Obstrüktif uyku apne sendromlu hastalarda oküler değişikliklerin ve meibografi eşliğinde meibom gland disfonksiyonunun araştırılması
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Tarih
2018
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Ege Üniversitesi, Tıp Fakültesi
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info:eu-repo/semantics/openAccess
Özet
AMAÇ: Obstrüktif Uyku Apne Sendromu (OUAS) prevalansı, son yıllarda obezitenin artmasıyla daha da artmaktadır. İntermitan hipoksi, siklik desaturasyonlar ve katekolaminlerdeki artış gibi OUAS'daki patofizyolojik mekanizmaların okülovasküler sağlığı da etkilediği belirtilmektedir. Bu çalışmada, OUAS'lu hastalarda göz yaşı ve oküler yüzey değişiklikleri, meibom gland disfonksiyonu (MGD) varlığı ile birlikte, kornea biyomekaniği ve kornea endotel değişikliklerinin, ayrıca retina sinir lifi tabakası (RSLT) ve subfoveal koroid kalınlık (SFKK) ölçümlerinin hastalık şiddetine göre ve kontrol grubuyla karşılaştırmalı olarak araştırılması amaçlanmıştır. GEREÇ ve YÖNTEM: Ege Üniversitesi Tıp Fakültesi Hastanesi (EÜTFH) Göğüs Hastalıkları AD Uyku Polikliniğine Mart 2016 ile Mayıs 2017 tarihleri arasında başvuran ve Polisomnografik ve/veya Poligrafik değerlendirme sonucunda 15 Basit Horlama ve 57 OUAS (hafif, orta ve ağır OUAS; sırasıyla 9, 12 ve 36 hasta) tanısı alan olgu çalışmaya dahil edildi. Tüm hastalarda tam bir oftalmolojik muayeneyi takiben gözyaşı testleri (Schirmer ve t-BUT) araştırıldı. Kornea topografisi, kornea biyomekaniği, endotel hücre morfolojisi, RSLT ve SFKK ölçümleri belirlendi. Meibografi ile MGD değerlendirildi. İstatistiksel analizlerde, hafif OUAS & Basit Horlama (Grup 1), orta OUAS (Grup 2) ve ağır OUAS (Grup 3) gruplarına ait veriler karşılaştırıldı. BULGULAR: Çalışmaya dahil edilen hastaların ortalama yaşı Grup 1 (13 erkek, 11 kadın), Grup 2 (11 erkek, 1 kadın) ve Grup 3 (28 erkek, 8 kadın)'de sırasıyla 47.9±10.5 (27-69), 51.5±12.9 (26-69) ve 50.8±8.3 (35-68) idi. Anterior ve vertikal distraksiyon mesafeleri, ağır OUAS'lularda anlamlı olarak daha yüksek izlendi (p<0.05, Kruskal Wallis test). OUAS şiddeti arttıkça, üst (Grup 1, 2 ve 3'te sırasıyla; 0.8±0.9 (0-3), 1.1±1.6 (0-4) ve 1.8±1.9 (0-8)) ve total (Grup 1, 2 ve 3'te sırasıyla; 1.1±2.2 (0-6), 1.8± 2.2(0-6) ve 2.8±2.3 (0-11)) meiboskorun anlamlı olarak arttığı, t-BUT (11.5±5.1 (4-24), 10.1±5.8 (4-18) ve 7.1±6.5 (2-17)) azaldığı saptandı (p<0.05, Kruskal Wallis test). t-BUT ile üst ve total meboskor değerleri arasında orta düzeyde negatif korelasyon mevcuttu (Spearman korelasyon katsayısı (r)=-0.425, p<0.001 and r=-0.352, p=0.002). Kornea topografik ve biyomekanik özellikleri, endotel hücre morfolojisi ölçümleri ve SFKK açısından gruplar arasında fark görülmedi (p>0.05, Kruskal Wallis test). RSLT'yla ilgili olarak, inferonazal RSLT kalınlığının ağır OUAS'lularda anlamlı olarak daha ince olduğu izlenirken(Grup 1, 2 ve 3'te sırasıyla; 129.23.6 (80.0-168.5), 116.4±25.3 (71.5-167.5) ve 102.9±18.9 (63.5-144.0)), diğer kadranlarda anlamlı fark saptanmadı. SONUÇ: OUAS'lu hastalarda MGD görülmekte olup MGD hastalık şiddetiyle korelasyon göstermektedir. Kornea topografisi, kornea biyomekaniği, endotel hücre morfolojisi, SFKK açısından gruplar arasında anlamlı fark izlenmezken, inferonazal RSLT kalınlığının OUAS şiddeti arttıkça anlamlı bir şekilde azaldığı belirlenmiştir.
PURPOSE: Recently, the prevalence of obstructive sleep apnea syndrome (OSAS) is increasing as obesity is seen more frequently. Pathophysiological mechanisms, such as intermittent hypoxia, cyclic desaturations and increased level of catecholamines, underlying OSAS has also an impact on oculovascular health. In this study, our aim is to investigate tear film and ocular surface abnormalities, meibomian gland dysfunction (MGD), along with corneal topographical and biomechanical properties, corneal endothelial cell morphology and to evaluate retinal nerve fiber layer (RNFL) and subfoveal choroidal thickness (SFCT) in OSAS patients, as compared with controls. MATERIALS and METHODS: Fifteen patients with simple snoring and 57 patients with OSAS (mild, moderate and severe OSAS; 9, 12 and 36 patients, respectively) according to polysomongraphic and/or polygraphic evaluation, who admitted to EUTF Department of Pulmonology, Sleep Laboratory from March 2016 to May 2017, were enrolled. Complete ophthalmological examination along with tear film tests (Scihrmer and t-BUT) were investigated. Corneal topographical and biomechanical properties, measurements of endothelial cell morphology, RNFL and SFCT were determined. MGD was evaluated with meibography. For statistical analysis, datas of simple snoring & mild OSAS (Group 1), moderate OSAS (Group 2) and severe OSAS (Group 3) were compared. RESULTS: The mean age of the patients was 47.9±10.5 (27-69), 51.5±12.9 (26-69) and 50.8±8.3 (35-68) in Group 1 (Male to Female ratio (M:F)=13/11), Group 2 (M:F=11/1) and Group 3 (M:F=28/8), respectively. Anterior and vertical distraction distance were significantly higher in patients with severe OSAS (p<0.05, Kruskal Wallis test). As severity of OSAS increases, upper (0.8±0.9 (0-3), 1.1±1.6 (0-4) and 1.8±1.9 (0-8) in Group 1, 2 and 3, respectively) and total (1.1±2.2 (0-6), 1.8± 2.2(0-6) and 2.8±2.3 (0-11) in Group 1, 2 and 3, respectively) meiboscores increase and t-BUT (11.5±5.1 (4-24), 10.1±5.8 (4-18) and 7.1±6.5 (2-17)in Group 1, 2 and 3, respectively) decreases significantly (p<0.05, Kruskal Wallis test). t-BUT was in moderate negative correlation with upper and total meiboscore (Spearman’s rho (r)=-0.425, p<0.001 and r=-0.352, p=0.002). Corneal topographical and biomechanical properties, measurements of endothelial cell morphology and SFCT did not differ significantly (p>0.05, Kruskal Wallis test). In terms of RNFL, inferonasal RNFL thickness (129.23.6 (80.0-168.5), 116.4±25.3 (71.5-167.5) and 102.9±18.9 (63.5-144.0) in Group 1, 2 and 3, respectively) was significantly lower in severe OSAS, while other quadrants showed no difference. CONCLUSION: In patients with OSAS, MGD is present and correlated with the severity of the disease. While there is no significant difference between groups, in terms of corneal topographical and biomechanical properties, corneal endothelial cell features and SFCT; significant decrement in inferonasal RNFL thickness was determined, as the OSAS severity increased.
PURPOSE: Recently, the prevalence of obstructive sleep apnea syndrome (OSAS) is increasing as obesity is seen more frequently. Pathophysiological mechanisms, such as intermittent hypoxia, cyclic desaturations and increased level of catecholamines, underlying OSAS has also an impact on oculovascular health. In this study, our aim is to investigate tear film and ocular surface abnormalities, meibomian gland dysfunction (MGD), along with corneal topographical and biomechanical properties, corneal endothelial cell morphology and to evaluate retinal nerve fiber layer (RNFL) and subfoveal choroidal thickness (SFCT) in OSAS patients, as compared with controls. MATERIALS and METHODS: Fifteen patients with simple snoring and 57 patients with OSAS (mild, moderate and severe OSAS; 9, 12 and 36 patients, respectively) according to polysomongraphic and/or polygraphic evaluation, who admitted to EUTF Department of Pulmonology, Sleep Laboratory from March 2016 to May 2017, were enrolled. Complete ophthalmological examination along with tear film tests (Scihrmer and t-BUT) were investigated. Corneal topographical and biomechanical properties, measurements of endothelial cell morphology, RNFL and SFCT were determined. MGD was evaluated with meibography. For statistical analysis, datas of simple snoring & mild OSAS (Group 1), moderate OSAS (Group 2) and severe OSAS (Group 3) were compared. RESULTS: The mean age of the patients was 47.9±10.5 (27-69), 51.5±12.9 (26-69) and 50.8±8.3 (35-68) in Group 1 (Male to Female ratio (M:F)=13/11), Group 2 (M:F=11/1) and Group 3 (M:F=28/8), respectively. Anterior and vertical distraction distance were significantly higher in patients with severe OSAS (p<0.05, Kruskal Wallis test). As severity of OSAS increases, upper (0.8±0.9 (0-3), 1.1±1.6 (0-4) and 1.8±1.9 (0-8) in Group 1, 2 and 3, respectively) and total (1.1±2.2 (0-6), 1.8± 2.2(0-6) and 2.8±2.3 (0-11) in Group 1, 2 and 3, respectively) meiboscores increase and t-BUT (11.5±5.1 (4-24), 10.1±5.8 (4-18) and 7.1±6.5 (2-17)in Group 1, 2 and 3, respectively) decreases significantly (p<0.05, Kruskal Wallis test). t-BUT was in moderate negative correlation with upper and total meiboscore (Spearman’s rho (r)=-0.425, p<0.001 and r=-0.352, p=0.002). Corneal topographical and biomechanical properties, measurements of endothelial cell morphology and SFCT did not differ significantly (p>0.05, Kruskal Wallis test). In terms of RNFL, inferonasal RNFL thickness (129.23.6 (80.0-168.5), 116.4±25.3 (71.5-167.5) and 102.9±18.9 (63.5-144.0) in Group 1, 2 and 3, respectively) was significantly lower in severe OSAS, while other quadrants showed no difference. CONCLUSION: In patients with OSAS, MGD is present and correlated with the severity of the disease. While there is no significant difference between groups, in terms of corneal topographical and biomechanical properties, corneal endothelial cell features and SFCT; significant decrement in inferonasal RNFL thickness was determined, as the OSAS severity increased.
Açıklama
Anahtar Kelimeler
Obstrüktif Uyku Apne Sendromu, OUAS, Non-Kontakt Meibografi, Meibom Gland Disfonksiyonu, Kuru Göz, Obstructive Sleep Apnea Syndrome, OSAS, Non-Contact Meibography, Meibom Gland Dysfunction, Dry Eye
