de Zambotti Massimiliano, Trinder John, Colrain Ian M, Baker Fiona C
Center for Health Sciences, SRI International, Menlo Park, CA, 94025, USA.
Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, 3010, Australia.
Psychoneuroendocrinology. 2017 Jan;75:44-51. doi: 10.1016/j.psyneuen.2016.10.009. Epub 2016 Oct 14.
Insomnia is considered a hyperarousal disorder, in which several psychophysiological domains including the autonomic nervous system (ANS) are over-activated, potentially contributing to increased risk for cardiovascular (CV) disease. Here, we aimed to determine whether insomnia that develops in the context of the transition to menopause (menopausal transition insomnia, MTI) is similarly characterized by autonomic arousal. We also took into account modulation of the ANS by the hormonal changes of the menstrual cycle, a factor that has not previously been considered in studies on insomnia. Twenty one women with insomnia (49.0±3y) and 25 controls (48.8±2.6 y), also in the menopausal transition, had overnight laboratory-based polysomnographic recordings, including electrocardiograph, during the follicular and/or luteal (progesterone≥3ngml) phases of the menstrual cycle, with 21 women having recordings in both phases. Nocturnal time and frequency-domain heart rate variability (HRV) measures were calculated. Heart rate (HR) was significantly elevated (by ∼4bpm) in MTI compared to controls in both follicular and luteal phases, across hours of the night, including during undisturbed periods of NREM and REM sleep (p<0.05). A higher HR tended to be associated with lower frequency- and time-domain vagal HRV indices in MTI compared with controls. In both groups, HR was significantly higher and total and high frequency HRV measures were lower in the luteal phase compared to the follicular phase (p<0.05). In addition, REM compared to NREM sleep was characterized by increased HR coupled with decreased vagal modulation and increased sympathovagal balance (p<0.01). Insomnia in the menopausal transition is characterized by nocturnal autonomic hyperarousal during both follicular and luteal phases of the menstrual cycle, which could be a factor in the etiology of MTI as well as a potential CV risk factor.
失眠被认为是一种高度唤醒障碍，其中包括自主神经系统（ANS）在内的几个心理生理领域过度激活，这可能会增加心血管（CV）疾病的风险。在此，我们旨在确定在向更年期过渡的背景下出现的失眠（更年期过渡性失眠，MTI）是否同样具有自主唤醒的特征。我们还考虑了月经周期激素变化对自主神经系统的调节作用，这一因素在以往的失眠研究中尚未被考虑。21名患有失眠症的女性（49.0±3岁）和25名同样处于更年期过渡阶段的对照组女性（48.8±2.6岁），在月经周期的卵泡期和/或黄体期（孕酮≥3ng/ml）进行了基于实验室的夜间多导睡眠图记录，包括心电图，其中21名女性在两个阶段都进行了记录。计算了夜间时域和频域心率变异性（HRV）指标。在卵泡期和黄体期的整个夜间，包括在非快速眼动（NREM）和快速眼动（REM）睡眠的未受干扰时段，MTI组的心率（HR）均显著高于对照组（约高4bpm）（p<0.05）。与对照组相比，MTI组较高的HR往往与较低的频域和时域迷走神经HRV指标相关。在两组中，黄体期的HR均显著高于卵泡期，总HRV和高频HRV指标均低于卵泡期（p<0.05）。此外，与NREM睡眠相比，REM睡眠的特征是HR增加，迷走神经调节减少，交感迷走神经平衡增加（p<0.01）。更年期过渡性失眠的特征是在月经周期的卵泡期和黄体期夜间自主神经高度唤醒，这可能是MTI病因的一个因素，也是潜在的心血管危险因素。
