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Yıl:2016; Cilt: 3; Sayı: 3>> Özet
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Türk Uyku Tıbbı Dergisi; 2016;3(3):73-78
Ürik Asit Obstrüktif Uyku Apne Sendromunda Bir Belirteç midir?
ET Parmaksız, B Salepçi, GA Güngör, S Cömert, E Parmaksız
Dr. Lütfi Kırdar Kartal Eğitim ve Araştırma Hastanesi, İstanbul
Amaç: Ürik asit, kardiyovasküler hastalıklar, kronik böbrek yetersizliği, metabolik sendrom gibi durumlarda yükselen güçlü ve bağımsız bir morbidite ve mortalite belirtecidir. Obstrüktif uyku apne sendromu’nda (OUAS) gece boyu meydana gelen hipoksi-arousal-reoksijenasyon siklusları, adenozin trifosfat yıkımına neden olarak pürin metabolizması ürünü olan ürik asit oluşumunu arttırır. Çalışmamızda OUAS ile serum ürik asit düzeyleri arasındaki ilişkiyi değerlendirmeyi amaçladık. Gereç ve Yöntem: Uyku laboratuvarımızda polisomnografi (PSG) ile değerlendirilen hastalar prospektif olarak değerlendirildi. Tüm hastaların demografik verileri, komorbiditelerini içeren ayrıntılı özgeçmişi, sigara öyküsü kaydedildi. Tüm gece PSG uygulandı, tam kan sayımı ve biyokimya analizleri yapıldı. Bulgular: Çalışmamıza yaş ortalaması 47,78 (18-65) olan 449 olgu dahil edildi. Çalışma popülasyonu 283 erkek (%63), 166 kadından (%37) oluşmaktaydı. PSG verilerine göre 43 hastada apne-hipopne indeksi <5 bulundu, 406 olguda OUAS saptandı. Ek hastalıklar değerlendirildiğinde hipertansiyon 135 (%30), diabetes mellitus 80 (%18), koroner arter hastalığı 53 (%12), astım 53 (%12), dislipidemi 14 (%3), kronik obstrüktif akciğer hastalığı 12 (%2,7) olguda saptandı. Serum ürik asit düzeyi 75 olguda yüksek bulundu; bu olguların 3’ü kontrol, 72’si OUAS grubunda idi. Hafif OUAS grubunda 13, orta OUAS grubunda 25, ağır OUAS grubunda ise 34 olguda ürik asit düzeyi artmış bulundu. Serum ürik asit düzeyi OUAS grubunda anlamlı olarak daha yüksek bulundu. Sonuç: Tam kan sayımı verileri ve serum üre düzeyi iki grupta benzer bulunurken, kreatinin düzeyi OUAS olanlarda anlamlı şekilde yüksek bulundu. Serum ürik asit ve kreatinin düzeyleri hastalığın ağırlığı ilerledikçe anlamlı olarak artmaktaydı. Olgularda cinsiyete göre ürik asit düzeyleri karşılaştırıldığında kadınlarda ortalama 5,29 mg/dL, erkeklerde ortalama 6,58 mg/dL ile bulundu; aradaki fark istatistiksel olarak anlamlıydı.
Is Uric Acid a Marker in Obstructive Sleep Apnea Syndrome?
Objective: Uric acid which arises in conditions such as cardiovascular diseases, Chronic kidney failure, metabolic syndrome is a strong and independent marker of morbidity and mortality. Hypoxia-arousalreoxygenation cycles that observed in Obstructive sleep apnea syndrome (OSAS) throughout the night increase adenosine triphosphate degradation and cause uric acid production, an end-product of purine metabolism. We aimed to evaluate the relationship between OSAS and serum uric acid levels. Materials and Methods: Subjects who were evaluated by polysomnography (PSG) in our sleep laboratory were prospectively analysed. Demographic data, detailed history including comorbidities, smoking history of all the patients were recorded. PSG was performed all night and complete blood count and biochemical analysis were done. Results: Total of 449 subjects with a mean age of 47.78 (18-65) were included in the study. The study population consisted of 283 (63%) male and 166 (37%) female. According to PSG data, 43 subjects had apneahypopnea index was <5 and 406 subjects had OSAS. As comorbidities evaluated, hypertension in 135 (30%), diabetes mellitus in 80 (18%), coronary heart disease in 53 (12%), asthma in 53 (12%), dyslipidemia in 14 (3%), chronic obstructive pulmonary disease in 12 (2.7%) patients were found. Serum uric acid level was high in 75 cases; 3 of which was in control group and 72 of which was in OSAS group. Uric acid level was increased in 13 patients with mild OSAS, 25 patients with moderate OSAS and 34 patients with severe OSAS. Serum uric acid level was significantly higher in OSAS group compared to control group. Conclusion: Complete blood count data and serum urea levels were found similar in both groups, whereas creatinine was significantly higher in OSAS patients. Serum uric acid and creatinine levels were increasing significantly as the disease got more severe. When patient uric acid levels were compared by gender, mean uric acid level was 5.29 mg/dL in women and 6.58 mg/dL in men; the difference between genders was statistically significant.

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