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首页> 外文期刊>Sleep >Reduced heart rate variability during sleep: a candidate PTSD biomarker with implications for health risk: Commentary on Ulmer et al., “Posttraumatic stress disorder diagnosis is associated with reduced parasympathetic activity during sleep in US veterans and military service members of the Iraq and Afghanistan wars”
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Reduced heart rate variability during sleep: a candidate PTSD biomarker with implications for health risk: Commentary on Ulmer et al., “Posttraumatic stress disorder diagnosis is associated with reduced parasympathetic activity during sleep in US veterans and military service members of the Iraq and Afghanistan wars”

机译：睡眠期间的心率变异性降低：候选PTSD生物标志物，具有健康风险的影响：ulmer等人的评论，“令人生畏的患者诊断与伊拉克和阿富汗军事服务成员睡眠期间的副交感神经活动减少有关 “

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Since the initial designation of posttraumatic stress disorder (PTSD) in the DSM-III, heightened arousal has been a core construct operationalized by symptom cluster criteria that have included insomnia symptoms, vigilant behaviors, poor concentration (perhaps as a consequence of the prior two symptoms), irritability, and startle reactivity [1]. The conceptualization underlying this cluster criterion has invoked that increasing arousal is an adaptive response to threat that can persist maladaptively after a period of trauma exposure, manifesting in the aforementioned symptoms. The most consistent validation of this construct has come from numerous demonstrations of conditioned reactivity to trauma-related stimuli (including stimuli with more generalized threatening content) with effects on psychological, physiological, and functional neuroimaging measures [2]. Establishing objective validation and biomarkers of heightened arousal absent a symptom provocation paradigm has been elusive. This uncertainty may have influenced the relabeling of the symptom cluster to “alterations in arousal and reactivity” in the DSM-5 PTSD definition which controversially now includes “self-destructive and reckless behavior.” [3] Evaluations of arousal in PTSD typically measure functions regulated by the autonomic nervous system and its involvement in regulating arousal, reactivity to stress, and altered activity with PTSD are well established [4, 5]. The PTSD symptom criterion in the DSM-5 for sleep has been subtly changed from difficulty initiating and maintaining sleep to disturbed sleep, which is defined as difficulty initiating and maintaining, and/or restless sleep [3]. This change may reflect the near ubiquity of reports of disturbed sleep with variability in finding abnormal sleep initiation and maintenance with PTSD in studies where sleep was objectively monitored [6]. This variability may in part be accounted for by differences in population (age, gender, and chronicity) and setting (home versus lab). Sleep disruption can be strongly conditioned by trauma, particularly when one is deployed to a threatening environment. Impairment in sleep is distinct in the arousal cluster in that it involves attainment of a restorative state of diminished arousal in contrast with reacting to provocative stimuli with increased arousal. Sleep also has critical benefits to health and well-being.
机译：由于DSM-III的初始指定术后应激障碍（PTSD），所需的唤醒是由症状集群标准运营的核心构建，这些标准包括失眠症状，警惕性行为，浓度较差（可能是由于前两种症状的后果也可能），烦躁和惊吓反应性[1]。此群集标准的概念化已经调用，增加唤醒是对在创伤暴露期后可能持续存在的威胁的适应性反应，表现为上述症状。该构建体最一致的验证来自于与创伤相关的刺激（包括具有更广泛威胁含量的刺激）的条件反应性的众多示范，其具有对心理，生理和功能性神经影像措施的影响[2]。建立了令人症状的客观验证和生物标志物缺乏症状挑衅范式一直难以捉摸。这种不确定性可能会影响症状集群在DSM-5 PTSD定义中的“唤醒和反应性的变化”中的抢购，这些定义具有争议现在包括“自我破坏性和鲁莽行为”。 [3] PTSD中唤醒的评估通常测量由自主神经系统调节的功能及其参与调节唤醒，对应激的反应性，并符合PTSD的改变活性[4,5]。 DSM-5用于睡眠中的PTSD症状标准已经从困难启动和维持睡眠到受干扰的睡眠，这被定义为启动和维护和/或焦躁睡眠[3]。这种变化可能反映了休眠睡眠报告的近乎浮气，以在客观监测睡眠中的研究中发现异常睡眠启动和维持的可变性[6]。这种可变性部分可以部分地通过人口（年龄，性别和慢性）和环境（家庭与实验室）的差异计算。睡眠中断可以通过创伤强烈调节，特别是当一个人部署到威胁环境时。睡眠中的损伤在唤醒集群中是不同的，因为它涉及达到恢复状态，相反，与唤起令人兴奋的刺激刺激反应。睡眠也对健康和幸福具有重要利益。

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