Krystal John H, Pietrzak Robert H, Rosenheck Robert A, Cramer Joyce A, Vessicchio Jennifer, Jones Karen M, Huang Grant D, Vertrees Julia E, Collins Joseph, Krystal Andrew D
Clinical Neurosciences Division, VA National Center for PTSD, VA Connecticut Healthcare System (151-D) 950 Campbell Ave, West Haven, CT 06516
J Clin Psychiatry. 2016 Apr;77(4):483-91. doi: 10.4088/JCP.14m09585.
Sleep disturbances are common among veterans with chronic military-related posttraumatic stress disorder (PTSD). This article reports the results of a multicenter clinical trial that explored the clinical correlates of reported sleep impairment in these veterans and tested the impact of the second-generation antipsychotic risperidone upon these symptoms.
This article reports secondary analyses of a 24-week multicenter randomized placebo-controlled trial of adjunctive risperidone in patients with chronic military-related PTSD symptoms (n = 267, 97% male) who were symptomatic despite treatment with antidepressants and other medications. The study was conducted between February 2007 and February 2010. DSM-IV PTSD diagnoses were made by using the Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Nonpatient Edition. Sleep disturbances were assessed principally by using the Pittsburgh Sleep Quality Index (PSQI) (primary outcome measure). Analyses were conducted using bivariate correlations and longitudinal mixed model regressions.
Eighty-eight percent of the patients in this study had clinically significantly impaired sleep on the PSQI. Severity of sleep disturbances correlated with PTSD symptom severity as measured by the Clinician-Administered PTSD Scale (CAPS) and reductions in multiple measures of quality of life (Veterans RAND 36-item Health Survey [SF-36 V] subscales, Boston Life Satisfaction Index). Risperidone produced small but statistically significant effects on total PSQI scores (main effect of drug: F1,228 = 4.57, P = .034; drug-by-time interaction: F2,421 = 4.32, P = .014) and severity of nightmares as assessed by the CAPS (main effect of drug: F1,248 = 4.60, P = .033). The improvements in sleep quality produced by risperidone correlated with reductions in PTSD symptom severity and improvement in the mental health subscale of the SF-36 V.
This study highlighted the near universality and significant negative impact of severe disturbances in sleep quality in veterans with chronic military-related PTSD who were partial responders to standard pharmacotherapies. The modest improvements in sleep quality produced by adjunctive risperidone were correlated with limited reductions in PTSD severity and improvements in quality of life.
ClinicalTrials.gov identifier: NCT00099983.
睡眠障碍在患有慢性军事相关创伤后应激障碍（PTSD）的退伍军人中很常见。本文报告了一项多中心临床试验的结果，该试验探讨了这些退伍军人报告的睡眠障碍的临床相关性，并测试了第二代抗精神病药物利培酮对这些症状的影响。
本文报告了一项为期24周的多中心随机安慰剂对照试验的二次分析，该试验针对患有慢性军事相关PTSD症状的患者（n = 267，97%为男性）使用利培酮辅助治疗，这些患者尽管接受了抗抑郁药和其他药物治疗仍有症状。该研究于2007年2月至2010年2月进行。使用《精神疾病诊断与统计手册》第四版非患者版轴I障碍结构化临床访谈进行DSM-IV PTSD诊断。主要通过匹兹堡睡眠质量指数（PSQI）评估睡眠障碍（主要结局指标）。使用双变量相关性和纵向混合模型回归进行分析。
本研究中88%的患者在PSQI上存在临床上显著的睡眠障碍。睡眠障碍的严重程度与临床医生管理的PTSD量表（CAPS）测量的PTSD症状严重程度以及多项生活质量指标（退伍军人兰德36项健康调查[SF-36 V]子量表、波士顿生活满意度指数）的降低相关。利培酮对PSQI总分产生了小但具有统计学意义的影响（药物的主要效应：F1,228 = 4.57，P = .034；药物与时间的交互作用：F2,421 = 4.32，P = .014），并且对CAPS评估的噩梦严重程度产生了影响（药物的主要效应：F1,248 = 4.60，P = .033）。利培酮改善睡眠质量与PTSD症状严重程度的降低以及SF-36 V心理健康子量表的改善相关。
本研究强调了慢性军事相关PTSD退伍军人中睡眠质量严重障碍的近乎普遍性和重大负面影响，这些退伍军人对标准药物治疗部分有效。辅助使用利培酮使睡眠质量有适度改善，这与PTSD严重程度的有限降低和生活质量的改善相关。
ClinicalTrials.gov标识符：NCT〇〇〇99983。
