title: The prognostic value of sleep patterns in disorders of consciousness in the sub-acute phase.
abstract: OBJECTIVE
  This study aimed to evaluate, through polysomnographic analysis, the prognostic value of sleep patterns, compared to other prognostic factors, in patients with disorders of consciousness (DOCs) in the sub-acute phase.
  
  
  METHODS
  Twenty-seven patients underwent 24-h polysomnography and clinical evaluation 3.5 ± 2 months after brain injury. Their clinical outcome was assessed 18.5 ± 9.9 months later. Polysomnographic recordings were evaluated using visual and quantitative indexes. A general linear model was applied to identify features able to predict clinical outcome. Clinical status at follow-up was analysed as a function of the baseline clinical status, the interval between brain injury and follow-up evaluation, patient age and gender, the aetiology of the injury, the lesion site, and visual and quantitative sleep indexes.
  
  
  RESULTS
  A better clinical outcome was predicted by a visual index indicating the presence of sleep integrity (p=0.0006), a better baseline clinical status (p=0.014), and younger age (p=0.031). Addition of the quantitative sleep index strengthened the prediction.
  
  
  CONCLUSIONS
  More structured sleep emerged as a valuable predictor of a positive clinical outcome in sub-acute DOC patients, even stronger than established predictors (e.g. age and baseline clinical condition).
  
  
  CONCLUSIONS
  Both visual and quantitative sleep evaluation could be helpful in predicting clinical outcome in sub-acute DOCs.
authors.affiliation: Clinical Neurology, Dept. of Neuroscience (DINOGMI), University of Genoa, Italy. Electronic address: dario.arnaldi@gmail.com.
authors.forename: Dario
authors.initials: D
authors.lastname: Arnaldi
authors.affiliation: Sleep Medicine and Epilepsy Unit - C. Mondino National Neurological Institute, IRCCS, Pavia, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Terzaghi
authors.affiliation: Sleep Medicine and Epilepsy Unit - C. Mondino National Neurological Institute, IRCCS, Pavia, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Cremascoli
authors.affiliation: Institute of Bioimaging and Molecular Physiology, National Research Council, Genoa, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: De Carli
authors.affiliation: Neurorehabilitation Unit, IRCCS, S. Maugeri Foundation, Pavia, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Maggioni
authors.affiliation: Neurorehabilitation Unit, IRCCS, S. Maugeri Foundation, Pavia, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Pistarini
authors.affiliation: Clinical Neurology, Dept. of Neuroscience (DINOGMI), University of Genoa, Italy.
authors.forename: Flavio
authors.initials: F
authors.lastname: Nobili
authors.affiliation: Sleep Medicine and Epilepsy Unit - C. Mondino National Neurological Institute, IRCCS, Pavia, Italy.
authors.forename: Arrigo
authors.initials: A
authors.lastname: Moglia
authors.affiliation: Sleep Medicine and Epilepsy Unit - C. Mondino National Neurological Institute, IRCCS, Pavia, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Manni
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003243:Consciousness / Q000502:physiology; D003244:Consciousness Disorders / Q000175:diagnosis* / Q000503:physiopathology*; D004569:Electroencephalography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography / Q000379:methods; D011379:Prognosis; D012894:Sleep Stages / Q000502:physiology*; D055815:Young Adult
keywords: Coma; EEG; Minimally conscious state; Sleep; Vegetative state