Hong Chien-Tai, Wong Chung-Shun, Ma Hon-Ping, Wu Dean, Huang Yao-Hsien, Wu Chung-Che, Lin Chien-Min, Su Yu-Kai, Liao Kuo-Hsing, Ou Ju-Chi, Hu Chaur-Jong
Department of Neurology, Taipei Medical University-Shuang Ho Hospital, Taiwan.
Department of Emergency Medicine, Taipei Medical University-Shuang Ho Hospital, Taiwan; Graduate Institute of Clinical Medicine, Taipei Medical University, Taiwan.
J Neurol Sci. 2015 Nov 15;358(1-2):385-9. doi: 10.1016/j.jns.2015.09.376. Epub 2015 Oct 4.
Mild traumatic brain injury (mTBI) causes transient sleep disorders and circadian dysrhythmia. One of the clock genes, PERIOD3 (PER3), regulates the circadian rhythm and contains a genetic polymorphism, namely a variable-number tandem repeat in the coding area with either four or five repeats. PER3(5) carriers are inclined to have a morning preference and associated with higher risk of bipolar disorder and diabetes. This study investigated the effects of PER3 polymorphism on sleep quality changes after mTBI.
From May 2012 to May 2014, a total of 96 mTBI patients completed the baseline (1 week after mTBI) and follow-up (6 weeks after mTBI) assessments, including the Pittsburgh Sleep Quality Index (PSQI) and anxiety and depression questionnaires. Statistics were analyzed using the Mann-Whitney U test, Wilcox signed-rank test or chi-squared test.
Among the 96 patients, 24 were heterozygous PER3(5) carriers (PER3(4/5)), and the rest of 72 were PER3(5) noncarriers (PER3(4/4)). The subscale of PSQI questionnaire results indicated that the PER3(5) allele was associated with significant sleep duration shortening, but improvement in overall sleep quality. Furthermore, analyzing patients with sleep disturbance at the baseline (PSQI >5) revealed that only the PER3(5) noncarriers exhibited a significant improvement in overall PSQI scores.
PER3(5) carriers exhibited sleep duration shortening and improved daytime function 6 weeks after mTBI compared with the baseline values. On the other hand, among poor sleepers, PER3(5) carriers did not embrace a significant improvement of overall PSQI scores as noncarriers. The underlying mechanisms and clinical significances must be investigated further.
轻度创伤性脑损伤（mTBI）会导致短暂性睡眠障碍和昼夜节律失调。生物钟基因之一的周期蛋白3（PER3）调节昼夜节律，且存在基因多态性，即在编码区有可变数目串联重复序列，有4次或5次重复两种情况。PER3(5)携带者倾向于偏好早晨，且患双相情感障碍和糖尿病的风险较高。本研究调查了PER3基因多态性对mTBI后睡眠质量变化的影响。
2012年5月至2014年5月，共有96例mTBI患者完成了基线（mTBI后1周）和随访（mTBI后6周）评估，包括匹兹堡睡眠质量指数（PSQI）以及焦虑和抑郁问卷。采用曼-惠特尼U检验、威尔科克森符号秩检验或卡方检验进行统计分析。
在96例患者中，24例为PER3(5)杂合携带者（PER3(4/5)），其余72例为PER3(5)非携带者（PER3(4/4)）。PSQI问卷结果的子量表显示，PER3(5)等位基因与睡眠时间显著缩短相关，但总体睡眠质量有所改善。此外，对基线时存在睡眠障碍（PSQI>5）的患者进行分析发现，只有PER3(5)非携带者的总体PSQI评分有显著改善。
与基线值相比，mTBI后6周，PER3(5)携带者睡眠时间缩短，白天功能有所改善。另一方面，在睡眠不佳的患者中，PER3(5)携带者总体PSQI评分并未像非携带者那样有显著改善。其潜在机制和临床意义必须进一步研究。
