title: In healthy volunteers responses to challenge with cholecystokinin tetrapeptide differ between administration during REM and delta sleep.
abstract: This study was designed to examine the sensitivity of different sleep stages to the pharmacological provocation of nocturnal panic attacks by cholecystokinin tetrapeptide (CCK-4). In a balanced cross-over design, healthy participants were challenged with identical doses of CCK-4 both during REM sleep and during delta sleep. In nine subjects, stimulation with 50 microg CCK-4 during REM sleep failed to elicit a full-blown panic awakening, while the same dose, administered during delta sleep, produced full-blown panic attacks in two participants. Similarly, stimulation of six subjects with 100 microg CCK-4 during REM sleep resulted in only one panic response, whereas four of nine subjects awoke experiencing a panic attack following stimulation with the identical dose during delta sleep. Severity of panic symptomatology, as measured by the self-rated Acute Panic Inventory, was also significantly increased when CCK-4 was administered during delta sleep. CCK-4 can be used as a challenge agent with an abrupt onset of action making it possible to provoke panic attacks precisely during a particular sleep stage. Sensitivity to the panicogenic effects of CCK-4 seems to be higher during delta sleep than REM sleep.
authors.affiliation: Central Institute of Mental Health, Mannheim, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Kronenberg
authors.forename: M
authors.initials: M
authors.lastname: Schredl
authors.forename: K
authors.initials: K
authors.lastname: Fiedler
authors.forename: I
authors.initials: I
authors.lastname: Heuser
mesh_terms: D000328:Adult; D001143:Arousal / Q000187:drug effects; D018592:Cross-Over Studies; D003700:Delta Rhythm; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D010200:Panic / Q000187:drug effects*; D010555:Personality Inventory; D017286:Polysomnography; D012016:Reference Values; D012894:Sleep Stages / Q000187:drug effects*; D012895:Sleep, REM / Q000187:drug effects*; D013758:Tetragastrin
chemical_list: D013758:Tetragastrin