睡眠结构在创伤性脑损伤后意识障碍患者意识状态评估及恢复中作用的研究进展

Role of sleep architecture in the assessment and recovery of conscious state in patients with consciousness disorders following traumatic brain injury:a review

创伤性脑损伤(TBI)后意识障碍是由于脑实质和(或)脑血管受损等原因导致的意识缺损。随着TBI患者数量不断增加,意识障碍患者数量也日益增多。此类患者病程较长,却丧失大部分自主能力,严重影响其生活质量。然而,目前关于意识障碍的脑损伤机制尚不明确。TBI后意识障碍患者的意识评估主要借助量表,误诊率较高;常用的干预手段包括金刚烷胺、唑吡坦等药物,以及包含神经调控和感觉刺激程序在内的非药物干预,均不能获得满意的疗效,亟需更加精准的评估指标及有效的干预措施。睡眠所维持的各种神经生理活动对意识至关重要,其规律性很可能反映TBI后意识障碍患者的意识状态,睡眠的规律性一般通过睡眠结构来体现,包括昼夜节律和各种睡眠特征,而改善患者睡眠的规律性也可能促进其意识状态的恢复。为此,笔者就睡眠结构在TBI后意识障碍患者意识状态评估及恢复中作用的研究进展进行综述,为其临床应用提供参考。

Consciousness disorders following traumatic brain injury(TBI)are alterations in consciousness due to damage to the brain parenchyma and/or brain vessels.As the number of TBI patients continues to increase,so does the number of patients with consciousness disorders following TBI.The patients′quality of life was seriously affected due to a long course of illness and loss of most of independence.However,at present,the mechanisms of consciousness disorders in TBI are still unknown.The assessment of conscious state in patients with consciousness disorders following TBI mainly depends on scales,resulting in a high rate of misdiagnosis.Common interventions,including pharmacological interventions such as amantadine and zolpidem,as well as non-pharmacological interventions such as neuromodulation and sensory stimulation programs,fail to achieve extensive efficacy.Therefore,there is an urgent need for more accurate assessment indicators as well as effective therapeutic interventions.Various neurophysiological activities sustained by sleep are crucial for consciousness.Sleep regularity is likely to reflect the conscious state of patients with consciousness disorders following TBI.Sleep regularity is generally reflected through sleep architecture,including circadian rhythms and various sleep characteristics.Therefore,the authors reviewed the research progress in the application of sleep architecture in the assessment and recovery of conscious state in patients with consciousness disorders following TBI,so as to provide reference for its clinical application.