Sleep disturbances as the hallmark of PTSD: where are we now?
Sleep disturbances as the hallmark of PTSD: where are we now?
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DOI：
10.1176/appi.ajp.2012.12040432
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发表时间：
2013-04
期刊：
影响因子：
--
通讯作者：
Germain A
中科院分区：
文献类型：
--
作者：
Germain A
1989年，Ross及其同事提出了快速眼动（REM）睡眠障碍是创伤后应激障碍（PTSD）标志的假设，这一假设激发了大量关于睡眠在PTSD病理生理学中作用的临床、临床前和动物研究。本审查重新审视这一有影响力的假设，在临床和实验结果，因为积累。对成年PTSD患者进行的多导睡眠图研究得出了关于REM睡眠障碍的混合结果，它们通常表明适度和非特异性的睡眠中断。前瞻性研究和治疗研究为睡眠障碍与精神疾病结局和症状之间的关系提供了更有力的证据。实验动物和人类研究探索了REM睡眠和恐惧反应之间的关系，以及更广泛地关注睡眠依赖性情感和记忆过程的研究，也为睡眠在PTSD相关过程中发挥重要作用的假设提供了强有力的支持。总的来说，文献表明，干扰REM或非REM睡眠可以导致适应不良的压力和创伤反应，并可能构成一个可修改的风险因素，为精神疾病的不良后果。临床医生需要考虑与噩梦相关的慢性睡眠中断可能会影响一线PTSD治疗的疗效，但有针对性的睡眠治疗可能会加速PTSD的恢复。这一领域已经成熟，可以在高危人群中进行前瞻性和纵向研究，以澄清睡眠生理学和神经生物学的变化如何导致精神病预后不良的风险增加。
The hypothesis that rapid eye movement (REM) sleep disturbances are the hallmark of posttraumatic stress disorder (PTSD), proposed by Ross and colleagues in 1989, has stimulated a wealth of clinical, preclinical, and animal studies on the role of sleep in the pathophysiology of PTSD. The present review revisits this influential hypothesis in light of clinical and experimental findings that have since accumulated. Polysomnographic studies conducted in adults with PTSD have yielded mixed findings regarding REM sleep disturbances, and they generally suggest modest and nonspecific sleep disruptions. Prospective and treatment studies have provided more robust evidence for the relationship between sleep disturbances and psychiatric outcomes and symptoms. Experimental animal and human studies that have probed the relationship between REM sleep and fear responses, as well as studies focused more broadly on sleep-dependent affective and memory processes, also provide strong support for the hypothesis that sleep plays an important role in PTSD-relevant processes. Overall, the literature suggests that disturbed REM or non-REM sleep can contribute to maladaptive stress and trauma responses and may constitute a modifiable risk factor for poor psychiatric outcomes. Clinicians need to consider that the chronic sleep disruption associated with nightmares may affect the efficacy of first-line PTSD treatments, but targeted sleep treatments may accelerate recovery from PTSD. The field is ripe for prospective and longitudinal studies in high-risk groups to clarify how changes in sleep physiology and neurobiology contribute to increased risk of poor psychiatric outcomes.
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