Öz
Özet
Amaç. Bu çalışma obstrüktif uyku apne sendromunun (OUAS) karotid arterler üzerine olan etkilerini doğrudan gözlemek için planlanmıştır Yöntem. Çalısmaya uyku laboratuarında uyku testi yapılan 90 olgu (56 erkek, 34 kadın) dahil edildi. Olgular uyku testinde saptanan apne-hipopne indekslerine (AHİ) göre OUAS ve kontrol grubu olacak şekilde 2 gruba ayrıldı. Olguların ana karotid arterleri (AKA) ve internal karotid arterleri (İKA) Doppler ultrasonografi ile incelendi. Tüm damarların pik sistolik hız (PSH), end diyastolik hız (EDH), rezistif indeks (RI) ve lümen çapları ölçüldü, akım miktarları hesaplandı. AKA ve İKA intima-medya kalınlıkları (İMK) ölçüldü. Bulgular. AKA ve İKA İMK ortalamaları sırasıyla OUAS grubunda 0,82±0,1 mm, 0,62±0,1 mm; kontrol grubunda ise 0,69±0,1 mm, 0,51±0,08 mm olarak bulundu ve bu fark istatistiksel olarak önemliydi (p<0,05). Sonuç. Elde ettiğimiz veriler OUAS’ın karotid arterlerin İMK’sini arttırdığını, bunun da ateroskleroza zemin hazırladığını ortaya koymaktadır.
Anahtar sözcükler: uyku apnesi, karotid arter
Abstarct
Aim. This study is designed to evaluate the direct effects of obstructive sleep apnea syndrome (OSAS) on carotid artery. Method. Study population consisted of 90 patients (56 male, 34 female) who had been evaluated for OSAS by sleep study in sleep laboratory for suspected symptoms. Patients were classified into 2 groups according to the apnea-hypopnea index (AHİ) reflecting the severity of obstructive sleep apnea syndrome. The common carotid arteries (CCA) and internal carotid arteries (ICA) were examined using Doppler ultrasonography. Peak systolic velocity (PSV), end diastolic velocity (EDV), resistive index (RI), and luminal diameters of the vessels were measured, and flow volumes were calculated in all the arteries. The common and internal carotid arteries intima-media thickness (IMT) were measured. Results. The mean CCA and ICA IMT value were 0.82±0.1 mm, 0.62±0.1 mm in the OSAS patients; 0.69±0.1 mm, 0.51±0.08 mm in control patients. This differance was statistically significant (p<0.05). Conclusion. The result of our study, OSAS make increases at carotid artery intima-media thickness, atherosclerosis.
Key words: sleep apnea, carotid artery
Anahtar Kelimeler
Kaynakça
- A report of National Commission on Sleep Disorders Research. Wake Up America: A National Sleep Alert. Washington, DC: U.S. Government Printing Office, 1995.
- Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med. 2002; 165: 1217-39.
- Jo-Dee LL, David S, Wilcox I. State of the Art Paper Obstructive Sleep Apnea and Cardiovascular Disease. J Am Coll Cardiol. 2003; 41: 1429 -37.
- Demir AU, Şahin A. Obstruktif uyku apnesi (OUAS) tanısı. Oto A (editör). Türk Kardiyoloji Seminerleri 2004; 4: 574-82.
- Gencbay M. OUAS ve koroner arter hastalığı. Türk Kardiyoloji Seminerleri 2004; 4: 615- 20.
- Yokoe T, Minoguchi K, Matsuo H. Elevated Levels of C-Reactive Protein and Interleukin-6 in Patients With OSAS are Decreased by Nasal Continuous Positive Airway Pressure. Circulation. 2003; 107: 1129-34.
- Woollard KJ, Phillips DC, Griffiths HR. Direct modulatory effect of C-reactive protein on primary human monocyte adhesion to human endothelial cells. Clin Exp Immunol 2002;130:256-62.
- Hartmann G, Tschop M, Fischer R, Bidlingmaier C, Riepl R, Tschöp K, Hautmann H, Endres S, Toepfer M. High altitude increases circulating interleukin-6, interleukin- 1 receptor antagonist and C-reactive protein. Cytokine 2000; 12: 246-52.
- Shamsuzzaman ASM, Winnicki M, Lanfranchi P, Wolk R, Kara T, Accurso V, Somers VK. Elevated C-Reactive Protein in Patients With Obstructive Sleep Apnea. Circulation 2002; 105: 2462-4.
- El-Solh AA, Mador MJ, Sikka P, Dhillon RS, Amsterdam D, Grant BJ. Adhesion molecules in patients with coronary artery disease and moderate-to-severe obstructive sleep apnea. Chest 2002; 121:1541-7
- Nachtmann A, Stang A, Wang YM, Wondzinski E, Thilmann AF. Association of obstructive sleep apnea and stenotic artery disease in ischemic stroke patients. Atherosclerosis. 2003; 169: 301-7
- Silvestrini M, Rizzato B, Placidi F, Baruffaldi R, Bianconi A, Diomedi M. Carotid Artery Wall Thickness in Patients With Obstructive Sleep Apnea Syndrome. Stroke. 2002; 33: 1782-1785
- Altın R, Özdemir H, Mahmutyazıcıoğlu K, Kart L, Uzun L, Ozer T, Savranlar A, Aydin M. Evaluation of Carotid Artery Wall Thickness with High-Resolution Sonography in OSAS. J Clin Ultrasound. 2005; 33: 80-6
- Minoguchi K, Yokoe T, Tazaki T, Minoguchi H, Tanaka A, Oda N, Okada S, Ohta S, Naito H, Adachi M. Increased Carotid Intima-Media Thickness and Serum Inflammatory Markers in Obstructive Sleep Apnea. Am J Respir Crit Care Med. 2005; 172: 625-30
- American Academy of Sleep Medicine. ICSD-2:The International Classification of Sleep Disorders. Diagnostic and Coding Manual, 2 nd ed.Westchester, Illinois: AASM,2005.
- Carlson JT, RangemarkC, Hedner JA. Attenuated endotheliumdependent vascular relaxation in patients with sleep apnoea. J Hypertens. 1996; 14: 577-84
- Dean RT, Wilcox I. Possible atherogenic effects of hypoxia during obstructive sleep apnea. Sleep 1993; 16: 15-21.
- Dursunoğlu N, Durdunoğlu D. Obstrüktif uyku apnesi sendromu, endotel disfonksiyonu ve koroner ateroskleroz. Tüberküloz ve Toraks Dergisi 2005; 53 : 299-306.
- Elmasry A, Lindberg E, Berne Cl. Sleep disorder breathing and glucose metabolism in hypertensive men: a population-based study. J Intern Med 2001; 249: 153-61.
- Fischer A, Chaudhary B, Taormina M, Akhtar B. Intracranial hemodynamics in sleep apnea. Chest 1992; 102: 1402-6.
- Yaman M, Yücel Altan B, Bölük A, Sezer M, Ünlü M. Nöroloji Polikliniğine Başvuran Hastalarda Obstrüktif Uyku Apne Sendromu Semptom Taraması, Türkiye Klinikleri J Med Sci 2007, 27: 513-7.
- Onat A, Hergenç G, Uyarel H, Yazici M, Tuncer M, Doğan Y, Can G, Rasche K. OSAS is associated with metabolic syndrome rather than insulin resistance Sleep Breath 2007; 11: 23-30.
- Duran J, Esnaola S, Rubio R, Iztueta A. Obstructive sleep apnea-hypopnea and related clinical features in a population-based sample of subjects aged 30 to 70 yr. Am J Respir Crit Care Med 2001; 163: 685-9.
- Thompson SR, Ackerman U, Horner RL. Sleep as a teaching tool for integrating respiratory physiology and moto control. Adv in Physiology Edu 2001; 25: 29-44.
- Aiman K, Ehab K, Guha K. Potential mechanisms connecting asthma, esophageal reflux, and obesity/sleep apnea complex. Sleep Medicine 2007; 11: 47-58.
- Fleetham JA. Upper airway imaging in relation to obstructive sleep apnea. Clin Chest Med 1992;13: 399-16.
- Rubinstein I, Colaptino N, Rotstein LE, Brown IG, Hoffstein V. Improvement in upper airway function after weight loss in patients with obstructive sleep apnea. Am Rev Respir Dis. 1988; 138: 1192-95.
- Uyar M, Elbek O, Aydın N. Clinical Profiles of Apnea Syndrome. Türk Toraks Derneği 2008; 9: 113-6.
- Baguet JP, Hammer L, Levy P, Pierre H, Launois S, Mallion JM, Pepin JL. The severity of oxygen desaturation is predictive of carotid wall thickening and plaque occurrence. Chest 2005; 128: 307-12.
- Kaynak D, Göksan B, Kaynak H, Degirmenci N, Daglioglu S. Is there a link between the severity of sleep disordered breathing and atherosclerotic disease of the carotid arteries? Eur J Neurol 2003; 10: 487-93.
- Suzuki T, Nakano H, Maekawa J, Okamoto Y, Ohnishi Y, Yamauchi M, Kimura H. Obstructive sleep apnea and carotid artery intima media thickness. Sleep 2004; 27: 129- 33.
- Labropoulos N, Zarge J, Mansour MA, Kang SS, Baker WH. Compensatory arterial enlargement is a common pathobiologic response in early atherosclerosis. Am J Surg 1998; 176:140-3.
- Hort W, Lichti H, Kalbfleisch H, Köhler F, Frenzel H, Milzner-Schwarz U. Causes of Sudden Cardiac Death in Young Athletes: The Role of Hypoperfusion. Histol 1982; 397: 37-59.
Öz
Amaç. Bu çalışma obstrüktif uyku apne sendromunun (OUAS) karotid arterler üzerine olan etkilerini doğrudan gözlemek için planlanmıştır Yöntem. Çalısmaya uyku laboratuarında uyku testi yapılan 90 olgu (56 erkek, 34 kadın) dahil edildi. Olgular uyku testinde saptanan apnehipopne indekslerine (AHİ) göre OUAS ve kontrol grubu olacak şekilde 2 gruba ayrıldı. Olguların ana karotid arterleri (AKA) ve internal karotid arterleri (İKA) Doppler ultrasonografi ile incelendi. Tüm damarların pik sistolik hız (PSH), end diyastolik hız (EDH), rezistif indeks (RI) ve lümen çapları ölçüldü, akım miktarları hesaplandı. AKA ve İKA intima-medya kalınlıkları (İMK) ölçüldü. Bulgular. AKA ve İKA İMK ortalamaları sırasıyla OUAS grubunda 0,82±0,1 mm, 0,62±0,1 mm; kontrol grubunda ise 0,69±0,1 mm, 0,51±0,08 mm olarak bulundu ve bu fark istatistiksel olarak önemliydi (p
Anahtar Kelimeler
Kaynakça
- A report of National Commission on Sleep Disorders Research. Wake Up America: A National Sleep Alert. Washington, DC: U.S. Government Printing Office, 1995.
- Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med. 2002; 165: 1217-39.
- Jo-Dee LL, David S, Wilcox I. State of the Art Paper Obstructive Sleep Apnea and Cardiovascular Disease. J Am Coll Cardiol. 2003; 41: 1429 -37.
- Demir AU, Şahin A. Obstruktif uyku apnesi (OUAS) tanısı. Oto A (editör). Türk Kardiyoloji Seminerleri 2004; 4: 574-82.
- Gencbay M. OUAS ve koroner arter hastalığı. Türk Kardiyoloji Seminerleri 2004; 4: 615- 20.
- Yokoe T, Minoguchi K, Matsuo H. Elevated Levels of C-Reactive Protein and Interleukin-6 in Patients With OSAS are Decreased by Nasal Continuous Positive Airway Pressure. Circulation. 2003; 107: 1129-34.
- Woollard KJ, Phillips DC, Griffiths HR. Direct modulatory effect of C-reactive protein on primary human monocyte adhesion to human endothelial cells. Clin Exp Immunol 2002;130:256-62.
- Hartmann G, Tschop M, Fischer R, Bidlingmaier C, Riepl R, Tschöp K, Hautmann H, Endres S, Toepfer M. High altitude increases circulating interleukin-6, interleukin- 1 receptor antagonist and C-reactive protein. Cytokine 2000; 12: 246-52.
- Shamsuzzaman ASM, Winnicki M, Lanfranchi P, Wolk R, Kara T, Accurso V, Somers VK. Elevated C-Reactive Protein in Patients With Obstructive Sleep Apnea. Circulation 2002; 105: 2462-4.
- El-Solh AA, Mador MJ, Sikka P, Dhillon RS, Amsterdam D, Grant BJ. Adhesion molecules in patients with coronary artery disease and moderate-to-severe obstructive sleep apnea. Chest 2002; 121:1541-7
- Nachtmann A, Stang A, Wang YM, Wondzinski E, Thilmann AF. Association of obstructive sleep apnea and stenotic artery disease in ischemic stroke patients. Atherosclerosis. 2003; 169: 301-7
- Silvestrini M, Rizzato B, Placidi F, Baruffaldi R, Bianconi A, Diomedi M. Carotid Artery Wall Thickness in Patients With Obstructive Sleep Apnea Syndrome. Stroke. 2002; 33: 1782-1785
- Altın R, Özdemir H, Mahmutyazıcıoğlu K, Kart L, Uzun L, Ozer T, Savranlar A, Aydin M. Evaluation of Carotid Artery Wall Thickness with High-Resolution Sonography in OSAS. J Clin Ultrasound. 2005; 33: 80-6
- Minoguchi K, Yokoe T, Tazaki T, Minoguchi H, Tanaka A, Oda N, Okada S, Ohta S, Naito H, Adachi M. Increased Carotid Intima-Media Thickness and Serum Inflammatory Markers in Obstructive Sleep Apnea. Am J Respir Crit Care Med. 2005; 172: 625-30
- American Academy of Sleep Medicine. ICSD-2:The International Classification of Sleep Disorders. Diagnostic and Coding Manual, 2 nd ed.Westchester, Illinois: AASM,2005.
- Carlson JT, RangemarkC, Hedner JA. Attenuated endotheliumdependent vascular relaxation in patients with sleep apnoea. J Hypertens. 1996; 14: 577-84
- Dean RT, Wilcox I. Possible atherogenic effects of hypoxia during obstructive sleep apnea. Sleep 1993; 16: 15-21.
- Dursunoğlu N, Durdunoğlu D. Obstrüktif uyku apnesi sendromu, endotel disfonksiyonu ve koroner ateroskleroz. Tüberküloz ve Toraks Dergisi 2005; 53 : 299-306.
- Elmasry A, Lindberg E, Berne Cl. Sleep disorder breathing and glucose metabolism in hypertensive men: a population-based study. J Intern Med 2001; 249: 153-61.
- Fischer A, Chaudhary B, Taormina M, Akhtar B. Intracranial hemodynamics in sleep apnea. Chest 1992; 102: 1402-6.
- Yaman M, Yücel Altan B, Bölük A, Sezer M, Ünlü M. Nöroloji Polikliniğine Başvuran Hastalarda Obstrüktif Uyku Apne Sendromu Semptom Taraması, Türkiye Klinikleri J Med Sci 2007, 27: 513-7.
- Onat A, Hergenç G, Uyarel H, Yazici M, Tuncer M, Doğan Y, Can G, Rasche K. OSAS is associated with metabolic syndrome rather than insulin resistance Sleep Breath 2007; 11: 23-30.
- Duran J, Esnaola S, Rubio R, Iztueta A. Obstructive sleep apnea-hypopnea and related clinical features in a population-based sample of subjects aged 30 to 70 yr. Am J Respir Crit Care Med 2001; 163: 685-9.
- Thompson SR, Ackerman U, Horner RL. Sleep as a teaching tool for integrating respiratory physiology and moto control. Adv in Physiology Edu 2001; 25: 29-44.
- Aiman K, Ehab K, Guha K. Potential mechanisms connecting asthma, esophageal reflux, and obesity/sleep apnea complex. Sleep Medicine 2007; 11: 47-58.
- Fleetham JA. Upper airway imaging in relation to obstructive sleep apnea. Clin Chest Med 1992;13: 399-16.
- Rubinstein I, Colaptino N, Rotstein LE, Brown IG, Hoffstein V. Improvement in upper airway function after weight loss in patients with obstructive sleep apnea. Am Rev Respir Dis. 1988; 138: 1192-95.
- Uyar M, Elbek O, Aydın N. Clinical Profiles of Apnea Syndrome. Türk Toraks Derneği 2008; 9: 113-6.
- Baguet JP, Hammer L, Levy P, Pierre H, Launois S, Mallion JM, Pepin JL. The severity of oxygen desaturation is predictive of carotid wall thickening and plaque occurrence. Chest 2005; 128: 307-12.
- Kaynak D, Göksan B, Kaynak H, Degirmenci N, Daglioglu S. Is there a link between the severity of sleep disordered breathing and atherosclerotic disease of the carotid arteries? Eur J Neurol 2003; 10: 487-93.
- Suzuki T, Nakano H, Maekawa J, Okamoto Y, Ohnishi Y, Yamauchi M, Kimura H. Obstructive sleep apnea and carotid artery intima media thickness. Sleep 2004; 27: 129- 33.
- Labropoulos N, Zarge J, Mansour MA, Kang SS, Baker WH. Compensatory arterial enlargement is a common pathobiologic response in early atherosclerosis. Am J Surg 1998; 176:140-3.
- Hort W, Lichti H, Kalbfleisch H, Köhler F, Frenzel H, Milzner-Schwarz U. Causes of Sudden Cardiac Death in Young Athletes: The Role of Hypoperfusion. Histol 1982; 397: 37-59.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Bölüm | Dahili Tıp Bilimleri Araştırma Yazıları |
| Yazarlar | |
| Yayımlanma Tarihi | 3 Şubat 2010 |
| Yayımlandığı Sayı | Yıl 2010Cilt: 32 Sayı: 3 |