Background

Early-onset sleep disturbance is common following moderate to severe traumatic brain injury (TBI) and often emerges while patients are in posttraumatic amnesia (PTA). However, sleep disruptions during this subacute recovery phase are not well-defined, and research often utilizes indirect measures (actigraphy) that quantify sleep based on activity. This study aims to examine sleep macro-architecture and sleep quality directly with ambulatory polysomnography (PSG) and measure endogenous salivary melatonin levels for patients experiencing PTA following moderate to severe TBI.

Method

Participants were recruited from an inpatient TBI rehabilitation unit. Nighttime PSG was administered at the patient’s bedside. Two saliva specimens were collected for melatonin testing on a separate evening (24:00 and 06:00 hours) using melatonin hormone profile test kits.

Results

Of 27 patients in whom PSG was recorded, the minimum required monitoring time occurred in n =17 (adherence: 63%) at a median of 37.0 days (quartile 1 [Q1] to quartile 3 [Q3]: 21.5-50.5) postinjury. Median non–rapid eye movement (NREM) and REM sleep proportions were similar to normal estimates. Slow-wave sleep was reduced and absent in 35.3% of patients. Sleep periods appeared fragmented, and median sleep efficiency was reduced (63.4%; Q1-Q3: 55.1-69.2). Median melatonin levels at both timepoints were outside the normal range of values specified for this test (from Australian Clinical Labs).

Conclusion

This study reports that ambulatory PSG and salivary melatonin assessment are feasible for patients experiencing PTA and offers new insight into the extent of sleep disturbance. Further research is necessary to understand associations between PTA and sleep disturbance.

中文翻译：

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在创伤性脑损伤后的创伤后失忆症期间使用多导睡眠图评估睡眠结构：一项初步研究

背景

早发性睡眠障碍在中度至重度创伤性脑损伤 (TBI) 后很常见，并且通常在患者处于创伤后健忘症 (PTA) 时出现。然而，在这个亚急性恢复阶段的睡眠中断并没有明确的定义，研究通常使用基于活动量化睡眠的间接措施（活动记录仪）。本研究旨在通过动态多导睡眠图 (PSG) 直接检查睡眠宏观结构和睡眠质量，并测量中度至重度 TBI 后经历 PTA 的患者的内源性唾液褪黑激素水平。

方法

参与者是从住院 TBI 康复单位招募的。在患者床边进行夜间 PSG。在单独的晚上（24:00 和 06:00）使用褪黑激素检测试剂盒收集两个唾液样本进行褪黑激素检测。

结果

在记录 PSG 的 27 名患者中，所需的最短监测时间发生在 n = 17（依从性：63%）中，中位数为 37.0 天（四分位数 1 [Q1] 至四分位数 3 [Q3]：21.5-50.5）。中位非快速眼动 (NREM) 和 REM 睡眠比例与正常估计值相似。35.3% 的患者慢波睡眠减少且不存在。睡眠时间显得支离破碎，中位睡眠效率降低（63.4%；Q1-Q3：55.1-69.2）。两个时间点的中位褪黑激素水平都超出了该测试指定的正常值范围（来自澳大利亚临床实验室）。

结论

这项研究报告说，动态 PSG 和唾液褪黑激素评估对于经历 PTA 的患者是可行的，并为睡眠障碍的程度提供了新的见解。需要进一步的研究来了解 PTA 与睡眠障碍之间的关联。