Ezgi DEMİRDÖĞEN, Ahmet URSAVAŞ, Mehmet KARADAĞ, Funda COŞKUN, Dane EDİGER, Esra UZASLAN, Ercüment EGE, Oktay GÖZÜ

Obstruktif Uyku Apne Sendromlu Hastalarda Fibrinojen Düzeylerinin Değerlendirilmesi

Obstrüktif uyku apne sendromu (OUAS) hastalarında vasküler hastalık riski artmıştır. Bu hastalarda kardiyovasküler hastalık gelişimine ait kesin mekanizma bilinmemektedir. Fibrinojen normal plazmanın ana bileşenidir. Akut faz reaktanı olan fibrinojen düzeyleri inflamatuar yanıtın bir parçası olarak yükselmektedir. Fibrinojenin koroner arter hastalığı ve inme için bağımsız risk faktörü olduğu gösterilmiştir. Çalışmamızda yeni orta/ağır OUAS tanısı almış hastalarda ve non-apneik olgularda plazma fibrinojen düzeylerini karşılaştırmayı ve polisomnografi (PSG) parametreleri ile ilişkisini değerlendirmeyi amaçladık. Tüm gece PSG sonrası yeni tanı almış 50 orta ve ağır OUAS olgusu ile 33 nonapneik kontrol olgu çalışmaya dahil edilmiştir. uyku çalışmasının ardından sabah 8.00-9.00 saatleri arasında kan örnekleri alınarak plazma fibrinojen düzeyleri Clauss metodu ile ölçülmüştür. Her iki grup arasında yaş, cinsiyet, sigara alışkanlığı açısından fark saptanmadı. Plazma fibrinojen düzeyleri OUAS grubunda (4.2 ± 0.14 g/L) kontrol grubuna göre anlamlı derecede yüksek bulundu (p<0.028). Plazma fibrinojen düzeyleri; Epworth uykululuk skalası (ESS) skoru (r=0.301, p=0.006), yaş (r=0.327, p=0.003), beden kitle indeksi (BKİ) (r=0.388, p<0.001), ortalama oksijen desaturasyonu (r=0.258, p=0.019), oksijen desaturasyon indeksi (r=0.281, p=0.010), oksijen satürasyonunun % 90’ın altında kalma süresi (r=0.248, p=0.024) ve arousal indeksi (r=0.220, p=0.046) ile pozitif korele idi. Plazma fibrinojen düzeyleri ile uykudaki oksijen saturasyonu arasında (r= -0.254, p=0.029) negatif korelasyon mevcuttu. Çoklu doğrusal regresyon analiz ile EUS skoru ve BKİ’nin, AHİ’den bağımsız olarak, fibrinojen düzeyleri ile ilişkili değişkenler olduğu saptanmıştır. Sonuçta plazma fibrinojen düzeyleri ile ESS ve BKİ’nin ilişkili olduğu bulunmuştur. Fibrinojen düzeyleri ve nokturnal desaturasyon arasındaki ilişki, hipoksi inflamasyon ilişkisini desteklemektedir. Yüksek fibrinojen düzeylerinin OUAS’lı hastalarda vasküler hastalık gelişimi için önemli bir faktör olabileceği sonucuna varılmıştır.

Anahtar Kelimeler:

Obstrüktif uyku apne sendromu (OUAS), fibrinojen, Epworth uykululuk skalası (ESS), hipoksi, vasküler hastalık.

Evaluation of Fibrinogen Levels in Patients with Obstructive Sleep Apnea

Risk of vascular disorders is increased at obstructive sleep apnea syndrome (OSAS) patients. The exact mechanism of development of vascular disease in patients with OSAS remains to be unknown. Fibrinogen is a major constituent of normal plasma. Fibrinogen is an acute phase reactant, with increasing levels as part of the of the acute inflammatory response. Fibrinogen has been shown to be an independent risk factor for coroner heart disease and stroke. Our aim was to compare plasma fibrinogen levels between OSAS and control groups, and relationship with polysomnograhy (PSG) parameters. Fifty patients with newly diagnosed moderate and severe OSAS and 33 non-apneic control subjects were enrolled in this study. Full-night PSG was performed in all patients. Blood samples were drawn at 8:00-9:00 am after the sleep study. Fibrinogen levels were analyzed with Clauss method. There were no significant differences in age, gender, smoking habit between the two groups. Plasma fibrinogen levels in the OSAS group (4.2 ± 0.14 g/L) were significantly higher than that in the control group (p<0.028). Plasma fibrinogen levels were positively correlated with Epworth sleepiness scale (ESS) (r=0.301, p=0.006), age (r=0.327, p=0.003), body mass index (BMI) (r=0.388, p<0.001), average oxygen desaturation (r=0.258, p=0.019), oxygen desaturation index (r=0.281, p=0.010), length of time spent with an oxygen saturation <90% (r=0.248, p=0.024) and arousal index (r=0.220, p=0.046). Plasma fibrinogen levels were negatively correlated with average oxygen saturation during sleep (r= -0.254, p=0.029). Multipl linear regression analyses showed that high ESS and BMI were related with elevated plasma fibrinogen levels, independent of apne hipopne index. In conclusion we suggest that plasma fibrinogen levels correlate with BMI and ESS. The association between plasma fibrinogen levels and nocturnal desaturation supports the linkage between hypoxia and inflamation. We conclude that fibrinogen may be an important factor for development of vascular disease in patients with OSAS.

Keywords:

Obstructive sleep apnea syndrome (OSAS), fibrinogen, Epworth sleepiness scale (ESS), hypoxia, vasculer disease,

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