Jones Melissa B, Jeevan Sangeeth, Wang Jingyan, Li Ruosha, Agrawal Ritwick, Sharafkaneh Amir, Marsh Laura, Jorge Ricardo E
The Veterans Affairs (VA) South Central Mental Illness Research, Education and Clinical Center, Houston (Jones); the Michael E. DeBakey Veterans Affairs Medical Center, Houston (Jones, Jeevan, Agrawal, Sharafkaneh, Marsh, Jorge); the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Jones, Marsh, Jorge); the Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston (Wang, Li); and the Department of Medicine, Pulmonary, Critical Medicine and Sleep Medicine Section, Baylor College of Medicine, Houston (Agrawal, Sharafkaneh).
J Neuropsychiatry Clin Neurosci. 2020 Spring;32(2):147-153. doi: 10.1176/appi.neuropsych.19010009. Epub 2019 Oct 7.
Veterans with posttraumatic stress disorder (PTSD) frequently report dream enactment behavior (DEB). Although DEBs are associated with PTSD symptoms, their relationship with other sleep disorders, including REM behavior disorder, warrants reexamination of their clinical correlates.
The investigators used a cross-sectional, exploratory analysis to compare demographic and clinical characteristics of veterans endorsing regularly occurring DEB compared with those endorsing no or infrequent DEB. The participants comprised a convenience sample of servicemembers who were previously deployed to Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) and enrolled in an ongoing cohort study.
Of the 78 eligible participants, 19 (24.4%) endorsed DEBs occurring at least once per week in the past month. Compared with participants who reported no or infrequent DEBs, participants with regularly occurring DEBs had poorer sleep quality, greater PTSD severity, a higher number of reported mild traumatic brain injuries (mTBI) with loss of consciousness, and a higher likelihood of being diagnosed with sleep disorders. After adjustment for global sleep quality, a significant association persisted between DEBs and the number of mTBI with loss of consciousness but not between DEBs and the severity of PTSD symptoms.
These results suggest that mTBI may disrupt neural circuits regulating sleep among OIF/OEF/OND veterans. Prospective, polysomnographic assessment of muscle tone and behavioral events during REM sleep is needed to characterize the physiology of DEBs in this population.
创伤后应激障碍（PTSD）退伍军人经常报告梦呓行为（DEB）。尽管梦呓行为与PTSD症状相关，但其与包括快速眼动睡眠行为障碍在内的其他睡眠障碍的关系，仍需重新审视其临床相关性。
研究人员采用横断面探索性分析，比较了经常出现梦呓行为的退伍军人与未出现或很少出现梦呓行为的退伍军人的人口统计学和临床特征。参与者包括一个便利样本，即曾被部署到持久自由行动/伊拉克自由行动/新黎明行动（OEF/OIF/OND）并参与一项正在进行的队列研究的军人。
在78名符合条件的参与者中，19名（24.4%）认可在过去一个月中每周至少出现一次梦呓行为。与报告未出现或很少出现梦呓行为的参与者相比，经常出现梦呓行为的参与者睡眠质量较差，PTSD严重程度更高，报告的伴有意识丧失的轻度创伤性脑损伤（mTBI）数量更多，被诊断为睡眠障碍的可能性更高。在调整总体睡眠质量后，梦呓行为与伴有意识丧失的mTBI数量之间仍存在显著关联，但梦呓行为与PTSD症状严重程度之间不存在显著关联。
这些结果表明，mTBI可能会扰乱OIF/OEF/OND退伍军人中调节睡眠的神经回路。需要对该人群在快速眼动睡眠期间的肌肉张力和行为事件进行前瞻性多导睡眠图评估，以描述梦呓行为的生理学特征。
