Tilt Table Tedavisi Uygulanan Nörolojik Rehabilitasyon Hastalarında Ortostatik Hipotansiyon Gelişimi ile Anksiyetenin İlişkisi

Amaç: Nörolojik rehabilitasyon uygulanan hastalarda sıklıkla görülen ortostatik hipotansiyon (OH), yaşam kalitesini ve bağımsızlığı azaltmakta, hastanede yatış süresini artırmaktadır. Tilt table’da vasovagal senkop gelişen hastalarda anksiyetenin semptomları tetiklediği bildirilmiştir. Nörolojik rehabilitasyon hastalarında anksiyete sıklıkla görülür. Ancak, nörojenik OH ile anksiyete arasındaki ilişki incelenmemiştir. Bu çalışmada tilt table tedavisi (TTT) uygulanan nörolojik rehabilitasyon hastalarında OH gelişimiyle anksiyete arasındaki ilişkinin incelenmesi amaçlandı.Yöntemler: Nörolojik rehabilitasyon ve TTT uygulanan hastaların yaşı, cinsiyeti, tanısı ve hastalık süresi kaydedildi. Hastalar Fonksiyonel Bağımsızlık Ölçeği (FBÖ) ve Beck Anksiyete Ölçeği (BAÖ) ile değerlendirildi. TTT sırasında nörojenik OH gelişip gelişmediği ve gelişme süresi (dakika) kaydedildi. Bulgular: Çalışmaya alınan 39 hastanın (12 kadın) yaş ortalaması 43±17,7 yıldı. Hastalardan 22’sinde OH gelişti. Hastalar OH (+) ve OH (-) şeklinde gruplandığında yaş, cinsiyet, hastalık süresi ve FBÖ skorları benzerdi (tümü için p>0.05), BAÖ skorları arasında da anlamlı fark izlenmedi (p=0.580). OH (+) hastalar anksiyete düzeylerine göre (minimal, hafif, orta, yüksek) gruplandırıldı ve gruplar arasında OH gelişim süresi açısından fark gözlenmedi (p=0.424). OH gelişim süresiyle anksiyete, yaş, hastalık süresi ve FBÖ arasında ilişki izlenmedi. Cinsiyet açısından incelendiğinde, OH (+) kadınlarda anksiyete skoru erkeklere kıyasla daha yüksekken (p=0.048), OH (-) grupta cinsiyet açısından anksiyete skoru benzerdi(p=0.111). Sonuç: Nörolojik rehabilitasyon uygulanan hastalardan TTT alanlarda nörojenik OH gelişimi ile anksiyete arasında ilişki gösterilemedi. OH (+) kadın hastaların anksiyete skorları erkek hastalara oranla daha yüksek bulundu. Nörojenik OH’lu kadın hastalarda yüksek anksiyetenin klinik öneminin ve hasta özelliklerine göre yaklaşım sonuçlarının belirlenmesi açısından daha kapsamlı çalışmalara ihtiyaç vardır.

The Association of Anxiety with the Emergence of Orthostatic Hypotension in Patients Undergoing Tilt Table Therapy Throughout Neurologic Rehabilitation

Objective: Orthostatic hypotension (OH), which is frequent in patients undergoing neurological rehabilitation, decreases the quality of life and independence and increases hospital-stay. Anxiety triggers symptoms of vasovagal syncope in patients on tilt table. Anxiety is frequent in patients undergoing neurological rehabilitation. However, the association between neurogenic OH and anxiety is unclear. This study aimed to investigate the relationship between the emergence of OH and anxiety in patients undergoing tilt table therapy (TTT) throughout neurological rehabilitation. Methods: The age, gender, diagnosis and disease duration of the patients on TTT were recorded. They were evaluated using the Functional Independence Measurement (FIM) and the Beck Anxiety Inventory (BAI). Emergence of neurogenic OH (if present) and time to emergence (minutes) were recorded. Results: The mean age of 39 patients (12 female) was 43±17,7 years. OH emerged in 22 patients. When the patients were grouped as OH(+) and OH(-), demographic characteristics and FIM scores were similar (p>0.05 for all), BAI scores were also similar (p=0.580). When OH(+) patients were grouped regarding anxiety levels (minimal, mild, moderate, high), duration to OH were similar between the groups (p=0.424). There was no relationship between the duration to OH and anxiety, age, disease duration and FIM. Regarding gender, the anxiety score was higher in OH(+) women than in OH(+) men (p=0.048), while the anxiety score within the OH(-) group was similar (p=0.111) Conclusion: There was no relationship between the emergence of neurogenic OH and anxiety in patients undergoing TTT throughout neurological rehabilitation. Anxiety scores of OH(+) females were higher than OH(+) males. Comprehensive studies are needed to determine the clinical significance of high anxiety in neurogenic OH(+) females and the results of the approach according to patient characteristics.

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