Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, 8091 Zurich, Switzerland.
Neuromolecular Med. 2012 Sep;14(3):205-12. doi: 10.1007/s12017-012-8178-x. Epub 2012 Mar 23.
Traumatic brain injury is a frequent condition worldwide, and sleep-wake disturbances often complicate the course after the injuring event. Current evidence suggests that the most common sleep-wake disturbances following traumatic brain injury include excessive daytime sleepiness and posttraumatic hypersomnia, that is, increased sleep need per 24 h. The neuromolecular basis of posttraumatic sleep pressure enhancement is not entirely clear. First neuropathological and clinical studies suggest that impaired hypocretin (orexin) signalling might contribute to sleepiness, but direct or indirect traumatic injury also to other sleep-wake modulating systems in the brainstem and the mesencephalon is likely. Posttraumatic insomnia may be less common than posttraumatic sleepiness, but studies on its frequency revealed conflicting results. Furthermore, insomnia is often associated with psychiatric comorbidities, and some patients with posttraumatic disruption of their circadian rhythm may be misdiagnosed as insomnia patients. The pathophysiology of posttraumatic circadian sleep disorders remains elusive; however, there is some evidence that reduced evening melatonin production due to traumatic brain damage may cause disruption of circadian regulation of sleep and wakefulness.
创伤性脑损伤是一种全球范围内常见的疾病，睡眠-觉醒障碍常常使受伤后的病程复杂化。目前的证据表明，创伤性脑损伤后最常见的睡眠-觉醒障碍包括日间过度嗜睡和创伤后嗜睡，即每 24 小时增加的睡眠需求。创伤后睡眠压力增强的神经分子基础尚不完全清楚。首先，神经病理学和临床研究表明，下丘脑泌素（食欲素）信号的损伤可能导致嗜睡，但直接或间接的创伤性损伤也可能影响脑干和中脑的其他睡眠-觉醒调节系统。创伤后失眠可能比创伤后嗜睡少见，但关于其频率的研究结果存在矛盾。此外，失眠常与精神共病有关，一些昼夜节律紊乱的创伤后患者可能被误诊为失眠患者。创伤后昼夜睡眠障碍的病理生理学仍然难以捉摸；然而，有一些证据表明，由于创伤性脑损伤导致的傍晚褪黑素生成减少可能导致睡眠和觉醒的昼夜调节紊乱。
