydı (sırasıyla P=0,004, P=0,003, P=0,004).

Sonuç: Tüm katılımcıların erkek olması hemogram parametrelerine hormonal etkilerin dışlanması nedeni ile idi. Ancak çalışmaya sadece erkek katılımcıların dahil edilmesi aynı zamanda bu çalışmanın limitasyonu olabilir. Çalışmamız MPV, RDW, PDW ve hemoglobin, hematokrit değerleri ve OUAS şiddeti arasında bir ilişki olduğunu göstermiştir. MPV, RDW, hemoglobin, hematokrit, trombosit, PAP tedavisini değerlendirmeyi bekleyen OUAS hastalarını önceliklendirmede faydalı kılan basit, ucuz bir kan biyobelirteçine dönüşebilir.

Keywords

Obstrüktif uyku apne sendromu, Eritrosit dağılım genişliği, Ortalama trombosit hacmi, Trombosit dağılım aralığı

Comparison of erythrocyte distribution width, mean platelet volume and platelet distribution width in patients with obstructive sleep apnea syndrome

Abstract

Aim: Reliable markers are needed to evaluate the response of chronic inflammation in obstructive sleep apnea syndrome (OSAS) to positive airway pressure (PAP) treatment. In this study, we aimed to investigate the long-term effects of PAP treatment on hemogram parameters and its relationship with inflammation and severity of disease in OSAS patients.

Methods: Based on polysomnography (PSG) results, 61 (35.1%) participants and 113 OSAS patients (64.9%) were included in the control and study groups, respectively. Among these patients, 31.6% had moderate and 33.3% had severe OSAS. MPV, PDW, RDW, hemoglobin, hemotocrit, platelet values were evaluated and compared between the groups at six and twelve-month intervals in this prospective cohort study. 

Results: All participants (n=174) were males aged between 33-62 years. Hemoglobin, hematocrit and MPV values of the study group were significantly higher at the baseline (P=0.008, P=0.007, P=0.004, respectively) and had decreased significantly by the 6th and 12th months in both groups P=0.004, P=0.003, P=0.004, respectively). 

Conclusion: All participants were chosen from males to exclude hormonal effects on hemogram parameters, which also turned out to be a limitation of this study. Our study showed a correlation between MPV, RDW, PDW, hemoglobin and hematocrit values and OSAS severity. MPV, RDW, hemoglobin, hematocrit and platelet may be considered inexpensive biomarkers easily obtained from blood tests which make it useful in determining the severity of OSAS and prioritizing patients for PAP therapy.

Keywords

Obstructive sleep apnea syndrome, Red cell distribution width, Mean platelet volume, Platelet distribution width

References

• 1. Sateia MJ. International classification of sleep disorders-third edition: highlights and modifications. Chest. 2014 Nov;146(5):1387-94.
• 2. Waters KA, Mast BT, Vella S, De la Eva R, O'brien LM, Bailey S, et al. Structural equation modeling of sleep apnea, inflammation, and metabolic dysfunction in children. J Sleep Res. 2007;16(4):388-95.
• 3. Rahangdale S, Yeh SY, Novack V, Stevenson K, Barnard MR, Furman MI, et al. The influence of intermittent hypoxemia on platelet activation in obese patients with obstructive sleep apnea. J Clin Sleep Med. 2011;7(02):172-8.
• 4. Drager LF, Togeiro SM, Polotsky VY, Lorenzi-Filho G. Obstructive sleep apnea: a cardiometabolic risk in obesity and the metabolic syndrome. J Am Coll Cardiol. 2013;62(7):569-76.
• 5. Leung RS, Douglas Bradley T. Sleep apnea and cardiovascular disease. Circulation. 2001;164(12):2147-65.
• 6. Ardiç S. Obstrüktif Uyku Apne Sendromu ve İnflamasyon. J Int Med Sci. 2007;3(26):61-8.
• 7. Kondo Y, Kuwahira I, Shimizu M, Nagai A, Iwamoto T, Kato S, et al. Significant relationship between platelet activation and apnea-hypopnea index in patients with obstructive sleep apnea syndrome. Tokai J Exp Clin Med. 2011;36(3):79-83.
• 8. Mandal S, Kent BDJJotd. Obstructive sleep apnoea and coronary artery disease. J Thorac Dis. 2018;10(Suppl 34):S4212.
• 9. Gabryelska A, Łukasik ZM, Makowska JS, Białasiewicz P. Obstructive sleep apnea: from intermittent hypoxia to cardiovascular complications via blood platelets. Front Neurol. 2018;9.
• 10. Langer HF, Gawaz M. Platelet-vessel wall interactions in atherosclerotic disease. Thromb Haemost. 2008 Mar;99(3):480-6.
• 11. Nena E, Papanas N, Steiropoulos P, Zikidou P, Zarogoulidis P, Pita E, et al. Mean platelet volume and platelet distribution width in non-diabetic subjects with obstructive sleep apnoea syndrome: new indices of severity? Platelets. 2012;23(6):447-54.
• 12. Coviello AD, Kaplan B, Lakshman KM, Chen T, Singh AB, Bhasin S. Effects of graded doses of testosterone on erythropoiesis in healthy young and older men. J Clin Endocrinol Metab. 2008 Mar;93(3):914-9.
• 13. Hiensch R, Nandedkar DS, Feinsilver SH. Optimizing CPAP Treatment for Obstructive Sleep Apnea. Curr Sleep Medicine Rep. 2016;2(2):120-5.
• 14. Wiwanitkit V. Plateletcrit, mean platelet volume, platelet distribution width: its expected values and correlation with parallel red blood cell parameters. Clinical and applied thrombosis/hemostasis: Official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis. Cardiology. 2004;10(2):175-8.
• 15. Vagdatli E, Gounari E, Lazaridou E, Katsibourlia E, Tsikopoulou F, Labrianou I. Platelet distribution width: a simple, practical and specific marker of activation of coagulation. Hippokratia. 2010;14(1):28.
• 16. Yokoe T, Minoguchi K, Matsuo H, Oda N, Minoguchi H, Yoshino G, et al. Elevated levels of C-reactive protein and interleukin-6 in patients with obstructive sleep apnea syndrome are decreased by nasal continuous positive airway pressure. Circulation. 2003;107(8):1129-34.
• 17. Ciccone M, Scicchitano P, Zito A, Cortese F, Boninfante B, Falcone V, et al. Correlation between inflammatory markers of atherosclerosis and carotid intima-media thickness in obstructive sleep apnea. Molecules. 2014;19(2):1651-62.
• 18. Karamanli H, Ozol D, Ugur KS, Yildirim Z, Armutcu F, Bozkurt B, et al. Influence of CPAP treatment on airway and systemic inflammation in OSAS patients. Sleep Breath. 2014;18(2):251-6.
• 19. Varol E, Ozturk O, Yucel H, Gonca T, Has M, Dogan A, et al. The effects of continuous positive airway pressure therapy on mean platelet volume in patients with obstructive sleep apnea. Platelets. 2011;22(7):552-6.
• 20. Sökücü SN, Özdemir C, Dalar L, Karasulu L, Aydın Ş, Altın S. Complete blood count alterations after six months of continuous positive airway pressure treatment in patients with severe obstructive sleep apnea. J Clin Sleep Med. 2014;10(08):873-8.
• 21. Gunbatar H, Sertogullarindan B, Ekin S, Akdag S, Arisoy A, Sayhan H, et al. The correlation between red blood cell distribution width levels with the severity of obstructive sleep apnea and carotid intima media thickness. Med Sci Monit. 2014;20:2199.
• 22. Akgül E, Engin M, Özyazıcıoğlu A. Effects of mean platelet volume and platelet counts on peripheral biodegradable stent restenosis. J Surg Med. 2019;3(9):663-5.
• 23. Lattimore J-DL, Celermajer DS, Wilcox I. Obstructive sleep apnea and cardiovascular disease. J Am Coll Cardiol. 2003;41(9):1429-37.
• 24. Macdougall IC, Cooper AJNDT. The inflammatory response and epoetin sensitivity. Nephrol Dial Transplant. 2002;17(90001):48-52.
• 25. İslamoğlu Z, Demirbaş A. Mean platelet volume and platelet distribution width levels in discoid lupus erythematosus patients: A case-control study. J Surg Med. 2019; 3(8): 561-563.
• 26. Sleep related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep. 1999;22:667-89.
• 27. Ozsu S, Abul Y, Gulsoy A, Bulbul Y, Yaman S, Ozlu T. Red cell distribution width in patients with obstructive sleep apnea syndrome. Lung. 2012;190(3):319-26.
• 28. Schofield CJ, Ratcliffe P. Oxygen sensing by HIF hydroxylases. Mol. Cell. Biol. 2004;5(5):343.
• 29. Bülbül Y, Aydın EÖ, Örem A. Platelet indices in obstructive sleep apnea: the role of mean platelet volume, platelet distribution widht and plateletcrit. Tuberk Toraks. 2016;64(3):206-10.
• 30. Feliciano A, Linhas R, Marçôa R, Cysneiros A, Martinho C, Reis R, et al. Hematological evaluation in males with obstructive sleep apnea before and after positive airway pressure. Rev Port Pneumol. 2017;23(2):71-8.