Sleep Disturbance in Chronic Military-Related PTSD: Clinical Impact and Response to Adjunctive Risperidone in the Veterans Affairs Cooperative Study #504
Sleep Disturbance in Chronic Military-Related PTSD: Clinical Impact and Response to Adjunctive Risperidone in the Veterans Affairs Cooperative Study #504
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DOI：
10.4088/jcp.14m09585
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发表时间：
2016-04-01
影响因子：
5.3
通讯作者：
Krystal, Andrew D.
中科院分区：
文献类型：
--
作者：
Krystal, John H.;Pietrzak, Robert H.;Krystal, Andrew D.
目的：睡眠障碍在患有慢性军事创伤后应激障碍（PTSD）的退伍军人中很常见。本文报道了一项多中心临床试验的结果，该试验探讨了这些退伍军人报告的睡眠障碍的临床相关性，并测试了第二代抗精神病药利培酮对这些症状的影响。方法：本文报告了一项为期24周的多中心随机安慰剂对照试验，对慢性军事相关PTSD症状患者进行连续利培酮治疗（n = 267，97%为男性），尽管接受了抗抑郁药和其他药物治疗，但仍有症状。该研究于2007年2月至2010年2月进行。通过使用DSM-IV-TR轴I障碍的结构化临床访谈，非患者版进行DSM-IV PTSD诊断。睡眠障碍主要通过匹兹堡睡眠质量指数（PSQI）（主要结局指标）进行评估。使用双变量相关性和纵向混合模型regressions.Results进行分析：88%的患者在这项研究中有临床显着受损的PSQI睡眠。睡眠障碍的严重程度与临床医生管理的PTSD量表（CAPS）测量的PTSD症状严重程度和多种生活质量指标（退伍军人兰德36项健康调查[SF-36 V]子量表，波士顿生活满意度指数）的降低相关。利培酮对PSQI总分（药物的主要效应：F-1，F-228 = 4.57，P= 0.034;药物与时间的相互作用：F-2，F-421 = 4.32，P= 0.014）和CAPS评估的噩梦严重程度（药物的主要效应：F-1，F-248 = 4.60，P= 0.033）产生了较小但具有统计学显著性的影响。利培酮产生的睡眠质量的改善与减少创伤后应激障碍症状的严重程度和SF-36 V的心理健康子量表的改善相关。结论：本研究强调了慢性军事相关的创伤后应激障碍的退伍军人的睡眠质量的严重干扰的近普遍性和显着的负面影响，他们是标准药物治疗的部分应答者。辅助利培酮对睡眠质量的适度改善与创伤后应激障碍严重程度的有限降低和生活质量的改善相关。(C)版权所有2016 Physicians Postgraduate Press，Inc.
Objective: Sleep disturbances are common among veterans with chronic military-related posttraumatic stress disorder (PTSD). This article reports the results of a multicenter clinical trial that explored the clinical correlates of reported sleep impairment in these veterans and tested the impact of the second-generation antipsychotic risperidone upon these symptoms.Method: This article reports secondary analyses of a 24-week multicenter randomized placebo-controlled trial of adjunctive risperidone in patients with chronic military-related PTSD symptoms (n = 267, 97% male) who were symptomatic despite treatment with antidepressants and other medications. The study was conducted between February 2007 and February 2010. DSM-IV PTSD diagnoses were made by using the Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Nonpatient Edition. Sleep disturbances were assessed principally by using the Pittsburgh Sleep Quality Index (PSQI) (primary outcome measure). Analyses were conducted using bivariate correlations and longitudinal mixed model regressions.Results: Eighty-eight percent of the patients in this study had clinically significantly impaired sleep on the PSQI. Severity of sleep disturbances correlated with PTSD symptom severity as measured by the Clinician-Administered PTSD Scale (CAPS) and reductions in multiple measures of quality of life (Veterans RAND 36-item Health Survey [SF-36 V] subscales, Boston Life Satisfaction Index). Risperidone produced small but statistically significant effects on total PSQI scores (main effect of drug: F-1,F-228 = 4.57, P=.034; drug-by-time interaction: F-2,F-421 = 4.32, P=.014) and severity of nightmares as assessed by the CAPS (main effect of drug: F-1,F-248 = 4.60, P=.033). The improvements in sleep quality produced by risperidone correlated with reductions in PTSD symptom severity and improvement in the mental health subscale of the SF-36 V.Conclusions: This study highlighted the near universality and significant negative impact of severe disturbances in sleep quality in veterans with chronic military-related PTSD who were partial responders to standard pharmacotherapies. The modest improvements in sleep quality produced by adjunctive risperidone were correlated with limited reductions in PTSD severity and improvements in quality of life. (C) Copyright 2016 Physicians Postgraduate Press, Inc.