Eichhorn Nicole, Treede Rolf-Detlef, Schuh-Hofer Sigrid
Department of Neurophysiology, Centre of Biomedicine and Medical Technology Mannheim, Heidelberg University, Medical Faculty Mannheim, Germany.
Department of Neurophysiology, Centre of Biomedicine and Medical Technology Mannheim, Heidelberg University, Medical Faculty Mannheim, Germany.
Neuroscience. 2018 Sep 1;387:191-200. doi: 10.1016/j.neuroscience.2017.09.044. Epub 2017 Oct 1.
Sex matters both in the clinical field of pain and sleep medicine. Sleep disturbances are highly prevalent in chronic pain patients and have been shown to deteriorate the pain condition. The pathomechanisms by which insomnia aggravates pain are currently unknown. Descending pain control may be compromised by disturbed sleep, but respective studies are few, inconsistent and largely imbalanced with respect to sex. We studied the role of sex on the effect of sleep deprivation on endogenous pain modulation and on nociceptive thresholds in a highly homogenous study population of 18 female (23.8 ± 3.4 years) and 18 male (23.3 ± 2.7) healthy students. One night of total sleep deprivation (TSD) was contrasted with one night of habitual sleep in a balanced cross-over design. A cold pressor test was used to explore the effect of TSD on supraspinal pain control. The effect of TSD on nociception was examined by Quantitative Sensory Testing (QST). RM-ANOVA was used for statistical analysis. We found a sex-dependent effect of TSD on descending pain pathways, since the endogenous capacity to inhibit pain was only reduced in sleep deprived females (interaction between 'sleep condition' and 'sex': p = 0.023). While TSD-induced cold and mechanical hyperalgesia were independent of sex, heat pain thresholds did only significantly decrease in sleep deprived females (p = 0.041). Our results point to a sex specific impact of TSD on descending pain inhibition. In the future, therapeutic strategies for pain patients with co-morbid insomnia may need to more explicitly respect the specific role of sex.
性别在疼痛和睡眠医学的临床领域中都很重要。睡眠障碍在慢性疼痛患者中非常普遍，并且已被证明会使疼痛状况恶化。目前尚不清楚失眠加重疼痛的病理机制。睡眠紊乱可能会损害下行性疼痛控制，但相关研究较少，结果不一致，而且在性别方面存在很大的不平衡。我们在一个由18名女性（23.8±3.4岁）和18名男性（23.3±2.7岁）健康学生组成的高度同质研究群体中，研究了性别对睡眠剥夺对内源性疼痛调节和伤害性感受阈值的影响。在平衡交叉设计中，将一晚的完全睡眠剥夺（TSD）与一晚的习惯性睡眠进行对比。使用冷加压试验来探究TSD对脊髓上疼痛控制的影响。通过定量感觉测试（QST）来检查TSD对伤害感受的影响。采用重复测量方差分析进行统计分析。我们发现TSD对下行性疼痛通路存在性别依赖性影响，因为只有睡眠剥夺的女性抑制疼痛的内源性能力降低（“睡眠状况”和“性别”之间的交互作用：p = 0.023）。虽然TSD诱导的冷痛觉过敏和机械性痛觉过敏与性别无关，但热痛阈值仅在睡眠剥夺的女性中显著降低（p = 0.041）。我们的结果表明TSD对下行性疼痛抑制存在性别特异性影响。未来，患有共病性失眠的疼痛患者的治疗策略可能需要更明确地考虑性别的特定作用。
