Obstructive sleep apnea syndrome (OSAS) is a chronic disease ranging from innocuous to lifethreatening .It results in excessive daytime sleepiness, impaired quality of life, and is associated
with an increased risk of cardiovascular disease and neurocognitive impairment .
Objective: To investigate the possible associations between sleep apnea syndrome, insulin
resistance, serum leptin level and other inflammatory cytokines mainly TNFα, IL6 and to
evaluate the role of surgical management on the OSA pattern, oxygen saturation, leptin level
and inflammatory cytokines.
Subjects and methods: Twenty eight obese patients with OSA (as patient study group), 20
obese subjects with no OSA (as patient control group) and 20 healthy normal weight subjects
(as healthy control group) were included in this study from ENT department of Benha and Ain
Shams Universities. Polysomnography studies were carried out on OSA patients and on the
obese control subjects. ENT examination , flexible nasopharyngolaryngoscopy and CT to
assess site of obstruction. Of OSAS group twenty eight patients were candidates for surgery(8
patients for nasal surgery 6 bilateral nasal polypi and 2 for septorhinoplasty for gross
deformation ) , other 20 patients were candidates for uvulopalatoplasty ( UPP) alone or
uvulopalatopharyngoplasty ( UPPP). Success is defined as complete response (AHI,< 10) or
partial response(AHI0.001) respectively).TNFα,
IL6 and serum leptin were significantly higher in obese patients with OSA than in obese and
normal weight control subjects (5.2±0.11, 3.9±0.43 and 23.3±1.3 (p>0.001) respectively). After 6
months of management , there was a non significant reduction of BMI (36.7±5.63 vs.
2
34.3±4.91), TNFα (5.2±0.11 vs. 5.1±0.3) and IL6 (3.9±0.43 vs. 3.7±0.62), however there was a
significant reduction of serum leptin (23.3±1.3 vs. 18.2±0.1 (p>0.001)), HOMA-IR (8.57±2.8 vs.
6.61±1.9 (p>0.001)) as well as an improvement of oxygen saturation (68.2±2.3 vs. 75.2±2.4
(p>0.001)).
Conclusion: Sleep apnea syndrome is associated with high serum leptin, TNFα and IL6.
Successful surgical management leads to improvement of both oxygen saturation and insulin
resistance, with a significant decrease of hyperleptinemia. |
