>>4901178
https://www.ncbi.nlm.nih.gov/m/pubmed/4174810/
- The sleep cycle in coma: prognostic value.
https://www.ncbi.nlm.nih.gov/pubmed/12167195
- Sleep cycle in patients in a state of permanent unconsciousness.
https://www.ncbi.nlm.nih.gov/pubmed/14564378
- Sleep in the intensive care unit.
https://www.ncbi.nlm.nih.gov/pubmed/14020346
- Electroencephalographic patterns resembling those of sleep in certain comatose states after injuries to the head.
https://www.ncbi.nlm.nih.gov/pubmed/6153604
- Time-related changes in the distribution of sleep stages in brain injured patients.
https://www.ncbi.nlm.nih.gov/pubmed/11560184
- Phasic activities of rapid eye movement sleep in vegetative state patients.
Etc. И попытка проанализировать доступные исследования и доступные кейсы:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2855378/
- Sleep in disorders of consciousness
- Earlier studies on coma suggested that the presence of EEG patterns resembling sleep may be reliable markers for a favorable outcome. It was reported that sleep patterns continue to become more complex during rehabilitation therapy, paralleling patients' cognitive recovery. Some authors have used standard Rechtschaffen & Kales sleep criteria to analyze the polysomno-graphic (PSG) data in DOC.
- In conclusion, the study of sleep is of particular interest in DOC with various different etiologies as it can provide relationships between some graphoelements and functional neuroanatomy. Whereas waking patterns, in non-comatose patients, only indicate the persistence of the reticular activating system. As an example, spindles may reflect the preserved functional integrity of the thalamus; SWS and REM sleep may reflect residual functioning of brainstem nuclei; and the circadian organization of sleep patterns are informative of residual hypothalamic functioning. Nevertheless the analysis of waking EEG, cleaned for muscular artifacts (which are often exacerbated in DOC) and eye-blinks may also yield useful diagnostic and prognostic information.
- Until recently, studying sleep in brain-dead patients seemed pointless as the EEG is invariantly isoelectrical in this condition. However a case-report recently described sleep-like periodic leg movements (PLM) in brain-death. Following a massive intracranial hemorrhage, a 50 year-old man remained comatose for 24 h and then was examined for 12 h before being diagnosed brain dead. Over this period leg movements, very similar to natural PLM during sleep in terms of both behavioral characteristics and periodicity, were observed for 30 h. Several earlier reports have described PLM during sleep although patients were suffering from severe brainstem and spinal cord lesions. This case-report suggests that, although the anatomical substrate involved in the generation of PLM remains unclear, PLM in sleep and in brain-death may share a common mechanism. The authors speculate that the brainstem looses its control over the descending spinal pathway during classical PLM in sleep as it does in brain-death.
- Some earlier studies have also indicated that sleep spindles may carry prognostic information. It was subsequently shown that the presence of spindle activity after hypoxic or anoxic injury does not always indicate a good outcome. However the absence of spindles or EEG background reactivity does predict a poor outcome. A more recent study supports these findings in comatose children and concludes that the reappearance of sleep patterns and sleep spindles is sign of good prognosis. In traumatic coma, these sleep elements are more frequently observed than in anoxic cases.
- In conclusion, patients who recover consciousness after coma may undergo various sleep disturbances (see Table 3) including insomnia, hypersomnia, sleep pattern and latency modifications – the latter often being associated with fatigue problems.
- From a methodological point of view, studying sleep in DOC is particularly challenging. Adapted and validated standardized behavioral scales (for review see) are rarely used in sleep research in DOC. Prolonged PSG in clinical or rehabilitation environments is difficult because artifacts may arise from medical and nursing activities and from clinical instability of DOC patients encompassing “vegetative storms” (particularly during the acute and sub-acute stages of injury). All these factors make the recording of reliable EEG a real challenge in these non-collaborative severely brain damaged patients. In addition, the different studies use different PSG protocols making data comparisons difficult.
У пациентов в коме могут быть те же циклы сна/бодрствования и те же фазы сна, что и у здоровых людей. На основании наличия циклов сна в коме можно делать прогнозы о возвращении сознания после выхода из комы.
Некоторые аспекты сна схожи с процессами, происходящими при смерти мозга.
Сознание абсолютно точно как-то связано со сном, но мы не знаем, как именно и почему.
При нарушениях сна, сознание страдает в гораздо меньшей степени, чем весь организм с физиологической точки зрения. Мозг при нарушениях сна в первую очередь страдает потому, что страдает весь организм, от состояния которого зависит и мозг.
Чем больше мы знаем про сон, тем меньше мы знаем про сон. Карательная медцина запрещена, к сожалениюсчастью, поэтому даже над пациентами в вегетативном состоянии крайне тяжело ставить какие-то эксперименты.
Корреляция активности мозга с различными системами на фоне доступных нам данных коворит чуть менее, чем ни о чём.
