Kronik obstrüktif akciğer hastalığı ve uyku

Uykunun hava yolu direnci, solunum kaslarının kasılımı ve solunum kontrolü dahil olmak üzere solunum sistemi üzerine etkileri bulunmaktadır. Kişinin solunum sorunları yoksa bu değişiklikler fizyolojik sınırlar içinde kalmaktadır. Ancak solunum sorunu olan olgularda ve özellikle kronik obstrüktif akciğer hastalarında (KOAH) uyku ciddi sorun yaratmaktadır. KOAH’ta solunumun kontrolü, uyku ve uyanıklıkta sağlıklı bireylerle aynı temel özelliklere sahip olmasına karşın, solunum ve gaz değişimi olumsuz etkilenmekte ve hızlı göz hareketleri (REM) sırasında solunum kaslarında görülen atoni hiperkapni ve hipoksiyi derinleştirmektedir. Hipoksi arousalları (uyanayazma), uyku bölünmelerini, pulmoner hipertansiyonu ve mortalite riskini artırmaktadır. KOAH’lı olgularda diğer kronik hastalıklarda olduğu gibi hipoksi olmaksızın uyku kalitesi bozulmakta ve tedavide kullanılan ilaçlar da uyku bölünmelerine ve uykusuzluğa neden olabilmektedir. Bu derlemede KOAH ile uyku bozukluklarının birlikteliğini, fizyolojik mekanizmaları ve kliniğe yansımalarını incelemek istedik.

Chronic obstructive pulmonary disease and sleep

Sleep affects the respirotory system by causing changes in airway resistance, respiratory muscle contractility, and central respiratory control. In an individual who has no respiratory problems, these changes remain within physiological limits. However, in patients with respiratory problems, especially chronic obstructive pulmonary disease (COPD), sleep creates a serious problem. Although the control of breathing in patients with COPD follows the same basic principles as it does in normal subjects, both awake and asleep, the respiratory and gas exchange is adversely affected and the atonia of respiratory muscles during rapid eye movement (REM) sleep deepens the hypoxia and hypercapnia. The hypoxia leads to increased arousals, sleep disruptions, pulmonary hypertension, and higher mortality. As with other chronic diseases, the quality of sleep among patients with COPD deteriorates without hypoxia and the drugs used in therapy cause sleep deprivations and insomnia. This review presents an examination of the association of COPD and sleep disorders, including the physiologic mechanisms and their clinical implications.

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