ÖZET
Amaç:
Bu çalışmanın amacı, yaygın değişken immün yetmezlik (YDİY) hastalarının uyku kalitesini incelemek ve uyku kalitesi ile depresyon, anksiyete, yorgunluk, gündüz aşırı uyku hali ve doğal öldürücü (NK) hücre sayıları arasındaki ilişkiyi araştırmaktır.
Gereç ve Yöntem:
Çalışmaya YDİY tanısı ile takip edilen toplam 53 hasta dahil edilmiştir. YDİY hastalarında uyku kalitesi ve uyku kalitesi ile ilişkili durumları belirlemek için Pittsburgh uyku kalitesi indeksi (PUKİ), yorgunluk şiddet ölçeği (YŞÖ), Hamilton depresyon ölçeği (HAM-D), Hamilton anksiyete ölçeği (HAM-A) ve Epworth uykululuk ölçeği (EUÖ) kullanılmıştır.
Bulgular:
Hastaların 37’sinde (%70) yorgunluk, 34’ünde (%64) kötü uyku kalitesi, 20’sinde (%38) depresyon, 16’sında (%30) anksiyete ve 11’inde (%21) gündüz aşırı uykululuğu saptanmıştır. Tüm YDİY hastaları immünoglobulin (IVIG) replasman tedavisi almakta idi [37 (%72) hastada intravenöz IVIG ve 16 (%28) hastada subkütan immünoglobulin (SCIG)]. IVIG tedavisi alan hastaların PUKİ, HAM-A, HAM-D ve YŞÖ skorları SCIG tedavisi alan hastalardan daha yüksekti (tümü, p<0,05). Çok değişkenli lojistik regresyon analizine göre, düşük NK hücre sayısı [olasılık oranı (OO)=13,384, %95 güven aralığı (GA)=2,478-72,284, p=0,003] ve depresyon (OO=7,030, %95 GA=1,320-37,435, p=0,022) kötü uyku kalitesi için risk faktörü olarak saptandı.
Sonuç:
Sonuçlarımız YDİY hastalarının genel popülasyona göre daha yüksek oranda kötü uyku kalitesi, depresyon, anksiyete, yorgunluk ve aşırı gündüz uykululuğuna sahip olduğunu göstermiştir. Bu nedenle YDİY’de rutin kontroller sırasında uyku kalitesi ve mental durum detaylı olarak sorgulanmalıdır.
References
1
Bousfiha A, Jeddane L, Picard C, Al-Herz W, Ailal F, Chatila T, Cunningham-Rundles C, Etzioni A, Franco JL, Holland SM, Klein C, Morio T, Ochs HD, Oksenhendler E, Puck J, Torgerson TR, Casanova JL, Sullivan KE, Tangye SG. Human Inborn Errors of Immunity: 2019 Update of the IUIS Phenotypical Classification. J Clin Immunol 2020;40:66-81.
2
Bousfiha A, Jeddane L, Picard C, Ailal F, Bobby Gaspar H, Al-Herz W, Chatila T, Crow YJ, Cunningham-Rundles C, Etzioni A, Franco JL, Holland SM, Klein C, Morio T, Ochs HD, Oksenhendler E, Puck J, Tang MLK, Tangye SG, Torgerson TR, Casanova JL, Sullivan KE. The 2017 IUIS Phenotypic Classification for Primary Immunodeficiencies. J Clin Immunol 2018;38:129-43.
3
Bonilla FA, Barlan I, Chapel H, Costa-Carvalho BT, Cunningham-Rundles C, de la Morena MT, Espinosa-Rosales FJ, Hammarström L, Nonoyama S, Quinti I, Routes JM, Tang ML, Warnatz K. International Consensus Document (ICON): Common Variable Immunodeficiency Disorders. J Allergy Clin Immunol Pract 2016;4:38-59.
4
Adelman DC, Howard K. Assessing Quality of Life in Patients with Common Variable Immunodeficiency: Why It Matters. J Allergy Clin Immunol Pract 2016;4:1180-1.
5
Gardulf A, Nicolay U, Math D, Asensio O, Bernatowska E, Böck A, Costa-Carvalho BT, Granert C, Haag S, Hernández D, Kiessling P, Kus J, Matamoros N, Niehues T, Schmidt S, Schulze I, Borte M. Children and adults with primary antibody deficiencies gain quality of life by subcutaneous IgG self-infusions at home. J Allergy Clin Immunol 2004;114:936-42.
6
Tcheurekdjian H, Palermo T, Hostoffer R. Quality of life in common variable immunodeficiency requiring intravenous immunoglobulin therapy. Ann Allergy Asthma Immunol 2004;93:160-5.
7
Bansal RA, Tadros S, Bansal AS. The presence of overlapping quality of life symptoms in primary antibody deficiency (PAD) and chronic fatigue syndrome (CFS). Allergy Asthma Clin Immunol 2020;16:21.
8
Lashley FR. A review of sleep in selected immune and autoimmune disorders. Holist Nurs Pract 2003;17:65-80.
9
Besedovsky L, Lange T, Born J. Sleep and immune function. Pflugers Arch 2012;463:121-37.
10
Fondell E, Axelsson J, Franck K, Ploner A, Lekander M, Bälter K, Gaines H. Short natural sleep is associated with higher T cell and lower NK cell activities. Brain Behav Immun 2011;25:1367-75.
11
Agargun MY, Kara H, Anlar O. The Validity and Reliability of the Pittsburgh Sleep Quality Index. Turkish Journal of Psychiatry 1996;7:107-11.
12
Armutlu K, Korkmaz NC, Keser I, Sumbuloglu V, Akbiyik DI, Guney Z, Karabudak R. The validity and reliability of the Fatigue Severity Scale in Turkish multiple sclerosis patients. Int J Rehabil Res 2007;30:81-5.
13
Akdemir A, Türkçapar MH, Orsel SD, Demirergi N, Dag I, Ozbay MH. Reliability and validity of the Turkish version of the Hamilton Depression Rating Scale. Compr Psychiatry 2001;42:161-5.
14
Yazici MK, Demir B, Tanriverdi N, Karaagaoğlu E, Yolaç P. Hamilton Anxiety Rating Scale: Interrater Reliabilty and Validity Study. Turkish Journal of Psychiatry 1998;9:114-7.
15
Izci B, Ardic S, Firat H, Sahin A, Altinors M, Karacan I. Reliability and validity studies of the Turkish version of the Epworth Sleepiness Scale. Sleep Breath 2008;12:161-8.
16
Madrid-Valero JJ, Martínez-Selva JM, Ribeiro do Couto B, Sánchez-Romera JF, Ordoñana JR. Age and gender effects on the prevalence of poor sleep quality in the adult population. Gac Sanit 2017;31:18-22.
17
Buysse DJ, Angst J, Gamma A, Ajdacic V, Eich D, Rössler W. Prevalence, course, and comorbidity of insomnia and depression in young adults. Sleep 2008;31:473-80.
18
Stranges S, Tigbe W, Gómez-Olivé FX, Thorogood M, Kandala NB. Sleep problems: an emerging global epidemic? Findings from the INDEPTH WHO-SAGE study among more than 40,000 older adults from 8 countries across Africa and Asia. Sleep 2012;35:1173-81.
19
Buysse DJ. Insomnia. JAMA 2013;309:706-16.
20
Fukuda K, Straus SE, Hickie I, Sharpe MC, Dobbins JG, Komaroff A. The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group. Ann Intern Med 1994;121:953-9.
21
Hajjar J, Guffey D, Minard CG, Orange JS. Increased Incidence of Fatigue in Patients with Primary Immunodeficiency Disorders: Prevalence and Associations Within the US Immunodeficiency Network Registry. J Clin Immunol 2017;37:153-65.
22
Malhi GS, Mann JJ. Depression. Lancet 2018;392:2299-312.
23
Happe S. Excessive daytime sleepiness and sleep disturbances in patients with neurological diseases: epidemiology and management. Drugs 2003;63:2725-37.
24
Anterasian C, Duong R, Gruenemeier P, Ernst C, Kitsen J, Geng B. Quality of Life Differences for Primary Immunodeficiency Patients on Home SCIG versus IVIG. J Clin Immunol 2019;39:814-22.
25
Zebracki K, Palermo TM, Hostoffer R, Duff K, Drotar D. Health-related quality of life of children with primary immunodeficiency disease: a comparison study. Ann Allergy Asthma Immunol 2004;93:557-61.
26
Bienvenu B, Cozon G, Hoarau C, Pasquet M, Cherin P, Clerson P, Hachulla E, Crave JC, Delain JC, Jaussaud R. Does the route of immunoglobin replacement therapy impact quality of life and satisfaction in patients with primary immunodeficiency? Insights from the French cohort "Visages". Orphanet J Rare Dis 2016;11:83.
27
Heath J, Lehman E, Saunders EF, Craig T. Anxiety and depression in adults with primary immunodeficiency: How much do these patients experience and how much do they attribute to their primary immunodeficiency? Allergy Asthma Proc 2016;37:409-15.
28
Hajjar J, Kutac C, Rider NL, Seeborg FO, Scalchunes C, Orange J. Fatigue and the wear-off effect in adult patients with common variable immunodeficiency. Clin Exp Immunol 2018;194:327-38.
29
Bonilla FA. Pharmacokinetics of immunoglobulin administered via intravenous or subcutaneous routes. Immunol Allergy Clin North Am 2008;28:803-19, ix.
30
Bonilla FA. Intravenous and subcutaneous immunoglobulin G replacement therapy. Allergy Asthma Proc 2016;37:426-31.
31
Ebbo M, Gérard L, Carpentier S, Vély F, Cypowyj S, Farnarier C, Vince N, Malphettes M, Fieschi C, Oksenhendler E, Schleinitz N, Vivier E; DEFI Study Group. Low Circulating Natural Killer Cell Counts are Associated With Severe Disease in Patients With Common Variable Immunodeficiency. EBioMedicine 2016;6:222-30.
32
Irwin MR. Sleep and inflammation: partners in sickness and in health. Nat Rev Immunol 2019;19:702-15.
33
Dolsen MR, Crosswell AD, Prather AA. Links Between Stress, Sleep, and Inflammation: Are there Sex Differences? Curr Psychiatry Rep 2019;21:8.
34
De Lorenzo BH, de Oliveira Marchioro L, Greco CR, Suchecki D. Sleep-deprivation reduces NK cell number and function mediated by beta-adrenergic signalling. Psychoneuroendocrinology 2015;57:134-43.
35
Suzuki H, Savitz J, Kent Teague T, Gandhapudi SK, Tan C, Misaki M, McKinney BA, Irwin MR, Drevets WC, Bodurka J. Altered populations of natural killer cells, cytotoxic T lymphocytes, and regulatory T cells in major depressive disorder: Association with sleep disturbance. Brain Behav Immun 2017;66:193-200.
36
Irwin M, McClintick J, Costlow C, Fortner M, White J, Gillin JC. Partial night sleep deprivation reduces natural killer and cellular immune responses in humans. FASEB J 1996;10:643-53.
37
Irwin M, Mascovich A, Gillin JC, Willoughby R, Pike J, Smith TL. Partial sleep deprivation reduces natural killer cell activity in humans. Psychosom Med 1994;56:493-8.
