Psychiatry Res. 2013 Dec 30;214(3):422-8. doi: 10.1016/j.pscychresns.2013.09.007.
Rapid eye movement (REM) sleep disturbances predict poor clinical outcomes in posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). In MDD, REM sleep is characterized by activation of limbic and paralimbic brain regions compared to wakefulness. The neural correlates of PTSD during REM sleep remain scarcely explored, and comparisons of PTSD and MDD have not been conducted. The present study sought to compare brain activity patterns during wakefulness and REM sleep in 13 adults with PTSD and 12 adults with MDD using [¹⁸F]-fluoro-2-deoxy-D-glucose positron emission tomography (PET). PTSD was associated with greater increase in relative regional cerebral metabolic rate of glucose (rCMRglc) in limbic and paralimbic structures in REM sleep compared to wakefulness. Post-hoc comparisons indicated that MDD was associated with greater limbic and paralimbic rCMRglc during wakefulness but not REM sleep compared to PTSD. Our findings suggest that PTSD is associated with increased REM sleep limbic and paralimbic metabolism, whereas MDD is associated with wake and REM hypermetabolism in these areas. These observations suggest that PTSD and MDD disrupt REM sleep through different neurobiological processes. Optimal sleep treatments between the two disorders may differ: REM-specific therapy may be more effective in PTSD.
快速眼动（REM）睡眠障碍可预测创伤后应激障碍（PTSD）和重性抑郁障碍（MDD）的临床预后不良。在 MDD 中，与清醒相比，REM 睡眠的特征是边缘和边缘下脑区的激活。REM 睡眠期间 PTSD 的神经相关性仍鲜有研究，且 PTSD 和 MDD 之间的比较尚未进行。本研究旨在使用[¹⁸F]-氟-2-脱氧-D-葡萄糖正电子发射断层扫描（PET）比较 13 名 PTSD 患者和 12 名 MDD 患者在清醒和 REM 睡眠期间的大脑活动模式。与清醒相比，REM 睡眠中 PTSD 与边缘和边缘下结构的相对局部脑代谢率葡萄糖（rCMRglc）的增加幅度更大。事后比较表明，与 PTSD 相比，MDD 在清醒时但不在 REM 睡眠时与更大的边缘和边缘下 rCMRglc 相关。我们的研究结果表明，PTSD 与 REM 睡眠边缘和边缘下代谢增加有关，而 MDD 与这些区域的清醒和 REM 过度代谢有关。这些观察结果表明，PTSD 和 MDD 通过不同的神经生物学过程破坏 REM 睡眠。两种疾病之间的最佳睡眠治疗可能不同：REM 特异性治疗可能对 PTSD 更有效。
