Kronik Kalp Yetmezliği Hastalarında Uyku Yapısının Polisomnografik Verilerle Değerlendirilmesi

Year 2024, Volume: 50 Issue: 2, 243 - 249, 08.10.2024

Ebru Yaşar Furkan Sarıdaş , Bilnur Yaşar Aylin Bican Demir

https://doi.org/10.32708/uutfd.1502734

Abstract

Kardiyovasküler hastalıklarda uyku ile ilgili bozuklukların önemine dair farkındalık artmaktadır. Uyku bozuklukları kalp yetmezliğinde yaygındır ve uykusuzluk, uyku mimarisinde bozulma, periyodik bacak hareketleri ve periyodik solunumu içerir. Uykuyu başlatma veya sürdürmede zorluk, çok erken uyanma ve tekrar uykuya dalamama ve gün içi uykululuk sıklıkla görülür. Biz çalışmamızda kronik, kompanse ve stabil seyirli kalp yetmezliği hastalarında polisomnografik olarak uyku mimarisi farklılıkları ve bu değişimlerin sol ventrikül sistolik fonksiyonu ile ilişkisinin polisomnografi (PSG) ve transtorasik ekokardiyografi ile ortaya çıkarılması amaçlandı. Transtorasik Ekokardiyografi ile değerlendirilmiş uyku şikayetleri olan 18-75 yaş hastalar dahil dahil edildi. En az dört hafta optimal Kalp Yetmezlik tedavisi alıyor olmak şartı arandı. Kalp kapak hastalıklarına bağlı kronik kalp yetmezliği, kalp nakli için listeleye alınma, yaşamı tehdit eden bilinen hastalıklar, oksijen veya pozitif hava yolu basıncı ile mevcut tedavi alıyor olmak, son 3 ay içinde kararsız anjina pektoris, akut myokard enfarktüsü ve kardiyak cerrahi öyküsü dışlama kriteri olarak belirlendi. Kalp yetmezlikli hastalarda N1 evre yüzdesi, total AHI, total RDI, total RERA, toplam obstrüktif apne sayısı, toplam desaturasyon süresi, total aurosal indeks, NREM evresinde poziyondan bağımsız olarak AHI, RERA ve RDI, REM evresinde poziyondan bağımsız olarak RDI, supin pozisyonda ise AHI kontrol grubuna göre daha yüksekti. Kalp yetmezliği erken evrede bile olsa uyku bozuklukları açısından dikkat edilmesi, uzun vadeli sonuçlar üzerinde muhtemel olumlu etkisi göz önüne alınarak kalp yetmezliği hastalarında uyku ve solunum bozukluklarının zamanında doğru tanımlanması ve tedavisi için önemli bir vurgu yapmakta, ayrıca klinik uyku yönetimi ve tedavisi için belirli bir teorik destek sağlamaktadır.

Keywords

kalp yetmezliği, polisomnografi, ekokardiyografi, uyku bozuklukları

Assessment of Sleep Structure in Patients with Chronic Heart Failure Using Polysomnographic

Abstract

Awareness of the significance of sleep-related disorders in cardiovascular diseases is increasing. Sleep disorders are common in heart failure, involving insomnia, disruptions in sleep architecture, periodic leg movements, and periodic breathing. Difficulties in initiating or maintaining sleep, early awakening, difficulty returning to sleep, and daytime sleepiness are frequently observed. In our study, we aimed to investigate polysomnographic differences in sleep architecture in patients with chronic, compensated, and stable heart failure and to reveal the relationship between these changes and left ventricular systolic function through polysomnography and transthoracic echocardiography. Patients between the ages of 18-75 with complaints of sleep disturbances, evaluated through Transthoracic Echocardiography, will be included in the study. A prerequisite for inclusion will be receiving optimal Heart Failure treatment for at least four weeks. Exclusion criteria will include chronic heart failure due to valvular heart diseases, listing for heart transplantation, known life-threatening diseases, current treatment with oxygen or positive airway pressure, and a history of unstable angina pectoris, acute myocardial infarction, and cardiac surgery within the last 3 months. In heart failure patients, the percentage of stage N1, total AHI, total RDI, total RERA, total obstructive apnea events, total desaturation duration, total arousal index, AHI, RERA, and RDI independent of position during NREM sleep, RDI independent of position during REM, and AHI in the supine position were higher compared to the control group. Heart failure, even in its early stages, warrants attention regarding sleep disorders. Emphasizing the timely and accurate identification, treatment of sleep and respiratory disorders in heart failure patients, considering the potential positive impact on long-term outcomes, is crucial.

Keywords

Heart failure, polysomnography, echocardiography, sleep disorders

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