Duclos Catherine, Dumont Marie, Arbour Caroline, Paquet Jean, Blais Hélène, Menon David K, De Beaumont Louis, Bernard Francis, Gosselin Nadia
From the Center for Advanced Research in Sleep Medicine (C.D., M.D., C.A., J.P., H.B., L.D.B., N.G.) and the Traumatology Program (F.B.), Hôpital du Sacré-Coeur de Montréal; Departments of Psychiatry (C.D., M.D.), Psychology (C.A., N.G.), and Medicine (F.B.), Université de Montréal, Canada; Division of Anaesthesia (D.K.M.), University of Cambridge, UK; and Department of Psychology (L.D.B.), Université du Québec à Trois-Rivières, Canada.
Neurology. 2017 Jan 17;88(3):268-275. doi: 10.1212/WNL.0000000000003508. Epub 2016 Dec 21.
To investigate whether the progressive recuperation of consciousness was associated with the reconsolidation of sleep and wake states in hospitalized patients with acute traumatic brain injury (TBI).
This study comprised 30 hospitalized patients (age 29.1 ± 13.5 years) in the acute phase of moderate or severe TBI. Testing started 21.0 ± 13.7 days postinjury. Consciousness level and cognitive functioning were assessed daily with the Rancho Los Amigos scale of cognitive functioning (RLA). Sleep and wake cycle characteristics were estimated with continuous wrist actigraphy. Mixed model analyses were performed on 233 days with the RLA (fixed effect) and sleep-wake variables (random effects). Linear contrast analyses were performed in order to verify if consolidation of the sleep and wake states improved linearly with increasing RLA score.
Associations were found between scores on the consciousness/cognitive functioning scale and measures of sleep-wake cycle consolidation (p < 0.001), nighttime sleep duration (p = 0.018), and nighttime fragmentation index (p < 0.001). These associations showed strong linear relationships (p < 0.01 for all), revealing that consciousness and cognition improved in parallel with sleep-wake quality. Consolidated 24-hour sleep-wake cycle occurred when patients were able to give context-appropriate, goal-directed responses.
Our results showed that when the brain has not sufficiently recovered a certain level of consciousness, it is also unable to generate a 24-hour sleep-wake cycle and consolidated nighttime sleep. This study contributes to elucidating the pathophysiology of severe sleep-wake cycle alterations in the acute phase of moderate to severe TBI.
探讨急性创伤性脑损伤（TBI）住院患者意识的逐步恢复是否与睡眠和觉醒状态的重新巩固有关。
本研究纳入30例中度或重度TBI急性期的住院患者（年龄29.1±13.5岁）。伤后21.0±13.7天开始测试。每天用认知功能的Rancho Los Amigos量表（RLA）评估意识水平和认知功能。通过连续手腕活动记录仪估计睡眠和觉醒周期特征。对233天的RLA（固定效应）和睡眠-觉醒变量（随机效应）进行混合模型分析。进行线性对比分析以验证睡眠和觉醒状态的巩固是否随着RLA评分的增加而线性改善。
意识/认知功能量表得分与睡眠-觉醒周期巩固指标（p<0.001）、夜间睡眠时间（p = 0.018）和夜间碎片化指数（p<0.001）之间存在关联。这些关联显示出很强的线性关系（均p<0.01），表明意识和认知与睡眠-觉醒质量同步改善。当患者能够做出情境适当、目标导向的反应时，出现了24小时巩固的睡眠-觉醒周期。
我们的结果表明，当大脑尚未充分恢复到一定的意识水平时，它也无法产生24小时的睡眠-觉醒周期和巩固的夜间睡眠。本研究有助于阐明中度至重度TBI急性期严重睡眠-觉醒周期改变的病理生理学。
