Bülent KARADAĞ, Fazilet KARAKOÇ, Refika ERSU, Yasemin GÖKDEMİR, Hatice Ezgi BARIŞ, Ela Erdem ERALP, Nilay Baş İKİZOĞLU

Çocuk uyku laboratuvarında polisomnografi yapılan çocukların klinik ve polisomnografik özellikleri

Amaç: Uykuyla ilişkili tıkayıcı solunum bozuklukları, çocuklarda yaygın bir sorun olup uyku esnasında üst hava yollarında artan dirence bağlı olarak ortaya çıkan, basit horlamadan tıkayıcı uyku apnesine kadar değişen aralıktaki hastalıkları kapsar. Bu çalışmada Tıp Fakültesi Hastanemizin Çocuk Uyku Laboratuvarı'nda polisomnografi ile değerlendirilen çocukların sonuçlarının geriye dönük olarak incelenmesi amaçlanmıştır.Gereç ve Yöntemler: Çocuk uyku laboratuvarında polisomnografi ile değerlendiren çocukların demografik ve klinik özellikleri, uyku ile ilgili yakınmaları, çocuk uyku anketi skorları, Pittsburgh uyku kalitesi göstergesi ve polisomnografi sonuçları geriye dönük olarak değerlendirildi.Bulgular: Polisomnografi uygulanan 131 hastanın %47,3'ü kız (n=62) %52,7'si erkektir (n=69). Yaş ortalaması 101,85±59,15 aydır. Hastaların %50'sinde (n=59) kronik horlama, %43,7'sinde (n=52) uykuda nefes durması vardı. Ortalama tıkayıcı hipopne apne göstergesi 5,12±11,72 olarak saptandı. Kronik horlama yakınması olanlarda tıkayıcı hipopne apne göstergesi ortalaması (6,93±13,53), horlama yakınması olmayanlara (2,32±5,43) göre anlamlı olarak daha yüksekti (p=0,011). Uykuda nefes durması yakınması olanlarda (7,52±14,25) da olmayanlara (2,61± 5,84) göre ortalama tıkayıcı hipopne apne göstergesinde anlamlı bir yükseklik olduğu görüldü (p=0,008). Tıkayıcı hipopne apne göstergesi değerleri ile çocuk uyku anketi ve Pittsburgh uyku kalitesi göstergesi puanları arasında korelasyon gözlenmedi. Tıkayıcı uyku apnesi sıklığı %33,6 idi (n=44). Çalışma sonrası hastaların %39,8'ine (n=49) tedavi başlandı. En sık önerilen tedaviler noninvaziv mekanik ventilasyon (n=23, %46,9), nazal steroid (n=15, %30,6), montelukast (n=11, %22,4) ve adenotonsillektomi (n=9, % 18,4) idi.Çıkarımlar: Uykuyla ilişkili solunum bozuklukları tanısında polisomnografi altın standarttır. Çocuk hekimleri uykuyla ilişkili tıkayıcı solunum bozuklukları bulgu ve belirtilerini erken tanıyarak riskli hastaları polisomnografi uygulanabilen merkezlere yönlendirmelidir.

Clinical and polysomnographic features of children evaluated with polysomnography in pediatric sleep laboratory

Aim: Sleep disordered breathing is a common problem in childhood that encompasses a spectrum of disorders extending from primary snoring to obstructive sleep apnea. This study aims to investigate the results of children undergoing evaluation with polysomnography in the sleep laboratory of a tertiary care hospital.Material and Methods: Demographic and clinical features as well as sleep associated symptoms, scores of pediatric sleep questionnaire and Pittsburgh sleep quality index and polysomnography results are retrospectively evaluated.Results: Totally 131 patients were evaluated, of which 47.3% (n=62) were females and 52.7% (n=69) were males. Mean age was 101.85±59.15 months at the time of the study. Fifty percent (n=59) of patients complained of snoring and 43.7% (n=52) of patients complained of apnea during sleep. Mean obstructive hypopnea-apnea index was 5.12±11.72. Mean obstructive hypopnea-apnea index of snorers (6.93±13.53) was significantly higher than the mean obstructive hypopnea-apnea index of nonsnorers (2.32±5.43) (p=0.011). Mean obstructive hypopnea-apnea index of patients experiencing apnea during sleep (7.52±14.25) was significantly higher than the mean obstructive hypopnea-apnea index of the children who do not experience apnea (2.61±5.84) (p=0.008). No significant correlation was observed between obstructive hypopnea-apnea index and scores of pediatric sleep questionnaire and Pittsburgh sleep quality index. The prevalence of obstructive sleep apnea was 33.6% (n=44). Forty nine patients (39.8%) were treated after polysomnography. Frequently suggested treatment options were noninvasive mechanical ventilation (n=23, %46.9), intranasal steroid (n=15, %30.6), montelukast (n=11, %22.4) and adenotonsillectomy (n=9, % 18.4).Conclusions: Polysomnography is the gold standard in the diagnosis of sleep disordered breathing in children. Pediatricians should be able to recognize early signs and symptoms of sleep disordered breathing and refer the patients in risk to centers where evaluation with polysomnography is available.

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