A Patient with the Disrupted Sleep-Wake Rhythm after Traumatic Brain Injury / 신경정신의학

Many patients with a traumatic brain injury (TBI) experience a range of sleep problems. Although some studies investigated the pathophysiology of sleep-wake cycle disturbances in TBI patients, it has not been clarified. This paper presents a middle aged female patient who showed sleep deprivation and sleep-wake cycle disturbances for approximately three months after TBI. The improvement in the subjective and objective sleep quality was shown by the sleep diary and actigraphy during this period. Moreover, the dim light melatonin onset (DLMO) had been delayed before returning to the normal range in 3 months. In addition, the patient showed an improvement in the neurocognitive function, including attention, memory and language function, along with a consolidation of the sleep-wake cycle. This case showed that the sleep disturbance following a TBI was probably caused by the disrupted melatonin rhythm based on the abnormality of the DLMO. In addition, the cognitive dysfunction after TBI could be associated with sleep-wake cycle disturbances because its gradual improvement occurred as the sleep disturbance diminished. Further studies on the change in circadian rhythm after a brain injury related to neurocognitive impairment are required.

Sleep-wake rhythm after extracorporeal circulation in New Zealand rabbits / 中南大学学报(医学版)

Objective:To evaluate the change of sleep-wake rhythm after extracorporeal circulation (ECC) in New Zealand rabbits,and to explore the role of clock genes in sleep-wake rhythm disorder by ECC.Methods:A total of 54 New Zealand rabbits were randomly divided into 3 groups:a normal group (Group N),a sham group (Group S) and a model group (Group ECC).Electrocorticogram (ECOG),electroophthalmogram (EOG) and electromyogram (EMG) were respectively recorded by multipurpose EEG recorder,and the sleep-wake rhythm was also recorded.The mRNA and protein expressions of period1 (Per1) and cryptochrome1 (Cry1) were detected by semiquantitative reverse transcriptase PCR (RT-PCR) and Western blot in pineal gland of rabbits.The differences between the 3 groups were compared.Results:1) Compared with the Group N and Group S at 24,48 h respectively,the total amount of sleep (TAS),light time,slow wave sleep (SWS) in the Group ECC at 24,48 h were significantly reduced (all P＜0.05),and the proportion of light sleep increased (all P＜0.05),the proportion of SWS decreased (all P＜0.05);2) Compared with the Group N and Group S,the expression of Per1 mRNA in the Group ECC at 24,48 h and Cry1 mRNA at 24 h significantly increased (all P＜0.05);3) Compared with the Group N and Group S,the expression of Perl protein in the Group ECC at 48 h and Cry1 protein at 24 h significantly increased (all P＜0.05);4) In the Group ECC,the sleepwake rhythm disorder and clock genes expression were ameliorated at 72 h after surgery.Conclusion:ECC can cause sleep-wake rhythm disorder in New Zealand rabbits,which may be related to the abnormal expression of Per1 and Cry1,and their transcription proteins.

Effects of sleep intervention on sleep quality of elderly patients with sleep-wake rhythm disorders / 现代临床护理

Objective To study the effects of sleep intervention on sleep quality of hospitalized elderly patients with sleep-wake rhythm disorders.Methods We applied sleep intervention among 39 hospitalized elderly patients with sleep-wake rhythm disorders.The degree of sleep-wake rhythm disorders was compared by using Athens Insomnia Scale(AIS)and Epworth Sleepiness Scale(ESS)between pro- and post-sleep intervention.Result The degree of sleep-wake rhythm disorders was significantly improved after 3 months of sleep intervention(Z=13.56,P<0.05).Conclusion Sleep intervention at daytime and nighttime may help the hospitalized elderly patients with sleep-wake rhythm disorders resume to normal sleep-wake rhythm gradually so that the hospitalized elderly patients with sleep-wake rhythm disorders can improve sleep quality and recover from diseases.

Overview of sleep & sleep disorders.

Sleep is defined on the basis of behavioural and physiological criteria dividing it into two states: non rapid eye movement (NREM) sleep which is subdivided into three stages (N1, N2, N3); and rapid eye movement (REM) sleep characterized by rapid eye movements, muscle atonia and desynchronized EEG. Circadian rhythm of sleep-wakefulness is controlled by the master clock located in the suprachiasmatic nuclei of the hypothalamus. The neuroanatomical substrates of the NREM sleep are located principally in the ventrolateral preoptic nucleus of the hypothalamus and those of REM sleep are located in pons. A variety of significant physiological changes occur in all body systems and organs during sleep as a result of functional alterations in the autonomic and somatic nervous systems. The international classification of sleep disorders (ICSD, ed 2) lists eight categories of sleep disorders along with appendix A and appendix B. The four major sleep complaints include excessive daytime sleepiness, insomnia, abnormal movements or behaviour during sleep and inability to sleep at the desired time. The most important step in assessing a patient with a sleep complaint is obtaining a detailed history including family and previous histories, medical, psychiatric, neurological, drug, alcohol and substance abuse disorders. Some important laboratory tests for investigating sleep disorders consist of an overnight polysomnography, multiple sleep latency and maintenance of wakefulness tests as well as actigraphy. General physicians should have a basic knowledge of the salient clinical features of common sleep disorders, such as insomnia, obstructive sleep apnoea syndrome, narcolepsy-cataplexy syndrome, circadian rhythm sleep disorders (e.g., jet leg, shift work disorder, etc.) and parasomnias (e.g., partial arousal disorders, REM behaviour disorder, etc.) and these are briefly described in this chapter. The principle of treatment of sleep disorders is first to find cause of the sleep disturbance and vigorously treat the co-morbid conditions causing the sleep disturbance. If a satisfactory treatment is not available for the primary condition or does not resolve the problem, the treatment should be directed at the specific sleep disturbance. Most sleep disorders, once diagnosed, can be managed with limited consultations. The treatment of primary sleep disorders, however, is best handled by a sleep specialist. An overview of sleep and sleep disorders viz., Basic science; international classification and approach; and phenomenology of common sleep disorders are presented.

Relationship of Neurocognitive Function with the Sleep-Wake Rhythm in Mild Cognitive Impairment Patients / 신경정신의학

OBJECTIVES: We compared the parameters of the sleep-wake rhythm in mild cognitive impairment (MCI) patients to those of normal elderly subjects, to illustrate how the characteristics of circadian rhythm relate to a specific neurocognitive function. METHODS: We selected 12 MCI patients and 12 age- and sex-matched normal control (NC) subjects and administered the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet (CERAD-K) Neuropsychological battery and Stroop Color-Word Test (SCWT) to each subject. We measured each subject's sleep-wake rhythm by applying actigraphy for 96 hours. The sleep-wake rhythm was examined by cosinor analysis. RESULTS: There was no significant difference in the amplitude or acrophase of the sleep-wake rhythms between the NC and MCI groups. In the combined group, amplitude was positively correlated with Constructional Praxis scores (r=0.434, p<0.05), and acrophases tended to be positively correlated with Word List Memory scores (r=0.370, p=0.07). CONCLUSION: There was no difference between MCI patients' sleep-wake rhythm's amplitude and acrophase and those of NC subjects. Furthermore, decreased amplitude was associated with impaired visuospatial function in the combined group. It will be necessary to confirm this result in an expanded MCI group in a future study.