Obstrüktif uyku apneli (Osas) hastalarda tedavi öncesi ve sonrası kognitif değerlendirme
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Dosyalar
Tarih
2015
Yazarlar
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Yayıncı
Trakya Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Obstrüktif uyku apne sendromu çeşitli fizyolojik, anatomik, genetik ve çevresel etmenlere bağlı üst solunum yolu obstruksiyonu sonucu ortaya çıkan; uykuda solunum bozukluğuna neden olarak çeşitli kardiyovasküler, pulmoner, serebrovasküler ve nörokognitif bozukluluklara yol açan bir sendromik hastalıktır. Cerrahi yöntemlerle tedavi edilemeyen hastalarda erken dönemde devamlı pozitif havayolu basıncı cihazının düzenli kullanımı ile sendroma bağlı gelişen nörokognitif fonksiyonlar da dahil olmak üzere komplikasyonların çoğu geri dönüşümlüdür. Amaç bu hastalarda tedavi öncesi ve sonrası Montreal Kognitif Değerlendirme yapılarak kognitif etkilenmenin varlığını ve alt tipini belirleme ve tedavinin nörokognitif fonksiyonlar üzerinde de iyileştirici etkisinin olup olmadığını anlamaktır. İkincil olarak da hastalık şiddeti ile kognitif fonksiyon alt tipleri arasında bir ilişki olup olmadığını incelemektir. Trakya Üniversitesi Tıp Fakültesi Nöroloji polikliniğine başvuran Obstrüktif uyku apne sendromu tanısı almış dahil edilme ve dışlanma kriterlerini karşılayan hastaların tanı aldıklarında, bir günlük tedavi sonrası ve üç aylık tedavi sonrası bilişsel fonksiyonları değerlendirildi Olguların %72.2’si erkek, %27.8’i kadındı. Yaş ortalaması 49.093 ± 9.4335 (min:23, max:65); kilo ortalaması 87,5 (min:61, max:119) olarak hesaplandı. Tedavi almadan önce hastalık şiddeti arttıkça bilişsel fonksiyonlar orantısal olarak düşmekte olup soyut düşünce ile hastalık şiddeti arasında nonparametrik korelasyon analizinde istatistiksel anlamlılık mevcuttu. ( Correlation Coefficient:0,270 ve sig:0.048) Friedman tekrarlanan ölçüm analizine göre üç aylık tedavi sonrası ile bir günlük tedavi sonrası ve üç aylık tedavi ile tanı anındaki bilişsel fonksiyonlarda iyileşme arasında istatistiksel anlamlık saptanmışken (P:<0,0001, P<0,0001); bir günlük tedavi ile tanı anındaki bilişsel değerlendirme arasında istatistiksel anlamlılık saptanmamıştır.(P=0,244) Sonuç olarak bu sendrom bilişsel fonksiyonları etkileyen bir hastalıktır ve şiddeti arttıkça bilişsel fonksiyonlarda bozulma artmaktadır. Üç aylık tedavi sonrası tedavi almayan hastalarla karşılaştırıldığında bilişsel fonksiyonlarda istatistiksel anlamlı olarak iyileşme gözlenmiştir
abstract
Obstructive sleep apnea syndrome is a syndromic disease that occurs with upper respiratory tract obstruction by releated to some of physiological, anatomical, genetic and environmental factors and that causes some cardiovascular, pulmonary, stroke and neurocognitive impairments by causing sleep-disordered breathing. İncluding neurocognitive functions most of the complications that related to the syndrome are reversible in patients who starts to use continuous positive airway pressure device in early time and can not treat with surgery. The aim is to identify presence and subtype of cognitive impairment in these patients before and after treatment by making Montreal Cognitive Assessment and to understand whether the remedial effect of the treatment on neurocognitive function. Secondarily is to examine whether there is a relationship between severity of disease and cognitive function subtype. The patient’s cognitive functions who admitted to the Trakya University Medical Faculty neurology clinic and had been diagnosed with obstructive sleep apnea syndrome and meeting the inclusion and exclusion criteria were evaluated when they diagnosed, after one day of treatment and after three months of treatment. 72.2% of patients were male and 27.8% were female. Respectively the average age calculated as 49,093 ± 9.4335 (min: 23, max: 65); and the average weight calculated as 87.5 (min: 61, max: 119). Before treatment with the increase of disease severity cognitive function was decreased proportionally.and statistical significance is available in nonparametric correlation analysis between the severity of disease and abstract thinking. ( Correlation Coefficient:0,270 ve sig:0.048) According to Friedman recursive evaluation analysis, despite of the statistical relevance between after three months treatment, daily treatment and diagnosis time on improvment in cognitive functions was determined (P:<0,0001, P<0,0001); but there were no statistically significant on cognitive assessment between daily treatment and the diagnosis time (P=0,244). Consequently this syndrome is a disease that affects cognitive functions and with the increase of severity of disease deterioration in cognitive function is increasing. After three months treatment compared with patients without treatment statistically significant improvement in cognitive function was observed.
abstract
Obstructive sleep apnea syndrome is a syndromic disease that occurs with upper respiratory tract obstruction by releated to some of physiological, anatomical, genetic and environmental factors and that causes some cardiovascular, pulmonary, stroke and neurocognitive impairments by causing sleep-disordered breathing. İncluding neurocognitive functions most of the complications that related to the syndrome are reversible in patients who starts to use continuous positive airway pressure device in early time and can not treat with surgery. The aim is to identify presence and subtype of cognitive impairment in these patients before and after treatment by making Montreal Cognitive Assessment and to understand whether the remedial effect of the treatment on neurocognitive function. Secondarily is to examine whether there is a relationship between severity of disease and cognitive function subtype. The patient’s cognitive functions who admitted to the Trakya University Medical Faculty neurology clinic and had been diagnosed with obstructive sleep apnea syndrome and meeting the inclusion and exclusion criteria were evaluated when they diagnosed, after one day of treatment and after three months of treatment. 72.2% of patients were male and 27.8% were female. Respectively the average age calculated as 49,093 ± 9.4335 (min: 23, max: 65); and the average weight calculated as 87.5 (min: 61, max: 119). Before treatment with the increase of disease severity cognitive function was decreased proportionally.and statistical significance is available in nonparametric correlation analysis between the severity of disease and abstract thinking. ( Correlation Coefficient:0,270 ve sig:0.048) According to Friedman recursive evaluation analysis, despite of the statistical relevance between after three months treatment, daily treatment and diagnosis time on improvment in cognitive functions was determined (P:<0,0001, P<0,0001); but there were no statistically significant on cognitive assessment between daily treatment and the diagnosis time (P=0,244). Consequently this syndrome is a disease that affects cognitive functions and with the increase of severity of disease deterioration in cognitive function is increasing. After three months treatment compared with patients without treatment statistically significant improvement in cognitive function was observed.
Açıklama
Tıpta Uzmanlık tezi
Anahtar Kelimeler
Devamlı Pozitif Havayolu Basıncı Tedavisi, Nörokognitif Fonksiyon, Obstrüktif Uyku Apne Sendromu, Continuous Positive Airway Pressure Treatment, Neurocognitive Function, Obstructive Sleep Apnea
