The association between the polysomnography data, melatonin secretion and neuroimaging data in chronic disorders of consciousness

SUMMARY. Chronic disturbances of consciousness (DoC) are characterized by a complete or partial absence of signs of awareness of oneself and the world around against the background of intact wakefulness. Recent data confirms the relationship of structural and functional characteristics in patients with Do C. Circadian rhythms are of particular interest, since the preserved sleep cycles are associated with prognosis in patients with Do C.

PURPOSE OF THE STUDY: to identify the relationship between changes in PSG and the rhythm of melatonin secretion, as well as structural changes in the brain, showed by MRI of the brain in patients with various forms of consciousness disorders.

MATERIALS AND METHODS. The study included 49 patients; all patients underwent a five-fold assessment on the Coma Recovery Scale — Revised (CRS-R scale). Patients in the vegetative state/areactive wakefulness syndrome (VS/AWS) were assigned to group 1 (19 patients, 70 % men), group 2 included patients in the “minus” state of consciousness (MCS “minus”) (17 patients, 59 % men), and group 3 was composed of patients in the MCS “plus” (13 patients, 46 % men). PSG was recorded for at least 24 hours, the level of melatonin in the blood was determined 6 times a day and 6-sulfatoxymelatonin in daytime and nighttime urine. An MRI of the brain (1.5 T) was performed with the assessment of structural changes in the thalamus, hypothalamus and stem structures.

RESULTS. In patients without structural changes in the hypothalamus, MRI showed distinct increases in the ratio of the total duration of the episodes of the sleep stage (REM, N 1, N 2, N 3) to the total sleep time. Preservation of the hypothalamic structures determined the presence of NREM/REM in patients in VS/AWS and MCS “minus” and closer to physiological sleep in patients in MCS “plus”. Disintegration was found in patients in VS/AWS — with excessive synthesis of melatonin, there was no formation of physiological sleep cycles according to PSG, which could indicate a dissociation of the functioning of the regulatory systems of the body.

CONCLUSION. In patients with a higher level of consciousness (MCS “plus”), melatonin secretion was maintained in a range close to normal, regardless of the etiology of brain damage. Correlations have been found between the severity of brain injury and melatonin levels. The study of the functional relationship of the structures regulating sleep-wake cycle will clarify the mechanisms underlying sleep disorders in patients with Do C.

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