BACKGROUND: The Vegetative and Minimally Conscious States (VS; MCS) are characterized by absent or highly disordered signs of awareness alongside preserved sleep-wake cycles. According to international diagnostic guidelines, sleep-wake cycles are assessed by means of observations of variable periods of eye-opening and eye-closure. However, there is little empirical evidence for true circadian sleep-wake cycling in these patients, and there have been no large-scale investigations of the validity of this diagnostic criterion. METHODS: We measured the circadian sleep-wake rhythms of 55 VS and MCS patients by means of wrist actigraphy, an indirect method that is highly correlated with polysomnographic estimates of sleeping/waking. RESULTS: Contrary to the diagnostic guidelines, a significant proportion of patients did not exhibit statistically reliable sleep-wake cycles. The circadian rhythms of VS patients were significantly more impaired than those of MCS patients, as were the circadian rhythms of patients with non-traumatic injuries relative to those with traumatic injuries. The reliability of the circadian rhythms were significantly predicted by the patients' levels of visual and motor functioning, consistent with the putative biological generators of these rhythms. CONCLUSIONS: The high variability across diagnoses and etiologies highlights the need for improved guidelines for the assessment of sleep-wake cycles in VS and MCS, and advocates the use of actigraphy as an inexpensive and non-invasive alternative.
BACKGROUND: The Vegetative and Minimally Conscious States (VS; MCS) are characterized by absent or highly disordered signs of awareness alongside preserved sleep-wake cycles. According to international diagnostic guidelines, sleep-wake cycles are assessed by means of observations of variable periods of eye-opening and eye-closure. However, there is little empirical evidence for true circadian sleep-wake cycling in these patients, and there have been no large-scale investigations of the validity of this diagnostic criterion. METHODS: We measured the circadian sleep-wake rhythms of 55 VS and MCSpatients by means of wrist actigraphy, an indirect method that is highly correlated with polysomnographic estimates of sleeping/waking. RESULTS: Contrary to the diagnostic guidelines, a significant proportion of patients did not exhibit statistically reliable sleep-wake cycles. The circadian rhythms of VS patients were significantly more impaired than those of MCSpatients, as were the circadian rhythms of patients with non-traumatic injuries relative to those with traumatic injuries. The reliability of the circadian rhythms were significantly predicted by the patients' levels of visual and motor functioning, consistent with the putative biological generators of these rhythms. CONCLUSIONS: The high variability across diagnoses and etiologies highlights the need for improved guidelines for the assessment of sleep-wake cycles in VS and MCS, and advocates the use of actigraphy as an inexpensive and non-invasive alternative.
Authors: Luciane de Souza; Ana Amélia Benedito-Silva; Maria Laura Nogueira Pires; Dalva Poyares; Sergio Tufik; Helena Maria Calil Journal: Sleep Date: 2003-02-01 Impact factor: 5.849
Authors: Sonia Ancoli-Israel; Jennifer L Martin; Daniel F Kripke; Matthew Marler; Melville R Klauber Journal: J Am Geriatr Soc Date: 2002-02 Impact factor: 5.562
Authors: Joseph T Giacino; S Ashwal; N Childs; R Cranford; B Jennett; D I Katz; J P Kelly; J H Rosenberg; J Whyte; R D Zafonte; N D Zasler Journal: Neurology Date: 2002-02-12 Impact factor: 9.910
Authors: Sonia Ancoli-Israel; Roger Cole; Cathy Alessi; Mark Chambers; William Moorcroft; Charles P Pollak Journal: Sleep Date: 2003-05-01 Impact factor: 5.849
Authors: Catherine Duclos; Marie Dumont; Caroline Arbour; Jean Paquet; Hélène Blais; David K Menon; Louis De Beaumont; Francis Bernard; Nadia Gosselin Journal: Neurology Date: 2016-12-21 Impact factor: 9.910
Authors: D Cruse; A Thibaut; A Demertzi; J C Nantes; M A Bruno; O Gosseries; A Vanhaudenhuyse; T A Bekinschtein; A M Owen; S Laureys Journal: BMC Med Date: 2018-08-11 Impact factor: 8.775
Authors: Prerna Gupta; Jennifer L Martin; Dale M Needham; Sitaram Vangala; Elizabeth Colantuoni; Biren B Kamdar Journal: Heart Lung Date: 2020-02-24 Impact factor: 2.210
Authors: Barbara Schorr; Winfried Schlee; Marion Arndt; Dorothée Lulé; Iris-Tatjana Kolassa; Alex Lopez-Rolon; Alexander Lopez-Rolon; Andreas Bender Journal: J Neurol Date: 2014-11-09 Impact factor: 4.849