Chiari tip I malformasyonunda konservatif tedavi ile cerrahi tedavinin uyku laboratuvarı parametrelerindeki değişimler üzerine etkisinin incelenmesi
Küçük Resim Yok
Tarih
2023
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
İnönü Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Chiari Malformasyon Tip 1 (CM I), beyin ve sinir cerrahisi pratiğinde sık karşılaşılan bir kraniyovertebral bileşke patolojisidir. Uykudaki solunum bozukluğu ile ilişkisi literatürde çok az sayıda vakada gösterilmiştir. Örneğin cerrahi uygulanan CM I olgularında patoloji ortadan kalktığında bir uyku bozukluğu olan santral uyku apnelerin düzeldiği gösterilmiştir. Çalışmamızın amacı, CM I olgularına ait uyku aktivitesinin nörofizyolojik mekanizmalarında meydana gelen olası değişiklikleri, sonrasında uygulanan konservatif veya cerrahi tedavi uygulama ile uyku ve dolayısı ile santral sinir sistemi sağlığının sürdürülmesinde meydana gelen değişiklikleri; elektrofizyolojik olarak ortaya çıkarmaktır. Gereç ve Yöntem: İnönü Üniversitesi Turgut Özal Tıp Merkezi Hastanesi Beyin ve Sinir Cerrahisi Kliniği'nde, Kasım 2014 - Eylül 2022 döneminde Chiari tip I malformasyonu tanısı ile takipli konservatif tedavi ile takip edilen ve suboksipital kraniektomi - C1 laminektomi – duraplasti operasyonu yapılan 59 hastanın İnönü Üniversitesi Turgut Özal Tıp Merkezi Hastanesi Uyku Bozuklukları Merkezi Polisomnografi laboratuvarı parametreleri, dosya bilgileri ve radyolojik görüntülemeleri retrospektif şekilde incelenmiştir. Çalışmada elde edilen bulgular değerlendirilirken, istatistiksel analizler için IBM SPSS Statistics 22 programı kullanıldı. Anlamlılık p<0.05 düzeyinde değerlendirildi. Bulgular: Çalışmamızda CM I tanısı ile takip edilen 108 hastadan yaşları 17 ile 64 arasında değişmekte olan, 18'i (%30.5) erkek ve 41'i (%69.5) kadın olmak üzere toplam 59 olgu ile yapılmıştır. CM I için yapılan ameliyat sonucunda, özellikle beyin sapı ve ponstaki temelde dekompresyon nedeniyle değişikliklere neden olmaktadır. Çalışmamızda literatürdeki çalışmalarla uyumlu olarak ameliyat sonrası total uyku süresinin arttığı gösterilmiştir. Uykuda NREM evre-1 %2-5, NREM evre-2 %45-55, NREM evre-3 %13-23 yaklaşık yüzdelik dilimlerden oluşmaktadır. Çalışmamızda, cerrahi olan grupta herniasyon miktarı azalmayan bir hasta olduğu için karşılaştırma yapılamamış olup, cerrahi olmayan grupta herniasyon miktarı azalırsa NREM evre-2 artmış, NREM evre-3 miktarındaki düşüş yüksek bulunmuştur. Herniasyon grupları arasında ilk uyku testindeki N2 sonucuna göre, ikinci uyku testinde görülen artış miktarları açısından istatistiksel olarak anlamlı farklılık vardır (p:0.038; p<0.05). Anlamlılığın hangi gruplardan kaynaklandığının tespiti için yapılan post hoc Dunn's test sonucunda; herniasyon azalan grubun N2 düzeyinde görülen artış miktarı, aynı kalan gruptan belirgin olarak yüksektir (p:0.040; p<0.05). Herniasyon gruplarında ilk uyku testindeki N3 sonucuna göre, ikinci uyku testinde görülen değişim miktarları açısından istatistiksel olarak anlamlı farklılık vardır (p:0.017; p<0.05). Anlamlılığın hangi gruplardan kaynaklandığının tespiti için yapılan post hoc Dunn's test sonucunda; herniasyon azalan grubun N3 düzeyinde izlenen azalma, aynı kalan gruptan istatiksel düzeyde anlamlı yüksek bulunmuştur (p:0.013; p<0.05). Çalışmamızda cerrahi tedavi uygulanan grupta BKİ düzeyi 30'un altında olan grupta ilk uyku testindeki REM sonucuna göre, ikinci uyku testinde görülen artış miktarı, BKİ düzeyi 30 ve üzerinden olan gruptan istatistiksel anlamlı düzeyde yüksektir (p:0.014; p<0.05).Bu da BKİ'nin tek başına uyku ile ilgili solunum bozukluğunun bir risk faktörü olduğu gerçeği ile açıklanabilir. Sonuçlar: CM I tanısı ile takip edilen 108 hastadan 59'unda (%54.62) uyku ile ilişkili solunum bozukluğu prevalansını, literatürdeki diğer çalışmalara oranla yüksek olarak saptadık. Uyku etkinliği; uyanıklıktan uykuya geçiş, uykunun sürdürülme gayreti, uykunun sürekliliği ve uyku verimliliği tarafından oluşmaktadır. Uykunun oluşabilmesi için, sempatik regülasyondan parasempatik regülasyona geçiş döneminin olması gerekmektedir. Çalışmamızda literatürdeki çalışmalarla uyumlu olarak ameliyat sonrası total uyku süresinin arttığı gösterilmiştir. Çalışmamızda elde ettiğimiz temel bulgular posterior fossa dekompresyonun uykuya bağlı solunum bozukluğunun birçok parametresinde belirgin düzelme oluşturduğunu göstermiştir. Dekompresyon yapılan hastalarda total uyku süresinde belirgin bir artış görülürken, hastaların REM süresinde artma, santral apne indeksinde ve santral apne sayısında azalma ile cerrahinin etkinliğinin literatüdeki diğer çalışmalara oranla daha yüksek oranda düzelme gösterdiğini belirlemiştir Çalışmamızda cerrahi işlem yapılmayan uyku ile ilişkili solunum bozukluğu CM I hastalarının polisomnografi değerlendirmelerinde BKİ 30 altında olan hastaların santral apne indeksi santral apne süresi ve santral apne sayısı BKİ 30 ve üzerinde olan hastalara göre belirgin düzeyde düşük olduğu görülmüştür. Bu da BKİ'nin tek başına uyku ile ilgili solunum bozukluğunun bir risk faktörü olduğu gerçeği ile açıklanabilir. Ameliyat sonrası uyku elektrofizyolojisinde ortaya çıkan olumlu değişiklikler göz önüne alındığında, uykuda elektrofizyolojik sinyal kaydı (polisomnografi) cerrahi tedavinin başarısı konusunda kriter sayılabilir, çalışmamıza ek olarak hasta sayısı arttırılıp izlem süresi uzatılabilir. Anahtar Kelimeler: REM, Tip 1 Chiari Malformasyonu, Uyku Elektrofizyolojisi
Objective: Chiari Malformation Type 1 (CM I) is a common craniovertebral junction pathology in neurosurgery practice. Its relationship with sleep-disordered breathing has been shown in very few cases in the literature. For example, it has been shown that central sleep apnea, a sleep disorder, improves when the pathology is eliminated in CM I cases that underwent surgery. The aim of our study is to examine the possible changes in the neurophysiological mechanisms of sleep activity in CM I cases, and the changes that occur in the maintenance of sleep and therefore the health of the central nervous system with subsequent conservative or surgical treatment; to reveal electrophysiologically. Materials and Methods: At İnönü University Turgut Özal Medical Center Hospital, Brain and Nerve Surgery Clinic, between November 2014 and September 2022, 59 patients were diagnosed with Chiari type I malformation and followed up with conservative treatment and underwent suboccipital craniectomy - C1 laminectomy - duraplasty surgery. University Turgut Özal Medical Center Hospital Sleep Disorders Center Polysomnography laboratory parameters, file information and radiological imaging were examined retrospectively. While evaluating the findings obtained in the study, IBM SPSS Statistics 22 program was used for statistical analysis. Significance was evaluated at p<0.05 level. Findings: Our study included a total of 59 patients, 18 (30.5%) of whom were male and 41 (69.5%) of whom were female, aged between 17 and 64, out of 108 patients followed up with a diagnosis of CM I. As a result of surgery for CM I, it causes changes due to decompression, especially in the brainstem and pons. In our study, it was shown that total sleep time increased after surgery, consistent with studies in the literature. During sleep, NREM stage-1 consists of approximately 2-5%, NREM stage-2 45- 55%, and NREM stage-3 13-23%. In our study, a comparison could not be made because there was one patient in the surgical group whose herniation amount did not decrease. If the amount of herniation decreased in the non-surgical group, NREM stage-2 increased and the decrease in the amount of NREM stage-3 was found to be high. There is a statistically significant difference between the herniation groups in terms of the increase in the second sleep test compared to the N2 result in the first sleep test (p:0.038; p<0.05). As a result of the post hoc Dunn's test conducted to determine which groups the significance originates from; The increase in N2 level in the group whose herniation decreased was significantly higher than the group that remained the same (p:0.040; p<0.05). There is a statistically significant difference in the amount of change seen in the second sleep test compared to the N3 result in the first sleep test in the herniation groups (p:0.017; p<0.05). As a result of the post hoc Dunn's test conducted to determine which groups the significance originates from; The decrease in the N3 level of the group whose herniation decreased was found to be statistically significantly higher than the group that remained the same (p:0.013; p<0.05). In our study, in the surgically treated group with a BMI level below 30, the amount of increase seen in the second sleep test, according to the REM result in the first sleep test, is statistically significantly higher than in the group with a BMI level of 30 and above (p:0.014; p<0.05). It may be explained by the fact that BMI alone is a risk factor for sleeprelated breathing disorder. Results: We found the prevalence of sleep-related breathing disorders in 59 (54.62%) of 108 patients followed up with a diagnosis of CM I, which was higher than other studies in the literature. Sleep efficiency; It consists of the transition from wakefulness to sleep, the effort to maintain sleep, the continuity of sleep and sleep efficiency. In order for sleep to occur, there must be a transition period from sympathetic regulation to parasympathetic regulation. In our study, it was shown that total sleep time increased after surgery, consistent with studies in the literature. The main findings of our study showed that posterior fossa decompression caused significant improvement in many parameters of sleep-related breathing disorder. While there was a significant increase in total sleep time in patients who underwent decompression, it was determined that the effectiveness of the surgery showed a higher improvement compared to other studies in the literature, with an increase in the patients' REM time, a decrease in the central apnea index and the number of central apneas. In our study, in the polysomnography evaluations of sleep-related breathing disorder CM I patients who did not undergo surgery, it was observed that the central apnea index, central apnea duration and central apnea number of patients with a BMI below 30 were significantly lower than those of patients with a BMI of 30 and above. This can be explained by the fact that BMI alone is a risk factor for sleep-related breathing disorders. Considering the positive changes in sleep electrophysiology after surgery, electrophysiological signal recording during sleep (polysomnography) can be considered a criterion for the success of surgical treatment. In addition to our study, the number of patients can be increased and the follow-up period can be extended. Key Words: REM, Type 1 Chiari Malformation, Sleep Electrophysiology
Objective: Chiari Malformation Type 1 (CM I) is a common craniovertebral junction pathology in neurosurgery practice. Its relationship with sleep-disordered breathing has been shown in very few cases in the literature. For example, it has been shown that central sleep apnea, a sleep disorder, improves when the pathology is eliminated in CM I cases that underwent surgery. The aim of our study is to examine the possible changes in the neurophysiological mechanisms of sleep activity in CM I cases, and the changes that occur in the maintenance of sleep and therefore the health of the central nervous system with subsequent conservative or surgical treatment; to reveal electrophysiologically. Materials and Methods: At İnönü University Turgut Özal Medical Center Hospital, Brain and Nerve Surgery Clinic, between November 2014 and September 2022, 59 patients were diagnosed with Chiari type I malformation and followed up with conservative treatment and underwent suboccipital craniectomy - C1 laminectomy - duraplasty surgery. University Turgut Özal Medical Center Hospital Sleep Disorders Center Polysomnography laboratory parameters, file information and radiological imaging were examined retrospectively. While evaluating the findings obtained in the study, IBM SPSS Statistics 22 program was used for statistical analysis. Significance was evaluated at p<0.05 level. Findings: Our study included a total of 59 patients, 18 (30.5%) of whom were male and 41 (69.5%) of whom were female, aged between 17 and 64, out of 108 patients followed up with a diagnosis of CM I. As a result of surgery for CM I, it causes changes due to decompression, especially in the brainstem and pons. In our study, it was shown that total sleep time increased after surgery, consistent with studies in the literature. During sleep, NREM stage-1 consists of approximately 2-5%, NREM stage-2 45- 55%, and NREM stage-3 13-23%. In our study, a comparison could not be made because there was one patient in the surgical group whose herniation amount did not decrease. If the amount of herniation decreased in the non-surgical group, NREM stage-2 increased and the decrease in the amount of NREM stage-3 was found to be high. There is a statistically significant difference between the herniation groups in terms of the increase in the second sleep test compared to the N2 result in the first sleep test (p:0.038; p<0.05). As a result of the post hoc Dunn's test conducted to determine which groups the significance originates from; The increase in N2 level in the group whose herniation decreased was significantly higher than the group that remained the same (p:0.040; p<0.05). There is a statistically significant difference in the amount of change seen in the second sleep test compared to the N3 result in the first sleep test in the herniation groups (p:0.017; p<0.05). As a result of the post hoc Dunn's test conducted to determine which groups the significance originates from; The decrease in the N3 level of the group whose herniation decreased was found to be statistically significantly higher than the group that remained the same (p:0.013; p<0.05). In our study, in the surgically treated group with a BMI level below 30, the amount of increase seen in the second sleep test, according to the REM result in the first sleep test, is statistically significantly higher than in the group with a BMI level of 30 and above (p:0.014; p<0.05). It may be explained by the fact that BMI alone is a risk factor for sleeprelated breathing disorder. Results: We found the prevalence of sleep-related breathing disorders in 59 (54.62%) of 108 patients followed up with a diagnosis of CM I, which was higher than other studies in the literature. Sleep efficiency; It consists of the transition from wakefulness to sleep, the effort to maintain sleep, the continuity of sleep and sleep efficiency. In order for sleep to occur, there must be a transition period from sympathetic regulation to parasympathetic regulation. In our study, it was shown that total sleep time increased after surgery, consistent with studies in the literature. The main findings of our study showed that posterior fossa decompression caused significant improvement in many parameters of sleep-related breathing disorder. While there was a significant increase in total sleep time in patients who underwent decompression, it was determined that the effectiveness of the surgery showed a higher improvement compared to other studies in the literature, with an increase in the patients' REM time, a decrease in the central apnea index and the number of central apneas. In our study, in the polysomnography evaluations of sleep-related breathing disorder CM I patients who did not undergo surgery, it was observed that the central apnea index, central apnea duration and central apnea number of patients with a BMI below 30 were significantly lower than those of patients with a BMI of 30 and above. This can be explained by the fact that BMI alone is a risk factor for sleep-related breathing disorders. Considering the positive changes in sleep electrophysiology after surgery, electrophysiological signal recording during sleep (polysomnography) can be considered a criterion for the success of surgical treatment. In addition to our study, the number of patients can be increased and the follow-up period can be extended. Key Words: REM, Type 1 Chiari Malformation, Sleep Electrophysiology
Açıklama
Anahtar Kelimeler
Nöroşirürji, Neurosurgery
