title: Polysomnographic Sleep Patterns in Children and Adolescents in Unresponsive Wakefulness Syndrome.
abstract: OBJECTIVE
  We aimed (i) to search for qualitative sleep patterns for pediatric unresponsive wakefulness syndrome (SPPUWS) in prolonged polysomnographic (PSG) recordings in children and adolescents with subacute severe disorders of consciousness due to an acquired brain damage; (ii) to investigate the clinical relevance of SPPUWS and of possible neurophysiological markers (rapid eye movement sleep and sleep spindles) in PSG recordings of pediatric patients with unresponsive wakefulness syndrome (UWS).
  
  
  METHODS
  We performed a PSG study in 27 children with UWS due to acquired brain damage in the subacute phase. Patients received a full neurological examination and a clinical assessment with standardized scales. In addition, outcome was assessed after 36 months.
  
  
  RESULTS
  We identified 6 PSG patterns (SPPUWS) corresponding to increasing neuroelectrical complexity. The presence of an organized sleep pattern, as well as rapid eye movement sleep and sleep spindles, in the subacute stage appeared highly predictive of a more favorable outcome. Correlation was found between SPPUWS and recovery, as assessed by several clinical and rehabilitation scales.
  
  
  CONCLUSIONS
  Polysomnography can be used as a prognostic tool, as it can help determine the capability to recover from a pediatric UWS and predict outcome well before the confirmation provided by suitable clinical scales.
authors.affiliation: Acquired Brain Injury Unit, Scientific Institute "Eugenio Medea," Bosisio Parini, Lecco, Italy (Drs Avantaggiato, Molteni, Formica, Arcieri, Locatelli, and Strazzer); Department of Experimental and Clinical Medicine, University of Udine Medical School, Udine, Italy (Drs Gigli and Valente); and Neurology Unit and Center of Sleep Medicine, "Santa Maria della Misericordia" University Hospital, Udine, Italy (Drs Lorenzut and de Biase).
authors.forename: Paolo
authors.initials: P
authors.lastname: Avantaggiato
authors.forename: Erika
authors.initials: E
authors.lastname: Molteni
authors.forename: Francesca
authors.initials: F
authors.lastname: Formica
authors.forename: Gian Luigi
authors.initials: GL
authors.lastname: Gigli
authors.forename: Mariarosaria
authors.initials: M
authors.lastname: Valente
authors.forename: Simone
authors.initials: S
authors.lastname: Lorenzut
authors.forename: Stefano
authors.initials: S
authors.lastname: de Biase
authors.forename: Salvatore
authors.initials: S
authors.lastname: Arcieri
authors.forename: Federica
authors.initials: F
authors.lastname: Locatelli
authors.forename: Sandra
authors.initials: S
authors.lastname: Strazzer
mesh_terms: D000293:Adolescent; D001930:Brain Injuries / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D002648:Child; D015331:Cohort Studies; D004569:Electroencephalography / Q000379:methods; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D018458:Persistent Vegetative State / Q000175:diagnosis* / Q000209:etiology*; D017286:Polysomnography / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012894:Sleep Stages / Q000502:physiology; D013577:Syndrome; D013997:Time Factors; D014851:Wakefulness / Q000502:physiology