Uyku ve Üst Solunum Sistemi
Synopsis
Uyku, temel bir fizyolojik aktivite olarak bireyin mental, fiziksel ve ruhsal sağlığı ile yakından ilişkilidir. Uyku, beynin ve vücudun yeniden yapılandırıldığı bir dönem olarak; odaklanma duygusunu güçlendirir, öğrenmeyi kolaylaştırır, büyüme ve gelişimin sağlanmasına ciddi katkıda bulunur. Uyku bozukluklarının geniş bir spektrumda dağılımı, erişkin ve pediatrik yaş gruplarında farklı özellikler içermesi, birçok organ ve sistemi etkilemesi sebebiyle, tanı ve tedavi süreçleri multidisipliner yaklaşımı zorunlu kılmaktadır. En yaygın uyku bozukluğu olarak, Obstrüktif Uyku Apne Sendromu (OSAS), uyku sırasında üst solunum yollarında 10 saniye veya daha uzun süre tıkanmalarla karakterize bir uyku bozukluğu şeklidir. Uyku bozukluklarının tanı ve tedavisinde ayrıntılı anamnez ile birlikte üst solunum yollarının ayrıntılı değerlendirilmesi büyük önem taşır. OSAS’da üst solunum yollarında multifaktöryel sebeplerle oluşabilen kollaps ya da üst solunum yollarında tıkanıklık yapan anatomik bir sorunun giderilmesi, çocuk ve erişkinlerde uyku bozukluklarının tedavisini sağlayabilir.
References
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American Academy of Sleep Medicine (AASM). International classification of sleepdisorders.2. Westchester, IL: Author;2001.
Doghramji K, Boon M. The role of upper airway stimulation therapy in the multidisciplinary management approach of obstructive sleep apnea in the adult patient. Laryngoscope. 2016 Sep;126 Suppl 7:S9-S11. doi: 10.1002/lary.26168.
Yunika, K., Mardalita, F., Noventi, S., Marliyawati, D., & Arifin, M. T. (2020). The correlation of upper airway abnormalities with obstructive sleep apnea syndrome in young adult. Intisari Sains Medis, 11(2), 461-465.
Paul W, WC C. otolaryngology head and neck surgery. 5th ed. WF P, CW C, editors. Elsevier Ireland Ltd; 2010. 298 p.
Skatvedt O. Localization of site of obstruction in snorers and patients with obstructive sleep apnea syndrome: a comparison of fiberoptic nasopharyngoscopy and pressure measurements. Acta Otolaryngol 1993;113(2):206–209.
Hoffstein V. Apnea and snoring: state of the art and future directions. Acta Otorhinolaryngol Belg 2002;56(2):205-236.
Ancoli-Israel S, Kripke DF, Klauber MR, Parker L, Stepnowsky C, Kullen A, et al. Natural history of sleep disordered breathing in community dwelling elderly. Sleep. 1993 Dec;16(8 Suppl):S25-9. doi: 10.1093/sleep/16.suppl_8.s25.
Pohunek P. Development, structure and function of the upper airways. Paediatr Respir Rev. 2004 Mar;5(1):2-8. doi: 10.1016/j.prrv.2003.09.002
Sahin-Yilmaz A, Naclerio RM. Anatomy and physiology of the upper airway. Proc Am Thorac Soc. 2011 Mar;8(1):31-9. doi: 10.1513/pats.201007-050RN.
Salman SD, Proctor DF, Swift DL, Eveering SA. Nasal resistance: description of a method and effect of temperature and humidity changes. Ann Otol Rhinol Laryngol 1971;80:736–743.
Clarke RW, Jones AS. Nasal airflow receptors: the relative importance of temperature and tactile stimulation. Clin Otolaryngol Allied Sci 1992;17:388–392.
Cingi C, Muluk NB, Ulusoy S, Lopatin A, Şahin E, Passali D, et al. Septoplasty in children. Am J Rhinol Allergy. 2016 Mar-Apr;30(2):e42-7. doi: 10.2500/ajra.2016.30.4289.
Grutzenmacher S, Robinson DM, Grafe K, Lang C, Mlynski G. First findings concerning airflow in noses with septal deviation and compensatory turbinate hypertrophy–a model study. ORL J Otorhinolaryngol Relat Spec 2006;68:199–205.
Cole P, Chaban R, Naito K, Oprysk D. The obstructive nasal septum. Effect of simulated deviations on nasal airflow resistance. Arch Otolaryngol Head Neck Surg 1988;114:410–412.
Mladina R, Cujic E, Subaric M, Vukovic K. Nasal septal deformities in ear, nose, and throat patients: an international study. Am J Otolaryngol 2008;29:75–82.
Swift DL, Proctor DF. Access of air to the respiratory tract. In Brain DJ, Proctor DF, Reid LM. editors. Respiratory defense mechanisms. New York; Marcel Dekker, 1977, p.63–93.
Wight RG, Jones AS, Clegg RT. A comparison of anterior and radical trimming of the inferior nasal turbinates and the effects on nasal resistance to airflow. Clin Otolaryngol Allied Sci 1988;13: 223–226
Cole P. Nasal and oral airflow resistors. Site, function, and assessment. Arch Otolaryngol Head Neck Surg 1992;118:790–793.
Latte J, Taverner D. Opening the nasal valve with external dilators reduces congestive symptoms in normal subjects. Am J Rhinol 2005;19:215–219.
Proctor DF, Adams GK III. Physiology and pharmacology of nasal function and mucus secretion. Pharmacol Ther [B] 1976;2:493–509.
Yu S, Liu Y, Sun X, Li S. Influence of nasal structure on the distribution of airflow in nasal cavity. Rhinology 2008;46:137–143.
Hairfield WM, Warren DW, Hinton VA, Seaton DL. Inspiratory and expiratory effects of nasal breathing. Cleft Palate J 1987;24:183–189.
Chung SK, Son YR, Shin SJ, Kim SK. Nasal airflow during respiratory cycle. Am J Rhinol 2006;20:379–384.
Kountakis, S. E., Önerci, M. (Eds.). (2007). Rhinologic and sleep apnea surgical techniques (pp. 265-269). Berlin: Springer.
Van den Bossche K, Van de Perck E, Kazemeini E, Willemen M, Van de Heyning PH, Verbraecken J, et al. Natural sleep endoscopy in obstructive sleep apnea: A systematic review. Sleep Med Rev. 2021 Dec;60:101534. doi: 10.1016/j.smrv.2021.101534.
Croft CB, Pringle M. Sleep nasendoscopy: a technique of assessment in snoring and obstructive sleep apnoea. Clin Otolaryngol Allied Sci. 1991 Oct;16(5):504-9. doi: 10.1111/j.1365-2273.1991.tb01050.x.
El Badawey MR, McKee G, Heggie N, Marshall H, Wilson JA. Predictive value of sleep nasendoscopy in the management of habitual snorers. Ann Otol Rhinol Laryngol. 2003 Jan;112(1):40-4. doi: 10.1177/000348940311200109.
Kezirian EJ, Hohenhorst W, de Vries N. Drug-induced sleep endoscopy: the VOTE classification. Eur Arch Otorhinolaryngol. 2011 Aug;268(8):1233-1236. doi: 10.1007/s00405-011-1633-8.
Schellenberg JB, Maislin G, Schwab RJ: Physical findings and the risk for obstructive sleep apnea. The importance of oropharyngeal structures. Am J Respir Crit Care Med 2000;162:740–748.
Stauffer JL, Buick MK, Bixler EO, Sharkey FE, Abt AB, Manders EK, et al. Morphology of the uvula in obstructive sleep apnea. Am Rev Respir Dis 1989;140:724–728.
Friedman M, Tanyeri H, La Rosa M, Landsberg R, Vaidyanathan K, Pieri S, et al. Clinical predictors of obstructive sleep apnea. Laryngoscope 1999;109:1901–1907.
Mallampati SR, Gatt SP, Gugino LD, Desai SP, Waraksa B, Freiberger D, et al. A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Soc J 1985;32:429–434.
Hiremath AS, Hillman DR, James AL, Noff singer WJ, Platt PR, Singer SL. Relationship between difficult tracheal intubation and obstructive sleep apnea. Br J Anaesth1998;80:606–611.
Goldberg AN, Schwab RJ. Identifying the patient with sleep apnea: upper airway assessment and physical examination. Otolaryngol Clin North Am 1998;31:919–930.
Schellenberg JB, Maislin G, Schwab RJ. Physical findings and the risk for obstructive sleep apnea. The importance of oropharyngeal structures. Am J Respir Crit Care Med 2000;162:740–748.
Mitchell RB. Adenotonsillectomy for obstructive sleep apnea in children: outcome evaluated by pre- and postoperative polysomnography. Laryngoscope. 2007 Oct;117(10):1844-54. doi: 10.1097/MLG.0b013e318123ee56.
Sjöblom HM, Nahkuri M, Suomela M, Jero J, Piitulainen JM. Treatment of sleep apnoea with tonsillectomy: a retrospective analysis using long-term follow-up data. Eur Arch Otorhinolaryngol. 2022 Jul;279(7):3727-3732. doi: 10.1007/s00405-022-07350-6.
Wulfsberg EA. The orofaical examination: Normal and abnormal findings. In:Wyszynski DF, ed. Cleft Lip and Palate: From Origin to Treatment. New York:Oxford University Press; 2002. p. 43-47.
Yao M, Utley DS, Terris DJ. Cephalometric parameters aft er multilevel pharyngeal surgery for patients with obstructive sleep apnea. Laryngoscope 1998;108:789–795.
Aboussouan LS, Golish JA, Wood BG, Mehta AC, Wood DE, Dinner DS. Dynamic pharyngoscopy in predicting outcome of uvulopalatopharyngoplasty for moderate and severe obstructive sleep apnea. Chest 1995;107:946–951.
Katsantonis GP, Maas CS, Walsh JK. The predictive efficacy of the Muller maneuver in uvulopalatopharyngoplasty. Laryngoscope 1989;99:677–680.
Guilleminault C, Stoohs R, Clerk A, Simmons J, Labanowski M. From obstructive sleep apnea syndrome to upper airway resistance syndrome: consistency of daytime sleepiness. Sleep. 1992 Dec;15(6 Suppl):S13-6.
Berry RB, Budhira R, Gottlieb DJ, Gozal D, Iber C, Kapur VK. The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. Darien, IL: American Academy of Sleep Medicine; 2014 Version 2.1
Köktürk, Oğuz, and S. Fırat Güven. "Üst solunum yolu rezistansı sendromu. Tüberküloz ve Toraks Dergisi 51.2 (2003): 216-26.
de Godoy LB, Palombini LO, Guilleminault C, Poyares D, Tufik S, Togeiro SM. Treatment of upper airway resistance syndrome in adults: Where do we stand? Sleep Sci. 2015;8(1):42-48. doi:10.1016/j.slsci.2015.03.001
Montserrat JM, Badia JR. Upper airway resistance syndrome. Sleep Medicine Reviews 1999; 3: 5-21.
Rühle KH, Schlenker E, Randerath W. Upper airway resistance syndrome. Respiration. 1997;64 Suppl 1:29-34. doi:10.1159/000196733
de Godoy LB, Luz GP, Palombini LO, E Silva LO, Hoshino W, Guimarães TM, et al. Upper Airway Resistance Syndrome Patients Have Worse Sleep Quality Compared to Mild Obstructive Sleep Apnea. PLoS One. 2016 May 26;11(5):e0156244. doi: 10.1371/journal.pone.0156244.
Arnold WC, Guilleminault C. Upper airway resistance syndrome 2018: non-hypoxic sleep-disordered breathing. Expert Rev Respir Med. 2019;13(4):317-326. doi:10.1080/17476348.2019.1575731
American Academy of Sleep Medicine (AASM). International classification of sleepdisorders.2. Westchester, IL: Author;2001.
Doghramji K, Boon M. The role of upper airway stimulation therapy in the multidisciplinary management approach of obstructive sleep apnea in the adult patient. Laryngoscope. 2016 Sep;126 Suppl 7:S9-S11. doi: 10.1002/lary.26168.
Yunika, K., Mardalita, F., Noventi, S., Marliyawati, D., & Arifin, M. T. (2020). The correlation of upper airway abnormalities with obstructive sleep apnea syndrome in young adult. Intisari Sains Medis, 11(2), 461-465.
Paul W, WC C. otolaryngology head and neck surgery. 5th ed. WF P, CW C, editors. Elsevier Ireland Ltd; 2010. 298 p.
Skatvedt O. Localization of site of obstruction in snorers and patients with obstructive sleep apnea syndrome: a comparison of fiberoptic nasopharyngoscopy and pressure measurements. Acta Otolaryngol 1993;113(2):206–209.
Hoffstein V. Apnea and snoring: state of the art and future directions. Acta Otorhinolaryngol Belg 2002;56(2):205-236.
Ancoli-Israel S, Kripke DF, Klauber MR, Parker L, Stepnowsky C, Kullen A, et al. Natural history of sleep disordered breathing in community dwelling elderly. Sleep. 1993 Dec;16(8 Suppl):S25-9. doi: 10.1093/sleep/16.suppl_8.s25.
Pohunek P. Development, structure and function of the upper airways. Paediatr Respir Rev. 2004 Mar;5(1):2-8. doi: 10.1016/j.prrv.2003.09.002
Sahin-Yilmaz A, Naclerio RM. Anatomy and physiology of the upper airway. Proc Am Thorac Soc. 2011 Mar;8(1):31-9. doi: 10.1513/pats.201007-050RN.
Salman SD, Proctor DF, Swift DL, Eveering SA. Nasal resistance: description of a method and effect of temperature and humidity changes. Ann Otol Rhinol Laryngol 1971;80:736–743.
Clarke RW, Jones AS. Nasal airflow receptors: the relative importance of temperature and tactile stimulation. Clin Otolaryngol Allied Sci 1992;17:388–392.
Cingi C, Muluk NB, Ulusoy S, Lopatin A, Şahin E, Passali D, et al. Septoplasty in children. Am J Rhinol Allergy. 2016 Mar-Apr;30(2):e42-7. doi: 10.2500/ajra.2016.30.4289.
Grutzenmacher S, Robinson DM, Grafe K, Lang C, Mlynski G. First findings concerning airflow in noses with septal deviation and compensatory turbinate hypertrophy–a model study. ORL J Otorhinolaryngol Relat Spec 2006;68:199–205.
Cole P, Chaban R, Naito K, Oprysk D. The obstructive nasal septum. Effect of simulated deviations on nasal airflow resistance. Arch Otolaryngol Head Neck Surg 1988;114:410–412.
Mladina R, Cujic E, Subaric M, Vukovic K. Nasal septal deformities in ear, nose, and throat patients: an international study. Am J Otolaryngol 2008;29:75–82.
Swift DL, Proctor DF. Access of air to the respiratory tract. In Brain DJ, Proctor DF, Reid LM. editors. Respiratory defense mechanisms. New York; Marcel Dekker, 1977, p.63–93.
Wight RG, Jones AS, Clegg RT. A comparison of anterior and radical trimming of the inferior nasal turbinates and the effects on nasal resistance to airflow. Clin Otolaryngol Allied Sci 1988;13: 223–226
Cole P. Nasal and oral airflow resistors. Site, function, and assessment. Arch Otolaryngol Head Neck Surg 1992;118:790–793.
Latte J, Taverner D. Opening the nasal valve with external dilators reduces congestive symptoms in normal subjects. Am J Rhinol 2005;19:215–219.
Proctor DF, Adams GK III. Physiology and pharmacology of nasal function and mucus secretion. Pharmacol Ther [B] 1976;2:493–509.
Yu S, Liu Y, Sun X, Li S. Influence of nasal structure on the distribution of airflow in nasal cavity. Rhinology 2008;46:137–143.
Hairfield WM, Warren DW, Hinton VA, Seaton DL. Inspiratory and expiratory effects of nasal breathing. Cleft Palate J 1987;24:183–189.
Chung SK, Son YR, Shin SJ, Kim SK. Nasal airflow during respiratory cycle. Am J Rhinol 2006;20:379–384.
Kountakis, S. E., Önerci, M. (Eds.). (2007). Rhinologic and sleep apnea surgical techniques (pp. 265-269). Berlin: Springer.
Van den Bossche K, Van de Perck E, Kazemeini E, Willemen M, Van de Heyning PH, Verbraecken J, et al. Natural sleep endoscopy in obstructive sleep apnea: A systematic review. Sleep Med Rev. 2021 Dec;60:101534. doi: 10.1016/j.smrv.2021.101534.
Croft CB, Pringle M. Sleep nasendoscopy: a technique of assessment in snoring and obstructive sleep apnoea. Clin Otolaryngol Allied Sci. 1991 Oct;16(5):504-9. doi: 10.1111/j.1365-2273.1991.tb01050.x.
El Badawey MR, McKee G, Heggie N, Marshall H, Wilson JA. Predictive value of sleep nasendoscopy in the management of habitual snorers. Ann Otol Rhinol Laryngol. 2003 Jan;112(1):40-4. doi: 10.1177/000348940311200109.
Kezirian EJ, Hohenhorst W, de Vries N. Drug-induced sleep endoscopy: the VOTE classification. Eur Arch Otorhinolaryngol. 2011 Aug;268(8):1233-1236. doi: 10.1007/s00405-011-1633-8.
Schellenberg JB, Maislin G, Schwab RJ: Physical findings and the risk for obstructive sleep apnea. The importance of oropharyngeal structures. Am J Respir Crit Care Med 2000;162:740–748.
Stauffer JL, Buick MK, Bixler EO, Sharkey FE, Abt AB, Manders EK, et al. Morphology of the uvula in obstructive sleep apnea. Am Rev Respir Dis 1989;140:724–728.
Friedman M, Tanyeri H, La Rosa M, Landsberg R, Vaidyanathan K, Pieri S, et al. Clinical predictors of obstructive sleep apnea. Laryngoscope 1999;109:1901–1907.
Mallampati SR, Gatt SP, Gugino LD, Desai SP, Waraksa B, Freiberger D, et al. A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Soc J 1985;32:429–434.
Hiremath AS, Hillman DR, James AL, Noff singer WJ, Platt PR, Singer SL. Relationship between difficult tracheal intubation and obstructive sleep apnea. Br J Anaesth1998;80:606–611.
Goldberg AN, Schwab RJ. Identifying the patient with sleep apnea: upper airway assessment and physical examination. Otolaryngol Clin North Am 1998;31:919–930.
Schellenberg JB, Maislin G, Schwab RJ. Physical findings and the risk for obstructive sleep apnea. The importance of oropharyngeal structures. Am J Respir Crit Care Med 2000;162:740–748.
Mitchell RB. Adenotonsillectomy for obstructive sleep apnea in children: outcome evaluated by pre- and postoperative polysomnography. Laryngoscope. 2007 Oct;117(10):1844-54. doi: 10.1097/MLG.0b013e318123ee56.
Sjöblom HM, Nahkuri M, Suomela M, Jero J, Piitulainen JM. Treatment of sleep apnoea with tonsillectomy: a retrospective analysis using long-term follow-up data. Eur Arch Otorhinolaryngol. 2022 Jul;279(7):3727-3732. doi: 10.1007/s00405-022-07350-6.
Wulfsberg EA. The orofaical examination: Normal and abnormal findings. In:Wyszynski DF, ed. Cleft Lip and Palate: From Origin to Treatment. New York:Oxford University Press; 2002. p. 43-47.
Yao M, Utley DS, Terris DJ. Cephalometric parameters aft er multilevel pharyngeal surgery for patients with obstructive sleep apnea. Laryngoscope 1998;108:789–795.
Aboussouan LS, Golish JA, Wood BG, Mehta AC, Wood DE, Dinner DS. Dynamic pharyngoscopy in predicting outcome of uvulopalatopharyngoplasty for moderate and severe obstructive sleep apnea. Chest 1995;107:946–951.
Katsantonis GP, Maas CS, Walsh JK. The predictive efficacy of the Muller maneuver in uvulopalatopharyngoplasty. Laryngoscope 1989;99:677–680.
Guilleminault C, Stoohs R, Clerk A, Simmons J, Labanowski M. From obstructive sleep apnea syndrome to upper airway resistance syndrome: consistency of daytime sleepiness. Sleep. 1992 Dec;15(6 Suppl):S13-6.
Berry RB, Budhira R, Gottlieb DJ, Gozal D, Iber C, Kapur VK. The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. Darien, IL: American Academy of Sleep Medicine; 2014 Version 2.1
Köktürk, Oğuz, and S. Fırat Güven. "Üst solunum yolu rezistansı sendromu. Tüberküloz ve Toraks Dergisi 51.2 (2003): 216-26.
de Godoy LB, Palombini LO, Guilleminault C, Poyares D, Tufik S, Togeiro SM. Treatment of upper airway resistance syndrome in adults: Where do we stand? Sleep Sci. 2015;8(1):42-48. doi:10.1016/j.slsci.2015.03.001
Montserrat JM, Badia JR. Upper airway resistance syndrome. Sleep Medicine Reviews 1999; 3: 5-21.
Rühle KH, Schlenker E, Randerath W. Upper airway resistance syndrome. Respiration. 1997;64 Suppl 1:29-34. doi:10.1159/000196733
de Godoy LB, Luz GP, Palombini LO, E Silva LO, Hoshino W, Guimarães TM, et al. Upper Airway Resistance Syndrome Patients Have Worse Sleep Quality Compared to Mild Obstructive Sleep Apnea. PLoS One. 2016 May 26;11(5):e0156244. doi: 10.1371/journal.pone.0156244.
Arnold WC, Guilleminault C. Upper airway resistance syndrome 2018: non-hypoxic sleep-disordered breathing. Expert Rev Respir Med. 2019;13(4):317-326. doi:10.1080/17476348.2019.1575731
Pages
21-36
Published
January 24, 2025
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