Pınar YILDIZ GÜLHAN, Mehmet Fatih ELVERİŞLİ, Şengül CANGÜR, Ege GÜLEÇ BALBAY, Bora BÜKEN

Obstrüktif Uyku Apnesi’nin Şiddet İçeren ve İçermeyen Davranışlar Üzerine Etkisi

Amaç: Obstrüktif uyku apne (OUA) üst hava yollarının uyku sırasında daralması ile karakterizedir ve bu durum oksijen desaturasyonu, sempatik aktivasyon, tekrarlayan arousallara neden olur. Uyku problemi yaşayan insanlar kendilerini agresif eğilimleri olan ve dürtüselliklerini daha az kontrol edebilen kişiler olarak düşünürler. Bu çalışmanın amacı OUA ve gündüz uykululuk halinin, şiddet içeren ya da içermeyen davranışlar üzerine etkilerini araştırmaktır. Gereç ve Yöntemler: Düzce Üniversitesi Tıp Fakültesi Hastanesi Göğüs Hastalıkları Polikliniğine uyku bozuklukları nedeniyle başvuran 150 kişi çalışmaya dâhil edildi. Tüm hastalara polisomnografi (PSG) yapıldı. Tüm diğer testler [Beck depresyon ölçeği (BDÖ), Beck anksiyete ölçeği (BAÖ), Epworth uykululuk skalası (EUS) ve Şiddet içeren ve içermeyen suç davranışları ölçeği (ŞİSDÖ)] katılımcılarla yüz yüze görüşme ile yapıldı. Bulgular: Bu çalışmada OUA hastalarında ŞİSDÖ ile apne-hipopne indeksi (AHI) arasında anlamlı bir ilişki saptanmadı. OUA’li hastalarda toplam ŞİSDÖ skoru ile EUS arasında anlamlı bir ilişki bulundu (r=0,267 p=0,003). EUS ile BDÖ skoru (r=0,314 p <0,001) ve BAÖ skalası skoru (r=0,319 p <0,001) arasında anlamlı bir ilişki vardı. Sonuç: AHI ile şiddet içeren ve şiddet içermeyen davranışlar arasında bir ilişki yoktu. Bununla birlikte ESS ile BDÖ, BAÖ, ŞİSDÖ arasında anlamlı bir ilişki vardı. Uyku ve şiddet davranışlarının ortak nörofizyolojik bir mekanizması olabilir. Çalışmamız gündüz uykululuk halinin artmasıyla şiddet eğiliminin arttığını göstermiştir. Uyku problemleri ile şiddet davranışlarının arasındaki ilişkiyi araştırmak için ileri çalışmalara ihtiyaç vardır.

Anahtar Kelimeler:

Gündüz uykululuk hali, obstrüktif uyku apne, şiddet davranışı

The Effect of Obstructive Sleep Apnea on Violent and Non-violent Behavior

Aim: Obstructive sleep apnea (OSA) characterized by repetitive collapse of the upper airway during sleep and this condition leading to oxygen desaturation, sympathetic activation, and recurrent arousals. Patients who experience sleep problems consider themselves, less able to control impulsive, aggressive tendencies. The aim of this study was to investigate the effect of OSA and daytime sleepiness on violent and non-violent behaviors. Material and Methods: Hundred fifty individuals who were admitted to the Chest Disease Polyclinic for Sleep Disorders of Duzce University, School of Medicine Hospital were included in the study. All patients underwent polysomnography (PSG). All tests [Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Epworth Sleepiness Scale (ESS) and Nonviolent and Violent Offending Behavior Scale (NVOBS)] were applied to all participants by face to face interview. Results: In this study, no significant relationship was found between NVOBS and AHI in OSA patients. Patients with OSA; There was a significant relationship between total score of NVOBS and ESS (r=0.267 p=0.003). There was a significant relationship between the ESS score and the BDI score (r=0.314 p <0.001) and BDI scale (r=0.319 p <0.001) scores. Conclusions: There was no significant relationship between violent and non-violent behaviors and AHI. However, there was a significant relationship between ESS and BDI, BAI and NVOBS. There may be common neurophysiological activation mechanisms of sleep and violence action. Today, violent behavior and sleep problems increase and further research is needed to investigate the relationship between sleep problems and violent behavior.

Keywords:

Daytime sleepiness, obstructive sleep apnea, violent behavior,

PDF

___

1. Knechtle B, Economou NT, Nikolaidis PT, Velentza L, Kallianos A, Steiropoulos P et al. Clinical Characteristics of Obstructive Sleep Apnea in Psychiatric Disease. J Clin Med. 2019; 8(4). pii: E534. doi: 10.3390/jcm8040534
2. Pack AI. Advances in sleep-disordered breathing. Am J Respir Crit Care Med. 2006; 73(1): 7-15.
3. Randerath W, Bonsignore MR, Herkenrath. Obstructive sleep apnoea in acute coronary syndrome European Respiratory Review. 2019; 28(153). pii: 180114. doi: 10.1183/16000617.0114-2018.
4. Güleç H, Topaloğlu M, Ünsal D, Altıntaş M. Violence as a Vicious Cycle. Current Approaches in Psychiatry. 2012; 4(1): 112-37.
5. Farrington DP. Early prediction of violent and nonviolent youthful offending. European Journal on Criminal Policy and Research. 2012; 5(2): 51-66.
6. MacDonald JM, Haviland A, Morral A R. Assessing the relationship between violent and non-violent criminal activity among serious adolescent. Journal of Research in Crime and Delinquency. 2009; 46(4): 553-80.
7. Tzoumakis S, Lussier P, Blanc, M L, Davies G. Onset, offending trajectories, and crime spe-cialization in violence. Youth Violence and Juvenile Justice. 2013; 11(2): 143-64.
8. Koçak M, Batıgün Durak A. Turkish adaptation of Non-violent and violent offending behavior scale. Journal of Clinical Psychology Research. 2017; 1(1): 1-11.
9. Ağan K, Özmerdivenli R, Değirmenci Y, Çağlar M, Başbuğ A, Güleç Balbay E et al. Evaluation of sleep in women with menopause: results of the Pittsburg sleep quality index and polysomnography. J Turk Ger Gynecol Assoc. 2015; 16(3): 149-52.
10. Thornton AJ, Graham-Kevan N, Archer J. Development and confirmatory factor analysis of the Non-violent and Violent Offending Behaviour Scale (NVOBS). Aggressive Behaviour. 2013; 39(3): 171-81.
11. Beck AT. An inventory for measuring depression. Arch Gen Psychiatry. 1961; 4: 561-71.
12. Hisli N. Beck depresyon envanterinin üniversite öğrencileri için geçerliliği ve güvenirliliği. Türk Psikoloji Dergisi. 1988; 6(23): 3-13.
13. Beck AT, Epstein N, Brown G. An inventory for measuring clinical anxiety: Psychometric properties. J Consult Clin Psychol. 1988; 56(6): 893-7.
14. Ulusoy M, Şahin N, Erkmen H. Turkish version of The Beck Anxiety Inventory: psychometric properties. J Cogn Psychother. 1998; 12(2): 28-35.
15. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991; 14(6): 540-5.
16. Agargün MY, Cilli AS, Kara H, Bilici M, Telcioğlu M, Semiz UB et al. Validity and Reliability of the Epworth Sleepiness Scale. Turkish Journal of Psychiatry. 1999; 10(4): 261-7.
17. Oğuztürk O, Ekici M, Cimen D, Ekici A, Senturk E. Attention deficit/hyperactivity disorder in adults with sleep apnea. J Clin Psychol Med Settings. 2013; 20(2): 234-9.
18. Cai SJ, Chen R, Zhang YL, Xiong KP, Lian YX, Li J et al. Correlation of Epworth Sleepiness Scale with multiple sleep latency test and its diagnostic accuracy in assessing excessive daytime sleepiness in patients with obstructive sleep apnea hypopnea syndrome. Chin Med J. 2013; 126(17): 3245-50.
19. Güleç Balbay E, Balbay Ö, Annakkaya AN, Suner K, Yuksel H, Tunç M et al. Obstructive sleep apnoea syndrome in patients with primary open-angle glaucoma. Hong Kong Med J. 2014; 20(5): 379-85.
20. Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American academy of sleep medicine clinical practice guideline. J Clin Sleep Med. 2017; 13(3): 479-504.
21. Babar E. Uyanma işlergeleri, uyku ve beynin elektriksel etkinliği. Ganong WF editör. Türk Fizyolojik Bilimler Derneği Tıbbi Fizyoloji. Ankara: Nobel Tıp Kitabevleri; 2002. s. 739-43.
22. Demiralp T. Beynin etkinlik durumları, uyku, beyin dalgaları, epilepsi, psikozlar. Guyton AC editör. Tıbbi Fizyoloji. İstanbul: Merck Yayıncılık; 2001. s. 689-91.
23. Aydın H, Özgen F. Sleep studies in psychiatric disorders. Turkish Journal of Clinical Psychiatry. 1998; 2(2): 89-97.
24. McBurnett K, Lahey B B, Rathouz P J, Loeber R. Low salivary cortisol and persistent aggression in boys referred for disruptive behavior. Arch Gen Psychiatry. 2000; 57(1): 38-43.
25. Yang Y, Raine A. Prefrontal structural and functional brain imaging findings in antisocial, violent and psychopathic individuals: a meta-analysis. Psychiatry Res. 2009; 174(2): 81-8.
26. Meijers J, Harte J M, Scherder F S. Disturbed sleep as a risk factor for aggression in prisoners with a psychotic illness: a brief report. Psychology Crime and Law. 2015; 21(10): 968-72.
27. Kamphuis J, Dijk D J, Spreen M, Lancel M. The relation between poor sleep, impulsivity and aggression in forensic psychiatric patients. Physiol Behav. 2014; 123(1): 168-73.
28. Ireland JL, Culpin V. The relationship between sleeping problems and aggression, anger, and impulsivity in a population of juvenile and young offenders. J Adolesc Health. 2006; 38(6): 649-55.
29. Akerstedt T. Psychosocial stress and impaired sleep. Scand J Work Environ Health. 2006; 32(6): 493-501.
30. Adrian Raine A, Venables PH. Adolescent daytime sleepiness as a risk factor for adult crime. Journal of Child Psychology and Psychiatry. 2017; 58(6): 728-35.
31. Nofzinger EA, Thase ME, Reynolds CF, Himmelhoch JM, Mallinger A, Houck P, et al. Hypersomnia in bipolar depression: a comparison with narcolepsy using the multiple sleep latency test. Am J Psychiatry. 1991; 148(9): 1177–81.
32. Vgontzas AN, Bixler EO, Kales A, Criley C, Vela-Bueno A. Differences in nocturnal and daytime sleep between primary and psychiatric hypersomnia: diagnostic and treatment implications. Psychosom Med. 2000; 62(2): 220-6.
33. Bixler EO, Vgontzas AN, Lin HM, Calhoun SL, Vela-Bueno A, Kales A. Excessive daytime sleepiness in a general population sample: the role of sleep apnea, age, obesity, diabetes, and depression. J Clin Endocrinol Metab. 2005; 90(8): 4510-5.
34. Dauvilliers Y, Lopez R, Ohayon M, Bayard S. Hypersomnia and depressive symptoms: methodological and clinical aspects. BMC Med. 2013; 11: 78. doi:10.1186/1741-7015-11-78
35. Vashum KP, Basta M, Lin HM, Pejovic S, Sarrigiannidis A, Bixler E, et al. Lack of regular exercise, depression, and degree of apnea are predictors of excessive daytime sleepiness in patients with sleep apnea: sex differences. J Clin Sleep Med. 2008; 4(1): 19-25.
36. Plante DT, Finn LA, Hagen EW, Mignot E, Peppard PE. Longitudinal associations of hypersomnolence and depression in the Wisconsin sleep cohort study. J Affect Disord. 2017; 207(1): 197-202.
37. Fernandez-Mendoza J, Vgontzas AN, Kritikou I, Calhoun SL, Liao D, Bixler EO. Natural history of excessive daytime sleepiness: role of obesity, weight loss, depression, and sleep propensity. Sleep. 2015; 38(3): 351-60.
38. Hambrick EP, Rubens SL, Brawner TW, Taussig HT. Do sleep problems mediate the link between adverse childhood experiences and delinquency in preadolescent children in foster care? J Child Psychol Psychiatry. 2018; 59(2): 140-9.