医学课件 effect of cpap treatment on hypoadiponectinemia in male patients with obstructive sleep apnea syndrome

Effect of CPAP treatment on hypoadiponectinemia in male patients with obstructive sleep apnea syndrome Zhang Xilong, Yin Kaisheng Tha First Affiliated Hospital of Nanjing Medical University, Nanjing, China,Research Background Adiponectin, secreted by adipocytes, has been found recently to be associated with diabetes, obesity and some cardiovascular diseases. Recent research suggested that obstructive sleep apnea syndrome (OSAS) might be independently associated with hypoadiponectinemia, which was linked to some complications of OSAS, such as hypertension, diabetes, etc.,Objective To investigate the effect of continuous positive airway pressure (CPAP) treatment on serum diponectine levels in male OSAS patients.,METHODS,Diagnosis of OSAS A Compumedic polysomnographer was used to measure and record overnight polysomnography (PSG) parameters. The mininal criteria for diagnosis of SAS is apnea hypopnea index (AHI)5. The event was considered obstructive when chest and abdominal respiratory movements existed during apnea.,Subjects 23 adult male patients with moderate or severe OSAS Age : 41.411.8 yrs (38 64 yrs ) BMI : 24.72.1,2,The exclusion criteria: type 2 diabetes or FBG 7.0mg/L BMI 28 cardiovascular diseases other chronic respiratory diseases,Test of serum adiponectin Three ml of venous blood was drawn at 7:00am following 12 hours overnight fasting. Serum adiponectin level was measured by radioimmunoassay. The agent kit for adiponectin testing was provided by LINCO Research Inc, USA.,Their blood samples were collected and mean arterial pressure (MAP, diastolic Bp + 1/3 pulse pressure)was measured at 6:00 A.M. before CPAP treatment on day 3, day 7, day 14 of CPAP treatment,RESULT,Comparison of serum adiponectin levels, AHI and MAP before and after CPAP treatment (xs )(n=23) - AHI MAP adipolectin (mmHg) (mg/L) - before CPAP 28.25.8 101.28.1 3.950.21 day 3 of CPAP 2.20.6 * 98.87.6 4.010.27 day 7 of CPAP 2.30.8 * 96.78.2 4.040.32 day 14 of CPAP 1.90.6 * 90.56.7 * 4.460.46* - * : P 0.05 vs before CPAP treatment; * : P0.01 vs before CPAP treatment MAP: mean arterial pressure= diastolic Bp + 1/3 pulse pressure, P 0.01, P 0.01,DISCUSSION,Different serum adiponectin levels based on different AHI in OSAS patients, P 0.05, P 0.01, P 0.05,Multiple biological functions of adiponectin - anti-inflammation, anti-atherosclerosis, increase in sensitivity to insulin, decrease in insulin resistance and so on.,Reasons causing lower serum adiponectin levels in OSAS a) OSAS SaO2 and arousals sympathetic nervous system activity ( beta adrenergic receptor agonist can inhibit the expression of adiponectin gene, decreased adiponectin secretion). Delporte ML, et al. Biochem J 2002; 367:677. b) OSAS interlukin-6 (IL-6) adiponectin secretion and expression Yokoe T, et al. Circulation, 2003, 107:1129. c) OSAS tumor necrosis facor-(TNF-) adiponectin secretion and expression Hatipoglu U, et al. Respiration 2003; 70:665,Common explanation for pathogenesis of OSAS-associated hypertension: 1) increase in sympathetic nerve system caused by recurrent hypoxia and arousals 2) increased level of blood vasoconstrictors - catecholamine, renin-angiotension-adolesterone, endothelin Problem: CPAP treatment can decrease the MAP as well as the above circulating vasoconstrictors, but usually they do not change simultaneously,b, P 0.01,CONCLUSION,1. OSAS should be an independ