Utjecaj kontinuiranoga pozitivnoga tlaka zraka na dišne puteve bolesnika s opstruktivnom apnejom u spavanju na vrijednost inhibitora plazminogenskoga aktivatora-1

doctoral thesis

• Title (english): Influence of continuous positive airway pressure in patients with obstructive sleep apnea on plasminogen activator inhibitor-1 value
• Author: Tea Friščić
• Mentor: Edvard Galić (mentor)
• Committee member: Joško Bulum (predsjednik povjerenstva)
• Committee member: Marina Boban (član povjerenstva)
• Committee member: Sanja Popović-Grle (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2024-01-23, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine
• Universal decimal classification (UDC): 616 - Pathology. Clinical medicine

Abstract

Opstruktivna apneja u spavanju (OSA) je poremećaj spavanja koji dovodi do povećanog rizika za razvoj kardiovaskularnih bolesti (KVB). Kontinuirani pozitivni tlak zraka (CPAP) koristi se u liječenju srednje teškog i teškog stupnja OSA. Svrha istraživanja bila je istražiti utjecaj CPAP terapije na kardiovaskularni sustav mjerenjem vrijednosti inhibitora plazminogenskoga aktivatora-1 (PAI-1), N-terminalnog prohormon moždanog natriuretskog peptida (NTproBNP), krvnog tlaka tijekom noćnih sati, varijabilnost srčanog ritma i dužinu QTc intervala. U istraživanje je inicijalno uključeno 58 ispitanika s teškim stupnjem OSA, a nakon najmanje 6 mjeseci CPAP terapije, kod 37 ispitanika je utvrđena zadovoljavajuća adherencija te su njihovi podaci uključeni su u daljnju analizu. Srednja dob ispitanika je bila 53 ± 10 godina. Većina ispitanika bila je muškog spola (78%), a 27% njih bili su pušači. Najčešći komorbiditeti bili su arterijska hipertenzija (51%) i šećerna bolest (16%). Vrijednosti koncentracije PAI-1 prije i nakon CPAP terapije nisu se statistički značajno razlikovale (P=0.9367), no nađen je statistički značajan pad vrijednosti NTproBNP-a (P=0.0427) i prosječnog noćnog dijastoličkog tlaka (P=0.0439). U domeni srčane varijabilnosti nađen je statistički značajan pad noćnih vrijednosti SDNN (P=0.0492), rMSSD (P=0.0193), spektralne snage (P=0.0097), VLF (P=0.0176), LF (P=0.0097) i HF (P=0.0319) kompenenti te porast dnevne spektralne snage (P=0.0282). Nije nađeno statistički značajne razlike u vrijednostima QTc (P=0.3898). Ovo istraživanje pokazalo je da terapija CPAP-om kod bolesnika s OSA-om pozitivno utječe na neke mehanizme razvoja KVB-a.

Abstract (english)

Obstructive sleep apnea (OSA) is a sleep disorder that is associated with an increased risk of cardiovascular disease. The continuous positive airway pressure (CPAP) device is used as an effective treatment for moderate and severe OSA. In this study, the effects of CPAP therapy on the cardiovascular system were investigated by measuring levels of plasminogen activator inhibitor-1 (PAI-1), N-terminal prohormone of brain natriuretic peptide (NT-proBNP), blood pressure during the night, heart rate variability (HRV) and QTc interval. Of 58 patients with severe OSA enrolled in the study at baseline, 37 had satisfactory CPAP adherence after at least 6 months of therapy and their data were analysed. The mean age was 53 ± 10 years. The majority of them were male (78%) and 27% were smokers. The most common comorbidities were hypertension (51%) and diabetes mellitus (16%). There was no statistically significant difference in PAI-1 values before and after CPAP therapy (P=0.9367), but there were statistically significantly lower NTproBNP values (P=0.0427) and lower diastolic blood pressure during the night (P=0.0439). In HRV, there were statistically significantly lower nighttime values of SDNN (P=0.0492), rMSSD (P=0.0193), spectral power (P=0.0097), VLF (P=0.0176), LF (P=0.0097) and HF (P=0.0319) bands and also significantly higher values of spectral power during the day (P=0.0282). There was no statistically significant difference in QTc values (P=0.3898). This study has shown that CPAP therapy has a positive effect on some mechanisms of CVD development in patients with OSA.

• Keywords: opstruktivna apneja u spavanju; kontinuirani pozitivni tlak zraka; rizik za kardiovaskularne bolesti; kardiovaskularna patofiziologija
• Keywords (english): obstructive sleep apnea; continuous positive airway pressure; cardiovascular risk; cardiovascular pathophysiology
• Language: croatian
• URN:NBN: urn:nbn:hr:105:752168
• Study programme: Title: Biomedicine and Health Sciences; Study programme type: university; Study level: postgraduate; Academic / professional title: doktor/doktorica znanosti, područje biomedicine i zdravstvo (doktor/doktorica znanosti, područje biomedicine i zdravstvo)
• Type of resource: Text
• Extent: 81 str.
• File origin: Born digital
• Access conditions: Open access
• Created on: 2024-02-01 11:48:53