Mohsenin Shahla, Mohsenin Vahid
Private Practice Psychiatry, New Haven, Connecticut (Dr S. Mohsenin) and Section of Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, New Haven, Connecticut (Dr V. Mohsenin).
Prim Care Companion CNS Disord. 2014 Dec 11;16(6). doi: 10.4088/PCC.14r01663. eCollection 2014.
International and societal conflicts and natural disasters can leave physical and mental scars in people who are directly affected by these traumatic experiences. Posttraumatic stress disorder (PTSD) is the clinical manifestation of these experiences in the form of re-experiencing the trauma, avoidance of trauma-related stimuli, and persistent symptoms of hyperarousal. There is growing evidence that sleep disruption that occurs following trauma exposure may in fact contribute to the pathophysiology of PTSD and poor clinical outcomes. The purpose of this review is to highlight the importance of recognition and management of sleep disorders in patients with PTSD.
English-language, adult research studies published between 1985 and April 2014 were identified via the PubMed database. The search terms used were PTSD AND sleep disorders.
The search identified 792 original and review articles. Of these, 53 articles that discussed or researched sleep disorders in PTSD were selected. Fourteen randomized controlled trials of therapy for PTSD are included in this review.
Impaired sleep is a common complaint mainly in the form of nightmares and insomnia among people with PTSD. Sleep apnea and periodic limb movement disorder are particularly prevalent in patients with PTSD and, yet, remain unrecognized. Although selective serotonin reuptake inhibitors are effective in improving PTSD global symptoms, they have a variable and modest effect on sleep disorder symptoms. Cognitive-behavioral treatment targeted to sleep and/or the use of the centrally acting selective α1 antagonist prazosin have been more successful in treating insomnia and nightmares in PTSD than other classes of medications. In view of the high occurrence of sleep apnea and periodic leg movement disorder, a thorough sleep evaluation and treatment are warranted.
Patients with PTSD have a high prevalence of sleep disorders and should be queried for insomnia, nightmares, periodic limb movement disorder, and sleep-disordered breathing.
国际冲突、社会冲突及自然灾害会给直接遭受这些创伤经历的人们留下身心创伤。创伤后应激障碍（PTSD）是这些经历的临床表现，表现为再次体验创伤、回避与创伤相关的刺激以及持续的过度警觉症状。越来越多的证据表明，创伤暴露后出现的睡眠中断实际上可能导致PTSD的病理生理过程及不良临床结局。本综述的目的是强调识别和管理PTSD患者睡眠障碍的重要性。
通过PubMed数据库检索1985年至2014年4月发表的英文成人研究。使用的检索词为“PTSD与睡眠障碍”。
检索到792篇原创和综述文章。其中，选取了53篇讨论或研究PTSD患者睡眠障碍的文章。本综述纳入了14项PTSD治疗的随机对照试验。
睡眠障碍是PTSD患者常见的主诉，主要表现为噩梦和失眠。睡眠呼吸暂停和周期性肢体运动障碍在PTSD患者中尤为普遍，但仍未得到充分认识。尽管选择性5-羟色胺再摄取抑制剂可有效改善PTSD的整体症状，但它们对睡眠障碍症状的影响不一且效果一般。针对睡眠的认知行为治疗和/或使用中枢性选择性α1拮抗剂哌唑嗪在治疗PTSD患者的失眠和噩梦方面比其他类药物更成功。鉴于睡眠呼吸暂停和周期性腿部运动障碍的高发生率，有必要进行全面的睡眠评估和治疗。
PTSD患者睡眠障碍的患病率很高，应询问其是否存在失眠、噩梦、周期性肢体运动障碍和睡眠呼吸障碍。
