The changing REM sleep signature of posttraumatic stress disorder.
The changing REM sleep signature of posttraumatic stress disorder.
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作者：
R. Ross
1281 社论—罗斯 对于创伤后应激障碍 (PTSD) 睡眠障碍的现象学和病理生理学，人们的共识非常少。这对针对严重扰乱大多数创伤后应激障碍 (PTSD) 患者睡眠的失眠和反复做恶梦的更有效治疗方法提出了重大阻碍。 Mellman 及其同事在本期《SLEEP》中进行的研究使我们在理解 PTSD 睡眠障碍的机制方面又迈进了一步。尽管对 PTSD 的睡眠结构异常缺乏共识，但仍有强有力的证据表明 REM 睡眠功能发生改变。2,3 有趣的是，在创伤后观察到了碎片化、保留和增强的 REM 睡眠连续性。4-7 在协调这些看似不一致的发现的过程中，Mellman 等人 1 提供了一个重要提醒，即 PTSD 是对创伤应激的长期反应的结果之一，在解释多导睡眠图时必须仔细考虑创伤后经过的时间。创伤后应激障碍 (PTSD) 的发现。他们研究创伤后睡眠变化发展的巧妙方法，虽然不是“黄金标准”纵向设计，但已经产生了重要的见解。在年轻人的非临床社区样本中发现，快速眼动睡眠百分比和快速眼动睡眠段长度均与 PTSD 持续时间呈正相关（通过患者访谈进行回顾性评估），而快速眼动睡眠潜伏期呈负相关，这导致人们认为快速眼动睡眠在 PTSD 发病机制中发挥着突出的、也许是核心的作用。梅尔曼等人。表明随着时间的推移，快速眼动睡眠百分比和片段连续性的增加可能反映了有助于从 PTSD 中恢复的适应性过程。他们指出，这一假设与快速眼动睡眠对于情绪记忆的成功处理非常重要的证据非常吻合。8-10 可以说，一个必要的推论是，在慢性 PTSD 创伤多年后观察到的重建快速眼动睡眠可能是病态的，事实上，这是对压力适应不良的证据；这是基于一个并非所有人都同意的假设，即折磨 PTSD 患者的反复噩梦主要来自快速眼动睡眠。3,7 用精神分析术语来说，重复的“创伤性梦”表明梦机制失败，而不是成功。11 社论
1281 Editorial—Ross There has been remarkably little agreement about the phenomenology and pathophysiology of the sleep disturbance in posttraumatic stress disorder (PTSD). This presents a significant deterrent to the introduction of more effective treatments for the insomnia and recurrent nightmares that severely disrupt the sleep of most individuals with PTSD. The study by Mellman and colleagues1 in the current issue of SLEEP takes us a next step in understanding the mechanisms of disturbed sleep in PTSD. In the absence of a consensus on sleep architecture abnormalities in PTSD, there is nevertheless strong evidence for altered REM sleep function.2,3 Interestingly, fragmented, preserved, and enhanced REM sleep continuity all have been observed following trauma.4-7 In the process of reconciling these seemingly discrepant findings, Mellman et al.1 provide an important reminder that PTSD is one outcome of an extended response to traumatic stress and that the time elapsed post-trauma must be carefully considered in explaining polysomnographic findings in PTSD. Their ingenious approach to investigating the development of sleep changes following trauma, while not a “gold standard” longitudinal design, has yielded important insights. The finding, in a nonclinical community sample of young adults, that REM sleep percentage and REM segment length both were positively correlated with PTSD duration, as assessed retrospectively by patient interview, and that REM sleep latency correlated negatively, leads to a view of PTSD pathogenesis in which REM sleep plays a prominent, perhaps central, role. Mellman et al. suggest that the increases in REM sleep percentage and segment continuity over time could reflect an adaptive process that aids in recovery from PTSD. This hypothesis, they note, fits well with evidence that REM sleep is important in the successful processing of emotional memories.8-10 A necessary corollary, it can be argued, is that the reconstituted REM sleep observed years after traumatization in chronic PTSD may be pathological and, in fact, evidence of maladaptation to stress; this follows from a presumption, not shared by all, that the recurrent nightmares that torment PTSD sufferers emerge largely from REM sleep.3,7 In psychoanalytic terms, the repeating “traumatic dream” would indicate a failure, not a success, of the dream mechanism.11 EDITORIAL