Prazosin effects on objective sleep measures and clinical symptoms in civilian trauma posttraumatic stress disorder: a placebo-controlled study.
BACKGROUND
Prazosin, a central nervous system (CNS) active alpha-1 adrenoreceptor antagonist, has reduced nightmares and sleep disturbance in placebo-controlled studies of combat-related posttraumatic stress disorder (PTSD). We evaluated objective sleep parameters and PTSD symptoms in a placebo-controlled prazosin trial for civilian trauma-related PTSD.


METHODS
Thirteen outpatients with chronic civilian trauma PTSD, frequent nightmares, and sleep disturbance participated in a randomized placebo-controlled crossover trial of prazosin. Sleep parameters were quantified at home with the REMView (Respironics, Pittsburgh, Pennsylvania). The PTSD symptoms were quantified with the Clinician Administered PTSD Scale (CAPS) "recurrent distressing dreams" and "disturbed sleep" items, a non-nightmare distressed awakenings scale, the PTSD Dream Rating Scale (PDRS), the PTSD Checklist-Civilian (PCL-C), and the Clinical Global Impression of Improvement (CGI-I).


RESULTS
Prazosin compared with placebo significantly increased total sleep time by 94 min; increased rapid eye movement (REM) sleep time and mean REM period duration without altering sleep onset latency; significantly reduced trauma-related nightmares, distressed awakenings, and total PCL scores; significantly improved CGI-I scores; and changed PDRS scores toward normal dreaming.


CONCLUSIONS
Prazosin reductions of nighttime PTSD symptoms in civilian trauma PTSD are accompanied by increased total sleep time, REM sleep time, and mean REM period duration in the absence of a sedative-like effect on sleep onset latency.
Taylor
Fletcher B
FB
Northwest Network VISN 20 Mental Illness Research, Education and Clinical Center, VA Puget Sound Health Care System, Seattle, Washington 98108, USA.
Martin
Patti
P
Thompson
Charles
C
Williams
Judi
J
Mellman
Thomas A
TA
Gross
Christopher
C
Peskind
Elaine R
ER
Raskind
Murray A
MA
D000317:Adrenergic alpha-Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D000328:Adult; D018592:Cross-Over Studies; D004325:Dreams / Q000187:drug effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D011224:Prazosin / Q000009:adverse effects / Q000627:therapeutic use*; D012890:Sleep / Q000187:drug effects*; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D012895:Sleep, REM / Q000187:drug effects; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000523:psychology; D014851:Wakefulness / Q000187:drug effects
D000317:Adrenergic alpha-Antagonists; D011224:Prazosin