Sandsmark Danielle K, Elliott Jonathan E, Lim Miranda M
Department of Neurology, University of Pennsylvania, Philadelphia, PA.
VA Portland Health Care System, Portland, OR.
Sleep. 2017 May 1;40(5). doi: 10.1093/sleep/zsx044.
Sleep-wake disturbances following traumatic brain injury (TBI) are increasingly recognized as a serious consequence following injury and as a barrier to recovery. Injury-induced sleep-wake disturbances can persist for years, often impairing quality of life. Recently, there has been a nearly exponential increase in the number of primary research articles published on the pathophysiology and mechanisms underlying sleep-wake disturbances after TBI, both in animal models and in humans, including in the pediatric population. In this review, we summarize over 200 articles on the topic, most of which were identified objectively using reproducible online search terms in PubMed. Although these studies differ in terms of methodology and detailed outcomes; overall, recent research describes a common phenotype of excessive daytime sleepiness, nighttime sleep fragmentation, insomnia, and electroencephalography spectral changes after TBI. Given the heterogeneity of the human disease phenotype, rigorous translation of animal models to the human condition is critical to our understanding of the mechanisms and of the temporal course of sleep-wake disturbances after injury. Arguably, this is most effectively accomplished when animal and human studies are performed by the same or collaborating research programs. Given the number of symptoms associated with TBI that are intimately related to, or directly stem from sleep dysfunction, sleep-wake disorders represent an important area in which mechanistic-based therapies may substantially impact recovery after TBI.
创伤性脑损伤(TBI)后的睡眠-觉醒障碍日益被视为损伤后的严重后果以及恢复的障碍。损伤引起的睡眠-觉醒障碍可能持续数年,常常损害生活质量。最近,关于TBI后睡眠-觉醒障碍潜在病理生理学和机制的原发性研究文章数量几乎呈指数级增长,这些研究涵盖动物模型和人类,包括儿科人群。在本综述中,我们总结了200多篇关于该主题的文章,其中大部分是通过在PubMed中使用可重复的在线搜索词客观识别出来的。尽管这些研究在方法和详细结果方面存在差异,但总体而言,最近的研究描述了TBI后白天过度嗜睡、夜间睡眠碎片化、失眠和脑电图频谱变化的共同表型。鉴于人类疾病表型的异质性,将动物模型严格转化到人类情况对于我们理解损伤后睡眠-觉醒障碍的机制和时间进程至关重要。可以说,当动物和人类研究由同一或合作研究项目进行时,这一点能最有效地实现。鉴于与TBI相关的许多症状与睡眠功能障碍密切相关或直接源于睡眠功能障碍,睡眠-觉醒障碍是一个重要领域,基于机制的疗法可能会对TBI后的恢复产生重大影响。
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