외상성 뇌손상 후 수면-각성 리듬 교란을 동반한 환자의 증례
A Patient with the Disrupted Sleep-Wake Rhythm after Traumatic Brain Injury
0
조회
0
다운로드
0
인용
0
참고문헌
초록
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.
Abstract
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.
참고문헌 (19)
- Ouellet MC, "Sleep-wake disturbances after traumatic brain injury", Lancet Neurol, 14, pp.746~757 (2015)
- Duclos C, "Sleep and wake disturbances following traumatic brain injury", Pathol Biol(Paris), 62, pp.252~261 (2014)
- Werner JK Jr, "TBI and sleep-wake disorders : pathophysiology, clinical management, and moving towards the future", Semin Neurol, 37, pp.419~432 (2017)
- Moore RY, "Suprachiasmatic nucleus organization", Cell Tissue Res, 309, pp.89~98 (2002)
- Lewy AJ, "Hormones, Brain and Behavior", pp.2505~2528 (2010), Elsevier
- Shekleton JA, "Sleep disturbance and melatonin levels following traumatic brain injury", Neurology, 74, pp.1732~1738 (2010)
- Duclos C, "Rest-activity cycle disturbances in the acute phase of moderate to severe traumatic brain injury", Neurorehabil Neural Repair, 28, pp.472~482 (2014)
- Malec JF, "The mayo classification system for traumatic brain injury severity", J Neurotrauma, 24, pp.1417~1424 (2007)
- Carskadon MA, "Adolescent sleep patterns, circadian timing, and sleepiness at a transition to early school days", Sleep, 21, pp.871~881 (1998)
- Quinto C, "Posttraumatic delayed sleep phase syndrome", Neurology, 54, pp.250~252 (2000)
- Duclos C, "Melatonin secretion and the rest-activity cycle in the acute phase of moderate-severe traumatic brain injury", Brain Inj, 28, pp.657~658 (2014)
- Steele DL, "The effect of traumatic brain injury on the timing of sleep", Chronobiol Int, 22, pp.89~105 (2005)
- Ayalon L, "Circadian rhythm sleep disorders following mild traumatic brain injury", Neurology, 68, pp.1136~1140 (2007)
- Grima NA, "Circadian melatonin rhythm following traumatic brain injury", Neurorehabil Neural Repair, 30, pp.972~977 (2016)
- Piotrowicz K, "The diurnal profile of melatonin during delirium in elderly patients--preliminary results", Exp Gerontol, 72, pp.45~49 (2015)
- Ángeles-Castellanos M, "Loss of melatonin daily rhythmicity is associated with delirium development in hospitalized older adults", Sleep Sci, 9, pp.285~288 (2016)
- Chen S, "Exogenous melatonin for delirium prevention : a meta-analysis of randomized controlled trials", Mol Neurobiol, 53, pp.4046~4053 (2016)
- Holcomb EM, "The relationship between sleep-wake cycle disturbance and trajectory of cognitive recovery during acute traumatic brain injury", J Head Trauma Rehabil, 31, pp.108~116 (2016)
- Duclos C, "Parallel recovery of consciousness and sleep in acute traumatic brain injury", Neurology, 88, pp.268~275 (2017)