الفهرس 
OBSTRUCTIVE SLEEP APNEAOnly 14 pages are availabe for public view
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Abstract
D
uring the last three decades there has been increasing interest in sleep related breathing disturbances, the most common ones are apnea where there’s complete cessation of air flow and hypopnea with diminished air flow, both lasting for at least ten seconds. Obstructive sleep apnea is a highly prevalent sleep disorder and leads to cardiovascular complications. The association between OSAS and cardiovascular disease arises from their overlapping risk factors, including obesity, a sedentary lifestyle, male gender and older age (Lorenzi et al., 2010).
Red blood cell distribution width (RDW) is a numerical measure of the size variability of circulating erythrocyte and is routinely reported as a component of complete blood count in the differential diagnosis of anaemia. The standard size of RBCs is about 6-8µm, and the normal reference range for human red blood cell is 11-15% (Harrington et al., 2008). Disorders related to ineffective erythropoiesis or increased blood cell destruction cause greater heterogeneity in size and thus a higher RDW (Tonelli et al., 2008). Recently, RDW and red blood cell indices have been reported as a strong independent predicators of adverse outcomes in general population and is believed to be associated with cardiovascular morbidity and mortality in patients with a previous myocardial infarction (perlstein et al., 2009).
The aim of the present study was to evaluate the relation between red blood cell indices and the severity of obstructive sleep apnea syndrome (OSAS).
This study was conducted upon 60 persons, they were divided into two groups as follow:
Group I: consisted of 45 patients diagnosed as obstructive sleep apnea hypopnea subjects based on clinical suspicion and polysomnographic study. All are referred from clinics of oto-rhino-laryngolists and pulmonologists.
Group II: consisted of 15 normal persons without OSAS as a control for them CBC were done.
OSAS patients were classified based on the AHI to14 patients with mild (AHI 5-15), 10 patients with moderate (AHI 15-30), and 21 patients with severe OSAS (AHI >30).
Exclusion criteria:
Patients known to have:
Polycythaemia, anaemia, coronary heart disease and/or heart failure, renal failure, liver cell failure, COPD with respiratory failure.
These patients were excluded because these diseases cause endothelial dysfunction and elevate the inflammatory markers levels which affect red cells indices and red cell distrubution width levels.
All persons were subjected to the following :
• Full history taking.
• Thorough clinical examination including general and local chest examination
• Blood sample taken and analysed for complete blood count levels.
• Polysomnography was done for 45 patients with history of sleep apnea (study group), but not done for 15 persons (control group).
The following results were obtained:
1- Comparing RBCs count and HGB levels in patients with OSA and control, it was found that there were no statistically significant differences between control and mild, control and moderate and control and severe sleep apnea as regard RBCs count and HGB level.
2- There was statistically significant difference between OSA patients and controls as regard HCT, there was statistically significant difference between mild and moderate also moderate and severe sleep apnea as regard HCT, also there was statistically significant difference between control compared with mild and severe sleep apnea as regard HCT (NB: all levels of HCT were within the normal referance ranges in all groups).
3- There were highly statistically significant differences between OSA patients and controls as regard MCV, there were no statistically significant differences between mild and moderate and severe sleep apnea as regard MCV, also there were statistically significant differences between control compared with mild and severe sleep apnea as regard MCV (NB: all levels of MCV were within the normal referance ranges in all groups) .
4- There were highly statistically significant differences between OSA patients and controls as regard MCH, there were no statistically significant differences between mild and moderate and severe sleep apnea as regard MCH, also there were no statistically significant differences between control compared with mild, moderate and severe sleep apnea as regard MCH (NB: all levels of MCH were within the normal referance ranges in all groups) .
5- There were statistically significant differences between OSA patients and controls as regard MCHC, there was no statistically significant differences between mild and moderate and severe sleep apnea as regard MCHC. Also there was no statistically significant differences between control compared with mild, moderate and severe sleep apnea as regard MCHC.
6- It was found that there were highly statistically significant differences between OSAS patients and controls as regard RDW, there was no statistically significant differences between mild and moderate and severe sleep apnea as regard RDW, also there was no statistically significant differences between control compared with mild, moderate and severe sleep apnea as regard RDW.
7- There was significant positive correlation between desaturation index and RDW for OSA patients.
8- There was no significant correlations between neither minimum Sp O2, baseline O2 saturation nor average SpO2 and RDW for OSA patients.
9- There was statistically significant positive correlation between AHI and RDW in OSA patients. The high RDW values we have observed in our OSAS patients may reflect the slight increase in the erythrocyte deformability indices.Since RDW is a measurement of the variability of red cell size, higher values indicate greater variation in size. There may be two explanations for the high RDW in OSAS patients. High RDW may indicate anisocytosis (variability in RBCs size) that may be due to chronic hypoxia. The other explanation is hemorheological (Hemorheology is concerned with the flow properties of cellular and plasmatic components of blood).
10- There was statistically significant difference between mild and severe as regard desaturation index also there was significant difference between mild and severe as regard minimal SpO2.