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Yıl:2019; Cilt: 56; Sayı: 4>> Özet
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Nöropsikiyatri Arşivi; 2019;56(4):264-268
İdiyopatik Parkinson Hastalığında Görülen Uyku Bozukluklarının Tanısında Uyku Testleri veSerum Melatonin Düzeyleri
HA Uysal, B İ Tiftikcioğlu, L Öcek, Y Zorlu
Tepecik Eğitim ve Araştırma Hastanesi, İzmir
Amaç: İdiyopatik Parkinson hastalığında (PH), uykuyu başlatmakta zorluk, uyku süresinde kısalma, sık uyanma ve artmış gündüz uykululuğu gibi uyku bozuklukları en sık görülen non-motor semptomlar arasındadır. Ancak, hastalar genellikle bu yakınmaları motor şikayetleri kadar önemli görmez ve dile getirmezler. Bu çalışmada Parkinson hastalarındaki gizli uyku bozukluklarının uyku değerlendirme ölçekleri kullanılarak araştırılması ve bu testler ile gece uykusu sırasında bakılan serum melatonin düzeyleri arasındaki ilişkinin incelenmesi amaçlanmıştır. Yöntem: Hareket hastalıkları polikliniğinde kayıtlı, 50 yaşın üstündeki toplam 40 (19, kadın) Parkinson hastası ile yaş ve cinsiyet açısından benzer, 40 sağlıklı kontrol bireyi (20, kadın) çalışmaya dahil edilmiştir. Tüm bireyler Pittsburg Uyku Kalitesi İndeksi (PUKİ) ve Epworth Uykululuk Ölçeği (EUÖ) ile değerlendirilmiştir. Tüm bireylerden gece uyku sırasında 00:00 ve 05:00’te iki kez kan örneği alınarak serum melatonin düzeyleri ölçülmüştür. İki grup, demografik veriler, uyku değerlendirme ölçekleri ve serum melatonin düzeyleri açısından karşılaştırılmıştır. Bulgular: Parkinson hastalarının PUKİ ve EUÖ puanları, kontrol bireylerine kıyasla anlamlı derecede yüksek saptanmıştır (p<0,001). Her ne kadar Parkinson hastalarında gece iki farklı saatte bakılan serum melatonin düzeyleri kontrollere göre daha düşük bulunmuş olsa da, bu farklılıklar istatistiksel anlamlılığa ulaşmamıştır. Hasta grubunda, PUKİ puanları ile serum melatonin düzeyleri arasında bir ilişki saptanmamıştır (p>0,05). Öte yandan, hastaların EUÖ puanları ile 00:00’da değil ama 05:00’te ölçülen serum melatonin düzeyleri arasında anlamlı fakat zayıf bir ilişki (r=-0,353, p=0,025) bulunmuştur. Sonuç: Parkinson hastalarındaki gizli kalmış uyku bozukluklarının tanısında PUKİ ve EUÖ gibi uyku değerlendirme ölçekleri faydalı olabilir; ancak, serum melatonin düzeyleri tek başına yeterli değildir
Serum Levels of Melatonin and Sleep Evaluation Scales in the Diagnosis ofSleep Disorders in Patients with Idiopathic Parkinson’s Disease
ntroduction: Sleep disturbances, such as difficulty in initiation of sleep, decrease in total sleep duration and efficacy, frequent awakenings, and increased daytime sleepiness are among the most common non-motor symptoms in patients with idiopathic Parkinson’s disease (PD). However, patients usually do not consider these symptoms as important as their motor symptoms, and do not complain. We aimed to investigate PD patients for subtle sleep disturbances using sleep evaluation scales, and to evaluate the relationship between these tests and the serum levels of melatonin during night-sleep. Methods: A total of 40 PD patients (19, female), older than 50 years, registered in our “Movement Disorders Out-patient Clinic”, and 40 healthy, age and sex-matched control subjects (20, female) were included in the study. All subjects were assessed using Pittsburg Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). Serum melatonin levels during nightsleep were measured in blood samples taken at 00:00 and 05:00 hours in every subject. Both groups were compared for demographical data, sleep evaluation scales and serum levels of melatonin. Results: Patients with PD had significantly higher scores in PSQI and ESS than the healthy controls (p<0.001). Although the serum melatonin levels at two different time points during night sleep were lower in PD patients than the controls, these differences did not reach statistical significance (p=0.104 at 00:00 am, p=0.528 at 05:00 am). There was no significant correlation between the PSQI scores and serum melatonin levels in patient group (p>0.05). However, there was a significant but weak correlation (r=-0.353, p=0.025) between ESS scores and the serum melatonin levels measured at 05:00 hours in patients, but not between the melatonin levels measured at 00:00 hours. Conclusion: Sleep evaluation questionnaires such as, PSQI and ESS, can provide useful information in PD patients with mild sleep disturbances. However, serum melatonin levels alone were not helpful in diagnosing the sleep disorders

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