School of Psychology and Psychiatry, Monash University, Victoria 3800, Australia.
Neurology. 2010 May 25;74(21):1732-8. doi: 10.1212/WNL.0b013e3181e0438b.
Sleep disturbances commonly follow traumatic brain injury (TBI) and contribute to ongoing disability. However, there are no conclusive findings regarding specific changes to sleep quality and sleep architecture measured using polysomnography. Possible causes of the sleep disturbances include disruption of circadian regulation of sleep-wakefulness, psychological distress, and a neuronal response to injury. We investigated sleep-wake disturbances and their underlying mechanisms in a TBI patient sample.
This was an observational study comparing 23 patients with TBI (429.7 +/- 287.6 days post injury) and 23 age- and gender-matched healthy volunteers on polysomnographic sleep measures, salivary dim light melatonin onset (DLMO) time, and self-reported sleep quality, anxiety, and depression.
Patients with TBI reported higher anxiety and depressive symptoms and sleep disturbance than controls. Patients with TBI showed decreased sleep efficiency (SE) and increased wake after sleep onset (WASO). Although no significant group differences were found in sleep architecture, when anxiety and depression scores were controlled, patients with TBI showed higher amount of slow wave sleep. No differences in self-reported sleep timing or salivary DLMO time were found. However, patients with TBI showed significantly lower levels of evening melatonin production. Melatonin level was significantly correlated with REM sleep but not SE or WASO.
Reduced evening melatonin production may indicate disruption to circadian regulation of melatonin synthesis. The results suggest that there are at least 2 factors contributing to sleep disturbances in patients with traumatic brain injury. We propose that elevated depression is associated with reduced sleep quality, and increased slow wave sleep is attributed to the effects of mechanical brain damage.
睡眠障碍在颅脑损伤（TBI）后很常见，并且是持续性残疾的原因之一。然而，目前尚无定论表明使用多导睡眠图测量时，睡眠质量和睡眠结构有具体变化。睡眠障碍的可能原因包括睡眠-觉醒的昼夜节律调节中断、心理困扰和神经元对损伤的反应。我们研究了 TBI 患者样本中的睡眠-觉醒障碍及其潜在机制。
这是一项观察性研究，比较了 23 例 TBI 患者（损伤后 429.7 +/- 287.6 天）和 23 例年龄和性别匹配的健康志愿者的多导睡眠图睡眠测量、唾液褪黑素初始时间（DLMO）和自我报告的睡眠质量、焦虑和抑郁。
TBI 患者报告的焦虑和抑郁症状以及睡眠障碍比对照组更严重。TBI 患者的睡眠效率（SE）降低，睡眠后觉醒时间（WASO）增加。尽管在睡眠结构方面没有发现显著的组间差异，但当控制焦虑和抑郁评分时，TBI 患者显示出更多的慢波睡眠。自我报告的睡眠时间或唾液 DLMO 时间没有差异。然而，TBI 患者的夜间褪黑素生成水平明显较低。褪黑素水平与 REM 睡眠显著相关，但与 SE 或 WASO 无关。
夜间褪黑素生成减少可能表明褪黑素合成的昼夜节律调节中断。结果表明，至少有 2 个因素导致 TBI 患者的睡眠障碍。我们提出，升高的抑郁与睡眠质量降低有关，而增加的慢波睡眠归因于机械性脑损伤的影响。
