Bell Allen, Hewins Bryson, Bishop Courtney, Fortin Amanda, Wang Jonathan, Creamer Jennifer L, Collen Jacob, Werner J Kent
Walter Reed National Military Medical Center, Bethesda, MD 20814, USA.
School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
Clocks Sleep. 2023 Apr 6;5(2):177-203. doi: 10.3390/clockssleep5020016.
Traumatic brain injury (TBI) is one of the most prevalent causes of morbidity in the United States and is associated with numerous chronic sequelae long after the point of injury. One of the most common long-term complaints in patients with TBI is sleep dysfunction. It is reported that alterations in melatonin follow TBI and may be linked with various sleep and circadian disorders directly (via cellular signaling) or indirectly (via free radicals and inflammatory signaling). Work over the past two decades has contributed to our understanding of the role of melatonin as a sleep regulator and neuroprotective anti-inflammatory agent. Although there is increasing interest in the treatment of insomnia following TBI, a lack of standardization and rigor in melatonin research has left behind a trail of non-generalizable data and ambiguous treatment recommendations. This narrative review describes the underlying biochemical properties of melatonin as they are relevant to TBI. We also discuss potential benefits and a path forward regarding the therapeutic management of TBI with melatonin treatment, including its role as a neuroprotectant, a somnogen, and a modulator of the circadian rhythm.
创伤性脑损伤（TBI）是美国发病率最高的病因之一，并且在损伤后很长时间都与众多慢性后遗症相关。TBI患者最常见的长期主诉之一是睡眠功能障碍。据报道，TBI后褪黑素会发生改变，可能直接（通过细胞信号传导）或间接（通过自由基和炎症信号传导）与各种睡眠和昼夜节律紊乱有关。过去二十年的研究有助于我们了解褪黑素作为睡眠调节因子和神经保护抗炎剂的作用。尽管人们对TBI后失眠的治疗越来越感兴趣，但褪黑素研究缺乏标准化和严谨性，留下了一系列无法推广的数据和模棱两可的治疗建议。这篇叙述性综述描述了褪黑素与TBI相关的潜在生化特性。我们还讨论了褪黑素治疗TBI的潜在益处以及治疗管理的未来方向，包括其作为神经保护剂、催眠剂和昼夜节律调节剂的作用。
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