Department of Neurology, Uniformed Services University of Health Sciences, Bethesda, MD.
Center for Neuroscience and Regenerative Medicine, Bethesda, MD.
Sleep. 2021 Jun 11;44(6). doi: 10.1093/sleep/zsaa272.
Sleep disorders affect over half of mild traumatic brain injury (mTBI) patients. Despite evidence linking sleep and neurodegeneration, longitudinal TBI-related dementia studies have not considered sleep. We hypothesized that poor sleepers with mTBI would have elevated markers of neurodegeneration and lower cognitive function compared to mTBI good sleepers and controls. Our objective was to compare biomarkers of neurodegeneration and cognitive function with sleep quality in warfighters with chronic mTBI.
In an observational warfighters cohort (n = 138 mTBI, 44 controls), the Pittsburgh Sleep Quality Index (PSQI) was compared with plasma biomarkers of neurodegeneration and cognitive scores collected an average of 8 years after injury.
In the mTBI cohort, poor sleepers (PSQI ≥ 10, n = 86) had elevated plasma neurofilament light (NfL, x̅ = 11.86 vs 7.91 pg/mL, p = 0.0007, d = 0.63) and lower executive function scores by the categorical fluency (x̅ = 18.0 vs 21.0, p = 0.0005, d = -0.65) and stop-go tests (x̅ = 30.1 vs 31.1, p = 0.024, d = -0.37). These findings were not observed in controls (n = 44). PSQI predicted NfL (beta = 0.22, p = 0.00002) and tau (beta = 0.14, p = 0.007), but not amyloid β42. Poor sleepers showed higher obstructive sleep apnea (OSA) risk by STOP-BANG scores (x̅ = 3.8 vs 2.7, p = 0.0005), raising the possibility that the PSQI might be partly secondary to OSA.
Poor sleep is linked to neurodegeneration and select measures of executive function in mTBI patients. This supports implementation of validated sleep measures in longitudinal studies investigating pathobiological mechanisms of TBI related neurodegeneration, which could have therapeutic implications.
睡眠障碍影响超过一半的轻度创伤性脑损伤（mTBI）患者。尽管有证据表明睡眠与神经退行性变有关，但与 TBI 相关的痴呆症的纵向研究并未考虑睡眠。我们假设与 mTBI 良好睡眠者和对照组相比，睡眠不佳的 mTBI 患者会有更高的神经退行性变标志物和更低的认知功能。我们的目的是比较慢性 mTBI 战士的睡眠质量与神经退行性变生物标志物和认知功能。
在一项观察性战士队列（n = 138 例 mTBI，44 例对照）中，比较匹兹堡睡眠质量指数（PSQI）与平均受伤 8 年后采集的神经退行性变血浆生物标志物和认知评分。
在 mTBI 队列中，睡眠不佳者（PSQI≥10，n = 86）的血浆神经丝轻链（NfL，x̅ = 11.86 与 7.91 pg/mL，p = 0.0007，d = 0.63）升高，且执行功能评分较低，类别流畅性（x̅ = 18.0 与 21.0，p = 0.0005，d = -0.65）和停止-走测试（x̅ = 30.1 与 31.1，p = 0.024，d = -0.37）。这些发现在对照组（n = 44）中并未观察到。PSQI 预测 NfL（β = 0.22，p = 0.00002）和 tau（β = 0.14，p = 0.007），但不预测淀粉样蛋白β42。睡眠不佳者的 STOP-BANG 评分显示阻塞性睡眠呼吸暂停（OSA）风险更高（x̅ = 3.8 与 2.7，p = 0.0005），这表明 PSQI 可能部分是由于 OSA 引起的。
睡眠质量差与 mTBI 患者的神经退行性变和特定执行功能测量有关。这支持在研究与 TBI 相关神经退行性变的病理生物学机制的纵向研究中实施经过验证的睡眠测量，这可能具有治疗意义。
