OBSTRÜKTİF UYKU APNESİ TEDAVİ ALTERNATİFLERİ VE ÖNERİLER

T.C. Ege Üniversitesi Diş Hekimliği Fakültesi Ortodonti Anabilim Dalı OBSTRÜKTİF UYKU APNESİ TEDAVİ ALTERNATİFLERİ VE ÖNERİLER BİTİRME TEZİ Stj. Dişhekimi Ahmet Halil TURAN Danışman Öğretim Üyesi: Prof. Dr. Servet DOĞAN İZMİR-2008

GİRİŞ VE AMAÇ Obstrüktif uyku apnesi sendromu (Obstructive sleep apnea syndrome, OSA) aşırı gündüz uyuklamaları, bozulmuş hayat kalitesiyle sonuçlanan, trafik kazaları ve kardiyovasküler hastalıklarala ilişklendirilen bir uyku düzensizliğidir. OSA için standart tedavi olan nasal devamlı pozistif hava basıncı (Nasal Continous Positive Air Presure, CPAP) uygulanması bu semptomları hızla engellemekte ve yalnızca küçük yan etkileri göstermektedir. Tüm bu iyi etkilerine karşın açıktır ki CPAP tedavisinin medikal yada psikolojik sebeplerle uygun olmadığı hastalar için tedavi alternatiflerinin bilinmesi önemlidir. CPAP tedavisine en önemli alternatif non invaziv ve klinik etkisi güvenilir olan oral uygulamalardır. Uyku sırasında dişlere sabitlenerek mandibulayı öne alan, hareketli oral aygıtların, uyku sırasında solunum düzensizliklerini ve bu düzensizliklerin semptomlarını önlediği, hastaya daha yüksek bir yaşam kalitesi sunduğu, uyanıklığı arttırıp, kan basıncını azalttığı bilinmektedir. Oral uygulamaların uzun dönem ve yan etkilerinin anlaşılması için daha ileri çalışmalar gerekmektedir. OSAS hastası obez hastalar için bariyatrik cerrahi hem obezitenin hem de OSA nın tedavisinde fayda göstermektedir. Adeno-tonsiller hipertrofi gösteren veya kraniofasiyal malformasyon gösteren hastalarda cerrahi teknikler üst hava yolunu genişleterek OSAS nun tedavisi için iyi bir alternatif olmaktadırlar. Bu çalışma da OSAS tedavisi alternatifleri incelenmektedir.

GİRİŞ VE AMAÇ..1 1. GENEL BİLGİLER...2 1.1. Uyku Fizyoljisi...4 1.2. Üst Solunum Yolu Uyku Düzensizliği Bulunmayan Bireylerin Anatomik ve Fizyolojik Özellikleri 6 1.3. Üst Solunum Yolu Uyku Bozukluğu Olan Bireylerin Anatomik ve Fizyolojik Özellikleri....6 2. OBSTRÜKTİF UYKU APNESİ.7 2.1. Horlama...9 2.2. Horlama ve/veya OSA da üst solunum yolu daralma veya obstrüksiyonunun nedenleri etyiolojik faktörleri..11 2.3. Anatomik Faktörler.11 2.4. Fonksiyonel faktörler 14 3. OBSTRÜKTİF UYKU APNESİNİN TEDAVİ ALTERNATİFLERİ.14 4. AŞIRI KİLONUN AZALTILMASI..16 5. ÜST SOLUNUM YOLU CERRAHİSİ.17 6. NAZAL OBTRÜKSÜYONUN TEDAVİSİ..18 7. İLAÇ TEDAVİLERİ, BİRLEŞİK VE DENEYSEL ÖLÇÜTLER...19 8. ORAL UYGULAMALAR..20 8.1. Tarihçe 21 8.2. Oral Uygulamaların tipleri 22 8.3. Oral Uygulamaların Etki Mekanizması... 24 8.4. Mandibuler ilerleticilerin tasarım ilkeleri 26 8.5. Oral uygulamarda Klinik Çalışmalar...28 8.6. Uyku apnesinin tedavisinde oral uygulamalar.28 8.7. Oral uygulamalar CPAP karşılaştırılması 32

8.8. Oral Uygulamaların Yan etkileri..33 8.9. Oral Uygulamalarla Tedavide Hasta Uyumu..35 9. SONUÇLAR..37 10. ÖZET..39 11. KAYNAKLAR..40 12. ÖZGEÇMİŞ...65

ÖNSÖZ Obstrüktif uyku apnesi tedavi alternatifleri konulu bitirme tezimde bana yol gösteren ve yardımlarını esirgemeyen değerli hocam Sayın Prof Dr Servet DOĞAN a öğretim üyeleri Dr Sercan AKYALÇIN ve Dr Hüseyin KURTULMUŞ a E.Ü. Diş Hekimliği Fakültesi öğretim üyeleri ve çalışanlarına, okul hayatım ve stajerliğim sırasında maddi manevi desteklerini sunan canım ailem ve arkadaşlarıma teşekkürü bir borç bilirim. İzmir-2008 Stj. Dişhekimi Ahmet Halil TURAN

ÖZET Obstrüktif uyku apnesi sendromu (OSAS) aşırı gün içi uyuklamaları, bozulmuş hayat kalitesi ile seyreden, trafik kazaları ve kardiyovasküler hastalıklarla ilişkilendirilen uyku solunum düzensizliğidir. Nasal devamlı pozitif hava basıncı uygulanması OSAS un tedavisinde kullanılan ve derhal semptomlarda azalma sağlayan standart tedavi metodudur. CPAP medikal yada psikolojik sebeplerle endike olmadığı hastalarda bu tedaviye alternatif tedavi ihtiyacı mevcuttur. Hareketli oral aygıtlar uyurken dişlere takılarak mandibulayı ileri alarak gece uyku düzensizliklerini ve bunların semptomlarını iyileştiren ve hayat kalitesini yükselten bir tedavi metodudur. Uzun süreli etkinlikleri ve yan etkilerinin anlaşılması için daha fazla çalışma yapılması gerekmektedir. OSAS hastası obez hastalarda obezitenin engellenmesi aynı zamanda OSAS semptomlarının azalmasına da katkıda bulur.adeno-tonsiller hipertrofili yada kranio-fasial malformasyonlu seçilmiş hastalarda da cerrahi teknikler üst soluk yolunu genişleterek alternatif tedavi seçeneği oluştururlar.

ÖZGEÇMİŞ 10 Ocak 1985 tarihinde İzmir de doğdum. 1996 yılında Umurbey İlkokulu ndan mezun oldum. Orta ve lise öğrenimimi Buca Anadolu Lisesi nde 2002 yılında tamamladım. Aynı yıl Ege üniversitesi Diş Hekimliği Fakültesi ne kaydımı yaptırdım.

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