SLEEP AND AROUSAL DISTURBANCES IN PTSD

描述(改编自申请人的摘要)：这是第一个 睡眠障碍生物学研究中的几个阶段 创伤后应激障碍(PTSD)。这项提案旨在研究 睡眠结构，特别是慢波睡眠与睡眠的关系 慢性创伤后应激障碍患者的下丘脑-垂体-肾上腺轴活动。这个 调查人员将研究无药物、非物质滥用的男性和 患有和不患有慢性创伤后应激障碍的越南退伍军人 并发重度抑郁障碍(MDD)。他们将检查这些影响 一种能增强慢波睡眠的抗糖皮质激素剂--美替拉酮 伴与不伴MDD的创伤后应激障碍患者的睡眠结构。的主要目标是 这项研究将采用两组设计，主要比较将 介于有当前MDD的PTSD(N=50)和无终生MDD的PTSD之间 (n=50)。研究人员将测试HPA活性是否存在差异 导致创伤后应激障碍患者睡眠生理的变异性。这项研究将 参与5个晚上的动态多导睡眠监测：2个在家里，3个在医院 医院观察单元，23小时尿游离皮质醇和 将进行甲氧苯丙酮挑战。居家睡眠和医院睡眠 相隔3个晚上。家庭与医院睡眠研究的先后顺序 将被平衡以研究适应录音的顺序效应 设备和住院费用。第三组战斗老兵控制组 无终生创伤后应激障碍或MDD(N=20)将被招募以允许 创伤后应激障碍对动态睡眠措施的影响 适应记录设备和医院环境。对照组 将进行4个晚上的动态多导睡眠监测：2个在家中， 2名患者在医院接受治疗，未接受甲替拉奉的治疗。最后，该研究将 验证腕部活动描记与动态多导睡眠描记的对比，并提供 创伤后应激障碍患者24小时睡眠-觉醒活动水平的数据。

DESCRIPTION (Adapted from applicant's abstract): This proposal is the first of several phases in a line of research on the biology of sleep disturbances in Post Traumatic Stress Disorder (PTSD). This proposal aims to examine the relationship between sleep architecture, particularly slow wave sleep, and hypothalamic-pituitary-adrenal axis activity in chronic PTSD. The investigators will study medication-free, non-substance abusing male and female Vietnam theater veterans with chronic PTSD with and without concurrent Major Depressive Disorder (MDD). They will examine the effects of metyrapone, an antiglucocorticoid agent that enhances slow wave sleep, on sleep architecture in PTSD subjects with and without MDD. The major aims of this study will be met with a two group design whose main comparisons will be between PTSD with current MDD (N=50) and PTSD without lifetime MDD (N=50). The investigators will test if differences in HPA activity contribute to the variability in sleep physiology in PTSD. The study will involve 5 nights of ambulatory polysomnography: 2 at home, and 3 in a hospital observation unit where 23 hour urinary free cortisol and a metyrapone challenge will be performed. The home sleep and hospital sleep are separated by 3 nights. The order of home vs. hospital sleep studies will be counterbalanced to study order effects in adaptation to recording equipment and hospitalization. A third group of combat veteran controls without lifetime PTSD or MDD (N=20) will be recruited to allow an examination of the effect of PTSD on ambulatory sleep measures and adaptation to recording equipment and hospital setting. The control group will be studied with ambulatory polysomnography for 4 nights: 2 at home, and 2 in the hospital with no metyrapone challenge. Finally, the study will validate wrist actigraphy against ambulatory polysomnography and provide data on 24 hour sleep-wake activity levels in PTSD.