Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Selçuk University, Konya, 42075, Turkey.
Department of Chest Disease, Faculty of Medicine, Selçuk University, Konya, Turkey.
Eur Arch Otorhinolaryngol. 2020 Jan;277(1):37-46. doi: 10.1007/s00405-019-05654-8. Epub 2019 Sep 21.
Our study aimed to evaluate the effects of chronic hypoxic state in Obstructive Sleep Apnea Syndrome (OSAS) on brainstem pathways using Vestibular Evoked Myogenic Potential (VEMP) test and to investigate the presence of new markers likely to be correlated with the severity of the disease.
The study was planned as prospective and double blind. A total of 60 patients (120 ears) diagnosed with mild, moderate and severe OSAS were included in the study and the patients are grouped as 20 patients in each group. Twenty volunteer healthy individuals (40 ears) shown to be without OSAS were included in the study. VEMP measurements were made in 60 study group patients (120 ears) and in 20 healthy controls (40 ears). The groups were compared in terms of variables such as the acquisition rate of oVEMP and cVEMP waves, interval between the waves, latency and amplitude of the waves. p < 0.05 values were considered as significant.
The results of cVEMP test showed that the rate of wave acquisition in the moderate and severe OSAS groups was significantly lower than the control group and mild OSAS groups (p = 0.008). There was no difference between the control group and the mild OSAS group in terms of the rate of obtaining the wave (p > 0.05). In the moderate and severe OSAS groups, P1N1 amplitude and N1P2 amplitude values were found to be significantly lower than the mild OSAS group (p = 0.007 and p = 0.017, respectively). In the oVEMP test, there was no significant difference between the mild OSAS group and the control group in terms of the wave yield (p > 0.05); however, it was found that the rate of wave acquisition in the moderate and severe OSAS groups was significantly lower than the mild OSAS group (p = 0.041). There was inverse correlation between the N1P2 interval and P1N1 amplitude value and AHI in simple regression analysis and multiple regression analysis (p = 0.012 and p = 0.021; p = 0.009 and p = 0.040, respectively).
The negative effects of chronic intermittent hypoxia related with OSAS on the brainstem and vestibular system can be demonstrated by VEMP tests. Especially, the inability to obtain the wave is the most important finding showing this situation. Also, we think that N1P2 interval and P1N1 amplitude markers can be used to detect the subclinical negative effect of chronic hypoxia on vestibular nuclei in the brainstem.
本研究旨在通过前庭诱发肌源性电位（VEMP）测试评估阻塞性睡眠呼吸暂停综合征（OSAS）患者慢性低氧状态对脑干通路的影响，并探讨可能与疾病严重程度相关的新标志物。
本研究为前瞻性、双盲研究。共纳入 60 例（120 耳）轻度、中度和重度 OSAS 患者，并将患者分为每组 20 例。同时纳入 20 例无 OSAS 的健康志愿者（40 耳）作为对照组。对 60 例研究组患者（120 耳）和 20 例健康对照组（40 耳）进行 VEMP 测量。比较各组间 oVEMP 和 cVEMP 波获取率、波间潜伏期和波幅等变量。p 值<0.05 认为有统计学意义。
cVEMP 测试结果显示，中重度 OSAS 组的波获取率明显低于对照组和轻度 OSAS 组（p=0.008）。对照组和轻度 OSAS 组间的波获取率无差异（p>0.05）。中重度 OSAS 组中，P1N1 振幅和 N1P2 振幅值明显低于轻度 OSAS 组（p=0.007 和 p=0.017）。oVEMP 测试中，轻度 OSAS 组与对照组间的波获取率无差异（p>0.05）；然而，中重度 OSAS 组的波获取率明显低于轻度 OSAS 组（p=0.041）。在简单回归分析和多元回归分析中，N1P2 潜伏期和 P1N1 振幅值与 AHI 呈负相关（p=0.012 和 p=0.021；p=0.009 和 p=0.040）。
VEMP 测试可显示与 OSAS 相关的慢性间歇性低氧对脑干和前庭系统的负面影响。特别是无法获取波是最能显示这种情况的重要发现。此外，我们认为 N1P2 潜伏期和 P1N1 振幅标志物可用于检测脑干前庭核亚临床慢性低氧的负面效应。
