Zeynep Pınar ÖNEN, Merda ERDEMİR IŞIK, Banu GÜLBAY, Turan ACICAN, Fatma ÇİFTCİ

Obez ve non-obez obstrüktif uyku apneli hastalar arasında klinik ve polisomnografik farklılıklar

Giriş: Obezite, obstrüktif uyku apne (OSA) için önemli bir risk faktörü olarakkabul edilmektedir. Bu çalışmada, obez ve non-obez OSA’lı hastalara ait klinikve polisomnografik farklılıkların araştırılması ve varsa bu farklılıkların günlükklinik pratiğimize nasıl yansıyabileceğinin değerlendirilmesi amaçlandı.Materyal ve Metod: Uyku çalışması yapılan 157 hastanın polisomnografik verileri analiz edildi. Doksan dokuz erişkin OSA tanılı [apne-hipopne indeksi (AHİ)≥ 5/saat] hasta retrospektif olarak, beden kitle indeksi (BKİ) sonuçlarına göre;obez (BKİ ≥ 30 kg/m2) ve non-obez (BKİ < 30 kg/m2) şeklinde iki grupta incelendi. Her iki gruptaki hastaların klinik ve polisomnografik sonuçları karşılaştırıldı.Bulgular: 2010-2011 yıllarında polisomnografi yapılan 157 hastadan 99 (31’ikadın, 68’i erkek)’una OSA tanısı (AHİ ≥ 5/saat) kondu. OSA tanısı konanhastalardan 36 (%36.4)’sı non-obez iken, 63 (%63.6)’ü obez idi. Her ikigrupta OSA ile ilişkili semptom sıklıkları açısından farklılık yoktu (p> 0.05).İstatistiksel anlamlılığı olmamakla birlikte obez gruptaki hastaların yaşları(50.5 ± 12.7 yıl), non-obez olanlara (54.9 ± 10.0 yıl) kıyasla daha düşük, totaluyku süreleri (TST) daha kısa, uyku başlangıçları daha geç, uyku etkinlikleri,arousal indeksleri, N3 ve REM %’leri daha düşük, N1 %’si daha yüksekti (p>0.05). Obez OSA’lılarda non-obezlere kıyasla AHİ ve Epworth Uykululukskalası daha yüksekti (sırasıyla; p= 0.028, p= 0.010), uykuda ortalama oksijensatürasyonu (SpO2) daha düşük (p< 0.001) idi. Her iki grupta hipertansiyonve aterosklerotik kalp hastalığı benzer oranlarda iken, diabetes mellitus obezOSA’lı grupta daha fazlaydı (p= 0.036). Antidepresan ilaç kullanımı non-obezhastalarda daha fazla idi (p= 0.011).Sonuç: Obez OSA’lı hastalarda, hastalığın şiddeti daha ağır olmakla birlikte non-obez kişilerde de OSA, benzer klinik ve polisomnografik bulgularla görülmektedir. Bu nedenle, uyumlu semptomları olan non-obez hastalar da OSA açısından gözden kaçırılmamalıdır.

The clinical and polysomnographic differences between obese and non-obese patients with obstructive sleep apnea

Introduction: Obesity has been considered to be one of the important risk factor for obstructive sleep apnea (OSA). We aimed to investigate the clinical and polysomnographic differences of obese and non-obese OSA patients and how these differences, if any, can be reflected in our daily clinical practice. Materials and Methods: The polysomnographic data of 157 consecutive patients that underwent a sleep study were analyzed. Ninety-nine adult patients with a diagnosis of OSA [apnea-hypopnea index (AHI) ≥ 5/hour] were retrospectively assesed in two groups in respect of obese (BMI ≥ 30 kg/m2) or non-obese (BMI < 30 kg/m2) according to body mass index (BMI). The clinical and polysomnographic results of the patients in both groups were compared. Results: Between 2010 and 2011, 99 (31 K/68 M) of 157 patients underwent polysomnography were diagnosed with OSA (AHI ≥ 5/hour). Thirthy six patients with OSA (36.4%) were non-obese and 63 patients (63.6%) were obese. There were no differences in the symptoms related to OSA between two groups (p> 0.05). Although there was no statistical significance, the age of the obese patients (50.5 ± 12.7 years) was lower than those of the non-obese (54.9 ± 10.0 years) in polysomnography their total sleep time was shorter and sleep latency later, and sleep efficiency, arousal index, N3%, and REM% were lower and N1% was higher (p> 0.05). While in the obese OSA patients the AHI and Epworth Sleepiness sclae were higher (respectively; p= 0.028, p= 0.01), average oxygen saturation at sleep was lower (p< 0.001). While obese OSA patients had similar ratio of hypertension and atherosclerotic heart disease with non-obese OSA patients, whereas diabetes mellitus was higher in obese OSA group (p= 0.036). The use of antidepressant drug was more common in the non-obese patients than the obese patients (p= 0.011). Conclusion: Although obese OSA patients have a more severe disease compared to nonobese OSA patients, there were no significant differences in clinical and polysomnographics findings between two groups. Should be noted that OSA may occur in non-obese patients.

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