الفهرس 
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Abstract
Obstructive sleep apnea syndrome (OSAS) is a sleep breathing disorder characterized by recurrent episodes of upper airway collapse leading to significant hypoxemia and disturbed sleep with increased arousals and sleep fragmentation. The etiology of obstruction of the upper airway in OSAS is postulated to be multifactorial, including anatomic narrowing due to structural changes, neurologic, vascular, and upper airway inflammation. The aim of this work was to study the impact of continuous positive airway pressure therapy on exhaled NO as marker of inflammation in obstructive sleep apnea syndrome. This case control observational study was conducted at sleep disordered breathing (SDB) unit, Mansoura University Main Hospital, Dakahlia, Egypt, during the period from June 2015 to August 2016. In which 2 groups were enrolled : 1st OSAS group included 27 patients after exclusion.2nd healthy control included 9healthy volunteer matched with age and sex. The studied patients adherent to CPAP seen at monthly intervals for 3 months when their FeNO and BMI will be recorded as well as adherence to CPAP treatment every month for 3months of follow up while S.CRP and spirometer recorded twice the first before CPAP use and the second at last visit of follow up. Results: It was found that; among the 27 patients studied and 9 person as a control. The mean age of cases was 49.11 ± 10.67, and the mean age of control was 41.89 ± 15.43, 10 patients (37%) were men and 17 (63%) were women, while 1 male (11.1%) and 8 female (88.9%) in control. The mean value of BMI was 45.26 ± 9.89 kg/m2 in cases and in control was 36.99 ± 7.75 kg/m2, and the mean value of N.C in cases was 44.44 ± 3.80 while in control was40.33 ± 3.57. And there were statistically significant higher AHI between OSA patients versus control group. It was found that statistically significant higher FeNO and S.CRP in OSA patients versus control group. There was no statistically significant difference in BMI pre and post 1st, 2nd and 3rd month of CPAP therapy in OSA patients. Pulmonary function were showed statistically significant increase FEV1 and FEV1/ FVC pre and post CPAP use while there was no significant difference as regard FVC. There were statistically significant decrease in both FeNO and S.CRP after 3months of CPAP therapy. There was statistically significant decrease in FeNO after 1st, 2nd and 3rd month of CPAP therapy. There was positive Correlation between AHI of full night PSG & FeNO pre CPAP use (r =0.873) with highly significant p value (p <0.001). onclusion: Our study supports the emerging concept that upper airway and systemic inflammation are present in OSAS, indicated by increasing both FENO and S.CRP. At 23 ppb cutoff point, the sensitivity of FeNO for prediction of OSA patients was 92.6%, with Specificity 88.9%. S.CRP cutoff point at 9.5 mg/l where the sensitivity of it for prediction of OSA patients was 74.1%, with Specificity 88.9 %. CPAP therapy reduced Fractional exhaled nitric oxide (FeNO) level in OSA patients. ey words: Continuous Positive Airway Pressure Therapy - Exhaled Nitric Oxide - Obstructive Sleep Apnea Syndrome.