Obstrüktif uyku apne sendromu izole pozisyonel ve izole rem bağımlı fenotiplerinin klinik, demografik özelliklerinin karşılaştırılması
Küçük Resim Yok
Tarih
2025
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Düzce Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Obstruktif Uyku Apne Sendromu (OUAS) fenotiplerinden sık görülen izole pozisyonel ve izole REM bağımlı OUAS tanılı hastaların klinik ve demografik özelliklerinin karşılaştırılması hedeflenmiştir. Gereç ve yöntem: Toplam 3742 hastanın PSG sonuçları değerlendirildi. İzole REM bağımlı OUAS tanı kriterini karşılayan toplam 35 hasta tespit edildi. Buna karşılık olarak en yakın tarihten geriye doğru ardışık olarak tespit edilen ve izole pozisyonel OUAS kriterlerine uyan 35 hasta çalışmaya dahil edildi. En yakın tarihten geriye doğru ardışık olarak Normal PSG olarak sonuçlanan 30 hasta da kontrol grubu olarak seçildi. Bulgular: Çalışmaya 45 kadın, 55 erkek toplam 100 olgu dahil oldu. Pozisyonel OUAS grubunda erkeklerin oranı (%82,9), REM bağımlı OUAS grubunda ve kontrol grubunda ise kadınların oranı (%60) istatistiksel anlamlı olarak daha yüksekti. REM bağımlı OUAS olgularının tamamı AHİ'ye göre hafif olgulardan oluşmaktayken, pozisyonel OUAS grubunun %48.6'sı hafif, %37.1'i orta ve %14.3'ü ise ağır OUAS olgularından oluşmaktaydı. OUAS majör semptomlarından horlama ve tanıklı apne REM bağımlı OUAS olgularında pozisyonel OUAS olgularına göre istatistiksel anlamlı olarak daha az sıklıkla görülmekteydi (%94.3 e karşı %28.6). Hatta horlama semptomu REM bağımlı olgularda kontrol grubundan bile daha az orandaydı (%28.6 ya karşı %56.7). Eşlik eden Diyabet ve hiperlipidemi REM bağımlı OUAS grubunda kontrol ve pozisyonel OUAS grublarına göre anlamlı olarak daha yüksek bulundu. Yine Ca kanal blokörü kullanım oranı REM bağımlı OUAS grubunda anlamlı olarak daha yüksekti. Kontrol grubu yaş ortalaması diğer 2 gruptan anlamlı olarak daha düşüktü. Grupların kilo ortalamaları benzerdi. REM bağımlı OUAS grubunda boy ortalaması anlamlı olarak daha kısa, vücut kitle indeksi ortalaması ise anlamlı olarak daha yüksekti. Epwort Uykululuk Skoru pozisyonel OUAS grubunda anlamlı olarak yüksekti. REM bağımlı OUAS grubunda hemoglobin ve hematokrit değerleri anlamlı olarak daha düşük bulundu. Total AHİ ortalaması pozisyonel OUAS'da anlamlı olarak daha yüksekti. Pozisyonel OUAS'da supin pozisyondaki AHİ (fenotipik AHİ) ortalaması REM bağımlı OUAS'da REM sırasındaki AHİ ortalamasından anlamlı olarak daha yüksekti (39,2 ± 23,5 karşı 26,3 ± 11,9). Desaturasyon indeksi pozisyonel OSAS grubunda anlamlı olarak daha yüksek bulundu. Multivariate Lojistik Regresyon analizi İzole Pozisyonel OUAS'dan izole REM bağımlı OUAS grubunu ayırt eden bağımsız faktörlerin kadın cinsiyet (p=0,035, Wald=4,424, B=2,073) ve kalsiyum kanal blokörü kullanımı (p=0,027, Wald=4,890, B= -2,753) olduğunu gösterdi. Sonuç: Çalışmanın sonuçları REM OUAS'ın asemptomatik ve düşük AHİ'li ancak yüksek komplikasyona sahip kadın olgulardan oluştuğunu gösterdi. Bulgular OUAS'ın erkek hastalığı olduğu klasik savını desteklememektedir. Toplumda olası tanı konmamış çok sayıda kadın OUAS hastası olabileceği, obez kadınlarda semptom olmasa dahi OUAS açısından dikkatli olunması gerektiği kanaatindeyiz. Bu konuda daha geniş kapsamlı çok ve çok merkezli çalışmalara ihtiyaç bulunmaktadır. Anahtar Kelimeler; Uyku Apne; cinsiyet; REM bağımlı uyku apne; pozisyonel uyku apne; uyku apne fenotipleri; horlama; diabet; kalsiyum kanal blokörü
Objective: This study aimed to compare the clinical and demographic characteristics of patients diagnosed with two common phenotypes of Obstructive Sleep Apnea Syndrome (OSAS): isolated positional OSAS and isolated REM-dependent OSAS. Materials and Methods: Polysomnography (PSG) data from a total of 3,742 patients were evaluated. Thirty-five patients who met the diagnostic criteria for isolated REM-dependent OSAS were identified. In parallel, the 35 most recently evaluated consecutive patients who met the criteria for isolated positional OSAS were included. Additionally, 30 consecutive patients whose PSG results were normal were selected as the control group. Results: A total of 100 patients were included (45 women, 55 men). The proportion of males was significantly higher in the positional OSAS group (82.9%), whereas females constituted a significantly higher proportion in both the REM-dependent OSAS group and the control group (60%). All REM-dependent OSAS cases were classified as mild based on the Apnea–Hypopnea Index (AHI), while the positional OSAS group consisted of 48.6% mild, 37.1% moderate, and 14.3% severe cases. Major OSAS symptoms—snoring and witnessed apnea—were significantly less frequent in REM-dependent OSAS compared to positional OSAS (28.6% vs. 94.3%). Notably, the prevalence of snoring in the REM-dependent group was even lower than in the control group (28.6% vs. 56.7%). Diabetes mellitus and hyperlipidemia were significantly more common in the REM-dependent OSAS group than in both the positional OSAS and control groups. Similarly, the use of calcium channel blockers was significantly higher among REM-dependent OSAS patients. The mean age of the control group was significantly lower than that of the other two groups. Body weight was similar across groups; however, patients with REM-dependent OSAS had significantly shorter height and higher body mass index. The Epworth Sleepiness Scale score was significantly higher in the positional OSAS group. Hemoglobin and hematocrit values were significantly lower in the REM-dependent OSAS group. Total AHI was significantly higher in positional OSAS. The mean supine AHI (phenotypic AHI) in positional OSAS was significantly higher than the REM-AHI in REM-dependent OSAS (39.2 ± 23.5 vs. 26.3 ± 11.9). The desaturation index was also significantly higher in the positional OSAS group. Multivariate logistic regression analysis identified female sex (p = 0.035, Wald = 4.424, B = 2.073) and calcium channel blocker use (p = 0.027, Wald = 4.890, B = –2.753) as independent factors distinguishing isolated REM-dependent OSAS from isolated positional OSAS. Conclusion: The findings indicate that REM-dependent OSAS predominantly affects women, presents with low AHI values, and is often asymptomatic despite a higher burden of complications. These results do not support the traditional view of OSAS as a predominantly male disorder. We believe that a substantial number of women with OSAS may remain undiagnosed and that obese women should be carefully evaluated for OSAS even in the absence of typical symptoms. Larger, multicenter studies are needed to further clarify these findings. Keywords: Sleep apnea; sex; REM-dependent sleep apnea; positional sleep apnea; sleep apnea phenotypes; snoring; diabetes; calcium channel blocker.
Objective: This study aimed to compare the clinical and demographic characteristics of patients diagnosed with two common phenotypes of Obstructive Sleep Apnea Syndrome (OSAS): isolated positional OSAS and isolated REM-dependent OSAS. Materials and Methods: Polysomnography (PSG) data from a total of 3,742 patients were evaluated. Thirty-five patients who met the diagnostic criteria for isolated REM-dependent OSAS were identified. In parallel, the 35 most recently evaluated consecutive patients who met the criteria for isolated positional OSAS were included. Additionally, 30 consecutive patients whose PSG results were normal were selected as the control group. Results: A total of 100 patients were included (45 women, 55 men). The proportion of males was significantly higher in the positional OSAS group (82.9%), whereas females constituted a significantly higher proportion in both the REM-dependent OSAS group and the control group (60%). All REM-dependent OSAS cases were classified as mild based on the Apnea–Hypopnea Index (AHI), while the positional OSAS group consisted of 48.6% mild, 37.1% moderate, and 14.3% severe cases. Major OSAS symptoms—snoring and witnessed apnea—were significantly less frequent in REM-dependent OSAS compared to positional OSAS (28.6% vs. 94.3%). Notably, the prevalence of snoring in the REM-dependent group was even lower than in the control group (28.6% vs. 56.7%). Diabetes mellitus and hyperlipidemia were significantly more common in the REM-dependent OSAS group than in both the positional OSAS and control groups. Similarly, the use of calcium channel blockers was significantly higher among REM-dependent OSAS patients. The mean age of the control group was significantly lower than that of the other two groups. Body weight was similar across groups; however, patients with REM-dependent OSAS had significantly shorter height and higher body mass index. The Epworth Sleepiness Scale score was significantly higher in the positional OSAS group. Hemoglobin and hematocrit values were significantly lower in the REM-dependent OSAS group. Total AHI was significantly higher in positional OSAS. The mean supine AHI (phenotypic AHI) in positional OSAS was significantly higher than the REM-AHI in REM-dependent OSAS (39.2 ± 23.5 vs. 26.3 ± 11.9). The desaturation index was also significantly higher in the positional OSAS group. Multivariate logistic regression analysis identified female sex (p = 0.035, Wald = 4.424, B = 2.073) and calcium channel blocker use (p = 0.027, Wald = 4.890, B = –2.753) as independent factors distinguishing isolated REM-dependent OSAS from isolated positional OSAS. Conclusion: The findings indicate that REM-dependent OSAS predominantly affects women, presents with low AHI values, and is often asymptomatic despite a higher burden of complications. These results do not support the traditional view of OSAS as a predominantly male disorder. We believe that a substantial number of women with OSAS may remain undiagnosed and that obese women should be carefully evaluated for OSAS even in the absence of typical symptoms. Larger, multicenter studies are needed to further clarify these findings. Keywords: Sleep apnea; sex; REM-dependent sleep apnea; positional sleep apnea; sleep apnea phenotypes; snoring; diabetes; calcium channel blocker.
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Nergis, M. S. (2025). Obstrüktif Uyku Apne Sendromu İzole Pozisyonel Ve İzole Rem Bağımlı Fenotiplerinin Klinik, Demografik Özelliklerinin Karşılaştırılması (Tez No. 989868) [Tıpta Uzmanlık Tezi, Düzce Üniversitesi].
