一种生态方法来临床评估 PTSD 严重的军事服务人员的噩梦。

An ecological approach to clinically assess nightmares in military service members with severe PTSD.

机构信息

Psychiatric Department, Begin Military Teaching Hospital, Saint-Mandé, 94160, France; VIFASOM (Vigilance Fatigue Sommeil et Santé Publique) URP 7330, Université Paris Cité, Paris, 75005, France.

VIFASOM (Vigilance Fatigue Sommeil et Santé Publique) URP 7330, Université Paris Cité, Paris, 75005, France; French Armed Forces Biomedical Research Institute, Bretigny-sur-Orge, 91220, France; ECE Paris Graduate School of Engineering, 75015 Paris, France.

出版信息

Sleep Med. 2023 Mar;103:78-88. doi: 10.1016/j.sleep.2023.01.024. Epub 2023 Jan 28.

DOI:10.1016/j.sleep.2023.01.024

PMID:36764045

Abstract

BACKGROUND

Trauma-related nightmares (TRNs) are distressing events which contribute to insomnia severity, chronicity and treatment resistance of PTSD. Therefore, recording TRNs is a crucial technical challenge in order to understand their physiopathological patterns and their impact on sleep. However, TRNs are difficult to record during a single night in a sleep laboratory, which, moreover, is likely to be considered by patients as a protective sleep environment that is therefore not representative of home sleep conditions.

METHOD

In the present study, we investigate if objective sleep measures acquired at-home using two ambulatory devices is of clinical value by correlating with PTSD patients' complaints about sleep and nightmares. A secondary objective is to relate awakenings associated with TRNs to sleep stages and to provide new insights into the use of electrodermal activity (EDA) as a potential physiological marker of TRNs. Sixty veterans and active-duty service members were assessed by questionnaires and recorded for 5 consecutive nights in their homes.

RESULTS

Our approach firstly identified positive correlations between subjective and objective sleep parameters (total sleep time, sleep-onset latency and TRNs frequency). We also developed a method of synchronization between the two ambulatory devices that allowed us to match 200 TRNs (reported by event marker push button) with sleep stages corresponding to 91 nights and 37 patients. Most awakenings associated with TRNs occurred during NREM sleep (65.5% versus 34.5% during REM sleep). Our results also reveal significant differences in the frequency of EDA peaks 10 min before the reported events, with a lower frequency in REM (13.7 peaks) than in NREM (24.8 peaks) awakenings associated with TRNs. This EDA peaks frequency in REM sleep is not statistically different from that in REM sleep preceding awakenings that are not associated with TRNs.

CONCLUSION

The development of wearable devices to collect physiological parameters is of interest in clinical practice to improve our knowledge of sleep and trauma-related nightmares in patients with PTSD.

摘要

背景

创伤相关的梦魇（TRNs）是令人痛苦的事件，会导致创伤后应激障碍（PTSD）患者的失眠严重程度、持续性和治疗抵抗性增加。因此，记录 TRNs 是理解其生理病理模式及其对睡眠影响的关键技术挑战。然而，TRNs 在睡眠实验室的单个夜间内很难被记录，而且患者很可能认为睡眠实验室是一个保护性的睡眠环境，因此不能代表家庭睡眠条件。

方法

在本研究中，我们通过将 PTSD 患者的睡眠和梦魇相关抱怨与在家中使用两种可移动设备获得的客观睡眠测量值相关联，来研究其是否具有临床价值。次要目标是将与 TRNs 相关的觉醒与睡眠阶段相关联，并为将皮肤电活动（EDA）作为 TRNs 的潜在生理标志物的使用提供新的见解。60 名退伍军人和现役军人接受了问卷调查，并在家中连续记录了 5 个晚上。

结果

我们的方法首先确定了主观和客观睡眠参数（总睡眠时间、入睡潜伏期和 TRNs 频率）之间的正相关关系。我们还开发了一种在两种可移动设备之间进行同步的方法，该方法允许我们将 200 个 TRNs（通过事件标记按钮报告）与对应于 91 个夜晚和 37 个患者的睡眠阶段相匹配。与 TRNs 相关的大多数觉醒发生在非快速眼动（NREM）睡眠期间（65.5%比 REM 睡眠期间的 34.5%）。我们的结果还揭示了报告事件前 10 分钟 EDA 峰值频率的显著差异，与与 TRNs 相关的 NREM（24.8 个峰）觉醒相比，REM（13.7 个峰）中的 EDA 峰值频率较低。与与 TRNs 无关的觉醒相关的 REM 睡眠中的 EDA 峰值频率与 REM 睡眠中的 EDA 峰值频率无统计学差异。