Geriatrik ve Erişkin Hastalarda Uyku Apne Sendromu ve Polisomnografi Özelliklerinin Karşılaştırılması
Öz
Amaç: Bu çalışmada geriatrik ve erişkin hastalarda obstruktif uyku apne sendromu (OUAS) ve
polisomnografi özelliklerinin karşılaştırılması amaçlandı.
Materyal ve Metot: Bu çalışma retrospektif dizaynda ve olgu‐kontrol çalışması olarak planlandı. Uyku
bozukluğu ön tanısı ile polisomnografi yapılan hastalar yaşlarına göre 65 yaş altı ve üzeri olarak 2 gruba
ayrıldı.Uyku bozukluklarının tespiti için Alice 6 bilgisayarlı sistem (Respironics; Philips, Illinois, ABD)
polisomnografisi uygulandı.
Bulgular: Yaşları 22 ile 101 arasında değişen ve ortalama 59,10 ± 13,70 yıl olan toplam 82 hasta dahil
edildi. Ortalama yaş geriatrik grupta istatistiksel olarak daha yüksek iken (p<0,001), gruplar arasında
cinsiyet, vücut kitle indeksi (VKİ) ve komorbiditeler açısından anlamlı fark saptanmadı (p>0,05).
Erişkinlerde normal ve hafif OUAS sıklığı daha yüksek iken, geriatrik grupta orta ve ileri evre OUAS
sıklığı daha yüksekti. OUAS ve obezite hipoventilasyon sendromu birlikteliği ise her iki grupta da
yüksekti. Total, REM, Non‐REM, supin ve yan apne hipopne indeksi skorları geriatrik hastalarda daha
yüksekti. Epworth Skoru geriatrik hastalarda daha yüksekti. Satürasyon ise geriatrik hasta grubunda
daha düşük olup desatürasyon indeksi geriatrik hasta grubunda daha düşüktü.
Sonuç: Geriatrik hastalarda uyku bozukluklarının özellikleri erişkin hastalarınkinden farklı
seyretmektedir ve genel olarak uyku bozuklukları geriatrik hastalarda daha ağırdır.
Anahtar Kelimeler
Kaynakça
- 1. Mazza M, Della Marca G, De Risio S, Mennuni GF, Mazza S. Sleep disorders in the elderly. Clin Ter 2004;155:391-4.
- 2. Barthlen GM. Sleep disorders obstructive sleep apnea syndrome, restless legs syndrome, and insomnia in geriatric patients. Geriatrics 2002;57:34-9.
- 3. Lurie A. Cardiovascular disorders associated with obstructive sleep apnea. Adv Cardiol 2011;46:197-266.
- 4. Bloom HG, Ahmed I, Alessi CA ve ark. Evidence-based recommendations for the assessment and management of sleep disorders in older persons. J Am Geriatr Soc 2009;57:761-9.
- 5. Berry RB, Brooks R, Gamaldo C, ve ark. AASM scoring manual updates for 2017 (Version 2.4). J Clin Sleep Med 2017;13:665–6.
- 6. Browne HA, Adams L, Simonds AK. Sleep apnoea and daytime function in the elderly: what is the impact of arousal frequency? Respir Med 2003;97:1102–8.
- 7. Boselli M, Parrino L, Smerieri A,Terzano MG. Effect of age on EEG arousals in normal sleep. Sleep 1998;21:351–7.
- 8. Bixler EO, Kales A, Jacoby JA, Soldatos CR, Vela-Bueno A. Nocturnal sleep and wakefulness: effects of age and sex in normal sleepers. Int J Neurosci 1984;23:33–42.
- 9. Redline S, Kirchner HL, Quan SF, Gottlieb DJ, Kapur V, Newman A.The effects of age, sex, ethnicity and sleep disordered breathing on sleep architecture. Arch Intern Med 2004;164:406–8.
- 10. Martin SE, Mathur R, Marshall I. Douglas NJ.The effect of age, sex, obesity and posture on upper airway size. Eur Respir J 1997;10: 2087–90. 11. Shigeta Y, Enciso R, Ogawa T. Changes in three dimensional simulation models of the airway which are due to increases in age or body mass index. Stud Health Technol Inform 2008;132:460–2. 12. Browne HAK, Adams L, Simonds AK. Impact of age on breathing and resistive pressure in people with and without sleep apnea. J Appl Physiol 2001;90:1074–82.
- 13. Schwab RJ, Pasirstein M, Pierson R et al. Mackley AIdentification of upper airway anatomic risk factors for obstructive sleep apnea with volumetric magnetic resonance imaging. Am J Respir Crit Care Med 2003;168:522–30.
- 14. Horner RL, Shea SA, McIvor J, Guz A. Pharyngeal size and shape during wakefulness and sleep in patients with obstructive sleep apnoea. Q J Med 1989;72:719–35.
- 15. Erskine RJ, Murphy PJ. Effect of age on the sensitivity of upper airway reflexes. Br J Anaesth 1993;70:574–5.
- 16. Klawe JJ, Tafil-Klawe M. Age-related response of the genioglossus muscle EMG-activity to hypoxia in humans. J Physiol Pharmacol 2003;54:14–9.
- 17. Worsnop C, Kay A, Kim Y, Trinder J, Pierce R. Effect of age on sleep onset-related changes in respiratory pump and upper airway muscle function. J Appl Physiol 2000;88:1831–9.
- 18. Kirkness JP, Schwartz AR, Schneider H, ve ark. Contribution of male sex, age, and obesity to mechanical instability of the upper airway during sleep. J Appl Physiol 2008;104:1618–24.
- 19. Davies RJ, Ali NJ, Stradling JR. Neck circumference and other clinical features in the diagnosis of the obstructive sleep apnoea syndrome. Thorax 1992;47:101–5.
- 20. Malhotra A, Huang Y, Fogel Ret al. Aging influences on pharyngeal anatomy and physiology: the predisposition to pharyngeal collapse. Am J Med 2006;119:9–14.
- 21. Köktürk O. Obstrüktif uyku apne sendromu epidemiyolojisi. Tüberküloz ve Toraks 1998;46:193-201.
- 22. Ancoli-Israel S, Gehrman P, Kripke DF et al. Long-term fallow-up of sleep disordered breathing in older adults. Sleep Med 2001;2:511-6.
- 23. Martin J, Shochat T, Gehrman PR, Ancoli-Israel S. Sleep in the elderly. In: Selecky PA (ed). Respiratory care clinics of North America. Sleep Disorders. Philadelphia, USA: WB Saunders, 1999;5(3):461-72.
- 24. Young T, Shahar E, Nieto FJ et al. Predictors of sleep-disordered breathing in community-dwelling adults: the sleep heart health study. Arch Intern Med 2002;162:893–900.
- 25. Köktürk O, Ulukavak Çiftçi T. Yaşlılarda uykuda solunum bozuklukları. Türk Geriatri Derg 2004;7:9-14.
- 26. Martins AB, Tufik S, Moura SM. Physiopathology of obstructive sleep apnea-hypopnea syndrome. J Bras Pneumol 2007;33:93-100.
- 27. George E, Katerina V, Maria S, Lambros B, Konstantina N, Dimitrios G. Clinical features and polysomnographic findings in greek male patients with obstructive sleep apnea syndrome: differences regarding the age. Sleep Disord 2012:324635. doi: 10.1155/2012/324635.
- 28. Morrell MJ, Finn L, McMillan A, Peppard PE. The impact of ageing and sex on the association between sleepiness and sleep disordered breathing. Eur Respir J 2012;40:386–93.
- 29. Ahmad N, Srinivasan K, Naicker TR, Moudgil H. Sleep apnoea in the elderly. Lancet Respir Med 2014;2:e21.
- 30. Jang MS, Kim HY, Dhong HJ et al. Effect of parapharyngeal fat on dynamic obstruction of the upper airway in patients with obstructive sleep apnea. Am J Respir Crit Care Med 2014;190:1318–21.
- 31. Gooneratne NS,Richards KC, Joffe M et al. Sleep disordered breathing with excessive day time sleepiness is a risk factor for mortality in older adults. Sleep 2011;34:435–42.
- 32. Durán J, Esnaola S, Rubio R et al. Obstructive sleep apnea–hypopnea and related clinical features in a population-based sample of subjects aged 30 to 70 yr. Am J Respir Crit Care Med 2001;163:685-9.
- 33. Djonlagic I, Malhotra A. Risk of stroke from sleep apnea in men and women. Expert Rev Neurother 2010;10:1267–71.
- 34. Lurie A. Cardiovascular disorders associated with obstructive sleep apnea. Adv Cardiol 2011;46:197-266.
Öz
Objectives: The aim of this study to compare the characteristics of obstructive
sleep apnea syndrome (OSAS) and polysomnography in geriatric and adult
patients.
Materials and Methods: This study was planned as a retrospective and case-control
study. Patients who underwent polysomnography evaluation with a prediagnosis of
sleep disoder were divided into two groups according to the age of the patients
as <65 years and >65 years. Polysomnography was performed with the Alice
6 computerized system (Respironics; Philips, Illinois, USA) for the detection
of sleep disorders.
Results: A total of 82 patients with a mean age of 59.10±13.7 years
(ranging between 22 and 101) were included. The mean age was significantly
higher in the geriatric group (p <0.001), but there was no significant
difference between the groups in terms of gender, body mass index and comorbidities
(p> 0.05 for all). While the normal and mild OSAS frequency was higher in
adults, the middle and advanced OSAS frequency was higher in the geriatric
group. Rate of OSAS and obesity hypoventilation syndrome coexistince was higher
in both groups. Total, REM, Non-REM, supine and apnea hypopnea index scores
were higher in geriatric patients. Epworth Score was higher in geriatric
patients. Saturation is lower in the geriatric patient group and desaturation
index is lower in the geriatric patient group.
Conclusion: The characteristics of sleep disorders in geriatric patients
differ from those of adults and sleep disorders are more severe in geriatric
patients.
Anahtar Kelimeler
Sleep apnea syndrome sleeping disorders apnea hypopnea index
Kaynakça
- 1. Mazza M, Della Marca G, De Risio S, Mennuni GF, Mazza S. Sleep disorders in the elderly. Clin Ter 2004;155:391-4.
- 2. Barthlen GM. Sleep disorders obstructive sleep apnea syndrome, restless legs syndrome, and insomnia in geriatric patients. Geriatrics 2002;57:34-9.
- 3. Lurie A. Cardiovascular disorders associated with obstructive sleep apnea. Adv Cardiol 2011;46:197-266.
- 4. Bloom HG, Ahmed I, Alessi CA ve ark. Evidence-based recommendations for the assessment and management of sleep disorders in older persons. J Am Geriatr Soc 2009;57:761-9.
- 5. Berry RB, Brooks R, Gamaldo C, ve ark. AASM scoring manual updates for 2017 (Version 2.4). J Clin Sleep Med 2017;13:665–6.
- 6. Browne HA, Adams L, Simonds AK. Sleep apnoea and daytime function in the elderly: what is the impact of arousal frequency? Respir Med 2003;97:1102–8.
- 7. Boselli M, Parrino L, Smerieri A,Terzano MG. Effect of age on EEG arousals in normal sleep. Sleep 1998;21:351–7.
- 8. Bixler EO, Kales A, Jacoby JA, Soldatos CR, Vela-Bueno A. Nocturnal sleep and wakefulness: effects of age and sex in normal sleepers. Int J Neurosci 1984;23:33–42.
- 9. Redline S, Kirchner HL, Quan SF, Gottlieb DJ, Kapur V, Newman A.The effects of age, sex, ethnicity and sleep disordered breathing on sleep architecture. Arch Intern Med 2004;164:406–8.
- 10. Martin SE, Mathur R, Marshall I. Douglas NJ.The effect of age, sex, obesity and posture on upper airway size. Eur Respir J 1997;10: 2087–90. 11. Shigeta Y, Enciso R, Ogawa T. Changes in three dimensional simulation models of the airway which are due to increases in age or body mass index. Stud Health Technol Inform 2008;132:460–2. 12. Browne HAK, Adams L, Simonds AK. Impact of age on breathing and resistive pressure in people with and without sleep apnea. J Appl Physiol 2001;90:1074–82.
- 13. Schwab RJ, Pasirstein M, Pierson R et al. Mackley AIdentification of upper airway anatomic risk factors for obstructive sleep apnea with volumetric magnetic resonance imaging. Am J Respir Crit Care Med 2003;168:522–30.
- 14. Horner RL, Shea SA, McIvor J, Guz A. Pharyngeal size and shape during wakefulness and sleep in patients with obstructive sleep apnoea. Q J Med 1989;72:719–35.
- 15. Erskine RJ, Murphy PJ. Effect of age on the sensitivity of upper airway reflexes. Br J Anaesth 1993;70:574–5.
- 16. Klawe JJ, Tafil-Klawe M. Age-related response of the genioglossus muscle EMG-activity to hypoxia in humans. J Physiol Pharmacol 2003;54:14–9.
- 17. Worsnop C, Kay A, Kim Y, Trinder J, Pierce R. Effect of age on sleep onset-related changes in respiratory pump and upper airway muscle function. J Appl Physiol 2000;88:1831–9.
- 18. Kirkness JP, Schwartz AR, Schneider H, ve ark. Contribution of male sex, age, and obesity to mechanical instability of the upper airway during sleep. J Appl Physiol 2008;104:1618–24.
- 19. Davies RJ, Ali NJ, Stradling JR. Neck circumference and other clinical features in the diagnosis of the obstructive sleep apnoea syndrome. Thorax 1992;47:101–5.
- 20. Malhotra A, Huang Y, Fogel Ret al. Aging influences on pharyngeal anatomy and physiology: the predisposition to pharyngeal collapse. Am J Med 2006;119:9–14.
- 21. Köktürk O. Obstrüktif uyku apne sendromu epidemiyolojisi. Tüberküloz ve Toraks 1998;46:193-201.
- 22. Ancoli-Israel S, Gehrman P, Kripke DF et al. Long-term fallow-up of sleep disordered breathing in older adults. Sleep Med 2001;2:511-6.
- 23. Martin J, Shochat T, Gehrman PR, Ancoli-Israel S. Sleep in the elderly. In: Selecky PA (ed). Respiratory care clinics of North America. Sleep Disorders. Philadelphia, USA: WB Saunders, 1999;5(3):461-72.
- 24. Young T, Shahar E, Nieto FJ et al. Predictors of sleep-disordered breathing in community-dwelling adults: the sleep heart health study. Arch Intern Med 2002;162:893–900.
- 25. Köktürk O, Ulukavak Çiftçi T. Yaşlılarda uykuda solunum bozuklukları. Türk Geriatri Derg 2004;7:9-14.
- 26. Martins AB, Tufik S, Moura SM. Physiopathology of obstructive sleep apnea-hypopnea syndrome. J Bras Pneumol 2007;33:93-100.
- 27. George E, Katerina V, Maria S, Lambros B, Konstantina N, Dimitrios G. Clinical features and polysomnographic findings in greek male patients with obstructive sleep apnea syndrome: differences regarding the age. Sleep Disord 2012:324635. doi: 10.1155/2012/324635.
- 28. Morrell MJ, Finn L, McMillan A, Peppard PE. The impact of ageing and sex on the association between sleepiness and sleep disordered breathing. Eur Respir J 2012;40:386–93.
- 29. Ahmad N, Srinivasan K, Naicker TR, Moudgil H. Sleep apnoea in the elderly. Lancet Respir Med 2014;2:e21.
- 30. Jang MS, Kim HY, Dhong HJ et al. Effect of parapharyngeal fat on dynamic obstruction of the upper airway in patients with obstructive sleep apnea. Am J Respir Crit Care Med 2014;190:1318–21.
- 31. Gooneratne NS,Richards KC, Joffe M et al. Sleep disordered breathing with excessive day time sleepiness is a risk factor for mortality in older adults. Sleep 2011;34:435–42.
- 32. Durán J, Esnaola S, Rubio R et al. Obstructive sleep apnea–hypopnea and related clinical features in a population-based sample of subjects aged 30 to 70 yr. Am J Respir Crit Care Med 2001;163:685-9.
- 33. Djonlagic I, Malhotra A. Risk of stroke from sleep apnea in men and women. Expert Rev Neurother 2010;10:1267–71.
- 34. Lurie A. Cardiovascular disorders associated with obstructive sleep apnea. Adv Cardiol 2011;46:197-266.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırmalar |
| Yazarlar | |
| Yayımlanma Tarihi | 27 Aralık 2018 |
| Yayımlandığı Sayı | Yıl 2018 Cilt: 18 Sayı: 4 |
