Can The Circumferences of Neck and Waist Be As a Predictor of Arterial İntima Media Thickness in The Patients with Obstructive Sleep Apnea Syndrome?

INTRODUCTION: Carotid and femoral artery intima media thickness (cIMT and fIMT) and body mass index (BMI) have been studied individually in patients with obstructive sleep apnea syndrome (OSAS). But no studies have examined the effect of the neck and waist circumference (NC and WC) on arterial IMT in their region. The aim of our study; to reveal this relationship and the possible causes. METHODS: A total of 245 study subjects were included in the study. Patients with a history of smoking, apnea, stroke, angina pectoris, chronic kidney disease, diabetes and those over 65 years of age were excluded from the study. Sonographic IMT measurements were performed with B-mode Ultrasound (Philips EPIQ 7). CIMT measurements were taken from the posteromedial wall of the right common carotid artery. FIMT measurements were also measured from the posterior wall of the right main femoral artery. NC and WC were measured and BMI was calculated in both groups. RESULTS: The mean cIMT, BMI, NC and WC were significantly higher in the OSAS group, but there was no difference in the fIMT values. In the OSAS group, there was a positive linear correlation between NC and cIMT measurements, whereas there was no correlation between WC and fIMT. DISCUSSION AND CONCLUSION: Early evaluation of OSAS patients is beneficial because it is an independent risk factor for cardiovascular and cerebrovascular diseases. Timely measurements of cIMT, NC and BMI may provide time for taking necessary measures for these diseases. In addition, even the NC measurement can provide information about cIMT.

Tıkayıcı Uyku Apne Sendromlu Hastalarda Boyun ve Bel Çevresi Arteriyel İntima Media Kalınlığının Bir Göstergesi Olabilir Mi?

GİRİŞ ve AMAÇ: Karotid ve femoral arter intima media kalınlığı (İMK), vücut kitle indeksi (VKİ) ölçümleri kardiyometabolik risk belirteçleridir. Literatürde tıkayıcı uyku apneli (TUA) hastalarında bu belirteçler tek tek ele alınmış fakat boyun ve bel çevresinin bölgelerindeki arter kalınlıkları üzerinde etkisini inceleyen bir çalışma yapılmamıştır. Çalışmamızın amacı; varsa bu ilişkiyi ortaya koymak ve olası sebeblerini irdelemektir. YÖNTEM ve GEREÇLER: Çalışmamıza toplam 195 hasta ve 50 kontrol hastası alındı. Hastalardan sigara içme, apne, inme, anjina pektoris, kronik böbrek hastalığı, diyabet öyküsü olanlar ve 65 yaş üstü olanlar çalışmadan dışlandılar. Sonografik İMK ölçümleri, yüksek çözünürlüklü B- mod Ultrason (Philips EPIQ 7)’nin lineer probu (8–12 MHz) ile yapıldı. KİMK ölçümleri; sağ arteria carotis communisin posteromedial duvarından, karotid bulbusun 1-3 cm distalinden, plak bulunmayan üç noktadan alındı. Femoral arter İMK ölçümleri de sağ ana femoral arterin arka duvarından ölçüldü. Her iki grupta boyun ve bel çevresi de ölçülüp ayrıca VKI hesaplandı. BULGULAR: TUA grubunda kontrol grubuna kıyasla kİMK, VKİ, boyun çevresi ve bel çevresi ortalamaları yüksek ve istatistiksel olarak anlamlıyken, fİMK değerlerinde fark yoktu. TUA grubunda boyun çevresi ile kİMK ölçümleri arasında pozitif yönlü doğrusal bir ilişki varken, bel çevresi ve fİMK arasında bir ilişki yoktu. TARTIŞMA ve SONUÇ: TUA hastalarının erken değerlendirilmesi, bu hastalığın kardiyovasküler ve serebrovasküler hastalıklar için bağımsız bir risk faktörü olmasından dolayı önemlidir. Bu hastalıklar için öncül olarak kabul edilen karotis IMT kalınlaşmasının, boyun çevresi ve VKİnin zamanında ölçümü gerekli önlemleri almak için zaman sağlayabilir. Ayrıca sadece boyun çevresi ölçümü bile kİMK hakkında bilgi verebilir

___

1. Young TT. Risk factors for obstructive sleep apnea in adults. JAMA: The Journal of the American Medical Association 2004; 291: 2013-16.

2. Shochat T, Pillar G. Sleep apnoea in the older adult: pathophysiology, epidemiology, consequences and management. Drugs Aging 2003; 20: 551–60.

3. Dülger SU, Yıldız T, Dikiş ÖŞ, Kaya H. Relation among obstructive sleep apnea, obesity, age and gender: A retrospective study. Kocaeli Med J 2018; 7(2): 98-102.

4. Lorenzi-Filho G, Drager LF. Obstructive sleep apnea and atherosclerosis: a new paradigm. Am J Respir Crit Care Med 2007; 175(12): 1219–21.

5. Parati G, Lombardi C, Narkiewicz K. Sleep apnea: epidemiology, pathophysiology, and relation to cardiovascular risk. Am J Physiol Regul Integr Comp Physiol 2007; 293: 1671–83

6. Butt M, Khair OA, Dwivedi G, Shantsila A, Shantsila E, Lip GY. Myocardial perfusion by myocardial contrast echocardiography and endothelial dysfunction in obstructive sleep apnea. Hypertension 2011; 58(3); 417-24

7. Polak JF, Pencina MJ, Pencina KM, O’Donnell CJ, Wolf PA, D’Agostino RB Sr. Carotid-wall intimamedia thickness and cardiovascular events. N Engl J Med 2011; 365: 213–21.

8. Wattanakit KK, Boland L, Punjabi NM, Shahar E. Relation of sleep-disordered breathing to carotid plaque and intima-media thickness. Atherosclerosis 2008; 197: 125-31.

9. Minoguchi K, Yokoe T, Tazaki T, Minoguchi H, Tanaka A, Oda N et al. Increased carotid intimamedia thickness and serum inflammatory markers in obstructive sleep apnea. Am J Respir Crit Care Med 2005; 172: 625–30.

10. 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(5): 487–93.

11. Hedner J, Wilcox I, Sullivan C. Speculations on the interaction between vascular disease and obstructive sleep apnoea. In: Saunders NA, Sullivan C (eds) 1994 Sleep and breathing. Dekker, New York, pp 823–846.

12. Amatoury J, Howitt L, Wheatley JR, Avolio A, Amis TC. Snoring-related energy transmission to the carotid artery in rabbits. J Appl Physiol 2006; 100: 1547–53.

13. Lévy P, Pépin JL, Arnaud C,Baguet JP, Dematteis M, Mach F. Obstructive sleep apnea and atherosclerosis. Prog Cardiovasc Dis 2009; 51: 400– 10.

14. Simon A, Megnien JL, Chironi G. The value of carotid intimamedia thickness for predicting cardiovascular risk. Arterioscler Thromb Vasc Biol 2010; 30: 182–85.

15. Lorenz MW, Markus HS, Bots ML, Rosvall M, Sitzer M. Prediction of clinical cardiovascular events with carotid intima-media thickness: a systematic review and meta-analysis. Circulation 2007; 115: 459–67.

16. Dijk JM, van der Graaf Y, Bots ML, Grobbee DE, Algra A. Carotid intima-media thickness and the risk of new vascular events in patients with manifest atherosclerotic disease: the SMARTstudy. Eur Heart J 2006; 27: 1971–78.

17. Kato M, Roberts-Thomson P, Phillips BG, Haynes WG, Winnicki M, Accurso V et al. Impairment of endothelium-dependent vasodilation of resistance vessels in patients with obstructive sleep apnea. Circulation 2000; 102(21): 2607-10.

18. Horner RL. Pathophysiology of obstructive sleep apnea. J Cardiopulm Rehabil Prev. 2008; 28(5) :289-98.

19. Rose S. Atherosclerosis — an inflammatory disease. N. Engl J Med 1999; 340(2): 115-26.

20. Minuz PP, Fava C, Cominacini L. Oxidative stress, antioxidants, and vascular damage. Br J Clin Pharmacol 2006; 61: 774-77.

21. Cho JG, Witting PK, Verma M, Wu BJ, Shanu A, Kairaitis K et al. Tissue vibration induces carotid artery endothelial dysfunction: a mechanism linking snoring and carotid atherosclerosis? Sleep 2011; 34: 751–57.

22. Lee SA, Amis TC, Byth K, Larcos G, Kairaitis K, Robinson TD et al. Heavy snoring as a cause of carotid artery atherosclerosis. Sleep 2008; 31: 1207–13.

23. Drager LF, Lorenzi-Filho G. Heavy snoring and carotid atherosclerosis: is there more than an association? Sleep 2008; 31(10): 1335.

24. Lee SA, Amis TC, Byth K, Larcos G, Kairaitis K, Robinson TD. A response to Drager and Lorenzi-Filho. Heavy Snoring and Carotid Atherosclerosis: Is There More Than an Association? Sleep 2008; 31: 1337.

25. Curry BD, Bain JL, Yan JG, Zhang LL, Yamaguchi M, Matloub HS et al. Vibration injury damages arterial endothelial cells. Muscle Nerve 2002; 25: 527–34.

26. Puig F, Rico F, Almendros I, Montserrat JM, Navajas D, Farre R. Vibration enhances interleukin-8 release in a cell model of snoring-induced airway inflammation. Sleep 2005; 28: 1312–1316.

27. Deeb R, Judge P, Peterson E, Lin JC, Yaremchuk K. Snoring and carotid artery intimamedia thickness. Laryngoscope. 2014; 124(6): 1486- 91.

28. Stensland-Bugge E, Bønaa KH, Joakimsen O, Njølstad I. Sex differences in the relationship of risk factors to subclinical carotid atherosclerosis measured 15 years later: The Tromsø study. Stroke 2000; 31(3): 574-81.

29. Stensland-Bugge E, Bønaa KH, Joakimsen O. Age and sex differences in the relationship between inherited and lifestyle risk factors and subclinical carotid atherosclerosis: The Tromsø study. Atherosclerosis 2001; 154(2): 437-48.

30. Altın R, Özdemir H, Mahmutyazıcıoğlu K, Kart L, Uzun L, Ozer T et al. Evaluation of carotid artery wall thickness with high-resolution sonography in obstructive sleep apnea syndrome. J Clin Ultrasound 2005; 33: 80-6.

31. 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: 1782-85.

32. Baguet JP, Nadra M, Barone-Rochette G, Ormezzano O, Pierre H, Pe´pin JL. Early cardiovascular abnormalities in newly diagnosed obstructive sleep apnea. Vasc Health Risk Manage 2009; 5: 1063-73.

33. Yılmaz Z, Şirinocak PB, Selçuk A, Esen E. Differences in the sleep structure and accompanying morbidities in obstructive sleep apnea patients with apnea versus hypopnea predominancy. Kocaeli Med J. 2017; 6(3): 41-46.

34. Steiropoulos P, Bogiatzi C, Archontogeorgis K, Nena E, Xanthoudaki M, Boglou P et al. Is there evidence of early vascular disease in patients with obstructive sleep apnoea without known comorbidities? Preliminary findings. Open Cardiovasc Med J. 2013; 7: 61-68.

35. Gorzewska A, Specjalski K, Drozdowski J, Kunicka K, Świerblewska E, Bieniaszewski L et al. Intima-media thickness in patients with obstructive sleep apnea without comorbidities. Lung 2013; 191(4):397-404.

36. Mason RH, Mehta Z, Fonseca AC, Stradling JR, Rothwell PM. Snoring and severity of symptomatic and asymptomatic carotid stenosis: a population-based study. Sleep 2012; 35(8): 1147–51.

37. Kocabora MS, Kocabora AG. Ocular Invovement In Carotid Artery Diseases. Kocaeli Med J 2012; 1(1): 55-62.

38. Uyar M, Elbek O, Aydın N, Çifçi N, Bayram N, Fakılı F et al. . Clinical Profiles of obstructive sleep apnea syndrome. Tur Toraks Der 2008; 9: 113-6.

39. 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.

40. Fleetham JA. Upper airway imaging in relation to obstructive sleep apnea. Clin Chest Med 1992; 13: 399-416.

41. Unal Y, Ozturk DA, Tosun K, Kutlu G Association between obstructive sleep apnea syndrome and waist-to-height ratio. Sleep Breath 2019; 23(2):523-529.
Kocaeli Tıp Dergisi-Cover
  • ISSN: 2147-0758
  • Başlangıç: 2012
  • Yayıncı: -
Sayıdaki Diğer Makaleler

The Effects of Grading Scales Used in Patients with Aneurysmal Subarachnoid Hemorrhage on Critical Care Outcomes

Arzu YILDIRIM AR, Tamer BAYRAM, Güldem TURAN

Difficult Diagnosis of Myosin Heavy Chain 9 Related Platelet Disorder

Sibel GÖKÇAY BEK, Necmi EREN, Metin ERGÜL

The Attitudes of Emergency Physicians in Turkey Towards The Snakebites

Melih YÜKSEL, Veysi ERYİĞİT, Mehmet Emre ERİMŞAH, Ulaş KARAASLAN, Tunç BÜYÜKYILMAZ, Eylem ERSAN

Türkiye'de Hastaya Gerçeğin Söylenmesi: Tıp Etiği ve Tıp Hukuku Açısından

Gürkan SERT

Kronik Lenfositik Lösemi Tanılı Hastalarda Vasküler Endotel Büyüme Faktör (VEGF) Düzeylerinin Prognozla İlişkisi

Esra TERZİ DEMİRSOY, Muhlis Cem AR

Miyozin Agir Zincir 9 Iliskili Trombosit Bozuklugu: Zor Tanı

Necmi EREN, Metin ERGÜL, Sibel GÖKÇAY BEK

Comparison of Sedation Types During Monitored Anesthesia Care for Gastrointestinal Endoscopy

Ayşe Zeynep TURAN, Mehmet Birhan YILMAZ, Aslı Duygu AYDAŞ, Hande Gürbüz AYTULUK, Tahsin ŞİMŞEK, Kemal Tolga SARAÇOĞLU

Time Dependent Gene Expression Analysis of Vitamin D3 (1,25 (OH)2 D3) Treated HL–60 Cells by Q-RT-PCR

Aylin KANLI, Mehmet Doğan GÜLKAÇ, Hakan SAVLI

Bir Büronun Beyaz Yakalı Çalışanlarında Kas-İskelet Sistemi Yakınmaları ve İlişkili Faktörler

Merve KURNAZ AY, Betül KARAKUŞ, Seyhan HIDIROĞLU, Melda KARAVUŞ, Ahsen AŞİKAR TOLA, Nurbanu KESKİN, Özüm KARA, Edibe Sevde EKER, Ebru PIÇAK

Ursodeoksikolik Asidin Streptozosin ile Diyabet Oluşturulmuş Farelerde Kardiyomyopatideki Antiinflamatuar ve Anti-Fibrotik Etkileri

Oytun ERBAŞ, İsmail Polat CANBOLAT, Gürkan YİĞİTTÜRT