Uyku İle İlişkili Hipoventilasyon ve Hipoksemi Bozuklukları
Özet
Uluslararası Uyku Bozuklukları Sınıflaması'na (ICSD-3) göre uyku ile ilişkili hipoventilasyon ve hipoksemi bozuklukları iki ana başlık altında incelenmektedir. Sağlıklı bireylerde uyku esnasında meydana gelen fizyolojik solunumsal değişiklikler sorun yaratmazken, solunum kontrol mekanizmalarındaki aksaklıklar ciddi hastalıklara yol açmaktadır. Uyku ile ilişkili hipoventilasyon bozukluklarının temel özellikleri, uykuda yetersiz ventilasyon ve arteriyel karbondioksit basıncındaki anormal yükselmedir. Bu grupta; obezite hipoventilasyon sendromu (OHS), konjenital santral alveolar hipoventilasyon sendromu (CCHS), hipotalamik bozuklukla birlikte geç başlangıçlı santral hipoventilasyon, idiopatik santral alveolar hipoventilasyon ile ilaç, madde veya tıbbi bir bozukluğa bağlı gelişen hipoventilasyon sendromları yer alır. Bu hastalıklardan en yaygını olan OHS; obezite, uyanıklıkta hipoventilasyon ve diğer nedenlerin ekarte edilmesiyle teşhis edilir. Tedavisinde pozitif havayolu basıncı (PAP) cihazları, kilo kontrolü ve yaşam tarzı değişiklikleri kombine olarak önerilir. Diğer ana başlık olan uyku ile ilişkili hipoksemi bozukluğu ise belirgin bir hipoventilasyon olmaksızın oksihemoglobin satürasyonunun uykuda uzun süre düşmesiyle karakterizedir. Hava yolu, parankim, göğüs duvarı, nöromuskuler ve vasküler hastalıklar bu duruma yol açabilir. Her iki bozukluk grubu da tedavi edilmediğinde pulmoner hipertansiyon, kor pulmonale ve nörobilişsel işlev bozuklukları gibi ağır komplikasyonlara zemin hazırlar.
According to the International Classification of Sleep Disorders (ICSD-3), sleep-related hypoventilation and hypoxemia disorders are examined under two main categories. While physiological respiratory changes during sleep do not cause problems in healthy individuals, defects in respiratory control mechanisms lead to serious conditions. The main features of sleep-related hypoventilation disorders are inadequate ventilation during sleep and an abnormal rise in arterial carbon dioxide pressure. This group includes obesity hypoventilation syndrome (OHS), congenital central alveolar hypoventilation syndrome (CCHS), late-onset central hypoventilation with hypothalamic dysfunction, idiopathic central alveolar hypoventilation, and hypoventilation due to medications, substances, or medical disorders. OHS, the most common among these, is diagnosed by the presence of obesity, daytime hypoventilation, and the exclusion of other causes. Its treatment involves a combined approach of positive airway pressure (PAP) therapies, weight management, and lifestyle modifications. The other major category, sleep-related hypoxemia disorder, is characterized by a sustained drop in oxyhemoglobin saturation during sleep without significant hypoventilation. Airway, parenchymal, chest wall, neuromuscular, and vascular diseases can trigger this condition. Left untreated, both groups of disorders predispose patients to severe complications such as pulmonary hypertension, cor pulmonale, and neurocognitive dysfunction.
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