Tissue hypoxia in sleep apnea syndrome assessed by uric acid and adenosine.
OBJECTIVE
Although the overnight increase in urinary uric acid/creatinine ratio (DeltaUA/Cr) is considered by some to be a marker of tissue hypoxia in patients with obstructive sleep apnea-hypopnea syndrome (OSAS), this index is not universally accepted. The purpose of this study was to confirm the validity of DeltaUA/Cr as a marker of tissue hypoxia by measuring the plasma level of adenosine during sleep, and also to test the hypothesis that the heart rate (HR) response to apnea is a determinant of tissue hypoxia.


METHODS
Intergroup comparative study.


METHODS
A university hospital, Sapporo, Japan.


METHODS
Eighteen patients with OSAS who had apnea-associated, moderate-to-severe arterial desaturation. The patients were classified into two groups: the DeltaUA/Cr-positive group, who were considered to have tissue hypoxia, and the DeltaUA/Cr-normal group, who were not.


RESULTS
Although there were no significant differences between two groups of the patients in either arterial desaturation parameters or the apnea-hypopnea index, the plasma level of adenosine during sleep was significantly higher in the DeltaUA/Cr-positive group than in the DeltaUA/Cr-normal group. Successful treatment with nasal continuous positive airway pressure significantly decreased both DeltaUA/Cr and the plasma level of adenosine only in the DeltaUA/Cr-positive group. The magnitude of the HR increase after the termination of apnea was significantly smaller in the DeltaUA/Cr-positive group.


CONCLUSIONS
DeltaUA/Cr is a marker of tissue hypoxia, which does not necessarily parallel arterial desaturation indexes in OSAS. Intersubject variability in the HR response to apnea may explain the discrepancy between tissue hypoxia and arterial desaturation indexes.
Saito
Hiroshi
H
First Department of Medicine, Hokkaido University School of Medicine. Currently at Kohnan Hospital, Kohnan, Japan.
Nishimura
Masaharu
M
Shibuya
Eiji
E
Makita
Hironi
H
Tsujino
Ichizo
I
Miyamoto
Kenji
K
Kawakami
Yoshikazu
Y
D000241:Adenosine / Q000097:blood*; D000328:Adult; D015415:Biomarkers / Q000097:blood / Q000652:urine; D015687:Cell Hypoxia; D006801:Humans; D008297:Male; D008875:Middle Aged; D016262:Postpoliomyelitis Syndrome / Q000378:metabolism; D012891:Sleep Apnea Syndromes / Q000378:metabolism*; D014527:Uric Acid / Q000652:urine*
D015415:Biomarkers; D014527:Uric Acid; D000241:Adenosine