Karamanlı Harun, Özol Duygu, Ugur K Serife, Yıldırım Zeki, Armutçu Ferah, Bozkurt Bulent, Yigitoglu Ramazan
Department of Respiratory Medicine, Fatih University Medical School, Ankara, Turkey.
Sleep Breath. 2014 May;18(2):251-6. doi: 10.1007/s11325-012-0761-8. Epub 2012 Sep 4.
Obstructive sleep apnea syndrome (OSAS) is characterized by recurrent respiratory disorders in the upper airways during sleep. Although continuous positive airway pressure (CPAP) has been accepted to be the most effective treatment for OSAS, its role on inflammation remains debatable. In this study, our aim was to examine the influence of 3 months of CPAP treatment on tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), 8-isoprostane, and peroxynitrite levels in exhaled breathing condensates (EBC) and serum.
Thirty-five patients who were newly diagnosed as moderate or severe OSAS with full night polysomnography and used CPAP therapy regularly for 3 months were included in the study. Polysomnography, spirometric tests, fasting blood samples, and EBC were ascertained on entry into the study and after 3 months of treatment. All patients were assessed monthly for treatment adherence and side effects.
We found that all polysomnographic parameters were normalized after CPAP therapy in the control polysomnogram. Also, all markers in EBC and nitrotyrosine and 8-isoprostane levels in serum were decreased significantly with CPAP treatment. Sedimentation rate, C-reactive protein, IL-6, and TNF-α remained unchanged in serum after treatment. We found that baseline nitrotyrosine levels were significantly correlated with apnea-hypopnea index, oxygen desaturation index, and percent time in SpO2 < 90 % (p < 0.01).
CPAP therapy has primarily a relevant impact on airways, and nitrotyrosine levels correlated well with severity of OSAS. This treatment decreases both inflammation and oxidative stress levels in airways in OSAS patients. Also, this treatment helps to decrease systemic oxidative stress levels in serum.
阻塞性睡眠呼吸暂停综合征（OSAS）的特征是睡眠期间上呼吸道反复出现呼吸紊乱。尽管持续气道正压通气（CPAP）已被公认为治疗OSAS最有效的方法，但其对炎症的作用仍存在争议。在本研究中，我们的目的是探讨3个月的CPAP治疗对呼出气体冷凝物（EBC）和血清中肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、8-异前列腺素和过氧亚硝酸盐水平的影响。
本研究纳入了35例经全夜多导睡眠图新诊断为中度或重度OSAS且规律使用CPAP治疗3个月的患者。在研究开始时和治疗3个月后进行多导睡眠图检查、肺功能测试、空腹血样采集和EBC检测。每月对所有患者进行治疗依从性和副作用评估。
我们发现，在对照多导睡眠图中，CPAP治疗后所有多导睡眠图参数均恢复正常。此外，CPAP治疗后EBC中的所有标志物以及血清中的硝基酪氨酸和8-异前列腺素水平均显著降低。治疗后血清中的血沉、C反应蛋白、IL-6和TNF-α保持不变。我们发现基线硝基酪氨酸水平与呼吸暂停低通气指数、氧饱和度下降指数以及SpO2<90%的时间百分比显著相关（p<0.01）。
CPAP治疗主要对气道有显著影响，硝基酪氨酸水平与OSAS的严重程度密切相关。这种治疗可降低OSAS患者气道中的炎症和氧化应激水平。此外，这种治疗有助于降低血清中的全身氧化应激水平。
