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Obstrüktif Uyku Apnesi’nin Şiddet İçeren ve İçermeyen Davranışlar Üzerine Etkisi

Yıl 2020, Cilt: 10 Sayı: 1, 22 - 28, 31.01.2020
https://doi.org/10.33631/duzcesbed.655994

Öz

Amaç:
Obstrüktif uyku apne (OUA) üst hava yollarının uyku sırasında daralması ile
karakterizedir ve bu durum oksijen desaturasyonu, sempatik aktivasyon,
tekrarlayan arousallara neden olur. Uyku problemi yaşayan insanlar kendilerini
agresif eğilimleri olan ve dürtüselliklerini daha az kontrol edebilen kişiler
olarak düşünürler. Bu çalışmanın amacı OUA ve gündüz uykululuk halinin, şiddet
içeren ya da içermeyen davranışlar üzerine etkilerini araştırmaktır.



Gereç
ve Yöntemler:
Düzce Üniversitesi Tıp Fakültesi
Hastanesi Göğüs Hastalıkları Polikliniğine uyku bozuklukları nedeniyle başvuran
150 kişi çalışmaya dâhil edildi. Tüm hastalara polisomnografi (PSG) yapıldı.
Tüm diğer testler [Beck depresyon ölçeği (BDÖ), Beck anksiyete ölçeği (BAÖ),
Epworth uykululuk skalası (EUS) ve Şiddet içeren ve içermeyen suç davranışları
ölçeği (ŞİSDÖ)]  katılımcılarla yüz yüze
görüşme ile yapıldı.



Bulgular:
Bu çalışmada OUA hastalarında ŞİSDÖ ile apne-hipopne
indeksi (AHI) arasında anlamlı bir ilişki saptanmadı. OUA’li hastalarda toplam
ŞİSDÖ skoru ile EUS arasında anlamlı bir ilişki bulundu (r=0,267 p=0,003). EUS
ile BDÖ skoru (r=0,314 p <0,001) ve BAÖ skalası skoru (r=0,319 p <0,001)
arasında anlamlı bir ilişki vardı.



Sonuç:
AHI ile şiddet içeren ve şiddet içermeyen davranışlar arasında bir ilişki
yoktu. Bununla birlikte ESS ile BDÖ, BAÖ, ŞİSDÖ arasında anlamlı bir ilişki
vardı. Uyku ve şiddet davranışlarının ortak nörofizyolojik bir mekanizması olabilir. Çalışmamız
gündüz uykululuk halinin artmasıyla şiddet eğiliminin arttığını göstermiştir.
Uyku
problemleri ile şiddet davranışlarının arasındaki ilişkiyi araştırmak için
ileri çalışmalara ihtiyaç vardır.

Kaynakça

  • 1. Knechtle B, Economou NT, Nikolaidis PT, Velentza L, Kallianos A, Steiropoulos P et al. Clinical Characteristics of Obstructive Sleep Apnea in Psychiatric Disease. J Clin Med. 2019; 8(4). pii: E534. doi: 10.3390/jcm8040534
  • 2. Pack AI. Advances in sleep-disordered breathing. Am J Respir Crit Care Med. 2006; 73(1): 7-15.
  • 3. Randerath W, Bonsignore MR, Herkenrath. Obstructive sleep apnoea in acute coronary syndrome European Respiratory Review. 2019; 28(153). pii: 180114. doi: 10.1183/16000617.0114-2018.
  • 4. Güleç H, Topaloğlu M, Ünsal D, Altıntaş M. Violence as a Vicious Cycle. Current Approaches in Psychiatry. 2012; 4(1): 112-37.
  • 5. Farrington DP. Early prediction of violent and nonviolent youthful offending. European Journal on Criminal Policy and Research. 2012; 5(2): 51-66.
  • 6. MacDonald JM, Haviland A, Morral A R. Assessing the relationship between violent and non-violent criminal activity among serious adolescent. Journal of Research in Crime and Delinquency. 2009; 46(4): 553-80.
  • 7. Tzoumakis S, Lussier P, Blanc, M L, Davies G. Onset, offending trajectories, and crime spe-cialization in violence. Youth Violence and Juvenile Justice. 2013; 11(2): 143-64.
  • 8. Koçak M, Batıgün Durak A. Turkish adaptation of Non-violent and violent offending behavior scale. Journal of Clinical Psychology Research. 2017; 1(1): 1-11.
  • 9. Ağan K, Özmerdivenli R, Değirmenci Y, Çağlar M, Başbuğ A, Güleç Balbay E et al. Evaluation of sleep in women with menopause: results of the Pittsburg sleep quality index and polysomnography. J Turk Ger Gynecol Assoc. 2015; 16(3): 149-52.
  • 10. Thornton AJ, Graham-Kevan N, Archer J. Development and confirmatory factor analysis of the Non-violent and Violent Offending Behaviour Scale (NVOBS). Aggressive Behaviour. 2013; 39(3): 171-81.
  • 11. Beck AT. An inventory for measuring depression. Arch Gen Psychiatry. 1961; 4: 561-71.
  • 12. Hisli N. Beck depresyon envanterinin üniversite öğrencileri için geçerliliği ve güvenirliliği. Türk Psikoloji Dergisi. 1988; 6(23): 3-13.
  • 13. Beck AT, Epstein N, Brown G. An inventory for measuring clinical anxiety: Psychometric properties. J Consult Clin Psychol. 1988; 56(6): 893-7.
  • 14. Ulusoy M, Şahin N, Erkmen H. Turkish version of The Beck Anxiety Inventory: psychometric properties. J Cogn Psychother. 1998; 12(2): 28-35.
  • 15. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991; 14(6): 540-5.
  • 16. Agargün MY, Cilli AS, Kara H, Bilici M, Telcioğlu M, Semiz UB et al. Validity and Reliability of the Epworth Sleepiness Scale. Turkish Journal of Psychiatry. 1999; 10(4): 261-7.
  • 17. Oğuztürk O, Ekici M, Cimen D, Ekici A, Senturk E. Attention deficit/hyperactivity disorder in adults with sleep apnea. J Clin Psychol Med Settings. 2013; 20(2): 234-9.
  • 18. Cai SJ, Chen R, Zhang YL, Xiong KP, Lian YX, Li J et al. Correlation of Epworth Sleepiness Scale with multiple sleep latency test and its diagnostic accuracy in assessing excessive daytime sleepiness in patients with obstructive sleep apnea hypopnea syndrome. Chin Med J. 2013; 126(17): 3245-50.
  • 19. Güleç Balbay E, Balbay Ö, Annakkaya AN, Suner K, Yuksel H, Tunç M et al. Obstructive sleep apnoea syndrome in patients with primary open-angle glaucoma. Hong Kong Med J. 2014; 20(5): 379-85.
  • 20. Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American academy of sleep medicine clinical practice guideline. J Clin Sleep Med. 2017; 13(3): 479-504.
  • 21. Babar E. Uyanma işlergeleri, uyku ve beynin elektriksel etkinliği. Ganong WF editör. Türk Fizyolojik Bilimler Derneği Tıbbi Fizyoloji. Ankara: Nobel Tıp Kitabevleri; 2002. s. 739-43.
  • 22. Demiralp T. Beynin etkinlik durumları, uyku, beyin dalgaları, epilepsi, psikozlar. Guyton AC editör. Tıbbi Fizyoloji. İstanbul: Merck Yayıncılık; 2001. s. 689-91.
  • 23. Aydın H, Özgen F. Sleep studies in psychiatric disorders. Turkish Journal of Clinical Psychiatry. 1998; 2(2): 89-97.
  • 24. McBurnett K, Lahey B B, Rathouz P J, Loeber R. Low salivary cortisol and persistent aggression in boys referred for disruptive behavior. Arch Gen Psychiatry. 2000; 57(1): 38-43.
  • 25. Yang Y, Raine A. Prefrontal structural and functional brain imaging findings in antisocial, violent and psychopathic individuals: a meta-analysis. Psychiatry Res. 2009; 174(2): 81-8.
  • 26. Meijers J, Harte J M, Scherder F S. Disturbed sleep as a risk factor for aggression in prisoners with a psychotic illness: a brief report. Psychology Crime and Law. 2015; 21(10): 968-72.
  • 27. Kamphuis J, Dijk D J, Spreen M, Lancel M. The relation between poor sleep, impulsivity and aggression in forensic psychiatric patients. Physiol Behav. 2014; 123(1): 168-73.
  • 28. Ireland JL, Culpin V. The relationship between sleeping problems and aggression, anger, and impulsivity in a population of juvenile and young offenders. J Adolesc Health. 2006; 38(6): 649-55.
  • 29. Akerstedt T. Psychosocial stress and impaired sleep. Scand J Work Environ Health. 2006; 32(6): 493-501.
  • 30. Adrian Raine A, Venables PH. Adolescent daytime sleepiness as a risk factor for adult crime. Journal of Child Psychology and Psychiatry. 2017; 58(6): 728-35.
  • 31. Nofzinger EA, Thase ME, Reynolds CF, Himmelhoch JM, Mallinger A, Houck P, et al. Hypersomnia in bipolar depression: a comparison with narcolepsy using the multiple sleep latency test. Am J Psychiatry. 1991; 148(9): 1177–81.
  • 32. Vgontzas AN, Bixler EO, Kales A, Criley C, Vela-Bueno A. Differences in nocturnal and daytime sleep between primary and psychiatric hypersomnia: diagnostic and treatment implications. Psychosom Med. 2000; 62(2): 220-6.
  • 33. Bixler EO, Vgontzas AN, Lin HM, Calhoun SL, Vela-Bueno A, Kales A. Excessive daytime sleepiness in a general population sample: the role of sleep apnea, age, obesity, diabetes, and depression. J Clin Endocrinol Metab. 2005; 90(8): 4510-5.
  • 34. Dauvilliers Y, Lopez R, Ohayon M, Bayard S. Hypersomnia and depressive symptoms: methodological and clinical aspects. BMC Med. 2013; 11: 78. doi:10.1186/1741-7015-11-78
  • 35. Vashum KP, Basta M, Lin HM, Pejovic S, Sarrigiannidis A, Bixler E, et al. Lack of regular exercise, depression, and degree of apnea are predictors of excessive daytime sleepiness in patients with sleep apnea: sex differences. J Clin Sleep Med. 2008; 4(1): 19-25.
  • 36. Plante DT, Finn LA, Hagen EW, Mignot E, Peppard PE. Longitudinal associations of hypersomnolence and depression in the Wisconsin sleep cohort study. J Affect Disord. 2017; 207(1): 197-202.
  • 37. Fernandez-Mendoza J, Vgontzas AN, Kritikou I, Calhoun SL, Liao D, Bixler EO. Natural history of excessive daytime sleepiness: role of obesity, weight loss, depression, and sleep propensity. Sleep. 2015; 38(3): 351-60.
  • 38. Hambrick EP, Rubens SL, Brawner TW, Taussig HT. Do sleep problems mediate the link between adverse childhood experiences and delinquency in preadolescent children in foster care? J Child Psychol Psychiatry. 2018; 59(2): 140-9.

The Effect of Obstructive Sleep Apnea on Violent and Non-violent Behavior

Yıl 2020, Cilt: 10 Sayı: 1, 22 - 28, 31.01.2020
https://doi.org/10.33631/duzcesbed.655994

Öz

Aim: Obstructive
sleep apnea (OSA) characterized by repetitive collapse of the upper airway
during sleep and this condition leading to oxygen desaturation, sympathetic
activation, and recurrent arousals. Patients who experience sleep problems
consider themselves, less able to control impulsive, aggressive tendencies. The
aim of this study was to investigate the effect of OSA and daytime sleepiness
on violent and non-violent behaviors.



Material and Methods: Hundred fifty individuals who were admitted to the Chest Disease
Polyclinic for Sleep Disorders of Duzce University, School of Medicine Hospital
were included in the study. All patients underwent polysomnography (PSG). All
tests [Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Epworth
Sleepiness Scale (ESS) and Nonviolent and Violent Offending Behavior Scale
(NVOBS)] were applied to all participants by face to face interview.



Results: In this
study, no significant relationship was found between NVOBS and AHI in OSA
patients. Patients with OSA; There was a significant relationship between total
score of NVOBS and ESS (r=0.267 p=0.003). There was a significant relationship
between the ESS score and the BDI score (r=0.314 p <0.001) and BDI scale
(r=0.319 p <0.001) scores.



Conclusions: There
was no significant relationship between violent and non-violent behaviors and
AHI. However, there was a significant relationship between ESS and BDI, BAI and
NVOBS. There may be common neurophysiological activation mechanisms of sleep
and violence action. Today, violent behavior and sleep problems increase and
further research is needed to investigate the relationship between sleep
problems and violent behavior.

Kaynakça

  • 1. Knechtle B, Economou NT, Nikolaidis PT, Velentza L, Kallianos A, Steiropoulos P et al. Clinical Characteristics of Obstructive Sleep Apnea in Psychiatric Disease. J Clin Med. 2019; 8(4). pii: E534. doi: 10.3390/jcm8040534
  • 2. Pack AI. Advances in sleep-disordered breathing. Am J Respir Crit Care Med. 2006; 73(1): 7-15.
  • 3. Randerath W, Bonsignore MR, Herkenrath. Obstructive sleep apnoea in acute coronary syndrome European Respiratory Review. 2019; 28(153). pii: 180114. doi: 10.1183/16000617.0114-2018.
  • 4. Güleç H, Topaloğlu M, Ünsal D, Altıntaş M. Violence as a Vicious Cycle. Current Approaches in Psychiatry. 2012; 4(1): 112-37.
  • 5. Farrington DP. Early prediction of violent and nonviolent youthful offending. European Journal on Criminal Policy and Research. 2012; 5(2): 51-66.
  • 6. MacDonald JM, Haviland A, Morral A R. Assessing the relationship between violent and non-violent criminal activity among serious adolescent. Journal of Research in Crime and Delinquency. 2009; 46(4): 553-80.
  • 7. Tzoumakis S, Lussier P, Blanc, M L, Davies G. Onset, offending trajectories, and crime spe-cialization in violence. Youth Violence and Juvenile Justice. 2013; 11(2): 143-64.
  • 8. Koçak M, Batıgün Durak A. Turkish adaptation of Non-violent and violent offending behavior scale. Journal of Clinical Psychology Research. 2017; 1(1): 1-11.
  • 9. Ağan K, Özmerdivenli R, Değirmenci Y, Çağlar M, Başbuğ A, Güleç Balbay E et al. Evaluation of sleep in women with menopause: results of the Pittsburg sleep quality index and polysomnography. J Turk Ger Gynecol Assoc. 2015; 16(3): 149-52.
  • 10. Thornton AJ, Graham-Kevan N, Archer J. Development and confirmatory factor analysis of the Non-violent and Violent Offending Behaviour Scale (NVOBS). Aggressive Behaviour. 2013; 39(3): 171-81.
  • 11. Beck AT. An inventory for measuring depression. Arch Gen Psychiatry. 1961; 4: 561-71.
  • 12. Hisli N. Beck depresyon envanterinin üniversite öğrencileri için geçerliliği ve güvenirliliği. Türk Psikoloji Dergisi. 1988; 6(23): 3-13.
  • 13. Beck AT, Epstein N, Brown G. An inventory for measuring clinical anxiety: Psychometric properties. J Consult Clin Psychol. 1988; 56(6): 893-7.
  • 14. Ulusoy M, Şahin N, Erkmen H. Turkish version of The Beck Anxiety Inventory: psychometric properties. J Cogn Psychother. 1998; 12(2): 28-35.
  • 15. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991; 14(6): 540-5.
  • 16. Agargün MY, Cilli AS, Kara H, Bilici M, Telcioğlu M, Semiz UB et al. Validity and Reliability of the Epworth Sleepiness Scale. Turkish Journal of Psychiatry. 1999; 10(4): 261-7.
  • 17. Oğuztürk O, Ekici M, Cimen D, Ekici A, Senturk E. Attention deficit/hyperactivity disorder in adults with sleep apnea. J Clin Psychol Med Settings. 2013; 20(2): 234-9.
  • 18. Cai SJ, Chen R, Zhang YL, Xiong KP, Lian YX, Li J et al. Correlation of Epworth Sleepiness Scale with multiple sleep latency test and its diagnostic accuracy in assessing excessive daytime sleepiness in patients with obstructive sleep apnea hypopnea syndrome. Chin Med J. 2013; 126(17): 3245-50.
  • 19. Güleç Balbay E, Balbay Ö, Annakkaya AN, Suner K, Yuksel H, Tunç M et al. Obstructive sleep apnoea syndrome in patients with primary open-angle glaucoma. Hong Kong Med J. 2014; 20(5): 379-85.
  • 20. Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American academy of sleep medicine clinical practice guideline. J Clin Sleep Med. 2017; 13(3): 479-504.
  • 21. Babar E. Uyanma işlergeleri, uyku ve beynin elektriksel etkinliği. Ganong WF editör. Türk Fizyolojik Bilimler Derneği Tıbbi Fizyoloji. Ankara: Nobel Tıp Kitabevleri; 2002. s. 739-43.
  • 22. Demiralp T. Beynin etkinlik durumları, uyku, beyin dalgaları, epilepsi, psikozlar. Guyton AC editör. Tıbbi Fizyoloji. İstanbul: Merck Yayıncılık; 2001. s. 689-91.
  • 23. Aydın H, Özgen F. Sleep studies in psychiatric disorders. Turkish Journal of Clinical Psychiatry. 1998; 2(2): 89-97.
  • 24. McBurnett K, Lahey B B, Rathouz P J, Loeber R. Low salivary cortisol and persistent aggression in boys referred for disruptive behavior. Arch Gen Psychiatry. 2000; 57(1): 38-43.
  • 25. Yang Y, Raine A. Prefrontal structural and functional brain imaging findings in antisocial, violent and psychopathic individuals: a meta-analysis. Psychiatry Res. 2009; 174(2): 81-8.
  • 26. Meijers J, Harte J M, Scherder F S. Disturbed sleep as a risk factor for aggression in prisoners with a psychotic illness: a brief report. Psychology Crime and Law. 2015; 21(10): 968-72.
  • 27. Kamphuis J, Dijk D J, Spreen M, Lancel M. The relation between poor sleep, impulsivity and aggression in forensic psychiatric patients. Physiol Behav. 2014; 123(1): 168-73.
  • 28. Ireland JL, Culpin V. The relationship between sleeping problems and aggression, anger, and impulsivity in a population of juvenile and young offenders. J Adolesc Health. 2006; 38(6): 649-55.
  • 29. Akerstedt T. Psychosocial stress and impaired sleep. Scand J Work Environ Health. 2006; 32(6): 493-501.
  • 30. Adrian Raine A, Venables PH. Adolescent daytime sleepiness as a risk factor for adult crime. Journal of Child Psychology and Psychiatry. 2017; 58(6): 728-35.
  • 31. Nofzinger EA, Thase ME, Reynolds CF, Himmelhoch JM, Mallinger A, Houck P, et al. Hypersomnia in bipolar depression: a comparison with narcolepsy using the multiple sleep latency test. Am J Psychiatry. 1991; 148(9): 1177–81.
  • 32. Vgontzas AN, Bixler EO, Kales A, Criley C, Vela-Bueno A. Differences in nocturnal and daytime sleep between primary and psychiatric hypersomnia: diagnostic and treatment implications. Psychosom Med. 2000; 62(2): 220-6.
  • 33. Bixler EO, Vgontzas AN, Lin HM, Calhoun SL, Vela-Bueno A, Kales A. Excessive daytime sleepiness in a general population sample: the role of sleep apnea, age, obesity, diabetes, and depression. J Clin Endocrinol Metab. 2005; 90(8): 4510-5.
  • 34. Dauvilliers Y, Lopez R, Ohayon M, Bayard S. Hypersomnia and depressive symptoms: methodological and clinical aspects. BMC Med. 2013; 11: 78. doi:10.1186/1741-7015-11-78
  • 35. Vashum KP, Basta M, Lin HM, Pejovic S, Sarrigiannidis A, Bixler E, et al. Lack of regular exercise, depression, and degree of apnea are predictors of excessive daytime sleepiness in patients with sleep apnea: sex differences. J Clin Sleep Med. 2008; 4(1): 19-25.
  • 36. Plante DT, Finn LA, Hagen EW, Mignot E, Peppard PE. Longitudinal associations of hypersomnolence and depression in the Wisconsin sleep cohort study. J Affect Disord. 2017; 207(1): 197-202.
  • 37. Fernandez-Mendoza J, Vgontzas AN, Kritikou I, Calhoun SL, Liao D, Bixler EO. Natural history of excessive daytime sleepiness: role of obesity, weight loss, depression, and sleep propensity. Sleep. 2015; 38(3): 351-60.
  • 38. Hambrick EP, Rubens SL, Brawner TW, Taussig HT. Do sleep problems mediate the link between adverse childhood experiences and delinquency in preadolescent children in foster care? J Child Psychol Psychiatry. 2018; 59(2): 140-9.
Toplam 38 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Araştırma Makaleleri
Yazarlar

Pınar Yıldız Gülhan 0000-0002-5347-2365

Mehmet Fatih Elverişli 0000-0002-5103-4089

Şengül Cangür 0000-0002-0732-8952

Ege Güleç Balbay 0000-0002-1557-7019

Bora Büken 0000-0003-2768-5946

Yayımlanma Tarihi 31 Ocak 2020
Gönderilme Tarihi 6 Aralık 2019
Yayımlandığı Sayı Yıl 2020 Cilt: 10 Sayı: 1

Kaynak Göster

APA Yıldız Gülhan, P., Elverişli, M. F., Cangür, Ş., Güleç Balbay, E., vd. (2020). The Effect of Obstructive Sleep Apnea on Violent and Non-violent Behavior. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi, 10(1), 22-28. https://doi.org/10.33631/duzcesbed.655994
AMA Yıldız Gülhan P, Elverişli MF, Cangür Ş, Güleç Balbay E, Büken B. The Effect of Obstructive Sleep Apnea on Violent and Non-violent Behavior. DÜ Sağlık Bil Enst Derg. Ocak 2020;10(1):22-28. doi:10.33631/duzcesbed.655994
Chicago Yıldız Gülhan, Pınar, Mehmet Fatih Elverişli, Şengül Cangür, Ege Güleç Balbay, ve Bora Büken. “The Effect of Obstructive Sleep Apnea on Violent and Non-Violent Behavior”. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi 10, sy. 1 (Ocak 2020): 22-28. https://doi.org/10.33631/duzcesbed.655994.
EndNote Yıldız Gülhan P, Elverişli MF, Cangür Ş, Güleç Balbay E, Büken B (01 Ocak 2020) The Effect of Obstructive Sleep Apnea on Violent and Non-violent Behavior. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi 10 1 22–28.
IEEE P. Yıldız Gülhan, M. F. Elverişli, Ş. Cangür, E. Güleç Balbay, ve B. Büken, “The Effect of Obstructive Sleep Apnea on Violent and Non-violent Behavior”, DÜ Sağlık Bil Enst Derg, c. 10, sy. 1, ss. 22–28, 2020, doi: 10.33631/duzcesbed.655994.
ISNAD Yıldız Gülhan, Pınar vd. “The Effect of Obstructive Sleep Apnea on Violent and Non-Violent Behavior”. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi 10/1 (Ocak 2020), 22-28. https://doi.org/10.33631/duzcesbed.655994.
JAMA Yıldız Gülhan P, Elverişli MF, Cangür Ş, Güleç Balbay E, Büken B. The Effect of Obstructive Sleep Apnea on Violent and Non-violent Behavior. DÜ Sağlık Bil Enst Derg. 2020;10:22–28.
MLA Yıldız Gülhan, Pınar vd. “The Effect of Obstructive Sleep Apnea on Violent and Non-Violent Behavior”. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi, c. 10, sy. 1, 2020, ss. 22-28, doi:10.33631/duzcesbed.655994.
Vancouver Yıldız Gülhan P, Elverişli MF, Cangür Ş, Güleç Balbay E, Büken B. The Effect of Obstructive Sleep Apnea on Violent and Non-violent Behavior. DÜ Sağlık Bil Enst Derg. 2020;10(1):22-8.