Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA.
Centre for Neuro Skills, Los Angeles, CA, USA; Department of Neurosurgery, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA.
Brain Res Bull. 2022 Jul;185:117-128. doi: 10.1016/j.brainresbull.2022.04.017. Epub 2022 May 7.
Following a traumatic brain injury (TBI), sleep-wake disturbances are one of the most prevalent and debilitating symptoms. A better understanding of the impact that sleep disturbances have on chronic TBI symptomatology is likely to maximize long-term recovery. While the current treatments of sleep-wake disturbances following TBI are disorder-specific, identifying the underlying pathology may lead to improved pharmacological and rehabilitative treatments. A TBI initiates secondary cellular and molecular cascades that include inflammation and the production of cytokines, as well endocrine dysfunction and concomitant disturbances in hormone secretions. Hormones and cytokines are mediators of the inflammatory response that also regulate endocrine function, thus, communication between the immune and endocrine systems is bidirectional. Interestingly, both the immune and endocrine systems play a critical role in sleep regulation. This narrative review summarizes sleep-wake disturbances reported after TBI and synthesizes the current human and animal literature centered on the hypothesis that immune-endocrine interactions after TBI may induce both acute and chronic disturbances of sleep and wakefulness. Furthermore, we discuss how the immune and endocrine systems may be plausible therapeutic targets to treat TBI-induced sleep disturbances.
颅脑损伤（TBI）后，睡眠-觉醒障碍是最常见和最具致残性的症状之一。更好地了解睡眠障碍对慢性 TBI 症状学的影响，可能会最大限度地促进长期康复。虽然目前针对 TBI 后睡眠-觉醒障碍的治疗是针对特定疾病的，但确定潜在的病理可能会导致改善药理学和康复治疗。TBI 引发继发性细胞和分子级联反应，包括炎症和细胞因子的产生，以及内分泌功能障碍和伴随的激素分泌紊乱。激素和细胞因子是炎症反应的介质，也调节内分泌功能，因此，免疫系统和内分泌系统之间的通讯是双向的。有趣的是，免疫系统和内分泌系统在睡眠调节中都起着关键作用。本综述总结了 TBI 后报告的睡眠-觉醒障碍，并综合了目前以免疫-内分泌相互作用假说为中心的人类和动物文献，该假说认为 TBI 后免疫-内分泌相互作用可能导致急性和慢性睡眠和觉醒障碍。此外，我们还讨论了免疫系统和内分泌系统如何成为治疗 TBI 引起的睡眠障碍的合理治疗靶点。
