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Ağrısız Dokunsal Uyaranlar Ve Uyku Non-Painful Tactile Stimuli and Sleep

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Ağrısız Dokunsal Uyaranlar Ve Uyku Non-Painful Tactile Stimuli and Sleep Özgün Makale / Original Article DO I: 10.4274/jtsm.02 Türk Uyku Tıbbi Dergisi 2014;1:9-15 Journal of Turkish Sleep Medicine 2014;1:9-15 Ağrısız Dokunsal Uyaranlar ve Uyku Non-Painful Tactile Stimuli and Sleep Gonca İnanç, Murat Özgören*, Adile Öniz* Dokuz Eylül Üniversitesi Tıp Fakültesi, Biyofizik Anabilim Dalı, İzmir, Türkiye *Dokuz Eylül Üniversitesi Tıp Fakültesi, Biyofizik Anabilim Dalı, Uyku ve Bilinç Durumları Teknolojisi Uygulama ve Araştırma Merkezi, İzmir, Türkiye Özet Summary Giriş: Çalışmanın amacı uyku sırasında uygulanan ağrısız dokunsal Introduction: The aim of this study is to examine electrophysiological uyaranlara karşı beyinde oluşan elektrofizyolojik yanıtları incelemektir. responses in the brain to painless somatosensory stimulation during sleep. Gereç ve Yöntem: Çalışmaya 15 sağlıklı gönüllü birey (8 kadın, yaş Materials and Methods: Fifteen healthy volunteers (8 female, with mean ortalamaları: 22,13±1,41) katılmıştır. Kayıtlar, NuAmps 40 kanallı kayıt age: 22.13±1.41) participated in the study. Recordings were carried out sistemi, pnömatik uyarıcı ünitesi (Somatosensory Stimulus Generator 4-D using NuAmps 40 channeled recording system, pneumatic stimulation Neuroimaging), Embedded Microcontroller Stimulation Unit (EMISU), unit (Somatosensory Stimulus Generator 4-D Neuroimaging), Embedded video kayıt sistemi ve analiz bilgisayarı gibi ek teknik donanım kullanılarak Microcontroller Stimulation Unit (EMISU), and additional equipment such gerçekleştirilmiştir. Sabit basınçta (140 kPa) ağrısız uyaranlar sağ el işaret as video recording system and analysis computer. Painless air pressure ve orta parmaklarına uygulanmıştır. Parmaklardan birine seyrek uyaran stimulation was applied at constant pressure rate to the fore and middle olarak uygulama yapılmıştır (%25). Sürekli elektroensefalografi (EEG), fingers of the right hand. Infrequent oddball stimulation was applied to elektrookülografi (EOG), elektromiyografi (EMG) kayıtları Amerikan Uyku one of the fingers (%25 of the time). Continuous electroencephalography Tıbbı Akademisi (AASM) kurallarına göre uyku evrelerine ayrılmıştır. (EEG), electrooculography (EOG) and electromyography (EMG) Somatosensoriyel öncelikli alanlar olarak C3 ve C4 elektrotlarında meydana recordings were sorted into sleep phases according to the guidelines set gelen yanıtlar incelenmiştir. İstatistiksel analizlerde bağımlı gruplarda t by the American Academy of Sleep Medicine (AASM). Responses recorded testi kullanılmıştır. from the C3 and C4 electrodes were examined as somatosensory regions Bulgular: Yüzeyel ve derin uykuda hem seyrek hem de sık uygulanan of priority. Paired samples T-tests were used for statistical analysis. uyaranlara karşı N100, P200, N300, P450, N550, P900 ve Ngeç dalga Results: N100, P200, N300, P450, N550, P900 Nlate wave forms were formları açıkça gözlenmiştir. Sağ elde, her iki uyarana karşı elde edilen clearly observed for both frequent and infrequent stimuli in light and deep yanıtlar birbirine benzer olarak bulunmuştur. sleep. Responses to both target and non-target stimuli on the right hand Sonuç: Uykuda beyin yanıtlılığı sürmekte ancak elektrofizyolojik were found to be similar to each other. yanıt paterni değişiklik göstermektedir. Ayrıca, uykuda yönlendirilmiş Discussion: Brain responsiveness continues in sleep; however dikkat, uyaran ayırt etme, çalışan bellek gibi süreçlerin istemli olarak electrophysiological response pattern can vary. Furthermore as processes kullanılamaması her iki uyarana karşı olan yanıtın birbirine benzer olmasına such as directed attention, stimulus discrimination and working memory neden olmaktadır. (JTSM 2014;1:9-15) cannot be voluntarily employed during sleep; responses to both kinds of stimuli are similar to one another. (JTSM 2014;1:9-15) Anah tar Ke li me ler: Uyku, elektroensefalografi, dokunsal olay ilişkili potansiyel, elektrofizyoloji Key Words: Sleep, electroencephalography, somatosensory event related potential, electrophysiology Ya z›fl ma Ad re si/ Ad dress for Cor res pon den ce: Dr. Adile Öniz, Dokuz Eylül Üniversitesi Tıp Fakültesi, Biyofizik Anabilim Dalı, Uyku ve Bilinç Durumları Teknolojisi Uygulama ve Araştırma Merkezi, İzmir, Türkiye Tel.: +90 232 412 44 98 E-mail: [email protected] Ge liş Ta ri hi/Re cei ved: 08.12.2013 Ka bul Ta ri hi/Ac cep ted: 16.03.2014 © Tür k Uyku Tıbbi Der gi si, Ga le nos Ya yı ne vi ta ra fın dan ba sıl mış tır./ © Journal of Turkish Sleep Me di ci ne, Pub lis hed by Ga le nos Pub lis hing. 9 İnanç G, ve ark. Ağrısız Dokunsal Uyaranlar ve Uyku Giriş Ölçeği) ve SCL-90R (Belirti Tarama) testleri uygulanmıştır. Herhangi bir nörolojik, psikiyatrik, kronik ve uyku bozukluğu Tarih boyunca uyku ile ilgili çalışmalara rastlamak mümkündür. tanısı alan bireyler çalışmadan dışlanmıştır. Richard Caton’ın tavşan beyninde elektriksel ritimlerin varlığını Katılımcılar elektromanyetik dalga ve sesten yalıtılmış özel bir göstermesinden sonra Hans Berger insan beyninde yaptığı odada uyumuşlardır. Kayıt sırasında oda, katılımcıların bilgisi ve çalışmalar ile uyku ve uyanıklık arasındaki farkları göstermiştir. 1938 yılında Loomis ve ark.’nın yaptıkları çalışmalar ile izni dahilinde kamera ile izlenmiştir. polisomnografinin (PSG) temeli atılmıştır (1). Kayıtlar, NuAmps 40 kanallı kayıt sistemi, gömülü mikrokontrollü PSG ile uykuda meydana gelen fizyolojik, psikolojik, patolojik uyarı ünitesi (Embedded Microcontroller Stimulation Unit- değişiklikleri ve uykunun yapısını araştırmak mümkündür. EMISU), pnömatik uyarıcı ünitesi (Somatosensory Stimulus PSG’de elektroensefalografi (EEG), elektrookülografi (EOG) Generator 4-D Neuroimaging), video kayıt sistemi ve EEG ve elektromiyografi (EMG) uyku evrelerinin belirlenmesinde bonesi, analiz bilgisayarı gibi ek teknik donanım kullanılarak kullanılan temel bileşenlerdir. Bu bileşenlerin dışında solunumsal gerçekleştirilmiştir. Katılımcıların kafalarına uygun büyüklükteki parametreler, kan basıncı, horlama, vücut pozisyonu gibi EEG kepi (Quick Cap, Neuromedical Supplies) kullanılmış ve parametreler ise uyku bozukluklarının tanımlanmasında uluslararası Jasper 10-20 sistemine göre bireylerin kafalarına kullanılmaktadır (2). PSG sistemi ile alınan kayıtlar standart uyku yerleştirilmiştir. Kepte bulunan elektrotlar ile saçlı deri arasındaki skorlama yöntemi ile evrelere ayrılır. Günümüzde uyku evrelerini iletkenliği sağlamak için elektrojel (ECI Electro-Gel, ElectroCap belirlemede Amerikan Uyku Tıbbı Akademisi (AASM, American International, Inc., ABD) kullanılmıştır. EEG elektrotları kulak Academy of Sleep Medicine) kuralları kullanılmaktadır (3). memelerine takılan elektrotlar ile referanslanmıştır [(A1+A2)/2]. Uyanıklık, uyku, koma, anestezi gibi farklı bilinç durumlarında Kayıt sırasında elektrotların empedansları ortalama 5 kOhm beynin kendiliğinden (spontan) gelişen elektriksel etkinlikleri civarında tutulmuştur. Sürekli EEG kaydı 1 kHz’lik örneklem hızı elektroensefalografi ile takip edilebilir. Beynin Etiği kitabında ile alınmıştır. doğum, fetusun 5-6 haftalık döneminde (40-43 gün) beynin Ağrısız dokunsal uyaranlar için pnömatik uyarıcı ünitesi ilk elektriksel aktivitesinin saptanmasıyla tanımlanırken; ölüm (4-D Neuroimaging Somatosensory Stimulus Generator) ise tüm dünyada beynin elektriksel aktivitesinin durması ile kullanılmıştır. Uyaranların uygulanabilmesi için parmağa tanımlanmaktadır (4). Beyin dinamik çalışan ve iç, dış uyaranlarla uyarılabilir bir temas yüzeyinde ortalama 8-9 mm çapında hareketli zar organdır. Beynin işlerliğini anlamak için beş duyuya ait uyaranlarla bulunan klipsler kullanılmıştır. Bu zar katılımcıların sağ el işaret bilişsel işlevleri ölçmeye ait deney desenleri ile elektrofizyolojik ve orta parmak pulpalarına gelecek şekilde yerleştirilmiştir. yanıtlardaki değişim incelenebilir. En sık kullanılan deney desenleri Klipsler izole oda dışında bulunan pnömatik uyarıcı ünitesine, uyarılma potansiyelleri ve olay ilişkili potansiyellerdir. Olay ilişkili ünite ise kuru hava tüpüne bağlıdır. MATLAB programında potansiyellerden en sık kullanılan ise seyrek uyaran deney desenidir hazırlanmış deney desenine göre katılımcılara ağrısız dokunsal (5). Dokunsal uyaranlar ile yapılan çalışmalar daha çok ağrılı uyaranlar uygulanmıştır. Çalışmada seyrek uyaran deney uyaranlar, laser uyaranı veya vibrasyondan oluşmaktadır (6,7). deseni kullanılmıştır. Katılımcılara her bir blokta 120 uyaran Uyanık süreçlerde uygulanarak temel veri gruplarının oluştuğu gönderilmiştir ve blok gece boyunca tekrarlanmıştır. Uyaranlar ve klasik kullanımda olan bu ölçümlerin uyku, anestezi altında ileti yollarının aynı olması nedeniyle el işaret ve orta parmağına beyin, koma vb. farklı bilinç durumlarında kullanılması ile uygulanmıştır. Uyaranların %25’i seyrek uyaran olarak bir beynin bilgi işlemleme araştırmaları son yıllarda hız kazanmıştır. parmağa, %75’i sık uyaran olarak diğer parmağa uygulanmıştır. Uyku sırasında beynin dış dünya ile iletişiminin kesilmediği ve Uyaranlar arası süre (ISI) 3-3,5 saniye olarak seçkisiz şekilde uyanıklıktan farklı olarak işlendiği bilinmektedir (8). Literatürde düzenlenmiştir (Şekil 1). uykuda bilgi işlemleme ile yapılan çalışmalarda genellikle EEG kayıtları kayıt sonrası değerlendirilmiştir. Uyku kayıtlarının uyarılma potansiyelleri ve olay ilişkili potansiyeller kullanılmakta skorlaması uluslararası Amerikan Uyku Tıbbı Akademisi (AASM, ve uyku sırasında uyaranlara verilen beyin yanıtları temel American Academy of Sleep Medicine) kurallarına göre alınarak incelenmektedir. yapılmıştır. Otuz saniyelik zaman dilimleri göz ile tek
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