Uyku Fizyolojisi ve Uykuda Solunum Fizyolojisi
Özet
Uyku, insan yaşamının yaklaşık üçte birini kapsayan, organizmanın fiziksel ve mental sağlık açısından gereksinim duyduğu aktif bir bilinçsizlik durumudur. Uyku-uyanıklık döngüsü sirkadiyen bir pacemaker olan suprakiazmatik nukleus (SKN) tarafından kontrol edilir. Uyanıklık asendan retiküler aktive edici sistem ve glutamat, asetilkolin gibi nörotransmitterlerle sürdürülürken, biriken adenozin ve VLPO aktivasyonu uykuyu başlatır. Uyku temel olarak NREM (%80) ve REM olmak üzere iki ana döngüden oluşur. Uyku evrelerinde büyüme hormonu ve melatonin seviyeleri artış gösterirken, kortizol sirkadiyen ritme bağlı olarak sabaha doğru zirve yapar. Solunum fizyolojisi açısından, hem NREM hem de REM evrelerinde dakika ventilasyonu, oksijen kullanımı ve karbonmonoksit üretimi azalır; ancak ventilasyondaki düşüş daha belirgin olduğundan kandaki oksijen miktarı azalırken karbonmonoksit artar. NREM döneminde solunum daha düzenliyken, REM döneminde üst hava yolu kaslarındaki atoni (gevşeme) nedeniyle solunum iş yükünü diyafragma üstlenir ve tidal volüm ile hipoksi/hiperkapniye verilen solunumsal yanıt en düşük seviyeye iner.
Sleep is an active state of unconsciousness vital for physical and mental health, encompassing approximately one-third of human life. The sleep-wake cycle is regulated circadianly by the suprachiasmatic nucleus (SCN). While wakefulness is maintained through the ascending reticular activating system and neurotransmitters like glutamate, the accumulation of adenosine and the activation of the ventrolateral preoptic nucleus (VLPO) initiate sleep. Sleep consists of two main stages: NREM, which accounts for 80% of total sleep, and REM. During sleep, growth hormone and melatonin levels increase, whereas cortisol levels peak in the morning aligned with the circadian rhythm. Regarding respiratory physiology, minute ventilation decreases during both NREM and REM stages. Since this reduction is more pronounced than the decline in metabolic oxygen consumption and carbon dioxide production, blood oxygen levels decrease while carbon dioxide increases. Breathing is more rhythmic and regular during NREM sleep. Conversely, REM sleep induces muscle atonia in the upper airways, shifting the workload of respiration entirely to the diaphragm, which significantly reduces tidal volume and weakens the ventilatory response to hypoxia and hypercapnia.
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