Asah Cresta, Sandahl Hinuga, Baandrup Lone, Carlsson Jessica, Jennum Poul
Department of Clinical Neurophysiology, Danish Center for Sleep Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Eur J Psychotraumatol. 2025 Dec;16(1):2444743. doi: 10.1080/20008066.2024.2444743. Epub 2025 Jan 7.
Sleep disturbances are widely reported in Post-Traumatic Stress Disorder (PTSD). Although Dream Enactment Behaviour (DEB) has long been associated with PTSD, its high prevalence has only recently been recognized, sparking discussions about the classification of trauma-related sleep disorders. The impact of DEB on treatment outcomes in PTSD remains unexplored. To investigate the role of DEB in functional impairment, symptom severity, subjective sleep disturbances, and treatment response in patients with PTSD, and how it relates to Trauma-Associated Sleep Disorder (TASD). We analyzed data from a randomized controlled trial carried out in a specialized mental health clinic in Denmark. The trial investigated refugees with PTSD allocated to four groups receiving different combinations of PTSD therapy. Participants completed self-report questionnaires assessing functional impairment, symptom severity, and subjective sleep disturbances, including the REM Sleep Behaviour Disorder Screening Questionnaire (RBDSQ), the Pittsburgh Sleep Quality Index (PSQI), and the Typical Dream Questionnaire (TDQ), at baseline and follow-up. The sample was split into two groups based on the presence of self-reported DEB, and compared at baseline and follow-up. Statistical analyses included chi-square test, Mann-Whitney U test, and regression. A sample of 176 RBDSQ respondents was studied, of which 71% met the criteria for DEB ( = 125). DEB was significantly associated with a poorer treatment response on sleep quality as assessed by the PSQI ( = 122, = .035), irrespective of treatment group. No differences were observed in functional impairment or symptom severity. Of the 67 TDQ respondents with DEB, 60% did not have trauma-related nightmares ( = 40). DEB is a significant feature of sleep in PTSD and seems to limit the efficacy of treatment interventions. TASD does not encompass all cases of DEB in PTSD and the concept needs further development to be clinically useful. ClinicalTrials.gov identifier: NCT02761161; clinicaltrials.gov/study/NCT02761161.
创伤后应激障碍（PTSD）患者中普遍存在睡眠障碍的情况。尽管梦呓行为（DEB）长期以来一直与PTSD相关，但直到最近才认识到其高患病率，这引发了关于创伤相关睡眠障碍分类的讨论。DEB对PTSD治疗结果的影响仍未得到研究。为了调查DEB在PTSD患者功能损害、症状严重程度、主观睡眠障碍和治疗反应中的作用，以及它与创伤相关睡眠障碍（TASD）的关系。我们分析了在丹麦一家专门的心理健康诊所进行的一项随机对照试验的数据。该试验研究了患有PTSD的难民，他们被分配到四组接受不同组合的PTSD治疗。参与者在基线和随访时完成了自我报告问卷，评估功能损害、症状严重程度和主观睡眠障碍，包括快速眼动睡眠行为障碍筛查问卷（RBDSQ）、匹兹堡睡眠质量指数（PSQI）和典型梦境问卷（TDQ）。根据自我报告的DEB情况将样本分为两组，并在基线和随访时进行比较。统计分析包括卡方检验、曼-惠特尼U检验和回归分析。对176名RBDSQ受访者的样本进行了研究，其中71%（n = 125）符合DEB标准。无论治疗组如何，通过PSQI评估，DEB与睡眠质量较差的治疗反应显著相关（n = 122，p = 0.035）。在功能损害或症状严重程度方面未观察到差异。在67名有DEB的TDQ受访者中，60%（n = 40）没有与创伤相关的噩梦。DEB是PTSD睡眠的一个显著特征，似乎会限制治疗干预的效果。TASD并未涵盖PTSD中所有的DEB病例，这一概念需要进一步发展才能在临床上发挥作用。ClinicalTrials.gov标识符：NCT02761161；clinicaltrials.gov/study/NCT02761161。
