SLEEP AND AROUSAL DISTURBANCES IN PTSD

描述（改编自申请人摘要）：本提案是第一个 睡眠障碍生物学研究的几个阶段 创伤后应激障碍（PTSD） 这项建议旨在研究 睡眠结构，特别是慢波睡眠， 慢性PTSD患者下丘脑-垂体-肾上腺轴活性 的 研究人员将研究无药物，非物质滥用的男性， 患有慢性创伤后应激障碍的女性越战退伍军人， 并发重度抑郁症（MDD）。 他们将检验 甲吡酮是一种抗糖皮质激素药物，可以增强慢波睡眠， PTSD伴和不伴MDD受试者睡眠结构 的主要内容 本研究将采用两组设计，其主要比较将 介于PTSD伴当前MDD（N=50）和PTSD不伴终生MDD之间 （N=50）。 研究人员将测试HPA活性的差异是否 导致了创伤后应激障碍患者睡眠生理的变化。 这项研究将 包括5个晚上的动态多导睡眠图：2个在家里，3个在一个 医院观察单位，23小时尿游离皮质醇和 将进行甲吡酮激发。 家庭睡眠和医院睡眠 相隔三个晚上。 家庭与医院睡眠研究的顺序 将被抵消，以研究适应记录的顺序效应 设备和住院治疗。 第三组战斗老兵控制着 没有终生PTSD或MDD的患者（N=20）将被招募， 检查PTSD对动态睡眠测量的影响， 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图研究：2个晚上在家， 2例在医院未接受甲吡酮治疗 最后，研究将 根据动态多导睡眠图验证腕关节活动记录仪，并提供 PTSD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.