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震惊暴露、睡眠障碍与恐惧消退巩固受损之间关系的神经相关性及其时间顺序。

The neural correlates and temporal sequence of the relationship between shock exposure, disturbed sleep and impaired consolidation of fear extinction.

机构信息

Max Planck Institute of Psychiatry, Kraepelinstr 2-10, 80804 Munich, Germany.

出版信息

J Psychiatr Res. 2010 Dec;44(16):1121-8. doi: 10.1016/j.jpsychires.2010.04.017. Epub 2010 May 13.

Abstract

Consolidation of extinction learning is a primary mechanism disrupted in posttraumatic stress disorder (PTSD), associated with hypoactivity of the ventromedial prefrontal cortex and hippocampus. A role for rapid eye movement (REM) sleep disturbances in this failure to consolidate extinction learning has been proposed. We performed functional magnetic resonance imaging (fMRI) with simultaneous skin conductance response (SCR) measurements in 16 healthy participants during conditioning/extinction and later recall of extinction. The visual stimuli were basic geometric forms and electrical shocks functioned as the unconditioned stimulus. Between the conditioning/extinction and recall sessions, participants received a 90-min sleep window in the sleep laboratory. This daytime sleep was polysomnographically recorded and scored by professionals blind to the study design. Only seven out of 16 participants had REM sleep; participants without REM sleep had a significantly slower decline of both SCR and neural activity of the laterodorsal tegmentum in response to electrical shocks during conditioning. At recall of fear extinction, participants with preceding REM sleep had a reduced SCR and stronger activation of the left ventromedial prefrontal cortex and bilateral lingual gyrus in response to the extinguished stimulus than participants lacking REM sleep. This study indicates that trait-like differences in shock reactivity/habituation (mediated by the brainstem) are predictive of REM sleep disruption, which in turn is associated with impaired consolidation of extinction (mediated by the ventromedial prefrontal cortex). These findings help understand the neurobiological basis and the temporal sequence of the relationship between shock exposure, disturbed sleep and impaired consolidation of extinction, as observed in PTSD.

摘要

巩固性消退学习是创伤后应激障碍(PTSD)的主要破坏机制,与腹内侧前额叶皮层和海马体的活动不足有关。有人提出,快速眼动(REM)睡眠紊乱在这一消退学习巩固失败中起作用。我们在 16 名健康参与者中进行了功能磁共振成像(fMRI)和同时的皮肤电反应(SCR)测量,以进行条件反射/消退以及随后的消退回忆。视觉刺激是基本的几何形状,电刺激作为非条件刺激。在条件反射/消退和回忆期间,参与者在睡眠实验室接受了 90 分钟的睡眠窗口。这段白天的睡眠被专业人员进行多导睡眠图记录和评分,他们对研究设计一无所知。在 16 名参与者中只有 7 人有 REM 睡眠;在条件反射期间,没有 REM 睡眠的参与者的皮肤电反应和外侧被盖核的神经活动对电刺激的下降速度明显较慢。在恐惧消退的回忆中,与没有 REM 睡眠的参与者相比,有 REM 睡眠的参与者的皮肤电反应降低,对被消除的刺激的左腹内侧前额叶皮层和双侧舌回的激活增强。这项研究表明,对电击的反应/习惯化(由脑干介导)的特质性差异可预测 REM 睡眠中断,而 REM 睡眠中断又与消退的巩固受损(由腹内侧前额叶皮层介导)有关。这些发现有助于理解 PTSD 中观察到的电击暴露、睡眠障碍和消退巩固受损之间的神经生物学基础和时间序列关系。

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