Yavaş Koroner Akım Tanısı Alan Obstruktif Uyku Apnesi Hastalarında Fiziksel İnaktivite ve Obezite Birlikteliği: Yaşam Tarzı Değişikliği Gereksinimi

Yıl 2019, Cilt: 7 Sayı: 2, 91 - 96, 02.02.2019

Esin Yalcınkaya Ayaydın , Ersin Saricam

Öz

Fiziksel inaktivite ve sağlıksız beslenme alışkanlıkları içeren yaşam tarzı obeziteye neden olmaktadır. Obezite hastalarında artışla birlikte obstruktif uyku apnesi sendromu sıklığı da artmaktadır. Obstrüktif uyku apnesi tedavi edilmezse kardiovaskuler mortalite ve morbidite artışına sebep olmaktadır. Bu çalışmada yavaş koroner akım tanısı konulan obstrüktif uyku apnesi hastalarında obezite ve fiziksel inaktivite birlikteliği araştırılmıştır. Gereç ve Yöntem: 4515 hastanın koroner anjiyografisi sonrası, 316 hasta yavaş koroner akım tanısı almıştır. Bu hastalar, kulak burun boğaz hastalıkları uzmanı tarafından değerlendirilmiş ve Berlin anketi kullanılarak 276 hastaya obstrüktif uyku apnesi tanısı konulmuştur. Obstrüktif uyku apnesi tanısı olan 276 hasta obezite ve fiziksel inaktivite açısından araştırılmıştır. Obezite tanısı Dünya Sağlık Örgütü (DSÖ) kurallarına göre Vücut Kitle İndeksi (VKİ) esas alınarak konulmuştur. Hastaların fiziksel inaktivite düzeyi ise Uluslararası Fiziksel Aktivite anketi-Kısa Form (UFAA-KF) ile değerlendirilmiştir. Sonuçlar: Çalışma grubu 276 hastadan oluşturuldu (188 erkek, 88 kadın). Ortalama yaş 48.48 ±7.61 yıl idi. Bu hastaların VKİ ortalamaları 33.02±2.18 kg/m2 olarak belirlendi. 276 hastanın 258'inde DSÖ kriterlerine göre obezite (VKİ> 30 kg/m2) saptandı. UFAA-KF skoruna göre hastaların %74 ü inaktif, %17 düşük seviyede aktif, %9 u aktifti. Tartışma: Yavaş koroner akımlı obstrüktif uyku apne hastalarında obezite ve fiziksel inaktivite birlikteliği saptandı. Fiziksel aktivitenin ve sağlıklı beslenme alışkanlıklarının arttırılması şeklinde yaşam tarzı değişiklikleri öneriyoruz.

Anahtar Kelimeler

Yavaş koroner akım, Obezite, Obstrüktif uyku apnesi, Yaşam tarzı değişikliği

The Coexistence of Obesity and Physical Inactivity in Obstructive Sleep Apnea Patients with Slow Coronary Flow: Lifestyle Change Requirement

Öz

Life style characteristics including physical inactivity and unhealthy eating cause obesity. With rising obesity, the number of people suffering from obstructive sleep apnea (OSA) syndrome is also increasing. If untreated, OSA causes increased cardiovascular morbidity and mortality. This study examined coexistence of obesity and physical inactivity in the OSA patients which were diagnosed with slow coronary flow. Material and Methods: After coronary angiography of 4515 patients, 316 patients were diagnosed with slow coronary flow. These patients were examined by an ear nose throat specialist and 276 patients were diagnosed in terms of OSA by using Berlin questionnaire (BQ). Control group patients (n=40) had normal coronary artery, which means they did not have slow coronary flow. Two hundred seventy-six patients with OSA were investigated for obesity and physical inactivity. The diagnosis of obesity was based on the Body Mass Index (BMI) according to the rules of the World Health Organization. Physical activity levels of the patients were evaluated with the International Physical Activity Questionnaire-Short Form (IPAQ, the short form). Results: The study group consisted of 276 patients (188 males, 88 females). The mean ages of the study group were 48.48 ±7.61 years. Of 276 patients, 258 patients were obese (BMI >30 kg/m2) according to WHO criteria. Mean BMI in the study group patients was 33.02±2.18 kg/m2. According to IPAQ-short form, 74% patients were inactive, 17% patients had low level activity, and 9% patients were active. Conclusion: We determined that obesity and physical inactivity coexist in OSA patients with slow coronary flow. Therefore, we recommend lifestyle changes, including increasing physical activity and healthy dietary habits to prevent obesity. 

Anahtar Kelimeler

Slow coronary flow, Obesity, Obstructive sleep apnea, Lifestyle changes

Kaynakça

• Referans 1-Lloyd-Jones DM, Hong Y, Labarthe D, Mozaffarian D, Appel LJ, Van Horn L, Greenlund K, Daniels S, Nichol G, Tomaselli GF, Arnett DK, Fonarow GC, Ho PM, Lauer MS, Masoudi FA, Robertson RM, Roger V, Schwamm LH, Sorlie P, Yancy CW, Rosamond WD; American Heart Association Strategic Planning Task Force and Statistics Committee. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association's strategic Impact Goal through 2020 and beyond. Circulation. 2010 Feb 2; 121(4):586-613.
• Referans 2-Stefan, N.; Schick, F.; Haring, H.U. Causes, Characteristics, and Consequences of Metabolically Unhealthy Normal Weight in Humans. Cell Metab. 2017, 26, 292–300.
• Referans 3-Canoy D, Boekholdt S.M, Wareham N, Luben R, Welch A, Bingham S, Buchan I, Day N, Khaw K.T. Body fat distribution and risk of coronary heart disease in men and women in the European Prospective Investigation Into Cancer and Nutrition in Norfolk cohort: A population-based prospective study. Circulation 2007, 116, 2933–2943.
• Referans 4-Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. JAMA 2012; 307:491–497.
• Referans 5-Flemons WW. Clinical practice. Obstructive sleep apnea. N Engl J Med 2002; 347:498–504.
• Referans 6-Jennum P, Riha RL. Epidemiology of sleep apnea/hypopnea syndrome and sleep-disordered breathing. Eur Respir J 2009; 33:907–14.
• Referans 7-Punjabi NM, Caffo BS, Goodwin JL, Gottlieb DJ, Newman AB, O'Connor GT, Rapoport DM, Redline S, Resnick HE, Robbins JA, Shahar E, Unruh ML, Samet JM. Sleep-disordered breathing and mortality: a prospective cohort study. PLoS Med. 2009; 6(8):e1000132.
• Referans 8-World Health Organization: Obesity: Preventing and Managing the Global Epidemic. Report of a WHO Consultation. WHO Technical Report Series, No 894. Geneva, World Health Organization, 2000.
• Referans 9-Gibson CM, Cannon CP, Daley WL, et al. TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation 1996; 93:879-88.
• Referans10-Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med. 1999; 131:485–491.
• Referans 11-Murphy EL, Schlumpf K, Wright DJ, Cable R, Roback J, Sacher R, Busch MP. NHLBI Retrovirus Epidemiology Donor Study II. BMI and obesity in US blood donors: a potential public health role for the blood centre. Public Health Nutr. 2012 Jun; (6):964-71.
• Referans12-Olshansky SJ, Passaro DJ, Hershow RC, et al. A potential decline in life expectancy in the United States in the 21st century. N Engl J Med. 2005; 352:1138–1145.
• Referans 13-Arnett DK, McGovern PG, Jacobs DR Jr, et al. Fifteen-year trends in cardiovascular risk factors (1980–1982 through 1995–1997): the Minnesota Heart Survey. Am J Epidemiol. 2002; 156:929– 935.
• Referans14-Alberti KG, Eckel RH, Grundy SM, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International association for the Study of Obesity. Circulation 2009; 120:1640-5.
• Referans15-Ford ES. Risks for all-cause mortality, cardiovascular disease, and diabetes associated with the metabolic syndrome: a summary of the evidence. Diabetes Care 2005; 28:1769-78.
• Referans16-Lam JC, Mak JC, Ip MS. Obesity, obstructive sleep apnea and metabolic syndrome. Respirology 2012; 17:223-36.
• Referans17-Dewan NA, Nieto FJ, Somers VK. Intermittent hypoxemia and OSA: implications for comorbidities. Chest. 2015; 147(1):266-274.
• Referans18- Somers VK, Mark AL, Zavala DC, Abboud FM. Influence of ventilation and hypocapnia on sympathetic nerve responses to hypoxia in normal humans . J Appl Physiol (1985). 1989; 67 (5):2095 – 2100.
• Referans 19- Somers VK, Dyken ME, Clary MP, Abboud FM. Sympathetic neural mechanisms in obstructive sleep apnea. J Clin Invest. 1995; 96 (4):1897 – 1904.
• Referans 20- Salord N, Gasa M, Mayos M, Fortuna-Gutierrez AM, Montserrat JM, Sánchez-de-la-Torre M, Barceló A, Barbé F, Vilarrasa N, Monasterio C. Impact of OSA on biological markers in morbid obesity and metabolic syndrome. J Clin Sleep Med. 2014 Mar 15; 10(3):263-70.
• Referans 21-Saglam M, Arikan H, Savci S, Inal-Ince D, Bosnak-Guclu M, Karabulut E, Tokgozoglu L. International physical activity questionnaire: reliability and validity of the Turkish version. Percept Mot Skills. 2010 Aug; 111(1):278-84.
• Referans 22-Craig CL, Marshall AL, Sjöström M, Bauman AE, Booth ML, Ainsworth BE, Pratt M, Ekelund U, Yngve A, Sallis JF, Oja P: International physical activity questionnaire: 12-Country reliability and validity. Medicine and Science in Sports and Exercise 2003, 35:1381-1395.