Romatizmal mitral darlığı olan hastalarda uyku kalitesi ve perkütan mitral balon valvüloplastinin uyku kalitesine etkisi

Year 2023, , 391 - 396, 31.12.2023

Mert Evlıce , Ömer Bedır , Samet Ayna , Halil Coşkun , İbrahim Halil Kurt

https://doi.org/10.36516/jocass.1361826

Abstract

Giriş: Kalp hastalığı olan hastalarda uyku kalitesinin bozulması yaygındır. Ancak mitral darlık (MD) şiddetinin ve perkütan mitral balon valvüloplastinin uyku kalitesine etkisine ilişkin veriler sınırlıdır.
Gereç ve Yöntemler: Çalışmaya dahil edilen 205 hasta, ciddi ve ciddi olmayan (hafif-orta dereceli MD) romatizmal MD olarak iki gruba ayrıldı. Hafif-orta dereceli MD olan grupta 123 hasta ve ciddi MD olan grupta 82 hasta analiz edildi. Perkütan mitral balon valvüloplasti uygulanan ciddi romatizmal mitral darlığı olan 82 hasta prospektif olarak dahil edildi. Uyku kalitesi, perkütan mitral balon valvüloplasti işleminden hemen önce ve yaklaşık altı ay sonra prospektif olarak araştırıldı. Uyku kalitesini değerlendirmek için Pittsburgh Uyku Kalitesi İndeksi (PUKİ) kullanıldı.
Sonuç: PUKİ skoru ciddi MD olanlarda, ciddi MD olmayanlara göre oldukça yüksekti (sırasıyla 3,7 ± 2,0 vs. 7,7 ± 2,9; p<0,001). Toplam PSQI skorları ile ekokardiyografik parametreler arasında anlamlı bir korelasyon olduğu gösterildi [Sol atriyum çapı (r= 0,599; p=0,003), Mitral kapak alanı (r= 0,837, p<0,001), Transmitral ortalama gradyan (r=0,773; p<0,001) ), TR maksimum hız (r=0,593; p=0,004), Tahmini PAP (r=0,530; p=0,01), TAPSE (r=-0,510; p=0,013)]. Ayrıca ekokardiyografik parametreler ile toplam PUKİ puanları arasında yapılan çok değişkenli regresyon analizinde mitral kapak alanı (QR=0,73; 95% GA: 0,54-0,92; p=0,011) ve ortalama transmitral gradiyenti (QR=1,78; 95% GA: 1,44-2,18; p <0,001) istatistiksel olarak anlamlı bulundu.
PMBV işleminden 6 ay sonraki toplam PUKİ skorları, PMBV işlemi öncesine göre anlamlı derecede düşüktü (7,1 ± 2,7'ye karşı 3,9 ± 2,5; p < 0,001). Uyku kalitesinin subjektif bir ölçütü olan PUKİ skorunda bir iyileşme oldu.
Tartışma: Uyku kalitesini subjektif olarak değerlendirebilen PUKİ skoru ile mitral kapak darlığının şiddeti arasında belirgin korelasyon bulundu. Mitral darlığın şiddeti arttıkça uyku kalitesi bozulabilir. PMBV'nin ek bir faydası, altta yatan uyku bozukluğunu iyileştirebilmesi olabilir. Perkütan mitral balon valvüloplasti erişkin MD hastalarında uyku kalitesinin iyileştirilmesinde faydalı olabilir.

Keywords

romatizmal mitral darlığı; perkütan mitral balon valvüloplastisi; Pittsburgh Uyku Kalitesi İndeksi; uyku kalitesi

Sleep Quality in patients with rheumatic mitral stenosis and the effect of percutaneous mitral balloon valvuloplasty on Sleep Quality

Abstract

Background: Impaired sleep quality is common in patients with heart disease. However, data on the effects of mitral stenosis severity and percutaneous mitral balloon valvuloplasty on sleep quality are scarce.
Materials and methods: 205 patients included in the study were divided into two groups as severe and non-severe (mild to moderate MS) rheumatic MS. 123 patients with mild to moderate MS and 82 patients with severe MS were analyzed. 82 patients with severe rheumatic MS who underwent percutaneous mitral balloon valvuloplasty were prospectively enrolled. Sleep quality was prospectively investigated immediately before and approximately six months after the percutaneous mitral balloon valvuloplasty procedure. The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality.
Results: The PSQI score was considerably higher in patients with severe MS compared to mild to moderate MS (3.7 ± 2.0 vs. 7.7 ± 2.9, p<0.001, respectively). A significant correlation was demonstrated between total PSQI scores and echocardiographic parameters [ Left atrial diameter (r= 0.599, p=0.003), Mitral valve area (r= 0.837, p<0.001), Transmitral mean gradient (r=0.773, p<0.001), TR max velocity (r=0.593, p=0.004), Estimated PAP (r=0.530, p=0.01), TAPSE (r=-0.510, p=0.013)]. In addition, mitral valve area (QR=0.73; 95% CI: 0.54-0.92; p=0.011) and transmitral mean gradient (QR=1.78; 95% CI: 1.44-2.18; p <0.001) were found to be statistically significant in the multivariate regression analysis performed between echocardiographic parameters and total PSQI scores.
Total PSQI scores at 6 months after the PMBV procedure were significantly lower than before the PMBV procedure (7.1 ± 2.7 vs. 3.9 ± 2.5; p < 0.001). There was an improvement in the PSQI score, a subjective measure of sleep quality.
Conclusions: A correlation was found between the PSQI score, which can subjectively assess sleep quality, and the severity of mitral valve stenosis. Sleep quality may deteriorate as the severity of mitral stenosis increases. An additional benefit of PMBV may be that it can ameliorate the underlying sleep disorder. Percutaneous mitral balloon valvuloplasty may be beneficial in improving sleep quality in adult patients with MS.

Keywords

rheumatic mitral stenosis, percutaneous mitral balloon valvuloplasty, Pittsburgh Sleep Quality Index, sleep quality

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