REFERAT GANGGUAN TIDUR PADA STROKE
Pembimbing: dr. H. Cep Juli, Sp.S
Disusun oleh: Levi Levina na Aud Audre rey y Kusu Kusuma madj djaj ajaa
!"# !"#!$ !$"% "%#$ #$"& "&'( '(
Haris Ca)rasana
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K+PA-+/AA KL--K 0A1-A -L23 P+4AK- SA/A5 /S3D /. S4A2S3D- SH, S3KA0325a)ul6as Kedo)6eran 3niversi6as Ka6oli) -ndonesia A6ma Jaya !"#7
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DAFTAR ISI
Da86 Da86ar ar -si -si .... ...... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .. Da86 Da86ar ar 1amb 1ambar ar .... ...... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .. Da86 Da86ar ar abel bel .... ...... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 0A0 0A0 -: P+D P+DAH AH3L 3L3A 3A .... ...... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... #.#. #.#. La6a La6arr 0ela 0ela)a )ang ng .... ...... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... #.!. #.!. ujua ujuan n Penu Penuli lisan san .... ...... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .. 0A0 --: -JA3 -JA3A A P3S P3SAKA ...... ......... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ... !.#. !.#. 5isio 5isiolo logi gi idur idur .... ...... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .. !.#. !.#.#. #. ahapa hapan n 6idu 6idurr .... ...... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .. !.#. !.#.!. !. Pera Perana nan n neur neuro6 o6ra ransm nsmi6 i66er 6er dal dalam am regu regula lasi si 6idu 6idurr ..... ....... .... .... .... .... .... .... .... .... .... !.#.! !.#.!.# .#.. 1lu6 1lu6am ama6 a6 ... ..... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... !.#. !.#.!. !.!. !. Sero Sero6o 6oni nin n .... ...... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .. !.#. !.#.!. !.9. 9. 2ela 2ela6o 6oni nin n .... ...... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... !.#. !.#.9. 9. /i6m /i6mee sir)ad sir)adia ian n dan 8ungs 8ungsii serebr serebrov ovas) as)ul ular ar ..... ....... .... .... .... .... .... .... .... .... .... .... .... !.#.7. Ascending !.#.7. Ascending Reticular Activating System A/AS( ..................... !.!. !.!. S6ro S6ro)e )e .... ...... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... !.!. !.!.#. #. De8in De8inisi isi .... ...... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .. !.!. !.!.!. !. ipe ipe s6ro s6ro)e )e ..... ....... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .. !.!. !.!.!. !.#. #. S6ro S6ro)e )e is)em is)emi) i) .... ...... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .. !.!.!. !.!.!.!. !. S6ro S6ro)e )e hemo hemorag ragi) i) ..... ....... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... !.!. !.!.!.9 !.9.. Perdar Perdaraha ahan n subara) subara)no noid id ...... ......... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ..... .. !.9. !.9. Hubung Hubungan an an6ara an6ara s6ro)e s6ro)e dan ganggu gangguan an 6idur 6idur ...... ......... ...... ...... ...... ...... ...... ...... ...... ...... ...... ..... !.9. !.9.#. #. 1lu6am 1lu6ama6 a6 .... ...... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... !.9. !.9.!. !. Sero6 Sero6on onin in ..... ....... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... !.9. !.9.9. 9. 2ela6 2ela6on onin in .... ...... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .. !.9.7. !.9.7. Lesi o6a) o6a) pada pada s6ro)e s6ro)e ...... ......... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ... !.7. !.7. Pena6a Pena6ala) la)san sanaan aan ganggu gangguan an 6idur 6idur pada pada s6ro)e s6ro)e ...... ......... ...... ...... ...... ...... ...... ...... ...... ...... ...... ... !.7.#. !.7.#. Pena6ala Pena6ala)sanaan )sanaan umum pada pasien dengan dengan gangguan gangguan 6idur ..... !.7.!. Selective serotonin s erotonin reuptake reuptake inhibitor SS/ SS/-(( .... ...... .... .... .... .... .... .... .... .... .... .... .... !.7.9. !.7.9. Agonis Agonis 1A0A 1A0A .......... ............... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... ..... !.7.7. Agonis Agonis sele)6i8 resep6or re sep6or mela6onin 2 #;2! ..... ...... .... .... .... .... .... .... .... .... ....... ... !.7.&. An6agonis An6agonis resep6or &$H ...... ......... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ..... 0A0 ---: ---: K+S-2P3L K+S-2P3LA A ......... .............. .......... .......... .......... .......... .......... .......... .......... .......... .......... ......... ......... .......... ......... .... DA5A/ DA5A/ P3SAK P3SAKA A ........... ................ .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... ......... ....... ...
ii iv v # # ! 9 9 9 7 7 & ' * * * * * #" ## ## ## #! #! #9 #7 #7 #& #& #% # #' #*
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DAFTAR GAMBAR
1ambar # 1amb 1ambar ar ! 1amb 1ambar ar 9
Posisi suprachiasmatic nucleus nucleus SC SC ( pada pada o6a) o6a) ... ...... ....... ...... .... .... .... .. % ran ransm smisi isi sinap sinap6i 6i) ) pad padaa sin sinap apss glu glu6a 6ama ma6e 6erg rgi) i) e)s e)si6 i6a6o a6ori ri)( )( .... ...... ## S6ru S6ru)6 )6ur ur )im )imia ia mel mela6 a6on onin in dan dan /am /amel el6e 6eon on ... ..... .... .... .... .... .... .... .... .... .... .... .... .... .... #
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DAFTAR TABEL
abel bel #
Pemb Pemberi erian an oba6 oba6 pada pada pend pender eri6 i6aa insom insomni niaa .... ...... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... ..
#&
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#
BAB I PENDAHULUAN
1.1. 1.1. Lata Latarr bela belaka kang ng S6ro)e di)enal sebagai penya)i6 yang menimbul)an disabili6as permanen
yang menyebab)an penderi6a )urang, bah)an 6ida) produ)6i8 lagi. 0erdasar)an da6a da6a dari dari /is)esd /is)esdas as 6ahun 6ahun !"", !"", s6ro)e s6ro)e adalah adalah penye penyebab bab u6ama u6ama )ema6ia )ema6ian n di -ndonesia di a6as usia & 6ahun dan melipu6i #&.*< )ema6ian pada )elompo) usia 7& hing hingga ga &7 6ahun 6ahun,, dan dan !%.' !%.'< < pada pada )elo )elomp mpo) o) usia usia && hing hingga ga %7 6ahun 6ahun.. Prevalensi s6ro)e nasional adalah ".'< dan usia ra6a$ra6a penderi6a adalah &'.& 6ahun.#,! Pada Pada pender penderi6a i6a s6ro)e s6ro)e 6erjadi 6erjadi bebera beberapa pa peruba perubahan han pada pada o6a) o6a) an6ara an6ara lain lain hilang hilangnya nya myelin myelin,, de8isi de8isi66 spesi8i spesi8i) ) pada pada sensor sensori) i) dan mo6or mo6ori), i), ser6a ser6a ganggu gangguan an )ogni6i8 yang )omple)s. 9 S6ro)e juga merubah ri6me sir)ardian dari penderi6a. 7 Peneli6ian pada bidang bio)imia dan )edo)6eran menunju))an bah=a beberapa neuro6 neuro6ran ransmi smi6er 6er o6a), o6a), >on6oh >on6ohny nyaa glu6am glu6ama6, a6, )emung )emung)in )inan an memili) memili)ii perana peranan n signi8i)an pada per)embangan )erusa)an o6a) se6elah episode s6ro)e. & Selain Selain peruba perubahan han pada pada o6a), o6a), sering) sering)ali ali di6emu di6emu)an )an juga juga ganggu gangguan an 6idur 6idur berupa insomnia, hipersomnia, a6au parasomnia. Keluhan berupa insomnia di6emu)an pada &< hingga %'< pasien dengan s6ro)e. & 1angguan 6idur pada penderi6a s6ro)e diper>ayai merupa)an a)iba6 dari 6ingginya )adar glu6ama6 pada o6a).% idur adalah proses a)6i8 yang dimulai dan dimodulasi oleh sua6u sis6em neural )omple)s yang sebagian besar 6erle6a) pada hipo6alamus, ba6ang o6a), dan 6alamus. 2enuru6 peneli6ian pada he=an, )e6i)a 6idur a)an 6erjadi pening)a6an reprodu)si oligodendrosi6 yang memben6u) myelin sehingga memban6u perbai)an dan dan per) per)em emba bang ngan an sel sel o6a) o6a).. Adany Adanyaa
gang ganggu guan an 6idu 6idurr dipe diper>a r>ay yai dapa dapa66
mempengaruhi perjalanan penya)i6, meliba6)an 8ungsi dan )uali6as hidup, ser6a morbidi6as dan mor6ili6as s6ro)e.9 Hing Hingga ga saa6 saa6 ini ini me)a me)ani nism smee gang ganggu guan an 6idu 6idurr pada pada s6ro s6ro)e )e masih masih belu belum m
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1.2. 1.2. T!an !an Pen Penl" l"#a #an n
3n6u) 3n6u) menge6 menge6ahu ahuii dan memaham memahamii 6en6an 6en6ang g ganggu gangguan an 6idur 6idur pada pada s6ro)e s6ro)e melipu6i neuro6ransmi6er dan pa6o8isiologi s6ro)e dan perannya 6erhadap gangguan 6idur, ser6a 6a6ala)sana gangguan 6idur pada pasien s6ro)e.
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9
BAB II TIN$AUAN PUSTAKA
2.1. 2.1. F"#" F"#"%l %l%g %g"" T"&r "&r 2.1.1. Ta'a(an Ta'a(an t"&r
Pada saa6 6idur, susunan sara8 mela)u)an sin)ronisasi dengan neuron subs6an subs6ansia sia re6i)ul re6i)ulari ariss dari dari ba6ang ba6ang o6a), o6a), sedang sedang)an )an pada pada saa6 =aspad =aspada, a, neuron mengada)an de$sin)ronisasi. 0agian dari susunan sara8 pusa6 yang ber8ungsi sin)ronisasi adalah subs6ansia re6i)ularis ven6ralis medula oblo oblong nga6a a6a dan dan dinam dinama) a)an an pusa6 pusa6 6idu 6idurr. 0agi 0agian an yang mela) mela)u) u)an an de$ de$ sin)ronisasi adalah subs6ansia re6i)ularis di bagian ros6ral ba6ang o6a) dan dinama)an arousal centre. centre. Perubahan a)6ivi6as o6a) selama 6idur sesuai dengan 6ahapan 6idur. erdap erdapa6 a6 & 6ahapa 6ahapan n 6idur 6idur.. ahap ahap - hingga hingga -? dinama dinama)an )an non-rapid non-rapid eye moveme movement nt sleep /+2S /+2S(( dan 6ahap ? dinama dinama)an )an rapid eye movement sleep /+2S(. ahap$6ahapnya ahap$6ahapnya adalah sebagai beri)u6:' ahap ahap 6idur per6ama adalah saa6 seseorang mulai 6er6idur. Pada 6ahap ini seluruh o6o6 menjadi lemas, )elopa) ma6a 6er6u6up dan )edua bola ma6a bergera) bola)$bali) )e )anan dan )iri. Pada ele)6roense8alogram 6er liha6 penurunan vol6asi 8re)uensinya. ahap --
dengan gelombang al8a
yang sema)in 6urun
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ahap --Pada 6ahap )e6iga, pada ++1 6ampa) perubahan gelombang dasar dari 9$ % si)lus per de6i) menjadi #$! si)lus per de6i), dan sese)ali diselingi oleh sleep spindles. spindles. ahap -? Di 6ahap )eempa6 ++1 meperliha6)an irama gelombang lamba6 dengan 8re)uensi #$! si)lus per de6i) 6anpa sleep 6anpa sleep spindles. spindles. Pada 6ahap -- hingga -?, 6onus o6o6 hilang seluruhnya. ahap ? Pada 6ahap )elima yang disebu6 /+2S a6au paradoxical a6au paradoxical sleep, sleep, 6onus o6o6 )embali 6inggi, 6eru6ama o6o6 rahang ba=ah, 6ermasu) o6o6 e)s6remi6as dan 6ubuh. Si8a6 6idur di 6ahap ini sanga6 nyenya), 6e6api )edua bola ma6a mulai bergera) )embali dengan )e>epa6an lebih 6inggi. 2impi 6imbul pada 6ahap ini. 0ias 0iasan anya ya,, 6aha 6ahap p /+2S /+2S dan dan /+2 /+2S S berg bergan an6i 6ian an 7 hing hingga ga % )ali )ali.. 0ila 0ila seseora seseorang ng )urang )urang >u)up >u)up 6ahap 6ahap /+2S, /+2S, ma)a ma)a a)an a)an >ender >enderung ung hipera) hipera)6i8, 6i8, )urang dapa6 mengendali)an diri dan emosi, ser6a napsu ma)an ber6ambah. e6api bila )e)urangan 6ahap /+2S ma)a a)an merasa )urang ber6enaga. Saa6 Saa6 ini ini sud sudah di)e6 i)e6ah ahu ui bah= bah=aa /+2S /+2S dia6u ia6urr oleh leh me)an e)anis ism me sero6oninergi) dan /+2S oleh me)anisme adrenergi). '
2.1.2. Peranan ner%tran#)"tter ner%tran#)"tter &ala) regla#" t"&r 2.1. 2.1.*. *.1. 1. Glt Glta) a)at at
3mumnya 3mumnya neuro6ransm neuro6ransmi66er i66er yang berperan pada sis6em sara8
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ormalnya )adar glu6ama6 dia6ur oleh glutamate oxaloacetate mengurangi )adar glu6ama6 glu6ama6 apabila apabila transaminase (GOT), yang mengurangi berlebih.## 1lu6am 1lu6ama6 a6 berhub berhubung ungan an dengan dengan penye penyesuai suaian an harian harian ri6me ri6me sir)adian di SC. 2edia6or primer dari respon in8ormasi >ahaya di re6ina adalah neuro6ransmi6er glu6ama6ergi). Pada malam hari, sedi)i6 >ah >ahaya aya
>u)u >u)up p
un6u n6u)
meny enyebab ebab)a )an n
peny penyes esu uaian aian
8ase 8ase
le=a le=a66
pening)a6an 8or8orilase pro6ein dan a)6ivasi 6rans)ripsi. e6api e6api penyesuaian ini a)an 6erhamba6 bila ada de8isiensi gen Per#.#!
2.1. 2.1.*. *.2. 2. Ser% Ser%t% t%n" n"n n
Sero Sero6o 6oni nin n
&$h &$hy ydro@ dro@y y6ry 6ryp6am p6amin inee
a6au a6au
&$H &$H((
adal adalah ah
neuro6ransm neuro6ransmi66er i66er yang pen6ing dalam memodulasi memodulasi beberapa beberapa 8ungsi 8ungsi 8isiol 8isiologi ogiss dan si)ap si)ap seper6i seper6i regula regulasi si mood, mood, 6idur, 6idur, bangu bangun, n, )ognis )ognisi, i, si)a si)ap p se)s se)sua ual, l, dan dan naps napsu u ma)a ma)an. n. 1ang 1anggu guan an a6au a6au peru peruba baha han n neur neuro6 o6ra ransm nsmis isii &$H &$H 6erl 6erlib iba6 a6 dalam dalam geja gejala la depr depres esii dan dan ansi ansie6a e6as, s, 6ermasu) )elainan pola 6idur. Selain menga6ur pola 6idur$bangun, &$ H juga memper6ahan)an )on6inui6as dari si)lus 6idur$bangun. Sin6esis &$H pada o6a) 6erjadi pada nu)leus raphe ba6ang o6a) bagian dorsal dan medial, )auda dari mesense8alon. euron &$H a)an e)s6ensi )e )ola6eral )ola6eral dan menyebar)an menyebar)an 6erminal 6erminal sara8 di seluruh seluruh forebrain. forebrain.
erdap rdapa6 a6
#7$# #7$#& &
sub6 sub6ip ipee
rese resep6 p6or or
sero sero6o 6one nerg rgi) i)
dan dan
neuro6ransmisinya bersi8a6 para)rin.' Serotonin Serotonin receptor receptor , pro6ein &$ H H(( yang di)o di)ode de oleh oleh gen gen H6r H6r,, di6e di6emu mu)a )an n di suprachiasmatic
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1ambar #. Posisi suprachiasmatic Posisi suprachiasmatic nucleus SC( pada o6a). *
Sero6onin disin6esis dari 6ryp6ophan yang berasal dari die6. L$ ryp6oph ryp6ophan an rp(. rp(. 0erdasar)an 0erdasar)an e)sperimen, e)sperimen, penurunan penurunan rp rp plasma plasma dapa6 menurun)an )adar &$H di o6a) le=a6 penurunan sin6esis &$ H.## rp )emudian diubah menjadi &$hydro@y$L$6ry6ophan &$HP( oleh 6ryp6opha 6ryp6ophan n &$hydro@y &$hydro@ylase lase ph(. ph(. Se6elah Se6elah sero6onin sero6onin 6erben6u), 6erben6u), mole)ul ini dengan >epa6 di6ranspor6 )e dalam vesi)el le=a6 vesicular monoamine monoamine transporter transporter ?2A ?2A(. ?esi)el si)el ini )emudi )emudian an melepa melepass sero sero6o 6oni nin n via via e)so e)sosi si6o 6osi siss )e dala dalam m synaptic cleft , dan dan sero sero6o 6oni nin n beri)a6an
dengan
resep6or
pre
dan;a6au
pos6$sinaps.
3n6u)
menghinda menghindari ri desensi6asi desensi6asi resep6or, resep6or, dibu6u)an dibu6u)an reuptake reuptake dari sero6onin via
6ranspor6e r6er
dependen
a; a;Cl$
yai6 ai6u
Serot Serotoni onin n
Reupta Reuptake ke
Transporter S+/ S+/(. (. Se6ela Se6elah h di reup6a reup6a)e, )e, sero6on sero6onin in dipe>ah dipe>ah oleh oleh 2ABA( menjadi menjadi 5-hydroxyindoleacetic acid monoamine monoamine oxidase oxidase A 2ABA(
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pernapasan a6as, sehingga mempengaruhi ou6pu6 mo6ori) pernapasan saa6 6idur 6idur.. Selain Selain i6u adany adanyaa in8lam in8lamasi asi dan si6o)i si6o)in n pro$in pro$in8lam 8lamasi, asi, 6eru6ama -L$# dan 5, 5, merubah me6abolisme sero6onin salah sa6unya dengan >ara mengubah me6abolisme 6ryp6ophan. 6r yp6ophan.
2.1. 2.1.*. *.*. *. Mela Melat% t%n" n"n n
2ela6onin 2ela6onin $a>e6yl$&$me6 $a>e6yl$&$me6ho@y ho@y6ryp6am 6ryp6amine( ine( adalah hormon hormon yang diprodu)si diprodu)si di )elenjar )elenjar pineal, pineal, yang yang dianggap dianggap sebagai salah sa6u modula6or primer dari ri6me sir)adian pada mamalia. #9,#7 Sin6esisnya memil emili) i)ii
pola ola
diurn iurnal al den dengan gan
pun> pun>a) a)ny nyaa
pad pada
malam alam hari. ari.
Penurununan )adar mela6onin saa6 adanya >ahaya 6erang merupa)an resp respon on a)u6 a)u6 yang ang berh berhub ubun unga gan n deng dengan an degr degrad adas asii serotonin Nacetyltransferase SA(. acetyltransferase SA(. -n8ormasi mengenai 6erang$gelap men>apai SC melalui sel ganglion re6ina yang 8o6osensi6i8. Kadar mela6onin mening)a6 saa6 hari mulai gelap dan pun>a)nya pada pu)ul !$7 dini hari.#& 2ela6onin 2ela6onin menyebab)an menyebab)an rasa )an6u) dan menurun)an menurun)an suhu 6ubuh, 6e6api yang mengon6rol si)lus harian pada sis6em para)rin dan endo)rin adalah sis6em sara8 pusa6, 6eru6ama SC. Se>ara 6emporal 6ahap /+2 diregulasi sebagian besar oleh sis6em sir)adian dan berhubungan dengan )adar mela6onin endogen sir)ulasi sir)ulasi yang yang 6inggi. 6inggi. Selain i6u, mela6onin mela6onin e)sogen e)sogen mening)a6 mening)a6)an )an =a)6u 6ahap /+2 pada orang yang seha6. #&
2.1.*. R"t)e #"rka&"an &an +ng#" #erebr%,a#klar#%
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sela selama ma !7 jam. jam. Siny Sinyal al 8o6i 8o6i) ) di)r di)rim im dari dari ma6a ma6a )e SC SC via via 6ra) 6ra)6u 6uss re6inohipo re6inohipo6alamu 6alamuss dan memediasi memediasi sis6em sir)adian. sir)adian.# 2e)anisme jam pada SC se>ara esensial adalah in6era)si si)li) an6ara gen dan pro6ein. #% Karena ri6me sir)adian ini 6ida) 6epa6 !7 jam, ma)a jam in6ernal membu6uh)an penyesuaian harian agar sesuai dengan =a)6u ling)ungan. Salah sa6u >ara pen6ing un6u) penyesuaian penyesuaian adalah >ahaya. #! Si)lus 6idur bangun di)on6rol oleh homeos6asis 6idur. Keinginan un6u) 6idu 6idurr meni mening ng)a )a66 se>ar se>araa grad gradua uall seiri seiring ng sema sema)i )in n panj panjan angn gnya ya =a)6 =a)6u u 6erbangun dan menurun seiring =a)6u 6idur. Selain i6u, 6idur dan bangun mun>ul mun>ul bergan6ian bergan6ian.. 1angguan 1angguan 6idur ri6me sir)adian sir)adian dide8inisi) dide8inisi)an an dengan dengan pola 6idur 6erganggu yang yang persis6en a6au re)uren. # erdapa6 )ira$)ira % jam perbedaan an6ara =a)6u ri6me sir)adian pada 8ungsi serebrovas)ular dan suhu in6i 6ubuh, sehingga 8ungsi serebrovas)ular 6erus menurun pada jam$jam a=al hingga per6engahan pagi hari )e6i)a suhu 6ubuh mening)a6. /ea)6ivi6as vasomo6ori) serebral 6erhadap hipo)apnia dan hiper)apnia 6ernya6a paling rendah pada pagi hari. -s6ilah rea)6ivi6as CB! serebrovas)ul serebrovas)ular ar menggambar menggambar)an )an inde)s inde)s dari )emampuan )emampuan cerebrovascular bed un6u) un6u) berdila6asi a6au )ons6ri)si sebagai
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de6i). de6i). 1anggu 1angguan an pada pada )edua )edua au6ore au6oregul gulasi asi ini berhub berhubung ungan an era6 dengan dengan pening)a6an )ejadian serebrovas)ular dan mor6ali6as. Pening)a6an 6e)anan darah 6iba$6iba diser6ai penurunan au6oregulasi serebra serebrall dan 8a)6or 8a)6or risi)o risi)o a)u6 a)u6 dan )ronis )ronis juga juga dapa6 dapa6 menge) menge)sase saserba rbasi si )emung)inan s6ro)e hemoragi) dan is)emi).
2.1.-. Ascending 2.1.-. Ascending Reticular Reticular Activating Activating System ARAS/#'
A/AS adalah sis6em arousal spesi8i) spesi8i) berasal dari nu)lei yang se>ara di8us 6erle6a) di sepanjang 8orma6io re6i)ularis ba6ang o6a). -mpuls a)6ivasi yang berasal dari A/AS di$relay di$ relay oleh nu)lei 6halamus 6er6en6u nu)leus an6erior an6erior ven6ralis, ven6ralis, nu)lei nu)lei in6ralaminar in6ralaminar 6eru6ama bagian bagian sen6romedia sen6romedial, l, dan nu)lei re6i)ularis( hingga seluruh neo)or6e)s. A)6ivasi A/AS a)an menghamba6 6idur dan )erusa)an pada A/AS a)an mengganggu mengganggu 6ing)a6 6ing)a6 )esadaran. )esadaran. -nisiasi penga6uran penga6uran 6idur pada malam hari sebagian besar dia=ali oleh in6i di o6a) depan yang lebih a)6i8 pada malam hari dibanding) dibanding)an an pada siang hari. Sebali)nya, Sebali)nya, sis6em )olinergi )olinergi) ) o6a) depan >enderung menghamba6 6idur.
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a6eros) a6eros)ler lero6i o6i) ) u6ama u6ama a6au a6au emboli emboli dari dari daerah daerah ini )e ar6eri ar6eri serebral yang lebih dis6al. -n8a -n8ar) r) sere serebr bral al embo emboli li) ) dise diseba bab) b)an an oleh oleh embo emboli li dari dari gumpalan darah pada ar6eri serebral yang da6ang pada bagian lain dari sis6em sis6em ar6erial ar6erial,, >on6oh >on6ohny nyaa dari dari lesi )ardia )ardia) ) pada pada )a6up, ruang jan6ung, gangguan ri6me seper6i pada 8ibrilasi a6rial. -n8ar) serebral la)unar adalah in8ar) )e>il yang dalam pada ar6eri pene6ra6i8 yang )e>il, )ebanya)an berhubungan dengan hiper6ensi )ronis.
2.2.2. 2.2.2.2. 2. Str Str%k %kee 'e)%rag" 'e)%rag"k k
Perdarah Perdarahan an in6rase in6rasereb rebral ral spon6a spon6an n )ebany )ebanya)an a)an disebab disebab)an )an oleh penya)i6 hiper6ensi8 ar6eriolar, lebih jarang lagi a)iba6 )elainan )oagulasi, mal8ormasi vas)ular dalam o6a), dan die6 seper seper6i 6i )ons )onsum umsi si al)o al)oho holl dala dalam m juml jumlah ah 6ing 6inggi gi.. #ortical amyloid amyloid angiopathy angiopathy sua6u sua6u )onse)u )onse)uens ensii dari dari hiper6 hiper6ensi ensi(( adalah penyebab perdarahan )or6i)al yang 6erjadi 6eru6ama
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2.*. Hb Hbngan ngan antara antara #tr%ke #tr%ke &an &an ganggan ganggan t"&r 2.*.1.Glta)at
Ke6i)a Ke6i)a pembul pembuluh uh darah darah o6a) o6a) 6erhamb 6erhamba6 a6 oleh oleh emboli emboli a6au a6au 6rombu 6rombus, s, o)sigen dan nu6risi 6ida) dapa6 men>apai neuron. euron yang )e)urangan o)sigen dan glu)osa a)an melepas glu6ama6 se>ara berlebihan dari synaptic dari synaptic bulbs. bulbs. 1lu6am 1lu6ama6 a6 )emudi )emudian an beri)a beri)a6an 6an dengan dengan resep6o resep6orr 2DA 2DA yang yang a)an a)an meme meme>a >ah h
AP
guna guna meng menga) a)6i 6i8) 8)an an AP$as P$asee
pada pada 1$pr 1$pro6 o6ei ein n
yang ang
merang merangsang sang in8lu) in8lu)ss berleb berlebih ih dari dari ion na6rium na6rium dan )alsiu )alsium, m, ser6a ser6a air )e dalam neuron pos6$sinaps sehingga 6erjadinya e)si6asi dari neuron 6ersebu6. !# A)ib A)iba6 a6ny nyaa 6erjad 6erjadii 6o)s 6o)sis isi6 i6as as neur neuron onal al dan dan dimu dimula laii pros proses es apop apop6o 6osi sis. s. 1lu6ama6 1lu6ama6 )eluar dari neuron yang ma6i dan memulai )as)ade proses 6o)si) 6erhada 6erhadap p neuron neuron lain. lain. Proses Proses 6eru6am 6eru6amaa paling paling mempen mempengar garuhi uhi neuron neuron di )or6e)s dan daerah hippo)ampus.
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meng menga) a)6i 6i8) 8)an an guanylyl cyclase, cyclase, menye menyebab bab)an )an lebih lebih banya banya) ) in8lu) in8lu)ss ion na6rium dan )alsium. &
2.*.2.Ser%t%n"n !"
Sebelunya 6elah di)e6ahui bah=a )onsolidasi 6idur$bangun 6ergan6ung dari ri6me sir)adian, dan ablasi SC mening)a6)an 8ragmen6asi 6idur. Hal ini menunju))an menunju))an bah=a &$H berperan berperan dalam me)anisme me)anisme coupling an6ara osila6or SC dan si)lus 6idur$bangun. Analisis imunohis6o)imia pada he=an menunju))an bah=a )urangnya inervasi sara8 &$H )e SC 6ermasu) jumlah badan sel &$H pada nu)leus raphe membua6 6i)us memili)i periode a)6i8 lebih lama, lebih malam, dan a)6ivi a)6ivi6asn 6asnya ya 6ida) 6ida) dipeng dipengaru aruhi hi suasan suasanaa gelap. gelap. Anali Analisis sis menunj menunju)) u))an an perubahan si)ap ini bu)an disebab)an perubahan s6ru)6ur s6r u)6ur SC 6e6api a)iba6 hilang hilangny nyaa inpu6 inpu6 sero6on sero6onerg ergi) i) 6erhad 6erhadap ap si)lus si)lus sir)adi sir)adian an dan penga6 penga6ura uran n a)6ivi6as a)6ivi6as oleh 6emporal. Peneli6ian menunju))an menunju))an a)6ivasi a)6ivasi resep6or resep6or &$H menyebab)an e)si6abili6as neuronal di sejumlah regio o6a). Selai Selain n i6u, i6u, pada pada s6ro) s6ro)ee 6erjad 6erjadii depl deplesi esi &$H &$H yang yang meny menyeb ebab) ab)an an perubahan gelombang ++1 menjadi menjadi slo$-$ave slo$-$ave sleep SS(. sleep SS(. SS memili)i
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berupa pene)anan produ)si mela6onin, gangguan me6abolisme a6au penurunan intake intake nu6risi pemben6u) mela6onin dan gangguan si)lus 6idur$ bangun seper6i gangguan pernapasan saa6 6idur. 6idur.#",#7
2.*.-. Le#" %tak (a&a #tr%ke #tr%ke
Si)lus Si)lus bangun bangun 6idur 6idur manusi manusiaa di a6ur a6ur oleh oleh 5ormas 5ormasio io /e6i)u /e6i)ular laris is yang 6erdapa6 pada ba6ang o6a), pada bagian As>ending /e6i>ular A>6iva6ing Sis6em A/AS(. Dalam hal ini, A/AS ber8ungsi sebangai penga6ur 6ing)a6 )esadaran pada manusia dan menjaga si)lus 6idur bangun manusia. Selain dari sys6em A/AS, irama 6idur merupa)an pengaruh dari irama sin)ardia yang di a6ur a6ur oleh suprachiasmatic nucleus SC( nucleus SC( pada hipo6alamus yang menya6u)an menya6u)an in8ormasi dari ling)ungan ling)ungan dan meng)oord meng)oordinasi inasi 8ase osila6or osila6or
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yang 6er)ena s6ro)e mung)in menunju))an adanya pengaruh jaringan in8ar) a6au sebuah respon in8lamasi yang mempengaruhi regulasi 6idur$bangun. S6ro 6ro)e
sub) sub)or or6i 6i)a )all
a)an a)an
mempe empen ngaru garuh hi
gan ganglia glia
basa basall
a)an a)an
bermani8es6asi pada )an6u) di siang hari yang berlebihan. Sedang)an s6ro)e hemis8 hemis8eri) eri) a)an a)an menimb menimbul) ul)an an )elain )elainan an 6idur 6idur /+2. /+2. Dalam Dalam salah salah sa6u peneli6ian mengenai s6ro)e hemis8eri), seper6iga pasien s6ro)e 6idur berlebihan, dan seper6iga lainnya mengalami penurunan =a)6u 6idur dibanding)an dengan =a)6u 6idur sebelum s6ro)e. Ji)a )erusa)an 6erjadi pada in6i penga6ur 6idur$bangun yang yang 6ida) dapa6 diperbai)i, pasien mung)in mengalami perubahan permanen seper6i hipersomnia, insomnia, disregulasi sir)adian, a6aupun de8isi6 lain.!#
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abel abel #. Pemberian oba6 pada penderi6a insomnia. !!
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Dosis Dosis pember pemberian ian benod benodiae iaepin pin un6u) un6u) 6erapi 6erapi insomn insomnia ia sebai) sebai)ny nyaa diberi)an diberi)an sampai sampai
! minggu, minggu, sedang)an sedang)an un6u) un6u) men>egah men>egah ansie6as ansie6as dapa6
diberi)an selama 7 minggu dan un6u) mendapa6)an e8e) an6i pani) dapa6 diberi)an diberi)an hingga hingga #! minggu. minggu. Penggunaan Penggunaan benodiaepin benodiaepin yang lama a)an meny menyeb ebab ab)a )an n )e6e )e6erg rgan an6u 6ung ngan an dan dan mun>u un>uln lny ya e8e) e8e) $ithdra$al seper6i gangguan )e>emasan, le6argi, 8o6o8obia, mual, dan nyeri )epala. !7 Pemberian agonis 1A0A 6erbu)6i pada sebuah peneli6ian di Aus6ralia didapa6)an penggunaan ba>lo8en !& mg mening)a6)an jumlah jam is6iraha6 pada 8ase /+2 maupun pada /+2 dibanding)an dengan pemberian plasebo. Pada pemberian plasebo didapa6)an ra6a$ra6a =a)6u 6idur 9&% meni6, sedang)an pada pemberian ba>lo8en =a)6u ra6a$ra6a 6idur adalah 9'% meni6.!&
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1ambar 9. S6ru)6ur )imia mela6onin dan /amel6eon. !%
2.-.. Antag%n"# re#e(t%r HT 3
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BAB III KESIMPULAN
Pada s6ro)e 6erjadi pelepasan berlebihan dari glu6ama6 ser6a penurunan se)resi sero6on sero6onin in dan mela6o mela6onin nin Selain Selain i6u lo)asi lo)asi lesi 6er6en6 6er6en6u u dapa6 dapa6 menye menyebab bab)an )an
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DAFTAR PUSTAKA
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