Straus Laura D, Acheson Dean T, Risbrough Victoria B, Drummond Sean P A
San Diego State University / University of California San Diego Joint Doctoral Program in Clinical Psychology. 6363 Alvarado Court, Suite 103, San Diego, CA 92120, USA.
Research Service, San Diego Veterans Affairs Healthcare System (SDVAHS). 3350 La Jolla Village Dr, San Diego, CA 92161, USA.
Biol Psychiatry Cogn Neurosci Neuroimaging. 2017 Mar;2(2):123-129. doi: 10.1016/j.bpsc.2016.05.004.
Learned fear is crucial in the development and maintenance of posttraumatic stress disorder (PTSD) and other anxiety disorders, and extinction of learned fear is necessary for response to exposure-based treatments. In humans, research suggests disrupted sleep impairs consolidation of extinction, though no studies have examined this experimentally using total sleep deprivation.
Seventy-one healthy controls underwent a paradigm to acquire conditioned fear to a visual cue. Twenty-four hours after fear conditioning, participants underwent extinction learning. Twenty-four hours after extinction learning, participants underwent extinction recall. Participants were randomized to three groups: 1) well-rested throughout testing ("normal sleep"; n = 21); 2) 36 hours total sleep deprivation before extinction learning ("pre-extinction deprivation"; n = 25); or 3) 36 hours total sleep deprivation after extinction learning and before extinction recall ("post-extinction deprivation"; n = 25). The groups were compared on blink EMG reactivity to the condition stimulus during extinction learning and recall.
There were no differences among the three groups during extinction learning. During extinction recall, the pre-extinction deprivation group demonstrated significantly less extinction recall than the normal sleep group. There was no significant difference between the normal sleep and post-extinction deprivation group during extinction recall. Results indicated sleep deprivation prior to extinction training significantly disrupts extinction recall.
These findings suggest that (1) sleep deprivation in the immediate aftermath of trauma could be a potential contributor to PTSD development and maintenance via interference with natural extinction processes and (2) management of sleep symptoms should be considered during extinction-based therapy.
习得性恐惧在创伤后应激障碍（PTSD）和其他焦虑症的发生及维持过程中至关重要，而消除习得性恐惧是基于暴露疗法产生疗效的必要条件。在人类中，研究表明睡眠中断会损害消退记忆的巩固，不过尚无研究通过完全睡眠剥夺对此进行实验研究。
71名健康对照者参与了一项对视觉线索形成条件性恐惧的范式实验。恐惧条件化24小时后，参与者进行消退学习。消退学习24小时后，参与者进行消退记忆测试。参与者被随机分为三组：1）整个测试过程中睡眠良好（“正常睡眠”；n = 21）；2）在消退学习前进行36小时的完全睡眠剥夺（“消退前剥夺”；n = 25）；或3）在消退学习后且在消退记忆测试前进行36小时的完全睡眠剥夺（“消退后剥夺”；n = 25）。比较三组在消退学习和记忆测试期间对条件刺激的眨眼肌电图反应。
在消退学习期间，三组之间没有差异。在消退记忆测试期间，消退前剥夺组的消退记忆明显少于正常睡眠组。在消退记忆测试期间，正常睡眠组和消退后剥夺组之间没有显著差异。结果表明，在消退训练前进行睡眠剥夺会显著干扰消退记忆。
这些发现表明：（1）创伤后立即出现的睡眠剥夺可能通过干扰自然消退过程而成为PTSD发生和维持的一个潜在因素；（2）在基于消退的治疗过程中应考虑对睡眠症状进行管理。
