ARTERIJSKA ELASTIČNOST U PACIJENATA S TEŠKOM OPSTRUKCIJSKOM APNEJOM TIJEKOM SPAVANJA

Objectives: Obstructive sleep apnea (OSA) could have detrimental effects on overall patients’ health. Moreover, OSA without other comorbidities may contribute to the increased risk of cardiovascular disease. The aim of the present study was to compare arterial stiffness parameters and laboratory parameters between severe OSA patients and healthy control subjects. Patients and methods: This study included 70 participants in total, 35 OSA patients and 35 healthy controls. All OSA patients underwent full-night polysomnography at the Split Sleep Medicine Centre. Venous blood samples were obtained from each participant after a fasting time of 12 hours. High sensitivity C-reactive protein (hsCRP) was determined by the immunoturbidimetric method on Architect c16200 system (Abbott, Chicago, IL, USA). Haemoglobin A1c (HbA1c) levels were measured by using high-performance liquid chromatography (HPLC) (Tosoh G8, Tosoh Bioscience, Tokyo, Japan). Total cholesterol, HDL, LDL and triglyceride levels were analysed by using standard laboratory methods (ARCHITECT ci16200, Abbott, Chicago, IL, USA). Tonometric measurements of arterial stiffness was performed by a trained physician using SphygmoCor (Version 8.1; AtCor Medical, Inc., Sydney, Australia). Readings of pulse wave velocity (PWV), peripheral and central augmentation index (pAIx, cAIx), central systolic blood pressure were obtained. Results: OSA group had elevated values of hsCRP (2.6 ± 1.2 vs. 1.1 ± 0.8 mg/L, P <0.001) and HbA1c (5.6 ± 0.4 vs. 5.4 ± 0.2 %, P=0.006), when compared to control group. Furthermore, HDL concentration was lower in OSA patients when compared to healthy controls, 1.1 ± 0.2 vs. 1.3.±.0.3 mmol/L, P<0.001. Statistically significant higher values of cAIx (26.3 ± 8.8 vs. 18.8 ± 9.0, P <0.001) and PWV (9.8 ± 3.1 vs. 7.4 ± 2.2, P <0.001) parameters were observed in OSA patients when compared to control group. PWV parameter showed positive correlation with AHI (r=0.476, P=0.003) and negative with minimum SpO2 (r=-0.369, P=0.029). PWV parameter showed positive correlation with neck circumference (r=0.406, P <0.001) and hsCRP (r=0.398, P <0.001). cAIx showed positive correlation with neck circumference (r=0.307, P=0.009). Conclusion: The higher values of cAIx and PWV parameters were observed in OSA patients, in comparison to control group. However, future studies are needed to elucidate connection between sleep apnea and impairment of arterial stiffness.Cilj: Opstrukcijska apneja tijekom spavanja (OSA) može imati negativne učinke na zdravlje pacijenata. Nadalje, OSA bez drugih komorbiditete može doprinijeti povećanom riziku od kardiovaskularnih bolesti. Cilj ovog istraživanja je usporediti parametre arterijske elastičnosti i laboratorijske nalaze u pacijenata s teškom OSA-om i zdravih ispitanika. Ispitanici i metode: U istraživanje je uključeno 70 ispitanika, 35 OSA pacijenata i 35 zdravih kontrolnih ispitanika. Svi OSA pacijenti bili su podvrgnuti cjelonoćnoj polisomnografiji u Centru za medicinu spavanja Split. Svim ispitanicima su izuzeti venski uzorci krvi nakon 12-satnog posta. Visoko osjetljivi C-reaktivni protein (hsCRP) je određen imunoturbidimetrijskom metodom na Architect c16200 sustavu (Abbott, Chicago, IL, USA). Hemoglobin A1c (HbA1c) je mjeren korištenjem visoko učinkovite tekućinske kromatografije (Tosoh G8, Tosoh Bioscience, Tokyo, Japan). Ukupni kolesterol, HDL, LDL i trigliceridi su analizirane koristeći standardne laboratorijske metode (ARCHITECT ci16200, Abbott, Chicago, IL, USA). Tonometrijska mjerenja arterijske elastičnosti proveo je obučeni liječnik koristeći SphygmoCor (Version 8.1; AtCor Medical, Inc., Sydney, Australia). Provedena su mjerenja brzine pulsnog vala (PWV), perifernog i centralnog augmentacijskog indeksa (pAIx, cAIx) te centralnog sistoličkog tlaka. Rezultati: OSA pacijenti imali su povišene vrijednosti hsCRP (2,6 ± 1,2 naprema 1,1 ± 0.8 mg/L, P <0,001) i HbA1c (5,6 ± 0,4 naprema 5,4 ± 0,2 %, P=0,006), u usporedbi s kontrolnom skupinom. Nadalje, koncentracija HDL-a bila je niža u OSA pacijenata u usporedbi sa zdravim kontrolama, 1,1 ± 0,2 naprema 1,3 ± 0,3 mmol/L, P<0,001. Statistički značajno više vrijednosti cAIx (26,3 ± 8,8 naprema 18,8 ± 9,0, P <0,001) i PWV (9,8 ± 3,1 naprema 7,4 ± 2,2, P <0,001) su opažene u OSA pacijenata, u usporedbi s kontrolnom skupinom. PWV je pozitivno korelirao s AHI (r=0,476, P=0,003), a negativno s minimalnim SpO2 (r=-0,369, P=0,029). PWV je pokazao pozitivnu korelaciju s opsegom vrata (r=0,406, P <0,001) i hsCRP (r=0,398, P