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Yıl:2018; Cilt: 5; Sayı: 3>> Özet
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Türk Uyku Tıbbı Dergisi; 2018;5(3):62-66
Obstrüktif Uyku Apne Sendromu Tanılı Hastalarda Hemogram Parametreleri ile Gece Desatürasyonu İlişkisi
Z Alaçam, S Pekcan, B Akdağ, H Şenol
Denizli Devlet Hastanesi, Denizli
Amaç: Obstrüktif Uyku Apne sendromu (OUAS) uyku sırasında tekrarlayan tam (apne) veya parsiyel (hipopne) üst solunum yolu obstrüksiyonu epizodları ve sıklıkla kan oksijen satürasyonunda azalma ile karakterize bir hastalıktır. OUAS’de olan gece hipoksileri ve arousalların sempatik aktivite artışı, endotel disfonksiyonu, hiperkoagülabiliteyi tetiklediği düşünülmektedir. Gereç ve Yöntem: Bu çalışmada kliniğimizde tetkik edilen OUAS tanılı hastalarda hastalığın ağırlığı ve gece hipoksi ciddiyeti ile hemogram parametreleri arasındaki ilişkiyi değerlendirmek amaçlanmıştır. Bunun için çalışmaya 24 kontrol, 24 hafif, 23 orta, 23 ağır OUAS olmak üzere toplam 94 olgu alındı. Bulgular: Hafif ve ağır OUAS gruplarında polisomnografide ortalama ve minimum oksijen satürasyon değerleri ile nötrofil sayısı ve nötrofil/lenfosit (N/L) oranında negatif korelasyon izlenmiştir. Orta ve ağır OUAS’de eritrosit dağılım genişliği (EDG) ile ortalama oksijen satürasyonu ve minimum oksijen satürasyonu arasında negatif korelasyon gözlenmiştir. Her 3 grupta EDG ve N/L oranının ortalama ve minimum oksijen satürasyonu ile regresyon analizi incelendiğinde; minimum oksijen satürasyonundaki 1 birim düşüş N/L oranını hafif OUAS’de 0,5 kat (p=0,02), ağır OUAS’de 0,5 kat (p=0,01); orta OUAS’de ise EDG oranını 0,5 kat (p=0,02) yükseltmektedir. Ortalama oksijen satürasyonundaki 1 birim düşüş ağır OUAS’de N/L oranını 0,4 kat (p=0,04), EDG’yi 0,8 kat yükseltmektedir (p=0,001). Sonuç: OUAS ağırlığı arttıkça hastaların hematokrit değerlerinin arttığı tespit edildi. Ancak hastaların uyku desatürasyonu arttıkça EDG, nötrofil sayısı ve N/L oranının arttığını görmekteyiz. Bu durum OUAS’de solunum yollarında hem mekanik stres hem de iskemi-reperfüzyon döngüleri ile oluşan lokal enflamasyonun sistemik dolaşıma dökülmesinin bir sonucu olduğunu düşündürmektedir.
The Relationship of Hemogram Parameters and Night Desaturation in PatientsDiagnosed with Obstructive Sleep Apnea Syndrome
Objective: Obstructive Sleep Apnea syndrome (OSAS) is a disease characterized by recurrent complete (apnea) or partial (hypopnea) upper respiratory tract obstructions episodes during sleep and often a decrease in blood oxygen saturation. Night hypoxias and sympathetic activity increase of arousals in OSAS are thought to stimulate that endothelial dysfunction and hypercoagulability. Materials and Methods: In this study, it was aimed to evaluate the relationship between the severity of the disease and the night hypoxia severity with hemogram parameters in patients diagnosed with OSAS who examined in our clinics. A total of 94 cases were included in the study, including 24 controls, 24 mild, 23 moderate, and 23 severe OSAS. Results: The mean and minimum oxygen saturation values in polisomnography with the number of neutrophils and neutrophil/ lymphocyte (N/L) ratio were negatively correlated in the mild and severe OSAS groups. A negative correlation was observed between erythrocyte distribution width (EDW) and, mean oxygen saturation and minimum oxygen saturation in moderate and severe OSAS. When the mean and minimum oxygen saturation with regression analysis of EDW and N/L ratio were examined in each three groups; the 1 unit decrease in the minimum oxygen saturation increases the N/L ratio by 0.5-fold (p=0.02) in the mild OSAS, 0.5-fold (p=0.01) in the severe OSAS and it increases the EDW by ratio 0.5-fold (p=0.02) in the moderate OSAS. The 1 unit decrease in the mean oxygen saturation increases the N/L ratio by 0.4- fold (p=0.04) and the EDW by 0.8-fold (p=0.001) in the severe OSAS. Conclusion: As long as the OSAS severity increases, it is determined that the hematocrit values of patients increasing. However, as patients’ sleep desaturation increase, we can see that EDW, the number of neutrophils, and N/L ratio also increasing. This situation suggests that the local inflammation caused by both mechanical stress and ischemiareperfusion cycles in the respiratory tract in OSAS is a consequence of spillage into the systemic circulation.

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