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Yıl:2017; Cilt: 4; Sayı: 3>> Özet
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Türk Uyku Tıbbı Dergisi; 2017;4(3):84-89
Obstrüktif Uyku Apne Sendrom’lu Hastalarda P Dalga Dispersiyonu, QT Dalga Dispersiyonu ve P Dalga Amplütüdünün Değerlendirilmesi
BO Arslan, H Fırat, S Ardıç
Sağlık Bilimleri Üniversitesi, İstanbul
Amaç: Atriyal ve ventriküler taşiaritmiler için non-invaziv risk belirteçleri olarak kabul edilen P dalga dispersiyonu (Pd) ve QT aralık dispersiyonu (QTc) parametreleri kullanılarak, Obstrüktif Uyku Apne sendromlu (OUAS) hastalarda atriyal ve ventriküler taşiaritmi riskleri ve P dalga amplütüdü (Pda) ölçümü ile sağ atriyal dilatasyon riskinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Kliniğimizin uyku laboratuvarına başvuran OUAS ön tanısıyla gelen hastalar değerlendirmeye alındılar. Çalışmaya kabul için gerekli kriterleri karşılayan 225 olgu çalışmaya dahil edildi. Tüm hastalara polisomnografik tetkik uygulandı ve rutin kan tetkikleri çalışıldı. Ek olarak elektrokardiyografi çekildi. On iki kanallı elektrokardiyografik tetkik üzerinden Pd, QTc ve düzeltilmiş QT dispersiyonu (QTcd) hesaplandı. Hasta ve kontrol gruplarındaki farklılık değerlendirildi. Bulgular: Polisomnografik tetkik sonrasında apne-hipopne indeksi (AHİ) <5 olan 56 olgu kontrol, AHİ ≥5 olan 169 olgu ise hasta grubu olarak çalışmaya dahil edildi. Ortalama yaş 48,3±8,9 olarak belirlendi. Hasta ve kontrol grupları arasında QTcmin, QTcmaks, QTd ve QTcd değerleri açısından istatistiksel olarak anlamlı farklılık tespit edilmedi (p>0,05). QTcd değeri hasta grubunda normal sınırın üstünde olmasına rağmen kontrol grubu değerleri ile karşılaştırıldığında fark anlamlı değildi (p>0,05). P dalgasına yönelik yapılan incelemelerde Pmaks, Pmin ve Pd açısından, değerlerin hasta grubunda kontrol grubuna göre daha yüksek tespit edilmesine rağmen, gruplar arasında anlamlı faklılık saptanmadı (p>0,05). P dalga amplitüdü hasta grubunda kontrol grubuna göre istatistiksel olarak anlamlı derecede yüksek tespit edildi (p=0,02). Sonuç: Pd ve QTc/QTcd parametreleri, OUAS’lu hastalarda ventriküler ve atriyal aritmi riskinin değerlendirilmesi amacına yönelik olarak uygun görünmemektedir. Bunun yanında Pda’da saptanan artış, sağ atriyal dilatasyon riskindeki artışı işaret ediyor olabilir. Konu ile ilgili netliğin sağlanması için geniş olgu serileri içeren, ileriye yönelik çalışmalara ihtiyaç vardır.
Evaluation of P Wave Dispersion, QT Dispersion and P Wave Amplitude in Patients with Obstructive Sleep Apnea Syndrome
Objective: The purpose of the study is to evaluate the risks of atrial and ventricular tachyarrhythmia and the risk of right atrial dilatation by using P wave amplitude (Pda) measurement, in patients with Obstructive Sleep Apnea syndrome (OSAS) by using the parameters of the P wave dispersion (Pd) and QT interval dispersion (QTc) the accepted noninvasive risk indicators for atrial and ventricular tachyarrhythmia. Materials and Methods: Patients who had applied to our clinic’s sleep laboratory with pre-diognosis of OSAS were evaluated. Two hundred twenty five cases were included in the study who met the criteria for acceptance to work. Polysomnographic tests and routine blood tests applied to all patients. In addition, electrocardiography was performed. Pd, QTc and corrected QT dispersion (QTcd) calculated on a 12 lead surface electrocardiographic examination. The difference between patient and control groups were evaluated. Results: After polysomnographic workup, 56 cases with apnea-hypopnea index (AHI) <5 were included as the control group and 169 cases with AHI =5 were included as the patient group. The mean age determined as 48.3±8.9. There was no statistically significant differences between patient and control group with regard to QTcmin, QTcmax, QTd and QTcd parameters (p>0.05). Although QTcd was higher than normal range in patient group, the differences was not significant compared to control group (p>0.05). In the studies made for P wave, although the values in terms of Pmax, Pmin and Pd were found higher in the patient group than in the control group, a significant difference was not determined between the groups. However, P wave amplitude was significantly higher as statistically in the patient group than in the control group (p=0.02). Conclusion: Pd and QTc/QTcd parameters do not seem to be appropriate for the assessment of ventricular and atrial arrhythmia risk in patients with OSAS. However, the increase in Pda may be indicative of an increased risk of right atrial dilatation. There is a need for forward studies involving large case series in order to provide clarity on the subject

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