Term ve preterm doğan okul öncesi çocukların uyku durumlarının değerlendirilmesi
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Dosyalar
Tarih
2015
Yazarlar
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Yayıncı
Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Uyku-uyanıklık düzenlenmesinin biyolojik olgunlaşma ve gelişimsel faktörler ile etkileşmesi sebebiyle çocuklarda uyku bozukluklarının görülme sıklığı yüksektir. Preterm doğan çocukların aynı yaş grubu term doğan çocuklara göre daha fazla uyku problemi yaşadığı öne sürülmekteyse de günümüze kadar uykunun hangi alt gruplarının etkilendiğini karşılaştırmalı değerlendiren çalışmalar bulunmamaktadır. Bu çalışma ile term ve preterm doğan okul öncesi çocukların uyku durumlarının "Çocuk Uyku Alışkanlıkları Anketi" ile ayrıntılı değerlendirilip karşılaştırılması amaçlanmıştır. Ocak 2008 ve Ocak 2010 tarihleri arasında doğan preterm yenidoğanlar (Grup 1; n=137;<38 hf) ve sağlıklı, term yenidoğanlardan oluşan kontrol grubu (Grup 2; n=145) uyku durumlarının karşılaştırmalı değerlendirilmesi için okul öncesi dönemde (4-6 yaş) prospektif olarak çalışmaya alındılar. Öykü ve fizik muayene formları ve 33 parametreden oluşan"Çocuk Uyku Alışkanlıkları Anketi" yüzyüze dolduruldu. T testi, Mann-Whitney U testi, Ki-kare testi ve Lojistik regresyon analizi yapıldı.. Okul öncesi dönemde gruplar uyku bozukluğu açısından karşılaştırıldığında toplam skor preterm grupta anlamlı yüksek bulundu. Bu grupta uykuda diş gıcırdatma, yüksek sesle horlama, uykusunda konuşma, gece uykusunda yürüme sıklığı, ev dışında uyuma sorunu yaşama, rüyadan telaşla uyanma, keyifsiz uyanma, sabah ayılmasının uzun sürmesi, arabada yolculuk yaparken çok uykusu gelme oranları term gruptan anlamlı olarak daha yüksek bulundu. Uyku bozukluğuna etki eden anne ve baba sigara kullanımı oranları, >3 kardeş sayısı, günde > 2 saat TV seyretme, annede horlama, infantil kolik öyküsü, tonsil/adenoid büyüklüğü, tonsillektomi öyküsü, hiperaktivite dikkat eksikliği, GER, GER bulgusu, regurjitasyon, obstrüktif apne sendromu oranları, Brodsky skoru, gece gürültülü horlama oranı kontrol grubundan anlamlı olarak daha yüksek, ebeveyn yatağında uykuya dalma sıklığı ise daha düşük olarak saptandı çoklu değişkenli analiz sonucunda gastroözafagial reflü bulgularından olan regurjitasyonun olması 6,93 kat, gece gürültülü horlama varlığı 2,31 kat ve ebeveyn odasında uyuma 1,46 kat uyku bozukluğuna artırıcı etki yaparken , kardeşinin olması 0,5 kat azaltıcı etki yaptığı saptandı. Preterm yenidoğanlarda uyku problemi toplam skoru term yenidoğanlara göre daha yüksek olduğu belirlendi. Bununla birlikte uyku ile ilişkili ve uykuya etki eden birçok faktör preterm doğan çocuklarda daha yüksek oranda saptandığı ve kardeş varlığı, regürjitasyon, gece gürültülü horlama ve uyuduğu yerin ebeveyn odası olması etki eden bağımsız risk faktörleri olarak belirlendi. Sonuç olarak uyku bozukluklarının çocuklarda oldukça sık rastlanan bir sorun olduğu çalışmamız bulguları ile de doğrulanmıştır. Doğum haftasının düşük olması risk faktörlerinden biri olarak gösterilmiştir. Bu nedenle preterm bebekler yakın takip edilmeli, çocukluk döneminde daha fazla uyku problemi yaşamamaları için ebeveynlerine özel rehberlik hizmeti verilmelidir.
Abstract
The prevalence of sleep disorders in children is high due to interaction of sleep-wake regulation and biological maturation and developmental factors. Altough children, born in preterm, were suggested to experience more sleep disorders compared to the same age children, born in term, there are comparative studies evaluating the affected subgroups. This study aimed to determine and compare the sleep status of term and preterm born preschool children using "Children's Sleep Habits Questionnaire". Preterm neonates (group 1, n=137, <38 weeks) and the control group with healthy and term neonates (group 2, n=145) born between January 2008 and 2010 were included in this prospective study to assess and compare sleep state of the preschool period (4-6 years old). Medical history and physical examinationwere completed as well as "Children's Sleep Habits Questionnaire" consisting 33 parameters face to face. T test, Mann-Whitney U test, chi-square test and Logistic regression analysis were performed. In terms of sleep disorders, the total score was found to be significantly higher in preterm group in preschool age (p=0.016). This group compared to term group had significantly higher incidence of teeth grinding, loud snoring, sleep talking, sleep walking at night, having difficulties to sleep outside the home, waking up in haste, seedy waking up, longer morning sobering, and oversleeping during travelling by car. And the following factors were found to be significantly higher for sleep disorder: parents smoking rates, having >3 siblings,>2 hours of TV, mother's snoring condition, history of infantile colic, increase in tonsillar/adenoid size, history of tonsillectomy, hyperactivity attention deficit disorder, GER, regurgitation, obstructive apnea syndrome, Brodsky score, and loud snoring during night; whereas falling asleep rates in parents' bed were significantly lower. Multivariate analysis showed that the regurgitation as a symptom of gastro-oesophageal reflux disease was 6.93 times, loud snoring presence at night was 2.31 times and sleeping in parents' room rates were 1.47 times more effective by increasing sleep disorders; whereas having siblings reduced the effect by 0.5 times. Total score of sleep problem determined to be higher in preterm neonates compared to term neonates. Additionally several factors associated with sleep were detected to be higher in children born in preterm, and independent risk factorswere determinedas having > 3 siblings, regurgitation, loud snoring, and sleeping in parents room. In conclusion, our study confirmed with study findings that sleep disorder is a very common problem in children. Low gestational age has been shown as one of the risk factors. Therefore, preterm infants should be closely monitored, and special guidance should be given to parents in order not to experience much more sleep problems during childhood.
Abstract
The prevalence of sleep disorders in children is high due to interaction of sleep-wake regulation and biological maturation and developmental factors. Altough children, born in preterm, were suggested to experience more sleep disorders compared to the same age children, born in term, there are comparative studies evaluating the affected subgroups. This study aimed to determine and compare the sleep status of term and preterm born preschool children using "Children's Sleep Habits Questionnaire". Preterm neonates (group 1, n=137, <38 weeks) and the control group with healthy and term neonates (group 2, n=145) born between January 2008 and 2010 were included in this prospective study to assess and compare sleep state of the preschool period (4-6 years old). Medical history and physical examinationwere completed as well as "Children's Sleep Habits Questionnaire" consisting 33 parameters face to face. T test, Mann-Whitney U test, chi-square test and Logistic regression analysis were performed. In terms of sleep disorders, the total score was found to be significantly higher in preterm group in preschool age (p=0.016). This group compared to term group had significantly higher incidence of teeth grinding, loud snoring, sleep talking, sleep walking at night, having difficulties to sleep outside the home, waking up in haste, seedy waking up, longer morning sobering, and oversleeping during travelling by car. And the following factors were found to be significantly higher for sleep disorder: parents smoking rates, having >3 siblings,>2 hours of TV, mother's snoring condition, history of infantile colic, increase in tonsillar/adenoid size, history of tonsillectomy, hyperactivity attention deficit disorder, GER, regurgitation, obstructive apnea syndrome, Brodsky score, and loud snoring during night; whereas falling asleep rates in parents' bed were significantly lower. Multivariate analysis showed that the regurgitation as a symptom of gastro-oesophageal reflux disease was 6.93 times, loud snoring presence at night was 2.31 times and sleeping in parents' room rates were 1.47 times more effective by increasing sleep disorders; whereas having siblings reduced the effect by 0.5 times. Total score of sleep problem determined to be higher in preterm neonates compared to term neonates. Additionally several factors associated with sleep were detected to be higher in children born in preterm, and independent risk factorswere determinedas having > 3 siblings, regurgitation, loud snoring, and sleeping in parents room. In conclusion, our study confirmed with study findings that sleep disorder is a very common problem in children. Low gestational age has been shown as one of the risk factors. Therefore, preterm infants should be closely monitored, and special guidance should be given to parents in order not to experience much more sleep problems during childhood.
Açıklama
Tıpta Uzmanlık Tezi
Anahtar Kelimeler
Term Yenidoğanlar, Okul Öncesi Çocuklar, Preterm, Uyku Bozukluğu, Uyku Bozukluğu Risk Faktörleri, Term Neonates, Preschool Children, Sleep Disorder, Sleep Disorder Risk Factors
