DOES SERUM ADIPONECTIN LEVEL AFFECT CARDIOVASCULAR RISK IN OBSTRUCTIVE SLEEP APNEA SYNDROME?

1. DOES SERUM ADIPONECTIN LEVEL AFFECT CARDIOVASCULAR RISK IN OBSTRUCTIVE SLEEP APNEA SYNDROME? Asiye Kanbay, Oğuz Köktürk, Tansu Ulukavak Çiftçi Yusuf Tavil, Neslihan Bukan Gazi University School Of Medicine Department of Pulmonary Medicine Department of Cardiology Department of Biochemistry

2. Introduction • Obstructive sleep apnea syndrome (OSAS) is more closely associated with cardiovascular and metabolic disorders. • It is difficult to demonstrate the influence of OSAS on cardiovascular system due to common risk factors including age, gender, obesity, and diabetes mellitus.

3. Adiponectin recently discovered and secreted by adipocytes and acts as an antidiabetic and antiatherogenic adipocytokine. • Its serum levels were significantly lower in patients with obesity, type II diabetes mellitus and coronary artery disease.

4. It has been recently reported that adiponectin significantly inhibited macrophage phagocytic activity and suppressed lipopolysaccharide-induced production of tumor necrosis factor (TNF)-α and had an important role in inhibition of effects of TNF-α.

5. Low serum adiponectin and high serum TNF-α levels are responsible for increased cardiovascular morbidity and mortality • The contribution of low plasma adiponectin levels is not well known in patients with diagnosed OSAS for cardiovascular diseases.

6. Aim • To evaluate the influence of serum adiponectin levels to cardiovascular disease in patients with OSAS • To determine the association between serum adiponectin and obesity, cardiovascular diseases and OSAS.

7. Materials and methods: • AHI ≥ 5 and PSG parameters are agreeable with OSAS is constituted as OSAS group, AHI  5 constituted as the control group • Demographic characteristics, sleep and medical history; including cardiovascular and metabolic diseases, medication use and habits were recorded • Serum adiponectin and TNF-a levels were measured

8. Results: • Control group: 17 male, 7 female • OSAS group: 81 male 33 female Serum adiponectin and serum TNF-α levels in study groups

9. The results of correlation analysis between adiponectin-TNF-a and other parameters in OSAS patients

10. The classification of study group according to obesity: the mean adiponectin levels with ratio of cardiovascular diseases Study group OSAS Control Obese(+) Obese(-) Obese(+) Obese(-) Adiponectin (µg/dL):13. 78 16.53 21.42 31.33 CVDdiseases (%): 66 35.29 36 38

11. Adiponectin levels were lower than control group in patients with OSAS (p:0.001) • When we compared the groups according to obesity, obese- OSAS patients had lower serum adiponectin levels than obese control patients (p:0.003) • Cardiovascular diseases were high in OSAS patients compared to control group (p:0.001)

12. Discussion • These results suggested that, although obesity is known to decrease plasma adiponectin levels, OSAS may also be risk factor for low adiponectin levels.

13. Repetitive episodes of airway occlusion with hypoxia result in diverse autonomic, humoral, neurohumoral and hemodynamic responses. • By increasing sympathetic activity, OSAS may decrease serum adiponectin levels

14. When we compared the obese subjects with and without OSAS; obese OSAS subjects had lower plasma adiponectin levels and higher rates of CVD than those without OSAS. • These results suggested that OSAS and obesity had cumulative influences on serum adiponectin levels and on cardiovascular risk

15. Conclusion • Lower adiponectin levels might explain the high incidence of cardiovascular diseases and metabolic syndrome in patients with OSAS