Ross R J, Ball W A, Dinges D F, Kribbs N B, Morrison A R, Silver S M, Mulvaney F D
Research Service, Philadelphia Veterans Affairs Medical Center, Pennsylvania 19104.
Sleep. 1994 Dec;17(8):723-32. doi: 10.1093/sleep/17.8.723.
A subjective disturbance of sleep, including the occurrence of repetitive, stereotypical anxiety dreams, is characteristic of posttraumatic stress disorder (PTSD). The phenomenology of the PTSD anxiety dream has seemed most consistent with an underlying rapid eye movement (REM) sleep dysfunction. However, motor behavior reportedly can accompany PTSD dreams, and normal REM sleep typically involves a nearly total paralysis of the body musculature. As a means of understanding this discrepancy, anterior tibialis muscle activity during sleep was studied in a group of Vietnam combat veterans with current PTSD and in an age-matched normal control group. The PTSD subjects had a higher percentage of REM sleep epochs with at least one prolonged twitch burst; they also were more likely to have periodic limb movements in sleep, during nonrapid eye movement sleep. Both these forms of muscle activation also have been observed in REM behavior disorder (RBD), a parasomnia characterized by the actual enactment of dream sequences during REM sleep. The identification of RBD-like signs in PTSD adds to the evidence for a fundamental disturbance of REM sleep phasic mechanisms in PTSD.
睡眠的主观障碍，包括反复出现的刻板焦虑梦境，是创伤后应激障碍（PTSD）的特征。PTSD焦虑梦境的现象学似乎与潜在的快速眼动（REM）睡眠功能障碍最为一致。然而，据报道运动行为可伴随PTSD梦境出现，而正常的REM睡眠通常涉及身体肌肉组织几乎完全麻痹。作为理解这种差异的一种方法，对一组患有当前PTSD的越南退伍军人以及年龄匹配的正常对照组在睡眠期间的胫骨前肌活动进行了研究。PTSD受试者中有较高百分比的REM睡眠时段至少有一次长时间的抽搐爆发；他们在非快速眼动睡眠期间睡眠中出现周期性肢体运动的可能性也更高。这两种肌肉激活形式在快速眼动睡眠行为障碍（RBD）中也有观察到，RBD是一种异态睡眠，其特征是在REM睡眠期间实际演绎梦境情节。在PTSD中识别出类似RBD的体征，为PTSD中REM睡眠相位机制的根本紊乱提供了更多证据。
