Steele D L, Rajaratnam S M W, Redman J R, Ponsford J L
School of Psychology, Psychiatry and Psychological Medicine, Building 17, Clayton Campus, Monash University, Melbourne, Victoria, Australia.
Chronobiol Int. 2005;22(1):89-105. doi: 10.1081/cbi-200042428.
While there have been single case reports of the development of circadian rhythm sleep disorders, most commonly delayed sleep phase syndrome following traumatic brain injury (TBI), to our knowledge there have been no group investigations of changes to sleep timing in this population. The aim of the present study was to investigate sleep timing following TBI using the dim light melatonin onset (DLMO) as a marker of circadian phase and the Morningness-Eveningness Questionnaire (MEQ) as a measure of sleep-wake behavior. A sleep-wake diary was also completed. It was hypothesized that the timing of DLMO would be delayed and that there would be a greater tendency toward eveningness on the MEQ in a post-acute TBI group (n=10) compared to a gender and age matched control group. Participants were recruited at routine outpatient review appointments (TBI) and from the general population (control) as part of a larger study. They attended the sleep laboratory where questionnaires were completed, some retrospectively, and saliva melatonin samples were collected half-hourly according to a standard protocol. The results show that the TBI and control groups reported similar habitual sleep times and this was reflected on the MEQ. There was, however, significant variability in the TBI group's change from the pre-injury to the current MEQ score. The timing of melatonin onset was not different between the groups. While subtle changes (advances or delays) in this small sample may have cancelled each other out,. the present study does not provide conclusive objective evidence of shift in circadian timing of sleep following TBI. Furthermore, although participants did report sleep timing changes, it is concluded that the MEQ may not be suitable for use with this cognitively impaired clinical group.
虽然有关于昼夜节律睡眠障碍发生的个别病例报告，最常见的是创伤性脑损伤（TBI）后出现睡眠时相延迟综合征，但据我们所知，尚未对该人群的睡眠时间变化进行群体调查。本研究的目的是使用暗光褪黑素起始时间（DLMO）作为昼夜节律相位的标志物，以及晨型-夜型问卷（MEQ）作为睡眠-觉醒行为的一种测量方法，来研究创伤性脑损伤后的睡眠时间。还完成了一份睡眠-觉醒日记。研究假设是，与性别和年龄匹配的对照组相比，急性创伤性脑损伤后组（n = 10）的DLMO时间会延迟，并且在MEQ上会有更大的倾向于夜型。参与者是在常规门诊复查预约时招募的（创伤性脑损伤组），以及从普通人群中招募的（对照组），作为一项更大规模研究的一部分。他们前往睡眠实验室，在那里完成问卷，有些是回顾性的，并且根据标准方案每半小时收集一次唾液褪黑素样本。结果表明，创伤性脑损伤组和对照组报告的习惯性睡眠时间相似，这在MEQ上也有所体现。然而，创伤性脑损伤组从损伤前到当前MEQ分数的变化存在显著差异。两组之间褪黑素起始时间没有差异。虽然在这个小样本中细微的变化（提前或延迟）可能相互抵消了，但本研究并未提供创伤性脑损伤后睡眠昼夜节律时间改变的确凿客观证据。此外，尽管参与者确实报告了睡眠时间的变化，但得出的结论是，MEQ可能不适用于这个认知受损的临床群体。
