Abstract
Among the possible points of therapeutic action and predicting the outcome in patients in a vegetative state and minimally conscious state, the analysis of circadian rhythms, such as the sleep-wake cycle, melatonin secretion, temperature trends, heart rate, and blood pressure, attracts more and more attention. In this review, we analyzed studies on circadian rhythms in patients with chronic disorders of consciousness, assessed the possible limitations of standard methods, proposed a concept for the development of an assessment of the sleep-wake cycle, and assessed the role of exogenous factors that are likely to be involved in the disturbance of circadian rhythms in intensive care units. Based on the results of the study, we came to the conclusion that for the full realization of the rehabilitation potential, it is necessary to develop methods for assessing circadian rhythms based on a multicomponent approach, including 24-hour monitoring using actigraphy for more accurate identification of the rest -activity cycle, video monitoring of the orofascial area to increase the reliability of oculographic assessment and revealing hidden patterns, analysis of the temperature curve, the level of melatonin, TSH, cortisol, as well as exogenous factors. It is necessary to use the information obtained for therapeutic, prognostic, diagnostic and rehabilitation purposes
Highlights
Среди возможных точек терапевтического воздействия и прогнозирования исхода у пациентов в вегетативном состоянии и состоянии малого сознания все большее внимание привлекает анализ циркадианных ритмов, таких как цикл сон–бодрствование, секреция мелатонина, тренды температуры, показатели артериального давления и частоты сердечных сокращений
We analyzed studies on circadian rhythms in patients with chronic disorders of consciousness, assessed the possible limitations of standard methods, proposed a concept for the development of an assessment of the sleep-wake cycle, and assessed the role of exogenous factors that are likely to be involved in the disturbance of circadian rhythms in intensive care units
Based on the results of the study, we came to the conclusion that for the full realization of the rehabilitation potential, it is necessary to develop methods for assessing circadian rhythms based on a multicomponent approach, including 24-hour monitoring using actigraphy for more accurate identification of the rest-activity cycle, video monitoring of the orofascial area to increase the reliability of oculographic assessment and revealing hidden patterns, analysis of the temperature curve, the level of melatonin, TSH, cortisol, as well as exogenous factors
Summary
В обзоре проанализированы результаты исследований суточного ритма у пациентов с хроническим нарушением сознания, выполнена оценка возможных ограничений применения стандартных методов, предложена концепция оценки цикла сон–бодрствование, а также роли вероятных экзогенных факторов, нарушающих циркадианные ритмы в условиях реанимации. По результатам исследования сделан вывод, что полноценная реализация реабилитационного потенциала нуждается в разработке методов оценки циркадианных ритмов на основе многокомпонентного подхода, включающего суточное мониторирование с использованием актиграфии для более точного выявления цикла активности–покоя; видеоминиторинг орофасциальной области для повышения надежности окулографической оценки и выявления скрытых паттернов; анализ температурной кривой, уровня мелатонина, тиреотропного гормона, кортизола, а также экзогенных факторов. Для цитирования: Канарский М.М., Штерн М.В., Воробьёва И.С., Горшков К.М., Крылова Т.Н., Горлачев М.М., Гудожникова В.В., Копылов П.М., Мирзаев Ф.Б., Борисов И.В., Некрасова Ю.Ю.
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