The goal of our study was to investigate different aspects of sleep, namely the sleep-wake cycle and sleep stages, in the vegetative state/unresponsive wakefulness syndrome (VS/UWS), and minimally conscious state (MCS). A 24-h polysomnography was performed in 20 patients who were in a UWS (n=10) or in a MCS (n=10) because of brain injury. The data were first tested for the presence of a sleep-wake cycle, and the observed sleep patterns were compared with standard scoring criteria. Sleep spindles, slow wave sleep, and rapid eye movement sleep were quantified and their clinical value was investigated. According to our results, an electrophysiological sleep-wake cycle was identified in five MCS and three VS/UWS patients. Sleep stages did not always match the standard scoring criteria, which therefore needed to be adapted. Sleep spindles were present more in patients who clinically improved within 6 months. Slow wave sleep was present in eight MCS and three VS/UWS patients but never in the ischemic etiology. Rapid eye movement sleep, and therefore dreaming that is a form of consciousness, was present in all MCS and three VS/UWS patients. In conclusion, the presence of alternating periods of eyes-open/eyes-closed cycles does not necessarily imply preserved electrophysiological sleep architecture in the UWS and MCS, contrary to previous definition. The investigation of sleep is a little studied yet simple and informative way to evaluate the integrity of residual brain function in patients with disorders of consciousness with possible clinical diagnostic and prognostic implications.

译文

:我们的研究目的是研究营养状态/无反应性清醒综合征(VS / UWS)和最低意识状态(MCS)下睡眠的不同方面,即睡眠-觉醒周期和睡眠阶段。在20例因脑损伤而处于UWS(n = 10)或MCS(n = 10)的患者中进行了24小时多导睡眠监测。首先测试数据是否存在睡眠-觉醒周期,并将观察到的睡眠模式与标准评分标准进行比较。对睡眠纺锤体,慢波睡眠和快速眼动睡眠进行了量化,并研究了它们的临床价值。根据我们的结果,在5例MCS和3例VS / UWS患者中发现了电生理睡眠-觉醒周期。睡眠阶段并不总是符合标准的评分标准,因此需要进行调整。在6个月内临床好转的患者中,睡眠纺锤体的比例更高。慢波睡眠存在于8例MCS和3例VS / UWS患者中,但从未出现在缺血性病因中。所有MCS和3名VS / UWS患者都出现了快速的眼球运动睡眠,并因此梦想成一种意识意识。总之,睁眼/闭眼周期交替周期的存在并不一定意味着在UWS和MCS中保留了电生理睡眠结构,这与先前的定义相反。对睡眠的研究是一项经过研究的简单方法,但它为评估意识障碍患者的残余脑功能的完整性提供了可能,该方法可能具有临床诊断和预后意义。

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