Preoperative evaluation of patients with obstructive sleep apnea syndrome, effects of anesthesia and surgery on inflammatory and stress parameters

Preoperative Evaluation of Patients with Obstructive Sleep Apnea Syndrome, Effects of Anesthesia and Surgery on Inflammatory and Stress Parameters Obstructive sleep apnea syndrome (OSAS) is a picture coursing with recurrent upper airway obstructions during sleep. According to the current opinion, both oxidative stress and airway inflammation are important in the pathophysiology of OSAS and its comorbidity. Due to the relationship between OSAS severity and difficult intubation, the upper respiratory control is one of the most important aspects of anesthesia management in patients with OSAS. Based on all this information, the purpose of the present study is to evaluate the intubation difficulty in non-OSAS patients and patients diagnosed with mild, moderate and severe OSAS according to the polysomnography and to examine the levels of inflammation parameters and oxidative stress parameters in these patients and to investigate the effect of surgical treatment on these parameters. PSG was performed on patients with at least one of the symptoms of snoring, obstructive apnea and excessive daytime sleepiness who applied to the Otorhinolaryngology Polyclinic of Akdeniz University Faculty of Medicine between November 2014 and May 2016. The patients who decided to undergo surgery recording to the examination and PSG results, included in the study, 18 patients with AHI below 5 (group 1), 28 patients with the AHI between 5-15 (group 2), 25 patients with the AHI between 15-30 (group 3), and 35 patients with the AHI over 30 (group 4). After recording the demographic characteristics of the patients, difficult intubation parameters were assessed and recorded. Intraoperative vital findings and ventilation parameters were also recorded. The blood of the patients was taken after anesthesia induction, postoperatively, on postoperative days 3-10 and after the 2nd postoperative months, the blood was centrifuged in the laboratory and arylesterase, paraoxonase, nitrotyrosine (NT), CRP, HDL and LDL values were examined. The PON1/HDL and Arylesterase/HDL ratios were also statistically calculated and recorded. The leukocyte values and blood gas analyses of the patients who underwent complete blood cell count in the routine controls were also recorded. After the induction of anesthesia, mask ventilation and intubation difficulty levels were determined and recorded by the anesthesiologist. Biochemical analysis and statistical analysis were carried out after all data were collected, and then the results were evaluated. Male gender was dominant in all patient groups [14 females (13.2%) and 92 males (86.8%)], and there was no difference between the groups in terms of gender. The weight and BMI of the patients were significantly different between the groups. Neck circumference was found to be different between the groups, and similarly to the previous studies, the relation between neck circumference, mandibular protrusion limitation, Mallampati, Cormack-Lehane grade and interim cirrhosis distance and intubation difficulty was found to be significant. In the present study, we found the ratio of moderate and difficult intubation and the number of intubation interventions at a higher level in the Severe OSAS group, but it was not statistically significant. There was no difference between the groups in other parameters except for the fact that the neck circumference was more in the Severe OSAS group. There was a difference in the third measurements of leukocyte and CRP values, the third and fourth measurements of HDL and the fourth measurement of LDL. There was no difference between the disease groups. Differently from previous studies, there was no difference between the HDL and LDL groups among OSAS patients in the present study. In previous studies, PON and ARE activities were found to be low in OSAS patients compared to the control group, whereas in the present study, there was no significant difference although it was higher in the Moderate and Severe OSAS groups. In this study, there was no statistically significant difference between the groups, although the CRP value was always higher in the groups with OSAS than the group without OSAS in all measurements. All these differences may be due to the fact that the number of patients in the present study was different. Similarly to a previous study, the nitrotyrosine values in this study were not different between the groups. The differences and similarities between the measurements could not be discussed due to the lack of similar studies. In the present study, a significant relation was found between the thickness of the neck circumference, mandibular protrusion limitation, Mallampati and Cormack-Lehane grade and interim cirrhosis distance shortness, and intubation difficulty, and it is thought that intubation difficulty can be estimated in patients with OSAS by evaluating these parameters in advance. It is thought that the CRP, HDL, LDL, PON, ARE, nitrotyrosine and leukocyte values were not related to the OSAS severity in patients with OSAS and that the difference between the CRP, leucocyte, HDL and LDL measurements was due to the inflammatory effect of the operation in the first 6 months. It is considered that the ratio of Arylesterase/HDL and the ratio of Paraoxonase/HDL can be used as a marker in the follow-up and treatment of OSAS patients, but it is insignificant in the evaluation of the intubation difficulty. The facts that the number of patients was low in the groups and that PSG was not performed postoperatively are the limitations of the present study. It is believed that more studies are required. Key words: Obstructive sleep apnea syndrome, intubation difficulty, inflammation and oxidative stress markers