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Yıl:2017; Cilt: 54; Sayı: 4>> Özet
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Nöropsikiyatri Arşivi; 2017;54(4):307-311
Obstrüktif Uyku Apnesi Hastalarında Karpal Tünel Sendromu
ÖB Topçuoğlu, Ö Oruç, S Saraç, GÇ Afşar, K Uluç
Süreyyapaşa Chest Diseases and Thorax Surgery Training and Research Hospital, İstanbul
Amaç: Karpal tünel sendromu (KTS) üst ekstremitenin en sık görülen tuzak nöropatisidir. En sık olarak median sinirin, karpal tünel içinde basıya uğramasıyla ilişkilendirilir. Ana semptomları olan ağrı ve uyuşma özellikle geceleri kötüleştiğinden KTS hastalarında uyku bozuklukları ve uykuda yatış pozisyonunun KTS oluşumu üzerine etkileri daha önce çeşitli araş- tırmacılar tarafından incelenmiştir. Ancak obstrüktif uyku apnesi (OUA) hastalarında KTS varlığı bildiğimiz kadarıyla ilk kez tarafımızdan çalışılmıştır. Bu çalışmadaki amacımız, OUA hastalarında KTS sıklığını belirlemek ve iki hastalık arasındaki olası nedensel ilişkiyi incelemektir. Yöntem: Uyku laboratuarımıza başvuran hastaların dosyaları retrospektif olarak incelenmiştir. OUA tanısı konmuş hastalar içinden KTS için yatkınlık oluşturabilecek ko-morbiditeleri (diabetes mellitus, hipotiroidi, romatizmal hastalıklar, servikal radikülopati) olmayan 80 hasta ve hastalarla yaş, cinsiyet, vücut kitle indeksi açısından uyumlu olan 80 sağlıklı kontrol çalışmaya dahil edilmiştir. Araştrıcıların körlüğünü sağlamak açı- sından hastalar çalışma öncesinde klinik bilgiler ve çalışmada kullanılacak bilgiler açısından sorgulanmamıştır. Tüm hasta ve kontrollere sinir iletim çalışması uygulanmıştır . KTS tesbit edilen hastalar KTS semptomları ve tercih ettikleri yatış pozisyonları açısından sorgulanmış ve Boston KTS sorgulama ölçeği verilmiştir. Bulgular: OUA hastalarında KTS sıklığı %27,5 bulunmuştur. Yatış pozisyonu ve el gücü ile çalışmanın KTS varlığı ile bir bağlantısı bulunmamıştır. Sonuç: OUA hastalarında KTS sıklığı genel populasyona göre çok yüksek bulunmuştur. Ancak polisomnografik ve elektrofizyolojik veriler olmadan yapılmış daha önceki çalışmaların aksine OUA hastalarında KTS varlığının biyomekanik faktörler ile bir bağlantısı bulunmamıştır. OUA’ da meydana gelen aralıklı hipokseminin KTS oluşumuna yatkınlık oluşturan ana faktör olduğunu düşünmekteyiz. İki hastalığın ortak etyopatogenezi olarak inflamasyon da suçlanabilir ancak
Carpal Tunnel Syndrome in Obstructive Sleep Apnea Patients
Introduction: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper extremity. It is usually associated with the compression of the median nerve in the median groove. Because the main symptoms of CTS pain and numbness worsen at night, sleep disorders in CTS patients and the impact of preferred sleeping position on CTS development have been formerly studied. However, to the best of our knowledge, this is the first study assessing the frequency of CTS in obstructive sleep apnea (OSA) patients. This study aimed to determine the frequency of CTS in OSA patients and evaluate the causative relation between the two diseases. Methods: Records of individuals who were admitted to our sleep laboratory were retrospectively scanned. Eighty patients who were diagnosed with OSA and did not have comorbidities that might cause OSA (e.g., diabetes mellitus, hypothyroiditis, rheumatic diseases, and cervical radiculopathy) were included in the study along with 80 healthy controls who matched for age, sex, and BMI of OSA patients. To maintain observer blindness, patients were not questioned regarding their symptoms or the clinical data that would be used in the study. All participants underwent nerve conduction studies. Those who were diagnosed with CTS were questioned regarding CTS symptoms and the preferred sleeping position. Subsequently, patients were given the Boston CTS questionnaire. Results: CTS frequency in OSA patients was found to be 27.5%. There was no significant relation between preferred sleeping position or being a manual worker and having CTS. Conclusion: CTS frequency in OSA patients is significantly higher than that in healthy individuals. In contrast to previous studies that have been performed in the absence of polysomnographic and electrophysiological data, in our study biomechanical factors were not associated with CTS presence. Therefore, we conclude that intermittent hypoxemia is the main etiological factor for CTS in OSA patients. Inflammation may be a common factor for etiopathogenesis for both diseases, but this hypothesis needs further investigation.

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