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Yıl:2021; Cilt: 8; Sayı: 3>> Özet
TAM METİN
Türk Uyku Tıbbı Dergisi; 2021;8(3):211-215
Astım ve Kronik Obstrüktif Akciğer Hastalığı Olan Hastalarda Polisomnografi Tetkikinde Karbondioksit Ölçümü Rutin Olarak Yapılmalı mı?
G Benbir-Şenel, D Karadeniz
İstanbul Üniversitesi-Cerrahpaşa,İstanbul
Amaç: Polisomnografi (PSG) tetkiki uyku ile ilişkili solunum bozukluklarının tanısı amacıyla uygulanan rutin, standart bir tetkiktir. Ancak erişkin hastalarda PSG tetkikinde karbondioksit ölçümü rutin olarak önerilmemektedir. Akciğer hastalığı olan hastalarda PSG tetkiki esnasında gece boyunca karbondioksit ölçümünün rutin olarak gerekliliğinin araştırılması planlanmıştır. Gereç ve Yöntem: Çalışmamıza, retrospektif kohort olarak son üç yıl içerisinde laboratuvarımızda karbondioksit monitorizasyonu ile PSG tetkiki yapılan ve eşlik eden akciğer hastalığı tanısı olan erişkin hastalar ile kontrol grubu dahil edildi. Bulgular: Otuz altı astım hastası, 27 kronik obstrüktif akciğer hastalığı (KOAH) olan hasta ve 52 kontrol dahil edildi. Üç grup yaş, cinsiyet ve vücut kitle indeksi açısından benzerdi. Obstrüktif uyku apne sendromu en sık KOAH grubunda saptandı (p=0,003); astım hastaları ile kontroller arasında anlamlı farklılık izlenmedi. Gece içi uyanıklık, NREM ve REM uyku evresi parsiyel karbondioksit basıncı astım, KOAH ve kontroller olmak üzere üç grup arasında, ya da akciğer hastalığı olan ve olmayan iki grup arasında anlamlı farklılık göstermedi. Kontrol grubunda uyku ile ilişkili hipoksemi/hipoventilasyona rastlanmadı. Astım hastalarında iki kişide uyku ile ilişkili hipoksemi (%5,5), KOAH hastalarında bir kişide uyku ile ilişkili hipoksemi (%3,7), bir kişide uyku ile ilişkili hipoventilasyon (%3,7) saptandı. Sonuç: Çalışmamızda, astım tanısı olan hastalar ile bilinen akciğer hastalığı olmayan ve kontrol grubunu oluşturan hastaların hiçbirinde uyku ile ilişkili hipoventilasyon saptanmazken, KOAH tanısı olan bir hastada PSG’de rutin karbondioksit ölçümü sonucunda uyku ile ilişkili hipoventilasyon tanısı konuldu. Bu bağlamda, KOAH hastalarının noktürnal hipoventilasyon için risk taşıdıkları, ancak PSG tetkikinde karbondioksit ölçümü yapılması gereken alt grubun, muhtemelen ek solunumsal parametreler kullanılarak, belirlenmesi gerektiği görülmektedir
Should Routine Carbon Dioxide Monitoring be Performed During Polysomnography in Patients with Asthma and Chronic Obstructive Pulmonary Disease?
Objective: Polysomnography (PSG) is a standard test used in the diagnosis of sleep-related breathing disorders. However, carbon dioxide monitoring is not routinely implemented in adults. This study aimed to investigate the necessity of full-night carbon dioxide monitoring during PSG in patients with pulmonary disease. Materials and Methods: This retrospective cohort study enrolled adult patients with pulmonary disease and a control group who had PSG recordings and carbon dioxide monitoring for the last 3 years. Results: The study group included 36 individuals with asthma and 27 individuals with chronic obstructive pulmonary disease (COPD), whereas the control group included 52 individuals without any pulmonary diseases. The three groups were comparable in terms of age, gender and body mass index. Obstructive sleep apnoea syndrome was most commonly observed in patients in the COPD group (p=0.003). However, no difference was observed between patients in the asthma and control groups. Partial carbon dioxide pressure during wakefulness, non-rapid eye movement and rapid eye movement sleep were not significantly different among the three groups. In the control group, no patient had sleep-related hypoxemia and/or hypoventilation. Two patients with asthma (5.5%) and one patient with COPD (3.7%) had sleep-related hypoxemia, while one patient with COPD had sleeprelated hypoventilation (3.7%). Conclusion: In this study, sleep-related hypoventilation was not detected in any patient with asthma and in controls, while one patient with COPD was diagnosed with sleep-related hypoventilation upon routine carbon dioxide monitoring. Defining some criteria using additional correlations with respiratory parameters would help monitor carbon dioxide level in a selected subgroup of patients with COPD

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