Gao Sijia, Bibineyshvili Yelena, Safavynia Seyed A, Calderón-Martínez Juan, Grinspan Zachary M, Calderon Diany P
Department of Anesthesiology, Weill Cornell Medical College, New York, NY 10065.
Department of Pediatrics, Weill Cornell Medical College, New York, NY 10065.
Proc Natl Acad Sci U S A. 2025 May 13;122(19):e2413789122. doi: 10.1073/pnas.2413789122. Epub 2025 May 5.
While current arousal level assessments in patients with disorders of consciousness discriminate altered states of consciousness, there are significant limitations in characterizing the transition from one state to another or quantifying the frequent arousal level fluctuations observed in a patient. Here, we identified a repeated, temporally discrete, dynamical pattern evident in the recovery of consciousness from anesthesia and brain injury coma models in rodents. We prospectively validated these features we label "Arousal Units" (AU) in neonatal humans recovering from static hypoxic injuries and senior patients emerging from anesthesia indicating their generalizability. The AUs lawfully link changes in spectral power and breathing frequency and reliably associate with motor changes. Distinctive cortical patterns within AUs can be transformed into arousal indices, determining arousal levels. The reliability of these events is demonstrated across intact and brain-injured states and translates to the human brain; extracting these stereotyped dynamics could aid anesthesia monitoring, tracking coma recovery, and identifying cognitive motor dissociation.
虽然目前对意识障碍患者的觉醒水平评估能够区分意识改变状态，但在表征从一种状态到另一种状态的转变或量化患者中观察到的频繁觉醒水平波动方面存在重大局限性。在这里，我们在啮齿动物从麻醉和脑损伤昏迷模型中恢复意识的过程中发现了一种重复的、时间上离散的动态模式。我们前瞻性地验证了这些我们标记为“觉醒单元”（AU）的特征，这些特征在从静态缺氧损伤中恢复的新生儿和从麻醉中苏醒的老年患者中得到体现，表明了它们的通用性。觉醒单元合法地将频谱功率和呼吸频率的变化联系起来，并可靠地与运动变化相关联。觉醒单元内独特的皮质模式可以转化为觉醒指数，从而确定觉醒水平。这些事件的可靠性在完整和脑损伤状态下均得到证明，并可转化应用于人类大脑；提取这些刻板的动态特征有助于麻醉监测、追踪昏迷恢复情况以及识别认知运动分离。
