OBEZ OLGULARDA ÜRİK ASİT DÜZEYİNİN UYKUDA SOLUNUM BOZUKLUKLARI İLE İLİŞKİSİ

Öz

Amaç: Bu çalışmada obez ve uyku ile ilişkili solunum bozuklukları (UİSB) olan olgularda serum ürik asit (ÜA) düzeyinin obstruktif uyku apne (OUA) şiddeti, nokturnal hipoksemi (NH) ve obezite hipoventilasyon sendromu (OHS) ile ilişkisi araştırıldı. Gereç ve Yöntem: Uyku laboratuarına başvuran vücut kitle indeksi (VKİ) ≥30 kg/m2 olan polisomnografi ile UİSB saptanan tüm olgular çalışmaya alındı. Demografik özellikler, antropometrik ölçümler ve serum ÜA düzeyleri kaydedildi. Apne-hipopne indeksi (AHİ) ve ODİ (oksijen desaturasyon indeksi) hesaplandı. AHİ 5-14 olay/sa hafif, 15-29 olay/sa orta ve ≥30 olay/sa ağır şiddette OUA olarak değerlendirildi. Nokturnal SpO2<%90 olan sure ≥%30 ise NH kabul edildi. PaCO2>45 mmHg ise OHS tanısı koyuldu. Bulgular: Çalışmaya 159 UİSB olan olgu (79 kadın, 80 erkek, yaş: 50,0±10,5 yıl, VKİ: 40,1±5,7 kg/m2) dahil edildi. Olguların 76'sında OHS ve 83'ün de saf OUA tanısı mevcuttu. NH %25,8'inde (n=41) saptandı. NH olanlarda ÜA düzeyi anlamlı olarak yüksekti (6,22±1,37 mg/dl, 5,67±1,51 mg/dl, p=0,008). OHS olgularında ÜA düzeyi saf OUA olguları ile benzerdi (5,91±1,25 mg/dl, 5,72±1,68 mg/dl, p=0,1). OUA şiddeti arttıkça ÜA düzeyi artmaktaydı (hafif: 5,03±1,41 mg/dl, orta: 5,46±1,55 mg/ dl, ağır: 6,19±1,8 mg/dl, p=0,039). Erkek OUA olgularında ÜA düzeyleri daha yüksekti (6,86±1,64 mg/dl, 4,84±1,10 mg/dl, p<0,001). ÜA düzeyi boyun çevresi (r=0,366, p<0,001), bel/kalça oranı (r=0,358, p<0,001), OUA şiddeti (r=0,224, p=0,005), AHİ (r=0,250, p=0,001), ODİ (r=291, p<0,001), nokturnal SpO2<%90 geçen süre (r=0,228, p=0,004) ile korelasyon göstermekteydi. Erkek cinsiyet, NH ve bel/kalça oranı ÜA düzeyi ile bağımsız ilişkili faktörler olarak bulundu (sırasıyla; p<0,001, p=0,03, p=0,03). Sonuç: UİSB olan obez olgularda, yüksek serum ÜA düzeyleri erkek cinsiyet, NH ve OUA şiddeti ile ilişkili bulunmuştur.

Anahtar Kelimeler

• Nokturnal hipoksemi
• obezite
• obezite hipoventilasyon sendromu
• obstruktif uyku ap
• ürik asit

RELATIONSHIP BETWEEN SERUM URIC ACID LEVELS AND SLEEP-RELATED BREATHING DISORDERS IN OBESE SUBJECTS

Öz

Objective: We examined the serum uric acid (UA) levels among patients with sleep-related breathing disorders (SRBD) and the relationship between UA levels and obstructive sleep apnea (OSA) severity, nocturnal hypoxemia (NH) and obesity hypoventilation syndrome (OHS). Material and Method: Subjects with body mass index (BMI) ≥30 kg/m2 who, according to polysomnography results, have SRBD were included. Demographics, anthropometric measurements and serum UA were recorded. The apnea-hypopnea index (AHI) and oxygen desaturation index (ODI) were recorded. The OSA severity was graded as mild (AHI 5-14 events/hour), moderate (AHI 15-29 events/hour) or severe (AHI ≥30 events/hour). NH was considered when sleep time spent with SpO2<90% was ≥30%. PaCO2>45 mmHg was considered OHS. Results: The study included 159 patients with SRBD (79 female, 80 males, age: 50.0±10.5 years, BMI: 40.1±5.7 kg/m2). Seventy- six had OHS and 83 had pure OSA. NH was detected in 25.8% of patients. UA levels were higher in subjects with NH (6.22±1.37 mg/dl, 5.67±1.51 mg/dl, p=0.008). UA levels were similar in patients with OHS and pure OSA (5.91±1.25 mg/dl, 5.72±1.68 mg/ dl, p=0.1). UA levels increased as OSA severity increased (mild: 5.03±1.41 mg/dl, moderate: 5.46±1.55 mg/dl, severe: 6.19±1.8 mg/dl, p=0.039). UA levels were higher in males with OSA (6.86±1.64 mg/dl, 4.84±1.10 mg/dl, p<0.001). UA levels were correlated with neck circumference (r=0.366, p<0.001), waist/ hip ratio (r=0.358, p<0.001), OSA severity (r=0.224, p=0.005), AHI (r=0.250, p=0.001), ODI (r=291, p<0.001) and sleep time with SpO2<90% (r=0.228, p=0.004). Male gender, waist/hip ratio and NH were factors independently related with UA levels (retrospectively; p<0.001, p=0.03, p=0.03). Conclusion: In obese subjects with SRBD, serum UA levels were associated with male gender, NH and OSA severity.

Anahtar Kelimeler

• nocturnal hypoxemia
• obesity
• obesity hypoventilation syndrome
• obstructive sleep apnea
• uric acid

Kaynakça

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