Mellman T A, Nolan B, Hebding J, Kulick-Bell R, Dominguez R
Miami Veterans Administration Medical Center, Florida, USA.
Sleep. 1997 Jan;20(1):46-51. doi: 10.1093/sleep/20.1.46.
Post-traumatic stress disorder (PTSD) overlaps major depression (MD) clinically, but differs with respect to treatment response and some biological markers. Sleep disturbances represent core features of PTSD and are also common in MD. Rapid eye movement sleep (REM) has been postulated to be involved in the pathophysiology of PTSD, and REM abnormalities occur in MD. Twenty-five patients with combat-related PTSD, 16 men with a principal diagnosis of MD, and 10 asymptomatic male controls were compared by polysomnography (PSG) under medication and substance-free conditions. Data were obtained from recordings made after an accommodation night. One subject from each group was excluded for significant apnea or limb movements. Sleep efficiency was decreased in the PTSD group compared to the MD and control groups. REM density was comparably increased in PTSD and MD groups, while the amount of REM sleep was reduced in PTSD compared to MD groups. These sleep measures were not significantly associated with co-morbid depression, substance-use disorder histories, or subclinical sleep apnea or limb movements within the PTSD group. These findings support sleep maintenance being impaired in chronic PTSD patients. Increased REM density in PTSD patients was replicated and was comparable to increases in the MD group. Divergence of REM time between these clinical groups suggests the possibility of different underlying mechanisms.
创伤后应激障碍（PTSD）在临床上与重度抑郁症（MD）有重叠，但在治疗反应和一些生物学标志物方面有所不同。睡眠障碍是PTSD的核心特征，在MD中也很常见。快速眼动睡眠（REM）被认为与PTSD的病理生理学有关，且MD中也会出现REM异常。对25名与战斗相关的PTSD患者、16名主要诊断为MD的男性以及10名无症状男性对照者在用药和无药物状态下进行多导睡眠图（PSG）检查并比较。数据来自适应夜后的记录。每组各有一名受试者因严重呼吸暂停或肢体运动被排除。与MD组和对照组相比，PTSD组的睡眠效率降低。PTSD组和MD组的REM密度均相对增加，而与MD组相比，PTSD组的REM睡眠量减少。这些睡眠指标与PTSD组内的共病抑郁症、物质使用障碍病史或亚临床睡眠呼吸暂停或肢体运动无显著关联。这些发现支持慢性PTSD患者的睡眠维持受损。PTSD患者REM密度增加得到重复，且与MD组的增加相当。这些临床组之间REM时间的差异表明可能存在不同的潜在机制。
