Çocukluk Çağı Kanserlerinde Uyku Bozukluğu

Yıl 2018, Cilt: 11 Sayı: 1, 61 - 64, 01.02.2018

Elif Bilsin Gülçin Özalp

Öz

Giriş: Kanser tanısı almak, kemoterapi, radyoterapi ve cerrahi tedaviler kısa ve uzun dönemde uyku bozukluğuna neden olmaktadır. Kanserli
çocukların %12.4-31’inin uyku bozukluğu yaşadığı bildirilmiştir. Uyku, ruh sağlığı, nörobilişsel yetenek ve sağlıkla ilişkili yaşam kalitesinde
önemli rol oynamaktadır. Ağrısı, anksiyetesi ve emosyonel stresi olan çocuklarda ise daha önemli bir yere sahiptir. Hem hastalık hem de
tedavi ile ilişkili fiziksel ve emosyonel bozukluklar ve başa etme mekanizması uykuyu etkilemektedir. Uyku düzenlenmesinde rol oynayan
homeostatik, kardiyo-respiratuar, nörolojik ve davranışsal mekanizmalar ve sirkadiyen ritmin bozulması kanserli çocuklarda uyku
bozukluğuna neden olmaktadır. Uykusuzluğun nedenleri açlık, bulantı, kusma, sık tuvalete gitme, kabus görme, yorgunluk, ağrı, ilaç
tedavisi, hastaneye yatış ve hastanedeki gürültü ve ışık olduğu belirlenmiştir. Ayrıca bazı hastalarda steroid kullanımının da uykusuzluğa
neden olduğu bildirilmiştir. Kanser uykuyu ya tümöre bağlı beyin hasarı ile doğrudan etkiler ya da tedaviye bağlı olarak stres, kemoterapi,
radyoterapi, ağrı, yorgunluk, endokrinopati veya organ hasarı ile dolaylı yoldan etkiler. Kanser aynı zamanda uyku-uyanıklık döngüsünün
normal sirkadiyen ritmini bozarak uykuyu etkiler. Ancak bu konuyu açıklayan mekanizmalar yetersizdir. Sirkadiyen ritimler fizyolojik ve
davranışsal süreçlerin biyolojik döngüsüdür. Uyku bozukluğu, çocuk ve adölesanlarda fizyolojik büyüme, endokrin sistem, doğal öldürücü
hücre ve sitokin aktivitesinin bozulması sonucunda davranışsal ve bilişsel sorunlara neden olmakta ve çocukların yaşam kalitesini
azaltmaktadır

Anahtar Kelimeler

Çocuk, Kanser, Uyku Bozukluğu.

Sleep Disorders In Childhood Cancers

Öz

Background: The diagnosis of cancer, chemotherapy, radiotherapy and surgical treatment cause sleep disorders in the short and long term.
In children with cancer, sleep disorders are reported between 12.4-31%. Sleep plays a fundamental role in the psychological health,
neurocognitive ability and health-related quality of life. It is more important in children with pain, anxiety and emotional stress. Both disease
and treatment-related physical and emotional disorders and the mechanism of coping affect sleep. Homeostatic, cardio-respiratory,
neurological and behavioral mechanisms playing role in sleep regulation and circadian rythm disturbance cause sleep disorders in children
with cancer. The causes of sleep disorders were determined to be hunger, nausea, vomiting, frequent needing to use the bathroom,
nightmares, fatigue, pain, drug treatment, hospital admission and noise and light in the hospital. It has also been reported that the use of
steroids in some patients sleep disorders. Cancer can have either direct effects on sleep whereby the physical presence of a tumour causes
brain injury, or indirect effects, including those due to treatment stress, neurosurgery, hydrocephalus, chemotherapy, cranial radiation
therapy, pain, fatigue, endocrinopathies or organ damage. Cancer also affects sleep by disrupting the normal circadian rhythm of the sleepwake
cycle. But the mechanisms that explain this issue are insufficient. Circadian rhythms are biological cycles of physiological and
behavioral processes. Sleep disorders reduce the quality of life for children and lead to behavioral and cognitive problems as a result of the
deterioration of physiological growth, endocrine system, natural killer cell and cytokine activity in children and adolescents.

Kaynakça

• Allen, J. M., Graef, D. M., Ehrentraut, J. H., Tynes, B. L., & Crabtree, V. M. (2016). Sleep and pain in pediatric illness: A conceptual review. CNS Neuroscience & Therapeutics, 22(11), 880-893.
• Bal Yılmaz, H., Karayağız Muslu, G., Taş, F., Başbakkal, Z., & Kantar, M. (2009). Çocukların kansere bağlı yaşadıkları semptomlar ve yorgunluğa ebeveyn bakışı. Türk Onkoloji Dergisi, 24(3), 122–127.
• Blazejova, K., Illnerova, H., Hajek, I., & Nevsimalova, S. (2008). Circadian rhythm in salivary melatonin in narcoleptic patients. Neuroscience Letters, 437(2), 162–164.
• Bruni, O., Alonso-Alconada, D., Besag, F., Biran, V., Braam, W., Cortese, S., ve ark. (2015). Current role of melatonin in pediatric neurology: Clinical recommendations. European Journal of Paediatric Neurology, 19(2), 122–133.
• Carrillo-Vico, A., Reiter, R. J., Lardone, P. J., Herrera, J. L., Fernández-Montesinos, R., Guerrero, J. M., & Pozo, D. (2006). The modulatory role of melatonin on immune responsiveness. Current Opinion in Investigational Drugs, 7(5), 423–431.
• Clanton, N. R., Klosky, J. L., Li, C., Jain, N., Srivastava, D. K., Mulrooney, D., ve ark. (2011). Fatigue, vitality, sleep and neurocognitive functioning in adult survivors of childhood cancer: A report from the childhood cancer survivor study. Cancer, 117(11), 2559–2568.
• Collins, J. J., Byrnes, M. E., Dunkel, I. J., Lapin, J., Nadel, T., Thaler, H. T., ve ark. (2000). The measurement of symptoms in children with cancer. Journal of Pain and Symptom Management, 19(5), 363–377.
• Çam, A., & Erdoğan, M. F. (2003). Melatonin. Ankara Üniversitesi Tıp Fakültesi Mecmuası, 56(2), 103–112.
• Erickson, J. M., MacPherson, C. F., Ameringer, S., Baggott, C., Linder, L., & Stegenga, K. (2013). Symptoms and symptom clusters in adolescents receiving cancer treatment: A review of the literature. International Journal of Nursing Studies, 50(6), 847–869.
• Finnegan, L., Campbell, R. T., & Ferrans, C. E. (2009). Symptom cluster experience profiles in adult survivors of childhood cancers. Journal of Pain and Symptom Management, 38(2), 258–269.
• Irwin, M., Clark, C., Kennedy, B., Gillin, J. C., & Ziegler, M. (2003). Nocturnal catecholamines and immune function in insomniacs, depressed patients, and control subjects. Brain, Behavior, and Immunity, 17(5), 365–372.
• Jacobs, S., Mowbray, C., Cates, L. M., Baylor, A., Gable, C., Skora, E., ve ark. (2016). Desmoplastic small round-cell tumor: Prolonged progression-free survival with aggressive multimodality therapy. Journal of Clinical Oncology, (63), 880–886.
• Jan, J. E., Tai, J., Hahn, G., & Rothstein, R. R. (2001). Melatonin replacement therapy in a child with a pineal tumor. Journal of Child Neurology, (16), 139–140.
• Kaleyias, J., Manley, P., & Kothare, S. V. (2012). Sleep disorders in children with cancer. Seminars in Pediatric Neurology, 19(1), 25–34.
• Keijzer, H., Smits, M. G., Peeters, T., Looman, C. W. N., Endenburg, S. C., & Gunnewiek, J. M. T. K. (2011). Evaluation of salivary melatonin measurements for Dim Light Melatonin Onset calculations in patients with possible sleep-wake rhythm disorders. Clinica Chimica Acta, 412(17–18), 1616–1620.
• Köroğlu, E. (2013). Uyku-uyanıklık bozuklukları. İçinde DSM-5 Tanı Ölçütleri Başvuru El Kitabı ( 5. Baskı, sy. 185-186). Ankara: HYB Yayıncılık.
• Lange, T., Dimitrov, S., & Born, J. (2010). Effects of sleep and circadian rhythm on the human immune system. Annals of the New York Academy of Sciences, 1193, 48–59.
• Lissoni, P. (2002). Is there a role for melatonin in supportive care? Supportive Care in Cancer, 10(2), 110–116
• Mandrell, B. N., Wise, M., Schoumacher, R. A., Pritchard, M., West, N., Ness, K. K., et al. (2012). Excessive daytime sleepiness and sleepdisordered breathing disturbances in survivors of childhood central nervous system tumors. Pediatric Blood & Cancer, 58(5), 746–51.
• McCulloch, R., Hemsley, J., & Kelly, P. (2013). Symptom management during chemotherapy. Pediatrics and Child Health, 24(4), 166–171.
• Nakamura, Y., Lipschitz, D. L., Kuhn, R., Kinney, A. Y., & Donaldson, G. W. (2013). Investigating efficacy of two brief mind-body intervention programs for managing sleep disturbance in cancer survivors: A pilot randomized controlled trial. Journal of Cancer Survivorship, 7(2), 165–182.
• Olson, K. (2014). Sleep-related disturbances among adolescents with cancer: A systematic review. Sleep Medicine, 15(5), 496–501.
• Ravindra, T., Lakshmi, N. K., & Ahuja, Y. R. (2006). Melatonin in pathogenesis and therapy of cancer. Indian Journal of Medical Sciences, 60(12), 523–535.
• Roscoe, J. A., Kaufman, M. E., Matteson-Rusby, S. E., Palesh, O. G., Ryan, J. L., Kohli, S., ve ark. (2007). Cancer-related fatigue and sleep disorders. Cancer, 12(suppl 1), 35–42.
• Rosen, G., & Brand, S. R. (2011). Sleep in children with cancer: Case review of 70 children evaluated in a comprehensive pediatric sleep center. Supportive Care in Cancer, 19(7), 985–994.
• Ruble, K., Georg, A., Gallicchio, L., & Gamaldo, C. (1996). Desmoplastic small round-cell tumor: Prolonged progression-free survival with aggressive multimodality therapy. Journal of Clinical Oncology, 14(5), 1526–1531.
• Sniecinska-Cooper, A. M., Iles, R. K., Butler, S. A., Jones, H., Bayford, R., & Dimitriou, D. (2015). Abnormal secretion of melatonin and cortisol in relation to sleep disturbances in children with Williams syndrome. Sleep Medicine, 16(1), 94–100.
• Szczepanik, M. (2007). Melatonin and its influence on immune system. Journal of Physiology and Pharmacology, 58(suppl 6), 115–124.
• Şener, G. (2010). Karanlığın hormonu: Melatonin. Marmara Pharmaceutical Journal, 14(3), 112–120.
• Walker, A. J., Johnson, K. P., Miaskowski, C., Lee, K. A., & Gedaly-Duff, V. (2010). Sleep quality and sleep hygiene behaviors of adolescents during chemotherapy. Journal of Clinical Sleep Medicine, 6(5), 439–444.
• Walter, L. M., Nixon, G. M., Davey, M. J., Downie, P. A., & Horne, R. S. C. (2015). Sleep and fatigue in pediatric oncology: A review of the literature. Sleep Medicine Reviews, 24, 71–82.
• Wright, M. (2011). Children receiving treatment for cancer and their caregivers: a mixed methods study of their sleep characteristics. Pediatr Blood Cancer, (56), 638–645.
• Yeh, C. H., Wang, C. H., Chiang, Y. C., Lin, L., & Chien, L. C. (2009). Assessment of symptoms reported by 10- to 18-year-old cancer patients in Taiwan. Journal of Pain and Symptom Management, 38(5), 738–746.
• Yoon, H., Yang, J. J., Song, Lee Minkyo, H., Lee, K., Lee, S., ve ark. (2015). Short sleep duration and its correlates among cancer survivors in Korea : The Korea National Health and Nutrition Examination Surveys, Asian Pacific Journal of Cancer Prevention, 16, 4705– 4710.
• Zhou, E. S., & Recklitis, C. J. (2014). Insomnia in adult survivors of childhood cancer: A report from project REACH. Supportive Care in Cancer, 22(11), 3061–3069.