School of Psychology and Psychiatry, Monash University, Victoria, Australia.
J Head Trauma Rehabil. 2012 May-Jun;27(3):224-33. doi: 10.1097/HTR.0b013e31824ee1a8.
Although fatigue and sleep disturbance are commonly reported following traumatic brain injury (TBI), understanding of their nature and treatment remains limited.
This article reviews a series of investigations of the nature and causes of fatigue and sleep disturbance following TBI.
A large cohort of community-based patients with TBI, recruited from a TBI rehabilitation program, completed measures of subjective fatigue and sleep disturbances, as well as attentional measures. A subgroup of participants completed polysomnography and assessment of dim light melatonin onset.
Fatigue and sleep disturbance are common. Both are associated with anxiety, depression, and pain. However, fatigue is also associated with slowed information processing and the need for increased effort in performing tasks. Sleep disturbances contribute to fatigue. Objective sleep studies show reduced sleep efficiency, increased sleep onset latency, and increased time awake after sleep onset. Depression and pain exacerbate but cannot entirely account for these problems. There is increased slow-wave sleep. Individuals with TBI show lower levels of evening melatonin production, associated with less rapid-eye movement sleep.
These findings suggest potential treatments including cognitive behavior therapy supporting lifestyle modifications, pharmacologic treatments with modafinil and melatonin, and light therapy to enhance alertness, vigilance, and mood. Controlled trials of these interventions are needed.
尽管创伤性脑损伤（TBI）后常报告出现疲劳和睡眠障碍，但对其性质和治疗的理解仍有限。
本文综述了一系列关于 TBI 后疲劳和睡眠障碍性质和原因的研究。
从 TBI 康复计划中招募了一大批来自社区的 TBI 患者，他们完成了主观疲劳和睡眠障碍以及注意力测量。部分参与者完成了多导睡眠图和暗光褪黑素起始评估。
疲劳和睡眠障碍很常见。两者均与焦虑、抑郁和疼痛相关。然而，疲劳也与信息处理速度减慢以及完成任务需要更多努力有关。睡眠障碍会导致疲劳。客观睡眠研究显示睡眠效率降低、睡眠潜伏期延长和睡眠后觉醒时间增加。抑郁和疼痛会加剧这些问题，但无法完全解释这些问题。慢波睡眠增加。TBI 患者的夜间褪黑素生成水平较低，与快速眼动睡眠减少有关。
这些发现表明可能的治疗方法包括认知行为疗法支持生活方式改变、莫达非尼和褪黑素的药物治疗以及光疗以提高警觉性、注意力和情绪。需要进行这些干预措施的对照试验。
