Department of Neuropsychiatry, Kurume University School of Medicine, Kurume, Fukuoka, Japan.
Department of Neuropsychiatry, Kurume University School of Medicine, Kurume, Fukuoka, Japan.
Sleep Med. 2018 Mar;43:34-39. doi: 10.1016/j.sleep.2017.10.012. Epub 2017 Nov 23.
The presence of repeated nightmares in posttraumatic stress disorder (PTSD) has been hypothesized as a dysfunction of rapid eye movement (REM) sleep, but there has been remarkably little agreement about the pathophysiology. This presents a deterrent to more effective treatments. REM sleep abnormalities including elevated REM density also have been replicated in major depressive disorder (MDD). The purpose of this study was to clarify the difference of REM sleep abnormalities between the two disorders for understanding the pathophysiology of sleep disturbances in PTSD.
Polysomnographic measures were compared among 14 PTSD patients (aged 23.7 ± 5.5 years) and 14 MDD patients (aged 27.9 ± 10.1 years) under drug-naive or drug-free conditions. We defined REM interruption by summing the intrusive wake times during the REM period and adding the subsequent wake times to the last epoch of REM period. The significant polysomnographic measures were correlated with PTSD symptoms within the PTSD group.
REM interruption was significantly increased in the PTSD group compared with the MDD group (12.2 vs 2.1 min, p = 0.001). REM density was also significantly increased in the PTSD group compared with the MDD group (30.5 vs 23.1%, p = 0.019). Within the PTSD group, we found significant correlations between the severity of trauma-related nightmare complaints and the percentage of REM interruption (R = 0.62, p = 0.017), but not REM density.
REM sleep abnormalities are different between PTSD and MDD. Increased REM interruption may be a biological marker correlated with nightmare complaints in PTSD patients. Treatments including pharmacotherapy that reduces REM interruption might ameliorate nightmares in PTSD.
创伤后应激障碍（PTSD）中反复出现的噩梦被假设为快速眼动（REM）睡眠功能障碍，但对于其病理生理学机制，尚未达成共识。这对更有效的治疗方法造成了阻碍。REM 睡眠异常，包括 REM 密度增加，也在重度抑郁症（MDD）中得到了复制。本研究旨在阐明两种疾病之间 REM 睡眠异常的差异，以了解 PTSD 中睡眠障碍的病理生理学。
在药物未治疗或无药物治疗条件下，比较了 14 名 PTSD 患者（年龄 23.7±5.5 岁）和 14 名 MDD 患者（年龄 27.9±10.1 岁）的多导睡眠图测量结果。我们通过将 REM 期间的侵入性唤醒时间相加，并将随后的唤醒时间添加到 REM 周期的最后一个时段，来定义 REM 中断。在 PTSD 组内，将有意义的多导睡眠图测量结果与 PTSD 症状相关联。
与 MDD 组相比，PTSD 组的 REM 中断明显增加（12.2 分钟比 2.1 分钟，p=0.001）。与 MDD 组相比，PTSD 组的 REM 密度也明显增加（30.5%比 23.1%，p=0.019）。在 PTSD 组内，我们发现创伤相关噩梦主诉的严重程度与 REM 中断百分比之间存在显著相关性（R=0.62，p=0.017），但与 REM 密度无关。
REM 睡眠异常在 PTSD 和 MDD 之间存在差异。REM 中断增加可能是与 PTSD 患者噩梦主诉相关的生物学标志物。包括减少 REM 中断的药物治疗在内的治疗方法可能会改善 PTSD 患者的噩梦。
