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Kanarskii M, Nekrasova J, Kondratieva E, Borisov I, Simenel E, Sviryaev Y, Pradhan P, Gorshkov K, Shestopalov A, Petrova M. Are circadian rhythms in disarray in patients with chronic critical illness? Sleep Med X 2024; 7:100101. [PMID: 38234313 PMCID: PMC10792261 DOI: 10.1016/j.sleepx.2023.100101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 12/17/2023] [Accepted: 12/19/2023] [Indexed: 01/19/2024] Open
Abstract
Aim The aim of our study is to assess circadian rhythms in patients with chronic critical illness due to severe brain injury in intensive care unit by establishing the relation between melatonin and cortisol secretion, considering astronomical time and the sleep-wake cycle in chronic critical illness. Materials and methods The study included 54 adult patients with chronic critical illness who resided in the intensive care unit for at least 30 days. The level of consciousness was determined using the CRS-R scale. We did the continuous electroencephalographic (EEG) monitoring with polygraphic leads for 24 h. Also, we determined the serum levels of cortisol and melatonin using the tandem mass spectrometry method with ultra-performance liquid chromatography. Results 90.74 % of patients had one acrophase in melatonin secretion curve, which suggests the preservation of the rhythmic secretion of melatonin. These acrophases of the melatonin rhythm occurred during the night time in 91.8 % of patients. Most of the patients (69.3 %) slept during the period from 2:00 to 4:00 a.m. The evening levels of cortisol and melatonin had an inverse relation (rs=0.61, p<0.05), i.e., a decrease in the level of cortisol secretion accompanies an increase in melatonin. Conclusions We concluded from our study that the rhythmic secretion of melatonin and cortisol is preserved in patients with chronic critical illness that resulted from severe brain injury. No statistically significant discrepancy between melatonin and cortisol secretion, day-and-night time and the sleep-wake cycle are found. We may focus our future work on finding more reliable methods to stabilize the preservation of circadian rhythms to protect vital organ functions.
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Affiliation(s)
- Mikhail Kanarskii
- Federal State Budget Scientific Institution «Federal Reserach and Clinical Center of Intensive Care Medicine and Rehabilitology», Moscow, Russia
| | - Julia Nekrasova
- Federal State Budget Scientific Institution «Federal Reserach and Clinical Center of Intensive Care Medicine and Rehabilitology», Moscow, Russia
| | - Ekaterina Kondratieva
- Federal State Budgetary Institution “Almazov National Medical Research Centre” of the Ministry of Health of the Russian Federation, St. Petersburg, Russia
| | - Ilya Borisov
- Federal State Budget Scientific Institution «Federal Reserach and Clinical Center of Intensive Care Medicine and Rehabilitology», Moscow, Russia
| | - Elena Simenel
- Labaratory of Chromatography and Mass Spectrometry, Мedical Laboratory Archimed, Moscow, St. Vavilova, d. 68 bldg, Russia
| | - Yurii Sviryaev
- Federal State Budgetary Institution “Almazov National Medical Research Centre” of the Ministry of Health of the Russian Federation, St. Petersburg, Russia
| | - Pranil Pradhan
- Federal State Budget Scientific Institution «Federal Reserach and Clinical Center of Intensive Care Medicine and Rehabilitology», Moscow, Russia
- Federal State Budgetary Educational Institution of Higher Education “Peoples' Friendship University of Russia”, Moscow, Russia
| | - Kirill Gorshkov
- Federal State Budget Scientific Institution «Federal Reserach and Clinical Center of Intensive Care Medicine and Rehabilitology», Moscow, Russia
| | - Alexander Shestopalov
- Federal State Budget Scientific Institution «Federal Reserach and Clinical Center of Intensive Care Medicine and Rehabilitology», Moscow, Russia
| | - Marina Petrova
- Federal State Budget Scientific Institution «Federal Reserach and Clinical Center of Intensive Care Medicine and Rehabilitology», Moscow, Russia
- Federal State Budgetary Educational Institution of Higher Education “Peoples' Friendship University of Russia”, Moscow, Russia
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Kanarskii M, Nekrasova J, Pradhan P, Borisov I, Korepina O, Kondratyeva E, Nikitkina A, Petrova M. The High-Dose of Exogenous Melatonin Did Not Alter the Sleep-Wake Cycle in Anoxic Brain Injury Patients. Sleep Med Res 2022. [DOI: 10.17241/smr.2022.01361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Disturbance in circadian rhythms and the sleep-wake cycle is typical for patients in the intensive care unit, which retards rehabilitation. To assess the effect of exogenous melatonin and simultaneous mitigation of intensive care unit environmental factors on sleep duration. We studied five patients with chronic disorder of consciousness caused by anoxic brain injury. In addition, we varied the level of melatonin secretion in blood plasma to assess melatonin’s bioavailability and elimination time. We evaluated the sleep-wake cycle using continuous videoelectroencephalogram monitoring with the addition of oculographic and myographic channels for 72 hours. All the patients received melatonin tablets on the second day, wore masks and ear plugs, and had no feeding and nursing manipulations at night on the second and third days. There was no significant difference in sleep time between the first, second, and third days. Future studies of the circadian rhythm should aim at gaining a deeper analysis of the characteristics of the sleep-wake cycle in patients with severe anoxic brain injury together with further research for possible ways to influence the circadian component of sleep.
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Nekrasova J, Kanarskii M, Borisov I, Pradhan P, Roshka S, Musatov D, Redkin I, Petrova MV. Two-year outcomes of patients with prolonged disorders of consciousness: a prospective cohort study in Russian Federation. Ann Palliat Med 2022; 11:3160-3170. [DOI: 10.21037/apm-22-403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 08/12/2022] [Indexed: 11/06/2022]
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Nekrasova J, Kanarskii M, Borisov I, Pradhan P, Shunenkov D, Vorobiev A, Smirnova M, Pasko V, Petrova MV, Luginina E, Pryanikov I. One-Year Demographical and Clinical Indices of Patients with Chronic Disorders of Consciousness. Brain Sci 2021; 11:brainsci11050651. [PMID: 34065687 PMCID: PMC8156613 DOI: 10.3390/brainsci11050651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/11/2021] [Accepted: 05/14/2021] [Indexed: 12/27/2022] Open
Abstract
This work aims to evaluate the prognostic value of the demographical and clinical data on long-term outcomes (up to 12 months) in patients with severe acquired brain injury with vegetative state/unresponsive wakefulness syndrome (VS/UWS/UWS) or a minimally conscious state (MCS). Patients (n = 211) with VS/UWS/UWS (n = 123) and MCS (n = 88) were admitted to the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology after anoxic brain injury (n = 53), vascular lesions (n = 59), traumatic brain injury (n = 93), and other causes (n = 6). At the beginning of the 12-month study, younger age and a higher score by the Coma Recovery Scale-Revised (CRS-R) predicted a survival. However, no reliable markers of significant positive dynamics of consciousness were found. Based on the etiology, anoxic brain injury has the most unfavorable prognosis. For patients with vascular lesions, the first three months after injury have the most important prognostic value. No correlations were found between survival, increased consciousness, and gender. The demographic and clinical characteristics of patients with chronic DOC can be used to predict long-term mortality in patients with chronic disorders of consciousness. Further research should be devoted to finding reliable predictors of recovery of consciousness.
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Affiliation(s)
- Julia Nekrasova
- Department for the Study of Chronic Disorder of Consciousness, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 107031 Moscow, Russia; (J.N.); (M.K.); (I.B.); (D.S.); (A.V.); (I.P.); (M.S.); (V.P.); (M.V.P.); (E.L.)
| | - Mikhail Kanarskii
- Department for the Study of Chronic Disorder of Consciousness, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 107031 Moscow, Russia; (J.N.); (M.K.); (I.B.); (D.S.); (A.V.); (I.P.); (M.S.); (V.P.); (M.V.P.); (E.L.)
| | - Ilya Borisov
- Department for the Study of Chronic Disorder of Consciousness, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 107031 Moscow, Russia; (J.N.); (M.K.); (I.B.); (D.S.); (A.V.); (I.P.); (M.S.); (V.P.); (M.V.P.); (E.L.)
| | - Pranil Pradhan
- Department for the Study of Chronic Disorder of Consciousness, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 107031 Moscow, Russia; (J.N.); (M.K.); (I.B.); (D.S.); (A.V.); (I.P.); (M.S.); (V.P.); (M.V.P.); (E.L.)
- Correspondence: ; Tel.: +7-(977)-709-4468
| | - Denis Shunenkov
- Department for the Study of Chronic Disorder of Consciousness, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 107031 Moscow, Russia; (J.N.); (M.K.); (I.B.); (D.S.); (A.V.); (I.P.); (M.S.); (V.P.); (M.V.P.); (E.L.)
| | - Alexey Vorobiev
- Department for the Study of Chronic Disorder of Consciousness, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 107031 Moscow, Russia; (J.N.); (M.K.); (I.B.); (D.S.); (A.V.); (I.P.); (M.S.); (V.P.); (M.V.P.); (E.L.)
| | - Maria Smirnova
- Department for the Study of Chronic Disorder of Consciousness, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 107031 Moscow, Russia; (J.N.); (M.K.); (I.B.); (D.S.); (A.V.); (I.P.); (M.S.); (V.P.); (M.V.P.); (E.L.)
| | - Vera Pasko
- Department for the Study of Chronic Disorder of Consciousness, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 107031 Moscow, Russia; (J.N.); (M.K.); (I.B.); (D.S.); (A.V.); (I.P.); (M.S.); (V.P.); (M.V.P.); (E.L.)
| | - Marina V. Petrova
- Department for the Study of Chronic Disorder of Consciousness, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 107031 Moscow, Russia; (J.N.); (M.K.); (I.B.); (D.S.); (A.V.); (I.P.); (M.S.); (V.P.); (M.V.P.); (E.L.)
- Department of Anestesiology-Reanimatology, People’s Friendship University of Russia, 117198 Moscow, Russia
| | - Elena Luginina
- Department for the Study of Chronic Disorder of Consciousness, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 107031 Moscow, Russia; (J.N.); (M.K.); (I.B.); (D.S.); (A.V.); (I.P.); (M.S.); (V.P.); (M.V.P.); (E.L.)
| | - Igor Pryanikov
- Department for the Study of Chronic Disorder of Consciousness, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 107031 Moscow, Russia; (J.N.); (M.K.); (I.B.); (D.S.); (A.V.); (I.P.); (M.S.); (V.P.); (M.V.P.); (E.L.)
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Kanarskii M, Nekrasova J, Vitkovskaya S, Pradhan P, Peshkov S, Borisova E, Borisov I, Panasenkova O, Petrova MV, Pryanikov I. Effect of Retinohypothalamic Tract Dysfunction on Melatonin Level in Patients with Chronic Disorders of Consciousness. Brain Sci 2021; 11:brainsci11050559. [PMID: 33925097 PMCID: PMC8145260 DOI: 10.3390/brainsci11050559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/23/2021] [Accepted: 04/26/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The aim of this study is to compare the secretion level of nocturnal melatonin and the characteristics of the peripheral part of the visual analyzer in patients with chronic disorders of consciousness (DOC). MATERIALS AND METHODS We studied the level of melatonin in 22 patients with chronic DOC and in 11 healthy volunteers. The fundus condition was assessed using the ophthalmoscopic method. RESULTS The average level of nocturnal melatonin in patients with DOC differed by 80% from the level of indole in healthy volunteers. This reveals a direct relationship between etiology, the level of consciousness, gaze fixation, coma recovery scale-revised score and the level of melatonin secretion. Examination by an ophthalmologist revealed a decrease in the macular reflex in a significant number of DOC patients, which in turn correlates negatively with the time from brain injury and positively with low values of nocturnal melatonin.
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Affiliation(s)
- Mikhail Kanarskii
- Department for the Study of Chronic Disorder of Consciousness, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 117647 Moscow, Russia; (M.K.); (J.N.); (S.V.); (S.P.); (E.B.); (I.B.); (O.P.); (M.V.P.); (I.P.)
| | - Julia Nekrasova
- Department for the Study of Chronic Disorder of Consciousness, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 117647 Moscow, Russia; (M.K.); (J.N.); (S.V.); (S.P.); (E.B.); (I.B.); (O.P.); (M.V.P.); (I.P.)
| | - Svetlana Vitkovskaya
- Department for the Study of Chronic Disorder of Consciousness, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 117647 Moscow, Russia; (M.K.); (J.N.); (S.V.); (S.P.); (E.B.); (I.B.); (O.P.); (M.V.P.); (I.P.)
| | - Pranil Pradhan
- Department for the Study of Chronic Disorder of Consciousness, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 117647 Moscow, Russia; (M.K.); (J.N.); (S.V.); (S.P.); (E.B.); (I.B.); (O.P.); (M.V.P.); (I.P.)
- Correspondence:
| | - Sergey Peshkov
- Department for the Study of Chronic Disorder of Consciousness, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 117647 Moscow, Russia; (M.K.); (J.N.); (S.V.); (S.P.); (E.B.); (I.B.); (O.P.); (M.V.P.); (I.P.)
| | - Elena Borisova
- Department for the Study of Chronic Disorder of Consciousness, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 117647 Moscow, Russia; (M.K.); (J.N.); (S.V.); (S.P.); (E.B.); (I.B.); (O.P.); (M.V.P.); (I.P.)
| | - Ilya Borisov
- Department for the Study of Chronic Disorder of Consciousness, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 117647 Moscow, Russia; (M.K.); (J.N.); (S.V.); (S.P.); (E.B.); (I.B.); (O.P.); (M.V.P.); (I.P.)
| | - Olga Panasenkova
- Department for the Study of Chronic Disorder of Consciousness, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 117647 Moscow, Russia; (M.K.); (J.N.); (S.V.); (S.P.); (E.B.); (I.B.); (O.P.); (M.V.P.); (I.P.)
| | - Marina V. Petrova
- Department for the Study of Chronic Disorder of Consciousness, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 117647 Moscow, Russia; (M.K.); (J.N.); (S.V.); (S.P.); (E.B.); (I.B.); (O.P.); (M.V.P.); (I.P.)
- Department of Anestesiology-Reanimatology, People’s Friendship University of Russia, 117198 Moscow, Russia
| | - Igor Pryanikov
- Department for the Study of Chronic Disorder of Consciousness, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 117647 Moscow, Russia; (M.K.); (J.N.); (S.V.); (S.P.); (E.B.); (I.B.); (O.P.); (M.V.P.); (I.P.)
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Nekrasova J, Kanarskii M, Yankevich D, Shpichko A, Borisov I, Pradhan P, Miroshnichenko M. Retrospective analysis of sleep patterns in patients with chronic disorders of consciousness. Sleep Med X 2020; 2:100024. [PMID: 33870176 PMCID: PMC8041117 DOI: 10.1016/j.sleepx.2020.100024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/13/2020] [Accepted: 08/24/2020] [Indexed: 12/04/2022] Open
Abstract
Analysis of sleep patterns in patients with chronic disorders of consciousness attracts attention from the perspective of the diagnosis and prognosis of the disease as well as the treatment. Yet, the very existence of normal sleep in patients in a vegetative or minimally conscious state is still a matter of debate. This paper presents a retrospective analysis of overnight polysomnographic records of 40 patients with chronic disorders of consciousness aimed at the possibility of establishing the connection between the degree of impaired consciousness and the presence and organization of polysomnographic graphical elements, associated with stages of sleep in normal individuals. Specialized software based on expert system artificial intelligence was developed to calculate indices and parameters that characterize sleep. It was shown that a remarkably low percentage of patients have a rhythmic change in sleep patterns, what indicates the prevalence of violations of the Sleep–Wake cycle in a vegetative state and minimally conscious state. Sleep spindles were not found in records, however, the absence can originate from the limitations of polysomnographic method applied to patients with severe brain damage. A positive correlation between the rhythmic change of sleep patterns, better outcome and CRS-R scores was confirmed. Sleep pattern is as a marker of higher level of consciousness and better outcome; PSG is not adequately informative in cases of significant damage to cerebral cortex; New methods and approaches for sleep analysis are needed; Artificial intelligence is encouraged to be used for sleep analysis in DOC patients.
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Affiliation(s)
- Julia Nekrasova
- Federal State Budget Scientific Institution, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia.,Federal State Budgetary Educational Institution of Higher Education, Moscow Aviation Institute (National Research University), Moscow, Russia
| | - Mikhail Kanarskii
- Federal State Budget Scientific Institution, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
| | - Dmitrii Yankevich
- Federal State Budget Scientific Institution, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
| | - Andrey Shpichko
- Federal State Budget Scientific Institution, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
| | - Ilya Borisov
- Federal State Budget Scientific Institution, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
| | - Pranil Pradhan
- Federal State Budget Scientific Institution, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
| | - Maria Miroshnichenko
- Federal State Budget Scientific Institution, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
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