Enflamatuvar bağırsak hastalığı tanısı ile izlenen çocuklarda hastalık aktivasyon indeksi ile uyku bozukluğu arasındaki ilişki
The relationship between disease activation index and sleep disorders in children with the diagnosis of inflammatory bowel disease
Yazar: DİLŞAT GÜNDOĞDU
Danışman: PROF. DR. NAFİYE URGANCI
Sağlık Bilimleri Üniversitesi / İstanbul Şişli Hamidiye Etfal Eğitim ve Araştırma Hastanesi / Çocuk Sağlığı ve Hastalıkları Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2020
Konu: Gastroenteroloji = Gastroenterology
Dizin: Crohn hastalığı = Crohn disease ; Enterokolit = Enterocolitis ; Kolit-ülseratif = Colitis-ulcerative ; Pittsburg uyku kalitesi ölçeği = Pittsburg sleep quality index ; Uyku = Sleep ; Uyku bozuklukları = Sleep disorders ; Çocuklar = Children ; İnflamatuar bağırsak hastalıkları = Inflammatory bowel diseases

Özet:
İnflamatuar barsak hastalıkları inflamasyonun yerine göre Ülseratif kolit (ÜK) ve Crohn hastalığı (CH) olmak üzere iki alt gruba ayrılmaktadır. Ülseratif kolit (ÜK), kolonun remisyon ve ataklar ile karakterize inflamatuar bir hastalığıdır. Uyku kalitesinin ve uyku bozukluğunun, çocuklarda enflamatuar barsak hastalığının aktivitesi ve  kontrolü üzerine etkisi tartışılmaktadır. Literatürde erişkinler ile ilgili çalışmalar mevcut iken özellikle çocuklarda bu konuda yeterli çalışmaya rastlanmadı. Bu çalışmada enflamatuar barsak hastalığı tanısı ile izlenen 6-18 yaş arasındaki İBH'lı ve 6-18 yaş arasındaki İBH'sı olmayan çocukların uyku kalitesi ve uyku bozukluklarının olup olmadığı ve hastalık aktivitesi ile ilişkisi  karşılaştırıldı.

Abstract:
Background/Aims  : Impairment of sleep quality is common in pediatric patients with inflammatory bowel diseases (IBDs) (eg, Crohn's disease [CD] and ulcerative colitis [UC]), even during clinical remission. Sleep impairment can activate inflammatory pathways. Few prospective studies have examined the role of sleep disturbance on risk of relapse in IBD of children.   This study examined the prevalence of poor sleep quality in pediatric  patients with  inactive Crohn's disease and ulcerative colitis compared with healthy controls. The current study had 3 primary aims: to assess the prevalence of sleep disturbance and characterize the nature of sleep quality in children with IBD, to examine the relationship of sleep disturbance to IBD disease activity and inflammatory markers, and to compare reports of sleep quality as reported by parents and adolescents.
Methods:  Participants included 55 patients with Ulcerative colitis disease, 44 patients with Crohn's disease and 80 healthy volunteers  attending the pediatric gastroenterology service and clinic. This study was cross-sectional with questionnaire surveys designed to evaluate sleep disturbance in pediatric IBD patients from 2015 to  2020 (total 5 years). All prospectively completed a demographic questionnaire and the Pittsburgh sleep quality index (PSQI). Patients with Crohn's disease completed the Pediatric Crohn's disease activity index (PCDAI)  and patients with Ulcerative Colitis disease completed the Pediatric  Ulcerative Colitis disease activity index (PUCAI) data on disease duration, medications, complications, and treatment were collected from the medical files and patients. 
Results: 179 pediatric patients with IBD (44 CD, 55 UC, and 80 healhty volunteers) participated in the study. While sleep disturbance was less common in control group without IBD disease, sleep disturbance was observed more frequently in crohn and UK patients (p <0.001). Diarrhea in patients with UC (p <0.001, r: 0.839), and abdominal pain in patients with crohn (p <0.001, r: 0.778) were the most important complaints that disturbed sleep and correlated with PSQI score. PCDAI and PUKAI score were correlated with the severity of sleep disturbance (r: 0.888, r: 0.924), significant in calculating risk for sleep disturbance (OR: 1.165, OR: 1.247) and strong tests to suspect sleep disorder (AUC: 0.923, AUC: 0.966)..
Conclusions: Results suggest that increased disease activity is associated with adverse effects on sleep quality. Based on the results of this study, pediatric patients with IBD should be screened for sleep disturbance.