Obstrüktif uyku apnesi olan hastalarda sürekli pozitif havayolu basıncı (CPAP) tedavisinin serum kaspaz-3 düzeyi üzerine etkisi
Küçük Resim Yok
Tarih
2023
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Düzce Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş: Aralıklı hipoksemi, obstrüktif uyku apne (OUA) komplikasyonlarının fizyopatogenezinde önemli bir yere sahiptir. OUA'da aralıklı hipoksemiye bağlı artmış apoptoz önemli bir klinik durum olabilir. Bu çalışmada OUA olan hastalarda artmış apoptozun dolaylı bir belirteci olan kaspaz-3 enzim düzeyini değerlendirmeyi ve sürekli pozitif hava yolu basıncı (CPAP) ile OUA tedavisinin kaspaz-3 enzim düzeyi üzerine etkisini değerlendirmeyi amaçladık. Gereç ve Yöntem: Bu çalışmaya uykuda solunum bozuklukları laboratuvarına 6 ay içinde başvuran ardışık 141 hasta dahil edildi. Tüm olgulara gece yapılan polisomnografi (PSG) sabahı alınan rutin kan örneklerinden kaspaz-3 ölçümleri yapıldı. PSG sonucuna göre OUA tespit edilip CPAP tedavisi uygulanmasına karar verilen olgular 3 aylık CPAP tedavisi sonrası kontrole çağrıldı. Kontrole gelen hastaların CPAP tedavisine uyumları değerlendirildi ve tedavi sonrası kaspaz-3 düzeylerine tekrar bakıldı. Bulgular: Çalışmaya 39'u kadın (%27,7) 102'si erkek (%72,3) toplam 141 olgu dahil oldu. Olguların yaş ortalaması 49±12 (min-17, max-77) idi. PSG sonuçlarına göre olguların %95,7'sinde (135/141) OUA tespit edildi. Hafif OUA 35 (%24,8), orta OUA 39 (%27,7), ağır OUA 61 (%43,3) olgu idi. Çalışma grubunda erkek ve kadınlarda medyan kaspaz-3 enzim düzeyleri benzerdi. OUA varlığı ve şiddetine göre ayrılmış gruplar arasında hemogram parametreleri ve kaspaz-3 enzimi düzeyi açısından istatistiksel anlamlı fark saptanmadı. Gündüz aşırı uykululuk hali olanlarda kaspaz-3 düzeyi anlamlı olarak yüksek, kardiyovasküler hastalığı olanlarda ise kaspaz-3 düzeyi anlamlı olarak düşük bulundu. OUA'da 3 aylık CPAP tedavisi sonrası kaspaz-3 enzim düzeyinin tedavi öncesine göre anlamlı olarak değişmediği tespit edildi. Kaspaz-3'ün hem CPAP tedavisi günlük kullanım yüzdesi hem de gecede 1 saatten fazla CPAP cihazı kullanım yüzdesi ile negatif korelasyon gösterdiği bulundu. CPAP tedavisi günlük kullanım yüzdesi arttıkça kontrol kaspaz-3 düzeyinin istatistiksel anlamlı olarak azaldığı bulundu (r=-0.397, p=0.030). Gecede 1 saatten fazla CPAP tedavisi kullanım yüzdesi arttıkça kontrol kaspaz-3 düzeyinin istatistiksel anlamlı olarak azaldığı bulundu (r=-0.411, p=0.024). Sonuç: Bu çalışmanın sonuçları OUA şiddetiyle kaspaz-3 düzeyleri arasındaki ilişkiyi ortaya koyamamıştır. Ancak tedavi uyumu arttıkça azalan kan kaspaz-3 seviyeleri OUA'da artmış apoptozu CPAP tedavisinin düzeltebileceğini düşündürmektedir. Bu konuda daha kapsamlı çalışmalar yapılmasına ihtiyaç vardır. Anahtar Kelimeler: Obstrüktif uyku apne, Kaspaz-3, Apoptozis, Aralıklı hipoksemi, CPAP
Introduction: Intermittent hypoxemia has an important role in the physiopathogenesis of obstructive sleep apnea (OSA) complications. Increased apoptosis due to intermittent hypoxemia may be an important clinical entity in OSA. In this study, we aimed to evaluate caspase-3 enzyme level, which is an indirect marker of increased apoptosis in patients with OSA and to evaluate the effect of OSA treatment with continuous positive airway pressure on caspase-3 enzyme level. Materials and methods: This study included 141 consecutive patients admitted to the sleep-disordered breathing laboratory within 6 months. Caspase-3 was measured in routine blood samples obtained on the morning of polysomnography (PSG) performed at night. The compliance of the patients to CPAP treatment was evaluated and caspase-3 levels were checked again after treatment. Results: A total of 141 patients, 39 females (27,7%) and 102 males (72,3%) were included in the study. The mean age of the patients was 49±12 years (min-17, max-77). According to PSG results, OSA was detected in 95.7% (135/141) of the cases. Mild OSA was 35 (24.8%), moderate OSA 39 (27.7%) and severe OSA 61 (43.3%) cases. Median caspase-3 enzyme levels were similar in men and women in the study group. There was no statistically significant difference in hemogram parameters and caspase-3 enzyme levels between the groups divided according to the presence and severity of OSA. Caspase-3 levels were significantly higher in patients with excessive daytime sleepiness and significantly lower in patients with cardiovascular disease. It was determined that caspase-3 enzyme level did not change significantly after 3 months of CPAP treatment in OSA compared to pretreatment. Caspase-3 was found to have a negative correlation with both the percentage of daily use of CPAP therapy and the percentage of CPAP device use for more than 1 hour per night. It was found that the control caspase-3 level decreased statistically significantly as the percentage of daily use of CPAP therapy increased (r=-0.397, p=0.030). It was found that the control caspase-3 level decreased statistically significantly as the percentage of CPAP therapy use for more than 1 hour per night increased (r=-0.411, p=0.024). Conclusion: The results of this study did not reveal a relationship between the severity of OSA and caspase-3 levels. However, blood caspase-3 levels decreased as treatment compliance increased, suggesting that CPAP treatment may correct increased apoptosis in OSA. There is a need for more comprehensive studies on this issue. Keywords: Obstructive sleep apnea, Caspase-3, Apoptosis, Intermittent hypoxemia, CPAP
Introduction: Intermittent hypoxemia has an important role in the physiopathogenesis of obstructive sleep apnea (OSA) complications. Increased apoptosis due to intermittent hypoxemia may be an important clinical entity in OSA. In this study, we aimed to evaluate caspase-3 enzyme level, which is an indirect marker of increased apoptosis in patients with OSA and to evaluate the effect of OSA treatment with continuous positive airway pressure on caspase-3 enzyme level. Materials and methods: This study included 141 consecutive patients admitted to the sleep-disordered breathing laboratory within 6 months. Caspase-3 was measured in routine blood samples obtained on the morning of polysomnography (PSG) performed at night. The compliance of the patients to CPAP treatment was evaluated and caspase-3 levels were checked again after treatment. Results: A total of 141 patients, 39 females (27,7%) and 102 males (72,3%) were included in the study. The mean age of the patients was 49±12 years (min-17, max-77). According to PSG results, OSA was detected in 95.7% (135/141) of the cases. Mild OSA was 35 (24.8%), moderate OSA 39 (27.7%) and severe OSA 61 (43.3%) cases. Median caspase-3 enzyme levels were similar in men and women in the study group. There was no statistically significant difference in hemogram parameters and caspase-3 enzyme levels between the groups divided according to the presence and severity of OSA. Caspase-3 levels were significantly higher in patients with excessive daytime sleepiness and significantly lower in patients with cardiovascular disease. It was determined that caspase-3 enzyme level did not change significantly after 3 months of CPAP treatment in OSA compared to pretreatment. Caspase-3 was found to have a negative correlation with both the percentage of daily use of CPAP therapy and the percentage of CPAP device use for more than 1 hour per night. It was found that the control caspase-3 level decreased statistically significantly as the percentage of daily use of CPAP therapy increased (r=-0.397, p=0.030). It was found that the control caspase-3 level decreased statistically significantly as the percentage of CPAP therapy use for more than 1 hour per night increased (r=-0.411, p=0.024). Conclusion: The results of this study did not reveal a relationship between the severity of OSA and caspase-3 levels. However, blood caspase-3 levels decreased as treatment compliance increased, suggesting that CPAP treatment may correct increased apoptosis in OSA. There is a need for more comprehensive studies on this issue. Keywords: Obstructive sleep apnea, Caspase-3, Apoptosis, Intermittent hypoxemia, CPAP
Açıklama
Anahtar Kelimeler
Göğüs Hastalıkları, Chest Diseases
