San Antonio Uniformed Services Health Education Consortium, Department of Sleep Medicine, JBSA Lackland, Texas.
Naval Postgraduate School, Monterey, California.
J Clin Sleep Med. 2022 Dec 1;18(12):2775-2784. doi: 10.5664/jcsm.10214.
Trauma associated sleep disorder is a proposed parasomnia that develops after trauma with clinical features of trauma related nightmares, disruptive nocturnal behaviors, and autonomic disturbances. The purpose of this case series is to better characterize the clinical and video-polysomnographic features of patients meeting clinical criteria for this proposed parasomnia.
Semistructured clinical interview and detailed video-polysomnography review of 40 patients. Movements and vocalizations in rapid eye movement sleep were quantified according to the rapid eye movement sleep behavior disorder severity scale.
Patients (n = 40, 32 males) were service members and veterans with a median age of 38.9 years (range 24-57 years) who reported trauma related nightmares and disruptive nocturnal behaviors at home. On video-polysomnography, 28 (71.8%) patients had disruptive nocturnal behaviors in rapid eye movement sleep consisting of limb, head, and axial movements; vocalizations were present in 8 (20%). On the rapid eye movement sleep behavior disorder severity scale, most (n = 28, 71.8%) had a low rating but those with greater severity (n = 11, 28.2%) had a higher prevalence of posttraumatic stress disorder ( = .013) and markedly less N3 sleep ( = .002). The cohort had a high rate of insomnia (n = 35, 87.5%) and obstructive sleep apnea (n = 19, 47.5%). Most patients were treated with prazosin (n = 29, 72.5%) with concomitant behavioral health interventions (n = 25, 64.1%); 15 (51.7%) patients receiving prazosin reported improved symptomatology.
Disruptive nocturnal behaviors can be captured on video-polysomnography during rapid eye movement sleep, although they may be less pronounced than what patients report in their habitual sleeping environment. Clinical and video-polysomnographic correlations are invaluable in assessing patients with trauma associated sleep disorder to document objective abnormalities. This case series provides a further basis for establishing trauma associated sleep disorder as a unique parasomnia.
Brock MS, Matsangas P, Creamer JL, et al. Clinical and polysomnographic features of trauma associated sleep disorder. . 2022;18(12):2775-2784.
创伤相关睡眠障碍是一种拟议的睡眠障碍，发生于创伤后，具有创伤相关噩梦、夜间行为障碍和自主神经紊乱的临床特征。本病例系列的目的是更好地描述符合该拟议睡眠障碍临床标准的患者的临床和视频多导睡眠图特征。
对 40 名患者进行半结构式临床访谈和详细的视频多导睡眠图回顾。根据快速眼动睡眠行为障碍严重程度量表对快速眼动睡眠中的运动和发声进行量化。
患者（n=40，男 32 例）为现役军人和退伍军人，中位年龄 38.9 岁（范围 24-57 岁），报告创伤后在家中出现与创伤相关的噩梦和夜间行为障碍。在视频多导睡眠图上，28 例（71.8%）患者在快速眼动睡眠中出现行为障碍，表现为肢体、头部和轴向运动；8 例（20%）出现发声。在快速眼动睡眠行为障碍严重程度量表上，大多数（n=28，71.8%）评分较低，但严重程度较高者（n=11，28.2%）创伤后应激障碍患病率较高（p=.013），N3 睡眠明显较少（p=.002）。该队列的失眠发生率较高（n=35，87.5%）和阻塞性睡眠呼吸暂停发生率较高（n=19，47.5%）。大多数患者接受了哌唑嗪治疗（n=29，72.5%），同时进行了行为健康干预（n=25，64.1%）；15 例（51.7%）接受哌唑嗪治疗的患者报告症状改善。
虽然在快速眼动睡眠期间可能无法观察到患者在习惯睡眠环境中报告的那么明显，但可以在视频多导睡眠图上捕捉到夜间行为障碍。临床和视频多导睡眠图的相关性对于评估创伤相关睡眠障碍患者以记录客观异常非常有价值。本病例系列为将创伤相关睡眠障碍确立为一种独特的睡眠障碍提供了进一步的依据。
