Süleyman GÖRPELİOĞLU, Gülcan KARAHAN, Özlem SUVAK

Postmenopozal Dönemdeki Kadınlarda Fiziksel Aktivitenin Uyku Kalitesi ve Kardiyovasküler Hastalık Riskine Etkisinin Değerlendirilmesi

Amaç: Menopoz dönemi kadınların kardiyovaskülerhastalık(KVH) riskinin ve uyku sorunlarının arttığı yaşam dönemidir. Çalışmada bu dönemdeki kadınlarda fiziksel aktivitenin kardiyovasküler riskve uyku kalitesine etkisini saptamayı amaçladık. Gereç ve Yöntem: Çalışma, Sağlık Bilimleri Üniversitesi Dışkapı Yıldırım Beyazıt Eğitim ve Araştırma Hastanesi’nde 2018 yılı Ağustos-Aralıkayları arasında polikliniğe başvuran dahil olma ve dışlanma kriterleri karşılayan 342 postmenopozal kadın ile yapılmıştır. Kadınlara sosyodemografik veri formu, Uluslararası Fiziksel Aktivite Anketi kısa form, Pittsburgh Uyku Kalite İndeksi uygulanmış, Framingham formülasyonu ile kardiyovasküler risktahmini hesaplanmıştır. Alınan veriler SPSS 23. programı ile değerlendirilmiş, Pearson korelasyon, ANOVA ve Ki-kare test teknikleri kullanılmıştır. Bulgular: Çalışmamızda kadınların yaş ortalaması 60,77±9,2 yıl idi. 10 yıllık KVR yüksek olanların oranı %66,1 idi. Pittsburgh Uyku Kalitesi (PUKİ) Skoru 9,05±4,33 ve iyi uyku kalitesine (PUKİ ≤5) sahip olanların oranı %24,6 idi. Fiziksel aktivite düzeyi 848,68±1213,08 MET-dk/hafta olarak saptandı. Fiziksel olarak aktif olmama durumunun hipertansiyon tanısı varlığı ile ilişkili olduğu görülmüştür. (p=0,026). Kadınlarda fiziksel aktivite düzeyi şiddetli olanların beden kitle indeksinin(BKİ) düşük olduğu (p = 0,035) , beden kitle indeksi ve gündüz işlev bozukluğu arttıkça KVR’ninarttığı görüldü. Kardiyovasküler riskile uyku kalite skoru ve alt parametreleri fiziksel aktiviteye göre değişmedi. Fiziksel aktivite düzeyinin şiddeti ile Framingham risk skoru(FRS) arasında anlamlı fark olduğu (p=0,032) , fiziksel aktivite düzeyi yüksek olanların FRS en yüksek iken fiziksel aktivite düzeyi düşük olanların FRS en düşüktü. Uyku kalitesi ve alt parametreleri fiziksel aktivite düzeyine göre değişmedi. Obezite varlığında kardiyovasküler risk, alışılmış uyku etkinliği ve uyku bozukluğu komponent skorunun arttığı gösterildi. Sonuç: Menopoz öncesi dönemden itibarenobeziteyi azaltıp KVH’ınbaşlamasını veya ilerlemesini önlemek için kadınlar uygun fiziksel aktivite yapmaya yönlendirilmelidir. Postmenopozal dönemde uyku kalitesini arttırmak amacıyla uyku hijyeni eğitimleri verilebilir.

Evaluation of the Effect of Physical Activity on Sleep Quality and Cardiovascular Disease Risk in Women in the Postmenoposal Period in Turkey

Objective: Menopause is a period of life in which women are at increased risk of cardiovascular diseases and sleep problems. In this study, we aimed to determine the effect of physical activity on CVR and sleep quality in women in this period. Methods: The study was conducted with 342 postmenopausal women (PMW) who met the inclusion and exclusion criteria who applied to the outpatient clinic between August and December 2018 at Health Sciences University Dışkapı Yıldırım Beyazıt Training and Research Hospital. Women were given sociodemographic data form, International Physical Activity Questionnaire short form(IPAQ-SF), Pittsburgh Sleep Quality Index (PSQI) , calculated CVR estimation with Framingham formulation. The data were evaluated with SPSS 23 program. Results: In our study the mean age of women was 60.77 ± 9.2 years. The rate of patients with a 10-year CVR was 66.1%. The Pittsburgh Sleep Quality (PSQI) scorewas 9.05 ± 4.33 and the rate of good sleep quality (PSQI ≤5) was 24.6%. Physical activity (PA) level was found to be 848.68 ± 1213.08 MET-min /week. It was observed that the state of being physically inactive was associated with the presence of a diagnosis of hypertension (p = 0.026). It was observed that those with severe PA levels in women had low body mass index (BMI) (p = 0.035), and increased CVD as the BMI and daytime dysfunction increased. Cardiovascular risk (CVR), sleep quality score and subparameters did not change according to physical activity. While there was a significant difference between the severity of PA level and Framingham risk score (FRS) (p = 0.032), those with high PA levels had the lowest FRS. Sleep quality and subparameters did not change according to PA level. In the presence of obesity, CVR, habitual sleep afficiency and sleep disorder component scores were shown to increase. Conclusions: From the pre-menopausal period, women should be directed to perform appropriate PA to reduce obesity and prevent the onset or progression of CVD. Sleep hygiene trainings can be given to improve sleep quality in the postmenopausal period.

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1. Chair SY, Wang Q, Cheng HY, Lo SW, Li XM, Wong EM, Sit JW. Relationship between sleep quality and CVD risk in Chinese post-menopausal women BMC Womens Health. 2017;17(1):79.
2. Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, et al. Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation. 2017;135(10):e146–603.
3. Dmitruk A, Czeczelewski J, Czeczelewska E, Golach J, Parnicka U. Body composition and fatty tissue distribution in women with various menstrual status. Rocz Panstw Zakl Hig. 2018;69(1):95-101.
4. Christ JP, Gunning MN, Palla G, Eijkemans MJC, Lambalk CB, Laven JSE, et al. Estrogen deprivation and CVD risk in primary ovarian insufficiency. Fertil Steril. 2018;109(4):594–600.e1.
5. Gameiro CM, Romao F, Castelo-Branco C. Menopause and aging: changes in the immune system-a review. Maturitas. 2010;67(4):316–20.
6. Guérin E., Prud’Homme D., Goldfield G. Trajectories of mood and stress and relationships with protective factors during the transition to menopause: Results using latent class growth modeling in a Canadian cohort. Arch. Women’s Ment. Health. 2017;20:733–7.
7. Lee J, Han Y, Cho HH, Kim MR. Sleep Disorders and Menopause J Menopausal Med. 2019 Aug;25(2):83-87.
8. Casas R, Gabriel P, Kriska AM, Kuller L, Conroy M Association of Leisure Physical Activity and Sleep with Cardiovascular Risk Factors in Postmenopausal Women. Menopause 2012 Apr;19(4):413-9.
9. Woolf K, Reese CE, Mason MP, Beaird LC, Tudor-Locke C et al. Physical Activity Is Associated With Risk Factors for Chronic Disease Across Adult Women's Life Cycle. J Am Diet Assoc 2008 Jun;108(6):948-59.
10. Beverly Hery CM, Hale L, Naughton MJ. Contributions of the Women's Health Initiative to understanding associations between sleep duration, insomnia symptoms, and sleep-disordered breathing across a range of health outcomes in postmenopausal women. Sleep Health. 2020 Feb;6(1):48-59.
11. Huang T, Mariani S, Redline S Sleep Irregularity and Risk of Cardiovascular Events: The Multi-Ethnic Study of Atherosclerosis. J Am Coll Cardiol. 2020 Mar 10;75(9):991-999.
12. Gaspard U, Buicu C, Creutz V Multiple Benefits of Physical Exercise in Menopausal Women Rev Med Liege 2001 Apr;56(4):219-22.
13. Best JR, Falck RS, Landry GJ, Liu-Ambrose T Analysis of dynamic, bidirectional associations in older adult physical activity and sleep quality. J Sleep Res. 2019 Aug;28(4):e12769.
14. Kelley GA, Kelley KS Exercise and sleep: a systematic review of previous meta-analyses. J Evid Based Med. 2017;10(1):26–36.
15. Grindler NM, Santoro NF. Menopause and Exercise. Menopause. 2015 Dec;22(12):1351-8.
16. Saglam M, Arikan H, Savci S, Inal-Ince D, Bosnak-Guclu M, Karabulut E, et al. International PA questionnaire: reliability and validity of the Turkish version. Percept Mot Skills. 2010;111:278–284.
17. Sjöström M, Oja P, Hagströmer M, Smith B. Health-enhancing physical activity across European Union countries: The Eurobarometer Study. J Public Health 2006; 14(5): 291–300.
18. 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 May;28(2):193-213.
19. Jiao L, Machuki JO, Wu Q, Shi M, Fu L et al. Estrogen and Calcium Handing Proteins: New Discoveries and Mechanisms in Cardiovascular Diseases. Am J Physiol Heart Circ Physiol. 2020 Apr 1;318(4):H820-H829.
20. Makarem N, St-Onge MP, Liao M, Lloyd-Jones DM, Aggarwal B. Association of sleep characteristics with cardiovascular health among women and differences by race/ethnicity and menopausal status: findings from the American Heart Association Go Red for Women Strategically Focused Research Network. Sleep Health. 2019 Oct;5(5):501-508.
21. Scheltens T, Verschuren WMM, Boshuizen HC, Hoes AH, Zuithhoff NP, Bots ML, et al. Estimation of CVR: a comparison between the Framingham and the SCORE model in people under 60 years of age. Eur J Cardiovasc Prev Rehabil, 2008;15(5):562-6.
22. de Kat AC, Dam V, Onland-Moret NC, Eijkemans MJC, Broekmans FJM, van der Schouw YT. Unraveling the associations of age and menopause with cardiovascular risk factors in a large population-based study. BMC Med. 2017 Jan 4;15(1):2.
23. Young DR, Hivert MF, Alhassan S, Camhi SM, Ferguson JF, Katzmarzyk PT, Lewis CE, Owen N, Perry CK, Siddique J, Yong CM. Sedentary behavior and cardiovascular morbidity and mortality: a science advisory from the American Heart Association. Circulation. 2016 Sep 27;134(13):e262-79.
24. Chang YJ, Bellettiere J, Godbole S, Keshavarz S, Maestas JP et al. Total Sitting Time and Sitting Pattern in Postmenopausal Women Differ by Hispanic Ethnicity and are Associated With Cardiometabolic Risk Biomarkers. J Am Heart Assoc. 2020 Feb 18;9(4):e013
25. Valiensi SM, et al. Maturitas. 2019 May;123:73-77.
26. Medic G, Wille M, Hemels ME. Short- and long-term health consequences of sleep disruption. Nat Sci Sleep. 2017 May 19;9:151-161.
27. Wu X, Tao S, Zhang Y, Zhang S, Tao F. Low physical activity and high screen time can ıncrease the risks of mental health problems and poor sleep quality among Chinese college students. PLoS ONE 2015;10(3):1
28. Magee CA, Reddy P, Robinson L, McGregor A. Sleep quality subtypes and obesity. Health Psychol 2016;35(12):1289-97.
29. Kim MJ, Yim G, Park HY Vasomotor and physical menopausal symptoms are associated with sleep quality. PLoS One. 2018;13(2):4-8
30. Zhou Y, Yang R, Li C, Tao M. Sleep disorder, an independent risk associated with arterial stiffness in menopause.Sci Rep. 2017;7(1):1904.
31. Cappuccio FP, Cooper D, D'Elia L, Strazzullo P, Miller MA. Sleep duration predicts cardiovascular outcomes: a systematic review and meta-analysis of prospective studies. Eur Heart J. 2011;32(12):1484-92
32. García Soto Z M, García SM, Hernández ML, Alemán JA. [Assessment of control of cardiovascular risk factors in obese posmenopausal women after monitoring a structured dietary education and exercise program. (SÍSIFO Program)]. Hipertens Riesgo Vasc. 2016;33(3):103-10.

ISSN: 1309-3878
Yayın Aralığı: 3
Başlangıç: 2009
Yayıncı: Düzce Üniversitesi Tıp Fakültesi Aile Hekimliği AD adına Yrd.Doç.Dr.Cemil Işık Sönmez