Çocukluk Çağı Kanserlerinde Uyku Bozukluğu

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.

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