Sandsmark Danielle K, Kumar Monisha A, Woodward Catherine S, Schmitt Sarah E, Park Soojin, Lim Miranda M
Department of Neurology, University of Pennsylvania, Philadelphia (Drs Sandsmark and Kumar); Departments of Neurology, Brigham and Women's Hospital & Massachusetts General Hospital, Boston, Massachusetts (Dr Woodward); Department of Neurology, Medical University of South Carolina, Charleston (Dr Schmitt); Department of Neurology, Columbia University, New York (Dr Park); and Veterans Affairs Portland Health Care System, Department of Medicine, Division of Pulmonary and Critical Care Medicine; Department of Neurology; Department of Behavioral Neuroscience; Oregon Health & Sciences University, and Oregon Institute of Occupational Health Sciences, Portland, Oregon (Dr Lim).
J Head Trauma Rehabil. 2016 Mar-Apr;31(2):101-7. doi: 10.1097/HTR.0000000000000217.
Sleep characteristics detected by electroencephalography (EEG) may be predictive of neurological recovery and rehabilitation outcomes after traumatic brain injury (TBI). We sought to determine whether sleep features were associated with greater access to rehabilitation therapies and better functional outcomes after severe TBI.
We retrospectively reviewed records of patients admitted with severe TBI who underwent 24 or more hours of continuous EEG (cEEG) monitoring within 14 days of injury for sleep elements and ictal activity. Patient outcomes included discharge disposition and modified Rankin Scale (mRS).
A total of 64 patients underwent cEEG monitoring for a mean of 50.6 hours. Status epilepticus or electrographic seizures detected by cEEG were associated with poor outcomes (death or discharge to skilled nursing facility). Sleep characteristics were present in 19 (30%) and associated with better outcome (89% discharged to home/acute rehabilitation; P = .0002). Lack of sleep elements on cEEG correlated with a poor outcome or mRS > 4 at hospital discharge (P = .012). Of those patients who were transferred to skilled nursing/acute rehabilitation, sleep architecture on cEEG associated with a shorter inpatient hospital stay (20 days vs 27 days) and earlier participation in therapy (9.8 days vs 13.2 days postinjury). Multivariable analyses indicated that sleep features on cEEG predicted functional outcomes independent of admission Glasgow Coma Scale and ictal-interictal activity.
The presence of sleep features in the acute period after TBI indicates earlier participation in rehabilitative therapies and a better functional recovery. By contrast, status epilepticus, other ictal activity, or absent sleep architecture may portend a worse prognosis. Whether sleep elements detected by EEG predict long-term prognosis remains to be determined.
通过脑电图（EEG）检测到的睡眠特征可能预示着创伤性脑损伤（TBI）后的神经恢复和康复结果。我们试图确定睡眠特征是否与重度TBI后获得更多康复治疗及更好的功能结局相关。
我们回顾性分析了重度TBI患者的记录，这些患者在受伤后14天内接受了24小时或更长时间的连续脑电图（cEEG）监测，以了解睡眠要素和发作期活动情况。患者结局包括出院处置和改良Rankin量表（mRS）。
共有64例患者接受了cEEG监测，平均监测时间为50.6小时。cEEG检测到的癫痫持续状态或脑电图发作与不良结局（死亡或出院至专业护理机构）相关。19例（30%）患者存在睡眠特征，且与较好的结局相关（89%出院回家/接受急性康复治疗；P = 0.0002）。cEEG上缺乏睡眠要素与出院时不良结局或mRS>4相关（P = 0.012）。在转至专业护理/急性康复机构的患者中，cEEG上的睡眠结构与住院时间较短（20天对27天）及更早参与治疗（受伤后9.8天对13.2天）相关。多变量分析表明，cEEG上的睡眠特征可独立于入院时格拉斯哥昏迷量表和发作期-发作间期活动情况预测功能结局。
TBI急性期出现睡眠特征表明能更早参与康复治疗并获得更好的功能恢复。相比之下，癫痫持续状态、其他发作期活动或缺乏睡眠结构可能预示预后更差。EEG检测到的睡眠要素是否能预测长期预后仍有待确定。
