BİRİNCİ BASAMAK SAĞLIK HİZMETLERİNDE UYKU BOZUKLUKLARI TARAMASI VE DEĞERLENDİRİLMESİ

Abstract

Uyku; sağlığın korunması, iyi bir yaşam kalitesi ve gün boyunca iyi bir performans için önemli olan temel bir ihtiyaçtır. Uyku bozuklukları, başta uykusuzluk bozuklukları ve obstrüktif uyku apnesi olmak üzere, toplumda yaygın olarak görülürler. Kronik uyku bozukluklarının uzun dönem kümülatif etkileri; mental problemler, kardiyovasküler hastalıklar, diyabet, obezite ve depresyon gibi pek çok olumsuz sağlık sonucu ile ilişkilidir. Uyku problemleri; yol açtığı bu sonuçlar nedeniyle, koruyucu hekimlik açısından ciddiye alınmalıdır. Bununla birlikte; prevalansının yüksekliğine ve ciddi sağlık sonuçları olmasına rağmen, toplumda uyku bozukluğu olan bireylerin yalnızca %20’si doğru tanı ve tedavi alabilmektedir. Bu sebeple, uyku problemlerinin sonuçları; mortalite ve morbidite hızları, kazalar, yaralanmalar ve sağlık hizmetlerinin kullanımı gibi birçok halk sağlığı göstergesini etkiler. Epidemiyolojik çalışmalar, uyku sorunlarının tanınması ve danışmanlık hizmeti verilmesinin önündeki engeller arasında; zaman yetersizliği, uyku sorunlarının hastalar tarafından hekimlerine daha az bildirilmesi, uyku bozukluklarının ciddi olmadığına dair yanlış kanılar ve hekimlerdeki farkındalık ve bilgi eksiklikleri olduğunu göstermiştir. Bu derlemede; toplumda yaygın görülen uyku bozukluklarının değerlendirilmesi için, birinci basamak sağlık hizmetlerinde kullanılabilecek tarama araçları sunulmuştur. 

Keywords

• Uyku bozuklukları,tarama,birinci basamak sağlık hizmetleri,uykusuzluk,uyku apnesi

SCREENING and ASSESSMENT for SLEEP DISORDERS in PRIMARY HEALTH CARE

Abstract

Sleep is a basic human need and is important for health, good quality of life and performing well during the day. Sleep disorders, especially insomnia and obstructive sleep apnea, are common in the community. The cumulative long-term effects of these disorders are associated with a wide range of adverse health consequences including mental problems, cardiovascular diseases, diabetes, obesity and depression. Sleep problems should be taken seriously in terms of preventive medicine due to these consequences. However, despite their high frequency and significant outcomes, less than 20% of individuals with sleep disorders are correctly diagnosed and treated. Therefore, consequences of sleep conditions affect many important indicators of public health such as mortality and morbidity rates, accidents, injuries, and health care utilization. Epidemiologic studies suggest that barriers to screening and counselling for sleep disorders include; limited time, low reporting of sleep problems by patients, misconceptions about the seriousness of sleep disorders, lack of awareness among physicians, and insufficient physician knowledge. In this review; assessment tools that can be used in primary health care for screening for common sleep problems are presented.

Keywords

• Sleep disorders,screening,primary health care,insomnia,sleep apnea

References

1. 1. Basner M, McGuire S. WHO Environmental Noise Guidelines for the European Region: A Systematic Review on Environmental Noise and Effects on Sleep. International journal of environmental research and public health. 2018;15(3):519.
2. 2. Özbay SY, Bilici M. Uykunun Nörobiyolojisi ve Fizyolojisi. Psikiyatride Güncel. 2016;6(2):89-95.
3. 3. Mental Health Foundation, Sleep Matters: The Impact Of Sleep On Health And Wellbeing. 2011. https://www.mentalhealth.org.uk/publications/sleep-report/ (Erişim Tarihi: 09.02.2019)
4. 4. Sateia MJ. International Classification of Sleep Disorders-Third Edition. CHEST. 2014;146(5):1387-94.
5. 5. Crowley K. Sleep and sleep disorders in older adults. Neuropsychology review. 2011;21(1):41-53.
6. 6. Ohayon MM. Prevalence and comorbidity of sleep disorders in general population. La Revue du praticien. 2007;57(14):1521-8.
7. 7. Im E, Kim G-S. Relationship between sleep duration and Framingham cardiovascular risk score and prevalence of cardiovascular disease in Koreans. Medicine. 2017;96(37):e7744-e.
8. 8. Ayas NT, White DP, Al-Delaimy WK, Manson JE, Stampfer MJ, Speizer FE, et al. A prospective study of self-reported sleep duration and incident diabetes in women. Diabetes care. 2003;26(2):380-4.

9. 9. Gottlieb DJ, Punjabi NM, Newman AB, Resnick HE, Redline S, Baldwin CM, et al. Association of Sleep Time With Diabetes Mellitus and Impaired Glucose Tolerance. Archives of internal medicine. 2005;165(8):863-7.
10. 10. Spiegel K, Leproult R, Van Cauter E. Impact of sleep debt on metabolic and endocrine function. Lancet (London, England). 1999;354(9188):1435-9.
11. 11. Bjorvatn B, Sagen IM, Oyane N, Waage S, Fetveit A, Pallesen S, et al. The association between sleep duration, body mass index and metabolic measures in the Hordaland Health Study. J Sleep Res. 2007;16(1):66-76.
12. 12. Cappuccio FP, Taggart FM, Kandala N-B, Currie A, Peile E, Stranges S, et al. Meta-analysis of short sleep duration and obesity in children and adults. Sleep. 2008;31(5):619-26.
13. 13. Kapur VK, Blough DK, Sandblom RE, Hert R, de Maine JB, Sullivan SD, et al. The medical cost of undiagnosed sleep apnea. Sleep. 1999;22(6):749-55.
14. 14. Kapur VK, Redline S, Nieto FJ, Young TB, Newman AB, Henderson JA. The relationship between chronically disrupted sleep and healthcare use. Sleep. 2002;25(3):289-96.
15. 15. Simon GE, VonKorff M. Prevalence, burden, and treatment of insomnia in primary care. The American journal of psychiatry. 1997;154(10):1417-23.
16. 16. Connor J, Norton R, Ameratunga S, Robinson E, Civil I, Dunn R, et al. Driver sleepiness and risk of serious injury to car occupants: population based case control study. BMJ (Clinical research ed). 2002;324(7346):1125.
17. 17. Akerstedt T, Fredlund P, Gillberg M, Jansson B. A prospective study of fatal occupational accidents -- relationship to sleeping difficulties and occupational factors. J Sleep Res. 2002;11(1):69-71.
18. 18. Baldwin DC, Jr., Daugherty SR. Sleep deprivation and fatigue in residency training: results of a national survey of first- and second-year residents. Sleep. 2004;27(2):217-23.
19. 19. Luyster FS, Choi J, Yeh C-H, Imes CC, Johansson AEE, Chasens ER. Screening and evaluation tools for sleep disorders in older adults. Applied nursing research : ANR. 2015;28(4):334-40.
20. 20. Young T, Evans L, Finn L, Palta M. Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep. 1997;20(9):705-6.
21. 21. Benca RM. Diagnosis and treatment of chronic insomnia: a review. Psychiatric services (Washington, DC). 2005;56(3):332-43.
22. 22. Rosen RC, Zozula R, Jahn EG, Carson JL. Low rates of recognition of sleep disorders in primary care: comparison of a community-based versus clinical academic setting. Sleep medicine. 2001;2(1):47-55.
23. 23. Al-Kandari S, Alsalem A, Al-Mutairi S, Al-Lumai D, Dawoud A, Moussa M. Association between sleep hygiene awareness and practice with sleep quality among Kuwait University students. Sleep health. 2017;3(5):342-7.
24. 24. Brown FC, Buboltz WC, Jr., Soper B. Relationship of sleep hygiene awareness, sleep hygiene practices, and sleep quality in university students. Behavioral medicine (Washington, DC). 2002;28(1):33-8.
25. 25. Irish LA, Kline CE, Gunn HE, Buysse DJ, Hall MH. The role of sleep hygiene in promoting public health: A review of empirical evidence. Sleep medicine reviews. 2015;22:23-36.
26. 26. Yetkin S. Uykusuzluk. Psikiyatride Güncel. 2016;6(2):106-15.
27. 27. Buysse DJ, Reynolds CF, 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry research. 1989;28(2):193-213.
28. 28. Suen LK, Tam WW, Hon KL. Association of sleep hygiene-related factors and sleep quality among university students in Hong Kong. Hong Kong medical journal = Xianggang yi xue za zhi. 2010;16(3):180-5.
29. 29. Li J, Zhou K, Li X, Liu M, Dang S, Wang D, et al. Mediator Effect of Sleep Hygiene Practices on Relationships Between Sleep Quality and Other Sleep-Related Factors in Chinese Mainland University Students. Behavioral sleep medicine. 2016;14(1):85-99.
30. 30. Ağargün MY, Kara H, Anlar Ö. Pittsburgh Uyku Kalitesi İndeksi'nin Geçerliği ve Güvenirliği. Türk Psikiyatri Dergisi. 1996;7(2):107-15.
31. 31. Anders MP, Breckenkamp J, Blettner M, Schlehofer B, Berg-Beckhoff G. Association between socioeconomic factors and sleep quality in an urban population-based sample in Germany. European journal of public health. 2014;24(6):968-73.
32. 32. Koh HW, Lim RB, Chia KS, Lim WY. The Pittsburgh Sleep Quality Index in a multi-ethnic Asian population contains a three-factor structure. Sleep & breathing = Schlaf & Atmung. 2015;19(4):1147-54.
33. 33. Bertolazi AN, Fagondes SC, Hoff LS, Pedro VD, Menna Barreto SS, Johns MW. Portuguese-language version of the Epworth sleepiness scale: validation for use in Brazil. Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia. 2009;35(9):877-83.
34. 34. Okubo N, Matsuzaka M, Takahashi I, Sawada K, Sato S, Akimoto N, et al. Relationship between self-reported sleep quality and metabolic syndrome in general population. BMC public health. 2014;14:562.
35. 35. Lee JA, Sunwoo S, Kim YS, Yu BY, Park HK, Jeon TH, et al. The Effect of Sleep Quality on the Development of Type 2 Diabetes in Primary Care Patients. Journal of Korean medical science. 2016;31(2):240-6.
36. 36. Fujieda M, Uchida K, Ikebe S, Kimura A, Kimura M, Watanabe T, et al. Inquiring about insomnia may facilitate diagnosis of depression in the primary care setting. Psychiatry and clinical neurosciences. 2017;71(6):383-94.
37. 37. Aysan E, Karaköse S, Zaybak A, İsmailoğlu EG. Üniversite öğrencilerinde uyku kalitesi ve etkileyen faktörler. Dokuz Eylül Üniversitesi Hemşirelik Fakültesi Elektronik Dergisi. 2014;7(3):193-8.
38. 38. Mastin DF, Bryson J, Corwyn R. Assessment of sleep hygiene using the Sleep Hygiene Index. Journal of behavioral medicine. 2006;29(3):223-7.
39. 39. Ozdemir PG, Boysan M, Selvi Y, Yildirim A, Yilmaz E. Psychometric properties of the Turkish version of the Sleep Hygiene Index in clinical and non-clinical samples. Comprehensive psychiatry. 2015;59:135-40.
40. 40. Chehri A, Kiamanesh A, Ahadi H, Khazaie H. Psychometric Properties of the Persian Version of Sleep Hygiene Index in the General Population. Iranian journal of psychiatry and behavioral sciences. 2016;10(3):e5268.
41. 41. Odabaşıoğlu E, Dedeoğlu T, Kasırga Z, Sünbül F. Üniversite Öğrencilerinde Uyku Hijyeni Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi. 2017;6(4):204-12.
42. 42. Seun-Fadipe CT, Aloba OO, Oginni OA, Mosaku KS. Sleep Hygiene Index: Psychometric Characteristics and Usefulness as a Screening Tool in a Sample of Nigerian Undergraduate Students. Journal of Clinical Sleep Medicine. 2018;14(8):1285-92.
43. 43. Sateia MJ, Doghramji K, Hauri PJ, Morin CM. Evaluation of chronic insomnia. An American Academy of Sleep Medicine review. Sleep. 2000;23(2):243-308.
44. 44. Lack L, Miller W, Turner D. A survey of sleeping difficulties in an Australian population. Community health studies. 1988;12(2):200-7.
45. 45. Ohayon MM. Epidemiology of insomnia: what we know and what we still need to learn. Sleep medicine reviews. 2002;6(2):97-111.
46. 46. Aslan S, Gulcat Z, Selda Albayrak F, Maral I, Yetkin S, Sutcigil L, et al. Prevalence of insomnia symptoms: results from an urban district in Ankara, Turkey. International journal of psychiatry in clinical practice. 2006;10(1):52-8.
47. 47. Benbir G, Demir AU, Aksu M, Ardic S, Firat H, Itil O, et al. Prevalence of insomnia and its clinical correlates in a general population in Turkey. Psychiatry and clinical neurosciences. 2015;69(9):543-52.
48. 48. Singareddy R, Vgontzas AN, Fernandez-Mendoza J, Liao D, Calhoun S, Shaffer ML, et al. Risk factors for incident chronic insomnia: a general population prospective study. Sleep medicine. 2012;13(4):346-53.
49. 49. Chesson A, Jr., Hartse K, Anderson WM, Davila D, Johnson S, Littner M, et al. Practice parameters for the evaluation of chronic insomnia. An American Academy of Sleep Medicine report. Standards of Practice Committee of the American Academy of Sleep Medicine. Sleep. 2000;23(2):237-41.
50. 50. Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M. Clinical guideline for the evaluation and management of chronic insomnia in adults. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine. 2008;4(5):487-504.
51. 51. Bastien CH, Vallieres A, Morin CM. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep medicine. 2001;2(4):297-307.
52. 52. Boysan M, Güleç M, Beşiroğlu L, Kalafat T. Uykusuzluk Şiddeti İndeksi’nin Türk örneklemindeki psikometrik özellikleri. Anadolu Psikiyatri Dergisi. 2010;11(3):248-52.
53. 53. Morin CM, Belleville G, Belanger L, Ivers H. The Insomnia Severity Index: psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep. 2011;34(5):601-8.
54. 54. Gagnon C, Belanger L, Ivers H, Morin CM. Validation of the Insomnia Severity Index in primary care. Journal of the American Board of Family Medicine : JABFM. 2013;26(6):701-10.
55. 55. Chung K-F, Kan KK-K, Yeung W-F. Assessing insomnia in adolescents: Comparison of Insomnia Severity Index, Athens Insomnia Scale and Sleep Quality Index. Sleep medicine. 2011;12(5):463-70.
56. 56. Jaisoorya TS, Dahale AB, Sunil KG, Manoj L, Gokul GR, Thennarassu K. Insomnia in primary care—a study from India. Sleep health. 2018;4(1):63-7.
57. 57. Gamsızkan Z, Aslan S. Birinci Basamakta İnsomnia Sıklığı ve İlişkili İnanç ve Tutumların Değerlendirilmesi. Journal of Cognitive Behavioral Psychotherapy and Research. 2014;3(3):156-61.
58. 58. Önal GŞ, Hisar KM. Üniversite Öğrencilerinde Uykusuzluk Şiddeti ve Depresyon Semptomları İlişkisi ve Depresyon Tedavisinin Uykusuzluk Şiddetine Etkisi. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi.7(1):125-30.
59. 59. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. The New England journal of medicine. 1993;328(17):1230-5.
60. 60. Kim J, In K, Kim J, You S, Kang K, Shim J, et al. Prevalence of sleep-disordered breathing in middle-aged Korean men and women. American journal of respiratory and critical care medicine. 2004;170(10):1108-13.
61. 61. Bixler EO, Vgontzas AN, Lin HM, Ten Have T, Rein J, Vela-Bueno A, et al. Prevalence of sleep-disordered breathing in women: effects of gender. American journal of respiratory and critical care medicine. 2001;163(3 Pt 1):608-13.
62. 62. Spicuzza L, Caruso D, Di Maria G. Obstructive sleep apnoea syndrome and its management. Therapeutic advances in chronic disease. 2015;6(5):273-85.
63. 63. Türk Toraks Dergisi, Obstrüktif Uyku Apne Sendromu Tanı Ve Tedavi Uzlaşı Raporu. 2012. https://www.toraks.org.tr/book.aspx?list=1378&menu=237 (Erişim Tarihi: 01.02.2019)
64. 64. Sleep-Related Breathing Disorders in Adults: Recommendations for Syndrome Definition and Measurement Techniques in Clinical Research. Sleep. 1999;22(5):667-89.
65. 65. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14(6):540-5.
66. 66. Izci B, Ardic S, Firat H, Sahin A, Altinors M, Karacan I. Reliability and validity studies of the Turkish version of the Epworth Sleepiness Scale. Sleep & breathing = Schlaf & Atmung. 2008;12(2):161-8.
67. 67. Johns MW. Daytime Sleepiness, Snoring, and Obstructive Sleep Apnea: The Epworth Sleepiness Scale. Chest. 1993;103(1):30-6.
68. 68. Kjelsberg FN, Ruud EA, Stavem K. Predictors of symptoms of anxiety and depression in obstructive sleep apnea. Sleep medicine. 2005;6(4):341-6.
69. 69. Unal E, Aydın R, Uzuner GT, Erdinç OO, Metintaş, S. Tıp fakültesi öğrencilerinde gündüz aşırı uykululuk hali ve depresyon şüphesi ilişkisi. Türk Dünyası Uygulama Ve Araştırma Merkezi Halk Sağlığı Dergisi. 2016;1(1):28-37.
70. 70. Burgess KR, Havryk A, Newton S, Tsai WH, Whitelaw WA. Targeted case finding for OSA within the primary care setting. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine. 2013;9(7):681-6.
71. 71. Manni R, Politini L, Ratti MT, Tartara A. Sleepiness in obstructive sleep apnea syndrome and simple snoring evaluated by the Epworth Sleepiness Scale. Journal of Sleep Research. 1999;8(4):319-20.
72. 72. Gottlieb DJ, Yao Q, Redline S, Ali T, Mahowald MW. Does snoring predict sleepiness independently of apnea and hypopnea frequency? American journal of respiratory and critical care medicine. 2000;162(4 Pt 1):1512-7.
73. 73. Karakoç Ö, Akçam T, Gerek M, Birkent H. Horlama ve Obstüriktif Uyku Apneli Hastalarda Epworth Uykululuk Skalasının Güvenilirliği. Elektronik Kulak Burun Boğaz ve Baş Boyun Cerrahisi Dergisi. 2007;6(3):86-9.
74. 74. Osman E, Osborne J, Hill P, Lee B. The Epworth Sleepiness Scale: can it be used for sleep apnoea screening among snorers? Clinical Otolaryngology & Allied Sciences. 1999;24(3):239-41.
75. 75. El-Sayed IH. Comparison of four sleep questionnaires for screening obstructive sleep apnea. Egyptian Journal of Chest Diseases and Tuberculosis. 2012;61(4):433-41.
76. 76. Miller JN, Berger AM. Screening and assessment for obstructive sleep apnea in primary care. Sleep medicine reviews. 2016;29:41-51.
77. 77. Kreuter MW, Chheda SG, Bull FC. How does physician advice influence patient behavior? Evidence for a priming effect. Archives of family medicine. 2000;9(5):426-33.
78. 78. Ossip-Klein DJ, McIntosh S, Utman C, Burton K, Spada J, Guido J. Smokers ages 50+: who gets physician advice to quit? Preventive medicine. 2000;31(4):364-9.