Hipotalamik Obezite ile Obstrüktif Uyku Apnesi İlişkisi

Abstract

Hypothalamus is an important regulator of sleep onset, sleep maintenance and wakefulness. Hypothalamic damage can be complicated by sleep dysregulation in addition to metabolic abnormalities including hypothalamic obesity, dyslipidemia and increased insulin resistance. Given the disturbances in hypothalamic damage, frequency of sleep apnea in hypothalamic obese patients can be more than exogenous obese subjects. We hypothesized that hypothalamic obese patients would be more prone to obstructive sleep apnea syndrome (OSAS) in comparison to exogenous obese subjects. Thus, we aim to compare frequency and severity of obstructive sleep apnea (OSA) with hypothalamic and exogenous obesity in children. Prospective, cross sectional study consisted of 14 hypothalamic obese children in study group and 30 exogenous obese children in control group was done in patients visiting Hacettepe University Ihsan Dogramaci Children’s Hospital Pediatric Endocrinology Clinic from January 2017 to December 2017 and firstly accepting to participate the study. Patients’ age were 14,58 ± 4,44 (6,1 – 18,6) in hypothalamic obesity group and13,08 ± 3,16 (6,6 – 17,1) in exogenous obesity group. Distributions of age and sex were similar within two groups. There were 10 craniopharyngiomas, 2 suprasellar non-glial tumors, 1 septo-optic dyslasia and 1 patient with damaged hypothalamus and hydrocephalus due to sequela of meningoencephalitis in hypothalamic obesity group. All of the craniopharyngioma patients were operated at least once and all of them had multiple hypophyseal hormone deficiency. Body mass indexes (BMI) and BMI z scores were founded higher in exogenous obesity group than hypothalamic obesity group. No differences was detected in hypertension, dyslipidemia, levels of fasting blood glucose, insulin, ratios of fasting blood glucose to insulin, hsCRP, TNFα, Mallampati scores and scoring of sleepiness between two groups. There were no correlation of degree of obstructive sleep apnea with hypertension, insulin resistance, dyslipidemia or levels of inflammatory markers. The apnea-hypopnea indexes (AHI) of hypothalamic obesity group were found higher than AHI of exogenous obesity group in full-night polysomnography. After adjusting for age, sex and BMI z score; the odss of OSA increased 4,4 fold for hypothalamic obese subjects in multivariant analysis. As a result, risk of OSA is found significantly increased in hypothalamic obesity group than exogenous obesity group. Therefore performing of polysomnography is suggested to all of the obese craniopharyngioma patients even without a complaint of sleepiness.

This study of thesis is financially supported by Hacettepe University Scientific Research Projects Coordination Unit (project code of THD-2017-13930) within ‘‘Rapid Support’’.