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Sankari S, Wrobel N, Leonard M, Grasser L, Sankari A, Javanbakht A. Relationship between Posttraumatic Stress Disorder and Sleep Disturbances in Syrian Refugees in the United States. Avicenna J Med 2023; 13:82-88. [PMID: 37435556 PMCID: PMC10332942 DOI: 10.1055/s-0043-1768646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023] Open
Abstract
Background Posttraumatic stress disorder (PTSD) is associated with disturbed sleep. However, the impact of sleep disturbances and PTSD symptomology in refugee populations is not well known. This study examined how PTSD-related sleep symptoms and overall sleep quality were impacted by previous and current traumatic and stressful experiences. Methods Adult Syrian refugees living in Southeast Michigan were assessed via scheduled in-home interviews. Overall sleep quality was measured using the Pittsburgh Sleep Quality Index. PTSD-related sleep disturbances were measured using the Pittsburgh Sleep Quality Index Addendum. The presence of PTSD symptomatology was assessed via self-report using the Posttraumatic Stress Disorder Checklist. The Life Events Checklist for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition-5 screened for prior traumatic events experienced and the Postmigration Living Difficulties Questionnaire was assessed for postmigration stressors. Correlational analysis was conducted between overall sleep quality, PTSD symptom severity, and previous trauma experienced. A stepwise linear regression analysis was conducted to examine the role of overall sleep quality, PTSD-specific sleep disturbances, current living difficulties, and the number of preimmigration traumatic events directly experienced or witnessed due to the presence of overall PTSD symptomology. Results A total of 53 adults completed the study. PTSD-disturbed sleep was found to be positively associated with overall poor sleep quality ( r = 0.42, p < 0.01), PTSD symptomology ( r = 0.65, p < 0.01), and current living difficulties ( r = 0.37, p < 0.05). The PTSD-related sleep disturbances (B = 0.66, p < 0.01) and postmigration living difficulties (B = 0.44, p < 0.01) were found to be the strongest predictors of PTSD symptoms. Conclusion Disturbed sleep is strongly associated with current stressful experiences and PTSD symptomology among Syrian refugees.
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Affiliation(s)
- Safa Sankari
- College of Arts, Sciences, and Letters, Behavioral Sciences, University of Michigan-Dearborn, Dearborn, Michigan, United States
| | - Nancy Wrobel
- College of Arts, Sciences, and Letters, Behavioral Sciences, University of Michigan-Dearborn, Dearborn, Michigan, United States
| | - Michelle Leonard
- College of Arts, Sciences, and Letters, Behavioral Sciences, University of Michigan-Dearborn, Dearborn, Michigan, United States
| | - Lana Grasser
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan, United States
| | - Abdulghani Sankari
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, United States
| | - Arash Javanbakht
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan, United States
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2
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Richards A, Woodward SH, Baquirin DPG, Yack LM, Metzler TJ, Udupa NS, Staggs EJ, Neylan TC. The sleep physiology of nightmares in veterans with psychological trauma: Evaluation of a dominant model using participant-applied electroencephalography in the home environment. J Sleep Res 2023; 32:e13639. [PMID: 35644523 DOI: 10.1111/jsr.13639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/25/2022] [Accepted: 05/02/2022] [Indexed: 11/27/2022]
Abstract
Nightmares are a core feature of posttraumatic stress disorder, are poorly understood, and are associated with serious negative outcomes. Their biology has been difficult to study, and the feasibility of capturing them in the naturalistic home environment has been poor. This said, the published research and dominant scientific model has focused on nightmares as a manifestation of noradrenergic hyperarousal during rapid eye movement sleep. The current study used at-home, participant-applied devices to measure nightmare physiology in posttraumatic stress disorder treatment-seeking veterans, by examining heartrate measures as indicators of noradrenergic tone, and sleep-stage characteristics and stability in the sleep preceding time-stamped nightmare awakenings. Our data indicate the high feasibility of participant-administered, at-home measurement, and showed an unexpected stability of -rapid eye movement sleep along with no evidence of heartrate elevations in sleep preceding nightmare awakenings. Altogether, these data highlight new opportunities for the study of nightmares while questioning the sufficiency of dominant models, which to date are largely theoretically based.
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Affiliation(s)
- Anne Richards
- University of California San Francisco, and San Francisco VA Healthcare System, San Francisco, California, USA
| | - Steven H Woodward
- University of California San Francisco, and San Francisco VA Healthcare System, San Francisco, California, USA
| | - David Paul G Baquirin
- University of California San Francisco, and San Francisco VA Healthcare System, San Francisco, California, USA
| | - Leslie M Yack
- University of California San Francisco, and San Francisco VA Healthcare System, San Francisco, California, USA
| | - Thomas J Metzler
- University of California San Francisco, and San Francisco VA Healthcare System, San Francisco, California, USA
| | - Nikhila S Udupa
- University of California San Francisco, and San Francisco VA Healthcare System, San Francisco, California, USA
| | - Emily J Staggs
- University of California San Francisco, and San Francisco VA Healthcare System, San Francisco, California, USA
| | - Thomas C Neylan
- University of California San Francisco, and San Francisco VA Healthcare System, San Francisco, California, USA
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3
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Daffre C, Oliver KI, Nazareno JRS, Mäder T, Seo J, Dominguez JP, Gannon K, Lasko NB, Orr SP, Pace-Schott EF. Rapid eye movement sleep parasympathetic activity predicts wake hyperarousal symptoms following a traumatic event. J Sleep Res 2023; 32:e13685. [PMID: 35915961 PMCID: PMC9851935 DOI: 10.1111/jsr.13685] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 06/09/2022] [Accepted: 06/17/2022] [Indexed: 02/03/2023]
Abstract
Heart rate variability (HRV) can be used to assess changes in output of the parasympathetic nervous system (PNS). Considering that patients with post-traumatic stress disorder (PTSD) often experience disturbances in sleep, arousal, and autonomic functioning, we sought to explore the association of PNS activity during sleep with hyperarousal symptoms of PTSD. Because a broad literature supports the importance of rapid eye movement (REM) sleep in PTSD, REM-sleep features were specifically examined as predictors of PTSD symptom severity. A total of 90 participants, primarily civilian and female, aged 18-40 years who had experienced a traumatic event in the last 2 years, underwent an ambulatory polysomnography (PSG) acclimation night followed by a second PSG night from which sleep physiological measures were computed. Participants underwent an ambulatory polysomnography (PSG) acclimation night followed by a second PSG night from which sleep physiological measures were computed. PTSD severity was measured using the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (PCL-5). Dependent variables were total PCL-5 score as well as its hyperarousal symptom subscore. Predictors included REM latency, percentage, density, segment length, and an index of parasympathetic tone (root mean square of the successive differences in the R-R interval or RMSSD). Hierarchical regression models were conducted to analyse the association of REM features with PCL-5 total and hyperarousal subscales. Using hierarchical regression, REM-sleep RMSSD accounted for a significant proportion of the variation in outcome variables, even when accounting for other REM-sleep features. The present findings support hypothesised relationships between PTSD symptomatology and REM-sleep physiology and, specifically, that lowered parasympathetic tone in REM may be an important associate of the hyperarousal symptom cluster in PTSD.
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Affiliation(s)
- Carolina Daffre
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA
| | - Katelyn I. Oliver
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA
| | - Jovi R. S. Nazareno
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA
| | - Thomas Mäder
- Department of Psychology, University of Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
| | - Jeehye Seo
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA
- Korea University, Department of Brain & Cognitive Engineering, Seongbuk-gu, Seoul, KR
| | - Jarrod P. Dominguez
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA
| | - Karen Gannon
- Department of Neurology, Massachusetts General Hospital, Charlestown, MA
| | - Natasha B. Lasko
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA
- Department of Psychiatry, Harvard Medical School, Charlestown, MA
| | - Scott P. Orr
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA
- Department of Psychiatry, Harvard Medical School, Charlestown, MA
| | - Edward F. Pace-Schott
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA
- Department of Psychiatry, Harvard Medical School, Charlestown, MA
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4
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Davenport ND, Werner JK. A randomized sham-controlled clinical trial of a novel wearable intervention for trauma-related nightmares in military veterans. J Clin Sleep Med 2023; 19:361-369. [PMID: 36305584 PMCID: PMC9892731 DOI: 10.5664/jcsm.10338] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 02/04/2023]
Abstract
STUDY OBJECTIVES Persistent nightmares are common among individuals exposed to trauma and are especially prevalent among veterans. While behavioral and pharmacological interventions are available, they have demonstrated limited efficacy. Innovations in wearable technology provide a potential avenue to match or exceed these existing treatments by directly targeting nightmare physiology. METHODS We conducted a randomized, sham-controlled study to determine the efficacy of a novel wearable device-based application in 65 veterans with impaired sleep secondary to trauma-related nightmares. Changes in measures of sleep quality, posttraumatic stress disorder/depression symptoms, and quality of life across the 30-day trial were compared between the Active and Sham systems. RESULTS Both groups demonstrated statistically significant within-person improvement on all measures. While the Active system was generally associated with stronger magnitude of improvement, none of the comparisons of individual measures across conditions reached statistical significance. However, a post-hoc analysis excluding participants with low frequency of usage demonstrated significantly better improvement in perceived sleep quality with the Active device than Sham. CONCLUSIONS Overall, these results provide preliminary evidence that a wearable device may improve self-reported sleep quality for veterans reporting frequent trauma-related nightmares, especially in compliant users. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Traumatic Nightmares Treated by NightWare (To Arouse Not Awaken) (TNT/NW); URL: https://www.clinicaltrials.gov/ct2/show/NCT04040387; Identifier: NCT04040387. CITATION Davenport ND, Werner JK. A randomized sham-controlled clinical trial of a novel wearable intervention for trauma-related nightmares in military veterans. J Clin Sleep Med. 2023;19(2):361-369.
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Affiliation(s)
- Nicholas D. Davenport
- Research, Minneapolis VA Health Care System, Minneapolis, Minnesota
- Departments of Psychiatry and Psychology, University of Minnesota, Minneapolis, Minnesota
| | - J. Kent Werner
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University, Bethesda, Maryland
- Department of Neurology, Uniformed Services University, Bethesda, Maryland
- Sleep Disorders Center, Walter Reed National Military Medical Center, Bethesda Maryland
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5
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Rabinowitz EP, Sayer MA, Richeson AL, Samii MR, Kutash LA, Delahanty DL. 50 Years After Political Protest Violence, Posttraumatic Growth is Associated with PTSD and Anxiety but not Depression or Sleep Difficulties. INTERNATIONAL JOURNAL OF APPLIED POSITIVE PSYCHOLOGY 2023; 8:195-210. [PMID: 36718256 PMCID: PMC9879249 DOI: 10.1007/s41042-023-00085-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/12/2023] [Indexed: 01/27/2023]
Abstract
Rates of, and relationships between, posttraumatic stress disorder (PTSD), depression, anxiety, and posttraumatic growth (PTG) decades after a single-incident trauma remain unclear. During a two-month period surrounding the 50th anniversary of the political protest violence at Kent State University on May 4, 1970, 132 individuals completed measures of PTG, PTSD, depression, anxiety, and sleep difficulties. Participants were, on average, 19 years old (SD = 3.01) on May 4, 1970, and 44% were present at the protests. 17% met cutoff scores consistent with PTG, 6% for PTSD, 8% for anxiety, 11% for depression and 20% for sleep difficulties. PTG was significantly and positively correlated with PTSD (r = .32, 95% CI: 0.17-0.44) and anxiety (r = .23, 95% CI: 0.08-0.38) but not depression or sleep difficulties after controlling for additional trauma exposure since May 4, 1970. All relationships were best explained by linear rather than curvilinear relationships and were not moderated by proximity to the events of May 4, 1970. Results indicate that clinicians working with survivors of trauma decades later may be able to capitalize on the adaptive functions of PTG to foster positive treatment outcomes.
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Affiliation(s)
- Emily P. Rabinowitz
- grid.258518.30000 0001 0656 9343Department of Psychological Sciences, Kent State University, 317 Kent Hall, 44240 Kent, OH USA
| | - MacKenzie A. Sayer
- grid.258518.30000 0001 0656 9343Department of Psychological Sciences, Kent State University, 317 Kent Hall, 44240 Kent, OH USA
| | - Alexis L. Richeson
- grid.258518.30000 0001 0656 9343Department of Psychological Sciences, Kent State University, 317 Kent Hall, 44240 Kent, OH USA
| | - Marielle R. Samii
- grid.258518.30000 0001 0656 9343Department of Psychological Sciences, Kent State University, 317 Kent Hall, 44240 Kent, OH USA
| | - Lindsay A. Kutash
- grid.258518.30000 0001 0656 9343Department of Psychological Sciences, Kent State University, 317 Kent Hall, 44240 Kent, OH USA
| | - Douglas L. Delahanty
- grid.258518.30000 0001 0656 9343Department of Psychological Sciences, Kent State University, 317 Kent Hall, 44240 Kent, OH USA ,grid.261103.70000 0004 0459 7529Northeast Ohio Medical University, Rootstown, OH USA
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6
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Zhou A, McDaniel M, Hong X, Mattin M, Wang X, Shih CH. Emotion dysregulation mediates the association between acute sleep disturbance and later posttraumatic stress symptoms in trauma exposed adults. Eur J Psychotraumatol 2023; 14:2202056. [PMID: 37096440 PMCID: PMC10132222 DOI: 10.1080/20008066.2023.2202056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 03/31/2023] [Accepted: 04/04/2023] [Indexed: 04/26/2023] Open
Abstract
Background: Sleep disturbance is common within days to weeks following a traumatic event and has been associated with emotion dysregulation, a strong risk factor for PTSD development. This study aims to examine if emotion dysregulation mediates the relationship between early post-trauma sleep disturbance and subsequent PTSD symptom severity.Methods: Adult participants (n = 125) completed questionnaires regarding sleep disturbance (via Pittsburgh Sleep Quality Index Addendum; PSQI-A) and emotion dysregulation (via Difficulties in Emotion Regulation Scale; DERS) within 2 weeks after exposure to traumatic events.Results: PTSD symptom severity was assessed with PTSD Checklist for DSM-5 (PCL-5) at 3-month follow-up. There were strong correlations between PSQI-A, DERS, and PCL-5 (r ranges between .38 and .45). Mediation analysis further revealed significant indirect effects of overall emotion regulation difficulties in the relationship between sleep disturbance at 2 weeks and PTSD symptom severity at 3 months (B = .372, SE = .136, 95% CI: [.128, .655]). Importantly, limited access to emotion regulation strategies emerged as the single, significant indirect effect in this relationship (B = .465, SE = .204, 95% CI [.127, .910]) while modelling DERS subscales as multiple parallel mediators.Conclusions: Early post-trauma sleep disturbance is associated with PTSD symptoms over months, and acute emotion dysregulation explains part of this association. Those with limited emotion regulation strategies are at particular risk of developing PTSD symptoms. Early interventions focusing on the appropriate strategies for emotion regulation may be crucial for trauma-exposed individuals.
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Affiliation(s)
- Adrian Zhou
- Department of Psychiatry, University of Toledo, Toledo, OH, USA
| | - Mitchell McDaniel
- Department of Psychiatry, University of Toledo, Toledo, OH, USA
- Department of Psychiatry, MetroHealth Medical Center, Cleveland, OH, USA
| | - Xie Hong
- Department of Neurosciences, University of Toledo, Toledo, OH, USA
| | - Michael Mattin
- Department of Emergency Medicine, University of Toledo, Toledo, OH, USA
| | - Xin Wang
- Department of Psychiatry, University of Toledo, Toledo, OH, USA
| | - Chia-Hao Shih
- Department of Emergency Medicine, University of Toledo, Toledo, OH, USA
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7
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Ansbjerg MB, Sandahl H, Baandrup L, Jennum P, Carlsson J. Sleep impairments in refugees diagnosed with post-traumatic stress disorder: a polysomnographic and self-report study. Eur J Psychotraumatol 2023; 14:2185943. [PMID: 36971225 PMCID: PMC10044313 DOI: 10.1080/20008066.2023.2185943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Background: Post-traumatic stress disorder (PTSD) is the clinical manifestation of traumatic events and is associated with sleep disturbances. Sleep disturbances, if left untreated, may perpetuate or even worsen symptoms of PTSD. Previous studies of other PTSD populations show a higher incidence of sleep impairments and sleep disorders compared to healthy controls (HCs); however, this has never been investigated in trauma-affected refugees diagnosed with PTSD.Objectives: To examine subjective sleep quality, measure sleep architecture, and identify latent sleep disorders in refugees diagnosed with PTSD compared to HCs.Method: This comparative study included 20 trauma-affected refugees diagnosed with PTSD and 20 HC matched on age, sex, and body mass index. All participants completed self-report questionnaires assessing sleep quality, insomnia severity, and disturbing nocturnal behaviour, and all took part in a one-night polysomnography (PSG) assessment.Results: Patients reported significantly poorer subjective sleep quality, sleep latency, sleep duration, and sleep efficiency compared to HCs. Subjective reports on hours spent in bed were not significantly different between patients and HCs. Patients reported significantly higher nightmare frequency and severity compared to HCs. PSG measures showed that patients had significantly reduced sleep efficiency, more awakenings, and longer REM sleep latency, and spent more time awake, whereas there was no significant differences regarding total time in bed, total sleep time, or sleep latency. The prevalence of sleep disorders was equal between groups.Conclusions: The study identified significant impairments in several sleep domains, with a preponderance of disturbed regulation of sleep resulting in awakenings. These results indicate a need for more focus on hyperarousal and nightmares as key elements of disturbed sleep in PTSD. Furthermore, the study identified a discrepancy between subjective and objective measures concerning total sleep time, raising questions regarding the causes of 'sleep state misperception'.Trial registration: ClinicalTrials.gov identifier: NCT03535636..Trial registration: Sleep Impairments in Refugees Diagnosed with PTSD (PSG-PTSD). URL: https://clinicaltrials.gov/ct2/show/NCT03535636. ClinicalTrials.gov NCT03535636. Date of registration: 24/05/2018.
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Affiliation(s)
- Mia Beicher Ansbjerg
- Competence Centre for Transcultural Psychiatry (CTP), Mental Health Centre, Ballerup, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Hinuga Sandahl
- Competence Centre for Transcultural Psychiatry (CTP), Mental Health Centre, Ballerup, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lone Baandrup
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department Bispebjerg-Gentofte, Mental Health Centre Copenhagen, Copenhagen, Denmark
| | - Poul Jennum
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Danish Centre for Sleep Medicine (DCSM), Copenhagen University Hospital - Rigshospitalet-Glostrup, Copenhagen, Denmark
| | - Jessica Carlsson
- Competence Centre for Transcultural Psychiatry (CTP), Mental Health Centre, Ballerup, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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8
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Mysliwiec V, Brock MS, Pruiksma KE, Straud CL, Taylor DJ, Hansen S, Foster SN, Mithani S, Zwetzig S, Gerwell K, Young-McCaughan S, Powell T, Blue Star JA, Cassidy DG, Mintz J, Peterson AL. A comprehensive evaluation of insomnia, obstructive sleep apnea and comorbid insomnia and obstructive sleep apnea in US military personnel. Sleep 2022; 45:6675630. [PMID: 36006786 DOI: 10.1093/sleep/zsac203] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/08/2022] [Indexed: 12/14/2022] Open
Abstract
STUDY OBJECTIVES The aim of this study was to characterize the sleep disorders of insomnia, obstructive sleep apnea (OSA), and comorbid insomnia and OSA (COMISA) in active duty military personnel. METHODS Prospective observational study of 309 military personnel with a mean age of 37.17 years (SD = 7.27). Participants served in four branches of the U.S. military (47.9% Air Force, 38.8% Army, 11.3% Navy, and 1.9% Marines). Sleep diagnoses were rendered after video-polysomnography and a clinical evaluation. Validated self-report measures assessed insomnia severity, excessive daytime sleepiness, sleep quality, disruptive nocturnal behaviors, nightmare disorder, shift work disorder (SWD), sleep impairment, fatigue, posttraumatic stress disorder (PTSD) symptoms, anxiety, depression, and traumatic brain injury (TBI). General linear models and Pearson chi-square tests were used for between-group differences in data analyses. RESULTS Insomnia was diagnosed in 32.7%, OSA in 30.4% and COMISA in 36.9%. Compared to military personnel with OSA alone, those with insomnia only and COMISA had significantly greater insomnia severity, disruptive nocturnal behaviors, sleep-related impairment, rates of nightmare disorder, and poorer sleep quality (all Ps < .05). They also reported greater symptoms of fatigue, PTSD, anxiety, and depression (all Ps < .05). There were no significant differences among the three sleep disorder diagnostic groups on sleepiness, SWD, or TBI. CONCLUSIONS Military personnel with insomnia only and COMISA overall report worsened symptoms of sleep disorders, sleep-related impairment, fatigue, and psychiatric disorders than those with OSA. Results highlight the importance of a comprehensive assessment for sleep-related impairment, sleep, and comorbid disorders in military personnel with clinically significant sleep disturbances.
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Affiliation(s)
- Vincent Mysliwiec
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Matthew S Brock
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, TX, USA
| | - Kristi E Pruiksma
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Casey L Straud
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX, USA.,Department of Psychology, University of Texas at San Antonio, San Antonio, TX, USA
| | - Daniel J Taylor
- Department of Psychology, University of Arizona, Tucson, AZ, USA
| | - Shana Hansen
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, TX, USA
| | - Shannon N Foster
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, TX, USA
| | - Sara Mithani
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Sarah Zwetzig
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Kelsi Gerwell
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Stacey Young-McCaughan
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Tyler Powell
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, TX, USA
| | - John A Blue Star
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, TX, USA
| | - Daniel G Cassidy
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, TX, USA
| | - Jim Mintz
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Alan L Peterson
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX, USA.,Department of Psychology, University of Texas at San Antonio, San Antonio, TX, USA
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9
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Berey BL, Aston ER, Kearns NT, McGeary JE, Borsari B, Metrik J. Prospective associations between sleep disturbances and cannabis use among Veterans: A behavioral economic approach. Addict Behav 2022; 134:107424. [PMID: 35863267 DOI: 10.1016/j.addbeh.2022.107424] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 05/20/2022] [Accepted: 07/05/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Veterans often use cannabis for sleep despite limited evidence of its efficacy. Moreover, how sleep disturbances impact cannabis use longitudinally is unclear. We applied a behavioral economic framework to examine whether sleep disturbances and cannabis demand (i.e., relative value) were related risk-factors for future cannabis use and problems. METHODS Veterans deployed post-9/11/2001 who reported past 6-month cannabis use at baseline (n = 126) completed surveys on their sleep disturbances, demand via the Marijuana Purchase Task (MPT), and cannabis use. Mediation analyses using Hayes' PROCESS Macro and zero-inflated negative binomial models tested indirect effects of baseline sleep disturbances on 12-month cannabis use frequency, quantity, and problems via 6-month cannabis demand (i.e., intensity, Omax, Pmax, and breakpoint). RESULTS Only Omax (i.e., maximum expenditure for cannabis) was a significant mediator for 12-month cannabis use quantity and problems when examined concurrently with other demand indices after controlling for covariates. Intensity (i.e., purchase at zero cost) was a significant mediator for 12-month cannabis use frequency when examined concurrently with other demand indices in models controlling for lifetime cannabis use, but not past 30-day use at baseline. CONCLUSION Cannabis demand, specifically intensity and Omax, may help to identify Veterans with sleep disturbances who are at increased risk for escalating their cannabis use. Subsequent research should assess the extent that sleep disturbances impact cannabis demand in the context of withdrawal, which will inform novel prevention and intervention strategies geared toward reducing negative cannabis-related outcomes among Veterans.
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Affiliation(s)
- Benjamin L Berey
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, United States
| | - Elizabeth R Aston
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, United States
| | - Nathan T Kearns
- U.S. Army Medical Research Directorate - West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, United States
| | - John E McGeary
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, United States; Department of Psychiatry and Human Behavior, Brown University, United States; Providence VA Medical Center, Providence, RI, United States
| | - Brian Borsari
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, United States; Mental Health Service, San Francisco VA Health Care System, United States
| | - Jane Metrik
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, United States; Department of Psychiatry and Human Behavior, Brown University, United States; Providence VA Medical Center, Providence, RI, United States.
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10
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Guo C. Assessing the Chinese version of Pittsburgh Sleep Quality Index in non-clinical adolescents. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-03581-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Jones MB, Agrawal R, Sharafkhaneh A, Kunik ME, Jorge RE, Marsh L. Dream Enactment Behaviors Associated With Posttraumatic Stress Disorder. J Neuropsychiatry Clin Neurosci 2022; 34:124-131. [PMID: 34763524 DOI: 10.1176/appi.neuropsych.21050115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The investigators aimed to draw attention to current debates surrounding the etiologies of dream enactment behaviors in patients with posttraumatic stress disorder (PTSD). The phenomenological overlap between PTSD-related nocturnal symptoms, rapid eye movement sleep behavior disorder (RBD), and trauma-associated sleep disorder (TASD) is discussed. Strategies used to diagnose and manage dream enactment behaviors, whether due to RBD or another confounding sleep disorder, are considered. Finally, the need for further research on the pathophysiological overlap and integrated treatment of PTSD, RBD, and, possibly, TASD is highlighted.
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Affiliation(s)
- Melissa B Jones
- Michael E. DeBakey VA Medical Center, Houston (Jones, Agrawal, Sharafkhaneh, Kunik, Jorge, Marsh); Menninger Department of Psychiatry and Behavioral Sciences, Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Baylor College of Medicine, Houston (Jones, Kunik, Jorge, Marsh); and Department of Pulmonary, Critical Medicine and Sleep Medicine, Baylor College of Medicine, Houston (Agrawal, Sharafkhaneh)
| | - Ritwick Agrawal
- Michael E. DeBakey VA Medical Center, Houston (Jones, Agrawal, Sharafkhaneh, Kunik, Jorge, Marsh); Menninger Department of Psychiatry and Behavioral Sciences, Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Baylor College of Medicine, Houston (Jones, Kunik, Jorge, Marsh); and Department of Pulmonary, Critical Medicine and Sleep Medicine, Baylor College of Medicine, Houston (Agrawal, Sharafkhaneh)
| | - Amir Sharafkhaneh
- Michael E. DeBakey VA Medical Center, Houston (Jones, Agrawal, Sharafkhaneh, Kunik, Jorge, Marsh); Menninger Department of Psychiatry and Behavioral Sciences, Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Baylor College of Medicine, Houston (Jones, Kunik, Jorge, Marsh); and Department of Pulmonary, Critical Medicine and Sleep Medicine, Baylor College of Medicine, Houston (Agrawal, Sharafkhaneh)
| | - Mark E Kunik
- Michael E. DeBakey VA Medical Center, Houston (Jones, Agrawal, Sharafkhaneh, Kunik, Jorge, Marsh); Menninger Department of Psychiatry and Behavioral Sciences, Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Baylor College of Medicine, Houston (Jones, Kunik, Jorge, Marsh); and Department of Pulmonary, Critical Medicine and Sleep Medicine, Baylor College of Medicine, Houston (Agrawal, Sharafkhaneh)
| | - Ricardo E Jorge
- Michael E. DeBakey VA Medical Center, Houston (Jones, Agrawal, Sharafkhaneh, Kunik, Jorge, Marsh); Menninger Department of Psychiatry and Behavioral Sciences, Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Baylor College of Medicine, Houston (Jones, Kunik, Jorge, Marsh); and Department of Pulmonary, Critical Medicine and Sleep Medicine, Baylor College of Medicine, Houston (Agrawal, Sharafkhaneh)
| | - Laura Marsh
- Michael E. DeBakey VA Medical Center, Houston (Jones, Agrawal, Sharafkhaneh, Kunik, Jorge, Marsh); Menninger Department of Psychiatry and Behavioral Sciences, Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Baylor College of Medicine, Houston (Jones, Kunik, Jorge, Marsh); and Department of Pulmonary, Critical Medicine and Sleep Medicine, Baylor College of Medicine, Houston (Agrawal, Sharafkhaneh)
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12
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Seo J, Oliver KI, Daffre C, Moore KN, Gazecki S, Lasko NB, Milad MR, Pace-Schott EF. Associations of sleep measures with neural activations accompanying fear conditioning and extinction learning and memory in trauma-exposed individuals. Sleep 2022; 45:zsab261. [PMID: 34718807 PMCID: PMC8919204 DOI: 10.1093/sleep/zsab261] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 10/26/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES Sleep disturbances increase risk of posttraumatic stress disorder (PTSD). Sleep effects on extinction may contribute to such risk. Neural activations to fear extinction were examined in trauma-exposed participants and associated with sleep variables. METHODS Individuals trauma-exposed within the past 2 years (N = 126, 63 PTSD) completed 2 weeks actigraphy and sleep diaries, three nights ambulatory polysomnography and a 2-day fMRI protocol with Fear-Conditioning, Extinction-Learning and, 24 h later, Extinction-Recall phases. Activations within the anterior cerebrum and regions of interest (ROI) were examined within the total, PTSD-diagnosed and trauma-exposed control (TEC) groups. Sleep variables were used to predict activations within groups and among total participants. Family wise error was controlled at p < 0.05 using nonparametric analysis with 5,000 permutations. RESULTS Initially, Fear Conditioning activated broad subcortical and cortical anterior-cerebral regions. Within-group analyses showed: (1) by end of Fear Conditioning activations decreased in TEC but not PTSD; (2) across Extinction Learning, TEC activated medial prefrontal areas associated with emotion regulation whereas PTSD did not; (3) beginning Extinction Recall, PTSD activated this emotion-regulatory region whereas TEC did not. However, the only between-group contrast reaching significance was greater activation of a hippocampal ROI in TEC at Extinction Recall. A greater number of sleep variables were associated with cortical activations in separate groups versus the entire sample and in PTSD versus TEC. CONCLUSIONS PTSD nonsignificantly delayed extinction learning relative to TEC possibly increasing vulnerability to pathological anxiety. The influence of sleep integrity on brain responses to threat and extinction may be greater in more symptomatic individuals.
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Affiliation(s)
- Jeehye Seo
- Department of Psychiatry, Massachusetts General Hospital, Charlestown MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
- Department of Psychiatry, Harvard Medical School, Charlestown, MA, USA
- Department of Brain & Cognitive Engineering, Korea University, Seongbuk-gu, Seoul, South Korea
| | - Katelyn I Oliver
- Department of Psychiatry, Massachusetts General Hospital, Charlestown MA, USA
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
| | - Carolina Daffre
- Department of Psychiatry, Massachusetts General Hospital, Charlestown MA, USA
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Kylie N Moore
- Department of Psychiatry, Massachusetts General Hospital, Charlestown MA, USA
- Graduate Program in Neuroscience, Boston University, Boston, MA, USA
| | - Samuel Gazecki
- Department of Psychiatry, Massachusetts General Hospital, Charlestown MA, USA
- Rush Medical College, Chicago, IL, USA
| | - Natasha B Lasko
- Department of Psychiatry, Massachusetts General Hospital, Charlestown MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
- Department of Psychiatry, Harvard Medical School, Charlestown, MA, USA
| | - Mohammed R Milad
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
- Nathan Kline Institute for Psychiatric Research, Rockland, NY, USA
| | - Edward F Pace-Schott
- Department of Psychiatry, Massachusetts General Hospital, Charlestown MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
- Department of Psychiatry, Harvard Medical School, Charlestown, MA, USA
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13
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Yang X, Liu L, Xiong X, Zhang Y, Liu Y, Li H, Yao K, Wang J. Effects of Bushen-Jiangya granules on blood pressure and pharmacogenomic evaluation in low-to-medium-risk hypertensive patients: study protocol for a randomized double-blind controlled trial. Trials 2022; 23:37. [PMID: 35033168 PMCID: PMC8760657 DOI: 10.1186/s13063-022-05999-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 01/03/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Hypertension is one of the most important risk factors for cardiovascular disease, and its control rates remain low worldwide. The most effective strategy is that patients with hypertension should be diagnosed and treated early. Preliminary studies showed that the Bushen Jiangya granule (BSJY) could suppress ventricular hypertrophy and inflammatory responses, lower blood pressure, and protect the target organs of hypertension. We designed a randomized, double-blind, placebo-controlled trial to evaluate the efficacy of BSJY in patients with low-to-medium risk hypertension. METHODS AND ANALYSIS This trial is a one-center, randomized, double-blind, placebo-controlled study. A total of 260 participants will be randomized in a 1:1 ratio to an experimental group (BSJY plus amlodipine) and a control group (placebo plus amlodipine). The trial cycle will last 8 weeks. The primary outcome is the change in 24-h average systolic and diastolic blood pressure. The secondary outcomes include heart rate variability, pharmacogenomic evaluation, improvement in TCM syndrome, and serum pro-inflammatory/anti-inflammatory cytokines between the two groups. The safety of medication will also be evaluated. All the data will be recorded in electronic case report forms and analyzed by SPSS V.22.0. ETHICS AND DISSEMINATION This study has been approved by the Research Ethics Committee of Guang'anmen Hospital, China Academy of Chinese Medical Sciences in Beijing, China (No. 2019-186-KY-01). The participants are volunteers, understand the process of this trial, and sign an informed consent. The results of this study will be disseminated to the public through peer-reviewed journals and academic conferences. DISCUSSION We hypothesize that patients with low-to-medium-risk hypertension will benefit from BSJY. If successful, this study will provide evidence-based recommendations for clinicians. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiMCTR1900002876. Registered in November 2019.
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Affiliation(s)
- Xiaochen Yang
- Department of Health Care, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
| | - Lanping Liu
- Department of Health Care, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xingjiang Xiong
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yun Zhang
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yongmei Liu
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Hongzheng Li
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Kuiwu Yao
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jie Wang
- Department of Health Care, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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14
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Denis D, Bottary R, Cunningham TJ, Zeng S, Daffre C, Oliver KL, Moore K, Gazecki S, Kram Mendelsohn A, Martinez U, Gannon K, Lasko NB, Pace-Schott EF. Sleep Power Spectral Density and Spindles in PTSD and Their Relationship to Symptom Severity. Front Psychiatry 2021; 12:766647. [PMID: 34867552 PMCID: PMC8640175 DOI: 10.3389/fpsyt.2021.766647] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 10/26/2021] [Indexed: 01/03/2023] Open
Abstract
Sleep disturbances are common in post-traumatic stress disorder (PTSD), although which sleep microarchitectural characteristics reliably classify those with and without PTSD remains equivocal. Here, we investigated sleep microarchitectural differences (i.e., spectral power, spindle activity) in trauma-exposed individuals that met (n = 45) or did not meet (n = 52) criteria for PTSD and how these differences relate to post-traumatic and related psychopathological symptoms. Using ecologically-relevant home sleep polysomnography recordings, we show that individuals with PTSD exhibit decreased beta spectral power during NREM sleep and increased fast sleep spindle peak frequencies. Contrary to prior reports, spectral power in the beta frequency range (20.31-29.88 Hz) was associated with reduced PTSD symptoms, reduced depression, anxiety and stress and greater subjective ability to regulate emotions. Increased fast frequency spindle activity was not associated with individual differences in psychopathology. Our findings may suggest an adaptive role for beta power during sleep in individuals exposed to a trauma, potentially conferring resilience. Further, we add to a growing body of evidence that spindle activity may be an important biomarker for studying PTSD pathophysiology.
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Affiliation(s)
- Dan Denis
- Department of Psychology, University of Notre Dame, Notre Dame, IN, United States
| | - Ryan Bottary
- Department of Psychology and Neuroscience, Boston College, Chestnut Hill, MA, United States
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, United States
| | - Tony J. Cunningham
- Department of Psychology and Neuroscience, Boston College, Chestnut Hill, MA, United States
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States
- Department of Psychiatry, Beth Israel Deaconess Medical School, Boston, MA, United States
| | - Shengzi Zeng
- Department of Psychology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Carolina Daffre
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, United States
- Department of Psychiatry, Harvard Medical School, Charlestown, MA, United States
| | - Kaitlyn L. Oliver
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, United States
- Department of Psychiatry, Harvard Medical School, Charlestown, MA, United States
| | - Kylie Moore
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, United States
- Department of Psychiatry, Harvard Medical School, Charlestown, MA, United States
| | - Samuel Gazecki
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, United States
- Department of Psychiatry, Harvard Medical School, Charlestown, MA, United States
| | - Augustus Kram Mendelsohn
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, United States
- Department of Psychiatry, Harvard Medical School, Charlestown, MA, United States
| | - Uriel Martinez
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, United States
- Department of Psychiatry, Harvard Medical School, Charlestown, MA, United States
| | - Karen Gannon
- Department of Neurology, Massachusetts General Hospital, Charlestown, MA, United States
| | - Natasha B. Lasko
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, United States
- Department of Psychiatry, Harvard Medical School, Charlestown, MA, United States
| | - Edward F. Pace-Schott
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, United States
- Department of Psychiatry, Harvard Medical School, Charlestown, MA, United States
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, United States
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15
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Cakmak AS, Alday EAP, Da Poian G, Rad AB, Metzler TJ, Neylan TC, House SL, Beaudoin FL, An X, Stevens JS, Zeng D, Linnstaedt SD, Jovanovic T, Germine LT, Bollen KA, Rauch SL, Lewandowski CA, Hendry PL, Sheikh S, Storrow AB, Musey PI, Haran JP, Jones CW, Punches BE, Swor RA, Gentile NT, McGrath ME, Seamon MJ, Mohiuddin K, Chang AM, Pearson C, Domeier RM, Bruce SE, O'Neil BJ, Rathlev NK, Sanchez LD, Pietrzak RH, Joormann J, Barch DM, Pizzagalli DA, Harte SE, Elliott JM, Kessler RC, Koenen KC, Ressler KJ, Mclean SA, Li Q, Clifford GD. Classification and Prediction of Post-Trauma Outcomes Related to PTSD Using Circadian Rhythm Changes Measured via Wrist-Worn Research Watch in a Large Longitudinal Cohort. IEEE J Biomed Health Inform 2021; 25:2866-2876. [PMID: 33481725 PMCID: PMC8395207 DOI: 10.1109/jbhi.2021.3053909] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Post-Traumatic Stress Disorder (PTSD) is a psychiatric condition resulting from threatening or horrifying events. We hypothesized that circadian rhythm changes, measured by a wrist-worn research watch are predictive of post-trauma outcomes. APPROACH 1618 post-trauma patients were enrolled after admission to emergency departments (ED). Three standardized questionnaires were administered at week eight to measure post-trauma outcomes related to PTSD, sleep disturbance, and pain interference with daily life. Pulse activity and movement data were captured from a research watch for eight weeks. Standard and novel movement and cardiovascular metrics that reflect circadian rhythms were derived using this data. These features were used to train different classifiers to predict the three outcomes derived from week-eight surveys. Clinical surveys administered at ED were also used as features in the baseline models. RESULTS The highest cross-validated performance of research watch-based features was achieved for classifying participants with pain interference by a logistic regression model, with an area under the receiver operating characteristic curve (AUC) of 0.70. The ED survey-based model achieved an AUC of 0.77, and the fusion of research watch and ED survey metrics improved the AUC to 0.79. SIGNIFICANCE This work represents the first attempt to predict and classify post-trauma symptoms from passive wearable data using machine learning approaches that leverage the circadian desynchrony in a potential PTSD population.
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16
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Bottary R, Seo J, Daffre C, Gazecki S, Moore KN, Kopotiyenko K, Dominguez JP, Gannon K, Lasko NB, Roth B, Milad MR, Pace-Schott EF. Fear extinction memory is negatively associated with REM sleep in insomnia disorder. Sleep 2021; 43:5717136. [PMID: 31993652 DOI: 10.1093/sleep/zsaa007] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 01/04/2020] [Indexed: 11/15/2022] Open
Abstract
STUDY OBJECTIVES Formation and maintenance of fear-extinction memories are disrupted in post-traumatic stress disorder (PTSD) and anxiety disorders. Sleep contributes to emotional memory consolidation and emotion regulation. Insomnia disorder (ID) is characterized by persistent sleep disturbance as well as rapid eye movement (REM) sleep abnormalities and often precedes or develops in parallel with PTSD and anxiety disorders. Here, we explore the impact of chronic poor sleep and sleep immediately following fear conditioning and extinction learning on preservation of extinction memories. METHODS Twenty-four ID age- and sex-matched to 24 healthy, good sleeper controls (GS) completed up to 2 weeks of habitual sleep monitoring with daily sleep-wake diaries and actigraphy, and then participated in a two-session fear conditioning, extinction learning and extinction recall procedure. Fear Conditioning and Extinction Learning occurred during session 1, followed by Extinction Recall approximately 24 hours later. Skin-conductance responses (SCR) and shock expectancies were recorded throughout all experimental phases to evaluate associative learning and memory. Overnight sleep between sessions 1 and 2 was recorded using ambulatory polysomnography. RESULTS ID showed greater physiological reactivity during Fear Conditioning. REM sleep physiology was associated with poorer extinction memory in ID but better extinction memory in GS. CONCLUSION REM sleep physiology may differentially support emotional memory retention and expression in ID and GS. In the former, REM may enhance retention of fear memories, while in the later, REM may enhance the expression of extinction memories.
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Affiliation(s)
- Ryan Bottary
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA
- Department of Psychology and Neuroscience, Boston College, Chestnut Hill, MA
| | - Jeehye Seo
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Carolina Daffre
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA
| | - Samuel Gazecki
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA
| | - Kylie N Moore
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA
- Center for Systems Neuroscience, Boston University, Boston, MA
| | | | - Jarrod P Dominguez
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA
| | - Karen Gannon
- Department of Neurology, Massachusetts General Hospital, Boston, MA
| | - Natasha B Lasko
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Brittainy Roth
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | | | - Edward F Pace-Schott
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
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17
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Bruck D, Atem Deng S, Kot B, Grossman M. Sleep difficulties among South Sudanese former refugees settled in Australia. Transcult Psychiatry 2021; 58:172-186. [PMID: 32216546 DOI: 10.1177/1363461520903122] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This quantitative study investigated self-reported sleep, mental health and trauma related nocturnal behaviours among South Sudanese Australians (SSA), examined sex differences in their responses, and sought to determine risk factors for insomnia in this population. Comparisons were also made to a general Australian (AUS) sample of 1,512 respondents, obtained in a previously published study using the same questions regarding sleep difficulties. Self-reports of sleep difficulties, psychological distress (Kessler Psychological Distress Scale, K10), and nocturnal post-traumatic stress symptoms (Pittsburgh Sleep Questionnaire Inventory-Addendum, PSQI-A) were obtained from 117 former refugees (aged 16-60 years) who had been resettled for a decade on average. A key finding was that SSA men (n = 62) reported many more problems compared to both SSA women and AUS men. These problems included high rates of clinical insomnia (32%), clinical-level nocturnal post-trauma symptoms (57%), restless legs (31%), daytime sleepiness (40%), fatigue (43%), and waking unrefreshed (55%). Nearly one in five SSA men had "very high psychological distress," a rate 10 times higher than that of men in Victoria and twice as high as SSA women. Analyses suggest that for many SSA men memories and dreams of past traumas may be affecting sleep health, with some improvement over time. It was concluded that men within the South Sudanese Australian community report hitherto unrecognised significant problems with their sleep. The findings are consistent with the interpretation that unresolved pre-migration trauma stress may be affecting the sleep of about half of the South Sudanese men in Australia.
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Affiliation(s)
- Dorothy Bruck
- College of Health and Biomedicine, 5399Victoria University
| | | | - Bichok Kot
- College of Arts and Education, 5399Victoria University
| | - Michele Grossman
- Alfred Deakin Institute for Citizenship and Globalisation, Deakin University
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18
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Powers MB, Pogue JR, Curcio NE, Patel S, Wierzchowski A, Thomas EV, Warren AM, Adams M, Turner E, Carl E, Froehlich-Grobe K, Sikka S, Foreman M, Leonard K, Douglas M, Bennett M, Driver S. Prolonged exposure therapy for PTSD among spinal cord injury survivors: Study protocol for a randomized controlled trial. Contemp Clin Trials Commun 2021; 22:100763. [PMID: 34013091 PMCID: PMC8113811 DOI: 10.1016/j.conctc.2021.100763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 01/28/2021] [Accepted: 03/26/2021] [Indexed: 10/28/2022] Open
Abstract
The National Spinal Cord Injury Statistical Center estimates 294,000 people in the US live with a spinal cord injury (SCI), with approximately 17,810 new cases each year. Although the physical outcomes associated with SCI have been widely studied, the psychological consequences of sustaining a SCI remain largely unexplored. Scant research has focused on posttraumatic stress disorder (PTSD) in this population, despite prevalence estimates suggesting that up to 60% of individuals with SCI experience PTSD post-injury, compared to only 7% of the general US population. Fortunately, prolonged exposure therapy (PE) is a well-researched and highly effective treatment for PTSD. However, no trauma focused exposure-based therapy for PTSD (e.g. PE) has not yet been tested in a SCI population. Thus, we aim to conduct the first test of an evidence-based intervention for PTSD among patients with SCI. Adults with SCI and PTSD (N = 60) will be randomly assigned to either: (1) 12-sessions of PE (2-3 sessions per week) or (2) a treatment as usual (TAU) control group who will receive the standard inpatient rehabilitation care for SCI patients. Primary outcomes will be assessed at 0, 6, 10, and 32 weeks.
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Affiliation(s)
- Mark B Powers
- Baylor University Medical Center, Dallas, TX, United States
| | - Jamie R Pogue
- Baylor University Medical Center, Dallas, TX, United States
| | | | - Sarita Patel
- Baylor University Medical Center, Dallas, TX, United States
| | | | | | | | - Maris Adams
- Baylor University Medical Center, Dallas, TX, United States
| | - Emma Turner
- Baylor University Medical Center, Dallas, TX, United States
| | - Emily Carl
- The University of Texas at Austin, Austin, TX, United States
| | | | - Seema Sikka
- Baylor Institute of Rehabilitation, Baylor Scott & White Health, Dallas, TX, United States
| | | | - Kiara Leonard
- Baylor University Medical Center, Dallas, TX, United States
| | - Megan Douglas
- Baylor Institute of Rehabilitation, Baylor Scott & White Health, Dallas, TX, United States
| | - Monica Bennett
- Baylor University Medical Center, Dallas, TX, United States
| | - Simon Driver
- Baylor Institute of Rehabilitation, Baylor Scott & White Health, Dallas, TX, United States
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19
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Sandahl H, Carlsson J, Sonne C, Mortensen EL, Jennum P, Baandrup L. Investigating the link between subjective sleep quality, symptoms of PTSD and level of functioning in a sample of trauma-affected refugees. Sleep 2021; 44:6168908. [PMID: 33710347 DOI: 10.1093/sleep/zsab063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 02/01/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES To examine whether baseline sleep quality is associated with baseline symptoms of posttraumatic stress disorder (PTSD) and level of functioning, and whether baseline sleep quality and improvement of sleep quality are specific predictors of change in PTSD symptoms and level of functioning. METHODS Data were derived from a four-armed randomised controlled superiority trial (N=219 trauma-affected refugees). All four groups received treatment as usual consisting of a 10-12 months bio-psycho-social treatment program with an additional differential treatment component added to each arm. We performed bivariate correlation analyses, multiple linear regression analyses and mediation analyses to examine associations between baseline sleep quality, change in sleep quality and treatment response for PTSD symptoms and level of functioning. RESULTS Baseline sleep quality correlated with symptoms of PTSD (r = .33) and level of functioning (r=0.15). Baseline sleep quality, improvement of sleep quality and improvement of general well-being were predictors of treatment response for symptoms of PTSD and level of functioning when controlling for age, gender, and baseline symptoms of PTSD and depression. CONCLUSIONS We found that good sleep quality at baseline and improvement of sleep quality were predictors of PTSD treatment response. However, treatment response was more closely associated with improvement in general well-being. The results indicate that the effect of improved sleep quality was partly mediated by a more general mental state improvement. Further research is needed to differentiate if a selected subgroup of patients may profit from sleep enhancing treatment.
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Affiliation(s)
- Hinuga Sandahl
- Competence Centre for Transcultural Psychiatry, Mental Health Center Ballerup, Mental Health Services in the Capital Region of Denmark, Ballerup, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jessica Carlsson
- Competence Centre for Transcultural Psychiatry, Mental Health Center Ballerup, Mental Health Services in the Capital Region of Denmark, Ballerup, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Sonne
- Competence Centre for Transcultural Psychiatry, Mental Health Center Ballerup, Mental Health Services in the Capital Region of Denmark, Ballerup, Denmark
| | - Erik Lykke Mortensen
- Department of Public Health and Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Poul Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet - Glostrup, Copenhagen University Hospital, Denmark
| | - Lone Baandrup
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Mental Health Center Copenhagen, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
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20
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Sandahl H, Jennum P, Baandrup L, Lykke Mortensen E, Carlsson J. Imagery rehearsal therapy and/or mianserin in treatment of refugees diagnosed with PTSD: Results from a randomized controlled trial. J Sleep Res 2021; 30:e13276. [PMID: 33529449 PMCID: PMC8365672 DOI: 10.1111/jsr.13276] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 12/23/2020] [Accepted: 12/23/2020] [Indexed: 11/30/2022]
Abstract
Sleep disturbances are frequently part of the symptomatology in refugees with post‐traumatic stress disorder (PTSD). It has been suggested that targeting sleep disturbances may enhance the outcome of PTSD treatment. However, randomized studies on the effect of treatment focusing on sleep disturbances in refugees with PTSD are lacking. The aim of this study was to examine add‐on treatment with imagery rehearsal therapy (IRT) and/or mianserin against treatment as usual (TAU) alone in a sample of trauma‐affected refugees with PTSD at 8–12 months follow‐up. In a randomized controlled trial, 219 adult refugees diagnosed with PTSD and suffering from sleep disturbances were randomized to four groups (1:1:1:1) receiving, respectively, TAU, TAU + mianserin, TAU + IRT, and TAU + IRT + mianserin. The primary outcome was subjective sleep quality (Pittsburgh Sleep Quality Index) and the secondary outcomes included PTSD and depression symptoms, level of functioning and subjective well‐being. The data were analysed using mixed models. The only significant effect of IRT was on level of functioning (p = .040, ES 0.44), whereas there was no significant effect of mianserin on any of the measured outcomes. Low adherence to both IRT (39%) and mianserin (20%) was observed. Contrary to our hypothesis, we did not find IRT or mianserin to be superior to TAU. The low adherence may potentially cause an underestimation of the effect of IRT and mianserin and indicates a necessity to further analyse the complex factors that may impact the motivation and ability of trauma‐affected refugees to participate in and profit from available treatment options.
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Affiliation(s)
- Hinuga Sandahl
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services in the Capital Region of Denmark, Ballerup, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Poul Jennum
- Danish Centre for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet - Glostrup, Copenhagen University Hospital, Glostrup, Denmark
| | - Lone Baandrup
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Mental Health Centre Copenhagen, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
| | - Erik Lykke Mortensen
- Department of Public Health and Centre for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Jessica Carlsson
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services in the Capital Region of Denmark, Ballerup, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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21
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Lancel M, van Marle HJF, Van Veen MM, van Schagen AM. Disturbed Sleep in PTSD: Thinking Beyond Nightmares. Front Psychiatry 2021; 12:767760. [PMID: 34899428 PMCID: PMC8654347 DOI: 10.3389/fpsyt.2021.767760] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/02/2021] [Indexed: 11/13/2022] Open
Abstract
Sleep disturbances frequently co-occur with posttraumatic stress disorder (PTSD). Insomnia and nightmares are viewed as core symptoms of PTSD. Yet, relations between disturbed sleep and PTSD are far more complex: PTSD is linked to a broad range of sleep disorders and disturbed sleep markedly affects PTSD-outcome. This article provides a concise overview of the literature on prevalent comorbid sleep disorders, their reciprocal relation with PTSD and possible underlying neurophysiological mechanisms. Furthermore, diagnostic procedures, standard interventions-particularly first choice non-pharmacological therapies-and practical problems that often arise in the assessment and treatment of sleep disturbances in PTSD are described. Finally, we will present some perspectives on future multidisciplinary clinical and experimental research to develop new, more effective sleep therapies to improve both sleep and PTSD.
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Affiliation(s)
- Marike Lancel
- Centre of Expertise on Sleep and Psychiatry, GGZ Drenthe Mental Health Institute, Assen, Netherlands.,Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands
| | - Hein J F van Marle
- Department of Psychiatry, Amsterdam Neuroscience, Vrije Universiteit, Amsterdam UMC, Amsterdam, Netherlands.,GGZ InGeest Specialized Mental Health Care, Amsterdam, Netherlands
| | - Maaike M Van Veen
- Centre of Expertise on Sleep and Psychiatry, GGZ Drenthe Mental Health Institute, Assen, Netherlands
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22
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Babakhanyan I, Jensen M, Remigio-Baker RA, Sargent P, Bailie JM. Use of a randomized clinical trial design to study cognitive rehabilitation approaches to enhance warfighter performance. Contemp Clin Trials Commun 2020; 20:100660. [PMID: 33094194 PMCID: PMC7568183 DOI: 10.1016/j.conctc.2020.100660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/11/2020] [Accepted: 09/16/2020] [Indexed: 11/09/2022] Open
Abstract
Within the military, cognitive readiness is essential to ensure the warfighter can return to highly demanding combat training and deployment operations. The warfighter must be able to make split second decisions and adapt to new tools and environments. After a traumatic brain injury, clinicians helping the warfighter must have techniques that address warfighter cognitive readiness. Current rehabilitation for cognitive complaints used in military medicine are modeled after civilian therapies which focus on remediating moderate to severe impairment through building compensatory strategies. This traditional approach to cognitive rehabilitation does not translate well to mild traumatic brain injury (mTBI) where impairments are subtle, nor does it meet the needs of our warfighters in deployed and combat training environments. Challenging our current methods is critical in adapting to the needs of this highly valued population to ensure that our warfighters are able to carry out mission critical decision making. Here we present a review of our best current practices for cognitive rehabilitation, describe the limitations our traditional approaches impose for mTBI in military personnel, and present an alternative treatment called Strategic Memory Advanced Reasoning Training (SMART) that can be adopted through a randomized clinical trial design. We propose directly comparing traditional treatment approaches with a novel cognitive rehabilitation strategy which has been well validated outside of the military setting. Procedures were developed to execute this clinical trial in a way that is most relevant to the study population by establishing ecologically valid outcome metrics.
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Affiliation(s)
- Ida Babakhanyan
- Defense and Veterans Brain Injury Center, Silver Spring, MD, USA
- Naval Hospital Camp Pendleton, Camp Pendleton, CA, USA
- General Dynamics Health Solutions, Fairfax, VA, USA
| | - Melissa Jensen
- Defense and Veterans Brain Injury Center, Silver Spring, MD, USA
- Naval Hospital Camp Pendleton, Camp Pendleton, CA, USA
- General Dynamics Health Solutions, Fairfax, VA, USA
| | - Rosemay A. Remigio-Baker
- Defense and Veterans Brain Injury Center, Silver Spring, MD, USA
- Naval Hospital Camp Pendleton, Camp Pendleton, CA, USA
- Henry M. Jackson Foundation, Bethesda, MD, USA
| | - Paul Sargent
- Naval Hospital Camp Pendleton, Camp Pendleton, CA, USA
| | - Jason M. Bailie
- Defense and Veterans Brain Injury Center, Silver Spring, MD, USA
- Naval Hospital Camp Pendleton, Camp Pendleton, CA, USA
- General Dynamics Health Solutions, Fairfax, VA, USA
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23
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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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24
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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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25
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Clifford RE, Baker D, Risbrough VB, Huang M, Yurgil KA. Impact of TBI, PTSD, and Hearing Loss on Tinnitus Progression in a US Marine Cohort. Mil Med 2020; 184:839-846. [PMID: 30793178 DOI: 10.1093/milmed/usz016] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 12/18/2018] [Accepted: 01/14/2019] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Mild TBI (TBI) is associated with up to a 75.7% incidence of tinnitus, and 33.0% of tinnitus patients at the US Veterans Administration carry a diagnosis of post-traumatic stress syndrome (PTSD). Yet factors contributing to new onset or exacerbation of tinnitus remain unclear. MATERIALS AND METHODS Here we measure intermittent and constant tinnitus at two time points to ascertain whether pre-existing or co-occurring traumatic brain injury (TBI), hearing loss, or post-traumatic stress disorder (PTSD) predicts new onset, lack of recovery and/or worsening of tinnitus in 2,600 United States Marines who were assessed before and after a combat deployment. RESULTS Ordinal regression revealed that constant tinnitus before deployment was likely to continue after deployment (odds ratio [OR] = 28.62, 95% confidence interval [CI]: 9.84,83.26). Prior intermittent tinnitus increased risk of post-deployment constant tinnitus (OR = 4.95, CI: 2.97,8.27). Likelihood of tinnitus progression increased with partial PTSD (OR = 2.39, CI: 1.50,3.80) and TBI (OR = 1.59, CI: 1.13,2.23), particularly for blast TBI (OR = 2.01, CI: 1.27,3.12) and moderate to severe TBI (OR = 2.57, CI: 1.46,4.51). Tinnitus progression also increased with low frequency hearing loss (OR = 1.94, CI: 1.05,3.59), high frequency loss (OR = 3.01, CI: 1.91,4.76) and loss across both low and high frequency ranges (OR = 5.73, CI: 2.67,12.30). CONCLUSIONS Screening for pre-existing or individual symptoms of PTSD, TBI, and hearing loss may allow for more focused treatment programs of comorbid disorders. Identification of those personnel vulnerable to tinnitus or its progression may direct increased acoustic protection for those at risk.
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Affiliation(s)
- Royce E Clifford
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA.,Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Drive, San Diego, CA.,Harvard University School of Public Health, 677 Huntington Ave, Boston, MA
| | - Dewleen Baker
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA.,Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Drive, San Diego, CA.,Department of Psychiatry, University of California San Diego School of Medicine, 9500 Gilman Dr, La Jolla, CA
| | - Victoria B Risbrough
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA.,Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Drive, San Diego, CA.,Department of Psychiatry, University of California San Diego School of Medicine, 9500 Gilman Dr, La Jolla, CA
| | - Mingxiong Huang
- Department of Radiology, University of California San Diego School of Medicine, 9500 Gilman Dr, La Jolla, CA
| | - Kate A Yurgil
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA.,Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Drive, San Diego, CA.,Department of Psychological Sciences, Loyola University New Orleans, 6363 St. Charles Ave., Box 194, New Orleans, LA
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26
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Stout JW, Beidel DC, Brush D, Bowers C. Sleep disturbance and cognitive functioning among firefighters. J Health Psychol 2020; 26:2248-2259. [PMID: 32126834 DOI: 10.1177/1359105320909861] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Firefighters are at risk for chronic sleep disruption due to their rotating 24-hour on and 48-hour off work schedule and hazardous work conditions. Forty-five firefighters were assessed to determine the impact of their shift schedule on sleep duration, sleep quality, processing speed, sustained attention, vigilance, and mental health. Assessments were conducted at the start and end of shift. Firefighters endorsed sleeping 5 hours 21 minutes at work, and the results suggest that even minimal sleep disruption affected cognitive functioning (e.g. processing speed, visual-motor coordination, and reaction time), increasing the likelihood of poor work performance or injury.
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27
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Shi H, Yang D, Qiao J, Sun R, Li R, Zhu C, Jing R, Liu L, Huang L, Li L. Effects of sang-qi granules on blood pressure and endothelial dysfunction in stage I or II hypertension: study protocol for a randomized double-blind double-simulation controlled trial. Trials 2020; 21:12. [PMID: 31907056 PMCID: PMC6945446 DOI: 10.1186/s13063-019-3690-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 08/30/2019] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND Worldwide, hypertension is an important public health challenge because of its high prevalence and the concomitant risks of cardiovascular disease. It induces half of the coronary heart disease and approximately two-thirds of the cerebrovascular disease burden. Vascular endothelial dysfunction has important roles in the pathophysiology of essential hypertension. Types I and II hypertension can be treated with sang-qi granules (SQG), a Chinese herbal formula. Several experimental studies on animals have shown that SQG can lower blood pressure and myocardial fibrosis by suppressing inflammatory responses. However, no standard clinical trial has confirmed this. Whether SQG can improve endothelial cell function is unknown. METHODS/DESIGN In this randomized double-blind double-simulation controlled trial, 300 patients with stage I or II hypertension will be recruited and randomly allocated in a 1:1:1 ratio to group A (treatment with SQG and placebo instead of Losartan), group B (treatment with Losartan and placebo instead of SQG), and group C (treatment with SQG and Losartan). In this study, 10 g of SQG (or its placebo) will be administrated twice a day and 50 mg of Losartan (or its placebo) will be administrated once in the morning. The primary endpoint is the drug efficiency for each of the three groups. The secondary endpoints are the change in average systolic and diastolic blood pressure during the day and the night, the change in the rate at which blood pressure drops at night, assessment of target organ damage (heart rate variability, ankle-brachial pressure index, and pulse wave velocity), assessment of any improvement in symptoms (Hypertension Symptom Scale, syndrome integral scale in traditional Chinese medicine, Pittsburgh Sleep Quality Index Scale, Self-Rating Anxiety Scale, Self-Rating Depression Scale, and the 36-Item Short Form Health Survey), blood lipids, serum indicators of vascular function (changes in serum levels of ET-1, TXA2, NO, and PGI2), and safety indicators. DISCUSSION This study aims to provide clinical evidence on the efficacy and safety of SQG in the treatment of hypertension. Moreover, the possible mechanism by which SQG may lower blood pressure will be explored by observing the protective effect of SQG on vascular endothelial function, as well as its effect on related clinical symptoms, risk factors, and the target organs of hypertension. TRIAL REGISTRATION Chinese Clinical Trials Registry, ChiCTR1800016427. Registered on 1 June 2018.
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Affiliation(s)
- Haoyue Shi
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Dong Cheng District, Beijing, 100010, China
| | - Deshuang Yang
- Graduate School, Beijing University of Chinese Medicine, Chao Yang District, Beijing, 100029, China
| | - Jiajun Qiao
- Graduate School, Beijing University of Chinese Medicine, Chao Yang District, Beijing, 100029, China
| | - Rui Sun
- Graduate School, Beijing University of Chinese Medicine, Chao Yang District, Beijing, 100029, China
| | - Ruihan Li
- Graduate School, Beijing University of Chinese Medicine, Chao Yang District, Beijing, 100029, China
| | - Chunlin Zhu
- Graduate School, Beijing University of Chinese Medicine, Chao Yang District, Beijing, 100029, China
| | - Ruiqing Jing
- Graduate School, Beijing University of Chinese Medicine, Chao Yang District, Beijing, 100029, China
| | - Liping Liu
- Department of Integrative Cardiology,, China-Japan Friendship Hospital,, Chao Yang District, Beijing, 100029, China
| | - Li Huang
- Department of Integrative Cardiology,, China-Japan Friendship Hospital,, Chao Yang District, Beijing, 100029, China.
| | - Lin Li
- Department of Integrative Cardiology,, China-Japan Friendship Hospital,, Chao Yang District, Beijing, 100029, China.
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28
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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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29
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Ulmer CS, Hall MH, Dennis PA, Beckham JC, Germain A. Posttraumatic stress disorder diagnosis is associated with reduced parasympathetic activity during sleep in US veterans and military service members of the Iraq and Afghanistan wars. Sleep 2019; 41:5086077. [PMID: 30169878 DOI: 10.1093/sleep/zsy174] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Indexed: 11/14/2022] Open
Abstract
Study Objectives To determine whether high-frequency heart rate variability (HF-HRV) during sleep differs between those with and without posttraumatic stress disorder (PTSD) as a function of sleep type (non-rapid eye movement [NREM] vs. rapid eye movement [REM]), and to explore this relationship across successive sleep cycles. Participants with PTSD were hypothesized to have lower HF-HRV across both REM and NREM sleep. Methods Sixty-two post-9/11 military veterans and service members completed self-report measures of sleep quality, insomnia severity, and disruptive nocturnal behaviors. Participants then completed a laboratory-based polysomnographic study night with concurrent HRV assessment. Results Participants with PTSD (N = 29) had lower HF-HRV in overall NREM sleep relative to those without PTSD (N = 33) (F(1, 54) = 4.24, p = .04). Groups did not differ on overall HF-HRV during REM sleep. HF-HRV increased over the night for the sample as a whole during both NREM and REM sleep. PTSD status did not moderate the association between HF-HRV and sleep cycles. However, the PTSD group had lower HF-HRV in the first t(155) = 2.67, p = .008, and fourth NREM cycles, t(155) = 2.11, p = .036, relative to participants without PTSD. Conclusions Findings suggest blunted parasympathetic modulation during NREM sleep in a young cohort of military veterans and service-members with PTSD. Findings are concerning considering the increased risk of incident cardiovascular events associated with impaired parasympathetic nervous system function. Reduced parasympathetic modulation may be one mechanism underlying the increased prevalence of cardiovascular disease (CVD) among veterans with PTSD.
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Affiliation(s)
- Christi S Ulmer
- Health Services Research & Development, Durham Veterans Affairs Healthcare System, Durham, NC.,Department of Psychiatry and Brain Sciences, Duke University, Durham, NC
| | - Martica H Hall
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | - Paul A Dennis
- Department of Psychiatry and Brain Sciences, Duke University, Durham, NC.,Research & Development, Durham Veterans Affairs Healthcare System, Durham, NC
| | - Jean C Beckham
- Department of Psychiatry and Brain Sciences, Duke University, Durham, NC
| | - Anne Germain
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
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30
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Ferrarelli F, Kaskie R, Laxminarayan S, Ramakrishnan S, Reifman J, Germain A. An increase in sleep slow waves predicts better working memory performance in healthy individuals. Neuroimage 2019; 191:1-9. [DOI: 10.1016/j.neuroimage.2019.02.020] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 01/14/2019] [Accepted: 02/07/2019] [Indexed: 11/16/2022] Open
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31
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Dedert EA, Dennis PA, Cunningham KC, Ulmer CS, Calhoun PS, Kimbrel N, Hicks TA, Neal JM, Beckham JC. Roles of Guilt Cognitions in Trauma-Related Sleep Disturbance in Military Veterans With Posttraumatic Stress Disorder. Behav Sleep Med 2019; 17:595-604. [PMID: 29482385 PMCID: PMC6109613 DOI: 10.1080/15402002.2018.1435544] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Objective/Background: Despite a well-established role of guilt cognitions in the maintenance and treatment of posttraumatic stress disorder (PTSD), relationships of guilt cognitions to nightmares are not well understood. This study investigated the ways in which guilt cognitions, related to traumatic events, influenced the relationship between combat exposure and trauma-related sleep disturbance in military Veterans with PTSD. Participants: We recruited a sample of 50 Veterans with PTSD who completed study measures at a screening session. Methods: Participants completed self-report measures of exposure to potentially traumatic events, trauma-related guilt (hindsight bias, wrongdoing, and lack of justification) and trauma-related sleep disturbance as measured by a self-report scale and clinician ratings of nightmare severity. Results: Bivariate regression analyses established a relationship of combat exposure to wrongdoing (β = .31, p = .031), and a relationship of wrongdoing with self-reported trauma-related sleep disturbance (β = .27, p = .049) and clinician-rated nightmare severity (β = .36, p = .009). Bootstrapping analysis that included years of education as a covariate found a significant overall indirect effect of combat exposure on clinician-rated nightmare severity exerted through wrongdoing (β = .10, 95% CI [.004, .246]). Conclusions: Results suggest the association of combat exposure with trauma-related sleep disturbance is significantly influenced by perceived wrongdoing related to a traumatic event. Targeting cognitions related to wrongdoing and moral injury during a traumatic event in PTSD treatment may help ameliorate trauma-related sleep disturbance.
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Affiliation(s)
- Eric A. Dedert
- Durham VA Medical Center, Durham, NC, United States,Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, Durham, NC, United States,VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC, United States,Correspondence concerning this article should be addressed to Eric Dedert, Durham VA Health Care System, 3022 Croasdaile Drive, Durham, NC 27705. Phone: (919) 384-8582, ext. 4055. Fax: (919) 681-7347,
| | - Paul A. Dennis
- Durham VA Medical Center, Durham, NC, United States,Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, Durham, NC, United States
| | - Katherine C. Cunningham
- Durham VA Medical Center, Durham, NC, United States,VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC, United States
| | - Christi S. Ulmer
- Durham VA Medical Center, Durham, NC, United States,Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, Durham, NC, United States
| | - Patrick S. Calhoun
- Durham VA Medical Center, Durham, NC, United States,Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, Durham, NC, United States,VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC, United States
| | - Nathan Kimbrel
- Durham VA Medical Center, Durham, NC, United States,Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, Durham, NC, United States,VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC, United States
| | - Terrell A. Hicks
- Virginia Commonwealth University, Virginia Institute of Psychiatric and Behavioral Genetics, Department of Psychiatry, Richmond, VA, United States
| | | | - Jean C. Beckham
- Durham VA Medical Center, Durham, NC, United States,Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, Durham, NC, United States,VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC, United States
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Pulantara IW, Parmanto B, Germain A. Clinical Feasibility of a Just-in-Time Adaptive Intervention App (iREST) as a Behavioral Sleep Treatment in a Military Population: Feasibility Comparative Effectiveness Study. J Med Internet Res 2018; 20:e10124. [PMID: 30530452 PMCID: PMC6303679 DOI: 10.2196/10124] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 08/22/2018] [Accepted: 09/10/2018] [Indexed: 01/23/2023] Open
Abstract
Background Although evidence-based cognitive behavioral sleep treatments have been shown to be safe and effective, these treatments have limited scalability. Mobile health tools can address this scalability challenge. iREST, or interactive Resilience Enhancing Sleep Tactics, is a mobile health platform designed to provide a just-in-time adaptive intervention (JITAI) in the assessment, monitoring, and delivery of evidence-based sleep recommendations in a scalable and personalized manner. The platform includes a mobile phone–based patient app linked to a clinician portal. Objective The first aim of the pilot study was to evaluate the effectiveness of JITAI using the iREST platform for delivering evidence-based sleep interventions in a sample of military service members and veterans. The second aim was to explore the potential effectiveness of this treatment delivery form relative to habitual in-person delivery. Methods In this pilot study, military service members and veterans between the ages of 18 and 60 years who reported clinically significant service-related sleep disturbances were enrolled as participants. Participants were asked to use iREST for a period of 4 to 6 weeks during which time they completed a daily sleep/wake diary. Through the clinician portal, trained clinicians offered recommendations consistent with evidence-based behavioral sleep treatments on weeks 2 through 4. To explore potential effectiveness, self-report measures were used, including the Insomnia Severity Index (ISI), the Pittsburgh Sleep Quality Index (PSQI), and the PSQI Addendum for Posttraumatic Stress Disorder. Results A total of 27 participants completed the posttreatment assessments. Between pre- and postintervention, clinically and statistically significant improvements in primary and secondary outcomes were detected (eg, a mean reduction on the ISI of 9.96, t26=9.99, P<.001). At posttreatment, 70% (19/27) of participants met the criteria for treatment response and 59% (16/27) achieved remission. Comparing these response and remission rates with previously published results for in-person trials showed no significant differences. Conclusion Participants who received evidence-based recommendations from their assigned clinicians through the iREST platform showed clinically significant improvements in insomnia severity, overall sleep quality, and disruptive nocturnal disturbances. These findings are promising, and a larger noninferiority clinical trial is warranted.
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Affiliation(s)
- I Wayan Pulantara
- Health and Rehabilitation Informatics Laboratory, Department of Health Information Management, University of Pittsburgh, Pittsburgh, PA, United States
| | - Bambang Parmanto
- Health and Rehabilitation Informatics Laboratory, Department of Health Information Management, University of Pittsburgh, Pittsburgh, PA, United States
| | - Anne Germain
- Sleep and Behavioral Neuroscience Center, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
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Sleep assessment in a randomized trial of hyperbaric oxygen in U.S. service members with post concussive mild traumatic brain injury compared to normal controls. Sleep Med 2018; 51:66-79. [DOI: 10.1016/j.sleep.2018.06.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 06/06/2018] [Accepted: 06/18/2018] [Indexed: 12/20/2022]
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Kanady JC, Talbot LS, Maguen S, Straus LD, Richards A, Ruoff L, Metzler TJ, Neylan TC. Cognitive Behavioral Therapy for Insomnia Reduces Fear of Sleep in Individuals With Posttraumatic Stress Disorder. J Clin Sleep Med 2018; 14:1193-1203. [PMID: 29991428 DOI: 10.5664/jcsm.7224] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 04/12/2018] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Our study aims were to examine (1) the association between fear of sleep and posttraumatic stress disorder (PTSD) symptoms, (2) the association between fear of sleep and subjective and objective insomnia symptoms and disruptive behaviors during sleep, and (3) whether fear of sleep decreases following cognitive behavioral therapy for insomnia (CBT-I). METHODS Forty-five adults with PTSD and insomnia participated in the study. Fear of sleep was assessed using the Fear of Sleep Inventory; PTSD symptoms were assessed using the Clinician Administered PTSD Scale; and sleep disturbance symptoms were assessed using the Insomnia Severity Index, polysomnography, sleep diaries, and the Pittsburgh Sleep Quality Index Addendum for PTSD. Participants were randomly assigned to 8 weeks of CBT-I (n = 29) or a waitlist control condition (n = 16). RESULTS Greater fear of sleep was associated with greater PTSD symptom severity, greater nightmare frequency, and greater hypervigilance intensity. Greater fear of sleep was associated with decreased wake after sleep onset (WASO), reduced total sleep time, and greater disruptive nocturnal behaviors. Following CBT-I, there was a significant reduction in fear of sleep compared to the waitlist condition. These improvements persisted 6 months later. CONCLUSIONS Fear of sleep was related to sleep disturbances specific to trauma rather than "classic" insomnia symptoms. Unexpectedly, greater fear of sleep was associated with reduced WASO. These results may be related to having a truncated sleep period and thus more consolidated sleep. Fear of sleep deceased following CBT-I despite not being a permissible target for this research protocol and not being related to insomnia symptoms. CLINICAL TRIAL REGISTRATION Registry: CinicalTrials.gov; Name: Treating People with Post-traumatic Stress Disorder with Cognitive Behavioral Therapy for Insomnia; Identifier: NCT00881647; URL: https://clinicaltrials.gov/ct2/show/NCT00881647.
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Affiliation(s)
- Jennifer C Kanady
- San Francisco VA Health Care System, San Francisco, California.,Department of Psychiatry, University of California, San Francisco, California.,Mental Illness, Research, Education, and Clinical Center, San Francisco, California
| | - Lisa S Talbot
- San Francisco VA Health Care System, San Francisco, California.,Department of Psychiatry, University of California, San Francisco, California
| | - Shira Maguen
- San Francisco VA Health Care System, San Francisco, California.,Department of Psychiatry, University of California, San Francisco, California
| | - Laura D Straus
- San Francisco VA Health Care System, San Francisco, California.,Department of Psychiatry, University of California, San Francisco, California.,Mental Illness, Research, Education, and Clinical Center, San Francisco, California
| | - Anne Richards
- San Francisco VA Health Care System, San Francisco, California.,Department of Psychiatry, University of California, San Francisco, California
| | - Leslie Ruoff
- San Francisco VA Health Care System, San Francisco, California
| | | | - Thomas C Neylan
- San Francisco VA Health Care System, San Francisco, California.,Department of Psychiatry, University of California, San Francisco, California
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DeGutis J, Chiu C, Thai M, Esterman M, Milberg W, McGlinchey R. Trauma Sequelae are Uniquely Associated with Components of Self-Reported Sleep Dysfunction in OEF/OIF/OND Veterans. Behav Sleep Med 2018; 16:38-63. [PMID: 27183394 DOI: 10.1080/15402002.2016.1173550] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
While the associations between psychological distress (e.g., posttraumatic stress disorder [PTSD], depression) and sleep dysfunction have been demonstrated in trauma-exposed populations, studies have not fully explored the associations between sleep dysfunction and the wide range of common physical and physiological changes that can occur after trauma exposure (e.g., pain, cardiometabolic risk factors). We aimed to clarify the unique associations of psychological and physical trauma sequelae with different aspects of self-reported sleep dysfunction. A comprehensive psychological and physical examination was administered to 283 combat-deployed trauma-exposed Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) veterans. The Pittsburgh Sleep Quality Index (PSQI) and PSQI Addendum for PSTD (PSQI-A) were administered along with measures of PTSD, depression, anxiety, pain, traumatic brain injury, alcohol use, nicotine dependence, and cardiometabolic symptoms. We first performed a confirmatory factor analysis of the PSQI and then conducted regressions with the separate PSQI factors as well as the PSQI-A to identify unique associations between trauma-related measures and the separate aspects of sleep. We found that the PSQI global score was composed of three factors: Sleep Efficiency (sleep efficiency/sleep duration), Perceived Sleep Quality (sleep quality/sleep latency/sleep medication) and Daily Disturbances (sleep disturbances/daytime dysfunction). Linear regressions demonstrated that PTSD symptoms were uniquely associated with the PSQI global score and all three factors, as well as the PSQI-A. For the other psychological distress variables, anxiety was independently associated with PSQI global as well as Sleep Efficiency, Perceived Sleep Quality, and PSQI-A, whereas depression was uniquely associated with Daily Disturbances and PSQI-A. Notably, cardiometabolic symptoms explained independent variance in PSQI global and Sleep Efficiency. These findings help lay the groundwork for further investigations of the mechanisms of sleep dysfunction in trauma-exposed individuals and may help in the development of more effective, individualized treatments.
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Affiliation(s)
- Joseph DeGutis
- a Boston Attention and Learning Laboratory , Boston Division VA Healthcare System , Boston , Massachusetts , USA.,b Geriatric Research Education and Clinical Center , Boston Division VA Healthcare System , Boston , Massachusetts , USA.,c Department of Medicine , Harvard Medical School , Boston , Massachusetts , USA
| | - Christopher Chiu
- a Boston Attention and Learning Laboratory , Boston Division VA Healthcare System , Boston , Massachusetts , USA.,b Geriatric Research Education and Clinical Center , Boston Division VA Healthcare System , Boston , Massachusetts , USA
| | - Michelle Thai
- a Boston Attention and Learning Laboratory , Boston Division VA Healthcare System , Boston , Massachusetts , USA.,b Geriatric Research Education and Clinical Center , Boston Division VA Healthcare System , Boston , Massachusetts , USA
| | - Michael Esterman
- a Boston Attention and Learning Laboratory , Boston Division VA Healthcare System , Boston , Massachusetts , USA.,b Geriatric Research Education and Clinical Center , Boston Division VA Healthcare System , Boston , Massachusetts , USA.,d Department of Psychiatry , Boston University School of Medicine , Boston , Massachusetts , USA
| | - William Milberg
- b Geriatric Research Education and Clinical Center , Boston Division VA Healthcare System , Boston , Massachusetts , USA.,e Translational Research Center for TBI and Stress Disorders (TRACTS) , VA RR&D TBI Center of Excellence, VA Boston Healthcare System , Boston , Massachusetts , USA
| | - Regina McGlinchey
- b Geriatric Research Education and Clinical Center , Boston Division VA Healthcare System , Boston , Massachusetts , USA.,e Translational Research Center for TBI and Stress Disorders (TRACTS) , VA RR&D TBI Center of Excellence, VA Boston Healthcare System , Boston , Massachusetts , USA
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36
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Denis D, French CC, Schneider MN, Gregory AM. Subjective sleep-related variables in those who have and have not experienced sleep paralysis. J Sleep Res 2017; 27:e12650. [DOI: 10.1111/jsr.12650] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 11/13/2017] [Indexed: 02/02/2023]
Affiliation(s)
- Dan Denis
- Department of Psychiatry; Beth Israel Deaconess Medical Center; Harvard Medical School; Boston MA USA
| | | | | | - Alice M. Gregory
- Department of Psychology, Goldsmiths; University of London; London UK
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Sleep Disturbances Among Combat Military Veterans: A Comparative Study Using Subjective and Objective Sleep Assessments. MILITARY PSYCHOLOGY 2017. [DOI: 10.1037/mil0000161] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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38
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Denis D, Eley TC, Rijsdijk F, Zavos HMS, Keers R, Espie CA, Luik AI, Badini I, Derveeuw S, Romero A, Hodsoll J, Gregory AM. Sleep Treatment Outcome Predictors (STOP) Pilot Study: a protocol for a randomised controlled trial examining predictors of change of insomnia symptoms and associated traits following cognitive-behavioural therapy for insomnia in an unselected sample. BMJ Open 2017; 7:e017177. [PMID: 29196479 PMCID: PMC5719290 DOI: 10.1136/bmjopen-2017-017177] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Cognitive-behavioural therapy for insomnia (CBT-I) leads to insomnia symptom improvements in a substantial proportion of patients. However, not everyone responds well to this treatment, and it is unclear what determines individual differences in response. The broader aim of this work is to examine to what extent response to CBT-I is due to genetic and environmental factors. The purpose of this pilot study is to examine feasibility of a design to test hypotheses focusing on an unselected sample, that is, without selection on insomnia complaints, in order to plan a larger behavioural genetics study where most participants will likely not have an insomnia disorder. METHODS AND ANALYSIS A two parallel-group randomised controlled trial is being conducted across three London universities. Female students (minimum age 18 years) enrolled on a psychology programme at one of the three sites were invited to participate. The target number of participants to be recruited is 240. Following baseline assessments, participants were randomly allocated to either the treatment group, where they received weekly sessions of digital CBT-I for 6 weeks, or the control group, where they completed an online puzzle each week for 6 weeks. Follow-up assessments have taken place mid-intervention (3 weeks) and end of intervention (6 weeks). A 6-month follow-up assessment will also occur. Primary outcomes will be assessed using descriptive statistics and effect size estimates for intervention effects. Secondary outcomes will be analysed using multivariate generalised estimating equation models. ETHICS AND DISSEMINATION The study received ethical approval from the Research Ethics and Integrity subcommittee, Goldsmiths, University of London (application reference: EA 1305). DNA sample collection for the BioResource received ethical approval from the NRES Committee South Central-Oxford (reference number: 15/SC/0388). The results of this work shall be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03062891; Results.
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Affiliation(s)
- Dan Denis
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- MRC Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Thalia C Eley
- MRC Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Fruhling Rijsdijk
- MRC Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Helena M S Zavos
- MRC Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Robert Keers
- School of Biological and Chemical Sciences, Queen Mary University of London, London, UK
| | - Colin A Espie
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Big Health Ltd, London, UK
| | - Annemarie I Luik
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Big Health Ltd, London, UK
| | - Isabella Badini
- Department of Psychology, Goldsmiths, University of London, London, UK
| | - Sarah Derveeuw
- MRC Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Alvin Romero
- SLaM BioResource for Mental Health, South London and Maudsley NHS Foundation Trust, King's College London, London, UK
| | - John Hodsoll
- Department of Biostatistics, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Alice M Gregory
- Department of Psychology, Goldsmiths, University of London, London, UK
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Sandahl H, Jennum P, Baandrup L, Poschmann IS, Carlsson J. Treatment of sleep disturbances in trauma-affected refugees: Study protocol for a randomised controlled trial. Trials 2017; 18:520. [PMID: 29110681 PMCID: PMC5674222 DOI: 10.1186/s13063-017-2260-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 10/13/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Sleep disturbances are often referred to as a hallmark and as core symptoms of post-traumatic stress disorder (PTSD). Untreated sleep disturbances can contribute to the maintenance and exacerbation of PTSD symptoms, which may diminish treatment response and constitute a risk factor for poor treatment outcome. Controlled trials on treatment of sleep disturbances in refugees suffering from PTSD are scarce. The present study aims to examine sleep-enhancing treatment in refugees with PTSD. We aim to assess if add-on treatment with mianserin and/or Imagery Rehearsal Therapy (IRT) to treatment as usual (TAU) for PTSD improves sleep disturbances. We will study the relation between sleep disturbances, PTSD symptoms, psychosocial functioning and quality of life. METHODS The study is a randomised controlled superiority trial with a 2 × 2 factorial design. The study will include 230 trauma-affected refugees. The patients are randomised into four groups. All four groups receive TAU - an interdisciplinary treatment approach covering a period of 6-8 months with pharmacological treatment, physiotherapy, psychoeducation and manual-based cognitive behavioural therapy within a framework of weekly sessions with a physician, physiotherapist or psychologist. One group receives solely TAU, serving as a control group, while the three remaining groups are active-treatment groups receiving add-on treatment with either mianserin, IRT or a combination of both. Treatment outcome is evaluated using self-administered rating scales, observer ratings and actigraph measurements at baseline, during treatment and post treatment. The primary outcome is subjective sleep quality using the Pittsburgh Sleep Quality Index. Secondary outcome measures are objective sleep length, nightmares, PTSD severity, symptoms of depression and anxiety, pain, quality of life and psychosocial functioning. DISCUSSION This trial will be the first randomised controlled trial to examine sleep-enhancing treatment in trauma-affected refugees, as well as the first trial to investigate the effect of IRT and mianserin in this population. Therefore, this trial may optimise treatment recommendations for sleep disturbances in trauma-affected refugees. Based on our findings, we expect to discuss the effect of treatment, focussing on sleep disturbances. Furthermore, the results will provide new information regarding the association between sleep disturbances, PTSD symptoms, psychosocial functioning and quality of life in trauma-affected refugees. TRIAL REGISTRATION EudraCT registration under the name 'Treatment of sleep disturbances in trauma-affected refugees - a randomised controlled trial', registration number: 2015-004153-40 , registered on 13 November 2015. ClinicalTrials.gov, ID: NCT02761161. Registered on 27 April 2016.
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Affiliation(s)
- Hinuga Sandahl
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region of Denmark, Ballerup, Denmark
| | - Poul Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet – Glostrup, Copenhagen University Hospital, Nordre Ringvej 57, 2600 Glostrup, Denmark
| | - Lone Baandrup
- Mental Health Centre Ballerup, Mental Health Services of the Capital Region of Denmark, Ballerup, Denmark
| | - Ida Sophie Poschmann
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region of Denmark, Ballerup, Denmark
| | - Jessica Carlsson
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region of Denmark, Ballerup, Denmark
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Cox RC, Tuck BM, Olatunji BO. Sleep Disturbance in Posttraumatic Stress Disorder: Epiphenomenon or Causal Factor? Curr Psychiatry Rep 2017; 19:22. [PMID: 28321643 DOI: 10.1007/s11920-017-0773-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE OF REVIEW The goal of this review is to integrate recent findings on sleep disturbance and PTSD, examine sleep disturbance as a causal factor in the development of PTSD, and identify future directions for research, treatment, and prevention. RECENT FINDINGS Recent research highlights a relationship between both objective and subjective sleep disturbance and PTSD across diverse samples. Sleep disturbance also predicts PTSD over time. Finally, treatments targeting sleep disturbance lead to decreased PTSD symptoms, while standard PTSD treatments conclude with residual sleep disturbance. Sleep disturbance may be more than a mere epiphenomenon of PTSD. Future research examining the causal role of sleep disturbance in the development of PTSD, as well as the utility of targeting sleep disturbance in prevention and treatment, is necessary to fully understand the likely bidirectional relationship between sleep disturbance and PTSD.
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Affiliation(s)
- Rebecca C Cox
- Department of Psychology, Vanderbilt University, 301 Wilson Hall, 111 21st Avenue South, Nashville, TN, 37240, USA
| | - Breanna M Tuck
- Department of Psychology, Vanderbilt University, 301 Wilson Hall, 111 21st Avenue South, Nashville, TN, 37240, USA
| | - Bunmi O Olatunji
- Department of Psychology, Vanderbilt University, 301 Wilson Hall, 111 21st Avenue South, Nashville, TN, 37240, USA.
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Stocker RPJ, Paul BTE, Mammen O, Khan H, Cieply MA, Germain A. Effects of Blast Exposure on Subjective and Objective Sleep Measures in Combat Veterans with and without PTSD. J Clin Sleep Med 2017; 12:49-56. [PMID: 26414975 DOI: 10.5664/jcsm.5392] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 07/20/2015] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES This study examined the extent to which self-reported exposure to blast during deployment to Iraq and Afghanistan affects subjective and objective sleep measures in service members and veterans with and without posttraumatic stress disorder (PTSD). METHODS Seventy-one medication-free service members and veterans (mean age = 29.47 ± 5.76 years old; 85% men) completed self-report sleep measures and overnight polysomnographic studies. Four multivariate analyses of variance (MANOVAs) were conducted to examine the impact of blast exposure and PTSD on subjective sleep measures, measures of sleep continuity, non-rapid eye movement (NREM) sleep parameters, and rapid eye movement (REM) sleep parameters. RESULTS There was no significant Blast × PTSD interaction on subjective sleep measures. Rather, PTSD had a main effect on insomnia severity, sleep quality, and disruptive nocturnal behaviors. There was no significant Blast × PTSD interaction, nor were there main effects of PTSD or Blast on measures of sleep continuity and NREM sleep. A significant PTSD × Blast interaction effect was found for REM fragmentation. CONCLUSIONS The results suggest that, although persistent concussive symptoms following blast exposure are associated with sleep disturbances, self-reported blast exposure without concurrent symptoms does not appear to contribute to poor sleep quality, insomnia, and disruptive nocturnal disturbances beyond the effects of PTSD. Reduced REM sleep fragmentation may be a sensitive index of the synergetic effects of both psychological and physical insults.
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Affiliation(s)
- Ryan P J Stocker
- University of Pittsburgh Medical Center, Pittsburgh, PA.,University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA
| | | | - Oommen Mammen
- University of Pittsburgh Medical Center, Pittsburgh, PA.,University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA
| | - Hassen Khan
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - Anne Germain
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA
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An examination of sleep quality in veterans with a dual diagnosis of PTSD and severe mental illness. Psychiatry Res 2017; 247:15-20. [PMID: 27863313 DOI: 10.1016/j.psychres.2016.07.062] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 05/25/2016] [Accepted: 07/12/2016] [Indexed: 11/21/2022]
Abstract
Poor sleep quality is one of the most frequently reported symptoms by veterans with Posttraumatic Stress Disorder (PTSD) and by veterans with severe mental illness (SMI; i.e., schizophrenia spectrum disorders, bipolar disorder, major depression with or without psychotic features). However, little is known about the compounding effects of co-occurring PTSD/SMI on sleep quality in this population. Given the high rates of comorbidity and poor functional outcomes associated with sleep dysfunction, there is a need to better understand patterns of poor sleep quality in this population. The present study provides a description of sleep quality in veterans with a dual diagnosis of PTSD/SMI relative to veterans with PTSD only. Results indicated that, despite similar reports of PTSD symptom severity between the groups, veterans with PTSD/SMI reported higher levels of poor sleep quality than veterans only diagnosed with PTSD. Specifically, veterans with PTSD/SMI reported significantly greater difficulties with sleep onset and overall more sleep disturbance than their non-SMI counterparts. Implications of the findings are discussed within the context of an existing model of insomnia and suggest that more comprehensive sleep assessment and the provision of targeted sleep interventions may be helpful for those with a dual diagnosis of PTSD/SMI.
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Otaghi M, Bastami M, Borji M, Tayebi A, Azami M. The Effect of Continuous Care Model on the Sleep Quality of Hemodialysis Patients. Nephrourol Mon 2016; 8:e35467. [PMID: 27570752 PMCID: PMC4983154 DOI: 10.5812/numonthly.35467] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 02/29/2016] [Indexed: 02/05/2023] Open
Abstract
Background One of the most prevalent problems in hemodialysis patients is sleep disturbance. Poor sleep quality has unpleasant bio-psycho-social outcomes. The positive effects of implementing the continuous care model (CCM) were verified with different variables, including sleep quality. This study was done with different populations, using two groups. Objectives This study aims to identify the sleep quality of hemodialysis patients in the city of Ilam and determine the effects of CCM on sleep quality. Patients and Methods We performed a quasi-experimental research study with 56 hemodialysis patients at the Shahid Mostafa Hospital in Ilam during 2014 and 2015. Pretests and posttests were conducted with the study groups and the control groups. Pretests were conducted over a one-month period, then repeated immediately before the study. Posttests were conducted immediately after the study and then repeated one month later. Participants were selected by census method and randomly divided into two groups. Ethical considerations were observed. Based on the continuous care model, interventions were performed through educational sessions over a three-week period. Consultations for continuous sleep monitoring, controls, and evaluations were conducted with the study group over the next nine weeks. Data were gathered from patient demographics questionnaires and PQSI, then introduced in SPSS 22 and analyzed with descriptive and analytic statistics (t-paired, ANOVA with repeated measures, follow-up tests such as S-N-K, Duncan, Sheffe and Tukey). Results One month prior to the study, 94.6% of the participants suffered from poor sleep quality. Immediately before and after the study, 91% complained of poor sleep quality. And one month after intervention, the figure dropped to 82%. Applying the CCM positively affected the sleep quality of hemodialysis patients in Ilam, and was statistically meaningful one month after intervention (P = 0.001). Conclusions Hemodialysis patients need a consistent care plan to manage poor sleep quality. This research has proven the effectiveness of implementing CCM as an intervention for improving the sleep quality of hemodialysis patients. CCM provides a comprehensive model for caring for hemodialysis patients, and its executive stages are congruent with the many stages of the nursing process. Practitioners in different domains of nursing care, education, and management can derive great benefit from this valuable care model
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Affiliation(s)
- Masoumeh Otaghi
- Research Center of Prevention of Psychosocial Damages, Ilam University of Medical Sciences, Ilam, IR Iran
- Nursing Department, Ilam University of Medical Sciences, Ilam, IR Iran
| | - Mohamadreza Bastami
- Research Center of Prevention of Psychosocial Damages, Ilam University of Medical Sciences, Ilam, IR Iran
- Nursing Department, Ilam University of Medical Sciences, Ilam, IR Iran
| | - Milad Borji
- Student Research Committee, Ilam University of Medical Sciences, Ilam, IR Iran
- Corresponding author: Milad Borji, Student Research Committee, Ilam University of Medical Sciences, Ilam, IR Iran. Tel: +98-9183404704, E-mail:
| | - Ali Tayebi
- Department of Medical-Surgical, School of Nursing, Baqiatallah University of Medical Sciences, Tehran, IR Iran
| | - Milad Azami
- Student Research Committee, Ilam University of Medical Sciences, Ilam, IR Iran
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Ulmer CS, Van Voorhees E, Germain AE, Voils CI, Beckham JC. A Comparison of Sleep Difficulties among Iraq/Afghanistan Theater Veterans with and without Mental Health Diagnoses. J Clin Sleep Med 2015; 11:995-1005. [PMID: 26094928 PMCID: PMC4543260 DOI: 10.5664/jcsm.5012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 04/17/2015] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Sleep disturbance is among the most common complaints of veterans and military personnel who deployed to the conflicts in Iraq and Afghanistan. A growing body of research has examined cross-sectional and longitudinal relationships between sleep disturbance and mental health symptoms and specific diagnoses in this population. However, prior research has not examined these relationships in terms of the presence or absence of any mental health diagnosis. The objective of the current study is to characterize the sleep complaints (sleep characteristics, sleep quality, insomnia symptoms, and distressing dreams and nightmares) of previously deployed military personnel in terms of the presence or absence of a mental health disorder, diagnosed using structured clinical diagnostic interviews. METHODS Participants (n = 1,238) were veterans and active duty military personnel serving in the military since September 11, 2001, and deployed at least once. Scale scores and item-level data from the Pittsburgh Sleep Quality Index (PSQI), the PSQI-Addendum, the Davidson Trauma Scale, and the Symptom Checklist-90 were used to compare sleep across mental health status (with/without mental health disorder). RESULTS As expected, self-reported sleep impairments were worse among those meeting criteria for a mental health disorder. However, findings also revealed very poor sleep among those without a mental health diagnosis as well. Mean values for both groups were suggestive of short sleep duration, low sleep efficiency, long sleep onset latencies, poor sleep quality, frequent insomnia symptoms, and nightmare frequencies that are well above norms for the general population. CONCLUSIONS Given the evidence for adverse mental and physical health sequelae of untreated sleep disturbance, increased attention to sleep in this population may serve as a primary prevention strategy.
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Affiliation(s)
- Christi S. Ulmer
- Durham Veterans Affairs Medical Center, Durham, NC
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Elizabeth Van Voorhees
- Durham Veterans Affairs Medical Center, Durham, NC
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Anne E. Germain
- University of Pittsburgh, Departments of Psychiatry and Psychology, Pittsburgh, PA
| | - Corrine I. Voils
- Durham Veterans Affairs Medical Center, Durham, NC
- Department of General Internal Medicine, Duke University Medical Center, Durham, NC
| | - Jean C. Beckham
- Durham Veterans Affairs Medical Center, Durham, NC
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
- VISN 6 Mental Illness Research, Education, and Clinical Center, Durham, NC
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Wallace ML, Iyengar S, Bramoweth AD, Frank E, Germain A. Clarifying Heterogeneity of Daytime and Nighttime Symptoms of Post-traumatic Stress in Combat Veterans with Insomnia. MILITARY PSYCHOLOGY 2015; 27:212-222. [PMID: 26457001 PMCID: PMC4596715 DOI: 10.1037/mil0000077] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Daytime and nighttime symptoms of posttraumatic stress disorder (PTSD) are common among combat veterans and military service members. However, there is a great deal of heterogeneity in how symptoms are expressed. Clarifying the heterogeneity of daytime and nighttime PTSD symptoms through exploratory clustering may generate hypotheses regarding ways to optimally match evidence-based treatments to PTSD symptom profiles. We used mixture modeling to reveal clusters based on six daytime and nighttime symptoms of 154 combat veterans with insomnia and varying levels of PTSD symptoms. Three clusters with increasing symptom severity were identified (N1=50, N2=70, N3=34). These results suggest that, among veterans with insomnia, PTSD symptoms tend to exist on a continuum of severity, rather than as a categorical PTSD diagnosis. Hypotheses regarding possible targeted treatment strategies for veterans within each identified cluster, as well as ways to generalize these methods to other groups within the military, are discussed.
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Affiliation(s)
- Meredith L. Wallace
- University of Pittsburgh Department of Psychiatry, Pittsburgh, PA
- University of Pittsburgh Department of Statistics, Pittsburgh, PA
| | - Satish Iyengar
- University of Pittsburgh Department of Psychiatry, Pittsburgh, PA
- University of Pittsburgh Department of Statistics, Pittsburgh, PA
| | - Adam D. Bramoweth
- VISN 4 Mental Illness Research, Education and Clinical Center (MIRECC), VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - Ellen Frank
- University of Pittsburgh Department of Psychiatry, Pittsburgh, PA
| | - Anne Germain
- University of Pittsburgh Department of Psychiatry, Pittsburgh, PA
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46
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Thordardottir EB, Valdimarsdottir UA, Hansdottir I, Resnick H, Shipherd JC, Gudmundsdottir B. Posttraumatic stress and other health consequences of catastrophic avalanches: A 16-year follow-up of survivors. J Anxiety Disord 2015; 32:103-11. [PMID: 25935315 DOI: 10.1016/j.janxdis.2015.03.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 02/19/2015] [Accepted: 03/09/2015] [Indexed: 11/18/2022]
Abstract
To date, no study has investigated the effects of avalanches on survivor's health beyond the first years. The aim of this study was to examine long-term health status 16 years after exposure to avalanches using a matched cohort design. Mental health, sleep quality and somatic symptoms among avalanche survivors (n=286) and non-exposed controls (n=357) were examined. Results showed that 16% of survivors currently experience avalanche-specific PTSD symptoms (PDS score>14). In addition, survivors presented with increased risk of PTSD hyperarousal symptoms (>85th percentile) (aRR=1.83; 98.3% CI [1.23-2.74]); sleep-related problems (PSQI score>5) (aRR=1.34; 95% CI [1.05-1.70]); PTSD-related sleep disturbances (PSQI-A score≥4) (aRR=1.86; 95% CI [1.30-2.67]); musculoskeletal and nervous system problems (aRR 1.43; 99% CI 1.06-1.93) and gastrointestinal problems (aRR 2.16; 99% CI 1.21-3.86) compared to the unexposed group. Results highlight the need for treatment for long-term PTSD symptoms and sleep disruption in disaster communities.
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Affiliation(s)
- Edda Bjork Thordardottir
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland; Faculty of Psychology, School of Health Sciences, University of Iceland, Reykjavik, Iceland.
| | - Unnur Anna Valdimarsdottir
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland; Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - Ingunn Hansdottir
- Faculty of Psychology, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Heidi Resnick
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, USA
| | - Jillian C Shipherd
- National Center for PTSD, VA Boston Healthcare System, USA; Department of Psychiatry, Boston University School of Medicine, USA
| | - Berglind Gudmundsdottir
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland; Faculty of Psychology, School of Health Sciences, University of Iceland, Reykjavik, Iceland; Mental Health Services, Landspitali - The National University Hospital of Iceland, Iceland
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47
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Almoznino G, Zini A, Sharav Y, Shahar A, Zlutzky H, Haviv Y, Lvovsky A, Aframian DJ. Sleep quality in patients with dental anxiety. J Psychiatr Res 2015; 61:214-22. [PMID: 25529787 DOI: 10.1016/j.jpsychires.2014.11.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 09/26/2014] [Accepted: 11/28/2014] [Indexed: 12/23/2022]
Abstract
BACKGROUND Psychological distress is associated with sleep disturbances; however there is little research on sleep quality in dental anxiety (DA) patients. OBJECTIVES To measure the sleep quality in patients with DA compared to patients with an exacerbated gag reflex (GAG) and controls and to analyze its association with various demographic and behavioral parameters. METHODS 67 DA patients, 54 GAG patients and 100 controls with no history of DA or GAG participated in the study. Data regarding: demographic details, smoking habits, the Pittsburgh Sleep Quality Index (PSQI), Numeric Rating Scale (NRS) for pain assessment, Corah's dental anxiety scale (DAS) and Oral Health Impact Profile-14 (OHIP-14), plaque index (PI) and Decay, Missing and Filled Teeth (DMFT) scores were collected. RESULTS 49.3% of the DA group and 38.9% of the GAG group were poor sleepers (mean PSQI score > 5), compared to 29.0% of the controls (PSQI mean scores: 5.8 ± 3.4, DA group; 5.2 ± 3.6 GAG group vs. 4.5 ± 2.7, control group; p = 0.029). Compared to controls, DA and GAG patients exhibited poorer scores in the sleep disturbances PSQI component (p = 0.001). DA patients exhibited poorer scores in the sleep duration PSQI component compared to the control (p = 0.002) and GAG groups (p = 0.033). Female gender (p = 0.039), higher current (p = 0.046) and maximal NRS (p = 0.019), higher DAS (p < 0.001) and OHIP-14 (p < 0.001) scores and more missing teeth (p = 0.003) were positively associated with higher PSQI scores. CONCLUSIONS DA patients suffered more from impaired sleep than controls and GAGs. Impaired sleep in DA patients is multidimensional phenomenon influenced by the specific diagnosis, gender, pain, dental anxiety levels, dental experience and oral health related quality of life.
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Affiliation(s)
- Galit Almoznino
- Department of Oral Medicine, Oral and Maxillofacial Center, Medical Corps, Israel Defense Forces, Tel-Hashomer, Israel; Department of Oral Medicine, Hebrew University - Hadassah School of Dental Medicine, Jerusalem, Israel.
| | - Avraham Zini
- Department of Community Dentistry, Hebrew University - Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Yair Sharav
- Department of Oral Medicine, Hebrew University - Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Adi Shahar
- Department of Oral Medicine, Oral and Maxillofacial Center, Medical Corps, Israel Defense Forces, Tel-Hashomer, Israel; In partial fulfillment of DMD Degree, Hebrew University - Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Hulio Zlutzky
- Department of Oral Medicine, Oral and Maxillofacial Center, Medical Corps, Israel Defense Forces, Tel-Hashomer, Israel
| | - Yaron Haviv
- Department of Oral Medicine, Hebrew University - Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Alex Lvovsky
- Department of Oral Medicine, Oral and Maxillofacial Center, Medical Corps, Israel Defense Forces, Tel-Hashomer, Israel
| | - Doron J Aframian
- Department of Oral Medicine, Hebrew University - Hadassah School of Dental Medicine, Jerusalem, Israel
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48
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Germain A, Richardson R, Stocker R, Mammen O, Hall M, Bramoweth AD, Begley A, Rode N, Frank E, Haas G, Buysse DJ. Treatment for insomnia in combat-exposed OEF/OIF/OND military veterans: preliminary randomized controlled trial. Behav Res Ther 2014; 61:78-88. [PMID: 25194223 DOI: 10.1016/j.brat.2014.07.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 07/28/2014] [Accepted: 07/29/2014] [Indexed: 10/24/2022]
Abstract
UNLABELLED Chronic insomnia is highly prevalent among military personnel returning from Iraq and Afghanistan. We evaluated the effects of a military version of a brief behavioral treatment of insomnia (BBTI-MV) compared to an information only control (IC) condition in combat-exposed Veterans of Operations Enduring/Iraqi Freedom or Operation New Dawn (OEF/OIF/OND) on insomnia, sleep quality, and daytime symptoms of anxiety and depression. Forty OEF/OIF/OND Veterans (Mean age = 38.4 years old, s.d. = 11.69; 85% men; 77.5% white) were randomized to one of two conditions. BBTI-MV consisted of two in-person sessions and two telephone contacts delivered over four weeks, and included personalized recommendations to reduce insomnia. The IC condition also consisted of 2 in-person sessions two telephone contacts delivered over four weeks, and Veterans were encouraged to read written information about sleep-promoting behaviors. The Insomnia Severity Index, Pittsburgh Sleep Quality Index, PTSD Checklist, and Beck Depression and Anxiety Inventories were completed at baseline, post-treatment, and at the six-month follow-up. Both interventions were associated with clinically significant improvements in insomnia, although the magnitude of improvements in sleep and rates of treatment response and remission were greater for BBTI-MV compared to IC from pre- to post-treatment. Both BBTI-MV and the provision of information were associated with clinically significant improvements in insomnia among Veterans. Despite the preliminary nature of the findings and limitations inherent to small controlled trials, the findings suggest that both approaches may provide viable options in a stepped-care approach to the treatment of insomnia in retuning combat-exposed Veterans. Larger, confirmatory effectiveness trials are required. CLINICALTRIALSGOV IDENTIFIER NCT00840255.
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Affiliation(s)
- Anne Germain
- Department of Psychiatry, University of Pittsburgh School of Medicine, USA.
| | | | | | - Oommen Mammen
- Department of Psychiatry, University of Pittsburgh School of Medicine, USA
| | - Martica Hall
- Department of Psychiatry, University of Pittsburgh School of Medicine, USA
| | - Adam D Bramoweth
- Department of Psychiatry, University of Pittsburgh School of Medicine, USA; VISN4 Mental Illness Research, Education and Clinical Center (MIRECC), VA Pittsburgh Healthcare System, USA
| | - Amy Begley
- University of Pittsburgh Medical Center, USA
| | - Noelle Rode
- University of Pittsburgh Medical Center, USA
| | - Ellen Frank
- Department of Psychiatry, University of Pittsburgh School of Medicine, USA
| | - Gretchen Haas
- Department of Psychiatry, University of Pittsburgh School of Medicine, USA; VISN4 Mental Illness Research, Education and Clinical Center (MIRECC), VA Pittsburgh Healthcare System, USA
| | - Daniel J Buysse
- Department of Psychiatry, University of Pittsburgh School of Medicine, USA
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49
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Barbosa Neto JB, Germain A, Mattos PF, Serafim PM, Santos RCM, Martini LC, Suchecki D, Mello MF. Psychometric properties of the Brazilian version of the Pittsburgh Sleep Quality Index Addendum for PTSD (PSQI-A). ACTA ACUST UNITED AC 2014; 36:330-5. [PMID: 25310204 DOI: 10.1590/1516-4446-2013-1225] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 11/28/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Sleep disturbances play a fundamental role in the pathophysiology posttraumatic stress disorder (PTSD), and are not only a secondary feature. The aim of this study was to validate and assess the psychometric properties of the Brazilian version of the Pittsburgh Sleep Quality Index Addendum for PTSD (PSQI-A-BR), a self-report instrument designed to assess the frequency of seven disruptive nocturnal behaviors, in a sample of participants with and without PTSD. METHODS PSQI-A was translated into Brazilian Portuguese and applied to a convenience sample of 190 volunteers, with and without PTSD, who had sought treatment for the consequences of a traumatic event. RESULTS The PSQI-A-BR displayed satisfactory internal consistency (Cronbach's coefficient of 0.83 between all items) and convergent validity with the Clinician Administered PTSD Scale (CAPS), even when excluding sleep-related items (r = 0.52). Test-retest yielded high agreement in the global PSQI-A-BR, with good stability over time (r = 0.88). A global PSQI-A-BR cutoff score of 7 yielded a sensitivity of 79%, specificity of 64%, and a global score of 7 yielded a positive predictive value of 93% for discriminating participants with PTSD from those without PTSD. CONCLUSION The PSQI-A-BR is a valid instrument for PTSD assessment, applicable to both clinical and research settings.
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Affiliation(s)
- Jair B Barbosa Neto
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Anne Germain
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Patrícia F Mattos
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Paula M Serafim
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Roberta C M Santos
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Larissa C Martini
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | | | - Marcelo F Mello
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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50
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Scarlata S, Pedone C, Curcio G, Cortese L, Chiurco D, Fontana D, Calabrese M, Fusiello R, Abbruzzese G, Santangelo S, Zito A, Incalzi RA. Pre-polysomnographic assessment using the Pittsburgh Sleep Quality Index questionnaire is not useful in identifying people at higher risk for obstructive sleep apnea. J Med Screen 2013; 20:220-6. [DOI: 10.1177/0969141313511591] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Polysomnography remains the diagnostic gold standard for obstructive sleep apnea syndrome (OSAS), but it is time consuming and requires dedicated personnel and setting. It may be more useful to plan a polysomnogram based on a preliminary screening. Objective To verify whether a questionnaire of general quality of sleep, the Pittsburgh Sleep Quality Index (PSQI), could outperform a dedicated questionnaire (Epworth Sleep Scale: ESS) in targeting OSAS patients in an at risk population. Methods 254 consecutive subjects attending the outpatient clinic for respiratory diseases were clinically evaluated for sleep apnea and referred to a 12 channel night-time polysomnography. All patients were administered the ESS and the PSQI before the procedure. The correlation between the Apnoea/Hypopnoea Index (AHI) and the global score of the PSQI was calculated; Sensitivity, specificity, positive and negative predictive values (PPV and NPV, respectively), Diagnostic accuracy and the area under the receiver operating characteristic curve (AUC) were calculated. ESS performance was used as a control reference. Results The mean age was 65.8 (standard deviation: 12.1) and the study group was 68.4% male. The mean BMI was 38.5; SD 7.7. Prevalence of OSAS in the study population was 55.5%; OSAS was severe in 60.5% of OSAS patients. ESS was significantly, but weakly, correlated with the AHI (AHI vs ESS: R = 0.308; p < 0.001), whereas PSQI was not (R = 0.037; p = 0.581). Both PSQI and ESS, however, performed unsatisfactorily: sensitivity 37.8% and 69.7%; Specificity 76.1% and 31.0%; Diagnostic Accuracy 57.5% and 49.8%; PPV 60% and 48.7%; NPV 56.3% and 52.2%; AUC 0.589 and 0.509, respectively. Conclusions The PSQI score is not helpful in the pre-polysomnographic assessment of people with suspected OSAS. Further studies are required to provide reliable pre-clinical instruments targeting patients amenable to polysomnography.
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Affiliation(s)
- Simone Scarlata
- Geriatrics – Unit of Respiratory Pathophysiology – Campus Bio Medico University and Teaching Hospital, Rome – Italy
| | - Claudio Pedone
- Geriatrics – Unit of Respiratory Pathophysiology – Campus Bio Medico University and Teaching Hospital, Rome – Italy
- Associazione Alberto Sordi, Rome, Italy
| | - Giuseppe Curcio
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Livio Cortese
- Geriatrics – Unit of Respiratory Pathophysiology – Campus Bio Medico University and Teaching Hospital, Rome – Italy
| | - Domenica Chiurco
- Geriatrics – Unit of Respiratory Pathophysiology – Campus Bio Medico University and Teaching Hospital, Rome – Italy
| | - Davide Fontana
- Geriatrics – Unit of Respiratory Pathophysiology – Campus Bio Medico University and Teaching Hospital, Rome – Italy
| | - Mariangela Calabrese
- Geriatrics – Unit of Respiratory Pathophysiology – Campus Bio Medico University and Teaching Hospital, Rome – Italy
| | - Riccardina Fusiello
- Geriatrics – Unit of Respiratory Pathophysiology – Campus Bio Medico University and Teaching Hospital, Rome – Italy
| | - Gloria Abbruzzese
- Geriatrics – Unit of Respiratory Pathophysiology – Campus Bio Medico University and Teaching Hospital, Rome – Italy
| | - Simona Santangelo
- Geriatrics – Unit of Respiratory Pathophysiology – Campus Bio Medico University and Teaching Hospital, Rome – Italy
| | - Anna Zito
- Geriatrics – Unit of Respiratory Pathophysiology – Campus Bio Medico University and Teaching Hospital, Rome – Italy
| | - Raffaele Antonelli Incalzi
- Geriatrics – Unit of Respiratory Pathophysiology – Campus Bio Medico University and Teaching Hospital, Rome – Italy
- San Raffaele Foundation – Casa sollievo della Sofferenza, Taranto – Italy
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