Abstract
With the development of intensive care technology, the number of patients who survive acute severe brain injury has increased significantly. At present, it is difficult to diagnose the patients with disorders of consciousness (DOCs) because motor responses in these patients may be very limited and inconsistent. Electrophysiological criteria, such as event-related potentials or motor imagery, have also been studied to establish a diagnosis and prognosis based on command-following or active paradigms. However, the use of such task-based techniques in DOC patients is methodologically complex and requires careful analysis and interpretation. The present paper focuses on the analysis of sleep patterns for the evaluation of DOC and its relationships with diagnosis and prognosis outcomes. We discuss the concepts of sleep patterns in patients suffering from DOC, identification of this challenging population, and the prognostic value of sleep. The available literature on individuals in an unresponsive wakefulness syndrome (UWS) or minimally conscious state (MCS) following traumatic or nontraumatic severe brain injury is reviewed. We can distinguish patients with different levels of consciousness by studying sleep patients with DOC. Most MCS patients have sleep and wake alternations, sleep spindles and rapid eye movement (REM) sleep, while UWS patients have few EEG changes. A large number of sleep spindles and organized sleep–wake patterns predict better clinical outcomes. It is expected that this review will promote our understanding of sleep EEG in DOC.
Highlights
Due to advances in critical care, an increasing number of patients survive acute brain injury, causing an increased incidence and prevalence of patients with disorders of consciousness (DOC)
Considering the above factors, we present a review of studies on sleep EEG for patients with DOC in this paper
Exclusion (n = 649) were records not closely related to the classification, diagnosis, and prognosis of DOC, which mainly included the studies of the state of consciousness under sleep or anesthesia, the studies of sleep under different lifestyles, the studies of the clinical manifestations of patients with schizophrenia, Alzheimer’s disease, or other mental disorders using different drugs, and the studies involving other types of measurements, such as functional magnetic resonance
Summary
Due to advances in critical care, an increasing number of patients survive acute brain injury, causing an increased incidence and prevalence of patients with disorders of consciousness (DOC). Patients with DOC are fatigued and have a considerably limited attention span, which results in false-negative findings Compared with these techniques, sleep assessment could provide an alternative way to assess residual brain function to refine diagnosis and prognosis in DOC [14]. Many highly reliable electrophysiological features can be observed during sleep, such as spindles, K-complex, slow waves, and rapid eye movements These features could be observed and accounted for in long-term monitoring using EEG or polysomnography (PSG). The diagnostic methods of patients with DOC using sleep EEG are mainly described. It is hoped that these resources can improve our knowledge of sleep EEG patterns in the evaluation, diagnosis, and prognosis in cases of DOC, provide some ideas and reduce obstacles for clinical rehabilitation
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