Abstract
Sleep disorders are among the main comorbidities in patients with a Disorder of Consciousness (DOC). Given the key role of sleep in neural and cognitive functioning, detecting and treating sleep disorders in DOCs might be an effective therapeutic strategy to boost consciousness recovery and levels of awareness. To date, no systematic reviews have been conducted that explore the effect of sleep treatments in DOCs; thus, we systematically reviewed the existing studies on both pharmacological and non-pharmacological treatments for sleep disorders in DOCs. Among 2267 assessed articles, only 7 were included in the systematic review. The studies focused on two sleep disorder categories (sleep-related breathing disorders and circadian rhythm dysregulation) treated with both pharmacological (Modafinil and Intrathecal Baclofen) and non-pharmacological (positive airway pressure, bright light stimulation, and central thalamic deep brain stimulation) interventions. Although the limited number of studies and their heterogeneity do not allow generalized conclusions, all the studies highlighted the effectiveness of treatments on both sleep disorders and levels of awareness. For this reason, clinical and diagnostic evaluations able to detect sleep disorders in DOC patients should be adopted in the clinical routine for the purpose of intervening promptly with the most appropriate treatment.
Highlights
After severe Acquired Brain Injury, certain patients may end up with prolonged/chronic Disorders of Consciousness (DOCs), characterized by alterations of self and/or environmental awareness
A reduction of both integration and segregation has been empirically described when an alteration of the diurnal sleep–wake cycle intervenes. Both resting-state functional Magnetic Resonance Imaging (fMRI) and EEG studies comparing network dynamics pre- and post- sleep deprivation on healthy individuals showed changes at the level of the brain networks’ functional connectivity, indicating a reduction of information integration [12,13,14] as well as a reduced segregation of networks highly segregated under regular sleep–wake cycle conditions [12], suggesting that “the preservation [ . . . ] of an optimal network architecture for information processing is affected by sleep [ . . . ]” [14] (p. 41)
It is recognized that sleep disorders are among the main comorbidities in severe Acquired Brain Injury (sABI) patients, and especially for those with DOC, and considering the pivotal role that sleep plays on cognitive and neural functions [15,16], no strong evidence emerges on the effect/efficacy of treatments for sleep disorders in relation to the recovery of consciousness and/or of the improvement of cognitive and behavioral functions in this population
Summary
After severe Acquired Brain Injury (sABI), certain patients may end up with prolonged/chronic Disorders of Consciousness (DOCs), characterized by alterations of self and/or environmental awareness. It has been hypothesized that DOCs are characterized by dysregulations involving excitatory wake-promoting and inhibitory sleep-promoting neurotransmitters which are involved in maintaining efficient connections between high-order cortical areas and sub-cortical structures [7]. A reduction of both integration and segregation has been empirically described when an alteration of the diurnal sleep–wake cycle intervenes Both resting-state fMRI and EEG studies comparing network dynamics pre- and post- sleep deprivation on healthy individuals showed changes at the level of the brain networks’ functional connectivity, indicating a reduction of information integration [12,13,14] as well as a reduced segregation of networks highly segregated under regular sleep–wake cycle conditions [12], suggesting that “the preservation [ . There was an improvement in the patient’s awareness, as detected by several outcome measures, including the DRS (a total score decrease from 19 to 14) and the Level of Cognitive Functioning Assessment Scale (LOCFAS; a level increase from 2 to 3)
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