Obstrüktif Uyku Apne Sendromu Sonuçları
Özet
Obstrüktif Uyku Apne Sendromu (OSAS), uyku sırasında tekrarlayan üst solunum yolu kollapsı ve aralıklı hipoksi ile karakterize, çoklu organ sistemlerini etkileyen kronik inflamatuar bir sağlık sorunudur. Tedavi edilmediğinde vasküler yapılarda aterosklerotik değişikliklere yol açarak başta sistemik hipertansiyon, kardiyak aritmiler, koroner arter hastalığı, kalp yetmezliği ve ani ölüm gibi ciddi kardiyovasküler komplikasyonlara neden olur. Ayrıca KOAH ve astım gibi akciğer hastalıklarıyla (Overlap Sendromu) birliktelik gösterir, inme riskini ve gündüz aşırı uykululuk haline bağlı motorlu taşıt ve iş kazalarını önemli ölçüde artırır. Depresyon gibi psikiyatrik, insülin direnci gibi metabolik, gastroözofageal reflü, noktüri ve pıhtılaşma bozuklukları gibi nefrolojik ve hematolojik sonuçlar doğurur. Teşhis ve tedavisinde gecikilmemesi gereken bu sendromda continuous positive airway pressure (CPAP) kullanımı, kan basıncını düşürmede, kardiyak fonksiyonları düzeltmede, astım ataklarını ve trafik kazası maliyetlerini azaltmada yüksek klinik ve sosyoekonomik başarı sağlamaktadır.
Obstructive Sleep Apnea Syndrome (OSAS) is a chronic inflammatory health condition characterized by recurrent upper airway collapse and intermittent hypoxia during sleep, impacting multiple organ systems. If left untreated, it triggers atherosclerotic changes in vascular structures, leading to severe cardiovascular complications such as systemic hypertension, cardiac arrhythmias, coronary artery disease, heart failure, and sudden death. Furthermore, it coexists with pulmonary diseases like COPD and asthma (Overlap Syndrome), significantly increasing the risk of stroke, as well as motor vehicle and occupational accidents due to daytime sleepiness. OSAS also results in psychiatric issues like depression, metabolic disfunctions such as insulin resistance, gastroesophageal reflux, and nephrological or hematological disorders like nocturia and hypercoagulability. Early diagnosis and intervention are critical, where continuous positive airway pressure (CPAP) therapy demonstrates substantial clinical and socioeconomic success by lowering blood pressure, improving cardiac functions, preventing asthma attacks, and reducing traffic accident costs.
Referanslar
Abbasi A, Gupta SS, Sabharwal N, Meghrajani V, Sharma S, Kamholz S, et al. A comprehensive review of obstructive sleep apnea. Sleep Sci. 2021;14(2):142-54.
Ryan S, Taylor CT, McNicholas WT. Systemic inflammation: a key factor in the pathogenesis of cardiovascular complications in obstructive sleep apnoea syndrome? Postgrad Med J. 2009;85(1010):693-8.
Phillips B. Sleep-disordered breathing and cardiovascular disease. Sleep Med Rev. 2005;9(2):131-40.
Sova M, Sovova E, Hobzova M, Zapletalova J, Kamasova M, Kolek V. The effect of continuous positive airway pressure therapy on the prevalence of masked hypertension in obstructive sleep apnea patients. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2015;159(2):277-82.
Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med. 2000;342(19):1378-84.
Shamsuzzaman AS, Gersh BJ, Somers VK. Obstructive sleep apnea: implications for cardiac and vascular disease. JAMA. 2003;290(14):1906-14.
Fava C, Dorigoni S, Dalle Vedove F, Danese E, Montagnana M, Guidi GC, et al. Effect of CPAP on blood pressure in patients with OSA/hypopnea a systematic review and meta-analysis. Chest. 2014;145(4):762-71.
Javaheri S, Barbe F, Campos-Rodriguez F, Dempsey JA, Khayat R, Javaheri S, et al. Sleep Apnea: Types, Mechanisms, and Clinical Cardiovascular Consequences. J Am Coll Cardiol. 2017;69(7):841-58.
Geovanini GR, Lorenzi-Filho G. Cardiac rhythm disorders in obstructive sleep apnea. J Thorac Dis. 2018;10(Suppl 34):S4221-S30.
Guilleminault C, Connolly SJ, Winkle RA. Cardiac arrhythmia and conduction disturbances during sleep in 400 patients with sleep apnea syndrome. Am J Cardiol. 1983;52(5):490-4.
Gottlieb DJ, Yenokyan G, Newman AB, O'Connor GT, Punjabi NM, Quan SF, et al. Prospective study of obstructive sleep apnea and incident coronary heart disease and heart failure: the sleep heart health study. Circulation. 2010;122(4):352-60.
Mooe T, Rabben T, Wiklund U, Franklin KA, Eriksson P. Sleep-disordered breathing in men with coronary artery disease. Chest. 1996;109(3):659-63.
Hung J, Whitford EG, Parsons RW, Hillman DR. Association of sleep apnoea with myocardial infarction in men. Lancet. 1990;336(8710):261-4.
Hanly P, Sasson Z, Zuberi N, Lunn K. ST-segment depression during sleep in obstructive sleep apnea. Am J Cardiol. 1993;71(15):1341-5.
Peled N, Abinader EG, Pillar G, Sharif D, Lavie P. Nocturnal ischemic events in patients with obstructive sleep apnea syndrome and ischemic heart disease: effects of continuous positive air pressure treatment. J Am Coll Cardiol. 1999;34(6):1744-9.
Arias MA, Garcia-Rio F, Alonso-Fernandez A, Mediano O, Martinez I, Villamor J. Obstructive sleep apnea syndrome affects left ventricular diastolic function: effects of nasal continuous positive airway pressure in men. Circulation. 2005;112(3):375-83.
Nieto FJ, Young TB, Lind BK, Shahar E, Samet JM, Redline S, et al. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. JAMA. 2000;283(14):1829-36.
Laaban JP, Pascal-Sebaoun S, Bloch E, Orvoen-Frija E, Oppert JM, Huchon G. Left ventricular systolic dysfunction in patients with obstructive sleep apnea syndrome. Chest. 2002;122(4):1133-8.
Kaneko Y, Floras JS, Usui K, Plante J, Tkacova R, Kubo T, et al. Cardiovascular effects of continuous positive airway pressure in patients with heart failure and obstructive sleep apnea. N Engl J Med. 2003;348(13):1233-41.
Agusti AG, Sauleda J, Miralles C, Gomez C, Togores B, Sala E, et al. Skeletal muscle apoptosis and weight loss in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2002;166(4):485-9.
Nadel JA, Widdicombe JG. Reflex effects of upper airway irritation on total lung resistance and blood pressure. J Appl Physiol. 1962;17:861-5.
Marin JM, Soriano JB, Carrizo SJ, Boldova A, Celli BR. Outcomes in patients with chronic obstructive pulmonary disease and obstructive sleep apnea: the overlap syndrome. Am J Respir Crit Care Med. 2010;182(3):325-31.
Lin CC, Lin CY. Obstructive sleep apnea syndrome and bronchial hyperreactivity. Lung. 1995;173(2):117-26.
Arter JL, Chi DS, M G, Fitzgerald SM, Guha B, Krishnaswamy G. Obstructive sleep apnea, inflammation, and cardiopulmonary disease. Front Biosci. 2004;9:2892-900.
Tsai JC. Neurological and neurobehavioral sequelae of obstructive sleep apnea. NeuroRehabilitation. 2010;26(1):85-94.
Valham F, Mooe T, Rabben T, Stenlund H, Wiklund U, Franklin KA. Increased risk of stroke in patients with coronary artery disease and sleep apnea: a 10-year follow-up. Circulation. 2008;118(9):955-60.
Dong R, Dong Z, Liu H, Shi F, Du J. Prevalence, Risk Factors, Outcomes, and Treatment of Obstructive Sleep Apnea in Patients with Cerebrovascular Disease: A Systematic Review. J Stroke Cerebrovasc Dis. 2018;27(6):1471-80.
Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med. 2005;353(19):2034-41.
Adams N, Strauss M, Schluchter M, Redline S. Relation of measures of sleep-disordered breathing to neuropsychological functioning. Am J Respir Crit Care Med. 2001;163(7):1626-31.
Schroder CM, O'Hara R. Depression and Obstructive Sleep Apnea (OSA). Ann Gen Psychiatry. 2005;4:13.
Shepertycky MR, Banno K, Kryger MH. Differences between men and women in the clinical presentation of patients diagnosed with obstructive sleep apnea syndrome. Sleep. 2005;28(3):309-14.
Kim DH, Kim B, Han K, Kim SW. The relationship between metabolic syndrome and obstructive sleep apnea syndrome: a nationwide population-based study. Sci Rep. 2021;11(1):8751.
Song SO, He K, Narla RR, Kang HG, Ryu HU, Boyko EJ. Metabolic Consequences of Obstructive Sleep Apnea Especially Pertaining to Diabetes Mellitus and Insulin Sensitivity. Diabetes Metab J. 2019;43(2):144-55.
Lavie L. Oxidative stress--a unifying paradigm in obstructive sleep apnea and comorbidities. Prog Cardiovasc Dis. 2009;51(4):303-12.
Polotsky VY, Li J, Punjabi NM, Rubin AE, Smith PL, Schwartz AR, et al. Intermittent hypoxia increases insulin resistance in genetically obese mice. J Physiol. 2003;552(Pt 1):253-64.
Li J, Nanayakkara A, Jun J, Savransky V, Polotsky VY. Effect of deficiency in SREBP cleavage-activating protein on lipid metabolism during intermittent hypoxia. Physiol Genomics. 2007;31(2):273-80.
Li J, Savransky V, Nanayakkara A, Smith PL, O'Donnell CP, Polotsky VY. Hyperlipidemia and lipid peroxidation are dependent on the severity of chronic intermittent hypoxia. J Appl Physiol (1985). 2007;102(2):557-63.
Oh JH. Gastroesophageal reflux disease: recent advances and its association with sleep. Ann N Y Acad Sci. 2016;1380(1):195-203.
Bortolotti M, Gentilini L, Morselli C, Giovannini M. Obstructive sleep apnoea is improved by a prolonged treatment of gastrooesophageal reflux with omeprazole. Dig Liver Dis. 2006;38(2):78-81.
Kang HH, Lim CH, Oh JH, Cho MJ, Lee SH. The Influence of Gastroesophageal Reflux Disease on Daytime Sleepiness and Depressive Symptom in Patients With Obstructive Sleep Apnea. J Neurogastroenterol Motil. 2021;27(2):215-22.
Arisoy A, Sertogullarindan B, Ekin S, Ozgokce M, Bulut MD, Huyut MT, et al. Sleep Apnea and Fatty Liver Are Coupled Via Energy Metabolism. Med Sci Monit. 2016;22:908-13.
Yalkut D, Lee LY, Grider J, Jorgensen M, Jackson B, Ott C. Mechanism of atrial natriuretic peptide release with increased inspiratory resistance. J Lab Clin Med. 1996;128(3):322-8.
Krieger J, Petiau C, Sforza E, Delanoe C, Hecht MT, Chamouard V. Nocturnal pollakiuria is a symptom of obstructive sleep apnea. Urol Int. 1993;50(2):93-7.
Rodenstein DO, D'Odemont JP, Pieters T, Aubert-Tulkens G. Diurnal and nocturnal diuresis and natriuresis in obstructive sleep apnea. Effects of nasal continuous positive airway pressure therapy. Am Rev Respir Dis. 1992;145(6):1367-71.
Patwardhan AA, Larson MG, Levy D, Benjamin EJ, Leip EP, Keyes MJ, et al. Obstructive sleep apnea and plasma natriuretic peptide levels in a community-based sample. Sleep. 2006;29(10):1301-6.
Vizioli L, Muscari S, Muscari A. The relationship of mean platelet volume with the risk and prognosis of cardiovascular diseases. Int J Clin Pract. 2009;63(10):1509-15.
Robinson GV, Pepperell JC, Segal HC, Davies RJ, Stradling JR. Circulating cardiovascular risk factors in obstructive sleep apnoea: data from randomised controlled trials. Thorax. 2004;59(9):777-82.
Liak C, Fitzpatrick M. Coagulability in obstructive sleep apnea. Can Respir J. 2011;18(6):338-48.
Banno K, Ramsey C, Walld R, Kryger MH. Expenditure on health care in obese women with and without sleep apnea. Sleep. 2009;32(2):247-52.
Ellen RL, Marshall SC, Palayew M, Molnar FJ, Wilson KG, Man-Son-Hing M. Systematic review of motor vehicle crash risk in persons with sleep apnea. J Clin Sleep Med. 2006;2(2):193-200.
Sassani A, Findley LJ, Kryger M, Goldlust E, George C, Davidson TM. Reducing motor-vehicle collisions, costs, and fatalities by treating obstructive sleep apnea syndrome. Sleep. 2004;27(3):453-8.
Lindberg E, Carter N, Gislason T, Janson C. Role of snoring and daytime sleepiness in occupational accidents. Am J Respir Crit Care Med. 2001;164(11):2031-5.
Keenan TD, Goldacre R, Goldacre MJ. Associations between obstructive sleep apnoea, primary open angle glaucoma and age-related macular degeneration: record linkage study. Br J Ophthalmol. 2017;101(2):155-9.
Faridi O, Park SC, Liebmann JM, Ritch R. Glaucoma and obstructive sleep apnoea syndrome. Clin Exp Ophthalmol. 2012;40(4):408-19.
Pepin JL, Chiquet C, Tamisier R, Levy P, Almanjoumi A, Romanet JP. Frequent loss of nyctohemeral rhythm of intraocular pressure restored by nCPAP treatment in patients with severe apnea. Arch Ophthalmol. 2010;128(10):1257-63.
Martines F, Ballacchino A, Sireci F, Mucia M, La Mattina E, Rizzo S, et al. Audiologic profile of OSAS and simple snoring patients: the effect of chronic nocturnal intermittent hypoxia on auditory function. Eur Arch Otorhinolaryngol. 2016;273(6):1419-24.
Sardesai MG, Tan AK, Fitzpatrick M. Noise-induced hearing loss in snorers and their bed partners. J Otolaryngol. 2003;32(3):141-5.
