YAWNINFL - PDF document

YAWNINFLÁVIO ALÓE* SUMMAR - Th ubiquitousnes o norma yawnin an th existenc o abnorma yawnin warran a understandino thi reflex It mechanism an functiona rol ar no entirel known A revie o th literatur reveal thayawnin i a brai ste arousa refle wit bot periphera an centra loop subservin reversa o brai hypoxi ohypoxemia * Sleep-Wak Disorde Center Departmen o Neurolog o th Universit o Sã Paul Medica SchoolAceite 22-novembro-1994 Dr Flávi Alo - Al Ja 179 - 01420-00 Sã Paul S - Brasil FA (55.11 280-9519 1 Inspirator phase Yawnin ma b precede b lookin about movin o arrangin one' hair The th loweja open involuntaril reachin maxima widenin whil a 4 t 6 second lon an dee inspiratio drain aithroug bot th mout an th nose Th nostril flare th respirator thoraci accessor muscle contrac i aincrease inspiratio placing a large volum o ai i contac wit th maximall widene nasopharynx28. Th sofpalat move u sealin rhinopharyn momentaril an th voca cord abduc maximally Th sub-hyio musclecontrac bringin th tongu forward descendin th hyio bon t th leve o th sevent cervica vertebrae Thmid-inspiratio closur o th Eustachia tube produce a transien hypoacusi wherea th end-inspirator openino th Eustachia tube produce a clickin i th ears28. Yawnin i usuall associate wit vigorous stretchin oth limbs tors an a brie shivering Durin stretching th soleus latera pterygoid an th diaphrag musclecontrac emptyin thei voluminou venou plexus thu increasin th venou retur t th hear wit a sligh oincreas o th hear rate12 Acme Thi brie phas onl last 2 t 4s Extensio o th neck force closur o th eyes lacrimatio ansalivatio occu an a vagu sensatio o pleasur i als describe t occur A large bolu o ai i place i contacwit th maximall expose nasopharynx2 a th acme3 Expiration Th acm come suddenl t a end th muscle involve i th tw previou phase rela an a quic passiv expiratio occur an subsequentl a brie apne ensues18. MECHANISMS Fatigu an boredo ar th tw mos poten stimul causin yawnin wherea drowsinesi th mos commo caus o i i humans29. Whe th environmen i borin an n longe abl t sustai thsubject' attention th bore min ha t mak a effor t maintai contac wit th surroundings Thes feeling oboredo throug th prefronta corte modif th patter o activit o th brai ste reticula formatio an o th ste midlin raph serotoninergi system Thi generate a subjectiv sensatio o drowsiness2 whic induceyawningVariou physiologica change occu durin yawning Vigorou stretchin o limb wit contractio o th laterapterygoids soleus diaphrag an othe muscle (th so-calle periphera hearts) increas th venou retur t thright chamber o th heart thu increasin th cardia outpu an consequentl increasin cerebra bloo flow18. Th dee an prolonge inspiratio phas o yawnin reverse hypoxia, hypercapni an alveola collapse31. Thdee inhalatio als stretche th termina bronchiole an alveoli Thi wil als dilat bronchia musculaturstimulatin th vaga terminals thu releasin acetylcholin whic i tur dilate th systemi arteriole eve furtherTh resul i a decreased periphera resistance increase arteria cerebra bloo flow increase oxyge saturatioan decrease C021418-31. Hyperoxygenatio an increase cerebra bloo flo activat th brai ste reticulaformatio leadin t increase alertness24. Yawnin seem indee t b a alertin reflex I tha line Karasaw e a showe tha i patient wit occlusivcerebrovascula diseas yawnin emerge whe th EE showe slowin o th posterio backgroun activit simultaneousl wit a mil hypoxemia17. Apparently boredom fatigu an drowsines al lea thypoventilatio an mil hypoxia Yawnin woul b a respons o th brai ste reticula formatio t reversdrowsines an t maintai attentio an alertness18. Yawnin i a th neurona leve th resul o conceitedl functionin comple neurona network whos anatomicacente i mos likel locate i th lowe brai ste nearb th brainste reticula formation11. Th yawnin neuronacomple i interconnecte wit th neurona aggregate of (a respirator neurons (b) moto nucle o th 5th 7th10th an 12t crania nerves (c th phreni nerv an accessor respirator muscles (d th parasympathetiterminal o th lacrima glands (e th fronta cortex91118. I favo o thi anatomi locatio ther i th repor bGeschwen wh describe a tetraplegi patien wit a pontin gliom wh coul no ope hi mouth spontaneouslbu wa abl t yawn16. Openin o th mout throug th moto corte wa impossibl bu reflexoge yawnin wastil possibl becaus o th shor interconnection betwee th reticula neuron an th moto axon o th fifth ansevent crania nerves Anothe tetraplegi an locked-i syndrom patien sufferin fro a gliom o th anteriopon coul yaw bu coul no ope hi mout voluntarily6. Th preservatio o th reticula formatio networmad yawnin possibl wherea th interruptio o th cortica moto fibe i th ventra pon prevente voluntar opening6,16. ABNORMA YAWNING Abnorma repetitiv yawnin ma b th consequenc o opiat withdrawalintoxicatio wit CN depressants dru sid effect (tricycli antidepressants reserpine)28; lesion t th CN suca postencephaliti conditions CN tumors apalli syndrome cerebra malformations transtentoria herniations11. Yawnin i associate wit diminishe brai oxidativ metabolism Suc i th cas o anemi o cerebra anemi(occlusio o th caroti arteries) hypoglycemi states18. I thes situations yawnin throug it actio o thcerebra bloo flow i a protectiv homeostati refle t increas brai oxyge levels1 i situation o decreasebrai oxidativ metabolism WH W YAWN I i no entirel clea wh peopl yawn18. I coul no purposelessl hav survive thevolutionar proces withou a reasonWherea actua yawnin i no elicite voluntarily i i a ideomoto actio easil elicite b suggestion b thoughtfupreoccupatio wit yawning an b unconsciou imitation18. I i layman' knowledg tha yawnin i a contagioubehavior Bel e a wer abl t induc yawnin i undergraduat student b instructin the t thin abou itshowin yawnin i perhap a stereotype imitativ behavior7-26-27. I i als commo knowledg tha yawnin caemerg befor psychologicall o physicall strenuou situations N explanatio fo thi i foun i curren medicaliterature O th othe hand psychoti patient hav a tendenc t yaw less18. Thi ha perhap som bearin o thfindin o increase yawnin afte apomorphin i animals20. Yawnin ma hav acquire a paralinguisti meanin wit evolution11. A a nonverba passiv behavior, i mahav a rol i huma communicatio expressin a refusa t participat i a dialogue3. Alternatively th purpos oyawnin ha t wit th sens o smel a a large bolu o ai i place i contac wit th maximall exposenasopharynx28. Yawnin possibl i a protectiv respons wit a mor logica reaso fo it existenc tha t revershypoxi an alveola collaps durin period o hypoventilation31. BIOCHEMISTR O YAWNING Variou agent ca induc yawnin i animals Dopaminergi ancholinergi agonists ACTH-MSH oxytoci produc yawnin i rats1 19-20,30. Th stretching-yawnin syndrom i animal (SYS whic include penil erectio i believe t involv dopaminergiinhibitor circuit an cholinergi activation1925,30. Th intraventricula administratio o ACT an alpha-MSstimulatin hormone induc SY i differen anima species2. Thi i a specifi an centrall mediate effec o thACTH-MS peptide an i i no obtaine afte periphera administration2-319. I ha bee suggeste tha septalhippocampa cholinergi neuron ar involve i th productio o SY followin administratio o thes peptides19. Thi sam effec o ACT i als foun interspecies Hypothalami extrac fro rat wil induc thi behavio irecipien rabbits13. Anothe hypothalami peptide oxytocin wa foun t b th singl mos poten stimulu producin yawningstretchin an penil erection i animal whe injecte directl int th CN (intraventricular^)1-2. Systemi injectioo apomorphin an othe dopaminergi o cholinergi agonist als produc SYS2-21-22-30. Apomorphin ma inducyawnin b increasin th releas o oxytoci directl fro th Paraventriculari Nucleu (PVN o th3-21-22. Amon pharmacologica agent abl t preven oxytocin ACTH-MS an apomorphine-induceyawnin an penil erection morphin i certainl on o th mos effective13-1-8-23. Dopaminergic oxytocinergiccholinergi antagonist preven SYS13,32. Lesion t th PV preven apomorphin bu no ACTH-induce yawninsuggestin ACT induce yawnin throug differen pathway fro thos o dopamine agonists4. Hypothalami oxytoci probabl function a th final commo pathwa neuropeptid release i respons t differenchemica stimuli2-4. Centrall injecte ACTH-MS seem t induc yawnin throug th releas o a secon an yeundetermine messenger23. ACTH-MS doe no ac o th PV o th hypothalamus1 no i i mediate b threleas o oxytoci lik apomorphine3-23. CONCLUSION1 N single peptide neurotransmitter neurona syste alon ca b assigne t yawningYawnin involve dopaminergic cholinergi neurona systems ACTH-MSH oxytocinergi peptidean it anatomica cente i mos likel locate i th lowe brai stem 2 Yawnin i a multifariourefle possibl subservin th purpose of a protectivel enhancin arousa an attention breversin mil brai hypoxi o hypoxemia c enhancin th sens o smell d non-verbacommunicationAcknowledgment - Specia thank t Dr Stell Tavare an Dr Letici Lob fo thei assistanceREFERENCE1 Argiola A Meli MR Gess GL Oxytocin a extremel poten induce o penil erection an yawning Eu J Pharmaco 1986 130:265-2722 Argiola A Meli MR Gess GL Yawning neurochemistry physiolog an pathology Cephalalgi1987 7:131-1373.Argiola A Meli MR Vargi L Gess GL d(CH2)s-Tyr(Me)-Orn8-vasotocin a poten oxytoci antagonistantagonize penil erectio an yawnin induce b oxytocin an apomorphine bu no b ACTH(1-24) Eu J Pharmaco 1987 134:221-224 4 Argiola A Meti MR Maur A Gess GL Paraventriculari nucleu lesio prevent yawnin an penile erectiob apomorphin an oxytoci bu no b ACT i rats Brai Re 1987 421 349-3525.Askenas JMM I yawnin a arousa defens refle ? Jour Psycho 1988, 23:609-6216 Baue G Gerstenbran F Henge W Involuntar moto phenomen i th locked-i syndrom J Neuro 1980223:191-1987 Bel LA Boredo an th yawn Re Esse Psycho Psychiatr 1980 17 91-1008 Berendse HHG Gower AJ Opiate-androge interactio i drug-induce yawnin an penil erectio i th ra. Neuroendocrinolog 1986 45:185-1909 Bigot-Masson D L bâilliemen Thes Medicine Pari VIII Paris 198910 Charco JM Leçon d mard d l Salpêtrière Tom III, Paris Lecrosnie e Bab Ed. 1890 p 1-1111 Chouar CH Bigot-Masson D Mécanisme e rôle physiologique d bâillement An Oto-Laryn 1990107:145-15312 D Vrie JIP Visse GHA Precht HFR Th emergenc o feta behavio II Quantativ Aspects E HumaDevelo 1985 7:301-32213 Ferrar W Gess GL Vargi L Behavioura effect induce b intracisternall injecte ACT an MSH AnN Aca Sc 1963 104:330-34514. Friedel A Letter N Eng J Me 1974 290 1439-144015 Gess GL Pisan M Vargi L Craba F Ferrar W Stretchin an yawnin movement afte intracerebrainjectio o ACTH Re Ca Bio 1976,26:229-23616 Geschwen J Yawnin i a cas wit transectin gliom o th pons Fortsch Neuro Psyc Grenzge 197745:652-65517 Karasaw J Kuryam Y Kur M Kikuch H Sawad T Mitsug T 1 Monitorin syste o cerebra flo ancerebra metabolism 2 Relationshi betwee interna jugula tensio an cerebra bloo flow Brain-Nerv 198234:239-24518 Lehman HE Yawning a homeostati refle an it psychologica Significance Bul Menninge Clini 197943:123-12619 Lob LL Neuman BG Eidma DS Tufi S Effect o RE slee deprivatio o ACTH-induce yawningPharmacolog 1990 40:174-1720 Meti MR Argiola A Gess G Apomorphine-induce penil erectio an yawning sit o actio o th brainBrai Re 1987 398:259-26521 Meti MR Argiola A Gess G Evidenc tha apomorphin induce penil erectio an yawnin b releasinoxytoci i th centra nervou system Eu J Pharmaco 1989 164 565-57222 Meti MR Argiola A Stamcanpian R Gess G Effect o apomorphin o oxytoci concentratio i differenbrai area an plasma Eu J Pharmaco 1990 182 101-10723 Meti MR Argiola A Stamcanpian R Gess GL Argiola A Preventio b morphin o apomorphine anoxytocin-induce penil erectio an yawning sit o actio i th brain Neuropsychopharmacolog 1992 6 17-2124 Montag A Wh w yawn JAM 1962 290:127-12825 Neuman BG Troncon LRP Bra S Tùfi S Modification o dopaminergi an cholinergi system induce bth wate tan technique analysi throug yawnin behavior Arc Inter Pharmacody Thera 1990,308:32-3826 Provin RR Hamerni HB Yawnin effect o stimulu interest Bul Psycho So 1986 24 437-43827 Provin RR Yawnin a a stereotype actio patter an releasin stimulus Etholog 1986 72 109-12228 Siega S Utter N Eng J Me 1974 290 1439-144029 Suganam S Stud o subjectiv symptom o fatigu o senio hig schoo students 2 Stud o physica loao senio hig schoo students Okayam Iqakka Zassh 1977 89 195-21830 Tufi S Troncon RPL Bra S Silva-Filh AR Neuman BG Doe RE slee deprivatio induc subsensitivito presynapti acetylcholin receptor i th ra brain? Eu J Pharmaco 1987 140 215-21931 Twies M Letter N Eng J Me 1974 290 1439-144032 Yamad K Furukar T Direc evidenc fo involvemen o dopaminergi inhibitio an activatioo yawning Psychopharmacolog 1980 67 39-43 4 Argiola A Meti MR Maur A Gess GL Paraventriculari nucleu lesio prevent yawnin an penile erectiob apomorphin an oxytoci bu no b ACT i rats Brai Re 1987 421 349-3525.Askenas JMM I yawnin a arousa defens refle ? Jour Psycho 1988, 23:609-6216 Baue G Gerstenbran F Henge W Involuntar moto phenomen i th locked-i syndrom J Neuro 1980223:191-1987 Bel LA Boredo an th yawn Re Esse Psycho Psychiatr 1980 17 91-1008 Berendse HHG Gower AJ Opiate-androge interactio i drug-induce yawnin an penil erectio i th ra. Neuroendocrinolog 1986 45:185-1909 Bigot-Masson D L bâilliemen Thes Medicine Pari VIII Paris 198910 Charco JM Leçon d mard d l Salpêtrière Tom III, Paris Lecrosnie e Bab Ed. 1890 p 1-1111 Chouar CH Bigot-Masson D Mécanisme e rôle physiologique d bâillement An Oto-Laryn 1990107:145-15312 D Vrie JIP Visse GHA Precht HFR Th emergenc o feta behavio II Quantativ Aspects E HumaDevelo 1985 7:301-32213 Ferrar W Gess GL Vargi L Behavioura effect induce b intracisternall injecte ACT an MSH AnN Aca Sc 1963 104:330-34514. Friedel A Letter N Eng J Me 1974 290 1439-144015 Gess GL Pisan M Vargi L Craba F Ferrar W Stretchin an yawnin movement afte intracerebrainjectio o ACTH Re Ca Bio 1976,26:229-23616 Geschwen J Yawnin i a cas wit transectin gliom o th pons Fortsch Neuro Psyc Grenzge 197745:652-65517 Karasaw J Kuryam Y Kur M Kikuch H Sawad T Mitsug T 1 Monitorin syste o cerebra flo ancerebra metabolism 2 Relationshi betwee interna jugula tensio an cerebra bloo flow Brain-Nerv 198234:239-24518 Lehman HE Yawning a homeostati refle an it psychologica Significance Bul Menninge Clini 197943:123-12619 Lob LL Neuman BG Eidma DS Tufi S Effect o RE slee deprivatio o ACTH-induce yawningPharmacolog 1990 40:174-1720 Meti MR Argiola A Gess G Apomorphine-induce penil erectio an yawning sit o actio o th brainBrai Re 1987 398:259-26521 Meti MR Argiola A Gess G Evidenc tha apomorphin induce penil erectio an yawnin b releasinoxytoci i th centra nervou system Eu J Pharmaco 1989 164 565-57222 Meti MR Argiola A Stamcanpian R Gess G Effect o apomorphin o oxytoci concentratio i differenbrai area an plasma Eu J Pharmaco 1990 182 101-10723 Meti MR Argiola A Stamcanpian R Gess GL Argiola A Preventio b morphin o apomorphine anoxytocin-induce penil erectio an yawning sit o actio i th brain Neuropsychopharmacolog 1992 6 17-2124 Montag A Wh w yawn JAM 1962 290:127-12825 Neuman BG Troncon LRP Bra S Tùfi S Modification o dopaminergi an cholinergi system induce bth wate tan technique analysi throug yawnin behavior Arc Inter Pharmacody Thera 1990,308:32-3826 Provin RR Hamerni HB Yawnin effect o stimulu interest Bul Psycho So 1986 24 437-43827 Provin RR Yawnin a a stereotype actio patter an releasin stimulus Etholog 1986 72 109-12228 Siega S Utter N Eng J Me 1974 290 1439-144029 Suganam S Stud o subjectiv symptom o fatigu o senio hig schoo students 2 Stud o physica loao senio hig schoo students Okayam Iqakka Zassh 1977 89 195-21830 Tufi S Troncon RPL Bra S Silva-Filh AR Neuman BG Doe RE slee deprivatio induc subsensitivito presynapti acetylcholin receptor i th ra brain? Eu J Pharmaco 1987 140 215-21931 Twies M Letter N Eng J Me 1974 290 1439-144032 Yamad K Furukar T Direc evidenc fo involvemen o dopaminergi inhibitio an activatioo yawning Psychopharmacolog 1980 67 39-43 4 Argiola A Meti MR Maur A Gess GL Paraventriculari nucleu lesio prevent yawnin an penile erectiob apomorphin an oxytoci bu no b ACT i rats Brai Re 1987 421 349-3525.Askenas JMM I yawnin a arousa defens refle ? Jour Psycho 1988, 23:609-6216 Baue G Gerstenbran F Henge W Involuntar moto phenomen i th locked-i syndrom J Neuro 1980223:191-1987 Bel LA Boredo an th yawn Re Esse Psycho Psychiatr 1980 17 91-1008 Berendse HHG Gower AJ Opiate-androge interactio i drug-induce yawnin an penil erectio i th ra. Neuroendocrinolog 1986 45:185-1909 Bigot-Masson D L bâilliemen Thes Medicine Pari VIII Paris 198910 Charco JM Leçon d mard d l Salpêtrière Tom III, Paris Lecrosnie e Bab Ed. 1890 p 1-1111 Chouar CH Bigot-Masson D Mécanisme e rôle physiologique d bâillement An Oto-Laryn 1990107:145-15312 D Vrie JIP Visse GHA Precht HFR Th emergenc o feta behavio II Quantativ Aspects E HumaDevelo 1985 7:301-32213 Ferrar W Gess GL Vargi L Behavioura effect induce b intracisternall injecte ACT an MSH AnN Aca Sc 1963 104:330-34514. Friedel A Letter N Eng J Me 1974 290 1439-144015 Gess GL Pisan M Vargi L Craba F Ferrar W Stretchin an yawnin movement afte intracerebrainjectio o ACTH Re Ca Bio 1976,26:229-23616 Geschwen J Yawnin i a cas wit transectin gliom o th pons Fortsch Neuro Psyc Grenzge 197745:652-65517 Karasaw J Kuryam Y Kur M Kikuch H Sawad T Mitsug T 1 Monitorin syste o cerebra flo ancerebra metabolism 2 Relationshi betwee interna jugula tensio an cerebra bloo flow Brain-Nerv 198234:239-24518 Lehman HE Yawning a homeostati refle an it psychologica Significance Bul Menninge Clini 197943:123-12619 Lob LL Neuman BG Eidma DS Tufi S Effect o RE slee deprivatio o ACTH-induce yawningPharmacolog 1990 40:174-1720 Meti MR Argiola A Gess G Apomorphine-induce penil erectio an yawning sit o actio o th brainBrai Re 1987 398:259-26521 Meti MR Argiola A Gess G Evidenc tha apomorphin induce penil erectio an yawnin b releasinoxytoci i th centra nervou system Eu J Pharmaco 1989 164 565-57222 Meti MR Argiola A Stamcanpian R Gess G Effect o apomorphin o oxytoci concentratio i differenbrai area an plasma Eu J Pharmaco 1990 182 101-10723 Meti MR Argiola A Stamcanpian R Gess GL Argiola A Preventio b morphin o apomorphine anoxytocin-induce penil erectio an yawning sit o actio i th brain Neuropsychopharmacolog 1992 6 17-2124 Montag A Wh w yawn JAM 1962 290:127-12825 Neuman BG Troncon LRP Bra S Tùfi S Modification o dopaminergi an cholinergi system induce bth wate tan technique analysi throug yawnin behavior Arc Inter Pharmacody Thera 1990,308:32-3826 Provin RR Hamerni HB Yawnin effect o stimulu interest Bul Psycho So 1986 24 437-43827 Provin RR Yawnin a a stereotype actio patter an releasin stimulus Etholog 1986 72 109-12228 Siega S Utter N Eng J Me 1974 290 1439-144029 Suganam S Stud o subjectiv symptom o fatigu o senio hig schoo students 2 Stud o physica loao senio hig schoo students Okayam Iqakka Zassh 1977 89 195-21830 Tufi S Troncon RPL Bra S Silva-Filh AR Neuman BG Doe RE slee deprivatio induc subsensitivito presynapti acetylcholin receptor i th ra brain? Eu J Pharmaco 1987 140 215-21931 Twies M Letter N Eng J Me 1974 290 1439-144032 Yamad K Furukar T Direc evidenc fo involvemen o dopaminergi inhibitio an activatioo yawning Psychopharmacolog 1980 67 39-43