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Keaton SA, Arnetz J, Jamil H, Dhalimi A, Stemmer PM, Ruden DM, Yamin J, Achtyes E, Smart L, Brundin L, Arnetz BB. IL-10: A possible immunobiological component of positive mental health in refugees. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2021; 8:100097. [PMID: 35757662 PMCID: PMC9216633 DOI: 10.1016/j.cpnec.2021.100097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 01/23/2023] Open
Abstract
Objective As the number of refugees continues to rise, there is growing concern about the impact from trauma exposures on their mental health. However, there is a limited understanding of possible biological mechanisms contributing to the substantial inter-individual differences in trauma-related outcomes, especially as it relates to positive mental health. Only sparse work has focused on the biology of positive mental health, including energy and sleep, in trauma-exposed persons. In this study, we analyzed cytokines in blood from newly arrived refugees with differential trauma exposures in relationship to self-reported energy, as a key marker of positive mental health. Methods Within the first month of arrival in the USA, 64 refugees from Iraq and Syria were interviewed. Refugees completed the clinical DSM-IV PTSD-Checklist Civilian Version (PCL-C), the Beck Anxiety Inventory (BAI), and the Hospital Anxiety and Depression Scale (HADS). Ten psychiatrically healthy non-refugee persons were used as healthy controls to compare levels of cytokines. Blood samples were collected at the time of the interview and subsequently analyzed for IL-1β, IL-6, IL-8, IL-10, and TNF-α concentrations. Results Energy correlated positively with current concentration ability and sleep quality, and negatively with stress, PCL-C, BAI and HADS scores (Spearman correlations, all p<0.05). Refugees had lower levels of IL-10 compared to controls (p<0.05). IL-10 levels in refugees correlated with higher energy levels (p<0.01). Conclusions Results suggest that self-reported energy is a key component of positive mental health in newly arrived traumatized refugees. Additionally, the anti-inflammatory cytokine IL-10 could be a marker of, or causally associated with positive mental health. A better understanding of the balance between pro- and anti-inflammatory states in highly traumatized individuals has the potential to create more targeted and effective treatments with implications for long-term health outcomes.
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Affiliation(s)
- Sarah A. Keaton
- Department of Physiology, Michigan State University, East Lansing, MI, USA
- Center for Neurodegenerative Science, Van Andel Research Institute, Grand Rapids, MI, USA
| | - Judy Arnetz
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | - Hikmet Jamil
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | - Abir Dhalimi
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | - Paul M. Stemmer
- Institute of Environmental Health Science, Wayne State University, Detroit, MI, USA
| | - Douglas M. Ruden
- Institute of Environmental Health Science, Wayne State University, Detroit, MI, USA
| | - Jolin Yamin
- Institute of Environmental Health Science, Wayne State University, Detroit, MI, USA
| | - Eric Achtyes
- Pine Rest Christian Mental Health, Grand Rapids, MI, USA
- Division of Psychiatry & Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - LeAnn Smart
- Pine Rest Christian Mental Health, Grand Rapids, MI, USA
| | - Lena Brundin
- Center for Neurodegenerative Science, Van Andel Research Institute, Grand Rapids, MI, USA
- Division of Psychiatry & Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Bengt B. Arnetz
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
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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: 4] [Impact Index Per Article: 1.3] [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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Lin CE, Chung CH, Chen LF, Chien WC, Chou PH. The Impact of Antidepressants on the Risk of Developing Obstructive Sleep Apnea in Posttraumatic Stress Disorder: A Nationwide Cohort Study in Taiwan. J Clin Sleep Med 2019; 15:1233-1241. [PMID: 31538594 PMCID: PMC6760393 DOI: 10.5664/jcsm.7910] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 04/16/2019] [Accepted: 04/16/2019] [Indexed: 12/15/2022]
Abstract
STUDY OBJECTIVES The association between posttraumatic stress disorder (PTSD) and obstructive sleep apnea (OSA) has been reported inconsistently, and the association between antidepressant use and the risk of developing OSA in patients with PTSD has not been previously studied. Therefore, we used the Longitudinal National Health Insurance Database (LHID) to investigate the impact of PTSD and antidepressant use on the risk of OSA development. METHODS Identified from the LHID, 2,316 individuals aged ≥ 18 years with PTSD, but with no history of OSA, and 23,160 control individuals matched for age, sex, obesity and index date were enrolled between 2000 and 2015 and followed up until the end of 2015 to identify the development of OSA. A two-tailed Bonferroni-corrected P < .00038 (.05/13) was considered statistically significant as we examined 13 antidepressants. RESULTS Individuals with PTSD had increased risk of developing OSA (adjusted hazard ratio 4.672, 95% confidence interval 2.246-9.787, P < .001) after adjusting for demographic data, medical comorbidities, and medication. Treatment with antidepressants was not significantly associated with an increased risk of developing OSA compared to no antidepressant treatment. CONCLUSIONS Asian patients with PTSD had increased risk of developing OSA, and treatment with antidepressants did not play a key role in increasing the risk of OSA development. Further studies are required to investigate the underlying mechanisms of PTSD and the roles of antidepressants on the risk of developing OSA. CITATION Lin C-E, Chung C-H, Chen L-F, Chien W-C, Chou P-H. The impact of antidepressants on the risk of developing obstructive sleep apnea in posttraumatic stress disorder: a nationwide cohort study in taiwan. J Clin Sleep Med. 2019;15(9):1233-1241.
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Affiliation(s)
- Ching-En Lin
- Department of Psychiatry, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Graduate Institute of Life Science, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Li-Fen Chen
- Department of Psychiatry, Hualien Armed Forces General Hospital, Taiwan
| | - Wu-Chien Chien
- Graduate Institute of Life Science, National Defense Medical Center, Taipei, Taiwan
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Po-Han Chou
- Department of Psychiatry, China Medical University Hsinchu Hospital, China Medical University, Taichung, Taiwan
- Department of Psychiatry, China Medical University Hospital, China Medical University, Taichung, Taiwan
- Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan
- Biological Optimal Imaging Lab, Department of Photonics, College of Electrical and Computer Engineering, National Chiao Tung University, Hsinchu, Taiwan
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Arnetz BB, Arnetz J, Harkema JR, Morishita M, Slonager K, Sudan S, Jamil H. Neighborhood air pollution and household environmental health as it relates to respiratory health and healthcare utilization among elderly persons with asthma. J Asthma 2019; 57:28-39. [PMID: 30810414 DOI: 10.1080/02770903.2018.1545856] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objective: The study investigated the associations between fine particulate matter (PM2.5; <2.5 μm in diameter), indoor environment, pulmonary function, and healthcare utilization in a vulnerable group of elderly persons with asthma. We hypothesized that environmental conditions were associated with adverse pulmonary health outcomes. Methods: The study involved elderly (n = 76; mean age 64.6 years; 48 women) vulnerable persons in Detroit, Michigan, USA, with physician-diagnosed asthma. Exposure variables included measured outdoor PM2.5, self-rated outdoor and household environmental pollutants. Outcome variables were self-rated and measured pulmonary function, and asthma-related healthcare utilization. Results: Mean ambient PM2.5 concentrations during the study was 14.14 ± (S.D. 6.36) µg/m3 during the summer and 14.20 (6.33) during the winter (p = 0.95). In multiple regression analyses, adjusting for age and gender, mean 6-month concentration of PM2.5 was related to shortness of breath (SHOB; standardized β = 0.26, p = 0.02) and inversely with self-rated respiratory health (SRRH; β = 0.28, p = 0.02). However, PM2.5 did not predict lung function (FEV1% predicted and FEV1/FVC). However, PM2.5 was related to use of asthma controller drugs (β = 0.38, p = 0.001). Participants' air pollution ratings predicted total healthcare utilization (β = 0.33, p = 0.01). Conclusions: In elderly persons with asthma, living near heavy industry and busy highways, objective and perceived environmental pollution relate to participants' respiratory health and healthcare utilization. Importantly, air pollution might increase use of asthma controller drugs containing corticosteroids with implication for elderly persons' risk to develop osteoporosis and cardiovascular disease.
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Affiliation(s)
- Bengt B Arnetz
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, Michigan, USA.,Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Judy Arnetz
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, Michigan, USA.,Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Jack R Harkema
- Department of Pathobiology and Diagnostic Investigation, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Masako Morishita
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, Michigan, USA
| | - Kathleen Slonager
- Asthma and Allergy Foundation of America, Michigan Chapter, Franklin, MI, USA
| | - Sukhesh Sudan
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, Michigan, USA
| | - Hikmet Jamil
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, Michigan, USA
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Baird T, Theal R, Gleeson S, McLeay S, O'Sullivan R, McLeay S, Harvey W, Romaniuk M, Crawford D, Colquhoun D, McD Young R, Dwyer M, Gibson J, O'Sullivan R, Cooksley G, Strakosch C, Thomson R, Voisey J, Lawford B. Detailed Polysomnography in Australian Vietnam Veterans With and Without Posttraumatic Stress Disorder. J Clin Sleep Med 2018; 14:1577-1586. [PMID: 30176975 DOI: 10.5664/jcsm.7340] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 06/05/2018] [Indexed: 01/26/2023]
Abstract
STUDY OBJECTIVES Recent results from the PTSD Initiative, a cross-sectional cohort study in Australian Vietnam veterans (VV) with and without posttraumatic stress disorder (PTSD), demonstrated an increased prevalence of self-reported sleep disturbances in those with PTSD. This study aimed to objectively assess the prevalence of sleep disorders in the same cohort using detailed polysomnography (PSG). METHODS Participants from the PTSD Initiative were recruited to undergo PSG. PTSD status was determined with the Clinician Administered PTSD Scale for DSM-5 (CAPS-5). Subjective sleep information was attained via structured questionnaires. Data from single night PSG were compared between trauma-exposed VV with and without PTSD. RESULTS A total of 74 trauma-exposed male VV (40 with PTSD) underwent PSG (prospective n = 59, retrospective n = 15). All PSG parameters were similar between groups. No difference was seen in PSG-diagnosed obstructive sleep apnea (OSA) or periodic limb movements of sleep (PLMS). VV with PTSD showed a trend toward increased duration of sleep with oxygen saturations < 90% (10% versus 1.8%; P = .07). VV with PTSD reported increased sleep onset latency (42.4 versus 13.3 minutes; P < .01); were less likely to report sleeping well (32.5% versus 67.5%; P < .01); had higher OSA risk using Berlin Questionnaire (BQ) (70% versus 38.2%; P < .01); and had higher rates of partner-reported limb movements (56.4% versus 17.6%; P < .01). No association between PSG-diagnosed OSA and PTSD severity was evident. CONCLUSIONS In Australian VV with and without PTSD, no difference was seen across all PSG parameters including the diagnosis and severity of OSA and PLMS. However, VV with PTSD demonstrated an increased perception of sleep disturbances.
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Affiliation(s)
- Timothy Baird
- Sleep Care, Greenslopes Private Hospital, Brisbane, Queensland, Australia.,Greenslopes Private Hospital, Brisbane, Queensland, Australia
| | - Rebecca Theal
- Gallipoli Medical Research Institute, Brisbane, Queensland, Australia
| | - Sarah Gleeson
- Sleep Care, Greenslopes Private Hospital, Brisbane, Queensland, Australia.,Greenslopes Private Hospital, Brisbane, Queensland, Australia
| | - Sarah McLeay
- Gallipoli Medical Research Institute, Brisbane, Queensland, Australia.,The University of Queensland, Brisbane, Queensland, Australia
| | - Robyn O'Sullivan
- Sleep Care, Greenslopes Private Hospital, Brisbane, Queensland, Australia.,Greenslopes Private Hospital, Brisbane, Queensland, Australia
| | | | - Sarah McLeay
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Newdegate St, Greenslopes
| | - Wendy Harvey
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Newdegate St, Greenslopes
| | - Madeline Romaniuk
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Newdegate St, Greenslopes.,School of Biomedical Sciences, Faculty of Health and Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD
| | - Darrell Crawford
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Newdegate St, Greenslopes.,School of Medicine, The University of Queensland, Herston, Queensland.,Greenslopes Private Hospital, Newdegate St, Greenslopes, Queensland
| | - David Colquhoun
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Newdegate St, Greenslopes.,School of Medicine, The University of Queensland, Herston, Queensland.,Greenslopes Private Hospital, Newdegate St, Greenslopes, Queensland
| | - Ross McD Young
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Newdegate St, Greenslopes.,Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD
| | - Miriam Dwyer
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Newdegate St, Greenslopes
| | - John Gibson
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Newdegate St, Greenslopes.,Greenslopes Private Hospital, Newdegate St, Greenslopes, Queensland
| | - Robyn O'Sullivan
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Newdegate St, Greenslopes.,School of Medicine, The University of Queensland, Herston, Queensland.,Greenslopes Private Hospital, Newdegate St, Greenslopes, Queensland
| | - Graham Cooksley
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Newdegate St, Greenslopes.,School of Medicine, The University of Queensland, Herston, Queensland
| | - Christopher Strakosch
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Newdegate St, Greenslopes.,School of Medicine, The University of Queensland, Herston, Queensland.,Greenslopes Private Hospital, Newdegate St, Greenslopes, Queensland
| | - Rachel Thomson
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Newdegate St, Greenslopes.,School of Medicine, The University of Queensland, Herston, Queensland.,Greenslopes Private Hospital, Newdegate St, Greenslopes, Queensland
| | - Joanne Voisey
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Newdegate St, Greenslopes.,School of Biomedical Sciences, Faculty of Health and Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD
| | - Bruce Lawford
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Newdegate St, Greenslopes.,School of Biomedical Sciences, Faculty of Health and Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD.,School of Medicine, The University of Queensland, Herston, Queensland.,Greenslopes Private Hospital, Newdegate St, Greenslopes, Queensland
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Abuelezam NN, El-Sayed AM, Galea S. The Health of Arab Americans in the United States: An Updated Comprehensive Literature Review. Front Public Health 2018; 6:262. [PMID: 30255009 PMCID: PMC6141804 DOI: 10.3389/fpubh.2018.00262] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 08/22/2018] [Indexed: 01/09/2023] Open
Abstract
Background: Arab Americans are a historically understudied minority group in the United States and their health needs and risks have been poorly documented. We aim to provide an updated comprehensive review of the literature on Arab American physical and mental health and provide suggestions for future work in this field. Methods: A comprehensive review of the English language medical and public health literature published prior to 2017 identified through multiple database searches was conducted with search terms describing Arab Americans and health outcomes and behaviors. The literature was qualitatively summarized by health behavior (vaccination, tobacco use, drug and alcohol use, and physical activity), health outcome (diabetes, mental health, cardiovascular disease, cancer, women's, and child health), and populations at increased risk of poor health outcomes (adolescents and the elderly). Results: The majority of studies identified exploring Arab American health have been published since 2009 with an increase in the number of longitudinal and intervention studies done with this population. The majority of research is being undertaken among individuals living in ethnic enclaves due to the lack of an ethnic or racial identifier that may help identify Arab Americans from population-based studies. Studies highlight the conflicting evidence in the prevalence of diabetes and cardiovascular disease based on study sample, an increased understanding of cancer incidence and barriers to identification, and an increased level of knowledge regarding mental health and sexual health needs in the population. Information on health behaviors has also increased, with a better understanding of physical activity, alcohol and drug use, and vaccination. Conclusion: More research on Arab American health is needed to identify risks and needs of this marginalized population given the current social and political climate in the United States, especially with regard to acculturation status and immigrant generation status. We provide recommendations on approaches that may help improve our understanding of Arab American health.
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Affiliation(s)
- Nadia N Abuelezam
- Boston College, William F. Connell School of Nursing, Chestnut Hill, MA, United States
| | | | - Sandro Galea
- School of Public Health, Boston University, Boston, MA, United States
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7
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Colvonen PJ, Straus LD, Stepnowsky C, McCarthy MJ, Goldstein LA, Norman SB. Recent Advancements in Treating Sleep Disorders in Co-Occurring PTSD. Curr Psychiatry Rep 2018; 20:48. [PMID: 29931537 PMCID: PMC6645398 DOI: 10.1007/s11920-018-0916-9] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW Comorbidity of posttraumatic stress disorder (PTSD) and insomnia, nightmares, and obstructive sleep apnea (OSA) is high. We review recent research on psychotherapeutic and pharmacological interventions for sleep disorders in PTSD. RECENT FINDINGS PTSD treatments decrease PTSD severity and nightmare frequency, but do not resolve OSA or insomnia. Research on whether insomnia hinders PTSD treatment shows mixed results; untreated OSA does interfere with PTSD treatment. Cognitive behavioral therapy for insomnia is the recommended treatment for insomnia; however, optimal ordering with PTSD treatment is unclear. PTSD treatment may be most useful for PTSD-related nightmares. CPAP therapy is recommended for OSA but adherence can be low. Targeted treatment of sleep disorders in the context of PTSD offers a unique and underutilized opportunity to advance clinical care and research. Research is needed to create screening protocols, determine optimal order of treatment, and elucidate mechanisms between sleep and PTSD treatments.
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Affiliation(s)
- Peter J. Colvonen
- VA San Diego Healthcare System, University of California San Diego, 3350 La Jolla Village Dr. (116B), San Diego, CA 92161, USA,Center of Excellence for Stress and Mental Health, University of California San Diego, San Diego, CA, USA,Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Laura D. Straus
- Sierra Pacific Mental Illness Research Education and Clinical Centers, San Francisco VA Healthcare System, San Francisco, CA, USA,Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Carl Stepnowsky
- VA San Diego Healthcare System, University of California San Diego, 3350 La Jolla Village Dr. (116B), San Diego, CA 92161, USA,Department of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Michael J. McCarthy
- VA San Diego Healthcare System, University of California San Diego, 3350 La Jolla Village Dr. (116B), San Diego, CA 92161, USA,Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Lizabeth A. Goldstein
- Sierra Pacific Mental Illness Research Education and Clinical Centers, San Francisco VA Healthcare System, San Francisco, CA, USA,Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Sonya B. Norman
- VA San Diego Healthcare System, University of California San Diego, 3350 La Jolla Village Dr. (116B), San Diego, CA 92161, USA,Center of Excellence for Stress and Mental Health, University of California San Diego, San Diego, CA, USA,Department of Psychiatry, University of California San Diego, San Diego, CA, USA,National Center for PTSD, Boston, MA, USA
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8
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Lettieri CJ, Williams SG, Collen JF. OSA Syndrome and Posttraumatic Stress Disorder: Clinical Outcomes and Impact of Positive Airway Pressure Therapy. Chest 2016; 149:483-490. [PMID: 26291560 DOI: 10.1378/chest.15-0693] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND We sought to determine the impact of OSA syndrome (OSAS) on symptoms and quality of life (QoL) among patients with posttraumatic stress disorder (PTSD). In addition, we assessed adherence and response to positive airway pressure (PAP) therapy in this population. METHODS This was a case-controlled observational cohort study at the Sleep Disorders Center of an academic military medical center. Two hundred consecutive patients with PTSD underwent sleep evaluations. Patients with PTSD with and without OSAS were compared with 50 consecutive age-matched patients with OSAS without PTSD and 50 age-matched normal control subjects. Polysomnographic data, sleep-related symptoms and QoL measures, and objective PAP usage were obtained. RESULTS Among patients with PTSD, more than one-half (56.6%) received a diagnosis of OSAS. Patients with PTSD and OSAS had lower QoL and more somnolence compared with the other groups. Patients with PTSD demonstrated significantly lower adherence and response to PAP therapy. Resolution of sleepiness occurred in 82% of patients with OSAS alone, compared with 62.5% of PAP-adherent and 21.4% of nonadherent patients with PTSD and OSAS (P < .001). Similarly, posttreatment Functional Outcomes of Sleep Questionnaire ≥ 17.9 was achieved in 72% of patients with OSAS, compared with only 56.3% of patients with PTSD and OSA who were PAP adherent and 26.2% who were nonadherent (P < .03). CONCLUSIONS In patients with PTSD, comorbid OSAS is associated with worsened symptoms, QoL, and adherence and response to PAP. Given the negative impact on outcomes, the possibility of OSAS should be considered carefully in patients with PTSD. Close follow-up is needed to optimize PAP adherence and efficacy in this at-risk population.
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Affiliation(s)
- Christopher J Lettieri
- Department of Medicine, Uniformed Services University, Bethesda, MD; Department of Pulmonary, Critical Care, and Sleep Medicine, Walter Reed National Military Medical Center, Bethesda, MD
| | - Scott G Williams
- Department of Medicine, Uniformed Services University, Bethesda, MD; Department of Pulmonary, Critical Care, and Sleep Medicine, Womack Army Medical Center, Fort Bragg, NC
| | - Jacob F Collen
- Department of Medicine, Uniformed Services University, Bethesda, MD; Department of Pulmonary, Critical Care, and Sleep Medicine, Brooke Army Medical Center, Fort Sam Houston, TX.
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9
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Mysliwiec V, Matsangas P, Gill J, Baxter T, O'Reilly B, Collen JF, Roth BJ. A Comparative Analysis of Sleep Disordered Breathing in Active Duty Service Members with and without Combat-Related Posttraumatic Stress Disorder. J Clin Sleep Med 2015; 11:1393-401. [PMID: 26156954 DOI: 10.5664/jcsm.5272] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 05/29/2015] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Posttraumatic stress disorder (PTSD) and obstructive sleep apnea (OSA) are frequently co-occurring illnesses. The purpose of this study was to determine whether comorbid PTSD/OSA is associated with increased PTSD symptoms or decreased OSA severity compared to PTSD or OSA alone in recently deployed Active Duty Service Members (ADSM). METHODS Cross-sectional observational study of ADSM who returned from combat within 24 months. Participants underwent an attended diagnostic polysomnogram and were assessed for PTSD, depression, combat exposure severity, sleepiness, and sleep quality with validated clinical instruments. RESULTS Our study included 109 military personnel who returned from a combat deployment within 24 months with a mean age of 34.3 ± 8.23 and BMI of 30.8 ± 3.99. Twenty-four participants had PTSD/OSA, 68 had OSA, and 17 had PTSD. Mean PTSD Checklist- Military Version (PCL-M) scores were 62.0 ± 8.95, 60.5 ± 4.73, and 32.5 ± 8.95 in PTSD/OSA, PTSD, and OSA, respectively. The mean AHI was 16.9 ± 15.0, 18.9 ± 17.0, and 1.73 ± 1.3 for those with PTSD/OSA, OSA, and PTSD. PTSD symptoms and OSA severity in military personnel with comorbid PTSD/OSA were not significantly different from those with PTSD or OSA alone. On multivariate analysis, BMI was a significant predictor of OSA (OR, 1.21; 95% CI, 1.04-1.44) and age trended towards significance. Depression, but not OSA severity, was associated with PTSD symptoms. CONCLUSIONS Following recent combat exposure, comorbid PTSD/OSA is not associated with increased PTSD symptoms or decreased severity of OSA. Early evaluation after traumatic exposure for comorbid OSA is indicated in PTSD patients with sleep complaints given the high co-occurrence and adverse clinical implications.
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Affiliation(s)
| | | | - Jessica Gill
- National Institutes of Health National Institute of Nursing Research, Bethesda, MD
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10
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Krakow BJ, Ulibarri VA, Moore BA, McIver ND. Posttraumatic stress disorder and sleep-disordered breathing: a review of comorbidity research. Sleep Med Rev 2015; 24:37-45. [DOI: 10.1016/j.smrv.2014.11.001] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 10/25/2014] [Accepted: 11/07/2014] [Indexed: 02/04/2023]
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Abstract
Post-traumatic stress disorder (PTSD) and sleep-disordered breathing (SDB) are shared by many patients. They both affect sleep and the quality of life of affected subjects. A critical review of the literature supports an association between the two disorders in both combat-related and non-combat-related PTSD. The exact mechanism linking PTSD and SDB is not fully understood. A complex interplay between sleep fragmentation and neuroendocrine pathways is suggested. The overlap of symptoms between PTSD and SDB raises diagnostic challenges that may require a novel approach in the methods used to diagnose the coexisting disorders. Similar therapeutic challenges face patients and providers when treating concomitant PTSD and SDB. Although continuous positive airway pressure therapy imparts a mitigating effect on PTSD symptomatology, lack of both acceptance and adherence are common. Future research should focus on ways to improve adherence to continuous positive airway pressure therapy and on the use of alternative therapeutic methods for treating SDB in patients with PTSD.
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Williams NJ, Grandne MA, Snipes A, Rogers A, Williams O, Airhihenbuwa C, Jean-Louis G. Racial/ethnic disparities in sleep health and health care: importance of the sociocultural context. Sleep Health 2015; 1:28-35. [PMID: 26229976 PMCID: PMC4517599 DOI: 10.1016/j.sleh.2014.12.004] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Natasha J. Williams
- Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, NYU Medical Center, 227 East 30th St, New York, NY 10016
| | - Michael A. Grandne
- Department of Psychiatry, Behavioral Sleep Medicine Program, University of Pennsylvania, 3535 Market St, Philadelphia, PA 19104
| | - Amy Snipes
- Department of Biobehavioral Health, The Penn State University, 219 Biobehavioral Health Building, University Park, PA, 16802
| | - April Rogers
- Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, NYU Medical Center, 227 East 30th St, New York, NY 10016
| | - Olajide Williams
- Columbia University, Department of Neurology, 710 West 168th St, New York, NY 10032
| | - Collins Airhihenbuwa
- Department of Biobehavioral Health, The Penn State University, 219 Biobehavioral Health Building, University Park, PA, 16802
| | - Girardin Jean-Louis
- Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, NYU Medical Center, 227 East 30th St, New York, NY 10016
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Jamil H, Barkho E, Broadbridge CL, Ventimiglia M, Arnetz JE, Lami F, Arnetz BB. Self-rated Health and Medical Conditions in Refugees and Immigrants from the Same Country of Origin. IRAQI JOURNAL OF MEDICAL SCIENCES 2015; 13:108-119. [PMID: 26644795 PMCID: PMC4669974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Research suggests that refugees are at an increased risk for poor health outcomes as compared to immigrants. However, prior studies have compared refugees and immigrants from different countries and have failed to isolate specific war-related factors. OBJECTIVE To compare health outcomes and their determinants in refugees and immigrants from the same country of origin. METHODS A cross-sectional study based on a convenient sample and on self-report participants were conducted at Southeast Michigan during the period September to December 2009. A validated survey was used to examine refugees (n = 75) and immigrants (n = 65) from Iraq. The survey covered socioeconomics, lifestyle, violence exposure, self-rated health, and number of medical conditions (high blood pressure, fatigue, and backache, shortness of breath, gastrointestinal disorders, skin problems, and musculoskeletal problems). Group differences and predictors of health outcomes were assessed. RESULTS Refugees reported significantly more violence exposure than immigrants (p < 0.001). There were no significant differences in self-rated health or medical disorders between groups; however, violence exposure was the main predictor of health outcomes in refugees, whereas age was the main predictor in immigrants. Other predictors also varied by migratory group. CONCLUSION Even though migration status did not directly influence health outcomes, results suggest that factors associated with migration status, e.g., violence exposure and age, do impact health. Future studies need to more carefully define and control for country-specific variables.
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Affiliation(s)
- Hikmet Jamil
- Wayne State University, Department of Family Medicine and Public Health Sciences, Detroit, Michigan, USA, Kentucky Wesleyan College, Division of Social Sciences, USA
| | - Evone Barkho
- Wayne State University, Department of Family Medicine and Public Health Sciences, Detroit, Michigan, USA, Kentucky Wesleyan College, Division of Social Sciences, USA
| | - Carissa L. Broadbridge
- Wayne State University, Department of Family Medicine and Public Health Sciences, Detroit, Michigan, USA, Kentucky Wesleyan College, Division of Social Sciences, USA
- Kentucky Wesleyan College, Division of Social Sciences, USA
| | - Matthew Ventimiglia
- Wayne State University, Department of Family Medicine and Public Health Sciences, Detroit, Michigan, USA, Kentucky Wesleyan College, Division of Social Sciences, USA
- University of Detroit Mercy, Department of Psychology, Detroit, Michigan, USA
| | - Judith E. Arnetz
- Wayne State University, Department of Family Medicine and Public Health Sciences, Detroit, Michigan, USA, Kentucky Wesleyan College, Division of Social Sciences, USA
- Uppsala Universities, Department of Public Health and Caring Sciences, Uppsala, Sweden
| | - Faris Lami
- Universities of Baghdad, Department of Community Medicine, Baghdad, Iraq
| | - Bengt B. Arnetz
- Wayne State University, Department of Family Medicine and Public Health Sciences, Detroit, Michigan, USA, Kentucky Wesleyan College, Division of Social Sciences, USA
- Uppsala Universities, Department of Public Health and Caring Sciences, Uppsala, Sweden
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14
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Sleep disorders in combat-related PTSD. Sleep Breath 2014; 19:175-82. [DOI: 10.1007/s11325-014-0984-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Revised: 03/31/2014] [Accepted: 04/04/2014] [Indexed: 10/25/2022]
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