Turkiye Klinikleri Archives of Lung

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Periyodik Bacak Hareketleri İndeksi, Obstrüktif Uyku Apne Sendromlu Hastalarda Kardiyovasküler Hastalıklarla İlişkili midir?
Is Periodic Leg Movements Index Associated with Cardiovascular Disease in Obstructive Sleep Apnea Syndome Patients?
Halil İbrahim YAKARa, Asiye KANBAYb
aTokat Gaziosmanpaşa Üniversitesi Tıp Fakültesi, Göğüs Hastalıkları ABD, Tokat, TÜRKİYE
bİstanbul Medeniyet Üniversitesi Tıp Fakültesi, Göğüs Hastalıkları ABD, İstanbul, TÜRKİYE
Turkiye Klinikleri Arch Lung. 2021;20(1):6-12
doi: 10.5336/archlung.2020-75693
Article Language: TR
Full Text
ÖZET
 Amaç: Obstrüktif uyku apne sendromu (OSAS), kardiyovasküler ve metabolik hastalıklar ile ilişkisi iyi bilinen bir hastalıktır. Apne-hipopne atakları ve aralıklı uyanmalar, uyku boyunca sempatik sistem aktivasyonuna neden olarak başta kardiyovasküler sistem olmak üzere pek çok sistemi etkilemektedir. Periyodik bacak hareketleri [(periodic leg movement (PLM)] sıklığının OSAS hastalarında artmış sempatik aktivasyonun bir göstergesi olarak değerlendirilebileceği araştırılmaktadır. Bu çalışmada, OSAS ağırlığına göre PLM indeksi (PLMI) ve kardiyovasküler hastalık (KVH) sıklığı ilişkisini araştırmak planlandı. Ayrıca sempatik sistem aktivasyonu göstergesi olabilecek bradikardi, taşikardi, nabız değişkenliği ile PLMI arasında ilişki incelenmiştir. Gereç ve Yöntemler: Çalışmaya uyku laboratuvarında tüm gece polisomnografi (PSG) yapılan 626 hasta alındı. PLMI, tüm olgularda standart tüm gece PSG kayıtlarından elde edildi. Anamnez bilgilerinden elde edilen aritmi, inme, iskemik kalp hastalığı ve hipertansiyon tanıları, KVH olarak tanımlandı. Bulgular: Farklı evrelerdeki 488 OSAS olgusu (Ort. yaş: 50,0±12,2 yıl, E/K: 314/182) ve 138 kontrol (Ort. yaş: 45,6±12,6, E/K: 55/75) grubu verisi kaydedildi. Grup dağılımları incelendiğinde, 166 olgu hafif, 92 olgu orta, 230 olgu ağır OSAS olarak sınıflandırıldı. PLMI düzeyinin kontrol grubundan ağır OSAS'li hastalara doğru kademeli olarak arttığı izlendi (sırasıyla 3,08±2,57; 5,84±4,01; 6,70±5,10 ve 7,65±3,82, p<0,001). PLMI ile tüm KVH'ler (İKH, HT, inme ve aritmi) ilişkili bulundu (sırasıyla p<0,001; p=0,008; p=0,007; p=0,004). Ayrıca PLMI ve nabız değişkenliği ilişkisi incelendiğinde, PLMI ile bradikardi arasında anlamlı ilişki olduğu bulundu (r=-0,11, p=0,007). Sonuç: KVH prevalansı, OSAS'li hastalarda, kontrol grubuna göre anlamlı derecede artmış ve KVH olanlarda PLMI daha yüksek bulunmuştur. OSAS'li hastalarda KVH riskini öngörmek için PLMI sempatik aktivitenin bir göstergesi olarak kullanılabileceği düşünülmektedir.

Anahtar Kelimeler: Obstrüktif uyku apne sendromu; periyodik bacak hareketleri indeksi; kardiyovasküler hastalık
ABSTRACT
 Objective: Obstructive sleep apnea syndrome (OSAS) is wellknown to be associated with cardiovascular and metabolic diseases. Apnea-hypopnea attacks and intermittent awakenings affect many systems, especially the cardiovascular system, by causing sympathetic system activation during sleep. It is thought that the frequency of periodic leg movements (PLM) can be evaluated as an indicator of increased sympathetic activation in OSAS patients. Herein we aimed to investigate the relationship of PLM index (PLMI) and cardiovascular disease (CVD) by OSAS stage. In addition, the relationship between PLM and pulse variability are investigated. Material and Methods: Overall, 626 participants who underwent all night polysomnography were recruited. The PLMI was obtained from standard all night polysomnography recordings in all patients. Arrhythmia, stroke, ischemic heart disease and hypertension were defined as CVD. Results: A total of 488 patients with varying severity of OSAS (mean age: 50.0±12.2 years, M/F:314/182) and 138 controls (mean age: 45.6±12.6, M/F:55/75) were enrolled. It was observed that the level of PLMI increased gradually from the control group to patients with severe OSAS (3.08±2.57; 5.84±4.01; 6.70±5.10 and 7.65±3.82, respectively (p<0.001)). PLMI was associated with all cardiovascular diseases (ICD, HT, CVD, Arrhythmia) (p<0.001, p=0.008, p=0.007, p=0.004, respectively). In addition, PLMI was associated with bradycardia (p=0.007). Conclusion: The prevalence of CVD increased significantly in patients with OSAS compared to the control group and PLMI was found higher in patients with CVD. It is thought that PLMI can be used as an indicator of sympathetic activity to predict the risk of CVD in patients with OSAS.

Keywords: Obstructive sleep apnea syndrome; periodic leg movement index; cardiovascular disease
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