UYKU APNE SENDROMU İLE GEÇİRİLMİŞ KAFA TRAVMASI İLİŞKİSİ

Öz

Uykuda solunum bozukluğu gelişiminin kafa travması geçiren hastalarda arttığı bildirilmiştir, ancak aralarındaki ilişki tam aydınlatılamamıştır. Çalışmamızda uyku apne sendromu ile kafa travması arasındaki ilişkiyi araştırmak amaçlanmıştır. Kafa travması ve trafik kazası öyküsü, uyku apne sendromu ön tanısı ile polisomnografi yapılan 564 hastadan, çalışmaya katılmayı kabul eden 334 hastada (katılım oranı: %59), telefonda uygulanan anket formu ile sorgulandı. Hastaların 263'ünde (%78.7) obstrüktif uyku apne sendromu (OUAS), 12'sinde (%3.6) santral uyku apne sendromu (SUAS) mevcuttu. Kafa travması, kafa ve boyunda yaralanma, servikal herni, trafik kazası sırasıyla 93 (%27.8), 40 (%12.0), 35 (%10.5), 82 (%24.6) hastada bildirildi. Lineer regresyon modelinde yaş, cinsiyet, BKİ kontrol edildiğinde, servikal herni, obstrüktif AHİ ile (beta-12.8, %95 GA: -22.5, -3.2); BKİ hariç etkenler kontrol edildi ğinde sürücüyken trafik kazası öyküsü, santral AHİ ile (beta: 4.8, %95GA: 1.4, 8.1) ilişkili bulundu. Bu çalışmada uyku apne sendromu ön tanısı ile uyku laboratuarında yatan hasta topluluğunda genel populasyona göre daha fazla oranda minörmaj ör kafa travması ve trafik kazası geçirme öyküsü saptanmıştır. Ayrıca santral tip uyku apne sendromunun daha önce geçirilmiş kafa travması ile ilişkili ortaya çıkabileceği, obstrüktif tip uyku apne sendromunun ise hastalığa bağlı olarak trafik kazası ve kafa travmasını artırdığını düşündürmüştür. Servikal herni ise üst solunum yolunda oluşan değişikliklerle OUAS için koruyucu olabileceğini düşündürmüştür.

Anahtar Kelimeler

• Uyku apne sendromu, kafa travması, trafik kazası

THE ASSOCIATION BETWEEN SLEEP APNEA SYNDROME AND HEAD TRAUMA

Abstract

Increased occurrence of sleep related breathing disorder has been reported in patients with head trauma, but the association has not been elucidated. This study was aimed to investigate the association between sleep apnea syndrome and head trauma. Of the 564 patients, who had polysomnography with a preliminary diagnosis of sleep apnea, 334 (participation rate: 59%) gave consent and had telephone administered survey, which included information on history of head trauma and traffic accident. Obstructive sleep apnea syndrome (OSAS) and central sleep apnea syndrome (CSAS) were present in 263 (78.7%) and 12 (3.6%) patients, respectively. Head trauma, head and neck injury, neck hernia and traffic accident were reported in 93 (27.8%), 40 (12.0%), 35 (10.5%), 82 (24.6%) patients, respectively. Linear regression analysis adjusting for age, gender and BMI found association of cervical hernia with obstructive AHI (beta-12.8, 95% CI: -22.5, -3.2); and traffic accident as a driver w ith central AHI (beta: 4.8, 95% CI: 1.4, 8.1) adjusted for the factors except BMI. Higher rate of minor- major head trauma and traffic accident were reported in the population who were admitted to sleep disorders laboratory with a suspicion of OSAS than the general population in this study. Moreover CSAS could be associated with previous brain injury due to head trauma and OSAS could increase the prevalence of traffic accidents and head trauma due to disease. Cervical hernia related upper airway changes could be protective for OSAS.

Keywords

• Sleep apnea syndrome, head trauma, traffic accident

Kaynakça

1. 1. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleepdisordered breathing among middle-aged adults. N Engl J Med 1993; 328: 1230-5.
2. 2. Young T, Evans L, Finn L, Palta M. Estimation of clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep 1997; 20: 705-6.
3. 3. Thal ER, Rochon RB. Inner-city trauma centers. Financial burdens or community saviors? Surg Clin North Am 1991; 71: 209-19.
4. 4. Tintinalli JE, Ruiz E, Krome RL. Emergency Medicine: A Comprehensive Study Guide. 3rd ed. McGraw Hill, New York; 1992.
5. 5. Legend D. The cost of sleep-related accidents: a report fort he National Commission on Sleep Disorders Research. Sleep 1994; 17: 84-93.
6. 6. Aldrich MS. Automobile accidents in patients with sleep disorders. Sleep 1989; 12: 487-94.
7. 7. Findley LJ, Unverzagt ME, Suratt PM: Automobile accident involving patient with obstructive sleep apnea. Am Rev Respir Dis 1988; 138: 337-40.
8. 8. Castriotta RJ, Lai JM. Sleep disorders associated with traumatic brain injury. Arch Phys Med Rehabil 2001; 82: 1403-6.

9. 9. Castoritta RJ, Wilde MC, Lai JM, Atanasov S, Masel BE, Kuna ST. Prevalence and consequences of sleep disorders in traumatic brain injury. J Clin Sleep Med 2007; 3: 349-56.
10. 10. Guilleminault C, Faul KF, Miles L, van den Hoed J. Posttraumatic excessive daytime sleepiness: a review of 20 subjects. Neurology 1983; 33: 1584-9.
11. 11. Guilleminault C, Yuen KM, Gulevich MG, Karadeniz D, Leger D, Philip P. Hypersomnia after head-neck trauma: a medicolegal dilemma. Neurology 2000; 54: 653-9.
12. 12. Masel BE, Scheibel RS, Kimbark T, Kuna ST. Excessive daytime sleepiness in adults with brain injuries. Arch Phys Med Rehabil 2001; 82: 1526-32.
13. 13. Webster JB, Bell KR, Hussey JD, Natale TK, Lakshminarayan S. Sleep apnea in adults with traumatic brain injury: a preliminary investigation. Arch Phys Med Rehabil 2001; 82: 316-21.
14. 14. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep 1999; 22(5): 667-89.
15. 15. Rechtschaffen A, Kales A. A Manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects. Los Angeles, Brain Information Service, 1968.
16. 16. American Academy of Sleep Medicine. International classification of sleep disorders: Diagnostic and coding manual. 2nd ed. Westchester, Illinois; 2005.
17. 17. Olshaker JS, Whye DPW. Head trauma. Emergency Medicine Clinics of North America 1993; 11: 165.
18. 18. Parker F, Andrews PJD, Azouvi P, Aghakhani N, Perrouin-Verbe B. Acute Traumatic Brain ‹njury. Continuum 2001; 7: 7-31.
19. 19. Verma A, Anand V, Verma NP. Sleep disorders in chronic traumatic brain injury. J Clin Sleep Med 2007; 3(4): 357-62.
20. 20. Wilde MC, Castriotta RJ, Lai JM, Atanasov S, Masel BE, Kuna ST. Cognitive impairment in patients with traumatic brain injury and obstructive sleep apnea. Arch Phys Med Rehabil 2007; 88: 1284-8.
21. 21. Kotterba S, Mueller N, Leidag M, et al. Comparison of driving Simulator performance and neuropsychological testing in narcolepsy. Clin Neurol Neurosurg 2004; 106: 275-9.
22. 22. Shiomi T, Arita AT, Sasanabe R, et al. Falling asleep while driving and automobile accidents among patients with obstructive sleep apneahypopnea syndrome. Psychiatry and Clinical Neurosciences 2002; 56(3): 333-6.
23. 23. Halbower AC, Degaonkar M, Barker PB, Early CJ, Marcus CL, Smith PL. Childhood obstructive sleep apnea associates with neuropsychological deficits and neuronal brain injury. PLoS Med 2006; 3(8): e301.
24. 24. Robbins J, Redline S, Ervin A, Walsleben JA, Ding J, Nieto FJ. Associations of sleep-disordered breathing and cerebral changes on MRI. J Clin Sleep Med 2005; 1(2): 159-65.
25. 25. Alchanatis M, Deligiorgis N, Zias N, et al. Frontal brain lobe impairment in obstructive sleep apnoea: a proton MR spectroscopy study. Eur Respir J 2004; 24(6): 980-6.