151
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Scarpelli S, Alfonsi V, Mangiaruga A, Musetti A, Quattropani MC, Lenzo V, Freda MF, Lemmo D, Vegni E, Borghi L, Saita E, Cattivelli R, Castelnuovo G, Plazzi G, De Gennaro L, Franceschini C. Pandemic nightmares: Effects on dream activity of the COVID-19 lockdown in Italy. J Sleep Res 2021; 30:e13300. [PMID: 33547703 PMCID: PMC7994972 DOI: 10.1111/jsr.13300] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/08/2021] [Accepted: 01/15/2021] [Indexed: 02/06/2023]
Abstract
COVID‐19 has critically impacted the world. Recent works have found substantial changes in sleep and mental health during the COVID‐19 pandemic. Dreams could give us crucial information about people's well‐being, so here we have directly investigated the consequences of lockdown on the oneiric activity in a large Italian sample: 5,988 adults completed a web‐survey during lockdown. We investigated sociodemographic and COVID‐19‐related information, sleep quality (by the Medical Outcomes Study‐Sleep Scale), mental health (by the Depression, Anxiety, and Stress Scales), dream and nightmare frequency, and related emotional aspects (by the Mannheim Dream Questionnaire). Comparisons between our sample and a population‐based sample revealed that Italians are having more frequent nightmares and dreams during the pandemic. A multiple logistic regression model showed the predictors of high dream recall (young age, female gender, not having children, sleep duration) and high nightmare frequency (young age, female gender, modification of napping, sleep duration, intrasleep wakefulness, sleep problem index, anxiety, depression). Moreover, we found higher emotional features of dream activity in workers who have stopped working, in people who have relatives/friends infected by or who have died from COVID‐19 and in subjects who have changed their sleep habits. Our findings point to the fact that the predictors of high dream recall and nightmares are consistent with the continuity between sleep mentation and daily experiences. According to the arousal‐retrieval model, we found that poor sleep predicts a high nightmare frequency. We suggest monitoring dream changes during the epidemic, and also considering the implications for clinical treatment and prevention of mental and sleep disorders.
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Affiliation(s)
- Serena Scarpelli
- IRCCS Fondazione Santa Lucia, Rome, Italy.,Department of Psychology, Sapienza University of Rome, Rome, Italy
| | | | - Anastasia Mangiaruga
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Alessandro Musetti
- Department of Humanities, Social Sciences and Cultural Industries, University of Parma, Parma, Italy
| | | | - Vittorio Lenzo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Daniela Lemmo
- Department of Humanistic Studies, Federico II University, Naples, Italy
| | - Elena Vegni
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Lidia Borghi
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Emanuela Saita
- Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Roberto Cattivelli
- Department of Psychology, Catholic University of Milan, Milan, Italy.,Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Verbania, Italy
| | - Gianluca Castelnuovo
- Department of Psychology, Catholic University of Milan, Milan, Italy.,Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Verbania, Italy
| | - Giuseppe Plazzi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Luigi De Gennaro
- IRCCS Fondazione Santa Lucia, Rome, Italy.,Department of Psychology, Sapienza University of Rome, Rome, Italy
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152
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Haeyen S, Staal M. Imagery Rehearsal Based Art Therapy: Treatment of Post-traumatic Nightmares in Art Therapy. Front Psychol 2021; 11:628717. [PMID: 33519657 PMCID: PMC7840539 DOI: 10.3389/fpsyg.2020.628717] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 12/22/2020] [Indexed: 11/13/2022] Open
Abstract
Imagery Rehearsal Therapy (IRT) is effective for trauma-related nightmares and is also a challenge to patients in finding access to their traumatic memories, because these are saved in non-verbal, visual, or audiovisual language. Art therapy (AT) is an experiential treatment that addresses images rather than words. This study investigates the possibility of an IRT-AT combination. Systematic literature review and field research was conducted, and the integration of theoretical and practice-based knowledge resulted in a framework for Imagery Rehearsal-based Art Therapy (IR-AT). The added value of AT in IRT appears to be more readily gaining access to traumatic experiences, living through feelings, and breaking through avoidance. Exposure and re-scripting take place more indirectly, experientially and sometimes in a playlike manner using art assignments and materials. In the artwork, imagination, play and fantasy offer creative space to stop the vicious circle of nightmares by changing theme, story line, ending, or any part of the dream into a more positive and acceptable one. IR-AT emerges as a promising method for treatment, and could be especially useful for patients who benefit least from verbal exposure techniques. This description of IR-AT offers a base for further research.
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Affiliation(s)
- Suzanne Haeyen
- GGNet Centre of Mental Health, Apeldoorn, Netherlands.,Hogeschool van Arnhem en Nijmegen [HAN] University of Applied Sciences, Nijmegen, Netherlands
| | - Merel Staal
- GGNet Centre of Mental Health, Apeldoorn, Netherlands
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153
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Lin YQ, Lin ZX, Wu YX, Wang L, Zeng ZN, Chen QY, Wang L, Xie XL, Wei SC. Reduced Sleep Duration and Sleep Efficiency Were Independently Associated With Frequent Nightmares in Chinese Frontline Medical Workers During the Coronavirus Disease 2019 Outbreak. Front Neurosci 2021; 14:631025. [PMID: 33551736 PMCID: PMC7855305 DOI: 10.3389/fnins.2020.631025] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 12/21/2020] [Indexed: 12/17/2022] Open
Abstract
Objectives Nightmares were related to emotion and behavioral problems and also emerged as one of the core features of post-traumatic stress disorder (PTSD). Our study aimed to investigate the associations of frequent nightmares with sleep duration and sleep efficiency among frontline medical workers in Wuhan during the coronavirus disease 2019 (COVID-19) outbreak. Methods A total of 528 health-care workers from the province of Fujian providing medical aid in Wuhan completed the online questionnaires. There were 114 doctors and 414 nurses. The age, sex, marital status, and work situation were recorded. A battery of scales including the Pittsburgh Sleep Quality Index (PSQI) and the 12-item General Health Questionnaire (GHQ-12) were used to evaluate subjects’ sleep and general mental health. Frequent nightmares were defined as the response of at least once a week in the item of “nightmare” of PSQI. Results Frequent nightmares were found in 27.3% of subjects. The frequent nightmare group had a higher score of PSQI-sleep duration and PSQI-habitual sleep efficiency (frequent nightmares vs. non-frequent nightmares: PSQI-sleep duration, 1.08 ± 0.97 vs. 0.74 ± 0.85, P < 0.001; PSQI-habitual sleep efficiency, 1.08 ± 1.10 vs. 0.62 ± 0.88, P < 0.001). Reduced sleep duration and reduced sleep efficiency were independently associated with frequent nightmares after adjustment for age, sex, poor mental health, and regular sleeping medication use (reduced sleep duration: OR = 1.96, 95% CI = 1.07–3.58, P = 0.029; reduced sleep efficiency: OR = 2.17, 95% CI = 1.09–4.32, P = 0.027). Subjects with both reduced sleep duration and sleep efficiency were also associated with frequent nightmares (OR = 2.70, 95% CI = 1.57–4.65, P < 0.001). Conclusion The present study found that sleep duration and sleep efficiency were both independently associated with frequent nightmares among frontline medical workers in Wuhan during the COVID-19 pandemic. We should pay attention to nightmares and even the ensuing PTSD symptoms among subjects with reduced sleep duration or sleep efficiency facing potential traumatic exposure.
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Affiliation(s)
- Yi-Qi Lin
- Department of Sleep Center, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China
| | - Ze-Xin Lin
- Xinjiang Medical University Second Clinical College, Ürümqi, China
| | - Yong-Xi Wu
- Department of Sleep Center, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China
| | - Lin Wang
- Department of Sleep Center, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China.,Administrative Office, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China
| | - Zhao-Nan Zeng
- Department of Sleep Center, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China.,Center for Experimental Research in Clinical Medicine, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China
| | - Qiu-Yang Chen
- Department of Sleep Center, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China.,The First Operating Room, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China
| | - Ling Wang
- Department of Sleep Center, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China.,Department of Pharmacy, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China
| | - Xiao-Liang Xie
- Department of Sleep Center, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China.,The First Operating Room, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China
| | - Shi-Chao Wei
- Department of Sleep Center, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China
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154
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Mascaro L, Phillips AJK, Clark JW, Straus LD, Drummond SPA. Diurnal Rhythm Robustness in Individuals With PTSD and Insomnia and The Association With Sleep. J Biol Rhythms 2021; 36:185-195. [PMID: 33472513 DOI: 10.1177/0748730420984563] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Posttraumatic stress disorder (PTSD) and insomnia are characterized by sleep disturbances and daytime functional impairments. Actigraphy metrics can quantify diurnal rhythms via interdaily stability, intradaily variability, relative amplitude, and sleep regularity. Here, we (a) compared diurnal rhythms in PTSD, insomnia, and healthy control samples using linear mixed modeling; (b) compared inter-individual variability of diurnal rhythms between groups using variance ratio tests; and (c) examined correlations between diurnal rhythms and sleep measures within the clinical samples. Participants (N = 98) wore wrist-activity monitors for one week and completed the Insomnia Severity Index and Pittsburgh Sleep Quality Index. Both clinical samples displayed significantly lower interdaily stability, relative amplitude, and sleep regularity compared with controls. Individuals with PTSD and insomnia did not differ on mean diurnal rhythm metrics. Both clinical samples showed more inter-individual variability in relative amplitude compared with controls, and the individuals with PTSD were distinguished from those with insomnia by greater inter-individual variability in interdaily stability and relative amplitude. Relative amplitude in the clinical samples was positively correlated with objective sleep efficiency and total sleep time. This is the first study to compare individuals with PTSD and insomnia on measures of diurnal rhythms, revealing those with PTSD and insomnia to have less robust and more variable diurnal rhythms compared with controls. Individuals with PTSD differed from those with insomnia in inter-individual variability of diurnal rest-activity stability and amplitude, highlighting this population as particularly heterogenous. Diurnal rhythm robustness might be considered an intervention target in insomnia and PTSD populations.
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Affiliation(s)
- Luis Mascaro
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Andrew J K Phillips
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Jacob W Clark
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Laura D Straus
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA.,San Francisco VA Medical Center, San Francisco, CA, USA
| | - Sean P A Drummond
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
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155
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Jones S, Castelnovo A, Riedner B, Flaherty B, Prehn-Kristensen A, Benca R, Tononi G, Herringa R. Sleep and emotion processing in paediatric posttraumatic stress disorder: A pilot investigation. J Sleep Res 2021; 30:e13261. [PMID: 33442931 PMCID: PMC8365752 DOI: 10.1111/jsr.13261] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/29/2020] [Accepted: 11/23/2020] [Indexed: 11/28/2022]
Abstract
Emotion processing abnormalities and sleep pathology are central to the phenomenology of paediatric posttraumatic stress disorder, and sleep disturbance has been linked to the development, maintenance and severity of the disorder. Given emerging evidence indicating a role for sleep in emotional brain function, it has been proposed that dysfunctional processing of emotional experiences during sleep may play a significant role in affective disorders, including posttraumatic stress disorder. Here we sought to examine the relationship between sleep and emotion processing in typically developing youth, and youth with a diagnosis of posttraumatic stress disorder . We use high-density electroencephalogram to compare baseline sleep with sleep following performance on a task designed to assess both memory for and reactivity to negative and neutral imagery in 10 youths with posttraumatic stress disorder, and 10 age- and sex-matched non-traumatized typically developing youths. Subjective ratings of arousal to negative imagery (ΔArousal = post-sleep minus pre-sleep arousal ratings) remain unchanged in youth with posttraumatic stress disorder following sleep (mean increase 0.15, CI -0.28 to +0.58), but decreased in TD youth (mean decrease -1.0, 95% CI -1.44 to -0.58). ΔArousal, or affective habituation, was negatively correlated with global change in slow-wave activity power (ρ = -0.58, p = .008). When considered topographically, the correlation between Δslow-wave activity power and affective habituation was most significant in a frontal cluster of 27 electrodes (Spearman, ρ = -0.51, p = .021). Our results highlight the importance of slow-wave sleep for adaptive emotional processing in youth, and have implications for symptom persistence in paediatric posttraumatic stress disorder. Impairments in slow-wave activity may represent a modifiable risk factor in paediatric posttraumatic stress disorder.
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Affiliation(s)
- Stephanie Jones
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA.,Wisconsin Institute for Sleep and Consciousness, University of Wisconsin-Madison, Madison, WI, USA
| | - Anna Castelnovo
- Sleep and Epilepsy Center, Neurocenter of the Southern Switzerland, Regional Hospital (EOC) of Lugano, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Brady Riedner
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA.,Wisconsin Institute for Sleep and Consciousness, University of Wisconsin-Madison, Madison, WI, USA
| | - Bethany Flaherty
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA.,Wisconsin Institute for Sleep and Consciousness, University of Wisconsin-Madison, Madison, WI, USA
| | - Alexander Prehn-Kristensen
- Department of Child and Adolescent Psychiatry and Psychotherapy, Centre for Integrative Psychiatry, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Ruth Benca
- Department of Psychiatry & Human Behavior, School of Medicine, University of California-Irvine, Irvine, CA, USA
| | - Giulio Tononi
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA.,Wisconsin Institute for Sleep and Consciousness, University of Wisconsin-Madison, Madison, WI, USA
| | - Ryan Herringa
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA
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156
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Panyard DJ, Kim KM, Darst BF, Deming YK, Zhong X, Wu Y, Kang H, Carlsson CM, Johnson SC, Asthana S, Engelman CD, Lu Q. Cerebrospinal fluid metabolomics identifies 19 brain-related phenotype associations. Commun Biol 2021; 4:63. [PMID: 33437055 PMCID: PMC7803963 DOI: 10.1038/s42003-020-01583-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 12/09/2020] [Indexed: 02/07/2023] Open
Abstract
The study of metabolomics and disease has enabled the discovery of new risk factors, diagnostic markers, and drug targets. For neurological and psychiatric phenotypes, the cerebrospinal fluid (CSF) is of particular importance. However, the CSF metabolome is difficult to study on a large scale due to the relative complexity of the procedure needed to collect the fluid. Here, we present a metabolome-wide association study (MWAS), which uses genetic and metabolomic data to impute metabolites into large samples with genome-wide association summary statistics. We conduct a metabolome-wide, genome-wide association analysis with 338 CSF metabolites, identifying 16 genotype-metabolite associations (metabolite quantitative trait loci, or mQTLs). We then build prediction models for all available CSF metabolites and test for associations with 27 neurological and psychiatric phenotypes, identifying 19 significant CSF metabolite-phenotype associations. Our results demonstrate the feasibility of MWAS to study omic data in scarce sample types.
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Grants
- R01 AG037639 NIA NIH HHS
- UL1 TR000427 NCATS NIH HHS
- T15 LM007359 NLM NIH HHS
- T32 LM012413 NLM NIH HHS
- RF1 AG027161 NIA NIH HHS
- T32 AG000213 NIA NIH HHS
- P2C HD047873 NICHD NIH HHS
- UL1 TR002373 NCATS NIH HHS
- P30 AG062715 NIA NIH HHS
- P50 AG033514 NIA NIH HHS
- R01 AG027161 NIA NIH HHS
- R01 AG054047 NIA NIH HHS
- P30 AG017266 NIA NIH HHS
- R21 AG067092 NIA NIH HHS
- U.S. Department of Health & Human Services | NIH | National Institute on Aging (U.S. National Institute on Aging)
- U.S. Department of Health & Human Services | NIH | Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
- U.S. Department of Health & Human Services | NIH | U.S. National Library of Medicine (NLM)
- NSF | Directorate for Mathematical & Physical Sciences | Division of Mathematical Sciences (DMS)
- U.S. Department of Health & Human Services | NIH | National Center for Advancing Translational Sciences (NCATS)
- This research is supported by National Institutes of Health (NIH) grants R01AG27161 (Wisconsin Registry for Alzheimer Prevention: Biomarkers of Preclinical AD), R01AG054047 (Genomic and Metabolomic Data Integration in a Longitudinal Cohort at Risk for Alzheimer’s Disease), R21AG067092 (Identifying Metabolomic Risk Factors in Plasma and Cerebrospinal Fluid for Alzheimer’s Disease), R01AG037639 (White Matter Degeneration: Biomarkers in Preclinical Alzheimer’s Disease), P30AG017266 (Center for Demography of Health and Aging), and P50AG033514 and P30AG062715 (Wisconsin Alzheimer’s Disease Research Center Grant), the Helen Bader Foundation, Northwestern Mutual Foundation, Extendicare Foundation, State of Wisconsin, the Clinical and Translational Science Award (CTSA) program through the NIH National Center for Advancing Translational Sciences (NCATS) grant UL1TR000427, and the University of Wisconsin-Madison Office of the Vice Chancellor for Research and Graduate Education with funding from the Wisconsin Alumni Research Foundation. This research was supported in part by the Intramural Research Program of the National Institute on Aging. Computational resources were supported by a core grant to the Center for Demography and Ecology at the University of Wisconsin-Madison (P2CHD047873). Author DJP was supported by an NLM training grant to the Bio-Data Science Training Program (T32LM012413). Author BFD was supported by an NLM training grant to the Computation and Informatics in Biology and Medicine Training Program (NLM 5T15LM007359). Author YKD was supported by a training grant from the National Institute on Aging (T32AG000213). Author HK was supported by National Science Foundation (NSF) grant DMS-1811414 (Theory and Methods for Inferring Causal Effects with Mendelian Randomization).
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Affiliation(s)
- Daniel J Panyard
- Department of Population Health Sciences, University of Wisconsin-Madison, 610 Walnut Street, 707 WARF Building, Madison, WI, 53726, USA
| | - Kyeong Mo Kim
- Department of Biotechnology, Yonsei University, 50 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Burcu F Darst
- Center for Genetic Epidemiology, Keck School of Medicine, University of Southern California, 1450 Biggy Street, Los Angeles, CA, 90033, USA
| | - Yuetiva K Deming
- Department of Population Health Sciences, University of Wisconsin-Madison, 610 Walnut Street, 707 WARF Building, Madison, WI, 53726, USA
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison, 600 Highland Avenue, J5/1 Mezzanine, Madison, WI, 53792, USA
- Department of Medicine, University of Wisconsin-Madison, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI, 53705, USA
| | - Xiaoyuan Zhong
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, WARF Room 201, 610 Walnut Street, Madison, WI, 53726, USA
| | - Yuchang Wu
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, WARF Room 201, 610 Walnut Street, Madison, WI, 53726, USA
| | - Hyunseung Kang
- Department of Statistics, University of Wisconsin-Madison, 1300 University Avenue, Madison, WI, 53706, USA
| | - Cynthia M Carlsson
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison, 600 Highland Avenue, J5/1 Mezzanine, Madison, WI, 53792, USA
- Department of Medicine, University of Wisconsin-Madison, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI, 53705, USA
- William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI, 53705, USA
| | - Sterling C Johnson
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison, 600 Highland Avenue, J5/1 Mezzanine, Madison, WI, 53792, USA
- Department of Medicine, University of Wisconsin-Madison, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI, 53705, USA
- William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI, 53705, USA
| | - Sanjay Asthana
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison, 600 Highland Avenue, J5/1 Mezzanine, Madison, WI, 53792, USA
- Department of Medicine, University of Wisconsin-Madison, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI, 53705, USA
- William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI, 53705, USA
| | - Corinne D Engelman
- Department of Population Health Sciences, University of Wisconsin-Madison, 610 Walnut Street, 707 WARF Building, Madison, WI, 53726, USA
| | - Qiongshi Lu
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, WARF Room 201, 610 Walnut Street, Madison, WI, 53726, USA.
- Department of Statistics, University of Wisconsin-Madison, 1300 University Avenue, Madison, WI, 53706, USA.
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157
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LaGoy AD, Kaskie R, Connaboy C, Germain A, Ferrarelli F. Overnight Sleep Parameter Increases in Frontoparietal Areas Predict Working Memory Improvements in Healthy Participants But Not in Individuals With Posttraumatic Stress Disorder. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2021; 6:1110-1117. [PMID: 33757792 DOI: 10.1016/j.bpsc.2020.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/02/2020] [Accepted: 12/17/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Preliminary evidence indicates that non-rapid eye movement (NREM) sleep is implicated in enhancing working memory (WM) performance across days in healthy individuals. While REM sleep has been implicated in other forms of memory, its role in WM remains unclear. Further, the relationship between sleep changes and WM improvement is largely unknown in posttraumatic stress disorder (PTSD). Examining the relationship between changes in sleep and WM improvement in healthy participants and participants with PTSD may inform cognitive enhancement strategies and intervention targets. METHODS Repeated assessments of WM and overnight measurement of NREM and REM sleep parameters were performed in 79 participants (participants with PTSD: n = 33) during a 48-hour laboratory stay. Relationships between sleep parameter changes, WM performance changes, and clinical characteristics were analyzed in PTSD and healthy groups. RESULTS A between-night enhancement in both NREM and REM sleep parameters in frontoparietal areas predicted across-day better WM performance in healthy participants, particularly in those with improved performance. In contrast, in participants with PTSD, an enhancement of these sleep parameters predicted a worse WM performance and was also associated with more PTSD-related sleep disturbances. CONCLUSIONS This study shows that higher sleep activity in frontoparietal areas leads to enhanced WM performance in healthy individuals, whereas in individuals with PTSD, it likely reflects the presence of sleep disturbances that interfere with WM improvement. Interventions focused on addressing sleep disturbances could therefore ameliorate cognitive impairments in individuals with PTSD.
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Affiliation(s)
- Alice D LaGoy
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Rachel Kaskie
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Christopher Connaboy
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Anne Germain
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Fabio Ferrarelli
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
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158
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MicroRNA-19b predicts widespread pain and posttraumatic stress symptom risk in a sex-dependent manner following trauma exposure. Pain 2021; 161:47-60. [PMID: 31569141 DOI: 10.1097/j.pain.0000000000001709] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Posttraumatic widespread pain (PTWP) and posttraumatic stress symptoms (PTSS) are frequent comorbid sequelae of trauma that occur at different rates in women and men. We sought to identify microRNA (miRNA) that may contribute to sex-dependent differences in vulnerability to these outcomes. Monte Carlo simulations (x10,000) identified miRNA in which predicted targeting of PTWP or PTSS genes was most enriched. Expression of the leading candidate miRNA to target PTWP/PTSS-related genes, miR-19b, has been shown to be influenced by estrogen and stress exposure. We evaluated whether peritraumatic miR-19b blood expression levels predicted PTWP and PTSS development in women and men experiencing trauma of motor vehicle collision (n = 179) and in women experiencing sexual assault trauma (n = 74). A sex-dependent relationship was observed between miR-19b expression levels and both PTWP (β = -2.41, P = 0.034) and PTSS (β = -3.01, P = 0.008) development 6 months after motor vehicle collision. The relationship between miR-19b and PTSS (but not PTWP) was validated in sexual assault survivors (β = -0.91, P = 0.013). Sex-dependent expression of miR-19b was also observed in blood and nervous tissue from 2 relevant animal models. Furthermore, in support of increasing evidence indicating a role for the circadian rhythm (CR) in PTWP and PTSS pathogenesis, miR-19b targets were enriched in CR gene transcripts. Human cohort and in vitro analyses assessing miR-19b regulation of key CR transcripts, CLOCK and RORA, supported the potential importance of miR-19b to regulating the CR pathway. Together, these results highlight the potential role that sex-dependent expression of miR-19b might play in PTWP and PTSS development after trauma/stress exposure.
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159
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Davis CJ, Gerstner JR, Vanderheyden WM. Single prolonged stress blocks sleep homeostasis and pre-trauma sleep deprivation does not exacerbate the severity of trauma-induced fear-associated memory impairments. PLoS One 2021; 16:e0243743. [PMID: 33406143 PMCID: PMC7787370 DOI: 10.1371/journal.pone.0243743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 11/26/2020] [Indexed: 11/25/2022] Open
Abstract
Sleep is intimately linked to cognitive performance and exposure to traumatic stress that leads to post-traumatic stress disorder (PTSD) impairs both sleep and cognitive function. However, the contribution of pre-trauma sleep loss to subsequent trauma-dependent fear-associated memory impairment remains unstudied. We hypothesized that sleep deprivation (SD) prior to trauma exposure may increase the severity of a PTSD-like phenotype in rats exposed to single prolonged stress (SPS), a rodent model of PTSD. Rats were exposed to SPS alone, SD alone, or a combination of SPS+SD and measures of fear-associated memory impairments and vigilance state changes were compared to a group of control animals not exposed to SPS or SD. We found that SPS, and SPS+SD animals showed impaired fear-associated memory processing and that the addition of SD to SPS did not further exaggerate the effect of SPS alone. Additionally, the combination of SPS with SD results in a unique homeostatic sleep duration phenotype when compared to SD, SPS, or control animals. SPS exposure following SD represses homeostatic rebound and eliminates sleep-deprivation-induced increases in NREM sleep delta power. This work identifies a unique time frame where trauma exposure and sleep interact and identifies this window of time as a potential therapeutic treatment window for staving off the negative consequences of trauma exposure.
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Affiliation(s)
- Christopher J. Davis
- Department of Biomedical Sciences, WSU Health Sciences Spokane, Elson S. Floyd College of Medicine, Spokane, Washington, United States of America
| | - Jason R. Gerstner
- Department of Biomedical Sciences, WSU Health Sciences Spokane, Elson S. Floyd College of Medicine, Spokane, Washington, United States of America
| | - William M. Vanderheyden
- Department of Biomedical Sciences, WSU Health Sciences Spokane, Elson S. Floyd College of Medicine, Spokane, Washington, United States of America
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Zhang S, Zhou Y, Ge LK, Zeng L, Liu Z, Qian W, Yang J, Zhou X, Wei GX, Zhang X. Interaction of Insomnia and Somatization with Post-Traumatic Stress Disorder in Pregnant Women During the COVID-19 Pandemic. Neuropsychiatr Dis Treat 2021; 17:2539-2547. [PMID: 34393483 PMCID: PMC8354733 DOI: 10.2147/ndt.s310300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/01/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Post-traumatic stress disorder (PTSD) has an adverse impact on the emotional health of prenatal maternal women and their offspring. During the Coronavirus Disease 2019 (COVID-19) pandemic, pregnant women are vulnerable to traumatic events and are prone to PTSD symptoms. The aim of the study was to explore the predictive effects of insomnia and somatization on PTSD in pregnant women by utilizing generalized additive model (GAM). MATERIALS AND METHODS A total of 1638 pregnant women from three local cities in China underwent online survey on sleep quality, somatization, and PTSD symptoms tested by the Insomnia Severity Index (ISI), the subscale somatization of Symptom Checklist-90 (SCL-90-S) and the Checklist for DSM-5 (PCL-5), respectively. RESULTS Insomnia was positively correlated with PTSD symptoms in pregnant women (p = 1.79×10-5). Interestingly, insomnia and somatization showed a complex non-primary linear interaction in predicting PTSD (p = 2.00×10-16). CONCLUSION Our results suggest that insomnia is a prominent predictor of PTSD symptoms in pregnant women in the context of public emergencies. In addition, the effects of insomnia and somatization on PTSD symptoms are characterized by complex non-primary linear relationships.
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Affiliation(s)
- Shu Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, People's Republic of China
| | - Yongjie Zhou
- Department of Psychiatric Rehabilitation, Shenzhen Kangning Hospital, Shenzhen, Guangdong, People's Republic of China.,Shenzhen Kangning Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Li-Kun Ge
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, People's Republic of China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, 100049, People's Republic of China
| | - Lingyun Zeng
- Department of Psychiatric Rehabilitation, Shenzhen Kangning Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Zhengkui Liu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, People's Republic of China
| | - Wei Qian
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, People's Republic of China
| | - Jiezhi Yang
- Shenzhen Health Development Research Center, Shenzhen, People's Republic of China
| | - Xin Zhou
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, People's Republic of China
| | - Gao-Xia Wei
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, People's Republic of China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, 100049, People's Republic of China
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, People's Republic of China
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161
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McDermott TJ, Lee JY, Paquet CP, Huber FA, Sitz AL, Robertson K, Davis JL. Exposure, relaxation, and rescripting therapy could treat residual nightmares following PTSD treatment. Psychiatry Res 2021; 295:113630. [PMID: 33310416 PMCID: PMC7868955 DOI: 10.1016/j.psychres.2020.113630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 12/03/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Timothy J McDermott
- Department of Psychology, University of Tulsa, Tulsa, OK, USA; Laureate Institute for Brain Research, Tulsa, OK, USA.
| | - Jenny Y Lee
- Department of Psychology, University of Tulsa, Tulsa, OK, USA
| | | | | | - Amber L Sitz
- Department of Psychology, University of Tulsa, Tulsa, OK, USA
| | | | - Joanne L Davis
- Department of Psychology, University of Tulsa, Tulsa, OK, USA
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162
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Abstract
The human circadian system creates and maintains cellular and systemic rhythmicity essential for the temporal organization of physiological processes promoting homeostasis and environmental adaptation. Sleep disruption and loss of circadian rhythmicity fundamentally affects master homeostasic regulating systems at the crossroads of peripheral and central susceptibility pathways, similar to acute or chronic stress and, thus, may play a central role in the development of stress-related disorders. Direct and indirect human and animal PTSD research accordingly suggests circadian-system-linked sleep, neuroendocrine, immune, metabolic and autonomic dysregulation, linking circadian misalignment to PTSD pathophysiology. Additionally, there is evidence that sleep and circadian disruption may represent a vital pre-existing risk factor in the prediction of PTSD development, while sleep-related symptoms are among the most prominent in trauma-associated disorders. These facts may represent a need for a shift towards a more chronobiological understanding of traumatic sequel and could support better prevention, evaluation and treatment of sleep and circadian disruption as first steps in PTSD management. In this special issue, we highlight and review recent advances from human sleep and chronobiological research that enhances our understanding of the development and maintenance of trauma-related disorders.
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Affiliation(s)
- Agorastos Agorastos
- Department of Psychiatry, Division of Neurosciences, School of Medicine, Faculty of Medical Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.,VA Center of Excellence for Stress and Mental Health (CESAMH), VA San Diego Healthcare System, San Diego, CA, USA
| | - Miranda Olff
- Department of PsychiatryAmsterdam UMC, Amsterdam Neuroscience of Amsterdam, The Netherlands.,ARQ National Psychotrauma Centre, Diemen, The Netherlands
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Rohr JC, Rufino KA, Alfano CA, Patriquin MA. Sleep disturbance in patients in an inpatient hospital mediates relationship between PTSD and suicidal ideation. J Psychiatr Res 2021; 133:174-180. [PMID: 33348251 DOI: 10.1016/j.jpsychires.2020.12.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/12/2020] [Accepted: 12/09/2020] [Indexed: 10/22/2022]
Abstract
A common reason for admission to inpatient psychiatric units is suicidal ideation. Growing evidence of the link between sleep disturbance and suicidal ideation brings an interest in greater clarity of the pathways; this paper focused on post-traumatic stress disorder (PTSD), which carries increased risk for both sleep disturbance and suicidal ideation, as well as sex differences in those pathways. Patients were 2822 inpatients studied at admission to an inpatient psychiatric hospital and mediation analyses were used to examine pathways of interest. There was an indirect effect of PTSD on suicidal ideation through sleep disturbances for the entire sample and for men and women separately. The effect for men was larger than that for women, suggesting a stronger effect for sleep disturbance in the relationship for men. For women only, the direct effect between PTSD and suicidal ideation remained significant after mediation. Sleep disturbance plays an important role in the relationship between PTSD and suicidal ideation. Early identification of sleep disturbance in inpatients and targeted focus of sleep in conjunction with resolving trauma-related symptoms may help reduce suicidal ideation. This may be especially true of men; the indirect effect was smaller for women, suggesting that sleep disturbance should be addressed in conjunction with other PTSD symptoms likely leading to suicidal ideation.
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Affiliation(s)
- Jessica C Rohr
- The Menninger Clinic, 12301 S. Main St., Houston TX 77035, USA; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd., Houston TX 77030, USA.
| | - Katrina A Rufino
- The Menninger Clinic, 12301 S. Main St., Houston TX 77035, USA; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd., Houston TX 77030, USA; The University of Houston Downtown, 1 Main St., Houston TX 77002, USA
| | - Candice A Alfano
- Sleep and Anxiety Center of Houston, University of Houston, 4505 Cullen Blvd., Houston TX 77204, USA
| | - Michelle A Patriquin
- The Menninger Clinic, 12301 S. Main St., Houston TX 77035, USA; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd., Houston TX 77030, USA; Michaeld E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd, Houston, TX, 77030, USA
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164
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Wright L, Steptoe A, Fancourt D. Are adversities and worries during the COVID-19 pandemic related to sleep quality? Longitudinal analyses of 46,000 UK adults. PLoS One 2021. [PMID: 33765097 DOI: 10.1101/2020.06.02.20120311v2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND There are concerns that both the experience of adversities during the COVID-19 pandemic and worries about experiencing adversities will have substantial and lasting effects on mental health. One pathway through which both experience of and worries about adversity may impact health is through effects on sleep. METHODS We used data from 46,284 UK adults in the COVID-19 Social Study assessed weekly from 01/04/2020-12/05/2020 to study the association between adversities and sleep quality. We studied six categories of adversity including both worries and experiences of: illness with COVID-19, financial difficulty, loss of paid work, difficulties acquiring medication, difficulties accessing food, and threats to personal safety. We used random-effect within-between models to account for all time-invariant confounders. RESULTS Both the total number of adversity experiences and total number of adversity worries were associated with lower quality sleep. Each additional experience was associated with a 1.16 (95% CI = 1.10, 1.22) times higher odds of poor quality sleep while each additional worry was associated with a 1.20 (95% CI = 1.17, 1.22) times higher odds of poor quality sleep. When considering specific experiences and worries, all worries and experiences were significantly related to poorer quality sleep except experiences relating to employment and finances. Having a larger social network offered some buffering effects on associations but there was limited further evidence of moderation by other social or psychiatric factors. CONCLUSION Poor sleep may be a mechanism by which COVID-19 adversities are affecting mental health. This highlights the importance of interventions that support adaptive coping strategies during the pandemic.
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Affiliation(s)
- Liam Wright
- Department of Behavioural Science and Health, University College London, London, United Kingdom
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Andrew Steptoe
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Daisy Fancourt
- Department of Behavioural Science and Health, University College London, London, United Kingdom
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165
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Fletcher KE, Steinbach S, Lewis F, Hendricks M, Kwan B. Hospitalized Medical Patients With Posttraumatic Stress Disorder (PTSD): Review of the Literature and a Roadmap for Improved Care. J Hosp Med 2021; 16:38-43. [PMID: 32853140 DOI: 10.12788/jhm.3409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 03/09/2020] [Indexed: 11/20/2022]
Abstract
Posttraumatic stress disorder (PTSD) is common in the United States, with a prevalence of nearly 8% in the general population and between 10% and 30% in veterans. Despite how common PTSD is, inpatient providers may not be familiar with its manifestations or feel comfortable taking care of patients who may exhibit symptoms related to it. In our combined experience as VA-based hospital medicine care providers, we have cared for thousands of patients hospitalized for a primary medical condition who also have PTSD as a comorbidity. We have noticed in our practices that we only focus our attention on PTSD if a related problem arises during a patient's hospitalization (eg, confrontations with the care team or high levels of anxiety). We contend that a more proactive approach could lead to better care, but little evidence about best practices exists to inform the interdisciplinary team how to optimally care for hospitalized medical patients with PTSD. In this narrative review, we present a synthesis of existing literature, describe how trauma-informed care could be used to guide the approach to patients with PTSD, and generate ideas for changes that inpatient providers could implement now, such as engaging patients to prevent PTSD exacerbations and promoting better sleep in the hospital.
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Affiliation(s)
- Kathlyn E Fletcher
- Medical College of Wisconsin, Milwaukee, Wisconsin
- Clement J Zablocki VA Medical Center, Milwaukee, Wisconsin
| | - Scott Steinbach
- Atlanta VA Medical Center, Atlanta, Georgia
- Emory University School of Medicine, Atlanta, Georgia
| | - Flower Lewis
- Clement J Zablocki VA Medical Center, Milwaukee, Wisconsin
| | | | - Brian Kwan
- VA San Diego Healthcare System, San Diego, California
- UC San Diego School of Medicine, San Diego, California
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Abstract
Sleep disturbances, particularly insomnia, nightmares, and excessive daytime sleepiness (EDS), are significant, proximal, and modifiable risk factors for suicidal ideation and behaviors (SIB) and could be targeted for preventative interventions. In this chapter, we review the evidence supporting the association of insomnia, nightmares, and EDS with SIB. We also describe these sleep disturbances in the general population, as well as their association with psychiatric disorders. A PubMed search was conducted to identify the relevant literature. Insomnia is very frequent across mental disorders, but SIB patients are particularly exposed. Specific interventions focused on insomnia are useful in contending suicidal ideation. Nightmares seem to constitute an independent risk factor for SIB, beyond insomnia, particularly in young people and when experienced frequently. The evidence regarding the association of EDS and SIB is less clear and probably explained by the reduction of health-related quality of life and comorbid depression. The mechanisms underlying the relationship between sleep disturbances and SIB as well as the role of potential confounders and future perspectives in this field are also discussed.
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Affiliation(s)
- Jorge Lopez-Castroman
- PSNREC, University of Montpellier, INSERM, Montpellier, France. .,Nimes University Hospital, Nimes, France. .,CIBERSAM, Madrid, Spain.
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167
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Zheng MX, Masters-Waage TC, Yao J, Lu Y, Tan N, Narayanan J. Stay Mindful and Carry on: Mindfulness Neutralizes COVID-19 Stressors on Work Engagement via Sleep Duration. Front Psychol 2020; 11:610156. [PMID: 33408674 PMCID: PMC7779584 DOI: 10.3389/fpsyg.2020.610156] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/26/2020] [Indexed: 11/13/2022] Open
Abstract
We examine whether mindfulness can neutralize the negative impact of COVID-19 stressors on employees' sleep duration and work engagement. In Study 1, we conducted a field experiment in Wuhan, China during the lockdown between February 20, 2020, and March 2, 2020, in which we induced state mindfulness by randomly assigning participants to either a daily mindfulness practice or a daily mind-wandering practice. Results showed that the sleep duration of participants in the mindfulness condition, compared with the control condition, was less impacted by COVID-19 stressors (i.e., the increase of infections in the community). In Study 2, in a 10-day daily diary study in the United Kingdom between June 8, 2020, and June 19, 2020, we replicate our results from Study 1 using a subjective measure of COVID-19 stressors and a daily measure of state mindfulness. In addition, we find that mindfulness buffers the negative effect of COVID-19 stressors on work engagement mediated by sleep duration. As the COVID-19 pandemic is ongoing and the number of reported cases continues to rise globally, our findings suggest that mindfulness is an evidence-based practice that can effectively neutralize the negative effect of COVID-19 stressors on sleep and work outcomes. The findings of the present study contribute to the employee stress and well-being literature as well as the emerging organizational research on mindfulness.
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Affiliation(s)
- Michelle Xue Zheng
- Department of Organizational Behavior and Human Resource Management, China Europe International Business School (CEIBS), Shanghai, China
| | | | - Jingxian Yao
- Católica Lisbon School of Business and Economics, Catholic University of Portugal, Lisbon, Portugal
| | - Yizhen Lu
- NUS Business School, National University of Singapore, Singapore, Singapore
| | - Noriko Tan
- NUS Business School, Singapore Management University, Singapore, Singapore
| | - Jayanth Narayanan
- NUS Business School, National University of Singapore, Singapore, Singapore
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168
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Cankardas S, Schenck CH. Sexual Behaviors and Sexual Health of Sexsomnia Individuals Aged 18-58. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2020; 33:29-39. [PMID: 38596470 PMCID: PMC10807804 DOI: 10.1080/19317611.2020.1850597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 11/03/2020] [Accepted: 11/06/2020] [Indexed: 04/11/2024]
Abstract
Objective: The objective of this study was to address the relationships between demographics and sexsomnia episodes, and sexual health issues in affected individuals. This study is the first sexsomnia survey conducted in Turkey. Sexsomnia comprises involuntary, unconscious sexual behavior during sleep, observed by a bed partner. Method:To reach people with and without sexsomnia, an online survey method was used. Among 274 participants, 42 of them reported having sexsomnia. Results: Women who do not have sexsomnia have more sexual problems than women who have sexsomnia episodes. The sexsomnia experiences of men and women also differed. Additionally, there were gender differences with difficulties caused by the sexsomnia. Conclusions: There is a need for further studies on sexsomnia that address socio-cultural, gender, and biological factors (including sleep disorders).
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Affiliation(s)
- Sinem Cankardas
- Department of Psychology, Izmir Democracy University, Izmir, Turkey
| | - Carlos H. Schenck
- Minnesota Regional Sleep Disorders Center, and Departments of Psychiatry, Hennepin County Medical Center and University of Minnesota Medical School, Minneapolis, Minnesota, USA
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169
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Agorastos A, Olff M. Traumatic stress and the circadian system: neurobiology, timing and treatment of posttraumatic chronodisruption. Eur J Psychotraumatol 2020; 11:1833644. [PMID: 33408808 PMCID: PMC7747941 DOI: 10.1080/20008198.2020.1833644] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: Humans have an evolutionary need for a well-preserved internal 'clock', adjusted to the 24-hour rotation period of our planet. This intrinsic circadian timing system enables the temporal organization of numerous physiologic processes, from gene expression to behaviour. The human circadian system is tightly and bidirectionally interconnected to the human stress system, as both systems regulate each other's activity along the anticipated diurnal challenges. The understanding of the temporal relationship between stressors and stress responses is critical in the molecular pathophysiology of stress-and trauma-related diseases, such as posttraumatic stress disorder (PTSD). Objectives/Methods: In this narrative review, we present the functional components of the stress and circadian system and their multilevel interactions and discuss how traumatic stress can affect the harmonious interplay between the two systems. Results: Circadian dysregulation after trauma exposure (posttraumatic chronodisruption) may represent a core feature of trauma-related disorders mediating enduring neurobiological correlates of traumatic stress through a loss of the temporal order at different organizational levels. Posttraumatic chronodisruption may, thus, affect fundamental properties of neuroendocrine, immune and autonomic systems, leading to a breakdown of biobehavioral adaptive mechanisms with increased stress sensitivity and vulnerability. Given that many traumatic events occur in the late evening or night hours, we also describe how the time of day of trauma exposure can differentially affect the stress system and, finally, discuss potential chronotherapeutic interventions. Conclusion: Understanding the stress-related mechanisms susceptible to chronodisruption and their role in PTSD could deliver new insights into stress pathophysiology, provide better psychochronobiological treatment alternatives and enhance preventive strategies in stress-exposed populations.
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Affiliation(s)
- Agorastos Agorastos
- II. Department of Psychiatry, Division of Neurosciences, School of Medicine, Faculty of Medical Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.,VA Center of Excellence for Stress and Mental Health (CESAMH), VA San Diego Healthcare System, San Diego, CA, USA
| | - Miranda Olff
- Department of Psychiatry, Amsterdam UMC, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands.,ARQ Psychotrauma Expert Group, Diemen, The Netherlands
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170
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Harb GC, Schultz JH. The nature of posttraumatic nightmares and school functioning in war-affected youth. PLoS One 2020; 15:e0242414. [PMID: 33237929 PMCID: PMC7688112 DOI: 10.1371/journal.pone.0242414] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 10/28/2020] [Indexed: 11/25/2022] Open
Abstract
Children and adolescents who have experienced traumatic events demonstrate a variety of posttraumatic symptoms, including recurrent nightmares, as well as adverse reactions in the school setting. The current study examined nightmare symptoms, posttraumatic stress, sleep disturbance, and self- and teacher-reported school functioning of 64 youths in the Gaza Strip, ages 12 to 16, who have lived through three wars and experience ongoing conflict and political insecurity. Students were treatment-seeking for sleep-problems and reported, on average, five nightmares per week for an average of three years, with concomitant disrupted sleep, fear of going to sleep, and not feeling rested in the morning. Both teachers and students reported that participants exhibited impaired academic functioning and daytime sleepiness. The content of the students’ nightmares demonstrated frightening themes of being under attack and loss of self-efficacy/control; threat levels were high, and almost 60% included the threat of death. Approximately half of the nightmares included surreal elements in addition to more realistic scenes of violence. Participants in the study demonstrated substantial posttraumatic sleep problems with intensely distressing, frequent and chronic nightmares, andnightmare symptoms were associated with impairment in school functioning. Given the disruptive and distressing nature of these students’ nightmare disturbance, we suggest that increasing self-efficacy in relation to the experience of recurrent nightmares may be a good point of intervention with these recurrently traumatized youth. Thus, increasing the understanding of students’ nightmare symptoms may lead to ameliorating the suffering of youths in war zones and may have positive effects on their school functioning.
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Affiliation(s)
- Gerlinde C. Harb
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States of America
- Arctic University of Norway, Tromsø, Norway
- * E-mail:
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Jones MB, Jeevan S, Wang J, Li R, Agrawal R, Sharafkaneh A, Marsh L, Jorge RE. Clinical Correlates of Dream Enactment Behaviors in Previously Deployed OEF/OIF/OND Veterans: An Exploratory Analysis. J Neuropsychiatry Clin Neurosci 2020; 32:147-153. [PMID: 31587626 DOI: 10.1176/appi.neuropsych.19010009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Veterans with posttraumatic stress disorder (PTSD) frequently report dream enactment behavior (DEB). Although DEBs are associated with PTSD symptoms, their relationship with other sleep disorders, including REM behavior disorder, warrants reexamination of their clinical correlates. METHODS The investigators used a cross-sectional, exploratory analysis to compare demographic and clinical characteristics of veterans endorsing regularly occurring DEB compared with those endorsing no or infrequent DEB. The participants comprised a convenience sample of servicemembers who were previously deployed to Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) and enrolled in an ongoing cohort study. RESULTS Of the 78 eligible participants, 19 (24.4%) endorsed DEBs occurring at least once per week in the past month. Compared with participants who reported no or infrequent DEBs, participants with regularly occurring DEBs had poorer sleep quality, greater PTSD severity, a higher number of reported mild traumatic brain injuries (mTBI) with loss of consciousness, and a higher likelihood of being diagnosed with sleep disorders. After adjustment for global sleep quality, a significant association persisted between DEBs and the number of mTBI with loss of consciousness but not between DEBs and the severity of PTSD symptoms. CONCLUSIONS These results suggest that mTBI may disrupt neural circuits regulating sleep among OIF/OEF/OND veterans. Prospective, polysomnographic assessment of muscle tone and behavioral events during REM sleep is needed to characterize the physiology of DEBs in this population.
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Affiliation(s)
- Melissa B Jones
- The Veterans Affairs (VA) South Central Mental Illness Research, Education and Clinical Center, Houston (Jones); the Michael E. DeBakey Veterans Affairs Medical Center, Houston (Jones, Jeevan, Agrawal, Sharafkaneh, Marsh, Jorge); the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Jones, Marsh, Jorge); the Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston (Wang, Li); and the Department of Medicine, Pulmonary, Critical Medicine and Sleep Medicine Section, Baylor College of Medicine, Houston (Agrawal, Sharafkaneh)
| | - Sangeeth Jeevan
- The Veterans Affairs (VA) South Central Mental Illness Research, Education and Clinical Center, Houston (Jones); the Michael E. DeBakey Veterans Affairs Medical Center, Houston (Jones, Jeevan, Agrawal, Sharafkaneh, Marsh, Jorge); the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Jones, Marsh, Jorge); the Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston (Wang, Li); and the Department of Medicine, Pulmonary, Critical Medicine and Sleep Medicine Section, Baylor College of Medicine, Houston (Agrawal, Sharafkaneh)
| | - Jingyan Wang
- The Veterans Affairs (VA) South Central Mental Illness Research, Education and Clinical Center, Houston (Jones); the Michael E. DeBakey Veterans Affairs Medical Center, Houston (Jones, Jeevan, Agrawal, Sharafkaneh, Marsh, Jorge); the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Jones, Marsh, Jorge); the Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston (Wang, Li); and the Department of Medicine, Pulmonary, Critical Medicine and Sleep Medicine Section, Baylor College of Medicine, Houston (Agrawal, Sharafkaneh)
| | - Ruosha Li
- The Veterans Affairs (VA) South Central Mental Illness Research, Education and Clinical Center, Houston (Jones); the Michael E. DeBakey Veterans Affairs Medical Center, Houston (Jones, Jeevan, Agrawal, Sharafkaneh, Marsh, Jorge); the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Jones, Marsh, Jorge); the Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston (Wang, Li); and the Department of Medicine, Pulmonary, Critical Medicine and Sleep Medicine Section, Baylor College of Medicine, Houston (Agrawal, Sharafkaneh)
| | - Ritwick Agrawal
- The Veterans Affairs (VA) South Central Mental Illness Research, Education and Clinical Center, Houston (Jones); the Michael E. DeBakey Veterans Affairs Medical Center, Houston (Jones, Jeevan, Agrawal, Sharafkaneh, Marsh, Jorge); the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Jones, Marsh, Jorge); the Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston (Wang, Li); and the Department of Medicine, Pulmonary, Critical Medicine and Sleep Medicine Section, Baylor College of Medicine, Houston (Agrawal, Sharafkaneh)
| | - Amir Sharafkaneh
- The Veterans Affairs (VA) South Central Mental Illness Research, Education and Clinical Center, Houston (Jones); the Michael E. DeBakey Veterans Affairs Medical Center, Houston (Jones, Jeevan, Agrawal, Sharafkaneh, Marsh, Jorge); the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Jones, Marsh, Jorge); the Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston (Wang, Li); and the Department of Medicine, Pulmonary, Critical Medicine and Sleep Medicine Section, Baylor College of Medicine, Houston (Agrawal, Sharafkaneh)
| | - Laura Marsh
- The Veterans Affairs (VA) South Central Mental Illness Research, Education and Clinical Center, Houston (Jones); the Michael E. DeBakey Veterans Affairs Medical Center, Houston (Jones, Jeevan, Agrawal, Sharafkaneh, Marsh, Jorge); the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Jones, Marsh, Jorge); the Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston (Wang, Li); and the Department of Medicine, Pulmonary, Critical Medicine and Sleep Medicine Section, Baylor College of Medicine, Houston (Agrawal, Sharafkaneh)
| | - Ricardo E Jorge
- The Veterans Affairs (VA) South Central Mental Illness Research, Education and Clinical Center, Houston (Jones); the Michael E. DeBakey Veterans Affairs Medical Center, Houston (Jones, Jeevan, Agrawal, Sharafkaneh, Marsh, Jorge); the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Jones, Marsh, Jorge); the Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston (Wang, Li); and the Department of Medicine, Pulmonary, Critical Medicine and Sleep Medicine Section, Baylor College of Medicine, Houston (Agrawal, Sharafkaneh)
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Barone DA. Dream enactment behavior-a real nightmare: a review of post-traumatic stress disorder, REM sleep behavior disorder, and trauma-associated sleep disorder. J Clin Sleep Med 2020; 16:1943-1948. [PMID: 32804070 PMCID: PMC8034213 DOI: 10.5664/jcsm.8758] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/06/2020] [Accepted: 08/06/2020] [Indexed: 01/16/2023]
Abstract
NONE Dream enactment behavior is a phenomenon demonstrated in patients with post-traumatic stress disorder, rapid eye movement sleep behavior disorder, as well as with a more recently described condition entitled trauma-associated sleep disorder, which shares diagnostic criteria for rapid eye movement sleep behavior disorder. While these conditions share some commonalities, namely dream enactment behavior, they are quite different in pathophysiology and underlying mechanisms. This review will focus on these 3 conditions, with the purpose of increasing awareness for trauma-associated sleep disorder in particular.
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173
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Persike DS, Al-Kass SY. Challenges of post-traumatic stress disorder (PTSD) in Iraq: biochemical network and methodologies. A brief review. Horm Mol Biol Clin Investig 2020; 41:/j/hmbci.ahead-of-print/hmbci-2020-0037/hmbci-2020-0037.xml. [PMID: 33155990 DOI: 10.1515/hmbci-2020-0037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/10/2020] [Indexed: 11/15/2022]
Abstract
Post-traumatic stress disorder (PTSD) is a multifaceted syndrome due to its complex pathophysiology. Signals of illness include alterations in genes, proteins, cells, tissues, and organism-level physiological modifications. Specificity of sensitivity to PTSD suggests that response to trauma depend on gender and type of adverse event being experienced. Individuals diagnosed with PTSD represent a heterogeneous group, as evidenced by differences in symptoms, course, and response to treatment. It is clear that the biochemical mechanisms involved in PTSD need to be elucidated to identify specific biomarkers. A brief review of the recent literature in Pubmed was made to explore the major biochemical mechanisms involved in PTSD and the methodologies applied in the assessment of the disease. PTSD shows pre-exposure vulnerability factors in addition to trauma-induced alterations. The disease was found to be associated with dysfunctions of the hypothalamic-pituitary-adrenal axis (HPA) and hypothalamus-pituitary-thyroid axis. Sympathetic nervous system (SNS) activity play a role in PTSD by releasing norepinephrine and epinephrine. Cortisol release from the adrenal cortex amplifies the SNS response. Cortisol levels in PTSD patients, especially women, are later reduced by a negative feedback mechanism which contributes to neuroendocrine alterations and promotes structural changes in the brain leading to PTSD. Gender differences in normal HPA responsiveness may be due to an increased vulnerability in women to PTSD. Serotonin and dopamine levels were found to be abnormal in the presence of PTSD. Mechanisms such as the induction of neuroinflammation and alterations of mitochondrial energy processing were also associated with PTSD.
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Affiliation(s)
- Daniele Suzete Persike
- Department of Medicinal Chemistry, College of Pharmacy, University of Dohuk, Kurdistan Region, Iraq
| | - Suad Yousif Al-Kass
- Department of Medicinal Chemistry, College of Pharmacy, University of Dohuk, Kurdistan Region, Iraq
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174
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Optogenetic sleep enhancement improves fear-associated memory processing following trauma exposure in rats. Sci Rep 2020; 10:18025. [PMID: 33093538 PMCID: PMC7581760 DOI: 10.1038/s41598-020-75237-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 10/12/2020] [Indexed: 01/08/2023] Open
Abstract
Sleep disturbances are commonly found in trauma-exposed populations. Additionally, trauma exposure results in fear-associated memory impairments. Given the interactions of sleep with learning and memory, we hypothesized that increasing sleep duration following trauma exposure would restore overall function and improve trauma-induced fear-associated memory dysfunction. Here, we utilized single prolonged stress, a validated rodent model of post-traumatic stress disorder, in combination with optogenetic activation of hypothalamic melanin-concentrating hormone containing cells to increase sleep duration. The goal of this work was to ascertain if post-trauma sleep increases are sufficient to improve fear-associated memory function. In our laboratory, optogenetic stimulation after trauma exposure was sufficient to increase REM sleep duration during both the Light and Dark Phase, whereas NREM sleep duration was only increased during the Dark Phase of the circadian day. Interestingly though, animals that received optogenetic stimulation showed significantly improved fear-associated memory processing compared to non-stimulated controls. These results suggest that sleep therapeutics immediately following trauma exposure may be beneficial and that post-trauma sleep needs to be further examined in the context of the development of post-traumatic stress disorder.
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175
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Sharma R, Sahota P, Thakkar MM. Short-term sleep deprivation immediately after contextual conditioning inhibits BDNF signaling and disrupts memory consolidation in predator odor trauma mice model of PTSD. Brain Res 2020; 1750:147155. [PMID: 33069732 DOI: 10.1016/j.brainres.2020.147155] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/02/2020] [Accepted: 10/09/2020] [Indexed: 12/21/2022]
Abstract
Post-traumatic stress disorder (PTSD) is a debilitating neuropsychiatric illness affecting > 7 million people every year in the US. Recently, we have shown that the mouse model of predator odor trauma (POT) displayed contextual conditioning and core features of PTSD including sleep disturbances (hyperarousal) and retrieval of traumatic memories following exposure to objective reminders (re-experiencing). PTSD is a disorder of memory function. Since memory consolidation requires the expression of BDNF along with an activation of MAPK/pERK signaling pathway in limbic brain structures (hippocampus and amygdala) and sleep favors memory consolidation, we hypothesized that short-term sleep deprivation (SD, 3 h), immediately after contextual conditioning will attenuate molecular correlates of memory consolidation, sleep disturbances, and memory consolidation. We performed two experiments in adult male C57BL/6J mice to test our hypothesis. Experiment 1 determined the effects of SD on contextual conditioning and changes in sleep wakefulness. Experiment 2 determined the effects of SD on contextual conditioning-induced changes in the expression of BDNF and pERK in hippocampus and amygdala. SD immediately after contextual conditioning (POT + SD group) significantly attenuated sleep disturbances, memory retrieval, and expression of pERK and BDNF in the hippocampus and amygdala as compared to POT-SD group (no SD after contextual conditioning). No significant differences were observed between POT + SD, NOC-SD (no contextual conditioning + no SD), and NOC + SD (no contextual conditioning + SD) groups. Memory consolidation requires sleep and the expression of pERK and BDNF in hippocampus and amygdala immediately after contextual conditioning in POT model of PTSD in mice.
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Affiliation(s)
- Rishi Sharma
- Harry S. Truman Memorial Veterans Hospital and Department of Neurology, University of Missouri-School of Medicine, Columbia, MO, United States
| | - Pradeep Sahota
- Harry S. Truman Memorial Veterans Hospital and Department of Neurology, University of Missouri-School of Medicine, Columbia, MO, United States
| | - Mahesh M Thakkar
- Harry S. Truman Memorial Veterans Hospital and Department of Neurology, University of Missouri-School of Medicine, Columbia, MO, United States.
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176
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Wang C, Laxminarayan S, Ramakrishnan S, Dovzhenok A, Cashmere JD, Germain A, Reifman J. Increased oscillatory frequency of sleep spindles in combat-exposed veteran men with post-traumatic stress disorder. Sleep 2020; 43:5814942. [PMID: 32239159 DOI: 10.1093/sleep/zsaa064] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 03/25/2020] [Indexed: 02/05/2023] Open
Abstract
STUDY OBJECTIVES Sleep disturbances are core symptoms of post-traumatic stress disorder (PTSD), but reliable sleep markers of PTSD have yet to be identified. Sleep spindles are important brain waves associated with sleep protection and sleep-dependent memory consolidation. The present study tested whether sleep spindles are altered in individuals with PTSD and whether the findings are reproducible across nights and subsamples of the study. METHODS Seventy-eight combat-exposed veteran men with (n = 31) and without (n = 47) PTSD completed two consecutive nights of high-density EEG recordings in a laboratory. We identified slow (10-13 Hz) and fast (13-16 Hz) sleep spindles during N2 and N3 sleep stages and performed topographical analyses of spindle parameters (amplitude, duration, oscillatory frequency, and density) on both nights. To assess reproducibility, we used the first 47 consecutive participants (18 with PTSD) for initial discovery and the remaining 31 participants (13 with PTSD) for replication assessment. RESULTS In the discovery analysis, compared to non-PTSD participants, PTSD participants exhibited (1) higher slow-spindle oscillatory frequency over the antero-frontal regions on both nights and (2) higher fast-spindle oscillatory frequency over the centro-parietal regions on the second night. The first finding was preserved in the replication analysis. We found no significant group differences in the amplitude, duration, or density of slow or fast spindles. CONCLUSIONS The elevated spindle oscillatory frequency in PTSD may indicate a deficient sensory-gating mechanism responsible for preserving sleep continuity. Our findings, if independently validated, may assist in the development of sleep-focused PTSD diagnostics and interventions.
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Affiliation(s)
- Chao Wang
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, MD.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD
| | - Srinivas Laxminarayan
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, MD.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD
| | - Sridhar Ramakrishnan
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, MD.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD
| | - Andrey Dovzhenok
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, MD.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD
| | - J David Cashmere
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Anne Germain
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Jaques Reifman
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, MD
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177
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Lou T, Ma J, Wang Z, Terakoshi Y, Lee CY, Asher G, Cao L, Chen Z, Sakurai K, Liu Q. Hyper-Activation of mPFC Underlies Specific Traumatic Stress-Induced Sleep-Wake EEG Disturbances. Front Neurosci 2020; 14:883. [PMID: 32973436 PMCID: PMC7461881 DOI: 10.3389/fnins.2020.00883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 07/28/2020] [Indexed: 11/28/2022] Open
Abstract
Sleep disturbances have been recognized as a core symptom of post-traumatic stress disorders (PTSD). However, the neural basis of PTSD-related sleep disturbances remains unclear. It has been challenging to establish the causality link between a specific brain region and traumatic stress-induced sleep abnormalities. Here, we found that single prolonged stress (SPS) could induce acute changes in sleep/wake duration as well as short- and long-term electroencephalogram (EEG) alterations in the isogenic mouse model. Moreover, the medial prefrontal cortex (mPFC) showed persistent high number of c-fos expressing neurons, of which more than 95% are excitatory neurons, during and immediately after SPS. Chemogenetic inhibition of the prelimbic region of mPFC during SPS could specifically reverse the SPS-induced acute suppression of delta power (1–4 Hz EEG) of non-rapid-eye-movement sleep (NREMS) as well as most of long-term EEG abnormalities. These findings suggest a causality link between hyper-activation of mPFC neurons and traumatic stress-induced specific sleep–wake EEG disturbances.
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Affiliation(s)
- Tingting Lou
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Japan
| | - Jing Ma
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Japan.,HIT Center for Life Sciences (HCLS), School of Life Sciences and Technology, Harbin Institute of Technology, Harbin, China
| | - Zhiqiang Wang
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Japan.,HIT Center for Life Sciences (HCLS), School of Life Sciences and Technology, Harbin Institute of Technology, Harbin, China
| | - Yuka Terakoshi
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Japan
| | - Chia-Ying Lee
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Japan
| | - Greg Asher
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Japan
| | - Liqin Cao
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Japan
| | - Zhiyu Chen
- National Institute of Biological Sciences (NIBS), Beijing, China.,Tsinghua Institute of Multidisciplinary Biomedical Research (TIMBR), Tsinghua University, Beijing, China
| | - Katsuyasu Sakurai
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Japan
| | - Qinghua Liu
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Japan.,National Institute of Biological Sciences (NIBS), Beijing, China.,Tsinghua Institute of Multidisciplinary Biomedical Research (TIMBR), Tsinghua University, Beijing, China
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178
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Swift KM. Sleep and PTSD: delving deeper to understand a complicated relationship. Sleep 2020. [DOI: 10.1093/sleep/zsaa074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kevin M Swift
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD
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179
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Fear of sleep and trauma-induced insomnia: A review and conceptual model. Sleep Med Rev 2020; 55:101383. [PMID: 32992229 DOI: 10.1016/j.smrv.2020.101383] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 07/01/2020] [Accepted: 07/01/2020] [Indexed: 02/06/2023]
Abstract
Trauma-induced insomnia is a symptom of posttraumatic stress disorder (PTSD), and is reported to be particularly distressing and often persists even after remission of the core symptoms of PTSD. Recently, it has been suggested that fear of sleep plays an important role in the development and maintenance of trauma-induced insomnia. The aim of this review is to propose a conceptual model of fear of sleep as a maintaining factor of trauma-induced insomnia. After a brief overview of the role of sleep in PTSD, the concept of fear of sleep is introduced. Theoretical considerations and empirical findings on the role of fear of sleep for trauma-induced insomnia in the context of PTSD are summarized and integrated. Specifically, links between PTSD symptoms and fear of sleep are presented, as well as possible consequences of fear of sleep leading to trauma-induced insomnia. Finally, we highlight methodological issues, identify areas for future research, and discuss potential clinical implications.
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180
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Wang C, Laxminarayan S, David Cashmere J, Germain A, Reifman J. Inter-channel phase differences during sleep spindles are altered in Veterans with PTSD. NEUROIMAGE-CLINICAL 2020; 28:102390. [PMID: 32882644 PMCID: PMC7479269 DOI: 10.1016/j.nicl.2020.102390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/30/2020] [Accepted: 08/17/2020] [Indexed: 01/07/2023]
Abstract
We assessed the spatiotemporal dynamics of slow and fast spindles in PTSD. Inter-channel phase differences during slow spindles were reduced in PTSD. This effect was reproducible across nights and subsamples of the study population. The spatiotemporal dynamics of fast spindles was not altered in PTSD.
Sleep disturbances are common complaints in patients with post-traumatic stress disorder (PTSD). To date, however, objective markers of PTSD during sleep remain elusive. Sleep spindles are distinctive bursts of brain oscillatory activity during non-rapid eye movement (NREM) sleep and have been implicated in sleep protection and sleep-dependent memory processes. In healthy sleep, spindles observed in electroencephalogram (EEG) data are highly synchronized across different regions of the scalp. Here, we aimed to investigate whether the spatiotemporal synchronization patterns between EEG channels during sleep spindles, as quantified by the phase-locking value (PLV) and the mean phase difference (MPD), are altered in PTSD. Using high-density (64-channel) EEG data recorded from 78 combat-exposed Veteran men (31 with PTSD and 47 without PTSD) during two consecutive nights of sleep, we examined group differences in the PLV and MPD for slow (10–13 Hz) and fast (13–16 Hz) spindles separately. To evaluate the reproducibility of our findings, we set apart the first 47 consecutive participants (18 with PTSD) for the initial discovery and reserved the remaining 31 participants (13 with PTSD) for replication analysis. In the discovery analysis, compared to the non-PTSD group, the PTSD group showed smaller MPDs during slow spindles between the frontal and centro-parietal channel pairs on both nights. We obtained reproducible results in the replication analysis in terms of statistical significance and effect size. The PLVs during slow or fast spindles did not significantly differ between groups. The reduced inter-channel phase difference during slow spindles in PTSD may reflect pathological changes in the underlying thalamocortical circuits. This novel finding, if independently validated, may prove useful in developing sleep-focused PTSD diagnostics and interventions.
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Affiliation(s)
- Chao Wang
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., USA
| | - Srinivas Laxminarayan
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., USA
| | - J David Cashmere
- Department of Psychiatry, University of Pittsburgh School of Medicine, USA
| | - Anne Germain
- Department of Psychiatry, University of Pittsburgh School of Medicine, USA
| | - Jaques Reifman
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, USA.
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181
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Pigeon WR, Funderburk JS, Cross W, Bishop TM, Crean HF. Brief CBT for insomnia delivered in primary care to patients endorsing suicidal ideation: a proof-of-concept randomized clinical trial. Transl Behav Med 2020; 9:1169-1177. [PMID: 31271210 DOI: 10.1093/tbm/ibz108] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Insomnia co-occurs frequently with major depressive disorder (MDD) and posttraumatic stress disorder (PTSD); all three conditions are prevalent among primary care patients and associated with suicidal ideation (SI). The purpose of the article was to test the effects of a brief cognitive behavioral therapy for insomnia (bCBTi) and the feasibility of delivering it to primary care patients with SI and insomnia in addition to either MDD and/or PTSD. Fifty-four patients were randomized to receive either bCBTi or treatment-as-usual for MDD and/or PTSD. The primary outcome was SI intensity as measured by the Columbia-Suicide Severity Rating Scale; secondary clinical outcomes were measured by the Insomnia Severity Index, Patient Health Questionnaire for depression, and PTSD Symptom Checklist. Effect sizes controlling for baseline values and sample size were calculated for each clinical outcome comparing pre-post differences between the two conditions with Hedge's g. The effect size of bCBTi on SI intensity was small (0.26). Effects were large on insomnia (1.91) and depression (1.16) with no effect for PTSD. There was a marginally significant (p = .069) effect of insomnia severity mediating the intervention's effect on SI. Findings from this proof-of-concept trial support the feasibility of delivering bCBTi in primary care and its capacity to improve mood and sleep in patients endorsing SI. The results do not support bCBTi as a stand-alone intervention to reduce SI, but this or other insomnia interventions may be considered as components of suicide prevention strategies.
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Affiliation(s)
- Wilfred R Pigeon
- VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, USA.,Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA.,Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA
| | - Jennifer S Funderburk
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA.,Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA.,Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Wendi Cross
- VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, USA.,Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Todd M Bishop
- VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, USA.,Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA.,Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA
| | - Hugh F Crean
- VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, USA.,Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
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182
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Simor P, van der Wijk G, Nobili L, Peigneux P. The microstructure of REM sleep: Why phasic and tonic? Sleep Med Rev 2020; 52:101305. [DOI: 10.1016/j.smrv.2020.101305] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/20/2020] [Accepted: 02/21/2020] [Indexed: 12/15/2022]
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183
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Youngren WA, Hamilton NA, Preacher KJ. Assessing Triggers of Posttrauma Nightmares. J Trauma Stress 2020; 33:511-520. [PMID: 32521086 DOI: 10.1002/jts.22532] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 12/21/2019] [Accepted: 12/25/2019] [Indexed: 11/09/2022]
Abstract
Posttrauma nightmares are recurring nightmares that begin after a traumatic experience and can occur as often as multiple times per week, often in a seemingly random pattern. Although these nightmares are prevalent in trauma survivors, little is known about the mechanisms underlying their sporadic occurrence. The present study aimed to investigate predictors of posttrauma nightmares. The sample included 146 observations nested within 27 female college students who reported frequent nightmares related to sexual trauma. Participants were recruited from an undergraduate student subject pool (n = 71) or were clinical referrals (n = 75). Participants completed an initial assessment battery and six consecutive days of pre- and postsleep diaries, which included measures of potential posttrauma nightmare triggers and measures intended to assess sleep quality and posttrauma nightmare occurrence. Descriptive statistics, mean comparisons, and multilevel modeling were used to examine the data. The results showed that both presleep cognitive arousal, γ10 SLij = 0.58, p = .006, z(1, N = 146) = -2.61; and sleep latency (SL), γ20 PCAij = 0.76, p < .001, z(1, N = 146) = -2.69, predicted posttrauma nightmare occurrence. Further investigation suggested that presleep cognitive arousal moderated the relation between SL and posttrauma nightmare occurrence, γ30 PCA x SLij = 0.67, p = .048 z(1, N = 146) = 1.98. The present results are the first to show that the co-occurrence of presleep arousal and delayed sleep onset latency may influence posttrauma nightmare occurrence, suggesting that the time immediately before sleep is crucial to the production of the posttrauma nightmares.
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Affiliation(s)
| | - Nancy A Hamilton
- Department of Psychology, University of Kansas, Lawrence, Kansas, USA
| | - Kris J Preacher
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee, USA
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184
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Cox RC, Parmar AM, Olatunji BO. Sleep in obsessive-compulsive and related disorders: a selective review and synthesis. Curr Opin Psychol 2020; 34:23-26. [DOI: 10.1016/j.copsyc.2019.08.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/07/2019] [Accepted: 08/16/2019] [Indexed: 02/07/2023]
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185
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von der Warth R, Hehn P, Wolff J, Kaier K. Hospital costs associated with post-traumatic stress disorder in somatic patients: a retrospective study. HEALTH ECONOMICS REVIEW 2020; 10:23. [PMID: 32653959 PMCID: PMC7354685 DOI: 10.1186/s13561-020-00281-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 07/05/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Post-traumatic stress disorder is likely to affect clinical courses in the somatic hospital ward when appearing as comorbidity. Thus, this study aimed to assess the costs associated with comorbid post-traumatic stress disorder in a somatic hospital and to analyze if reimbursement appropriately compensated additional costs. METHODS The study used data from a German university hospital between 2011 and 2014, analyzing 198,819 inpatient episodes. Inpatient's episodes were included for analysis if they had a somatic primary diagnosis and a secondary diagnosis of post-traumatic stress disorder. Costs were calculated based on resource use and compared to reimbursement. Analyses were adjusted for sex, age and somatic comorbidities. RESULTS N = 219 Inpatient's episode were found with primary somatic disorder and a comorbid post-traumatic stress disorder. Inpatients episodes with comorbid post-traumatic stress disorder were compared to 34,229 control episodes, which were hospitalized with the same main diagnosis. Post-traumatic stress disorder was associated with additional hospital costs of €2311 [95%CI €1268 - €3355], while reimbursement rose by €1387 [€563 - €2212]. Results indicate that extra costs associated with post-traumatic stress disorder are not fully reimbursed. Male patients showed higher hospital costs associated with post-traumatic stress disorder. On average, post-traumatic stress disorder was associated with an extra length of stay of 3.4 days [2.1-4.6 days]. CONCLUSION Costs associated with post-traumatic stress disorder were substantial and exceeded reimbursement, indicating an inadequate reimbursement for somatic patients with comorbid post-traumatic stress disorder.
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Affiliation(s)
- Rieka von der Warth
- Section of Health Care Research and Rehabilitation Research, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany.
| | - Philip Hehn
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - Jan Wolff
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Klaus Kaier
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
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186
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Jang J, Lee G, Seo J, Na EJ, Park JY, Jeon HJ. Suicidal attempts, insomnia, and major depressive disorder among family members of suicide victims in South Korea. J Affect Disord 2020; 272:423-431. [PMID: 32553386 DOI: 10.1016/j.jad.2020.04.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 04/09/2020] [Accepted: 04/20/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Suicide survivors are defined as victims who experienced suicide of siblings or parents, spouses, or lineal relatives within the fourth degree who had lived with them. We compared the effects of major depressive disorder (MDD), symptoms of posttraumatic stress disorder (PTSD), and impulsivity on lifetime suicide attempts among suicide survivors. METHODS Participants included 272 suicide survivors. We compared them to 5,200 members from the general population who were matched by age, sex, and years of education. We evaluated participants using the Patient Health Questionnaire-9 (PHQ-9), the EuroQuality of Life (EuroQol) scale, the Impact of Events Scale-Revised (IES-R), the Barratt Impulsiveness Scale-11 (BIS-11), and the Composite International Diagnostic Interview (K-CIDI). RESULTS Among the 272 suicide survivors, MDD was nine times higher (47.1% vs. 5.3%), and suicidal attempts were six times higher (20.5% vs. 3.3%) than reported among the general population. The suicide survivors showed more severe depression, greater impulsivity, and poorer quality of life than did the general population. In multivariate logistic regression analyses performed to evaluate each IES-R item, "trouble staying asleep" was the only PTSD symptom item that was significantly associated with suicide attempts among suicide survivors. Suicide survivors who had both MDD with insomnia and high impulsivity were at four times higher risk for suicide attempts than the general population with no MDD (AOR = 4.04, 95% CI: 1.25-13.09). CONCLUSIONS Surviving suicide by family members is an important risk factor for suicide attempts. In particular, MDD with insomnia and impulsivity are associated with suicide attempts among suicide survivors.
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Affiliation(s)
- Jihoon Jang
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Korea Psychological Autopsy Center (KPAC), Seoul, South Korea; Department of Psychiatry, Keyo Hospital, Uiwang, South Korea
| | - Gusang Lee
- Korea Psychological Autopsy Center (KPAC), Seoul, South Korea
| | - Jihye Seo
- Korea Psychological Autopsy Center (KPAC), Seoul, South Korea
| | - Eun Jin Na
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Korea Psychological Autopsy Center (KPAC), Seoul, South Korea; Department of Psychiatry, Seoul Medical Center, Seoul, South Korea
| | - Jae-Young Park
- Korea Psychological Autopsy Center (KPAC), Seoul, South Korea
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Korea Psychological Autopsy Center (KPAC), Seoul, South Korea; Department of Health Sciences & Technology, Department of Medical Device Management & Research, and Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea.
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187
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Freeman D, Sheaves B, Waite F, Harvey AG, Harrison PJ. Sleep disturbance and psychiatric disorders. Lancet Psychiatry 2020; 7:628-637. [PMID: 32563308 DOI: 10.1016/s2215-0366(20)30136-x] [Citation(s) in RCA: 273] [Impact Index Per Article: 68.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 02/22/2020] [Accepted: 03/17/2020] [Indexed: 01/10/2023]
Abstract
Signs of mental ill health that cut across psychiatric diagnostic categories at high rates are typically viewed as non-specific occurrences, downgraded in importance and disregarded. However, problems not associated with particular diagnoses should be expected if there is shared causation across mental health conditions. If dynamic networks of interacting symptoms are the reality of mental health presentations, then particularly disruptive and highly connected problems should be especially common. The non-specific occurrence might be highly consequential. One non-specific occurrence that is often overlooked is patients' chronic difficulty in getting good sleep. In this Review, we consider whether disrupted sleep might be a contributory causal factor in the occurrence of major types of mental health disorders. It is argued that insomnia and other mental health conditions not only share common causes but also show a bidirectional relationship, with typically the strongest pathway being disrupted sleep as a causal factor in the occurrence of other psychiatric problems. Treating insomnia lessens other mental health problems. Intervening on sleep at an early stage might be a preventive strategy for the onset of clinical disorders. Our recommendations are that insomnia is assessed routinely in the occurrence of mental health disorders; that sleep disturbance is treated in services as a problem in its own right, yet also recognised as a pathway to reduce other mental health difficulties; and that access to evidence-based treatment for sleep difficulties is expanded in mental health services.
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Affiliation(s)
- Daniel Freeman
- Department of Psychiatry, University of Oxford, Oxford, UK; Health National Health Service Foundation Trust, Oxford, UK.
| | - Bryony Sheaves
- Department of Psychiatry, University of Oxford, Oxford, UK; Health National Health Service Foundation Trust, Oxford, UK
| | - Felicity Waite
- Department of Psychiatry, University of Oxford, Oxford, UK; Health National Health Service Foundation Trust, Oxford, UK
| | - Allison G Harvey
- Department of Psychology, University of California, Berkeley, CA, USA
| | - Paul J Harrison
- Department of Psychiatry, University of Oxford, Oxford, UK; Health National Health Service Foundation Trust, Oxford, UK
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188
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Lancel M, Stroebe M, Eisma MC. Sleep disturbances in bereavement: A systematic review. Sleep Med Rev 2020; 53:101331. [PMID: 32505968 DOI: 10.1016/j.smrv.2020.101331] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/05/2020] [Accepted: 03/09/2020] [Indexed: 12/16/2022]
Abstract
Severe, persistent and disabling grief occurs among a sizable minority experiencing bereavement, with diagnostic manuals newly including complicated grief (CG) disorders. Sleep disturbances/disorders have been established as worsening affective and stress-related conditions. However, the role of sleep difficulties in bereavement and CG has not received similar scientific attention. We therefore conducted a systematic review with narrative syntheses on this topic to clarify the role of sleep in bereavement (PROSPERO: CRD42018093145). We searched PubMed, Web of Science and PsychInfo for peer-reviewed English-language articles including (at least one) bereaved sample and sleep disturbance measure. We identified 85 articles on 12.294 participants. We answered seven pre-defined research questions demonstrating: high prevalence of sleep disturbances in bereavement; positive associations of grief intensity with sleep difficulties; preliminary indications of risk factors of post-loss sleep disturbance; higher prevalence of sleep disturbances in CG, enhanced by psychiatric comorbidity (i.e., depression); and initial evidence of causal relationships between (complicated) grief and sleep. Grief therapy partly improves sleep difficulties, yet no intervention studies have specifically targeted sleep problems in bereaved persons. Causal relationships between sleep and grief require further examination in intensive longitudinal investigations, including randomized trials, thereby clarifying whether treating sleep problems enhances CG treatment effects.
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Affiliation(s)
- Marike Lancel
- Department of Clinical Psychology & Experimental Psychopathology, University of Groningen, Groningen, the Netherlands; Psychiatric Sleep Center Assen, Mental Health Services Drenthe, the Netherlands.
| | - Margaret Stroebe
- Department of Clinical Psychology & Experimental Psychopathology, University of Groningen, Groningen, the Netherlands; Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
| | - Maarten C Eisma
- Department of Clinical Psychology & Experimental Psychopathology, University of Groningen, Groningen, the Netherlands
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189
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McCall CA, Turkheimer E, Tsang S, Avery A, Duncan GE, Watson NF. Sleep duration and post-traumatic stress disorder symptoms: a twin study. Sleep 2020; 42:5549607. [PMID: 31408518 DOI: 10.1093/sleep/zsz179] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 06/18/2019] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES Long and short sleep duration are associated with greater risk of developing post-traumatic stress disorder (PTSD); however, it is unknown how genetic and environmental influences affect this relationship. Thus, we investigated the association between sleep duration and PTSD symptoms using twin models. METHODS Data were obtained from 1865 monozygotic and 758 dizygotic twin pairs enrolled in the community-based Washington State Twin Registry. PTSD symptoms were assessed using the Impact of Events Scale (IES). A classical twin model decomposed the variances of sleep duration and IES score into additive genetic, shared environmental, and unique environmental components. We used correlated factor models to examine the moderation of variance components of sleep duration and IES. RESULTS Shorter and longer sleep duration were associated with higher IES scores with a quadratic association (p < 0.001). The heritability of sleep duration was 36%, and IES 31%. Variance in sleep duration attributable to shared (b1C1 = 2.91, 95% CI = 1.40 to 4.43; p < 0.001) and unique (b1E1 = 0.18, 95% CI = 0.10 to 0.27; p < 0.001) environment was moderated by IES score. Similarly, but to a lesser extent, variance in IES attributable to additive genetics (b1A2 = -0.23, 95% CI = -0.45 to 0.00; p = 0.048) was moderated by sleep duration. CONCLUSIONS Greater PTSD symptom severity was associated with short and long sleep duration. Increasing PTSD symptoms increased variability in sleep duration primarily via shared environmental factors, whereas decreasing sleep duration increased variability in PTSD symptoms primarily via additive genetic factors. This suggests childhood experiences affect variability of sleep duration and genetic factors affect the variability of PTSD symptoms in trauma-exposed individuals.
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Affiliation(s)
- Catherine A McCall
- Department of Pulmonary, Critical Care, and Sleep Medicine, VA Puget Sound Health Care System, Seattle.,Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine and University of Washington Sleep Medicine Center, Seattle
| | - Eric Turkheimer
- Department of Psychology, University of Virginia, Charlottesville
| | - Siny Tsang
- Washington State Twin Registry, Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Ally Avery
- Washington State Twin Registry, Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Glen E Duncan
- Washington State Twin Registry, Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Nathaniel F Watson
- Department of Neurology, University of Washington School of Medicine and University of Washington Sleep Medicine Center, Seattle
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190
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Toscano-Hermoso MD, Arbinaga F, Fernández-Ozcorta EJ, Gómez-Salgado J, Ruiz-Frutos C. Influence of Sleeping Patterns in Health and Academic Performance Among University Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2760. [PMID: 32316249 PMCID: PMC7215924 DOI: 10.3390/ijerph17082760] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 04/12/2020] [Accepted: 04/14/2020] [Indexed: 01/20/2023]
Abstract
Sleep problems in university students are important and have implications for health, quality of life, and academic performance. Using an ex post facto design, a total sample of 855 students (55.7% women) participated in the study. Sleep assessment was conducted using the Pittsburgh Sleep Quality Index, the Nightmare Frequency Scale, the Nightmare Proneness Scale, and the Composite Morningness Scale. Women show a higher risk [OR = 2.61] of presenting poor sleep quality (> 5 points on the PSQI) compared with men (p < 0.001). Similarly, women reported a greater frequency of nightmares (p < 0.001, d = 0.60), greater propensity for nightmares (p < 0.001, d = 0.70) and a higher score on Item-5h of the PSQI regarding nightmares (p < 0.001, d = 0.59). Women, compared with men, show higher risk [OR = 2.84] for a sleep disorder related to nightmares (p = 0.012). Women need more time to reach a state of alertness after getting up (p = 0.022), and there was an interaction between sex and the alertness factor when evaluating the subjective quality of sleep (p = 0.030). Women show worse sleep quality and a higher frequency and propensity for suffering nightmares. When considering the relationship between sleep quality and academic performance, it is observed that students with poor sleep quality obtain lower academic scores (M = 7.21, SD = 0.805) than those with good sleep quality (M = 7.32, SD = 0.685), an effect that reaches significance (t = 2.116, p = 0.035). Regarding the relationship between the categorized chronotype and academic performance, students with a morning chronotype achieve better academic results (M = 7.41, SD = 0.89) than their evening counterparts (M = 7.15, SD = 0.76), although these differences have a small effect size (d = 0.31).
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Affiliation(s)
| | - Félix Arbinaga
- Faculty of Education, Psychology and Sports Science, Department of Clinical and Experimental Psychology, University of Huelva, 21007 Huelva, Spain
| | - Eduardo J. Fernández-Ozcorta
- Department of Physical Activity and Sports, Center for University Studies Cardenal Spínola CEU, University of Seville attached centre, 41930 Bormujos, Spain;
| | - Juan Gómez-Salgado
- School of Labour Sciences, Department of Sociology, Social Work and Public Health, University of Huelva, 21007 Huelva, Spain;
- Safety and Health Posgrade Program, University Espiritu Santo, 092301 Guayaquil, Ecuador
| | - Carlos Ruiz-Frutos
- School of Labour Sciences, Department of Sociology, Social Work and Public Health, University of Huelva, 21007 Huelva, Spain;
- Safety and Health Posgrade Program, University Espiritu Santo, 092301 Guayaquil, Ecuador
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191
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Nowak J, Dimitrov A, Oei NYL, Walter H, Adli M, Veer IM. Association of naturally occurring sleep loss with reduced amygdala resting-state functional connectivity following psychosocial stress. Psychoneuroendocrinology 2020; 114:104585. [PMID: 32018119 DOI: 10.1016/j.psyneuen.2020.104585] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 01/09/2020] [Accepted: 01/10/2020] [Indexed: 12/15/2022]
Abstract
Enduring sleep loss is a risk factor for a variety of both somatic and mental health issues. When subjected to sleep loss, the brain becomes vulnerable to critical alterations in cognitive and emotional processing. In our study, we examined the effect of psychosocial stress on amygdala resting-state functional connectivity in participants with cumulative sleep loss calculated across the seven days preceding scanning. For this purpose, forty-five healthy male participants completed a one-week sleep diary and underwent resting-state scans before and after taking part in the ScanSTRESS paradigm, which allows social stress induction during functional magnetic resonance imaging. Sleep loss was negatively associated with seed-based functional connectivity of the left amygdala with the medial prefrontal cortex, dorsal anterior cingulate cortex, anterior insula, posterior cingulate cortex, and dorsolateral prefrontal cortex. That is, participants with higher amounts of sleep loss showed reduced left amygdala connectivity after social stress induction to cortical regions encompassing main nodes of the brain's default mode network and salience network. Our results shed more light on how brain functional connectivity may shape the brain's stress response in the context of naturally occurring sleep loss, revealing a potential neural mechanism for increased vulnerability to stress-related psychopathology.
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Affiliation(s)
- Jonathan Nowak
- Division of Mind and Brain Research, Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Annika Dimitrov
- Division of Mind and Brain Research, Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Mood Disorders Research Group, Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Nicole Y L Oei
- Department of Developmental Psychology (Addiction, Development, and Psychopathology lab), Institute of Psychology, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands
| | - Henrik Walter
- Division of Mind and Brain Research, Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Mazda Adli
- Mood Disorders Research Group, Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ilya M Veer
- Division of Mind and Brain Research, Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
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192
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Grafe LA, O'Mara L, Branch A, Dobkin J, Luz S, Vigderman A, Shingala A, Kubin L, Ross R, Bhatnagar S. Passive Coping Strategies During Repeated Social Defeat Are Associated With Long-Lasting Changes in Sleep in Rats. Front Syst Neurosci 2020; 14:6. [PMID: 32140101 PMCID: PMC7043017 DOI: 10.3389/fnsys.2020.00006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/23/2020] [Indexed: 12/20/2022] Open
Abstract
Exposure to severe stress has immediate and prolonged neuropsychiatric consequences and increases the risk of developing Posttraumatic Stress Disorder (PTSD). Importantly, PTSD develops in only a subset of individuals after exposure to a traumatic event, with the understanding of this selective vulnerability being very limited. Individuals who go on to develop PTSD after a traumatic experience typically demonstrate sleep disturbances including persistent insomnia and recurrent trauma-related nightmares. We previously established a repeated social defeat paradigm in which rats segregate into either passively or actively coping subpopulations, and we found that this distinction correlates with measures of vulnerability or resilience to stress. In this study, we examined differences between these two behavioral phenotypes in sleep changes resulting from repeated social defeat stress. Our data indicate that, compared to control and actively coping rats, passively coping rats have less slow-wave sleep (SWS) for at least 2 weeks after the end of a series of exposures to social defeat. Furthermore, resilient rats show less exaggerated motor activation at awakenings from rapid eye movement (REM) sleep and less fragmentation of REM sleep compared to control and passively coping rats. Together, these data associate a passive coping strategy in response to repeated social defeat stress with persisting sleep disturbances. Conversely, an active coping strategy may be associated with resilience to sleep disturbances. These findings may have both prognostic and therapeutic applications to stress-associated neuropsychiatric disorders, including PTSD.
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Affiliation(s)
- Laura A Grafe
- Department of Psychology, Bryn Mawr College, Bryn Mawr, PA, United States
| | - Lauren O'Mara
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Anna Branch
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Jane Dobkin
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Sandra Luz
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Abigail Vigderman
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Aakash Shingala
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Leszek Kubin
- Department of Biomedical Sciences, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Richard Ross
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Behavioral Health Service, Crescenz Veterans Affairs Medical Center, Philadelphia, PA, United States
| | - Seema Bhatnagar
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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193
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Hansen C, McFarlane A, Iannos M, Sadler N, Benassi H, Lawrence-Wood E, Hodson S, Searle A, Van Hooff M. Psychosocial factors associated with psychological distress and functional difficulties in recently transitioned and current serving regular Australian Defence Force members. Psychiatry Res 2020; 286:112860. [PMID: 32065981 DOI: 10.1016/j.psychres.2020.112860] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 02/07/2020] [Accepted: 02/08/2020] [Indexed: 11/19/2022]
Abstract
The transition period from military-to-civilian life can be one of the most significant and stressful periods in the military life cycle. We explore the psychosocial factors associated with psychological distress and functional impairment among those who recently transitioned from the Australian Defence Force (ADF) and those currently serving in 2015. Using data from the Transition and Wellbeing Research Programme, multinomial logistic regression models were used to analyze the associations between a combined measure of psychological distress and functional impairment (K10/SDS) with various psychosocial, lifestyle, and physical health factors. There were 10,210 in the final analytic cohort (Transitioned=3,254; Regular 2015 ADF=6,956). Overall, the odds of belonging to the highly distressed/impaired group were greatest among those with insomnia (Odds Ratio 18.53), low resilience (OR 7.67), physical health symptoms (OR 7.16), and alcohol risk (OR 4.67). Other factors included pain (OR 3.36), financial issues (OR 2.38), and social strain (OR 1.98). The associations with insomnia and physical health symptoms were stronger among the Transitioned compared to the Regular 2015 ADF. Results of this research highlights the importance of taking a multi-dimensional perspective of symptoms in military populations, particularly in those recently transitioned from permanent service, as predictors of future risk of disorder.
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Affiliation(s)
- Craig Hansen
- Centre for Traumatic Stress Studies, University of Adelaide, South Australia, Australia.
| | - Alexander McFarlane
- Centre for Traumatic Stress Studies, University of Adelaide, South Australia, Australia
| | - Marie Iannos
- Centre for Traumatic Stress Studies, University of Adelaide, South Australia, Australia
| | - Nicole Sadler
- Department of Defence, Canberra, Australia; Phoenix Australia, Centre for Posttraumatic Mental Health, Melbourne, Australia
| | - Helen Benassi
- Department of Defence, Canberra, Australia; Australian National University, Canberra, Australia
| | - Ellie Lawrence-Wood
- Centre for Traumatic Stress Studies, University of Adelaide, South Australia, Australia
| | | | - Amelia Searle
- Centre for Traumatic Stress Studies, University of Adelaide, South Australia, Australia
| | - Miranda Van Hooff
- Centre for Traumatic Stress Studies, University of Adelaide, South Australia, Australia
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194
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Reeves JW, Fisher AJ. An Examination of Idiographic Networks of Posttraumatic Stress Disorder Symptoms. J Trauma Stress 2020; 33:84-95. [PMID: 32103567 DOI: 10.1002/jts.22491] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 11/06/2019] [Accepted: 11/13/2019] [Indexed: 12/19/2022]
Abstract
Although the application of network theory to posttraumatic stress disorder (PTSD) has yielded promising insights, the lack of equivalence between inter- and intraindividual variation limits the generalizability of these findings to any one individual with PTSD. Instead, a better understanding of how PTSD symptoms occur and vary over time within an individual requires exploring the idiographic network structure of PTSD. To do so, the present study used an intensive repeated-measures design to estimate intraindividual networks of PTSD symptoms on a person-by-person basis. Participants were 20 individuals who met criteria for PTSD and completed daily surveys assessing PTSD symptoms; surveys were completed four times per day for approximately 30 days. Employing a recently validated method provided by Fisher, Reeves, Lawyer, Medaglia, and Rubel (2017), we used these data to estimate a contemporaneous and temporal network of PTSD symptoms for individuals on a person-by-person basis. We then calculated centrality metrics to determine the relative importance of each symptom in each idiographic network. Across all contemporaneous networks, negative trauma-related cognitions and emotions were most commonly the most central symptoms. Further, across all temporal networks, (a) negative trauma-related emotions were the most common driver of variation in other symptoms over time and (b) distressing trauma-related dreams and sleep disturbance were the most common downstream consequences of variation in other PTSD symptoms over time. We also reviewed data from two randomly selected participants to illustrate how this approach could be used to identify maintenance factors of PTSD for each individual and guide individual treatment planning.
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Affiliation(s)
- Jonathan W Reeves
- Department of Psychology, University of California, Berkeley, Berkeley, California, USA
| | - Aaron J Fisher
- Department of Psychology, University of California, Berkeley, Berkeley, California, USA
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195
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Ma Z, Lin Z. The impact of exposure to memorial reports on the 5.12 Wenchuan earthquake on sleep quality among adult survivors ten years after the disaster: Evidence for nonlinear associations. Compr Psychiatry 2020; 97:152150. [PMID: 31864220 DOI: 10.1016/j.comppsych.2019.152150] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 10/16/2019] [Accepted: 11/29/2019] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Very few studies have explored the effect of exposure to disaster memorial reports in the media on long-term sleep quality during the recovery period and post-disaster era. This study investigated the relationship between exposure to memorial reports and adult survivors' long-term sleep quality 10 years after the 5.12 Wenchuan earthquake in 2008, and determined whether exposure to memorial reports are associated with poor sleep quality. METHOD Using a cross-sectional methodology, we surveyed participants (N = 1000) recruited from six disaster-affected counties. We measured sleep quality using the Pittsburgh Sleep Quality Index questionnaire (PSQI). RESULTS After controlling for the effects of demographic factors, socioeconomic status, and earthquake exposure factors, exposure to memorial reports and the PSQI global score had a strong inverted U-shaped relationship. Relationships among three sub-scores of PSQI (subjective sleep quality, sleep latency, daytime dysfunction) were also found to have similar relationships with memorial report exposure. That is, survivors who were exposed to low or high degrees of memorial reports had better sleep quality than those who were exposed to intermediate memorial reports. DISCUSSION The curvilinear relationship between media exposure and sleep quality in the post-disaster era reveals that media exposure could be used to identify victims at risk of poor sleep quality. Clinicians and practitioners may consider adopting psychological intervention programs to enhance victims' psychological controllability to overcome mental disorders caused by media exposure.
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Affiliation(s)
- Zhihao Ma
- Computational Communication Collaboratory, School of Journalism and Communication, Nanjing University, Nanjing 210093, PR China
| | - Zhongxuan Lin
- School of Journalism and Communication, Jinan University, Guangzhou 510632, PR China.
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196
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Laxminarayan S, Wang C, Oyama T, Cashmere JD, Germain A, Reifman J. Identification of Veterans With PTSD Based on EEG Features Collected During Sleep. Front Psychiatry 2020; 11:532623. [PMID: 33329079 PMCID: PMC7673410 DOI: 10.3389/fpsyt.2020.532623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 10/09/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Previously, we identified sleep-electroencephalography (EEG) spectral power and synchrony features that differed significantly at a population-average level between subjects with and without posttraumatic stress disorder (PTSD). Here, we aimed to examine the extent to which a combination of such features could objectively identify individual subjects with PTSD. Methods: We analyzed EEG data recorded from 78 combat-exposed Veteran men with (n = 31) and without (n = 47) PTSD during two consecutive nights of sleep. To obviate the need for manual assessment of sleep staging and facilitate extraction of features from the EEG data, for each subject, we computed 780 stage-independent, whole-night features from the 10 most commonly used EEG channels. We performed feature selection and trained a logistic regression model using a training set consisting of the first 47 consecutive subjects (18 with PTSD) of the study. Then, we evaluated the model on a testing set consisting of the remaining 31 subjects (13 with PTSD). Results: Feature selection yielded three uncorrelated features that were consistent across the two consecutive nights and discriminative of PTSD. One feature was from the spectral power in the delta band (2-4 Hz) and the other two were from phase synchronies in the alpha (10-12 Hz) and gamma (32-40 Hz) bands. When we combined these features into a logistic regression model to predict the subjects in the testing set, the trained model yielded areas under the receiver operating characteristic curve of at least 0.80. Importantly, the model yielded a testing-set sensitivity of 0.85 and a positive predictive value (PPV) of 0.31. Conclusions: We identified robust stage-independent, whole-night features from EEG signals and combined them into a logistic regression model to discriminate subjects with and without PTSD. On the testing set, the model yielded a high sensitivity and a PPV that was twice the prevalence rate of PTSD in the U.S. Veteran population. We conclude that, using EEG signals collected during sleep, such a model can potentially serve as a means to objectively identify U.S. Veteran men with PTSD.
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Affiliation(s)
- Srinivas Laxminarayan
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, MD, United States.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States
| | - Chao Wang
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, MD, United States.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States
| | - Tatsuya Oyama
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, MD, United States.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States
| | - J David Cashmere
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Anne Germain
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Jaques Reifman
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, MD, United States
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197
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Repantis D, Wermuth K, Tsamitros N, Danker-Hopfe H, Bublitz JC, Kühn S, Dresler M. REM sleep in acutely traumatized individuals and interventions for the secondary prevention of post-traumatic stress disorder. Eur J Psychotraumatol 2020; 11:1740492. [PMID: 32341766 PMCID: PMC7170365 DOI: 10.1080/20008198.2020.1740492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/26/2020] [Accepted: 03/03/2020] [Indexed: 01/04/2023] Open
Abstract
Increasing evidence supports a close link between REM sleep and the consolidation of emotionally toned memories such as traumatic experiences. In order to investigate the role of sleep for the development of symptoms related to traumatic experiences, beyond experimental models in the laboratory, sleep of acutely traumatised individuals may be examined on the first night after trauma. This might allow us to identify EEG variables predicting the development of posttraumatic stress disorder (PTSD) symptoms, and guide the way to novel sleep interventions to prevent PTSD. Based on our experience, patients' acceptance of polysomnography in the first hours after treatment in an emergency room poses obstacles to such a strategy. Wearable, self-applicable sleep recorders might be an option for the investigation of sleep in the aftermath of trauma. They would considerably decrease the perceived burden for patients and thus increase the likelihood of successful patient recruitment. As one potential sleep intervention, sleep deprivation directly after trauma has been suggested to reduce the consolidation of traumatic memories and hence act as a secondary preventive measure. However, experimental data from sleep deprivation studies in healthy volunteers with the trauma film paradigm have been inconclusive regarding the beneficial or detrimental effects of sleep on traumatic memory processing. Depending on further insights into the role of sleep in traumatic memory consolidation through observational and experimental studies, several options for therapeutic sleep interventions are conceivable: besides behavioural sleep deprivation, selective REM sleep suppression or enhancement by a pharmacological intervention into the serotonergic, noradrenergic or cholinergic systems might provide novel therapeutic options. While REM-modulating drugs have been used with some success for the prevention of PTSD after trauma, they have never been tried before the first night of sleep. In conclusion, more experimental and observational research is needed before sleep interventions are performed in actual trauma victims.
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Affiliation(s)
- Dimitris Repantis
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Lise Meitner Group for Environmental Neuroscience, Max Planck Institute for Human Development, Berlin, Germany
| | - Katharina Wermuth
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Nikolaos Tsamitros
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Heidi Danker-Hopfe
- Competence Center of Sleep Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jan Christoph Bublitz
- Faculty of Law, Universität Hamburg, Hamburg, Germany.,Centre for Interdisciplinary Research (ZiF), Bielefeld, Germany
| | - Simone Kühn
- Lise Meitner Group for Environmental Neuroscience, Max Planck Institute for Human Development, Berlin, Germany.,Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Martin Dresler
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
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198
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Short NA, Schmidt NB. Developing and Testing a Novel, Computerized Insomnia and Anxiety Intervention to Reduce Safety Aids Among an at-Risk Student Sample: A Randomized Controlled Trial. Behav Ther 2020; 51:149-161. [PMID: 32005332 DOI: 10.1016/j.beth.2019.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 05/21/2019] [Accepted: 05/24/2019] [Indexed: 11/16/2022]
Abstract
Anxiety and insomnia disorders are two of the most common and costly mental health conditions. They are frequently comorbid, but current treatments do not target both. To streamline treatment, we developed a computerized intervention targeting a transdiagnostic factor, safety aids (cognitive or behavioral strategies used to cope with distress that paradoxically exacerbate symptoms). We conducted a randomized controlled trial to determine the acceptability and efficacy of this brief one-session intervention. Young adult undergraduates (N = 61) with elevated subclinical anxiety and insomnia were randomized to receive the anxiety-insomnia intervention or a physical health control condition. Participants were followed for 1 month and completed self-report measures. Analyses indicated that participants found the intervention acceptable, credible, and engaging. Analyses revealed the active intervention reduced sleep- and anxiety-related safety aids, with medium to large effect sizes. Findings suggest that targeting safety aids for anxiety and insomnia is acceptable and effective in reducing the target mechanism, safety aids, as well as worry. Future research should replicate these findings within a clinical sample and with a longer-term follow-up.
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Affiliation(s)
- Nicole A Short
- Florida State University; Medical University of South Carolina
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199
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Richards A, Kanady JC, Neylan TC. Sleep disturbance in PTSD and other anxiety-related disorders: an updated review of clinical features, physiological characteristics, and psychological and neurobiological mechanisms. Neuropsychopharmacology 2020; 45:55-73. [PMID: 31443103 PMCID: PMC6879567 DOI: 10.1038/s41386-019-0486-5] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 08/09/2019] [Accepted: 08/12/2019] [Indexed: 02/08/2023]
Abstract
The current report provides an updated review of sleep disturbance in posttraumatic stress disorder and anxiety-related disorders. First, this review provides a summary description of the unique and overlapping clinical characteristics and physiological features of sleep disturbance in specific DSM anxiety-related disorders. Second, this review presents evidence of a bidirectional relationship between sleep disturbance and anxiety-related disorders, and provides a model to explain this relationship by integrating research on psychological and neurocognitive processes with a current understanding of neurobiological pathways. A heuristic neurobiological framework for understanding the bidirectional relationship between abnormalities in sleep and anxiety-related brain pathways is presented. Directions for future research are suggested.
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Affiliation(s)
- Anne Richards
- The San Francisco VA Health Care System, San Francisco, CA, USA.
- The University of California, San Francisco, San Francisco, CA, USA.
| | - Jennifer C Kanady
- The San Francisco VA Health Care System, San Francisco, CA, USA
- The University of California, San Francisco, San Francisco, CA, USA
| | - Thomas C Neylan
- The San Francisco VA Health Care System, San Francisco, CA, USA
- The University of California, San Francisco, San Francisco, CA, USA
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200
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Maguire DG, Ruddock MW, Milanak ME, Moore T, Cobice D, Armour C. Sleep, a Governor of Morbidity in PTSD: A Systematic Review of Biological Markers in PTSD-Related Sleep Disturbances. Nat Sci Sleep 2020; 12:545-562. [PMID: 32801980 PMCID: PMC7402856 DOI: 10.2147/nss.s260734] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/06/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Sleep disturbances (SD) are the most impactful and commonly reported symptoms in post-traumatic stress disorder (PTSD). Yet, they are often resistant to primary PTSD therapies. Research has identified two distinct SDs highly prevalent in PTSD; insomnia and nightmares. Those who report SDs prior to a traumatic event are at greater risk for developing PTSD; highlighting that sleep potentially plays a role in PTSD's pathology. To further understand the pathobiological mechanisms that lead to the development of PTSD, it is first imperative to understand the interplay which exists between sleep and PTSD on a biological level. The aim of this systematic review is to determine if biological or physiological markers are related to SD in PTSD. METHODS A systematic literature search was conducted on the electronic databases; Medline, Embase, AMED and PsycINFO, using Medical Subject Headings and associated keywords. RESULTS Sixteen studies were included in the final analyses. Physiological makers of autonomic function, and biochemical markers of HPA-axis activity; inflammatory processes; and trophic factor regulation were related to the severity of SDs in PTSD. CONCLUSION These findings add to the growing literature base supporting a central focus on sleep in research aiming to define the pathophysiological processes which result in PTSD, as well as emphasising the importance of specifically targeting sleep as part of a successful PTSD intervention strategy. Resolving SDs will not only reduce PTSD symptom severity and improve quality of life but will also reduce all-cause mortality, hospital admissions and lifetime healthcare costs for those with PTSD. Limitations of the current literature are discussed, and key recommendations future research must adhere to are made within.
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Affiliation(s)
- Daniel G Maguire
- Biomedical Sciences Research Institute, Ulster University, Coleraine BT52 1SA, Northern Ireland
| | - Mark W Ruddock
- Randox Laboratories Ltd, Clinical Studies, Crumlin, County Antrim BT29 4QY, Northern Ireland
| | - Melissa E Milanak
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Tara Moore
- Biomedical Sciences Research Institute, Ulster University, Coleraine BT52 1SA, Northern Ireland
| | - Diego Cobice
- Biomedical Sciences Research Institute, Ulster University, Coleraine BT52 1SA, Northern Ireland
| | - Cherie Armour
- School of Psychology, David Keir Building, Queen's University Belfast, Belfast BT9 5BN, Northern Ireland
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