Tesis

Hubungan Beban Antikolinergik dengan Kejadian Insomnia pada Pasien Geriatri Rawat Jalan = The Relationship between Anticholinergic Burden and Insomnia Incidence in Outpatient Geriatric Patients.

Latar Belakang : Usila rentan mengalami insomnia akibat perubahan fisiologis dan penggunaan banyak obat dengan efek antikolinergik. Penggunaan beberapa obat antikolinergik pada geriatri menyebabkan adanya akumulasi efek yang disebut beban antikolinergik. Beban antikolinergik yang tinggi berpotensi menyebabkan terjadinya insomnia. Hubungan antara beban antikolinergik dengan kejadian insomnia pada pasien geriatri rawat jalan belum pernah diteliti di Indonesia. Tujuan : Penelitian ini bertujuan untuk mengetahui hubungan antara beban antikolinergik terhadap kejadian insomnia pada pasien geriatri rawat jalan. Metode : Penelitian ini merupakan studi cross sectional yang merupakan bagian dari pohon penelitian sebelumnya. Subjek penelitian diambil dengan metode consecutive sampling dengan menggunakan data sekunder dari rekam medis pasien geriatri di poliklinik yang memenuhi kriteria inklusi dan tidak memenuhi kriteria ekslusi. Peneliti mengambil data karakteristik dasar, komorbiditas dan data obat-obatan dari data sekunder rekam medis. Beban antikolinergik diukur dengan Anticholinergic Cognitive Burden (ACB) Scale, sedangkan tingkat insomnia diukur menggunakan kuesioner Insomnia Severity Index versi Indonesia (ISI-INA). Analisis data menggunakan uji Chi-Square dan multivariat analisis untuk mengontrol variabel perancu. Hasil : Dari total subjek sebanyak 190 orang didapatkan median usia 74 tahun, usia terbanyak ≥70 tahun 77,37%, dengan 65,79% perempuan. Obat antikolinergik yang sering digunakan lansoprazol, metformin dan sertralin. Total skor ACB dari masingmasing subjek penelitian didapatkan pada rentang 0-9, dengan skor ACB rata-rata 1,44. Proporsi penggunaan obat antikolinergik 66,32%, dengan beban antikolinergik potensi tinggi 34,21%. Pada analisa bivariat ditemukan hubungan yang tidak bermakna antara insomnia dengan beban antikolinergik (p = 0,551) sebaliknya ditemukan hubungan yang bermakna antara insomnia dengan beberapa variabel perancu (status kognitif, status fungsional, multimorbiditas, status nutrisi, dan status depresi). Berdasarkan hasil analisa multivariat menunjukkan bahwa beban antikolinergik tidak berhubungan signifikan dengan insomnia setelah dikontrol variabel perancu (adjusted PR=0,853; IK95%=0,623- 1,168). Simpulan : Proporsi pemakaian obat antikolinergik pada pasien geriatri yang berobat jalan dipoliklinik 66,32%. Beban antikolinergik tidak memiliki hubungan yang bermakna dengan kejadian insomnia.
Kata Kunci : Beban antikolinergik, Insomnia, Geriatri, Skor ACB


Background : Elderly people are prone to insomnia due to physiological changes and the use of many drugs with anticholinergic effects. The use of several anticholinergic drugs in geriatrics causes an accumulation of effects called anticholinergic burden. High anticholinergic burden has the potential to cause insomnia. The relationship between anticholinergic burden and the incidence of insomnia has never been studied in geriatric outpatients in Indonesia. Objective : This study aims to determine the relationship between anticholinergic burden and the incidence of insomnia in geriatric outpatients. Methods : This study is a cross-sectional study that is part of a previous research tree. The research subjects were selected using consecutive sampling with secondary data from the medical records of geriatric patients at the polyclinic who met the inclusion criteria and did not meet the exclusion criteria. The researchers collected basic characteristics, comorbidities, and medication data from secondary medical records. Anticholinergic burden was measured using the Anticholinergic Cognitive Burden (ACB) Scale, while insomnia levels were measured using the Indonesian version of the Insomnia Severity Index (ISI-INA) questionnaire. Data analysis was performed using Chi-Square and multivariate analysis to control for confounding variables. Result : Of the total 190 subjects, the median age was 74 years, with 77.37% aged ≥70 years and 65.79% female. The anticholinergic drugs commonly used were lansoprazole, metformin, and sertraline. The total ACB score for each research subject was in the range of 0-9, with an average ACB score of 1.44. The proportion of anticholinergic drug use was 66.32%, with a high potential anticholinergic burden of 34.21%. In the bivariate analysis, no significant relationship was found between insomnia and anticholinergic burden (p = 0.551). Conversely, a significant relationship was found between insomnia and several confounding variables, such as cognitive status, functional status, multimorbidity, nutritional status, and depression status. Based on the results of multivariate analysis, anticholinergic burden was not significantly associated with insomnia after controlling for confounding variables (adjusted PR=0.853; 95% CI=0.623- 1.168). Conclusion : The proportion of anticholinergic drug use among geriatric outpatients at the clinic was 66.32%. Anticholinergic burden did not have a significant association with the occurrence of insomnia.
Keywords : Anticholinergic burden, Insomnia, Geriatric, ACB Score