Monosemptomatik enürezis nokturnalı hastalarda uyku bozukluklarının değerlendirilmesi
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Dosyalar
Tarih
2015
Yazarlar
Dergi Başlığı
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Cilt Başlığı
Yayıncı
Düzce Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Bu çalışmada monosemptomatik enürezis nokturna (MEN) şikayeti bulunan hastalarda uyku bozukluklarının araştırılması ve uyku bozukluğu ile MEN arasındaki ilişkinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Hastanemiz Çocuk Sağlığı ve Hastalıkları polikliniğine başvuran ve enürezis nokturna şikayeti bulunan 50 hasta alındı. 5 yaşın üzerinde, haftada en az 2 veya daha fazla alt ıslatması olan ve 3 aydan daha uzun süredir alt ıslatma problemi devam eden hastalar enürezis nokturna olarak kabul edildi. Vakaların hepsi enürezise neden olabilecek sekonder organik nedenler yönünden değerlendirildi. İki defadan fazla tekrarlayan idrar yolu enfeksiyonu geçiren, aşırı aktif mesane bulguları olan, enürezis diürnası olan ve üriner sistemle ilgili anomalisi olduğu tespit edilen hastalar çalışmadan çıkarıldı. Hastaların sorgulaması anket formu ile yapıldı. Hastaların öyküsü, özgeçmişi ve soy geçmişi alındı ve fizik muayeneleri yapıldı. Ayakta ve yatarak direk batın grafileri çekilerek üriner sistem ultrosonografileri yapıldı. USG ile mesane kapasitesi ölçümleri yapıldı. Anamnez ve tetkikler sonucunda primer monosemptomatik enürezis nokturna'sı olduğu tespit edilen olguların tümüne tüm gece full polisomnografi yöntemiyle uyku testi uygulandı. İstatistiksel analizler NCSS (Number Cruncher Statistical System) 2007 Statistical Software (Utah, USA) paket programı ile yapıldı. Sonuçlar, anlamlılık p < 0,05 düzeyinde değerlendirildi. Bulgular: Primer monosemptomatik enürezis nokturna (PMEN)'sı olan toplam 34 hastaya uyku testi uygulandı ve bu hastaların 29'unda (%85) değişik derecelerde uyku bozukluğu tespit edildi. PMEN hastalarının çoğunluğu erkek çocuklardan oluşmaktaydı. Tüm hastaların apne skoru ortalaması 4.99 ve alt ıslatma sıklığı ortalaması haftada 5 gün ve üzerinde (5.55) bulundu. Apne skoru sonuçlarına bakıldığında obstrüktif uyku apne sendromu (OSAS) derecesi; 20 hastada hafif (<5), 6 hastada orta (5-10) ve 3 hastada ağır (>10) olarak bulundu. Apne skoru değerleri ile BMI arasında pozitif yönde istatistiksel olarak anlamlı ilişki gözlendi (p=0.047). Obez grubun apne skoru ortalaması normal ve fazla kilolu gruptan istatistiksel olarak anlamlı derecede yüksek bulundu (p=0,042, p=0,048) ancak, normal ve fazla kilolu grupları arasında istatistiksel olarak anlamlı farklılık gözlenmedi (p=0,809). PMEN'lı ve OSAS (+) olan hastaların USG sonuçları incelendiğinde; 8 (%27.6) hastada mesane kapasitesinin yeterli ve 21 (%72.4) hastada da yetersiz olduğu tespit edildi. Mesane kapasitesi oranı değerleri ile alt ıslatma sıklığı arasında negatif yönde istatistiksel olarak anlamlı ilişki gözlendi (r=-0,441 p=0,017). Hastaların 14'ünde (%48.2) sık üst solunum yolu enfeksiyonu (ÜSYE) geçirme öyküsünün mevcut olduğu bulundu. Sık ÜSYE geçirme öyküsü olan ve olmayan grupların apne skoru ortalamaları karşılaştırıldığında istatistiksel olarak anlamlı bir farklılık saptanmadı (p>0.05). Sonuç: Çalışmamızda enürezis nokturna için başta gelen predispozan faktörler olarak pozitif aile öyküsü, obezite ve uyku bozukluğu tespit edildi. PMEN'nın tanımında sekonder nedenler dışlanmakla birlikte; çalışmamızda uyku bozukluğu ve obezitenin, enürezis etiyolojisinde kolaylaştırıcı ve belirleyici bir faktör olduğu düşünülmelidir. OSAS ile PMEN arasındaki ilişkiyi daha da açıklayan ileri araştırmalara ihtiyaç vardır.
Objectives: The purpose of this study was aimed to investigate the sleep disorders in patients with monosymptomatic enuresis nocturna (MEN) and the relation between sleep disorders and MEN was evaluated. Material and Methods: Fifty patients presenting with enuresis nocturna that were admitted to our outpatient clinic was enrolled. Patients over 5 years old and having bedwetting at least two times during nighttime in a week for 3 months and longer were accepted as diagnosis of enuresis nocturnia. All the patients were evaluated for the secondary causes of enuresis nocturna. Patients with history of urinary tract infections more than two times, signs of overactive bladder, enuresis diurna and urinary system anomaly were excluded from the study. Informations about the patients were taken by questionnaire. Patients' medical and family histories were taken and physical examinations were performed. Supine and plain abdominal x-rays and ultrasonography (USG) of the urinary system were applied. Bladder capacities were calculated with USG. According to anamnesis and examination results; the full night polysomnography test was performed for all the patients with primary monosemptomatic enuresis nocturna (PMEN). Statistical analysis was done by NCSS (Number Crunher Statistical System) 2007 statistical software (Utah, USA) programme. Analysis of results was accepted if p value was at the P < 0.05. Results: Thirty four patients with PMEN were assessed with polysomnography test and sleep disorder was found in 29 (85%) of them at different levels. Most of the patients were male. Respectively, avarage apnea score of patients and wet nights per week were 4.99 (1.5-21.5) and five and over times (5.55). Based on apnea score, the grades of ostructive sleep apnea syndrome were mild (<5) in 20 patients, medium (5-10) in 6 patients and severe (>10) in 3 patients. Statistically significant relation was found between apnea scores and body mass indexes (p=0.047). Apnea scores of obese patients were statistically significantly higher than patients with lean body and overweigh (p=0.042, p=0.048) but there was no statistically significant difference between the normal and overweighted patients (p=0.809). Based on analysis of the USG results of patients with PMEN and OSAS, bladder capacities were sufficient in 27.6% (8) and insufficient in 72.4% (21) patients. There was statistically significant negative relation between bladder capacity and wet night frequency (r=-0.441, p=0.017). A history of frequent upper respiratory tract infection (URTI) was found in 14 (48.2%) patients. There was no statistically significant difference in the apnea scores of patients between with and without history of frequent URTI (p>0.05). Conclusion: Positive family history, obesity and sleep disorders were detected as the main predisposing factors for the enuresis nocturna in our study. Although the secondary causes for diagnosis of PMEN should be excluded, sleep disorders and obesity were considered to be the major predisposing factors in the etiology of enuresis nocturna. Further studies are needed to explore the relation between sleep apnea and PMEN.
Objectives: The purpose of this study was aimed to investigate the sleep disorders in patients with monosymptomatic enuresis nocturna (MEN) and the relation between sleep disorders and MEN was evaluated. Material and Methods: Fifty patients presenting with enuresis nocturna that were admitted to our outpatient clinic was enrolled. Patients over 5 years old and having bedwetting at least two times during nighttime in a week for 3 months and longer were accepted as diagnosis of enuresis nocturnia. All the patients were evaluated for the secondary causes of enuresis nocturna. Patients with history of urinary tract infections more than two times, signs of overactive bladder, enuresis diurna and urinary system anomaly were excluded from the study. Informations about the patients were taken by questionnaire. Patients' medical and family histories were taken and physical examinations were performed. Supine and plain abdominal x-rays and ultrasonography (USG) of the urinary system were applied. Bladder capacities were calculated with USG. According to anamnesis and examination results; the full night polysomnography test was performed for all the patients with primary monosemptomatic enuresis nocturna (PMEN). Statistical analysis was done by NCSS (Number Crunher Statistical System) 2007 statistical software (Utah, USA) programme. Analysis of results was accepted if p value was at the P < 0.05. Results: Thirty four patients with PMEN were assessed with polysomnography test and sleep disorder was found in 29 (85%) of them at different levels. Most of the patients were male. Respectively, avarage apnea score of patients and wet nights per week were 4.99 (1.5-21.5) and five and over times (5.55). Based on apnea score, the grades of ostructive sleep apnea syndrome were mild (<5) in 20 patients, medium (5-10) in 6 patients and severe (>10) in 3 patients. Statistically significant relation was found between apnea scores and body mass indexes (p=0.047). Apnea scores of obese patients were statistically significantly higher than patients with lean body and overweigh (p=0.042, p=0.048) but there was no statistically significant difference between the normal and overweighted patients (p=0.809). Based on analysis of the USG results of patients with PMEN and OSAS, bladder capacities were sufficient in 27.6% (8) and insufficient in 72.4% (21) patients. There was statistically significant negative relation between bladder capacity and wet night frequency (r=-0.441, p=0.017). A history of frequent upper respiratory tract infection (URTI) was found in 14 (48.2%) patients. There was no statistically significant difference in the apnea scores of patients between with and without history of frequent URTI (p>0.05). Conclusion: Positive family history, obesity and sleep disorders were detected as the main predisposing factors for the enuresis nocturna in our study. Although the secondary causes for diagnosis of PMEN should be excluded, sleep disorders and obesity were considered to be the major predisposing factors in the etiology of enuresis nocturna. Further studies are needed to explore the relation between sleep apnea and PMEN.
Açıklama
YÖK Tez No: 406821
Anahtar Kelimeler
Çocuk Sağlığı ve Hastalıkları, Child Health and Diseases, Enürezis, Enuresis, Uyku, Sleep, Uyku apne sendromları, Sleep apnea syndromes, Uyku bozuklukları, Sleep disorders, Ölçekler, Scales
