Sleep inertia refers to the transient physiological state of hypoarousal upon awakening, associated with various degrees of impaired neurobehavioral performance, confusion, a desire to return to sleep and often a negative emotional state. Scalp and intracranial electro-encephalography as well as functional imaging studies have provided evidence that the sleep inertia phenomenon is underpinned by an heterogenous cerebral state mixing local sleep and local wake patterns of activity, at the neuronal and network levels. Sleep inertia is modulated by homeostasis and circadian processes, sleep stage upon awakening, and individual factors; this translates into a huge variability in its intensity even under physiological conditions. In sleep disorders, especially in hypersomnolence disorders such as idiopathic hypersomnia, sleep inertia may be a daily, serious and long-lasting symptom leading to severe impairment. To date, few tools have been developed to assess sleep inertia in clinical practice. They include mainly questionnaires and behavioral tests such as the psychomotor vigilance task. Only one neurophysiological protocol has been evaluated in hypersomnia, the forced awakening test which is based on an event-related potentials paradigm upon awakening. This contrasts with the major functional consequences of sleep inertia and its potentially dangerous consequences in subjects required to perform safety-critical tasks soon after awakening. There is a great need to identify reproducible biomarkers correlated with sleep inertia-associated cognitive and behavioral impairment. These biomarkers will aim at better understanding and measuring sleep inertia in physiological and pathological conditions, as well as objectively evaluating wake-promoting treatments or non-pharmacological countermeasures to reduce this phenomenon.

中文翻译：

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从生理觉醒到病理性睡眠惰性：睡眠到觉醒转变的神经生理学和行为特征

睡眠惰性是指觉醒时短暂的生理状态，与不同程度的神经行为表现受损、混乱、渴望返回睡眠以及通常的消极情绪状态相关。头皮和颅内脑电图以及功能成像研究提供的证据表明，睡眠惯性现象是由在神经元和网络水平上混合局部睡眠和局部唤醒活动模式的异质大脑状态支撑的。睡眠惰性受体内平衡和昼夜节律过程、醒来时的睡眠阶段以及个人因素的调节；即使在生理条件下，这也会导致其强度的巨大变化。在睡眠障碍中，尤其是在嗜睡症如特发性嗜睡症中，睡眠惰性可能是一种日常的、严重且持久的症状，导致严重损害。迄今为止，在临床实践中几乎没有开发出评估睡眠惰性的工具。它们主要包括问卷和行为测试，例如精神运动警惕任务。在嗜睡症中仅评估了一种神经生理学方案，即基于觉醒时事件相关电位范式的强迫觉醒测试。这与睡眠惯性的主要功能后果及其对醒来后需要立即执行安全关键任务的受试者的潜在危险后果形成鲜明对比。非常需要识别与睡眠惯性相关的认知和行为障碍相关的可重复的生物标志物。这些生物标志物旨在更好地理解和测量生理和病理条件下的睡眠惰性，并客观评估促进觉醒的治疗或非药物对策以减少这种现象。