OBSTRUKTİF UYKU APNE SENDROMU'NDA İNFLAMASYON

Öz

Amaç: Obstruktif uyku apne sendromu (OUAS) ve inflamasyon arasındaki ilişki tartışmalıdır. Uyku apne ve obesite farklı mekanizmalarla inflamasyonu arttırabilir. Bu çalışma uyku apnesi ve obesite ile proinflamatuar durumun ilişkisini inceledi. Metod: Toplam 133 olguya polisomnografi yapıldı. Polisomnografileri yapılarak, apne hipopne indeksi (AHI)>5 olan 112 OUAS tanılı hasta ve AHI5 olan 21 kontrol grubu birey çalışmaya dahil edildi. Kontrol grubu bireyler grup A olarak kabul edildi. Bununla birlikte OUAS tanılı hastalar VKİ’lerine göre non-obese grup (B grup) (VKİ<30) ve obese grup (C grup) (VKİ>30) olarak iki gruba ayrıldı. Bulgular: Tüm inflamatuar sitokinler (CRP, hs CRP, TNF-ά, IL-6) obez uyku apneli hastalarda kontrol grubu bireylerden anlamlı olarak daha yüksekti. İnsülin rezistansı obez uyku apneli hastalarda obez olmayan hastalardan ve kontrol grubundan daha yüksekti fakat insülin rezistansı kontrol grubu ve obez olmayan uyku apneli hastalar arasında farklı değildi. Tüm inflamatuar sitokinler pearson korelasyon analizinde VKİ ile anlamlı ilişki gösterdi. Ancak multiple varians analizinde CRP, hs CRP VKİ ile anlamlı ilişkiliyken, TNF-ά, IL-6’nın VKİ ile anlamlı ilişkisi yoktu. Tüm inflamatuar sitokinler yine bu analize göre desaturasyon indeksi ile anlamlı ilişkiliydi. Sonuç: Adipöz dokunun proinflamatuar durumun gelişiminde anahtar rol oynadığı için bu hastalarda obesite hem uyku apnesinin şiddetini arttırır hem de inflamasyonun artışını tetikler. OSAS’ın ve metabolik bozuklukların erken tespiti kardiovasküler morbidite ve mortalitenin azalmasına yardımcı olur.

Anahtar Kelimeler

• Obstruktif uyku apne sendromu, İnflamasyon, Obesite, İnsülin rezistansı

THE INFLAMMATION IN OBSTRUCTIVE SLEEP APNEA SYNDROME

Öz

Aim: The association between obstructive sleep apnea syndrome (OSAS) and inflammation remains controversial. This study investigated the relationship between OSAS and obesity with proinflammatory state. Method: A total of 133 consecutive subjects who were referred for polysomnography. 112 were documented to have OSAS defined as AHI >5 and 21 control subjects with AHI<5 were selected upon polysomnography. Control group has been accepted as A group. In addition, patients with OSAS were divided into the following two groups based on the BMI as non-obese (B group) (BMI <30) and obese (C group) (BMI>30). Result: CRP, hs CRP, TNF-ά, IL-6 were significantly higher in the obese patients with OSAS than in the control group. Insulin resistance was higher in obese patients with sleep apnea than both in nonobese patients and control group but insulin resistance did not differ between control group and non-obese patients with sleep apnea. All of inflammatory cytokines showed significant associations with BMI in pearson correlation analysis. However, in multiple variance analysis, CRP, hs CRP were significant associated with BMI while TNF-ά, IL-6 were not significant associated BMI. All of inflamatory cytokines were significantly associated with desaturation index according to this analysis. Conclusion: Obesity increases both severity of sleep apnea and causes aggravate of inflammation in these patients because adipose tissue play a key role for the development of the proinflammatory state. Early detection of OSAS and metabolic dysfunction may help to decrease the cardiovascular morbidity and mortality.

Anahtar Kelimeler

• Obstructive Sleep Apnea Syndrome, Inflammation, Obesity, Insulin Resistance

Kaynakça

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