The importance of polysomnography in the evaluation of prolonged disorders of consciousness: sleep recordings more adequately correlate than stimulus-related evoked potentials with patients' clinical status
The importance of polysomnography in the evaluation of prolonged disorders of consciousness: sleep recordings more adequately correlate than stimulus-related evoked potentials with patients' clinical status
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DOI：
10.1016/j.sleep.2013.09.026
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发表时间：
2014-04-01
期刊：
影响因子：
4.8
通讯作者：
Valente, Mariarosaria
中科院分区：
文献类型：
--
作者：
de Biase, Stefano;Gigli, Gian Luigi;Valente, Mariarosaria
目的：本研究的目的是通过将神经生理学变量与使用特定标准化量表获得的临床评价相关联，评估睡眠记录和刺激相关诱发电位（EPs）在延长性意识障碍（DOCs）患者中的重要性。方法：对27例植物人状态（VS）和5例最低意识状态（MCS）患者进行临床和神经生理学评价。临床评价包括昏迷恢复量表（CRS-R）、残疾评定量表（DRS）和格拉斯哥昏迷量表（GCS）。神经生理学评估包括24小时多导睡眠图（PSG）、体感EPs （sep）、脑干听觉EPs （BAEPs）和视觉EPs （VEPs）。结果：保留每个睡眠元素（睡眠-觉醒周期、睡眠纺锤波、k -复合体和快速眼动[REM]睡眠）的患者总是比没有保留的患者表现出更好的临床评分。只有在快速眼动睡眠中才有统计学意义。在7例患者中，PSG显示所有考虑的睡眠因素存在，他们的CRS-R评分为8.29 +/- 1.38。相比之下，缺乏一种或多种睡眠元素的25例患者的CRS-R评分为4.84 +/- 1.46 （P < 0.05）。我们的多变量分析表明，睡眠纺锤波和快速眼动睡眠同时存在与更高的CRS-R评分相关（正交互作用，P < 0.0001）。另一方面，EPs与CRS-R评分之间没有显著关联。结论：PSG记录已被证明是长期DOCs患者神经生理学评估的可靠工具，与EPs相比，PSG记录与临床评估和意识水平的相关性更充分。较高临床评分的主要贡献是由伴随的快速眼动睡眠和睡眠纺锤波决定的。PSG记录可以被认为是廉价、无创和易于执行的检查，为长期doc患者提供补充信息。(C) 2014 Elsevier b.v.版权所有
Objectives: The aim of our study was to evaluate the importance of sleep recordings and stimulus-related evoked potentials (EPs) in patients with prolonged disorders of consciousness (DOCs) by correlating neurophysiologic variables with clinical evaluation obtained using specific standardized scales.Methods: There were 27 vegetative state (VS) and 5 minimally conscious state (MCS) patients who were evaluated from a clinical and neurophysiologic perspective. Clinical evaluation included the Coma Recovery Scale-Revised (CRS-R), Disability Rating Scale (DRS), and Glasgow Coma Scale (GCS). Neurophysiologic evaluation included 24-h polysomnography (PSG), somatosensory EPs (SEPs), brainstem auditory EPs (BAEPs), and visual EPs (VEPs).Results: Patients with preservation of each single sleep element (sleep-wake cycle, sleep spindles, K-complexes, and rapid eye movement [ REM] sleep) always showed better clinical scores compared to those who did not have preservation. Statistical significance was only achieved for REM sleep. In 7 patients PSG showed the presence of all considered sleep elements, and they had a CRS-R score of 8.29 +/- 1.38. In contrast, 25 patients who lacked one or more of the sleep elements had a CRS-R score of 4.84 +/- 1.46 (P < .05). Our multivariate analysis clarified that concurrent presence of sleep spindles and REM sleep were associated with a much higher CRS-R score (positive interaction, P < .0001). On the other hand, no significant associations were found between EPs and CRS-R scores.Conclusions: PSG recordings have proved to be a reliable tool in the neurophysiologic assessment of patients with prolonged DOCs, correlating more adequately than EPs with the clinical evaluation and the level of consciousness. The main contribution to higher clinical scores was determined by the concomitant presence of REM sleep and sleep spindles. PSG recordings may be considered inexpensive, non-invasive, and easy-to-perform examinations to provide supplementary information in patients with prolonged DOCs. (C) 2014 Elsevier B. V. All rights reserved.