Epilepsili Hastalarda Uyku ve Duygudurum Bozuklukları ve İlişkili Faktörler

Yıl 2024, Cilt: 18 Sayı: 2, 154 - 161, 28.05.2024

Pınar Bengi Boz , Gülçin Ortaç , Derya Ozdogru , Elif Banu Söker , Miray Erdem

https://doi.org/10.21763/tjfmpc.1404102

Öz

Giriş: Epilepsi hastalarında subjektif uyku bozuklukları ve psikiyatrik komorbiditeler genel popülasyona göre daha fazla görülmektedir ve bu durum yaşam kalitesini olumsuz yönde etkilemektedir. Bu çalışmada epilepsi hastalarında uyku ve duygu durum bozuklukları ve ilişkili faktörleri belirlemeyi amaçladık.
Yöntem: Adana Şehir Eğitim ve Araştırma Hastanesi Epilepsi polikliniğinde Uluslararası Epilepsi ile Savaş Ligi tanı kriterlerine göre epilepsi tanısı ile en az iki yıldır takip edilen 75 hasta çalışmaya dahil edildi. Hastaların demografik verileri, nöbet tipi, nöbet sıklığı, hastalık süresi, kullandığı ilaç sayısı, status epileptikus öyküsü, nöbetlerin uykuda ve uyanıklıkta olma durumları kaydedildi. Huzursuz bacaklar sendromu varlığı Uluslararası Huzursuz Bacaklar Sendromu çalışma grubu kriterlerine göre sorgulandı. Hastalara Pittsburgh uyku kalitesi indeksi, Epworth uykululuk ölçeği, Beck depresyon envanteri ve Beck anksiyete ölçeği uygulandı. Tüm hastalardan bilgilendirilmiş onam formu alındı.
Bulgular: Çalışmaya dahil edilen 75 hastanın; 43’ü (%57,3) kadın, 32’si (%42.7) erkek olup, yaş ortalamaları 33±13.9 ve hastalık süreleri ortalama 12.9±11.2 idi. Hastaların 36’sında (%48) nöbetler uykuda, 66’sında ise (%88) uyanıklıkta idi. 25 (%33,3) hastada huzursuz bacaklar sendromu kaydedildi. Nokturnal ve sık nöbet öyküsü ile huzursuz bacaklar sendromu bulguları olanların kötü uyku kalitesi ve uzun dönem uyku bozukluğu mevcuttu(p<0.05). Hastaların Beck depresyon ölçeği puanı ile huzursuz bacaklar sendromu arasında pozitif korelasyon saptandı. Ayrıca huzursuz bacaklar sendromu varlığında ve jeneralize başlangıçlı nöbetleri olan hastalarda kaygı düzeyi yüksek olarak bulundu(p<0.05).
Sonuç: Çalışmamız epilepsi hastalarında; kötü uyku kalitesinin uykuda nöbet varlığı, nöbet sıklığı, anksiyete ve depresyon semptomlarıyla ilişkili olabileceğini göstermiştir. Ek olarak huzursuz bacaklar sendromu bulguları varlığının buna olumsuz katkıda bulunabileceği saptanmıştır. Epilepsi hastalarında, daha iyi bir yaşam kalitesi tedavi hedeflerimiz arasında olmalı ve bu hastalarda etkin nöbet kontrolü ve uygun tedavi alternatifleriyle uyku kalitesinin artırılması sağlanmalıdır.

Anahtar Kelimeler

epilepsi, huzursuz bacaklar sendromu, uyku, duygu durum bozuklukları

Etik Beyan

Çalışma için Adana Şehir Eğitim ve Araştırma Hastanesi Klinik Araştırmalar Etik Kurulu 07/12/2023 tarih ve 2984-141 Karar no ile onay alınmıştır.

Destekleyen Kurum

Yazarlar bu çalışma için finansal destek ve bağış almadıklarını beyan etmişlerdir.

Sleep and Mood Disorders and Related Factors in Patients with Epilepsy

Öz

Introduction: Subjective sleep disorders and psychiatric comorbidities are more common in patients with epilepsy than in the general population, and this negatively affects quality of life. In this study, we aimed to determine sleep and mood disorders and related factors in epilepsy patients.
Method: Seventy-five patients who had been followed up in the epilepsy outpatient clinic of Adana City Training and Research Hospital for at least two years with a diagnosis of epilepsy according to the International League Against Epilepsy diagnostic criteria were included in the study. Demographic data, seizure type, seizure frequency, duration of the disease, number of medications used, history of status epilepticus, and the occurrence of seizures during sleep and wakefulness were recorded. The presence of restless legs syndrome was questioned according to the International Restless Legs Syndrome Study Group criteria. Pittsburgh sleep quality index, Epworth sleepiness scale, Beck depression inventory and Beck anxiety scale were administered. Informed consent form was obtained from all patients.
Results: Of the 75 patients included in the study, 43 (57.3%) were female and 32 (42.7%) were male, with a mean age of 33±13.9 years and a mean disease duration of 12.9±11.2 years. Seizures occurred during sleep in 36 (48%) and during wakefulness in 66 (88%) patients. Restless legs syndrome was noted in 25 (33.3%) patients. Those with a history of nocturnal and frequent seizures and restless legs syndrome findings had poor sleep quality and long-term sleep disturbance (p<0.05). There was a positive correlation between Beck depression scale score and restless legs syndrome. In addition, anxiety level was found to be high in the presence of restless legs syndrome and in patients with generalized onset seizures (p<0.05).
Conclusion: Our study showed that poor sleep quality may be associated with the presence of seizures, seizure frequency, anxiety and depression symptoms in epilepsy patients. In addition, it was found that the presence of restless legs syndrome findings may contribute negatively to this. A better quality of life should be among our treatment goals in epilepsy patients and sleep quality should be improved with effective seizure control and appropriate treatment alternatives.

Anahtar Kelimeler

epilepsy, restless leg syndrome, sleep, mood disorders

Kaynakça

• 1. Khatami R, Zutter D, Siegel A, Mathis J, Donati F, Bassetti CL. Sleep-wake habits and disorders in a series of 100 adult epilepsy patients--a prospective study. Seizure. 2006;15(5):299-306. doi:10.1016/j.seizure.2006.02.018
• 2. Vendrame M, Yang B, Jackson S, Auerbach SH. Insomnia and epilepsy: a questionnaire-based study. J Clin Sleep Med JCSM Off Publ Am Acad Sleep Med. 2013;9(2):141-146. doi:10.5664/jcsm.2410
• 3. Jacoby A, Snape D, Lane S, Baker GA. Self-reported anxiety and sleep problems in people with epilepsy and their association with quality of life. Epilepsy Behav EB. 2015;43:149-158. doi:10.1016/j.yebeh.2014.09.071
• 4. Matos G, Andersen ML, do Valle AC, Tufik S. The relationship between sleep and epilepsy: evidence from clinical trials and animal models. J Neurol Sci. 2010;295(1-2):1-7. doi:10.1016/j.jns.2010.05.003
• 5. Manni R, Terzaghi M. Comorbidity between epilepsy and sleep disorders. Epilepsy Res. 2010;90(3):171-177. doi:10.1016/j.eplepsyres.2010.05.006
• 6. Marghalani YO, Aljabri A, Kaneetah AH, Alzahrani SG, Hmoud M, Attar A.Quality of Life in Pediatrics With Intractable Epilepsy at King Abdulaziz Medical City, Jeddah, Saudi Arabia: A Cross-Sectional Study.Cureus. 2023 Jul 25;15(7):e42417. doi: 10.7759/cureus.42417. eCollection 2023 Jul.
• 7. Öz B, Şahin AK, Türay S, Sungur MA. Evaluation of sleep habits, sleep chronotype, and quality of life in children with drug-resistant epilepsy in Turkey. Epilepsy Behav EB. 2022;130:108675. doi:10.1016/j.yebeh.2022.108675
• 8. Allen RP, Picchietti DL, Garcia-Borreguero D, Ondo WG, Walters AS, Winkelman JW et al. Restless legs syndrome/Willis-Ekbom disease diagnostic criteria: updated International Restless Legs Syndrome Study Group (IRLSSG) consensus criteria--history, rationale, description, and significance. Sleep Med. 2014;15(8):860-873. doi:10.1016/j.sleep.2014.03.025
• 9. Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol. 1988;56(6):893-897. doi:10.1037//0022-006x.56.6.893
• 10. Ulusoy M, Sahin NH, Erkmen H. Turkish version of the Beck Anxiety Inventory: Psychometric properties. J Cogn Psychother, 1998;12:163-172.
• 11. Beck AT, Steer RA, Carbin MG. Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation. Clin Psychol Rev. 1988;8(1):77-100. doi:10.1016/0272-7358(88)90050-5
• 12. Hisli N. Beck Depresyon Ölçeği’nin bir Türk örnekleminde geçerlilik ve güvenilirliği. Psikoloji Dergisi. 1988; 6:118-122.
• 13. Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193-213. doi:10.1016/0165-1781(89)90047-4
• 14. Agargun MY, Kara H, Anlar O. The validity and reliability of the Pittsburgh Sleep Quality Index. Turk Psikiyatri Derg. 1996;7 (2), 107-115
• 15. 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 Breath Schlaf Atm. 2008;12(2):161-168. doi:10.1007/s11325-007-0145-7
• 16. Agargun MY, Çilli AS, Kara H, Bilici M, Telcioğlu M, Semiz ÜB. Epworth Uykululuk Ölçeği'nin Geçerliği Ve Güvenirliği. Türk Psikiyatri Dergisi. 1999;10 (4), 261-267
• 17. Stauder M, Vogel AC, Nirola DK, Tshering L, Dema U, Dorji C et al. Depression, sleep quality, and social isolation among people with epilepsy in Bhutan: A cross-sectional study. Epilepsy Behav EB. 2020;112:107450. doi:10.1016/j.yebeh.2020.107450
• 18. Chong CS, Tan JK, Ng BH, Lin ABY, Khoo CS, Rajah R et al. The prevalence and predictors of poor sleep quality and excessive daytime sleepiness in epilepsy: A single tertiary centre experience in Malaysia. J Clin Neurosci. 2023;118:132-142. doi:10.1016/j.jocn.2023.10.012
• 19. Im HJ, Park SH, Baek SH, Chu MK, Yang KI, Kim WJ et al. Associations of impaired sleep quality, insomnia, and sleepiness with epilepsy: A questionnaire-based case-control study. Epilepsy Behav EB. 2016;57(Pt A):55-59. doi:10.1016/j.yebeh.2016.01.022
• 20. Shvarts V, Chung S. Epilepsy, antiseizure therapy, and sleep cycle parameters. Epilepsy Res Treat. 2013;2013:670682. doi:10.1155/2013/670682
• 21. Unterberger I, Gabelia D, Prieschl M, Chea K, Hofer M, Högl B et al. Sleep disorders and circadian rhythm in epilepsy revisited: a prospective controlled study. Sleep Med. 2015;16(2):237-242. doi:10.1016/j.sleep.2014.09.021
• 22. Çilliler AE, Güven B. Sleep quality and related clinical features in patients with epilepsy: A preliminary report. Epilepsy Behav EB. 2020;102:106661. doi:10.1016/j.yebeh.2019.106661
• 23. Gümüşyayla Ş, Vural G. Epilepsili Hastalarda Uyku Bozuklukları ve Bunun Yaşam Kalitesine Etkisi. Kafkas J Med Sci. 2018;8(1):59-69. doi:10.5505/kjms.2017.93824
• 24. Cronin W, Kwan P, Foster E.Anxiety and depressive symptoms in adults with new-onset seizures: A scoping review.Epilepsia Open. 2023 Sep;8(3):758-772. doi: 10.1002/epi4.12766. Epub 2023 Jun 6.
• 25. Yang Y, Yang M, Shi Q, Wang T, Jiang M. Risk factors for depression in patients with epilepsy: A meta-analysis. Epilepsy Behav. 2020;106:107030. doi:10.1016/j.yebeh.2020.107030
• 26. Roebber JK, Lewis PA, Crunelli V, Navarrete M, Hamandi K. Effects of Anti-Seizure Medication on Sleep Spindles and Slow Waves in Drug-Resistant Epilepsy. Brain Sci. 2022 Sep 24;12(10):1288. doi: 10.3390/brainsci12101288.
• 27. Moore JL, Carvalho DZ, St Louis EK, Bazil C. Sleep and Epilepsy: a Focused Review of Pathophysiology, Clinical Syndromes, Co-morbidities, and Therapy. Neurother J Am Soc Exp Neurother. 2021;18(1):170-180. doi:10.1007/s13311-021-01021-w
• 28. Dede HÖ, Bebek N, Oğuz Akarsu E, Samancı B, Karbay M,Gürses C et al. Relationship Between Sleep Characteristics and Sudden Unexplained Death Risk in Epilepsy. The Neurologist. 2019;24(6):170-175. doi:10.1097/NRL.0000000000000254
• 29. Khachatryan SG, Ghahramanyan L, Tavadyan Z, Yeghiazaryan N, Attarian HP. Sleep-related movement disorders in a population of patients with epilepsy: prevalence and impact of restless legs syndrome and sleep bruxism. J Clin Sleep Med JCSM Off Publ Am Acad Sleep Med. 2020;16(3):409-414. doi:10.5664/jcsm.8218
• 30. Geyer JD, Geyer EE, Fetterman Z, Carney PR. Epilepsy and restless legs syndrome. Epilepsy Behav. 2017;68:41-44. doi:10.1016/j.yebeh.2016.12.010
• 31. Gammino M, Zummo L, Bue AL, Urso L, Terruso V, Marrone O et al. Excessive Daytime Sleepiness and Sleep Disorders in a Population of Patients with Epilepsy: a Case-Control Study. J Epilepsy Res. 2016;6(2):81-88. doi:10.14581/jer.16015