Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany.
Department of Sleep and Human Factors Research, Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany; Institute of Experimental Epileptology and Cognition Research, University of Bonn Medical Center, Bonn, Germany; Division of Sleep Medicine, Harvard Medical School, Boston, United States.
Sleep Med Rev. 2022 Feb;61:101583. doi: 10.1016/j.smrv.2021.101583. Epub 2021 Dec 8.
Anxiety is the most common mental health problem worldwide. Epidemiological studies show that sleep disturbances, particularly insomnia, affect ∼50% of individuals with anxiety, and that insufficient sleep can instigate or further exacerbate it. This review outlines brain mechanisms underlying sleep and anxiety, by addressing recent human functional/structural imaging studies on brain networks underlying the anxiogenic impact of sleep loss, and the beneficial effect of sleep on these brain networks. We discuss recent developments from human molecular imaging studies that highlight the role of specific brain neurotransmitter mechanisms, such as the adenosinergic receptor system, on anxiety, arousal, and sleep. This review further discusses frontline sleep interventions aimed at enhancing sleep in individuals experiencing anxiety, such as nonbenzodiazepines/antidepressants, lifestyle and sleep interventions and cognitive behavioral therapy for insomnia. Notwithstanding therapeutic success, up to ∼30% of individuals with anxiety can be nonresponsive to frontline treatments. Thus, we address novel non-invasive brain stimulation techniques that can enhance electroencephalographic slow waves, and might help alleviate sleep and anxiety symptoms. Collectively, these findings contribute to an emerging biological framework that elucidates the interrelationship between sleep and anxiety, and highlight the prospect of slow wave sleep as a potential therapeutic target for reducing anxiety.
焦虑是全球最常见的心理健康问题。流行病学研究表明，睡眠障碍，特别是失眠，影响了大约 50%的焦虑患者，而睡眠不足会引发或进一步加重焦虑。本综述通过探讨睡眠不足对焦虑影响的大脑网络以及睡眠对这些大脑网络的有益作用，概述了睡眠和焦虑的大脑机制。我们讨论了人类分子成像研究的最新进展，这些研究强调了特定脑神经递质机制（如腺苷能受体系统）在焦虑、觉醒和睡眠中的作用。本综述还进一步讨论了旨在改善焦虑个体睡眠的前沿睡眠干预措施，如非苯二氮䓬类/抗抑郁药、生活方式和睡眠干预以及失眠的认知行为疗法。尽管治疗取得了成功，但多达 30%的焦虑患者可能对一线治疗无反应。因此，我们探讨了新的非侵入性脑刺激技术，这些技术可以增强脑电图慢波，并可能有助于缓解睡眠和焦虑症状。综上所述，这些发现有助于建立一个新兴的生物学框架，阐明睡眠和焦虑之间的相互关系，并强调慢波睡眠作为减轻焦虑的潜在治疗靶点的前景。
