The evaluation of inflammatory process, endothelial dysfunction and oxidative stress in sleep apnea

Yıl 2014, Cilt: 4 Sayı: 2, 61 - 65, 01.06.2014

Yusuf Dündar Emel Çadallı Tatar Güleser Saylam Hakan Korkmaz Ömer Tarık Selçuk Ali Özdek Sadık Ardıç

https://doi.org/10.2399/jmu.2014002007

Öz

Objective: To investigate the correlation of inflammatory process, endothelial dysfunction and oxidative stress with obstructive sleep apnea (OSA). Methods: In our prospective cross-sectional clinical study in a tertiary referral hospital, we evaluated 63 patients with newly diagnosed OSA and 9 simple snorers. Each patient was evaluated in terms of additional systemic diseases and laboratory tests. In addition to routine blood analysis; oxidative stress markers (leptine, RBP), vascular endothelial markers (ICAM-I, VCAM-I) and inflammatory markers (Crp, IL-6, TNF-alpha, isoprostane) were analyzed. Polysomnography test was performed and study population was divided into four groups depending on their AHI values. The levels of markers were analyzed and compared between the four groups. Results: There was a weak correlation between the isoprostane levels and mean apnea duration and also a mild correlation to the maximum apnea duration. A weak correlation was detected between leptine and VCAM levels to age and also a weak negative correlation was detected between CRP levels to age. The leptin levels were found to be mildly correlated to BMI and abdominal circumference. The ICAM levels were found to have a weak correlation to BMI and abdominal circumference. Conclusion: Our results indicate a correlation between sleep apnea and oxidative stress. These results may help to explain the association of co-morbid diseases with OSAS. Further investigators should aim to explain key steps of inflammatory response in sleep apnea.

Anahtar Kelimeler

Sleep apnea, inflammation, oxidative stress, vascular endothelia

Uyku apnesinde inflamatuar süreç, endotelial fonksiyon bozukluğu ve oksidatif stresin incelenmesi

Öz

Amaç: Uyku apnesinde inflamatuar süreç, endotelial fonksiyon bozukluğu ve oksidatif stresin ilişkisinin incelenmesi. Yöntem: Üçüncü basamak bir referans hastanesinde planlanan çalışmaya 63 yeni tanı almış uyku apnesi hastası ve 9 basit horlama hastası dahil edildi. Hastalar ek sistemik hastalıklar ve laboratuvar testleri açısından değerlendirildi, fizik muayeneleri yapıldı. Rutin laboratuvar testlerine ek olarak oksidatif stres belirteçleri (leptin, RBP), endothelial fonksiyon bozukluğu belirteçleri (ICAM-I, VCAM-I) ve inflamatuar süreç belirteçleri (CRP, IL-6, TNF-alfa, izoprostan) açısından analiz edildi. Hastalar apne hipopne indekslerine göre 4 alt gruba ayrıldı. Gruplar arasında çapraz analizler yapılarak gruplar arasındaki farklılıklar test edildi. Bulgular: İzoprostan seviyesi ile ortalama apne süresi arasında hafif, maksimum apne süresi arasında orta seviyede korrelasyon gözlendi. Hastaların yaş ortalaması ile leptin ve VCAM-I arasında zayıf pozitif korrelasyon gözlenirken, CRP seviyesi ile ortalama yaş arasında zayıf negatif korelasyon izlendi. Leptin seviyesi ile vücut kitle indeksi ve abdominal çevre arasında orta seviyeli korelasyon izlendi. ICAM-I seviyesi ile vücut kitle endeksi ve karın çevresi arasında zayıf korelasyon mevcuttu. Sonuç: Çalışmamız sonucunda oksidatif stress ile uyku apnesi arasında ilişki olduğunu tespit ettik. Bu ilişki uyku apnesine eşlik eden komorbid hastalıkların açıklanmasında önemli bir basamak olabilir. Bu konuda yapılacak olan yeni çalışmalarda bu inflamatuar sürecin basamakları ve klinik yansımaları açıklanmaya çalışılmalıdır.

Anahtar Kelimeler

Uyku apnesi, inflamasyon, oksidatif stress, vasküler endotel

Kaynakça

• Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993;328:1230-5.
• Libby P, Ridker PM, Maseri A. Inflammation and atherosclero- sis. Circulation 2002;105:1135-43.
• Yokoe T, Minoguchi K, Matsuo H, 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;107:1129-34.
• Ip MS, Tse HF, Lam B, Tsang KW, Lam WK. Endothelial function in obstructive sleep apnea and response to treatment. Am J Respir Crit Care Med 2004;169:348-53.
• Chin K, Nakamura T, Shimizu K, et al. Effects of nasal contin- uous positive airway pressure on soluble cell adhesion molecules in patients with obstructive sleep apnea syndrome. Am J Med 2000;109:562-7.
• Hayes AL, Xu F, Babineau D, Patel SR. Sleep duration and cir- culating adipokine levels. Sleep 2011;34:147-52.
• Kang IG, Jung JH, Kim ST. The effect of obstructive sleep apnea on DNA damage and oxidative stress. Clin Exp Otorhinolaryngol 2013;6:68-72.
• Decker MJ, Jones KA, Solomon IG, Keating GL, Rye DB. Reduced extracellular dopamine and increased responsiveness to novelty: neurochemical and behavioral sequelae of intermittent hypoxia. Sleep 2005;28(2):169-76.
• Schulz R, Mahmoudi S, Hattar K, et al. Enhanced release of superoxide from polymorphonuclear neutrophils in obstructive sleep apnea. Impact of continuous positive airway pressure ther- apy. Am J Respir Crit Care Med 2000;162(2 Pt 1):566-70.
• Li Q, Verma IM. NF-kappaB regulation in the immune system. Nat Rev Immunol 2002;2:725-34.
• Ryan S, Taylor CT, McNicholas WT. Systemic inflammation: a key factor in the pathogenesis of cardiovascular complications in obstructive sleep apnoea syndrome? Postgrad Med J 2009;85(1010): 693-8.
• Burke AP, Tracy RP, Kolodgie F, et al. Elevated C-reactive pro- tein values and atherosclerosis in sudden coronary death: associ- ation with different pathologies. Circulation 2002;105:2019-23.
• Haverkate F, Thompson SG, Pyke SD, Gallimore JR, Pepys MB. Production of C-reactive protein and risk of coronary events in stable and unstable angina. European Concerted Action on Thrombosis and Disabilities Angina Pectoris Study Group. Lancet 1997;349(9050):462-6.
• Celec P, Hodosy J, Behuliak M, et al. Oxidative and carbonyl stress in patients with obstructive sleep apnea treated with con- tinuous positive airway pressure. Sleep Breath 2012;16:393-8.
• Lawson JA, Rokach J, FitzGerald GA. Isoprostanes: formation, analysis and use as indices of lipid peroxidation in vivo. J Biol Chem 1999;274:24441-4.
• Ntalapascha M, Makris D, Kyparos A, et al. Oxidative stress in patients with obstructive sleep apnea syndrome. Sleep Breath 2013;17:549-55.
• Alam I, Lewis K, Stephens JW, Baxter JN. Obesity, metabolic syndrome and sleep apnoea: all pro-inflammatory states. Obes Rev 2007;8:119-27.
• Mancuso M, Bonanni E, LoGerfo A, et al. Oxidative stress bio- markers in patients with untreated obstructive sleep apnea syn- drome. Sleep Med 2012;13:632-6.
• Christou K, Kostikas K, Pastaka C, Tanou K, Antoniadou I, Gourgoulianis KI. Nasal continuous positive airway pressure treatment reduces systemic oxidative stress in patients with severe obstructive sleep apnea syndrome. Sleep Med 2009;10:87- 94.
• Harsch IA, Konturek PC, Koebnick C, et al. Leptin and ghrelin levels in patients with obstructive sleep apnoea: effect of CPAP treatment. Eur Respir J 2003;22:251-7.
• Graham TE, Yang Q, Blüher M, et al. Retinol-binding protein 4 and insulin resistance in lean, obese, and diabetic subjects. N Engl J Med 2006;354:2552-63.
• Harsch IA, Schahin SP, Radespiel-Tröger M, et al. Continuous positive airway pressure treatment rapidly improves insulin sen- sitivity in patients with obstructive sleep apnea syndrome. Am J Respir Crit Care Med 2004;169:156-62.
• Nena E, Steiropoulos P, Tzouvelekis A, et al. Reduction of serum retinol-binding protein-4 levels in nondiabetic obstruc- tive sleep apnea patients under continuous positive airway pres- sure treatment. Respiration 2010;80:517-23.
• Ohga E, Nagase T, Tomita T, et al. Increased levels of circulat- ing ICAM-1, VCAM-1, and L-selectin in obstructive sleep apnea syndrome. J Appl Physiol 1999;87:10-4.
• Jang Y, Lincoff AM, Plow EF, Topol EJ. Cell adhesion molecules in coronary artery disease. J Am Coll Cardiol 1994;24:1591-601.
• This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported (CC BY
• NC-ND0) Licence (http://creativecommons.org/licenses/by-nc-nd/3.0/) which permits unrestricted noncommercial use, distribution, and reproduc
• tion in any medium, provided the original work is properly cited.
• Please cite this article as: Dündar Y, Çadallı Tatar E, Saylam G, Korkmaz H, Selçuk ÖT, Özdek A, Ardıç S. The evaluation of inflammatory process,
• endothelial dysfunction and oxidative stress in sleep apnea. J Med Updates 2014;4(2):61-65.