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Fedele B, Williams G, McKenzie D, Giles R, McKay A, Olver J. Sleep Disturbance During Post-Traumatic Amnesia and Early Recovery After Traumatic Brain Injury. J Neurotrauma 2024. [PMID: 38553904 DOI: 10.1089/neu.2023.0656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Abstract
After moderate to severe traumatic brain injury (TBI), sleep disturbance commonly emerges during the confused post-traumatic amnesia (PTA) recovery stage. However, the evaluation of early sleep disturbance during PTA, its recovery trajectory, and influencing factors is limited. This study aimed to evaluate sleep outcomes in patients experiencing PTA using ambulatory gold-standard polysomnography (PSG) overnight and salivary endogenous melatonin (a hormone that influences the sleep-wake cycle) assessment at two time-points. The relationships between PSG-derived sleep-wake parameters and PTA symptoms (i.e., agitation and cognitive disturbance) were also evaluated. In a patient subset, PSG was repeated after PTA had resolved to assess the trajectory of sleep disturbance. Participants with PTA were recruited from Epworth HealthCare's inpatient TBI Rehabilitation Unit. Trained nurses administered overnight PSG at the patient bedside using the Compumedics Somté portable PSG device (Compumedics, Ltd., Australia). Two weeks after PTA had resolved, PSG was repeated. On a separate evening, two saliva specimens were collected (at 24:00 and 06:00) for melatonin testing. Results of routine daily hospital measures (i.e., Agitated Behavior Scale and Westmead PTA Scale) were also collected. Twenty-nine patients were monitored with PSG (mean: 41.6 days post-TBI; standard deviation [SD]: 28.3). Patients' mean sleep duration was reduced (5.6 h, SD: 1.2), and was fragmented with frequent awakenings (mean: 27.7, SD: 15.0). Deep, slow-wave restorative sleep was reduced, or completely absent (37.9% of patients). The use of PSG did not appear to exacerbate patient agitation or cognitive disturbance. Mean melatonin levels at both time-points were commonly outside of normal reference ranges. After PTA resolved, patients (n = 11) displayed significantly longer mean sleep time (5.3 h [PTA]; 6.5 h [out of PTA], difference between means: 1.2, p = 0.005). However, disturbances to other sleep-wake parameters (e.g., increased awakenings, wake time, and sleep latency) persisted after PTA resolved. This is the first study to evaluate sleep disturbance in a cohort of patients as they progressed through the early TBI recovery phases. There is a clear need for tailored assessment of sleep disturbance during PTA, which currently does not form part of routine hospital assessment, to suggest new treatment paradigms, enhance patient recovery, and reduce its long-term impacts.
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Affiliation(s)
- Bianca Fedele
- Department of Rehabilitation, Department of Rehabilitation and Mental Health, Epworth HealthCare, Melbourne, Australia
- Department of Rehabilitation, Epworth Monash Rehabilitation Medicine (EMReM) Unit, Melbourne, Australia
- School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Gavin Williams
- Department of Rehabilitation, Department of Rehabilitation and Mental Health, Epworth HealthCare, Melbourne, Australia
- Department of Rehabilitation, Epworth Monash Rehabilitation Medicine (EMReM) Unit, Melbourne, Australia
- Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
| | - Dean McKenzie
- Research Development and Governance Unit, Department of Rehabilitation and Mental Health, Epworth HealthCare, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Robert Giles
- Sleep Unit, Department of Rehabilitation and Mental Health, Epworth HealthCare, Melbourne, Australia
| | - Adam McKay
- Department of Rehabilitation, Department of Rehabilitation and Mental Health, Epworth HealthCare, Melbourne, Australia
- School of Psychological Sciences, Monash University, Melbourne, Australia
- Monash Epworth Rehabilitation Research Centre, Melbourne, Australia
| | - John Olver
- Department of Rehabilitation, Department of Rehabilitation and Mental Health, Epworth HealthCare, Melbourne, Australia
- Department of Rehabilitation, Epworth Monash Rehabilitation Medicine (EMReM) Unit, Melbourne, Australia
- School of Clinical Sciences, Monash University, Melbourne, Australia
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Drăgoi CM, Nicolae AC, Ungurianu A, Margină DM, Grădinaru D, Dumitrescu IB. Circadian Rhythms, Chrononutrition, Physical Training, and Redox Homeostasis-Molecular Mechanisms in Human Health. Cells 2024; 13:138. [PMID: 38247830 PMCID: PMC10814043 DOI: 10.3390/cells13020138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/05/2024] [Accepted: 01/09/2024] [Indexed: 01/23/2024] Open
Abstract
A multitude of physiological processes, human behavioral patterns, and social interactions are intricately governed by the complex interplay between external circumstances and endogenous circadian rhythms. This multidimensional regulatory framework is susceptible to disruptions, and in contemporary society, there is a prevalent occurrence of misalignments between the circadian system and environmental cues, a phenomenon frequently associated with adverse health consequences. The onset of most prevalent current chronic diseases is intimately connected with alterations in human lifestyle practices under various facets, including the following: reduced physical activity, the exposure to artificial light, also acknowledged as light pollution, sedentary behavior coupled with consuming energy-dense nutriments, irregular eating frameworks, disruptions in sleep patterns (inadequate quality and duration), engagement in shift work, and the phenomenon known as social jetlag. The rapid evolution of contemporary life and domestic routines has significantly outpaced the rate of genetic adaptation. Consequently, the underlying circadian rhythms are exposed to multiple shifts, thereby elevating the susceptibility to disease predisposition. This comprehensive review endeavors to synthesize existing empirical evidence that substantiates the conceptual integration of the circadian clock, biochemical molecular homeostasis, oxidative stress, and the stimuli imparted by physical exercise, sleep, and nutrition.
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Affiliation(s)
- Cristina Manuela Drăgoi
- Department of Biochemistry, Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy, 020956 Bucharest, Romania; (C.M.D.); (A.C.N.); (A.U.); (D.M.M.)
| | - Alina Crenguţa Nicolae
- Department of Biochemistry, Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy, 020956 Bucharest, Romania; (C.M.D.); (A.C.N.); (A.U.); (D.M.M.)
| | - Anca Ungurianu
- Department of Biochemistry, Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy, 020956 Bucharest, Romania; (C.M.D.); (A.C.N.); (A.U.); (D.M.M.)
| | - Denisa Marilena Margină
- Department of Biochemistry, Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy, 020956 Bucharest, Romania; (C.M.D.); (A.C.N.); (A.U.); (D.M.M.)
| | - Daniela Grădinaru
- Department of Biochemistry, Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy, 020956 Bucharest, Romania; (C.M.D.); (A.C.N.); (A.U.); (D.M.M.)
| | - Ion-Bogdan Dumitrescu
- Department of Physics and Informatics, Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy, 020956 Bucharest, Romania;
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Kureshi S, Stowe C, Francis J, Djalilian H. Circadian therapy interventions for glymphatic dysfunction in concussions injuries: A narrative review. Sci Prog 2023; 106:368504231189536. [PMID: 37499049 PMCID: PMC10388340 DOI: 10.1177/00368504231189536] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
There are two primary threats to the brain after concussion. The first is a buildup of neurotoxic proteins in the brain. The second, a partial consequence of the first, is a sustained neuroinflammatory response that may lead to central sensitization and the development of persistent post-concussive symptoms. These threats make neurotoxin clearance a high clinical priority in the acute period after injury. The glymphatic system is the brain's primary mechanism for clearing neurotoxic waste. The glymphatic system is intimately tied to the sleep cycle and circadian dynamics. However, glymphatic dysfunction and sleep disturbances are nearly ubiquitous in the acute period after concussion injury. Because of this, sleep optimization via circadian therapy is a time-sensitive and critical tool in acute concussion management.
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Affiliation(s)
- Sohaib Kureshi
- Neurosurgical Medical Clinic, San Diego, CA, USA
- TBI Virtual, San Diego, CA, USA
| | | | | | - Hamid Djalilian
- TBI Virtual, San Diego, CA, USA
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, USA
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