Saim YANIK, Mehmet Emrah POLAT, Zafer SAK

OSAS'lı Hastalarda Temporomandibular Eklem Rahatsızlıklarının Prevelansının Değerlendirilmesi

Amaç: Çalışmamızın amacı polisomnografi (PSG) ile Obstrüktif Uyku Apne sendromu (OSAS) teşhisi konmuş 54 hastada Temporomandibular eklem (TME) rahatsızlığı prevelansını, ve OSAS’ın yaş ve cinsiyet ile ilişkisini araştırmaktır.Materyal ve Metod: Çalışmamıza Ocak 2018 – Haziran 2018 tarihleri arasında Harran Üniversitesi Tıp Fakültesi Göğüs Hastalıkları Anabilim Dalında OSAS teşhisi konmuş fakat OSAS tedavisine başlanmamış 54 hasta dâhil edildi. OSAS teşhisi konmuş hastalar Harran Üniversitesi Diş Hekimliği Fakültesi Ağız, Diş ve Çene Cerrahisi kliniğine yönlendirildi. Bu hastaların TME muayenesi tek hekim tarafından bilateral olarak yapıldı. Muayene esnasında TME rahatsızlığına bakıldı. Teşhis edilen rahatsızlıklar TME rahatsızlığı/eksen 1 (RDC/TMD Axis 1) sınıflandırmasına göre klasifiye edildi. Ayrıca hastaların yaş ve cinsiyetleri de kayıt edildi.Bulgular: Elde edilen sonuçlara göre hastaların % 75,9’u erkek, % 24,1’i kadındır. % 24,1’inde bruksizm, % 9,3’ünde redüksiyonlu disk deplasmanı vardır. Apne/Hipopne indeksi (AHİ) indeksine göre hastaların % 70,4’ünde ağır derecede, % 20,4’ünde orta derece, % 9,3’ünde hafif derecede OSAS bulunmaktaydı. Hastaların yaş ortalaması yaklaşık 50, hafif derecede OSAS grubunun yaş ortalaması 33,4, orta derecede OSAS grubunun yaş ortalaması 49,3 ve ağır derecede OSAS grubunun yaş ortalaması ise 51,8'dır. Test istatistiğinin anlamlılık değerlerine göre, hastalık derecesi ile yalnızca yaş grupları arasında istatistiksel olarak anlamlı ilişki bulunmuştur (p<0.05). Çoklu karşılaştırma testi bulgularına göre ağır derecede OSAS teşhisi konulan hastaların yaş ortalamaları, hafif derecede OSAS teşhisi konulan hastalara göre anlamlı ölçüde yüksektir. Diğer tüm faktörlerle hastalık derecesi arasında istatistiksel olarak anlamlı ilişki bulunamamıştır (p>0.05).Sonuç: OSAS erkelerde ve ilerleyen yaşlarda daha yüksek oranda görülmektedir ve yaş ilerledikçe hastalığın şiddeti de artmaktadır. Çalışmamızda OSAS’lı hastalarda üçte birinde TME rahatsızlığının eşlik ettiği görülmüş olup en sık gözlenen TME rahatsızlığı bruksizm olarak kaydedilmiştir. Yazarlar bunun nedeni olarak uyku kalitesinin bozulmasının hastalarda psikolojik strese yol açtığını ve sonuç olarak bruksizmi tetiklediğini düşünmektedir. Bununla birlikte çalışmanın daha geniş hasta popülasyonları üzerinde yapılmasına ve ayrıca OSAS’lı hastaların tedavi öncesi ve sonrası TME rahatsızlığı bulgularını karşılaştıran ileri çalışmalara ihtiyaç bulunmaktadır.

Anahtar Kelimeler:

Temporomandibular eklem rahatsızlığı, OSAS, YAŞ, CİNSİYET

Evaluation of Prevalence of Temporomandibular Joint Disorders in Patients with OSAS

Background: The aim of our study was to investigate the prevalence of Temporomandibular Joint (TMJ) disorder in 54 patients diagnosed with Obstructive Sleep Apnea syndrome (OSAS) by polysomnography (PSG) and to invetigate age and sex relationship.Materials and Methods: 54 patients who were diagnosed with OSAS Between January 2018 and June 2018, in the Department of Pulmonology, Faculty of Medicine, Harran University were included in this study. Patients diagnosed with OSAS were referred to the Oral, Dental and Maxillofacial Surgery Clinic of the Faculty of Dentistry at Harran University. TME examination of these patients was performed bilaterally by the same physician. TME was examined during the examination. The diagnosed ailments were classed according to the RDC/TMD Axis 1 classification. The age and sex of the patients were also recorded.Results: According to the results, 75.9% of the patients were male and 24.1% were female. 24.1% have bruxism and 9.3% have reduced disc displacement. According to the ahi index, 70.4% of patients had severe, 20.4% had moderate, 9.3% had mild OSAS. The mean age of the patients was approximately 50, the mean age of the mild Osas group was 33.4, the mean age of the moderate OSAS group was 49.3 and the mean age of the severe OSAS group was 51.8. According to the significance values of the test statistics, there was a statistically significant relationship between the degree of disease and age groups only (p<0.05). The average age of patients diagnosed with severe OSAS is significantly higher than those diagnosed with mild OSAS, according to the findings of the multiple comparison test. There was no statistically significant association between all other factors and the degree of disease (p>0.05).Conclusions: OSAS is more common in men and in later ages, and the severity of the disease increases as age progresses. In our study, TME disorder was observed in one third of patients with OSAS and bruxism was recorded as the most common TME disorder group. The authors consider this to be due to impaired sleep quality leading to psychological stress in patients and consequently triggering bruxism. However, the study needs to be carried out on the wider patient population and further studies comparing the findings of TME disease before and after treatment of patients with OSAS are needed.

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