KOMORBİD HASTALIKLARIN VE VİTAMİN DÜZEYLERİNİN UYKU KALİTESİNE ETKİSİNİN İNCELENMESİ

Öz

AMAÇ: Bu çalışmanın amacı, bir uyku kliniğinde polisomnografi (PSG) yapılan hastaların komorbid hastalıkları, vitamin düzeyleri ve uyku kalitesi arasındaki ilişkiyi araştırmaktır. GEREÇ VE YÖNTEMLER: Bolu Abant İzzet Baysal Eğitim ve Araştırma Hastanesi Uyku Kliniği'nde Ocak 2018-Aralık 2018 tarihleri arasında PSG uygulanan 54 hasta çalışmaya dahil edildi. PSG ölçümleri uygun hazırlık prosedürlerini takiben uyku kliniğinde yapıldı. BULGULAR: Çalışma grubunun 41'i (%78,8) erkek, 11'i (%21,2) kadındı. Ortalama yaş 49.25 ± 12.77 idi. Uyku apnesi sayısı (p = 0.013), santral apne (p = 0.037), apne / hipopne indeksi (p = 0.026) ve RDI (p = 0.021) diabetes melllitus (DM) hastalarında daha yüksekti. Hipertansiyonlu (HT) hastalarda (p = 0.021) ve koroner arter hastalığı (KAH) olanlarda (p = 0.013) REM uyku süresinin kısaldığı tespit edildi. D vitamini düzeyleri ile 2. evre uyku süresi arasında pozitif yönde zayıf korelasyon vardı (p = 0.032, r = 0.309). Folat seviyeleri (p = 0.039, r = -0.305) ve B12 vitamini seviyeleri (p = 0.035, r = -0.305) arttıkça arousal indeks değerleri azaldı. SONUÇ: HT ve KAH uyku üzerinde çok sınırlı etkiye sahiptir. Ek olarak, bu çalışmada uyku parametrelerini en fazla DM olumsuz olarak etkilemiştir. Değerlendirilen vitamin düzeylerinin de uykuyu bazı parametrelerde çok sınırlı düzeyde etkilediği bulunmuştur.

Anahtar Kelimeler

• komorbidite
• polisomnografi
• vitamin düzeyleri

EXAMINATION OF THE EFFECT OF COMORBID DISEASES AND VITAMIN LEVELS ON SLEEP QUALITY

Öz

AIM: The aim of this study was to investigate the relationship between comorbid diseases, vitamins levels and sleep quality of patients undergoing polysomnography (PSG) in a sleep clinic. MATERIAL AND METHODS: Fifty-four patients who underwent PSG between January 2018 and December 2018 at Bolu Abant İzzet Baysal Training and Research Hospital Sleep Clinic were included in the study. PSG measurements were performed in the sleep clinic following appropriate preparatory procedures. RESULTS: Of the study group, 41 (78.8%) were male and 11 (21.2%) were female. The mean age was 49.25 ± 12.77 years. The number of sleep apneas (p=0.013), central apnea (p=0.037), apnea / hypopnea index (p=0.026) and RDI (p=0.021) were higher in patients with diabetes melllitus (DM). It was found that REM sleep time was shortened in patients with hypertension (HT) (p=0.021) and patients with CAD (p=0.013). There was a positive weak correlation between vitamin D levels and stage 2 sleep duration (p=0.032, r = 0.309). As folate levels (p=0.039, r =-0.305) and vitamin B12 levels (p=0.035, r=-0.305) increased, arousal index values decreased. CONCLUSION: HT and CAD have very limited effects on sleep. In addition, DM most negatively affected sleep parameters in this study. It was also found that the evaluated vitamin levels affect sleep only very limited in some parameters.

Anahtar Kelimeler

• comorbidity
• polysomnography
• vitamin levels

Kaynakça

1. 1.) Ohayon M, Wickwire EM, Hirshkowitz M, et al. National Sleep Foundation's sleep quality recommendations: first report. Sleep Health. 2017; 3: 6-19.
2. 2.) Akman T, Yavuzsen T, Sevgen Z, et al. Evaluation of sleep disorders in cancer patients based on Pittsburgh Sleep Quality Index. European journal of cancer care. 2015; 24: 553-9.
3. 3.) Garcia S, Alosco ML, Spitznagel MB, et al. Poor sleep quality and reduced cognitive function in persons with heart failure. Int J Cardiol. 2012; 156: 248.
4. 4.) Punjabi NM, Shahar E, Redline S, et al. Sleep-disordered breathing, glucose intolerance, and insulin resistance: the Sleep Heart Health Study. Am J Epidemiol. 2004; 160: 521-30.
5. 5.) Liu R-Q, Qian Z, Trevathan E, et al. Poor sleep quality associated with high risk of hypertension and elevated blood pressure in China: results from a large population-based study. Hypertens Res. 2016; 39: 54.
6. 6.) Knutson KL, Ryden AM, Mander BA, et al. Role of sleep duration and quality in the risk and severity of type 2 diabetes mellitus. Arch Intern Med. 2006; 166: 1768-74.
7. 7.) Lamond N, Tiggemann M, Dawson D. Factors predicting sleep disruption in Type II diabetes. Sleep. 2000; 23: 415-6.
8. 8.) Lopes LA, De Mm Lins C, Adeodato VG, et al. Restless legs syndrome and quality of sleep in type 2 diabetes. Diabetes Care. 2005; 28: 2633-6.

9. 9.) Gangwisch JE. A review of evidence for the link between sleep duration and hypertension. Am J Hypertens. 2014; 27: 1235-42.
10. 10.) Mohsenin V. Obstructive sleep apnea and hypertension: a critical review. Curr Hypertens Rep. 2014; 16: 482.
11. 11.) Sforza E, Saint Martin M, Barthelemy JC, et al. Association of self-reported sleep and hypertension in non-insomniac elderly subjects. J Clin Sleep Med. 2014; 10: 965-71.
12. 12.) Portaluppi F, Vergnani L, Manfredini R, et al. Endocrine mechanisms of blood pressure rhythms. Ann N Y Acad Sci. 1996; 783: 113-31.
13. 13.) Bonsignore M, Marrone O, Insalaco G, et al. The cardiovascular effects of obstructive sleep apnoeas: analysis of pathogenic mechanisms. Eur Respir J. 1994; 7: 786-805.
14. 14.) Mullington JM, Haack M, Toth M, et al. Cardiovascular, inflammatory, and metabolic consequences of sleep deprivation. Prog Cardiovasc Dis. 2009; 51: 294-302.
15. 15.) Burgess HJ, Trinder J, Kim Y, et al. Sleep and circadian influences on cardiac autonomic nervous system activity. American Journal of Physiology-Heart and Circulatory Physiology. 1997; 273: H1761-H8.
16. 16.) Marin JM, Carrizo SJ, Vicente E, et al. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. The Lancet. 2005; 365: 1046-53.
17. 17.) Muscogiuri G, Barrea L, Scannapieco M, et al. The lullaby of the sun: the role of vitamin D in sleep disturbance. Sleep Med. 2018.
18. 18.) Ikonte C, Reider C, Fulgoni Iii V, et al. Analysis of NHANES 2005–2016 Data Showed Significant Association Between Micro and Macronutrient Intake and Various Sleep Variables (P06-103-19). Oxford University Press; 2019.
19. 19.) Baglioni C, Nanovska S, Regen W, et al. Sleep and mental disorders: A meta-analysis of polysomnographic research. Psychol Bull. 2016; 142: 969.
20. 20.) Berry RB, Brooks R, Gamaldo CE, et al. The AASM manual for the scoring of sleep and associated events. Rules, Terminology and Technical Specifications, Darien, Illinois, American Academy of Sleep Medicine. 2012; 176.
21. 21.) Mollayeva T, Thurairajah P, Burton K, et al. The Pittsburgh sleep quality index as a screening tool for sleep dysfunction in clinical and non-clinical samples: a systematic review and meta-analysis. Sleep Med Rev. 2016; 25: 52-73.
22. 22.) Da Silva AA, De Mello RGB, Schaan CW, et al. Sleep duration and mortality in the elderly: a systematic review with meta-analysis. BMJ open. 2016; 6: e008119.
23. 23.) Yang X, Chen H, Li S, et al. Association of sleep duration with the morbidity and mortality of coronary artery disease: a meta-analysis of prospective studies. Heart, Lung and Circulation. 2015; 24: 1180-90.
24. 24.) Surani S, Brito V, Surani A, et al. Effect of diabetes mellitus on sleep quality. World J Diabetes. 2015; 6: 868.
25. 25.) Cuellar NG, Ratcliffe SJ. A comparison of glycemic control, sleep, fatigue, and depression in type 2 diabetes with and without restless legs syndrome. J Clin Sleep Med. 2008; 4: 50-6.
26. 26.) Faraco G, Iadecola C. Hypertension: a harbinger of stroke and dementia. Hypertension. 2013; 62: 810-7.
27. 27.) Wang Q, Xi B, Liu M, et al. Short sleep duration is associated with hypertension risk among adults: a systematic review and meta-analysis. Hypertens Res. 2012; 35: 1012.
28. 28.) Cappuccio FP, Cooper D, D'elia L, et al. Sleep duration predicts cardiovascular outcomes: a systematic review and meta-analysis of prospective studies. Eur Heart J. 2011; 32: 1484-92.
29. 29.) Sherwood A, Hill LK, Blumenthal JA, et al. The effects of ambulatory blood pressure monitoring on sleep quality in men and women with hypertension: dipper vs. nondipper and race differences. Am J Hypertens. 2018; 32: 54-60.
30. 30.) Lo K, Woo B, Wong M, et al. Subjective sleep quality, blood pressure, and hypertension: a meta‐analysis. The Journal of Clinical Hypertension. 2018; 20: 592-605.
31. 31.) Li X, Li J, Liu K, et al. Association between sleep disorders and morning blood pressure in hypertensive patients. Clin Exp Hypertens. 2018; 40: 337-43.
32. 32.) Madsen MT, Huang C, Zangger G, et al. Sleep Disturbances in Patients With Coronary Heart Disease: A Systematic Review. J Clin Sleep Med. 2019; 15: 489-504.
33. 33.) Kim JH, Chang JH, Kim DY, et al. Association Between Self‐Reported Sleep Duration and Serum Vitamin D Level in Elderly Korean Adults. J Am Geriatr Soc. 2014; 62: 2327-32.
34. 34.) Massa J, Stone KL, Wei EK, et al. Vitamin D and actigraphic sleep outcomes in older community-dwelling men: the MrOS sleep study. Sleep. 2015; 38: 251-7.
35. 35.) Peuhkuri K, Sihvola N, Korpela R. Diet promotes sleep duration and quality. Nutr Res. 2012; 32: 309-19.
36. 36.) Hashimoto S, Kohsaka M, Morita N, et al. Vitamin B12 enhances the phase-response of circadian melatonin rhythm to a single bright light exposure in humans. Neurosci Lett. 1996; 220: 129-32.
37. 37.) Mayer G, Kröger M, Meier-Ewert K. Effects of vitamin B12 on performance and circadian rhythm in normal subjects. Neuropsychopharmacology. 1996; 15: 456.