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Retrospective analysis of sleep patterns in patients with chronic disorders of consciousness.

ABSTRACT: Analysis of sleep patterns in patients with chronic disorders of consciousness attracts attention from the perspective of the diagnosis and prognosis of the disease as well as the treatment. Yet, the very existence of normal sleep in patients in a vegetative or minimally conscious state is still a matter of debate. This paper presents a retrospective analysis of overnight polysomnographic records of 40 patients with chronic disorders of consciousness aimed at the possibility of establishing the connection between the degree of impaired consciousness and the presence and organization of polysomnographic graphical elements, associated with stages of sleep in normal individuals. Specialized software based on expert system artificial intelligence was developed to calculate indices and parameters that characterize sleep. It was shown that a remarkably low percentage of patients have a rhythmic change in sleep patterns, what indicates the prevalence of violations of the Sleep-Wake cycle in a vegetative state and minimally conscious state. Sleep spindles were not found in records, however, the absence can originate from the limitations of polysomnographic method applied to patients with severe brain damage. A positive correlation between the rhythmic change of sleep patterns, better outcome and CRS-R scores was confirmed.

SUBMITTER: Nekrasova J

PROVIDER: S-EPMC8041117 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

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Retrospective analysis of sleep patterns in patients with chronic disorders of consciousness.

Nekrasova Julia J Kanarskii Mikhail M Yankevich Dmitrii D Shpichko Andrey A Borisov Ilya I Pradhan Pranil P Miroshnichenko Maria M

Sleep medicine: X 20200828

Analysis of sleep patterns in patients with chronic disorders of consciousness attracts attention from the perspective of the diagnosis and prognosis of the disease as well as the treatment. Yet, the very existence of normal sleep in patients in a vegetative or minimally conscious state is still a matter of debate. This paper presents a retrospective analysis of overnight polysomnographic records of 40 patients with chronic disorders of consciousness aimed at the possibility of establishing the ...[more]

PMID: 33870176

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Project description:BackgroundSleep-wakefulness cycles are an essential diagnostic criterion for disorders of consciousness (DOC), differentiating prolonged DOC from coma. Specific sleep features, like the presence of sleep spindles, are an important marker for the prognosis of recovery from DOC. Based on increasing evidence for a link between sleep and neuronal plasticity, understanding sleep in DOC might facilitate the development of novel methods for rehabilitation. Yet, well-controlled studies of sleep in DOC are lacking. Here, we aimed to quantify, on a reliable evaluation basis, the distribution of behavioral and neurophysiological sleep patterns in DOC over a 24-h period while controlling for environmental factors (by recruiting a group of conscious tetraplegic patients who resided in the same hospital).MethodsWe evaluated the distribution of sleep and wakefulness by means of polysomnography (EEG, EOG, EMG) and video recordings in 32 DOC patients (16 unresponsive wakefulness syndrome [UWS], 16 minimally conscious state [MCS]), and 10 clinical control patients with severe tetraplegia. Three independent raters scored the patients' polysomnographic recordings.ResultsAll but one patient (UWS) showed behavioral and electrophysiological signs of sleep. Control and MCS patients spent significantly more time in sleep during the night than during daytime, a pattern that was not evident in UWS. DOC patients (particularly UWS) exhibited less REM sleep than control patients. Forty-four percent of UWS patients and 12% of MCS patients did not have any REM sleep, while all control patients (100%) showed signs of all sleep stages and sleep spindles. Furthermore, no sleep spindles were found in 62% of UWS patients and 21% of MCS patients. In the remaining DOC patients who had spindles, their number and amplitude were significantly lower than in controls.ConclusionsThe distribution of sleep signs in DOC over 24 h differs significantly from the normal sleep-wakefulness pattern. These abnormalities of sleep in DOC are independent of external factors such as severe immobility and hospital environment.

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Retrospective analysis of sleep patterns in patients with chronic disorders of consciousness.

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Retrospective analysis of sleep patterns in patients with chronic disorders of consciousness.

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