Saadet Koc OKUDUR, Pınar SOYSAL, Lee SMITH, Burcu AKPINAR SÖYLEMEZ, Merve Aliye AKYOL

Yaşlı Bireylerde Uykusuzluk ve Gündüz Aşırı Uykululuk Halinin Klinik Etkilerinin Değerlendirilmesi

Giriş: Uykusuzluk ve gündüz aşırı uykululuk (GAU), yaşlı hastalarda sık görülen uyku bozukluklarındandır. Her ikisi de çok sayıda olumsuz sağlık durumlarıyla ilişkilidir. Amaç: Uykusuzluk ve/veya GAU’nun yaşlılarda fonksiyonellik, yürüme-denge fonksiyonları, kognisyon, duygu durum, düşme ve düşme korkusu (DK) üzerine etkilerini değerlendirmek, hemşirelik pratiği açısından önemini belirlemek ve konuyla ilgili farkındalık yaratmaktır. Yöntem: Kesitsel araştırma tasarımı kullanıldı. Çalışmaya ≥ 65 yaş, 661 ayaktan hasta dahil edildi. Tüm hastalara ayrıntılı geriatrik değerlendirme yapıldı. Komorbiditeler, son bir yıldaki düşmeler ve kullanılan ilaçlar kaydedildi. DK' nu belirlemek ve sınıflandırmak için Uluslararası Düşme Etkinliği Ölçeği (UDEÖ), nörokognitif değerlendirme için Standardize Mini Mental Test (SMMT) ölçeği, günlük yaşam aktivitelerini değerlendirmek için Temel Günlük Yaşam Aktiviteleri (TGYA) ve Enstrümental Günlük Yaşam Aktiviteleri (EGYA) kullanılmıştır. Uykusuzluk Şiddet İndeksinin ≥ 8 puan olması uykusuzluk, Epworth Uykululuk Skalasının ≥ 11 puan olması GAU olarak değerlendirildi. Bulgular: Yaş ortalaması 77.78 ±7.73 yıldı. GAU, uykusuzluk ve GAU ve uykusuzluk halinin prevalansları sırasıyla %5.45, %50.38 ve %12.56 idi. İki değişkenli ve çok değişkenli lojistik regresyon analizi sonucunda; GAU ve uykusuzluk ile orta ve yüksek DK (OR=2.24, %95 CI: 1.74-2.89), polifarmasi (OR=1.20, %95 CI: 1.09-1.30), TGYA (OR=0.94, %95 CI: 0.93-0.96), EGYA (OR=0.87, %95 CI: 0.84-0.91) ve SMMT (OR=0.91, %95 CI: 0.86-0.98) arasında anlamlı ilişki saptanmıştır (p<.05). Sonuç: Yaşlı yetişkinlerde GAU ve uykusuzluk ile DK, polifarmasi, günlük yaşam aktiviteleri ve kognisyon arasında yakın ilişki vardır. Yaşlı bireylerle çalışan sağlık çalışanlarının uyku alanını değerlendirirken bu parametreleri göz önünde bulundurmaları önerilmektedir.

Anahtar Kelimeler:

Uykusuzluk, Gündüz Aşırı Uykululuk, Yaşlı Birey.

Evaluation of the Clinical Effects of Insomnia and Excessive Daytime Sleepiness in Older Adults

Background: Insomnia and excessive daytime sleepiness (EDS) are common sleep disorders in older adults. Both are associated with numerous adverse health conditions. Objectives: The aim of our study is to evaluate the effects of insomnia and/or EDS on functionality, gait-balance functions, cognition, mood, falls and fear of falling (FoF) in older adults, to determine its importance in terms of nursing practice and to raise awareness on the subject. Methods: A cross-sectional study design was used. A total of 661 outpatients were included, aged ≥ 65 years. All patients underwent comprehensive geriatric assessment. Comorbidities, falls in the last year and drugs used were recorded. The Falls Efficacy Scale–International (FES-I) was used to determine and classify FoF. MMSE was applied to all patients for neurocognitive evaluation. Activities of daily living were assessed by Basic Activities of Daily Living Scale (BADL) and Instrumental Activities of Daily Living (IADL) scales. Insomnia Severity Index (ISI) with scores of 8 and over indicated insomnia. The Epworth Sleepiness Scale score of ≥ 11 points indicated EDS. Results: The mean age was 77.78 ± 7.73 years. The prevalences of EDS, insomnia, and EDS+insomnia were 5.45%, 50.38%, and 12.56%, respectively. As a result of bivariate and multivariate logistic regression analysis, there was a significant relationship between EDS+insomnia with moderate and high FoF (OR=2.24, 95% CI: 1.74 to 2.89), polypharmacy (OR=1.20, 95% CI: 1.09 to 1.30), BADL (OR=0.94, 95% CI: 0.93 to 0.96) ), IADL (OR=0.87, 95% CI: 0.84 to 0.91) and MMSE (OR=0.91, 95% CI: 0.86 to 0.98) (p<.05). Conclusions: There is a close relationship between EDS+insomnia and FoF, polypharmacy, activities of daily living and cognition in older adults.

Keywords:

Insomnia, Excessive Daytime Sleepiness, Older Adults,

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