) Basit Horlama
F. SONUÇ VE YORUM
Obstrüktif Uyku Apne Sendromu (OUAS), popülasyonun %24’ünde asemptomatik olarak izlenmesi, uyku polikliniklerine başvuran hastalar arasında %21-90 arasında görülmesi ve son yıllarda obezitenin de artması dolayısıyla sık karşılaşılan bir sağlık problemi olarak karşımıza çıkmaktadır.Horlama, tanıklı apne, gündüz aşırı uyku hali, yetersiz uyku gibi başlıca semptomlarla başvuran hastalarda, intermitan hipoksi, siklik desaturasyonlar ve katekolaminlerdeki artışa bağlı olarak etkilenen uyku-uyanıklık döngüsü, beraberindesistemik hipertansiyon, ateroskleroz, endotel disfonksiyonu, insülin direnci ve otonomik disfonksiyon gibi değişiklikler; koroner kalp hastalığı, inme, konjestif kalp yetmezliği gibi yaşamı tehdit eden komorbiditelerve hatta ölüm ile sonuçlanabilmektedir. Benzer mekanizmalarla OUAS’nun okülovasküler sağlığı etkileyerek oküler bozukluklara da neden olabileceğindenyola çıkarak yürütülen bu çalışmada, OUAS’lu hastalarda göz yaşı ve oküler yüzey değişiklikleri, meibom gland disfonksiyonu varlığı ile birlikte, kornea biyomekaniği ve kornea endotel değişikliklerini; retina sinir lifi tabakası ve koroid kalınlık ölçümlerini hastalık şiddetine göre ve kontrol grubuyla karşılaştırmalı olarak araştırıldı. OUAS’lu hastalarda özellikle gözyaşı ve oküler yüzey sağlığının kontrol grubuyla karşılaştırıldığında etkilenmiş olduğu ve bu etkinin OUAS’nun şiddetiyle artmakta olduğu belirlendi. Schirmer 1 test değerlerinde değişiklik görülmemesi, bununla birlikte t-BUT’un kısa, üst ve total meiboskor değerlerinin anlamlı olarak yüksek izlenmesi, OUAS’lu hastalarda meibom gland disfonksiyonu ve evaporatif tipte kuru göz sendromunun varlığını destekler nitelikteydi. OUAS’un şiddeti arttıkça oküler yüzey sağlığındaki bozulmanın daha ileri derecede olmasına ek olarak, FES ile daha sık karşılaşıldığı belirlendi. Ayrıca FES’lu hastalarda, benzer OUAS şiddetine sahip FES izlenmeyen hastalarla karşılaştırıldığında özellikle konjonktivoşalazisin anlamlı olarak daha sık ve ciddi olduğu saptanırken, göz yaşı kalitesi ve oküler yüzey sağlığı ile ilişkili bulgularda anlamlı farklılık görülmedi. Ancak semptomların değerlendirildiği OSDI skoru, FES’lu hastalarda anlamlı olarak daha yüksek idi. Bunun birlikte, hastalar kontrol grubuyla ve OUAS’nun şiddetine göre kıyaslandığında korneanın topografik vebiyomekanik özelliklerinin, kornea endotel
değişikliklerinin ve total retina sinir lifi tabakası ölçümlerinin anlamlı farlılık göstermediği gözlendi.Subfoveal koroid kalınlık ölçümlerinde ise, anlamlı olmamakla birlikte artan OUAS şiddetiyle korele bir azalma olduğu belirlendi.
Sonuç olarak, OUAS sistemik patofizyolojik mekanizmalar üzerinden oküler sağlığı da etkileyen bir hastalıktır. Belirgin olarak gözyaşı ve oküler yüzey sağlığında ortaya çıkan bu değişiklikler, bu hastaların ilk planda kuru göz sendromu açısından değerlendirilmeleri ve uygun tedavilerin başlanması gerekliliğini ortaya koymaktadır. Bununla birlikte, OUAS’nun pek çok sistemik komorbitedeye yol açabileceği düşünüldüğünde, bu hastalarda özellikle artan OUAS şiddetiyle birlikte farklı oküler değişikliklerin de ortaya çıkabileceği ve bunun daha şiddetli olarak görülebileceği akılda tutulmalıdır. Dolayısıyla OUAS’lu hastaların tanı anından itibaren oküler değişiklikler açısından sorgulanması ve izlenmesi önem arz etmektedir.
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