Obstrüktif uyku apne sendromlu hastalarda CPAP (Continuous Positive Airway Pressure), egzersiz ve diyetin egzersiz kapasitesi üzerine etkisi.
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Dosyalar
Tarih
2021
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç. Bu çalışmada; ağır dereceli obstrüktif uyku apneli (OUAS) hastalarda CPAP tedavisi ve
CPAP tedavisine ek olarak uygulanan egzersiz ve diyet uygulamasının egzersiz kapasitesi,
solunum fonksiyonları ve biyokimyasal parametreler üzerine etkisinin değerlendirilmesi
amaçlanmıştır.
Yöntem. Konya Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi Göğüs Hastalıkları Kliniği
Uyku Laboratuvarı ve Pulmoner Rehabilitasyon bölümünde Haziran 2019 tarihinden sonra OUAS
nedeniyle takip edilen 30 hasta çalışmaya dahil edildi. Yeni tanı almış 15 ağır dereceli OUAS
olgusu ve ağır dereceli OUAS’lı ve en az 3 aydır CPAP tedavisi almaktayken 12 hafta boyunca
CPAP tedavisine ek olarak pulmoner rehabilitasyon ve diyet polikliniği kontrolünde diyet ve
egzersiz yapan hasta grupları çalışmaya dahil edilmiştir.
Bulgular. Olguların %43,3’ü kadın, yaş ortalaması 49,03 ± 12,23, VKİ ortalaması 34,01 ± 5,05’ti.
Tedavi almayan grup ile karşılaştırıldığında, CPAP tedavisi alan olguların FVC değeri (p=0,003), 6
dakikada yürüdüğü mesafe (p=0,003) ve tahmin edilen mesafe yüzdesi (p=0,002) anlamlı düzeyde
daha fazla, bitiş BORG skoru ve EUS skor ortalaması anlamlı düzeyde daha düşüktü (sırasıyla
p=0,006 ve p<0,001). 3 Ay CPAP tedavisi alan ve almayan OUAS gruplarının polisomnografileri
karşılaştırıldığında uyku etkinliği ve NREM3 oranı dışında tüm parametrelerde istatistiki olarak
anlamlı düzelme mevcuttu (Tüm p<0.05). Gruplar arasında biyokimyasal değerler açısından fark
yoktu (Tüm p>0.05). 3 ay boyunca sadece CPAP tedavisi verildikten sonraki sonuçlar ile
karşılaştırıldığında, 3 ay boyunca CPAP tedavisine ek olarak diyet ve egzersiz yapan grupta, VKİ,
kan basıncı, CRP, insülin, proBNP, kolesterol, VLDL, trigliserid, glukoz, BORG skoru, EUS skoru
istatistiksel olarak anlamlı düzeyde azalırken (p<0,05), HDL, FEV1, FVC, ortalama SpO2 ve
NREM3 % değerleri istatistiksel olarak anlamlı düzeyde artmıştı (p<0,05) 6DYT sonuçları
incelendiğinde sadece CPAP tedavisi sonuçları ile karşılaştırıldığında, 3 ay boyunca CPAP
tedavisine ek olarak diyet ve egzersiz yapan olguların bitiş kalp hızı anlamlı düzeyde azalırken,
başlangıç ve bitiş SpO2, 6 dakikada yürüdüğü mesafe ve tahmin edilen mesafe yüzdesi değerleri
istatistiksel olarak anlamlı düzeyde artmıştı (p<0,05). CPAP+Egzersiz ve diyet tedavisi sonrasında
VKİ’deki değişim ile EUS değişimi arasında, 6DYT’deki değişim ile NREM3% ve SpO2 düzeyi
(r=0,571, p=0,025).değişimleri arasında istatistiksel olarak anlamlı, pozitif yönde, orta düzeyde
korelasyon ilişkisi olduğu saptandı. Tedavi almayan olgularda, CPAP tedavisi sonrası olumlu
olarak değiştiği belirlenen parametreler arasından EUS ile tahmin edilen mesafe yüzdesi arasında
istatistiksel olarak anlamlı düzeyde negatif yönde orta düzeyde, FVC ile 6 dakikada yürüdüğü
mesafe arasında pozitif yönde yüksek düzeyde korelasyon ilişkisi olduğu saptandı.
Sonuç. Çalışmamızda OUAS olgularında CPAP tedavisine ek olarak egzersiz ve diyet
uygulamalarının hastaların egzersiz kapasitesi başta olmak üzere gündüz aşırı uyku hallerinde, kan
basıncı, CRP, insülin, proBNP, kolesterol, VLDL, trigliserid, glukoz, BORG skoru değerlerinde
düzelmeye neden olduğu, OUAS’a bağlı metabolik ve kardiyak komorbiditelerin azaltılmasında
egzersiz ve diyetin tek başına CPAP tan daha etkili olduğu belirlendi.
Aim. In this study; We aimed to evaluate the effects of exercise and diet application applied in addition to CPAP treatment and CPAP treatment on exercise capacity, respiratory functions and biochemical parameters in patients with severe obstructive sleep apnea (OSAS). Method. Thirty patients who were followed up for OSAS in Konya Necmettin Erbakan University Meram Medical Faculty Chest Diseases Clinic Sleep Laboratory and Pulmonary Rehabilitation Department after June 2019 were included in the study. Fifteen newly diagnosed patients with severe OSAS and patients with severe OSAS who had been receiving CPAP treatment for at least 3 months, and who used diet and exercise under the control of pulmonary rehabilitation and diet polyclinic in addition to CPAP for 12 weeks were included in the study. Results. 43.3% of the cases were female, the mean age was 49.03 ± 12.23 and the mean BMI was 34.01 ± 5.05. Compared to the group who did not receive treatment, the FVC value (p = 0.003), distance walked in 6 minutes (p = 0.003) and the percentage of estimated distance (p = 0.002) were significantly higher in patients who received CPAP treatment, and the end BORG score and EUS score mean were significantly higher. levels were lower (p = 0.006 and p <0.001, respectively). When the polysomnographies of OSAS groups with and without CPAP for 3 months were compared, there was a statistically significant improvement in all parameters except sleep efficiency and NREM3 ratio (All p <0.05). There was no difference between the groups in terms of biochemical values (All p> 0.05). Compared with the results after only CPAP treatment for 3 months, BMI, blood pressure, CRP, insulin, proBNP, cholesterol, VLDL, triglyceride, glucose, BORG score, EUS score were statistically HDL, FEV1, FVC, mean SpO2 and NREM3% values were statistically significantly increased (p <0.05). When 6MWT results were examined, only CPAP treatment results were compared with CPAP for 3 months. While the end heart rate decreased significantly in the patients who did diet and exercise in addition to their treatment, the values of SpO2 at the beginning and end, the distance walked in 6 minutes and the percentage of estimated distance increased statistically (p <0.05). There is a statistically significant, positive, moderate correlation between the change in BMI after CPAP + exercise and diet therapy and the change in EUS, the change in 6MWT and the changes in NREM3% and SpO2 level (r = 0.571, p = 0.025). was detected. Among the parameters determined to be positively changed after CPAP treatment, it was found that there was a statistically significant negative correlation between the percentage of distance estimated by EUS, and a high level of positive correlation between the FVC and the distance walked in 6 minutes. Conclusion. In our study, in OSAS cases, exercise and diet applications in addition to CPAP treatment led to improvement in the patients' excessive daytime sleepiness, especially the exercise capacity, blood pressure, CRP, insulin, proBNP, cholesterol, VLDL, triglyceride, glucose, BORG score values. Exercise and diet alone were found to be more effective than CPAP in reducing metabolic and cardiac comorbidities
Aim. In this study; We aimed to evaluate the effects of exercise and diet application applied in addition to CPAP treatment and CPAP treatment on exercise capacity, respiratory functions and biochemical parameters in patients with severe obstructive sleep apnea (OSAS). Method. Thirty patients who were followed up for OSAS in Konya Necmettin Erbakan University Meram Medical Faculty Chest Diseases Clinic Sleep Laboratory and Pulmonary Rehabilitation Department after June 2019 were included in the study. Fifteen newly diagnosed patients with severe OSAS and patients with severe OSAS who had been receiving CPAP treatment for at least 3 months, and who used diet and exercise under the control of pulmonary rehabilitation and diet polyclinic in addition to CPAP for 12 weeks were included in the study. Results. 43.3% of the cases were female, the mean age was 49.03 ± 12.23 and the mean BMI was 34.01 ± 5.05. Compared to the group who did not receive treatment, the FVC value (p = 0.003), distance walked in 6 minutes (p = 0.003) and the percentage of estimated distance (p = 0.002) were significantly higher in patients who received CPAP treatment, and the end BORG score and EUS score mean were significantly higher. levels were lower (p = 0.006 and p <0.001, respectively). When the polysomnographies of OSAS groups with and without CPAP for 3 months were compared, there was a statistically significant improvement in all parameters except sleep efficiency and NREM3 ratio (All p <0.05). There was no difference between the groups in terms of biochemical values (All p> 0.05). Compared with the results after only CPAP treatment for 3 months, BMI, blood pressure, CRP, insulin, proBNP, cholesterol, VLDL, triglyceride, glucose, BORG score, EUS score were statistically HDL, FEV1, FVC, mean SpO2 and NREM3% values were statistically significantly increased (p <0.05). When 6MWT results were examined, only CPAP treatment results were compared with CPAP for 3 months. While the end heart rate decreased significantly in the patients who did diet and exercise in addition to their treatment, the values of SpO2 at the beginning and end, the distance walked in 6 minutes and the percentage of estimated distance increased statistically (p <0.05). There is a statistically significant, positive, moderate correlation between the change in BMI after CPAP + exercise and diet therapy and the change in EUS, the change in 6MWT and the changes in NREM3% and SpO2 level (r = 0.571, p = 0.025). was detected. Among the parameters determined to be positively changed after CPAP treatment, it was found that there was a statistically significant negative correlation between the percentage of distance estimated by EUS, and a high level of positive correlation between the FVC and the distance walked in 6 minutes. Conclusion. In our study, in OSAS cases, exercise and diet applications in addition to CPAP treatment led to improvement in the patients' excessive daytime sleepiness, especially the exercise capacity, blood pressure, CRP, insulin, proBNP, cholesterol, VLDL, triglyceride, glucose, BORG score values. Exercise and diet alone were found to be more effective than CPAP in reducing metabolic and cardiac comorbidities
Açıklama
Anahtar Kelimeler
Obstrüktif Uyku Apne Sendromu, Sürekli Pozitif Havayolu Basıncı, Egzersiz, Diyet, Egzersiz kapasitesi, Obstructive Sleep Apnea Syndrome, Continuous Positive Airway Pressure, Exercise, Diet, Exercise capacity
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Türker, I. (2021). Obstrüktif uyku apne sendromlu hastalarda CPAP (Continuous Positive Airway Pressure), egzersiz ve diyetin egzersiz kapasitesi üzerine etkisi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Göğüs Hastalıkları Anabilim Dalı, Konya.
