Duclos Catherine, Dumont Marie, Blais Hélène, Paquet Jean, Laflamme Elyse, de Beaumont Louis, Wiseman-Hakes Catherine, Menon David K, Bernard Francis, Gosselin Nadia
Hôpital du Sacré-Coeur de Montréal, Montréal, Canada Université de Montréal, Montréal, Canada.
Hôpital du Sacré-Coeur de Montréal, Montréal, Canada.
Neurorehabil Neural Repair. 2014 Jun;28(5):472-82. doi: 10.1177/1545968313517756. Epub 2013 Dec 30.
Sleep-wake disturbances are among the most persistent sequelae after traumatic brain injury (TBI) and probably arise during the hospital stay following TBI. These disturbances are characterized by difficulties sleeping at night and staying awake during the day.
The aim of the present study was to document rest-activity cycle consolidation in acute moderate/severe TBI using actigraphy and to assess its association with injury severity and outcome.
In all, 16 hospitalized patients (27.1 ± 11.3 years) with moderate/severe TBI wore actigraphs for 10 days, starting in the intensive care unit (ICU) when continuous sedation was discontinued and patients had reached medical stability. Activity counts were summed for daytime (7:00-21:59 hours) and nighttime periods (22:00-6:59 hours). The ratio of daytime period activity to total 24-hour activity was used to quantify rest-activity cycle consolidation. An analysis of variance was carried out to characterize the evolution of the daytime activity ratio over the recording period.
Rest-activity cycle was consolidated only 46.6% of all days; however, a significant linear trend of improvement was observed over time. Greater TBI severity and longer ICU and hospital lengths of stay were associated with poorer rest-activity cycle consolidation and evolution. Patients with more rapid return to consolidated rest-activity cycle were more likely to have cleared posttraumatic amnesia and have lower disability at hospital discharge.
Patients with acute moderate/severe TBI had an altered rest-activity cycle, probably reflecting severe fragmentation of sleep and wake episodes, which globally improved over time. A faster return to rest-activity cycle consolidation may predict enhanced brain recovery.
睡眠-觉醒障碍是创伤性脑损伤（TBI）后最持久的后遗症之一，可能在TBI后的住院期间出现。这些障碍的特征是夜间睡眠困难和白天难以保持清醒。
本研究的目的是使用活动记录仪记录急性中度/重度TBI患者的休息-活动周期巩固情况，并评估其与损伤严重程度和预后的关系。
总共16名中度/重度TBI住院患者（27.1±11.3岁）佩戴活动记录仪10天，从重症监护病房（ICU）开始，当持续镇静停止且患者达到医学稳定状态时开始。计算白天（7:00-21:59）和夜间（22:00-6:59）的活动计数。白天活动与24小时总活动的比率用于量化休息-活动周期的巩固情况。进行方差分析以描述记录期内白天活动比率的变化情况。
休息-活动周期在所有天数中仅46.6%得到巩固；然而，随着时间的推移观察到显著的线性改善趋势。TBI严重程度越高、ICU和住院时间越长，休息-活动周期的巩固和进展越差。恢复到巩固的休息-活动周期更快的患者更有可能清除创伤后遗忘症，并且出院时残疾程度更低。
急性中度/重度TBI患者的休息-活动周期发生改变，可能反映了睡眠和觉醒发作的严重碎片化，随着时间的推移总体上有所改善。更快恢复到休息-活动周期巩固可能预示着脑恢复增强。
