Serum Asimetrik Dimetil Arjinin (ADMA) Düzeyi ve Obstruktif Uyku Apne Sendromu (OUAS) Ağırlığı Arasındaki İlişki

Öz

Giriş: Obstrüktif Uyku Apne Sendromu (OUAS) olan hastalarda ortaya çıkan tekrarlayan hipoksemi ve reoksijenasyon oksidatif stres mekanizmalarını tetikleyebilir. Oksidatif stres OUAS hastalarında Asimetrik dimetilarginin (ADMA) düzeylerini artırır. Amaç: Serum Asimetrik Dimetil Arjinin (ADMA) düzeyi ve ObstrÜktif Uyku Apne Sendromu (OUAS) ağırlığı arasındaki ilişkiyi incelemeyi amaçladık. Method: Polisomnografi yapılan 330 hasta kayıtları retrospektif olarak değerlendirildi. Anormal serum glukozu, lipid, tiroid, böbrek ve karaciğer bozuklukları olan hastalar çalışma dışı bırakıldı. Kabul kriterleri 72 sağladı. Hastalar apne hipopne indekslerine göre beş gruba ayrıldılar. Asimetrik Dimetil Arjinin ölçümleri ELİSA kiti ile yapıldı. Bulgular: Ortalama yaş 44,19 ± 14,24 idi. Hastaların %31,9'u kadındı . Hastalar normal, ağır, orta, hafif, rem-pozisyonel olarak gruplandığında; %26, %25, %6,9 , %16,7 ve %25 oranlarındaydılar. AHI ve ADMA arasında anlamlı korelasyon saptandı (r= 0,483; p<0,001). ADMA için uygun cut-off değeri 1,39 olarak belirlendi. Bu değer için duyarlılık %73,58 (%95 güven aralığı (CI): 61,71- % 85,45 %), özgünlük %94,74 (95 % CI: 84,70- % 100%)idi. oğruluk ya da doğru sınıflandırma oranı %79,17 olarak bulundu. Pozitif kestirim değeri %97,5 ve negatif kestirim değeri ise %56,25 idi. Pozitif olabilirlik oranı (LR+) 13,98 (LR+>10) ve negatif olabilirlik oranı (LR-) 0,28 (LR-<1) olarak saptandı. Sonuç: ADMA test yöntemi; normal glukoz, lipid, tiroid, karaciğer ve böbrek fonksiyon testine sahip hastalarda ,güçlü ve iyi bir tanı testi kriteri olma özelliklerine sahip olabilir.

Anahtar Kelimeler

• obstrüktif uyku apne sendromu
• hipoksemi
• ADMA

Relationship Between Serum Asymmetric Dimethylarginine (ADMA) Level And Obstructive Sleep Apnea Syndrome (OSAS) Severity

Öz

Introduction: The repetitive hypoxemia can induce oxidative stress mechanisms. Oxidative stress increases serum ADMA levels in patients with OSAS. Aim: To investigate the relationship between serum levels of ADMA and OSAS severity. Methods: 330 patient’s records, who underwent overnight polysomnography (PSG) were retrospectively examined. The patients who had a abnormal serum glucose, lipid, thyroid, renal and liver function tests levels, had excluded. 72 patients had participating criteria. Patients were categorized into five groups according to apnea/hipopnea index (AHI). Measurement of ADMA levels was performed by ELISA kit. Results: The mean age was 44,19 ± 14,24 years. 31,9 % of the patients were female. Patients in normal group, severe, medium, mild and positional–REM dependent OSAS group were 26,4%, 25%, 6,9 %, 16,7% and 25%; respectively. A significant positive correlation was found between AHI and ADMA (r= 0,483; p<0,001). Appropriate cut-off criterion was set at 1,39 for ADMA. Sensitivity for this value was 73,58 % (95 % Confidence Interval (CI): 61,71- % 85,45 %) and specificity was 94,74 % (95 % CI: 84,70- % to 100%). Accuracy or correct classification rate was found to be 79,17 %. The positive predictive value was 97,5 % and negative predictive value was 56,25 %. The positive likelihood ratio (LR +) was 13,98 (LR + > 10) and the negative likelihood ratio was (LR-) 0,28 (R- <1). Conclusions: ADMA was found to be a strong and good diagnostic tool among patients with normal levels for glucose, lipid, TSH, creatinine and liver function tests.

Anahtar Kelimeler

• obstructive sleep apnea
• hypoxemia
• ADMA

Kaynakça

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