Background:Sleep disorders frequently occur in posttraumatic stress disorder(PTSD)patients.Chronic insomnia is a common feature of and criteria for the diagnosis of PTSD.Another sleep disorder,obstructive sleep apnea(...Background:Sleep disorders frequently occur in posttraumatic stress disorder(PTSD)patients.Chronic insomnia is a common feature of and criteria for the diagnosis of PTSD.Another sleep disorder,obstructive sleep apnea(OSA),also occurs frequently in PTSD,and emerging research indicates OSA fuels chronic insomnia.Scant research has investigated the impact of OSA treatment on insomnia outcomes(Insomnia Severity Index,ISI)in trauma survivors.Methods:OSA patients with moderately severe posttraumatic stress symptoms were studied in a retrospective chart review.Ninety-six patients who failed CPAP therapy due to expiratory pressure intolerance or complex sleep apnea or both underwent manual titration with advanced PAP modes[autobilevel(ABPAP);adaptive servo-ventilation(ASV)],which were subsequently prescribed.PAP use measured by objective data downloads divided the sample into three groups:compliant regular users(C-RU):n=68;subthreshold users(SC-RU):n=12;and noncompliant users(NC-MU):n=16.The average follow-up was 11.89±12.22 months.Baseline and posttreatment ISI scores were analyzed to assess residual insomnia symptoms as well as cure rates.Results:The C-RU group showed significant improvements in insomnia with very large effects compared to those in the NC-MU reference group(P=0.019).Insomnia severity significantly decreased in all three groups with large effects(C-RU,P=0.001;SC-RU,P=0.027;NC-MU,P=0.007).Hours of weekly PAP use and insomnia severity were inversely correlated(P=0.001,r=–0.321).However,residual insomnia symptoms based on established ISI cut-offs were quite common,even among the C-RU group.Post hoc analysis showed that several categories of sedating medications reported at baseline(hypnotics,anti-epileptic,opiates)as well as actual use of any sedating medication(prescription or nonprescription)were associated with smaller insomnia improvements than those in patients not using any sedating agents.Conclusions:In a retrospective,nonrandomized analysis of a select sample of sleep clinic patients with OSA and PTSD symptoms,advanced PAP therapy was associated with significant improvement in insomnia severity for both compliant and partial users.However,residual insomnia symptoms persisted,indicating that PAP therapy provides only limited treatment.RCTs are warranted to assess the effect of ABPAP and ASV modes of therapy on adherence and sleep outcomes,and their potential impact on posttraumatic stress symptoms.Treatment arms that combine PAP with CBT-I would be expected to yield the greatest potency.展开更多
A man with insomnia was treated with psychoanalysis for a period of nearly three years. The analysis showed that, except for insomnia, the patient had suffered from other symptoms such as obsessional images, social an...A man with insomnia was treated with psychoanalysis for a period of nearly three years. The analysis showed that, except for insomnia, the patient had suffered from other symptoms such as obsessional images, social anxiety, and fear of bed etc. All of these symptoms were interpreted as steming from unsolved Oedipus conflicts in childhood. The disadvantage of the modern diagnosis and classification systems, as well as the relation between Oedipus complex and the Chinese filial piety culture were discussed.展开更多
目的:基于复杂网络探析针灸治疗高血压合并失眠的临床规律,为临床治疗取穴及刺激方式提供参考。方法:检索近20年中国知网、万方、维普、中国生物医学文献数据库、PubMed、Web of Science数据库中针灸治疗高血压合并失眠的相关临床文献,...目的:基于复杂网络探析针灸治疗高血压合并失眠的临床规律,为临床治疗取穴及刺激方式提供参考。方法:检索近20年中国知网、万方、维普、中国生物医学文献数据库、PubMed、Web of Science数据库中针灸治疗高血压合并失眠的相关临床文献,筛选后建立数据库。运用SPSS25.0,SPSS Modeler18.0及Gephi0.9.2分别进行疗效指标、关联规则及复杂网络分析。结果:纳入46篇文献,共提取49条针灸处方,涉及64个腧穴、12种针灸治疗方法。针灸疗法结合降压药应用频数最高,各疗法治疗后均可有效降低PSQI评分及血压水平(P<0.05)。使用频数最高的腧穴为百会,经脉为督脉,支持度最高的腧穴组合是三阴交-内关和百会-内关。针灸处方包含百会、四神聪、风池、安眠、完骨等16个核心腧穴。社团分析显示针灸处方具有按照穴位功效、所属部位及经脉属性进行配伍的3个主要规律。结论:针灸疗法结合降压药是临床治疗高血压合并失眠的一种安全而有效的方法。百会、四神聪是其主要核心腧穴,腧穴配伍以调和阴阳为原则,远近配穴和辨证配穴相结合。展开更多
基金small private donations to the Sleep&Human Health Institute.
文摘Background:Sleep disorders frequently occur in posttraumatic stress disorder(PTSD)patients.Chronic insomnia is a common feature of and criteria for the diagnosis of PTSD.Another sleep disorder,obstructive sleep apnea(OSA),also occurs frequently in PTSD,and emerging research indicates OSA fuels chronic insomnia.Scant research has investigated the impact of OSA treatment on insomnia outcomes(Insomnia Severity Index,ISI)in trauma survivors.Methods:OSA patients with moderately severe posttraumatic stress symptoms were studied in a retrospective chart review.Ninety-six patients who failed CPAP therapy due to expiratory pressure intolerance or complex sleep apnea or both underwent manual titration with advanced PAP modes[autobilevel(ABPAP);adaptive servo-ventilation(ASV)],which were subsequently prescribed.PAP use measured by objective data downloads divided the sample into three groups:compliant regular users(C-RU):n=68;subthreshold users(SC-RU):n=12;and noncompliant users(NC-MU):n=16.The average follow-up was 11.89±12.22 months.Baseline and posttreatment ISI scores were analyzed to assess residual insomnia symptoms as well as cure rates.Results:The C-RU group showed significant improvements in insomnia with very large effects compared to those in the NC-MU reference group(P=0.019).Insomnia severity significantly decreased in all three groups with large effects(C-RU,P=0.001;SC-RU,P=0.027;NC-MU,P=0.007).Hours of weekly PAP use and insomnia severity were inversely correlated(P=0.001,r=–0.321).However,residual insomnia symptoms based on established ISI cut-offs were quite common,even among the C-RU group.Post hoc analysis showed that several categories of sedating medications reported at baseline(hypnotics,anti-epileptic,opiates)as well as actual use of any sedating medication(prescription or nonprescription)were associated with smaller insomnia improvements than those in patients not using any sedating agents.Conclusions:In a retrospective,nonrandomized analysis of a select sample of sleep clinic patients with OSA and PTSD symptoms,advanced PAP therapy was associated with significant improvement in insomnia severity for both compliant and partial users.However,residual insomnia symptoms persisted,indicating that PAP therapy provides only limited treatment.RCTs are warranted to assess the effect of ABPAP and ASV modes of therapy on adherence and sleep outcomes,and their potential impact on posttraumatic stress symptoms.Treatment arms that combine PAP with CBT-I would be expected to yield the greatest potency.
文摘A man with insomnia was treated with psychoanalysis for a period of nearly three years. The analysis showed that, except for insomnia, the patient had suffered from other symptoms such as obsessional images, social anxiety, and fear of bed etc. All of these symptoms were interpreted as steming from unsolved Oedipus conflicts in childhood. The disadvantage of the modern diagnosis and classification systems, as well as the relation between Oedipus complex and the Chinese filial piety culture were discussed.
文摘目的:基于复杂网络探析针灸治疗高血压合并失眠的临床规律,为临床治疗取穴及刺激方式提供参考。方法:检索近20年中国知网、万方、维普、中国生物医学文献数据库、PubMed、Web of Science数据库中针灸治疗高血压合并失眠的相关临床文献,筛选后建立数据库。运用SPSS25.0,SPSS Modeler18.0及Gephi0.9.2分别进行疗效指标、关联规则及复杂网络分析。结果:纳入46篇文献,共提取49条针灸处方,涉及64个腧穴、12种针灸治疗方法。针灸疗法结合降压药应用频数最高,各疗法治疗后均可有效降低PSQI评分及血压水平(P<0.05)。使用频数最高的腧穴为百会,经脉为督脉,支持度最高的腧穴组合是三阴交-内关和百会-内关。针灸处方包含百会、四神聪、风池、安眠、完骨等16个核心腧穴。社团分析显示针灸处方具有按照穴位功效、所属部位及经脉属性进行配伍的3个主要规律。结论:针灸疗法结合降压药是临床治疗高血压合并失眠的一种安全而有效的方法。百会、四神聪是其主要核心腧穴,腧穴配伍以调和阴阳为原则,远近配穴和辨证配穴相结合。
