Obstruktif Uyku Apne Sendromu Olan Hastalarda Ambulatuvar Kan Basıncının Önemi ve Vücut Kitle İndeksinin Nondipping Patern Üzerine Etkisi

Yıl 2021, Cilt: 16 Sayı: 3, 393 - 396, 01.11.2021

Buket Tuğan Yıldız , Deniz Tuncel , Gülizar Sökmen

https://doi.org/10.17517/ksutfd.951570

Öz

Amaç: Obstruktif uyku apne sendromunda görülen kardiyovasküler olaylar ve mortaliteden nondipping paternin sorumlu olduğu düşünülmektedir. Çalışmamızda vücut kitle indeksi ile nondipping patern arasındaki ilişkiyi saptamayı amaçladık.
Gereç ve yöntemler: Hastanemiz uyku bozuklukları polikliniğinde polisomnografi ile ağır obstruktif uyku apnesi tanısı alan 29 'u erkek (%83) ve 6 'sı kadın (%17) toplam 35 hasta çalışmaya alınmıştır. Hastaların poliklinik muayeneleri srasında kan basınçları, yaşları, cinsiyetleri, vücut kitle indeksleri kaydedilmiştir. Hastalara 24 saatlik ambulatuvar tansiyon holter takılmıştır. Gece ortalama sistolik kan basıncı, gündüz ortalama sistolik kan basıncının %10 'undan fazla düşmeyen hastalar nondipping olarak kaydedilmiştir.
Bulgular: Hastaların yaş ortalaması 51,97 ±8,89; vücut kitle indeksi ortalaması 33,94± 6.17 idi. Poliklinik kan basıncı ölçümleri ortalaması ve 24 saat ambulatuvar kan basıncı ölçümleri ortalamaları Amerikan Kalp Derneği tanı kriterlerine göre hipertansiyon kriterlerini karşılamamaktadır. Hastaların 24 (%69)' unda nondipping paterni görülmüştür. Non dipping paterni ile vücut kitle indeksi karşılaştırıldığında aralarında anlamlı ilişki saptanmıştır(p:0,008). Hastaların vücut kitle indeksi değerleri arttıkça, sistolik kan basıncı gece değerlerinin arttığı saptanmıştır ve aralarında pozitif yönde ve anlamlı bir ilişki vardır (r:0.389, p:0.021). Vücut kitle indeksi değerleri arttıkça, sistolik kan basıncı ortalama ve sistolik kan basıncı gündüz değerlerinin arttığı saptandı ancak aralarında anlamlı ilişki yoktu (sırasıyla p: 0,123; 0.259).
Sonuç: Obstruktif uyku apne sendromu hastalarının kardiyovasküler risk faktörlerinin belirlenmesinde ve takibinde poliklinik koşullarında bakılan kan basıncı yeterli olmayabilir. Tanı konan hastalardan takipleri boyunca en az bir kez 24 saatlik tansiyon holter monitorizasyon yapılmalıdır.
Vücut kitle indeksi nondipping patern ve morbidite üzerine direk etkilidir. Hastanın kilo vermesi non dipping patern üzerine etkili olacak, morbidite ve mortaliteyi azaltacaktır.

Anahtar Kelimeler

Obstruktif uyku apne sendromu, nondipping, vücut kitle indeksi, sempatik aktivasyon

The importance of ambulatory blood pressure and the effect of body mass index on nondipping pattern in patients with obstructive sleep apnea syndrome

Öz

Objective: It is thought that nondipping pattern is responsible for cardiovascular events and mortality in obstructive sleep apnea syndrome. In our study, we aimed to determine the relationship between body mass index and nondipping pattern.
Material and methods: A total of 35 patients, 29 male (83%) and 6 female (17%) diagnosed with severe obstructive sleep apnea by polysomnography in the sleep disorders outpatient clinic of our hospital, were included in the study. Blood pressure, age, gender and body mass index of the patients were recorded during the outpatient clinic examinations. A 24-hour ambulatory blood pressure holter measurement was made. The patients whose mean systolic blood pressure at night did not decrease more than 10% of the mean systolic blood pressure during the daytime were recorded as nondipping.
Results: The mean age of the patients was 51.97 ±8.89; mean body mass index was 33.94±6.17. Mean outpatient blood pressure measurements and 24-hour ambulatory blood pressure measurements do not meet the criteria for hypertension according to the American Heart Association diagnostic criteria. Nondipping pattern was observed in 24 (69%) of the patients. When the non-dipping pattern and body mass index were compared, a significant relationship was found between them (p:0.008). As the body mass index values of the patients increased, the nighttime systolic blood pressure values increased and there was a positive and significant relationship between them (r:0.389, p:0.021). As the body mass index values increased, mean systolic blood pressure and daytime systolic blood pressure values increased, but there was no significant relationship between them (p: 0.123; 0.259, respectively).
Conclusion: The blood pressure measured in outpatient clinics may not be sufficient in the determination and follow-up of cardiovascular risk factors in patients with obstructive sleep apnea syndrome. 24-hour blood pressure holter monitoring should be performed at least once during the follow-up of the diagnosed patients.
Body mass index has a direct effect on nondipping pattern and morbidity. Weight loss of the patient will affect the non-dipping pattern and reduce morbidity and mortality.

Anahtar Kelimeler

Obstructive sleep apnea syndrome, nondipping, body mass index, sympathetic activation

Kaynakça

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