الفهرس 
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Abstract
Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorders that characterized by obstructive apneas, hypopneas and/or respiratory effort related arousal (RERA). OSA caused by repetitive collapse of the upper airway during sleep. The diagnosis should be considered whenever a patient presents with risk factors or clinical manifestations that are compatible with OSA.
Leptin is a pleiotropic cytokine with a circadian rhythm in expression, which is produced mainly by white adipose tissue (WAT) and has a regu¬latory role in body adiposity with high levels acting as a satiety signal. Leptin levels are increased in OSAS, but due to a central leptin resistance that occurs in obesity, it fails its regulatory role in reducing adiposity. OSA patients have been found to have higher leptin measured in the morning than controls.
Ghrelin is secreted primarily in the lining of the stomach. Ghrelin increases hunger. No statistically significant difference of serum ghrelin levels between OSA patients and controls.
The aim of this work was to study of leptin and ghrelin serum levels in OSA patients.
The present study included fifteen healthy control subjects and thirty OSA patients diagnosed according to established criteria. After history taking which included Epworth sleepiness scale (ESS) and clinical apnea score, clinical examination and routine laboratory investigations, All patients were subjected to the following: anthropometric measurements (body mass index; BMI, neck circumference; NC), serum total cholesterol and triglyceride and polysomnography. Manual analysis and scoring were performed using criteria established by the American Academy of Sleep Medicine.
In the present study, the Patient’s age ranges between 25 and 86 years (mean±S.D. 51±10.076 years) while in Control subjects it ranges between 25 – 45 years (mean±S.D. 34.27±5.650 years).
Patient’s BMI ranges between 24.65 – 58.64 kg/m2 (mean±S.D. 41.635±9.736 kg/m2) while in control subjects it ranges between 22.46 – 29.76 kg/m2 (mean±S.D. 25.092±2.126 kg/m2), 27 patients of them (90%) were obese. The Patient’s NC ranges between 39 and 56 cm (mean±S.D. 47.83±4.691cm) while in control subjects it ranges between 35 – 40 cm (mean±S.D. 37.47±1.506cm ). BMI and NC showed statistically significant direct correlation with leptin.
Patient’s serum leptin ranges between 11.4 – 66.4 ng/ml with mean±S.D. 33.303±15.728 while in control subjects it ranges between 0.5 – 34.7 ng/ml with mean±S.D. 10.467±10.339.
Patient’s serum ghrelin ranges between 103.5 – 6673 pg/ml with mean±S.D. 2034.527±1815.687 while in control subjects it ranges between 976 – 2184 pg/ml with mean±S.D. 1682.467±334.064.
In patients group as regards presence of apnea-hypopnea index (AHI) ranges between 13 and 115 (mean±SD value of 43.43 ± 26.204). A 2 patients (6.7%) had mild OSA, 10 (33.3%) had moderate OSA, 14 (46.7%) had severe OSA, 3 (10%) had very severe OSA and 1 (3.3%) had extreme OSA. AHI showed statistically significant direct correlation with leptin.
The desaturation index (DI) ranges between 9 and 86 % and showed statistically significant direct correlation with leptin. Triglyceride level (mg/dl) ranges between 83 and 363 (mean±SD value of 178.7 ± 60.597) and showed statistically significant direct correlation with leptin.
Leptin levels are statistically significantly higher in OSAH patients versus control subjects. Leptin levels are statistically significantly correlated with some indices of OSAHS severity, i.e. AHI and desaturation index (DI). Leptin levels are statistically significantly correlated with a variety of anthropometric measurements, including body mass index (BMI) and neck circumference (NC). Leptin levels are statistically significantly correlated with serum triglyceride levels.
Regression analysis revealed, the best predicted variables for leptin levels were the lowest oxygen saturation, average SaO2, sleep time with oxygen saturation less than 90% (t90%), and BMI.
There was no statistically significant difference between the two studied groups for serum ghrelin levels and no statistical significant correlation with any parameter.
We recommend further studies to provide a better understanding of the link between OSAS and serum levels of leptin and ghrelin which could lead to better treatment options.