Uyku apne sendromu olan olgularda edı modunda optik koherens tomografi ile koroid kalınlıklarının değerlendirilmesi
Choroidal thickness evaluation by spectral domain optic coherence tomography in subjects with sleep apnea syndrome
Yazar: MUSTAFA ÖZKÖSE
Danışman: DOÇ. DR. HATİCE ARDA
Erciyes Üniversitesi / Tıp Fakültesi / Göz Hastalıkları Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2016
Konu: Göz Hastalıkları = Eye Diseases
Dizin: Koroid = Choroid ; Retina = Retina ; Sinir lifleri = Nerve fibers ; Tomografi-optik koherens = Tomography-optical coherence ; Uyku = Sleep ; Uyku apne sendromları = Sleep apnea syndromes ; Uyku bozuklukları = Sleep disorders

Özet:
Amaç: Herhangi bir retinal patalojisi olmayan uyku apne sendromu hastalarında enhaced depth imaging optik koherens tomografi (EDI-OKT) ile koroid kalınlığının (KK) ve retina sinir lifi tabakası (RSLT) kalınlığının ölçümlerinin değerlendirilmesi.
Gereç ve Yöntemler: Bu prospektif çalışma yeni tanılı, tedavi olmamış 34 obstrüktif uyku apne sendromu (OUAS) hastasının 68 gözünü ve yaş, cinsiyet, ve beden kitle indeksi uyumlu 20 kontrol grubununun 40 gözünü içermektedir. Erciyes Üniversitesi Tıp Fakültesi Nöroloji polikliniğine başvuran ve polisomnografi (PSG) testi uygulanan hastalar apne hipopne indeksi (AHİ) değerlerine göre hafif 5≤AHI<15, orta (15≤AHI<30) ve ciddi (30≥AHI) olarak 3 gruba ayrıldı. Kontrol grubu ise 5 0.05). Hafif OUAS grubunda inferior KK 3000 µm değeri (301.6 ± 54.0µm) orta OUAS (239.4 ± 66.0µm) ve ağır OUAS (256.0 ± 46.7µm) grubundan anlamlı (p ˂ 0.05) olarak daha yüksekti. Koroid kalınlıklarıyla yaş arasında negatif korelasyon bulunurken, refraksiyon değeri ve aksiyel uzunluk arasında korelasyon yoktu. Orta OUAS grubunda nazal RSLT değeri (82.6 ± 7.5) kontrol grubu (71.8 ± 9.0) ve hafif OUAS grubundan (68.6 ± 11.9) anlamlı (p ˂ 0.05) olarak daha yüksek bulundu. Hafif OUAS grubunda temporal İnferior RSLT değeri (128.8 ± 23.7) kontrol grubundan (146.4 ± 15.6) , orta OUAS grubundan (108.7 ± 28.0) ve ağır OUAS grubundan (151.0 ± 25.5 ) anlamlı (p ˂ 0.05) olarak daha düşüktü. AHİ index ile nazal koroid kalınlığı 1000µm değeri arasında anlamlı (p ˂0.05) negatif korelasyon mevcuttu. AHİ index ile temporal, nazal, superior, inferior koroid kalınlığı 3000µm değeri arasında anlamlı (p ˂0.05) negatif korelasyon mevcuttu.
Sonuç: OUAS hastalarında azalmış koroid kalınlığı bu hastalıkla ilişkilli olan otonomik disregülasyona bağlı olabilir. Artan RSLT kalınlığı bu çalışmaya alınan hastaların yaş ortalamasının düşük olmasından kaynaklanıyor olabilir. RSLT kalınlğının azalışını yeni tanı konulan hastaların takibi ile gösterebilmek mümkün olabilir.

Abstract:
Purpose: To assess the retinal nerve fiber layer (RNFL) and choroidal thickness (CT) change in patients with obstructive sleep-apnea syndrome (OSAS) with no significiant symptoms and pathological changes in the retina.
Materials and Methods: This prospective study consisted of 68 eyes of 34 patients with obstructive sleep apnea syndrome (OSAS) and 40 eyes of 20 controls those were matched 1:1 with OSAS for age, sex and body-mass index (BMI) controls. Patients suspected of clinically of having obstructive sleep-apnea syndrome (OSAS) examinated and underwent standart Polysomnography (PSG) in the sleep unit of the neurology department of our university. OSAS was diagnosed and  graded according to the Apnea-hipopnea index (AHI)  values. Diagnosis of OSAS was made when the AHI value was over 5. When the AHI was between 5 and 15, OSAS was regarded as "mild", when it was between 16 and 30 as "moderate", and when it was over than 30, it was regarded as "severe". Subjects that have AHI<5 value were included as control subjects that were matched 1:1with OSAS patients for body mass index (BMI), and age. Also, all patients  underwent a detailed ophthalmic examination. Choroidal thickness (CT) was  measured by optical coherence tomography (OCT) and axial length (AL)  was also measured.For CT measurements 9 points were chosen ; subfovea, 1000µm (1mm) nazal, 1000µm temporal, 1000µm superior, 1000µm inferior, 3000µm (3mm) nasal, 3000µm temporal, 3000µ superior, 3000µm inferior to the fovea.
Results: The mean age of the control group  was 41.6 ± 11.4 years, it was 44.2 ± 11.5 years in the mild OSAS, 48.4 ± 11.4 in moderate OSAS, and 45.4 ± 10.6 in severe OSAS. There was no significant difference between control group  and OSAS groups  for the choroidal thickness (CT) (P>0.05) .The CT  of the 3mm  inferior to the fovea was found significantly thicker in the mild OSAS (301.6 ± 54.0µm) compared with the moderate (239.4 ± 66.0µm) and severe group (256.0 ± 46.7µm) (p ˂ 0.05). There was a negative correlation between the CT and age. There was no correlation between the CT, AL and refraction. There was a statistically significant difference in nasal RNFL thickness and it was thicker in the moderate group (82.6 ± 7.5µm) compared with the control group (71.8 ± 9.0µm) and mild group (68.6 ± 11.9) (p ˂ 0.05). The temporal-inferior RNFL thickness was significantly thinner in the mild group (128.8 ± 23.7µm) than those of the control (146.4 ± 15.6) , moderate (108.7 ± 28.0µm) and severe group (151.0 ± 25.5µm) (p ˂ 0.05). The AHI was significantly and negatively correlated (p ˂ 0.05) with the choroidal thickness of the 1mm  nasal to the fovea and 3mm temporal, nasal and superior to the fovea.
Conclusion: The decreased choroidal thickness of the patients with OSAS might be related to the autonomic disregulation associated with this disease. The increased RNFL thickness might be related to low  mean age in our subjects. Follow up studies are more likely to explain possible RNFL decrease in this patients.