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Blaskovich B, Bullón-Tarrasó E, Pöhlchen D, Manafis A, Neumayer H, Besedovsky L, Brückl T, Simor P, Binder FP, Spoormaker VI. The utility of wearable headband electroencephalography and pulse photoplethysmography to assess cortical and physiological arousal in individuals with stress-related mental disorders. J Sleep Res 2024; 33:e14123. [PMID: 38099396 DOI: 10.1111/jsr.14123] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 11/16/2023] [Accepted: 11/27/2023] [Indexed: 07/17/2024]
Abstract
Several stress-related mental disorders are characterised by disturbed sleep, but objective sleep biomarkers are not routinely examined in psychiatric patients. We examined the use of wearable-based sleep biomarkers in a psychiatric sample with headband electroencephalography (EEG) including pulse photoplethysmography (PPG), with an additional focus on microstructural elements as especially the shift from low to high frequencies appears relevant for several stress-related mental disorders. We analysed 371 nights of sufficient quality from 83 healthy participants and those with a confirmed stress-related mental disorder (anxiety-affective spectrum). The median value of macrostructural, microstructural (spectral slope fitting), and heart rate variables was calculated across nights and analysed at the individual level (N = 83). The headbands were accepted well by patients and the data quality was sufficient for most nights. The macrostructural analyses revealed trends for significance regarding sleep continuity but not sleep depth variables. The spectral analyses yielded no between-group differences except for a group × age interaction, with the normal age-related decline in the low versus high frequency power ratio flattening in the patient group. The PPG analyses showed that the mean heart rate was higher in the patient group in pre-sleep epochs, a difference that reduced during sleep and dissipated at wakefulness. Wearable devices that record EEG and/or PPG could be used over multiple nights to assess sleep fragmentation, spectral balance, and sympathetic drive throughout the sleep-wake cycle in patients with stress-related mental disorders and healthy controls, although macrostructural and spectral markers did not differ between the two groups.
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Affiliation(s)
- Borbala Blaskovich
- Department Genes and Environment, Max Planck Institute of Psychiatry, Munich, Germany
- Institute of Medical Psychology, Faculty of Medicine, LMU Munich, Munich, Germany
| | | | - Dorothee Pöhlchen
- Department Genes and Environment, Max Planck Institute of Psychiatry, Munich, Germany
| | - Alexandros Manafis
- Department Genes and Environment, Max Planck Institute of Psychiatry, Munich, Germany
| | - Hannah Neumayer
- Department Genes and Environment, Max Planck Institute of Psychiatry, Munich, Germany
| | - Luciana Besedovsky
- Institute of Medical Psychology, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Tanja Brückl
- Department Genes and Environment, Max Planck Institute of Psychiatry, Munich, Germany
| | - Peter Simor
- Institute of Psychology, ELTE, Eötvös Loránd University, Budapest, Hungary
- Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary
| | - Florian P Binder
- Department Genes and Environment, Max Planck Institute of Psychiatry, Munich, Germany
| | - Victor I Spoormaker
- Department Genes and Environment, Max Planck Institute of Psychiatry, Munich, Germany
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Pinto JV, Hoeboer C, Hunt C, O’Toole B, Olff M. Examining the clinical validity of the global psychotrauma screen in refugees. Front Psychol 2024; 15:1394014. [PMID: 39105148 PMCID: PMC11299515 DOI: 10.3389/fpsyg.2024.1394014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 06/26/2024] [Indexed: 08/07/2024] Open
Abstract
Introduction The Global Psychotrauma Screen (GPS) is a brief transdiagnostic screener that covers a broad range of trauma-related disorders as well as risk factors known to influence the course of symptoms. Methods We analyzed data from African war refugees in Australia (n = 70), including the GPS, the Structured Clinical Interview for DSM-5 Disorders (SCID-5), the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), and the Brief Resilience Scale (BRS). Results Using the Youden's J Index to examine the clinical validity of the GPS subscales measuring PTSD, dissociation, depression, and generalized anxiety disorder (GAD), we found that a PTSD subscale score of 3 or higher, and a depression and dissociation subscale score of 1 or higher, was optimally efficient for detecting a probable diagnosis (Youden's J = 0.76, J = 0.72, and J = 0.90, respectively) with high sensitivity and specificity. We were unable to test the GPS clinical validity for GAD due to the low GAD occurrence. The GPS resilience item was not related to the total score (r = 0.02), indicating low convergent validity for resilience. Risk factors, including current stressors and childhood trauma history, were related to more severe GPS symptom scores, while lack of resilience, social support, and history of mental illness were not. Conclusion We conclude that the GPS may be a useful screening tool for PTSD, depression, and the dissociative subtype in refugees.
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Affiliation(s)
- Janaina V. Pinto
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | | | - Caroline Hunt
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Brian O’Toole
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Miranda Olff
- Amsterdam University Medical Center, Amsterdam, Netherlands
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Yuksel C, Watford L, Muranaka M, McCoy E, Lax H, Mendelsohn AK, Oliver KI, Daffre C, Acosta A, Vidrin A, Martinez U, Lasko N, Orr S, Pace-Schott EF. REM disruption and REM Vagal Activity Predict Extinction Recall in Trauma-Exposed Individuals. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2023.09.28.560007. [PMID: 37808660 PMCID: PMC10557699 DOI: 10.1101/2023.09.28.560007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Accumulating evidence suggests that rapid eye movement sleep (REM) supports the consolidation of extinction memory. REM is disrupted in PTSD, and REM abnormalities after traumatic events increase the risk of developing PTSD. Therefore, it was hypothesized that abnormal REM in trauma-exposed individuals may pave the way for PTSD by interfering with the processing of extinction memory. In addition, PTSD patients display reduced vagal activity. Vagal activity contributes to the strengthening of memories, including fear extinction memory, and recent studies show that the role of vagus in memory processing extends to memory consolidation during sleep. Therefore, it is plausible that reduced vagal activity during sleep in trauma-exposed individuals may be an additional mechanism that impairs extinction memory consolidation. However, to date, the contribution of sleep vagal activity to the consolidation of extinction memory or any emotional memory has not been investigated. To test these hypotheses, we examined the association of extinction memory with REM characteristics and REM vagal activity (indexed as heart rate variability) in a large sample of trauma-exposed individuals (n=113). Consistent with our hypotheses, REM disruption was associated with poorer physiological and explicit extinction memory. Furthermore, higher vagal activity during REM was associated with better explicit extinction memory, and physiological extinction memory in males. These findings support the notion that abnormal REM may contribute to PTSD by impairing the consolidation of extinction memory and indicate the potential utility of interventions that target REM sleep characteristics and REM vagal activity in fear-related disorders.
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Affiliation(s)
- Cagri Yuksel
- McLean Hospital, Belmont, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | | | | | | | - Hannah Lax
- McLean Hospital, Belmont, MA
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA
| | - Augustus Kram Mendelsohn
- 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
| | - Carolina Daffre
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA
| | - Alexis Acosta
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA
| | - Abegail Vidrin
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA
| | - Uriel Martinez
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA
| | - Natasha Lasko
- Department of Psychiatry, Harvard Medical School, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Scott Orr
- Department of Psychiatry, Harvard Medical School, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Edward F. Pace-Schott
- Department of Psychiatry, Harvard Medical School, Boston, MA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA
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Contractor AA, Almeida IM, Fentem A, Griffith EL, Kaur G, Slavish DC. Posttraumatic Stress Disorder Symptoms and Sleep Disturbances Among Asian Indians: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2024; 25:1468-1483. [PMID: 37427484 DOI: 10.1177/15248380231184207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Substantial comorbidity exists between posttraumatic stress disorder and sleep disturbances/disorders. Such comorbidities are understudied in minority groups, including Asian Indians residing in countries outside India. Thus, we synthesized the existing literature specific to this group of Asian Indians to determine (a) prevalence estimates of posttraumatic stress disorder (PTSD) and sleep disturbances/disorders; and (b) PTSD-sleep comorbidity estimates. For this systematic review, we searched four databases (PubMed, PsycInfo, PTSDpubs, Web of Science) using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Of 3,796 screened articles, 9 articles (10 studies) met inclusion criteria. Study sample sizes ranged from 11 to 2,112 Asian Indians; studies were conducted in Singapore or Malaysia. No reviewed study examined PTSD. All studies examined sleep disturbances/disorders among Asian Indians; prevalence estimates were: 8.3% to 70.4% for short sleep duration, 2.0% to 22.9% for long sleep duration, 25.9% to 56.3% for poor sleep quality, 3.4% to 67.5% for insomnia diagnosis or probable insomnia, 7.7% for excessive daytime sleepiness, 3.8% to 54.6% for obstructive sleep apnea (OSA) diagnosis or high OSA risk, and 5.1% to 11.1% for sleep-disordered breathing. Specific to Asian Indians residing in countries outside India, this review advances PTSD-sleep literature by (a) suggesting substantial prevalence of sleep disturbances/disorders; (b) highlighting the need for culturally relevant sleep interventions; and (c) highlighting research gaps (e.g., no PTSD-focused research).
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Bottari SA, Lamb DG, Porges EC, Murphy AJ, Tran AB, Ferri R, Jaffee MS, Davila MI, Hartmann S, Baumert M, Williamson JB. Preliminary evidence of transcutaneous vagus nerve stimulation effects on sleep in veterans with post-traumatic stress disorder. J Sleep Res 2024; 33:e13891. [PMID: 37039398 DOI: 10.1111/jsr.13891] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/15/2023] [Accepted: 03/06/2023] [Indexed: 04/12/2023]
Abstract
Sleep problems are common among veterans with post-traumatic stress disorder and closely associated with hyperarousal symptoms. Transcutaneous vagus nerve stimulation (tVNS) may have potential to improve sleep quality in veterans with PTSD through effects on brain systems relevant to hyperarousal and sleep-wake regulation. The current pilot study examines the effect of 1 h of tVNS administered at "lights out" on sleep architecture, microstructure, and autonomic activity. Thirteen veterans with PTSD completed two nights of laboratory-based polysomnography during which they received 1 h of either active tVNS (tragus) or sham stimulation (earlobe) at "lights out" with randomised order. Sleep staging and stability metrics were derived from polysomnography data. Autonomic activity during sleep was assessed using the Porges-Bohrer method for calculating respiratory sinus arrhythmia (RSAP-B ). Paired t-tests revealed a small decrease in the total sleep time (d = -0.31), increase in N3 sleep (d = 0.23), and a small-to-moderate decrease in REM sleep (d = -0.48) on nights of active tVNS relative to sham stimulation. tVNS was also associated with a moderate reduction in cyclic alternating pattern (CAP) rate (d = -0.65) and small-to-moderate increase in RSAP-B during NREM sleep. Greater NREM RSAP-B was associated with a reduced CAP rate and NREM alpha power. This pilot study provides preliminary evidence that tVNS may improve sleep depth and stability in veterans with PTSD, as well as increase parasympathetically mediated nocturnal autonomic activity. These results warrant continued investigation into tVNS as a potential tool for treating sleep disturbance in veterans with PTSD.
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Affiliation(s)
- Sarah A Bottari
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
- Center for OCD, Anxiety, and Related Disorders, Department of Psychiatry, University of Florida, Gainesville, Florida, USA
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, Florida, USA
| | - Damon G Lamb
- Center for OCD, Anxiety, and Related Disorders, Department of Psychiatry, University of Florida, Gainesville, Florida, USA
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, Florida, USA
- Department of Neuroscience, University of Florida, Gainesville, Florida, USA
- Department of Biomedical Engineering, University of Florida, Gainesville, Florida, USA
- Center for Cognitive Aging and Memory, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Eric C Porges
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
- Center for Cognitive Aging and Memory, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Aidan J Murphy
- Department of Human Evolutionary Biology, Harvard University, Cambridge, Massachusetts, USA
| | - Amy B Tran
- College of Medicine, Florida State University, Tallahassee, Florida, USA
| | - Raffaele Ferri
- Sleep Research Center, Oasi Research Institute - IRCCS, Troina, Italy
| | - Michael S Jaffee
- Department of Neurology, University of Florida, Gainesville, Florida, USA
| | - Maria I Davila
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Simon Hartmann
- School of Electrical and Electronic Engineering, The University of Adelaide, Adelaide, South Australia, Australia
| | - Mathias Baumert
- School of Electrical and Electronic Engineering, The University of Adelaide, Adelaide, South Australia, Australia
| | - John B Williamson
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
- Center for OCD, Anxiety, and Related Disorders, Department of Psychiatry, University of Florida, Gainesville, Florida, USA
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, Florida, USA
- Department of Neuroscience, University of Florida, Gainesville, Florida, USA
- Center for Cognitive Aging and Memory, College of Medicine, University of Florida, Gainesville, Florida, USA
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Vasileva AV. [Posttraumatic stress disorder clinical guidelines and treatment standards: focus on the symptoms of the psychophysiological arousal]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:58-68. [PMID: 38884431 DOI: 10.17116/jnevro202412405158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
The article describes the main diagnostic criteria and principles of posttraumatic stress disorder (PTSD) diagnostic with the consideration of risk factors and specific clinical features. The main biomarkers search trends and existing limitations are considered. The role of the psychophysiological arousal symptoms claster is highlighted in the clinical picture of PTSD as well as in connection with the main cluster of re-experiencing symptoms activation and slowing of sanogenesis process. The necessity of PTSD detection in somatic medicine is thoroughly described. The article presents therapeutic algorithms of the latest international and Russian PTSD treatment clinical guidelines based on the individual combination of psychotherapy and psychopharmacotherapy treatment choice. Additionally the accumulated during the last decades national clinical experience of the anxiety disorders treatment, including the symptoms of psychophysiological arousal is highlighted that determined the list of the recommended drugs indicating the evidence level, in the PTSD treatment standards and guidelines. The treatment choices possibilities with the consideration of different PTSD symptoms cluster expression and comorbid states and individual case distress level specific are presented. Main evidence based psychotherapeutic methods are described.
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Affiliation(s)
- A V Vasileva
- Bekhterev National Medical Research Center for Psychiatry and Neurology, St. Petersburg, Russia
- Mechnikov North-Western State Medical University, St. Petersburg, Russia
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7
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Grafe L, Miller KE, Ross RJ, Bhatnagar S. The importance of REM sleep fragmentation in the effects of stress on sleep: Perspectives from preclinical studies. Neurobiol Stress 2024; 28:100588. [PMID: 38075023 PMCID: PMC10709081 DOI: 10.1016/j.ynstr.2023.100588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 11/03/2023] [Accepted: 11/05/2023] [Indexed: 02/12/2024] Open
Abstract
Psychological stress poses a risk for sleep disturbances. Importantly, trauma-exposed individuals who develop posttraumatic stress disorder (PTSD) frequently report insomnia and recurrent nightmares. Clinical studies have provided insight into the mechanisms of these sleep disturbances. We review polysomnographic findings in PTSD and identify analogous measures that have been made in animal models of PTSD. There is a rich empirical and theoretical literature on rapid eye movement sleep (REMS) substrates of insomnia and nightmares, with an emphasis on REMS fragmentation. For future investigations of stress-induced sleep changes, we recommend a focus on tonic, phasic and other microarchitectural REMS measures. Power spectral density analysis of the sleep EEG should also be utilized. Animal models with high construct validity can provide insight into gender and time following stressor exposure as moderating variables. Ultimately, preclinical studies with translational potential will lead to improved treatment for stress-related sleep disturbances.
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Affiliation(s)
- Laura Grafe
- Department of Psychology, Bryn Mawr College, Bryn Mawr, PA, USA
| | | | - Richard J. Ross
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- Department of Psychiatry, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Seema Bhatnagar
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Anesthesiology and Critical Care, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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8
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Gao JX, Yan G, Li XX, Xie JF, Spruyt K, Shao YF, Hou YP. The Ponto-Geniculo-Occipital (PGO) Waves in Dreaming: An Overview. Brain Sci 2023; 13:1350. [PMID: 37759951 PMCID: PMC10526299 DOI: 10.3390/brainsci13091350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/11/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
Rapid eye movement (REM) sleep is the main sleep correlate of dreaming. Ponto-geniculo-occipital (PGO) waves are a signature of REM sleep. They represent the physiological mechanism of REM sleep that specifically limits the processing of external information. PGO waves look just like a message sent from the pons to the lateral geniculate nucleus of the visual thalamus, the occipital cortex, and other areas of the brain. The dedicated visual pathway of PGO waves can be interpreted by the brain as visual information, leading to the visual hallucinosis of dreams. PGO waves are considered to be both a reflection of REM sleep brain activity and causal to dreams due to their stimulation of the cortex. In this review, we summarize the role of PGO waves in potential neural circuits of two major theories, i.e., (1) dreams are generated by the activation of neural activity in the brainstem; (2) PGO waves signaling to the cortex. In addition, the potential physiological functions during REM sleep dreams, such as memory consolidation, unlearning, and brain development and plasticity and mood regulation, are discussed. It is hoped that our review will support and encourage research into the phenomenon of human PGO waves and their possible functions in dreaming.
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Affiliation(s)
- Jin-Xian Gao
- Key Laboratory of Preclinical Study for New Drugs of Gansu Province, Departments of Neuroscience, Anatomy, Histology, and Embryology, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China; (J.-X.G.); (G.Y.); (X.-X.L.); (J.-F.X.)
| | - Guizhong Yan
- Key Laboratory of Preclinical Study for New Drugs of Gansu Province, Departments of Neuroscience, Anatomy, Histology, and Embryology, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China; (J.-X.G.); (G.Y.); (X.-X.L.); (J.-F.X.)
| | - Xin-Xuan Li
- Key Laboratory of Preclinical Study for New Drugs of Gansu Province, Departments of Neuroscience, Anatomy, Histology, and Embryology, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China; (J.-X.G.); (G.Y.); (X.-X.L.); (J.-F.X.)
| | - Jun-Fan Xie
- Key Laboratory of Preclinical Study for New Drugs of Gansu Province, Departments of Neuroscience, Anatomy, Histology, and Embryology, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China; (J.-X.G.); (G.Y.); (X.-X.L.); (J.-F.X.)
| | - Karen Spruyt
- NeuroDiderot-INSERM, Université de Paris, 75019 Paris, France;
| | - Yu-Feng Shao
- Key Laboratory of Preclinical Study for New Drugs of Gansu Province, Departments of Neuroscience, Anatomy, Histology, and Embryology, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China; (J.-X.G.); (G.Y.); (X.-X.L.); (J.-F.X.)
| | - Yi-Ping Hou
- Key Laboratory of Preclinical Study for New Drugs of Gansu Province, Departments of Neuroscience, Anatomy, Histology, and Embryology, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China; (J.-X.G.); (G.Y.); (X.-X.L.); (J.-F.X.)
- Sleep Medicine Center of Gansu Provincial Hospital, Lanzhou 730000, China
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9
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Simon L, Admon R. From childhood adversity to latent stress vulnerability in adulthood: the mediating roles of sleep disturbances and HPA axis dysfunction. Neuropsychopharmacology 2023; 48:1425-1435. [PMID: 37391592 PMCID: PMC10425434 DOI: 10.1038/s41386-023-01638-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/29/2023] [Accepted: 06/16/2023] [Indexed: 07/02/2023]
Abstract
Childhood adversity is a prominent predisposing risk factor for latent stress vulnerability, expressed as an elevated likelihood of developing stress-related psychopathology upon subsequent exposure to trauma in adulthood. Sleep disturbances have emerged as one of the most pronounced maladaptive behavioral outcomes of childhood adversity and are also a highly prevalent core feature of stress-related psychopathology, including post-traumatic stress disorder (PTSD). After reviewing the extensive literature supporting these claims, the current review addresses the notion that childhood adversity-induced sleep disturbances may play a causal role in elevating individuals' stress vulnerability in adulthood. Corroborating this, sleep disturbances that predate adult trauma exposure have been associated with an increased likelihood of developing stress-related psychopathology post-exposure. Furthermore, novel empirical evidence suggests that sleep disturbances, including irregularity of the sleep-wake cycle, mediate the link between childhood adversity and stress vulnerability in adulthood. We also discuss cognitive and behavioral mechanisms through which such a cascade may evolve, highlighting the putative role of impaired memory consolidation and fear extinction. Next, we present evidence to support the contribution of the hypothalamic-pituitary-adrenal (HPA) axis to these associations, stemming from its critical role in stress and sleep regulatory pathways. Childhood adversity may yield bi-directional effects within the HPA stress and sleep axes in which sleep disturbances and HPA axis dysfunction reinforce each other, leading to elevated stress vulnerability. To conclude, we postulate a conceptual path model from childhood adversity to latent stress vulnerability in adulthood and discuss the potential clinical implications of these notions, while highlighting directions for future research.
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Affiliation(s)
- Lisa Simon
- School of Psychological Sciences, University of Haifa, Haifa, Israel
| | - Roee Admon
- School of Psychological Sciences, University of Haifa, Haifa, Israel.
- The Integrated Brain and Behavior Research Center (IBBRC), University of Haifa, Haifa, Israel.
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10
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Li Y, Li Y, Zhang X, Li Y, Liu Y, Xu H. CaMKIIa Neurons of the Ventromedial Hypothalamus Mediate Wakefulness and Anxiety-like Behavior. Neurochem Res 2023:10.1007/s11064-023-03925-9. [PMID: 37014492 DOI: 10.1007/s11064-023-03925-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/21/2023] [Accepted: 03/25/2023] [Indexed: 04/05/2023]
Abstract
Insomnia and anxiety are two common and closely related clinical problems that pose a threat to individuals' physical and mental well-being. There is a possibility that some nuclei and neural circuits in the brain are shared by both insomnia and anxiety. In the present study, using a combination of chemogenetics, optogenetics, polysomnographic recordings and the classic tests of anxiety-like behaviors, we verified that the calmodulin-dependent protein kinase II alpha (CaMKIIa) neurons of the ventromedial hypothalamus (VMH) are involved in the regulation of both wakefulness and anxiety. Chemogenetic manipulation of the VMH CaMKIIa neurons elicited an apparent increase in wakefulness during activation, whereas inhibition decreased wakefulness mildly. It substantiated that the VMH CaMKIIa neurons contribute to wakefulness. Then in millisecond-scale control of neuronal activity, short-term and long-term optogenetic activation induced the initiation and maintenance of wakefulness, respectively. We also observed that mice reduced exploratory behaviors in classic anxiety tests while activating the VMH CaMKIIa neurons and were anxiolytic while inhibiting. Additionally, photostimulation of the VMH CaMKIIa axons in the paraventricular hypothalamus (PVH) mediated wakefulness and triggered anxiety-like behaviors as well. In conclusion, our results demonstrate that the VMH participates in the control of wakefulness and anxiety, and offer a neurological explanation for insomnia and anxiety, which may be valuable for therapeutic interventions such as medication and transcranial magnetic stimulation.
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Affiliation(s)
- Yidan Li
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuchang District, Wuhan City, Hubei Province, 430071, China
| | - Yue Li
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuchang District, Wuhan City, Hubei Province, 430071, China
| | - Xuefen Zhang
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuchang District, Wuhan City, Hubei Province, 430071, China
| | - Ying Li
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuchang District, Wuhan City, Hubei Province, 430071, China
| | - Yanchao Liu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuchang District, Wuhan City, Hubei Province, 430071, China
| | - Haibo Xu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuchang District, Wuhan City, Hubei Province, 430071, China.
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Prieto S, Nolan KE, Moody JN, Hayes SM, Hayes JP. Posttraumatic stress symptom severity predicts cognitive decline beyond the effect of Alzheimer's disease biomarkers in Veterans. Transl Psychiatry 2023; 13:102. [PMID: 36990983 PMCID: PMC10060413 DOI: 10.1038/s41398-023-02354-0] [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: 10/15/2022] [Revised: 01/25/2023] [Accepted: 02/03/2023] [Indexed: 03/31/2023] Open
Abstract
Chronic stress is a risk factor for dementia but whether it explains unique variance in cognitive decline in older adults above Alzheimer's disease (AD) biomarkers is unknown. In a preclinical cohort of Vietnam Veterans, we examined the relationship between posttraumatic stress disorder (PTSD) symptom severity, AD biomarkers of beta-amyloid (Aβ) and tau, and change in cognitive performance on two widely-used screeners, the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). Analyses indicated that PTSD symptom severity was associated with a greater decline on the MMSE (p < 0.04) and MoCA (p < 0.024) after adjusting for biomarkers of AD, notably on the attention scale of the MoCA and the memory index of the MMSE. These analyses survived multiple comparison corrections. Taken together, PTSD symptom severity is associated with accelerated cognitive decline. Treating PTSD should be considered instrumental to maintaining cognitive function as adults age.
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Affiliation(s)
- Sarah Prieto
- Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - Kate E Nolan
- Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - Jena N Moody
- Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - Scott M Hayes
- Department of Psychology, The Ohio State University, Columbus, OH, USA
- Chronic Brain Injury Initiative, The Ohio State University, Columbus, OH, USA
| | - Jasmeet P Hayes
- Department of Psychology, The Ohio State University, Columbus, OH, USA.
- Chronic Brain Injury Initiative, The Ohio State University, Columbus, OH, USA.
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12
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Messman BA, Jin L, Slavish DC, Alghraibeh AM, Aljomaa SS, Contractor AA. The role of positive affect processes in the association between posttraumatic stress disorder symptoms and sleep: A multi-study design. J Affect Disord 2023; 324:511-520. [PMID: 36603602 DOI: 10.1016/j.jad.2022.12.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 11/04/2022] [Accepted: 12/23/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Posttraumatic stress disorder (PTSD) symptoms have been linked to sleep disturbances. Limited work has explored how positive affect processes may account for this relationship. Advancing research in this area, we utilized a multi-study design to investigate the role of positive affect processes (levels of positive affect, positive emotionality, hedonic deficits, negative affect interference) in the PTSD-sleep association. METHODS Data from 149 trauma-exposed firefighters (Mage = 38.93 ± 9.65, 5.40 % women) were collected between September 2021 and November 2021, and data from 119 trauma-exposed community members (Mage = 29.60 ± 8.67, 68.10 % women) were collected between February 2021 and December 2021. Participants completed an online survey on PTSD symptoms, sleep disturbances, and positive affect processes. RESULTS Positive affect levels (b = 0.03, 95 % confidence interval [CI] [0.01, 0.06]; firefighter sample), positive emotionality (b = 0.07, CI [0.03, 0.13]; community sample), and negative affect interference (b = 0.06, CI [0.01, 0.14]; community sample) significantly accounted for the associations between PTSD symptom severity and sleep disturbances controlling for the effects of gender and age. CONCLUSION Findings highlight the role of positive affect processes in the link between PTSD and sleep, and support addressing positive affect processes as potential targets in clinical interventions for co-occurring PTSD-sleep problems.
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Affiliation(s)
- Brett A Messman
- Department of Psychology, University of North Texas, Denton, TX, USA.
| | - Ling Jin
- Werklund School of Education, University of Calgary, Calgary, AB, Canada
| | - Danica C Slavish
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Ahmad M Alghraibeh
- Department of Psychology, College of Education, King Saud University, Riyadh, Saudi Arabia
| | - Suliman S Aljomaa
- Department of Psychology, College of Education, King Saud University, Riyadh, Saudi Arabia
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13
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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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14
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Hruska B, Patterson PD, Doshi AA, Guyette MK, Wong AH, Chang BP, Suffoletto BP, Pacella-LaBarbara ML. Examining the prevalence and health impairment associated with subthreshold PTSD symptoms (PTSS) among frontline healthcare workers during the COVID-19 pandemic. J Psychiatr Res 2023; 158:202-208. [PMID: 36592534 PMCID: PMC9796598 DOI: 10.1016/j.jpsychires.2022.12.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/15/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022]
Abstract
The COVID-19 pandemic has increased healthcare workers' (HCWs) risk for posttraumatic stress disorder (PTSD). Although subthreshold PTSD symptoms (PTSS) are common and increase vulnerability for health impairments, they have received little attention. We examined the prevalence of subthreshold PTSS and their relationship to physical health symptoms and sleep problems among HCWs during the pandemic's second wave (01/21-02/21). Participants (N = 852; 63.1% male; Mage = 38.34) completed the Short-Form PTSD Checklist (SF-PCL), the Cohen-Hoberman Inventory of Physical Symptoms, and the PROMIS Sleep-Related Impairment-Short-Form 4a. We created three groups with the SF-PCL: scores ≥11 = probable PTSD (5.5%); scores between 1 and 10 = subthreshold PTSS (55.3%); scores of 0 = no PTSS (39.2%). After controlling for demographics, occupational characteristics, and COVID-19 status, HCWs with subthreshold PTSS experienced greater physical health symptoms and sleep problems than HCWs with no PTSS. While HCWs with PTSD reported the greatest health impairment, HCWs with subthreshold PTSS reported 88% more physical health symptoms and 36% more sleep problems than HCWs with no PTSS. Subthreshold PTSS are common and increase risk for health impairment. Interventions addressing HCWs' mental health in response to the COVID-19 pandemic must include subthreshold PTSS to ensure their effectiveness.
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Affiliation(s)
- Bryce Hruska
- Department of Public Health, Syracuse University, Syracuse, NY, USA
| | - P Daniel Patterson
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ankur A Doshi
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Ambrose H Wong
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Bernard P Chang
- Department of Emergency Medicine, Columbia University Medical Center, New York, NY, USA
| | - Brian P Suffoletto
- Department of Emergency Medicine, Stanford University, Palo Alto, CA, USA
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15
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Sleep spindles, stress and PTSD: The state of the science and future directions. Neurobiol Stress 2023; 23:100516. [PMID: 36861030 PMCID: PMC9969071 DOI: 10.1016/j.ynstr.2023.100516] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/27/2023] Open
Abstract
Sleep spindles are a signature feature of non-REM (NREM) sleep, with demonstrated relationships to sleep maintenance and learning and memory. Because PTSD is characterized by disturbances in sleep maintenance and in stress learning and memory, there is now a growing interest in examining the role of sleep spindles in the neurobiology of PTSD. This review provides an overview of methods for measuring and detecting sleep spindles as they pertain to human PTSD and stress research, presents a critical review of early findings examining sleep spindles in PTSD and stress neurobiology, and proposes several directions for future research. In doing so, this review underscores the extensive heterogeneity in sleep spindle measurement and detection methods, the wide range of spindle features that may be and have been examined, the many persisting unknowns about the clinical and functional relevance of those features, and the problems considering PTSD as a homogeneous group in between-group comparisons. This review also highlights the progress that has been made in this field and underscores the strong rationale for ongoing work in this area.
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16
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Modeling integrated stress, sleep, fear and neuroimmune responses: Relevance for understanding trauma and stress-related disorders. Neurobiol Stress 2023; 23:100517. [PMID: 36793998 PMCID: PMC9923229 DOI: 10.1016/j.ynstr.2023.100517] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 12/30/2022] [Accepted: 01/19/2023] [Indexed: 01/24/2023] Open
Abstract
Sleep and stress have complex interactions that are implicated in both physical diseases and psychiatric disorders. These interactions can be modulated by learning and memory, and involve additional interactions with the neuroimmune system. In this paper, we propose that stressful challenges induce integrated responses across multiple systems that can vary depending on situational variables in which the initial stress was experienced, and with the ability of the individual to cope with stress- and fear-inducing challenges. Differences in coping may involve differences in resilience and vulnerability and/or whether the stressful context allows adaptive learning and responses. We provide data demonstrating both common (corticosterone, SIH and fear behaviors) and distinguishing (sleep and neuroimmune) responses that are associated with an individual's ability to respond and relative resilience and vulnerability. We discuss neurocircuitry regulating integrated stress, sleep, neuroimmune and fear responses, and show that responses can be modulated at the neural level. Finally, we discuss factors that need to be considered in models of integrated stress responses and their relevance for understanding stress-related disorders in humans.
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17
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Holter KM, Pierce BE, Gould RW. Metabotropic glutamate receptor function and regulation of sleep-wake cycles. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2023; 168:93-175. [PMID: 36868636 DOI: 10.1016/bs.irn.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Metabotropic glutamate (mGlu) receptors are the most abundant family of G-protein coupled receptors and are widely expressed throughout the central nervous system (CNS). Alterations in glutamate homeostasis, including dysregulations in mGlu receptor function, have been indicated as key contributors to multiple CNS disorders. Fluctuations in mGlu receptor expression and function also occur across diurnal sleep-wake cycles. Sleep disturbances including insomnia are frequently comorbid with neuropsychiatric, neurodevelopmental, and neurodegenerative conditions. These often precede behavioral symptoms and/or correlate with symptom severity and relapse. Chronic sleep disturbances may also be a consequence of primary symptom progression and can exacerbate neurodegeneration in disorders including Alzheimer's disease (AD). Thus, there is a bidirectional relationship between sleep disturbances and CNS disorders; disrupted sleep may serve as both a cause and a consequence of the disorder. Importantly, comorbid sleep disturbances are rarely a direct target of primary pharmacological treatments for neuropsychiatric disorders even though improving sleep can positively impact other symptom clusters. This chapter details known roles of mGlu receptor subtypes in both sleep-wake regulation and CNS disorders focusing on schizophrenia, major depressive disorder, post-traumatic stress disorder, AD, and substance use disorder (cocaine and opioid). In this chapter, preclinical electrophysiological, genetic, and pharmacological studies are described, and, when possible, human genetic, imaging, and post-mortem studies are also discussed. In addition to reviewing the important relationships between sleep, mGlu receptors, and CNS disorders, this chapter highlights the development of selective mGlu receptor ligands that hold promise for improving both primary symptoms and sleep disturbances.
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Affiliation(s)
- Kimberly M Holter
- Department of Physiology and Pharmacology, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Bethany E Pierce
- Department of Physiology and Pharmacology, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Robert W Gould
- Department of Physiology and Pharmacology, Wake Forest University School of Medicine, Winston-Salem, NC, United States.
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18
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Nijdam MJ, Vermetten E, McFarlane AC. Toward staging differentiation for posttraumatic stress disorder treatment. Acta Psychiatr Scand 2023; 147:65-80. [PMID: 36367112 PMCID: PMC10100486 DOI: 10.1111/acps.13520] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 11/02/2022] [Accepted: 11/04/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Several medical and psychiatric disorders have stage-based treatment decision-making methods. However, international treatment guidelines for posttraumatic stress disorder (PTSD) fail to give specific treatment recommendations based on chronicity or stage of the disorder. There is convincing evidence of a finite range of PTSD symptom trajectories, implying that different phenotypes of the disorder can be distinguished, which are highly relevant for a staging typology of PTSD. METHODS State-of-the-art review building on prior work on staging models in other disorders as a mapping tool to identify and synthesize toward PTSD. RESULTS We propose a four-stage model of PTSD ranging from stage 0: trauma-exposed asymptomatic but at risk to stage 4: severe unremitting illness of increasing chronicity. We favor a symptom description in various chronological characteristics based on neurobiological markers, information processing systems, stress reactivity, and consciousness dimensions. We also advocate for a separate phenomenology of treatment resistance since this can yield treatment recommendations. CONCLUSION A staging perspective in the field of PTSD is highly needed. This can facilitate the selection of interventions that are proportionate to patients' current needs and risk of illness progression and can also contribute to an efficient framework to organize biomarker data and guide service delivery. Therefore, we propose that a neurobiologically driven trajectory-based typology of PTSD can help deduct several treatment recommendations leading to a more personalized and refined grid to strategize, plan and evaluate treatment interventions.
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Affiliation(s)
- Mirjam J Nijdam
- Department of Psychiatry, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,ARQ National Psychotrauma Center, Diemen, The Netherlands
| | - Eric Vermetten
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Alexander C McFarlane
- Discipline of Psychiatry, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
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19
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Slavish DC, Ruggero CJ, Briggs M, Messman BA, Contractor AA, Miao J, Oltmanns JR, Waszczuk MA, Luft BJ, Kotov R. Longitudinal associations between PTSD and sleep disturbances among World Trade Center responders. Sleep Med 2023; 101:269-277. [PMID: 36462305 DOI: 10.1016/j.sleep.2022.11.021] [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: 07/18/2022] [Revised: 10/28/2022] [Accepted: 11/18/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE/BACKGROUND Post-traumatic stress disorder (PTSD) is characterized by substantial disruptions in sleep quality, continuity, and depth. Sleep problems also may exacerbate PTSD symptom severity. Understanding how PTSD and sleep may reinforce one another is critical for informing effective treatments. PATIENTS/METHODS In a sample of 452 World Trade Center 9/11 responders (mean age = 55.22, 89.4% male, 66.1% current or former police), we examined concurrent and cross-lagged associations between PTSD symptom severity, insomnia symptoms, nightmares, and sleep quality at 3 time points ∼1 year apart. Data were analyzed using random intercept cross-lagged panel models. RESULTS PTSD symptom severity and sleep variables were relatively stable across time (intraclass correlation coefficients: 0.63 to 0.84). Individuals with more insomnia symptoms, more nightmares, and poorer sleep quality had greater PTSD symptom severity, on average. Within-person results revealed that greater insomnia symptoms and nightmares at Time 1 were concurrently associated with greater PTSD symptoms at Time 1. Insomnia symptoms were also concurrently associated with PTSD symptoms at Times 2 and 3, respectively. Cross-lagged and autoregressive results revealed that PTSD symptoms and nightmares predicted nightmares at the next timepoint. CONCLUSIONS Overall, results suggest PTSD and sleep problems may be linked at the same point in time but may not always influence each other longitudinally. Further, individuals who experience more sleep disturbances on average may suffer from more debilitating PTSD. Evidence-based treatments for PTSD may consider incorporating treatment of underlying sleep disturbances and nightmares.
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Affiliation(s)
- Danica C Slavish
- Department of Psychology, University of North Texas, Denton, TX, 76203, USA.
| | - Camilo J Ruggero
- Department of Psychology, University of North Texas, Denton, TX, 76203, USA.
| | - Madasen Briggs
- Department of Psychology, University of North Texas, Denton, TX, 76203, USA.
| | - Brett A Messman
- Department of Psychology, University of North Texas, Denton, TX, 76203, USA.
| | - Ateka A Contractor
- Department of Psychology, University of North Texas, Denton, TX, 76203, USA.
| | - Jiaju Miao
- Department of Psychiatry and Behavioral Health, Stony Brook University, Stony Brook, NY, 11794, USA.
| | - Joshua R Oltmanns
- Department of Psychiatry and Behavioral Health, Stony Brook University, Stony Brook, NY, 11794, USA.
| | - Monika A Waszczuk
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, 60064, USA.
| | - Benjamin J Luft
- Department of Medicine, Stony Brook University, Stony Brook, NY, 11794, USA.
| | - Roman Kotov
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, 11794, USA.
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20
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Schenker MT, Theoswin PM, Qian H, Jordan AS, Nicholas CL, Felmingham KL. Sleep and day-to-day PTSD symptom variability: an ecological momentary assessment and actigraphy monitored study in trauma-exposed young adults. Eur J Psychotraumatol 2023; 14:2202058. [PMID: 37096587 PMCID: PMC10132228 DOI: 10.1080/20008066.2023.2202058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Disrupted sleep and post-traumatic stress disorder (PTSD) are bi-directionally linked and have been found to mutually reinforce each other on a day-to-day basis. However, most of the previous research has focused on subjective measures of sleep only. OBJECTIVE Here, we investigated the temporal relationship between sleep and PTSD symptoms using both subjective (sleep diary) and objective measures of sleep (actigraphy). METHODS Forty-one non-treatment seeking, trauma exposed young adults (age M = 24.68, SD = 8.15) with a range of PTSD symptom severities (PTSS, 0-53 on PCL-5) were recruited. Participants completed two surveys per day over four weeks to measure day-time PTSD symptoms (i.e. PTSS and number of intrusions) and night-time sleep subjectively, while wearing an actigraphy watch to measure sleep objectively. RESULTS Linear mixed models revealed that subjectively reported sleep disruptions were associated with elevated next-day PTSS and increasing number of intrusive memories both within and between participants. Similar results were found for daytime PTSD symptoms on night-time sleep. However, these associations were not found using objective sleep data. Exploratory moderator analyses including sex (male vs. female) found that these associations differed in strength between sexes but were generally in the same direction. DISCUSSION These results were in line with our hypothesis with regards to the sleep diary (subjective sleep), but not actigraphy (objective sleep). Several factors which have implications on both PTSD and sleep, such as the COVID-19 pandemic and/ or sleep-state misperception, may be potential reasons behind those discrepancies. However, this study had limited power and needs to be replicated in larger samples. Nonetheless, these results add to the current literature about the bi-directional relationship between sleep and PTSD and have clinical implications for treatment strategies.
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Affiliation(s)
- Maya T Schenker
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Australia
| | | | - Hang Qian
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Australia
| | - Amy S Jordan
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Australia
| | - Christian L Nicholas
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Australia
| | - Kim L Felmingham
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Australia
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21
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Correia ATL, Lipinska G, Rauch HGL, Forshaw PE, Roden LC, Rae DE. Associations between sleep-related heart rate variability and both sleep and symptoms of depression and anxiety: A systematic review. Sleep Med 2023; 101:106-117. [PMID: 36370515 DOI: 10.1016/j.sleep.2022.10.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/05/2022] [Accepted: 10/20/2022] [Indexed: 11/07/2022]
Abstract
There is a bidirectional relationship between poor sleep and both mood- and anxiety-related disorders, which are among leading global health concerns. Additionally, both disordered sleep and these psychiatric disorders appear to be independently associated with altered autonomic nervous system (ANS) function. We hypothesise that ANS dysregulation during sleep may explain part of the relationship between poor sleep and mood- and anxiety-related disorders. Heart rate variability (HRV) is a frequently used marker of ANS function and gives an indication of ANS input to the heart - in particular, of the relative contributions of sympathetic and parasympathetic activity. A systematic review of PubMed, Scopus and Web of Science yielded 41 studies dealing with sleep, mood- and anxiety-related disorders and sleep-related HRV. Hyperarousal during sleep, reflecting a predominance of sympathetic activation and indicative of ANS dysregulation, may be an important factor in the association between poor sleep and mood-related disorders. Longitudinal studies and mediation analyses are necessary to further understand the potential mediating role of ANS dysregulation on the relationship between poor sleep and mood- and anxiety-related disorders.
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Affiliation(s)
- Arron T L Correia
- Health Through Physical Activity, Lifestyle and Sport Research Centre & Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - Gosia Lipinska
- Department of Psychology, Faculty of Humanities, University of Cape Town, South Africa
| | - H G Laurie Rauch
- Health Through Physical Activity, Lifestyle and Sport Research Centre & Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Philippa E Forshaw
- Health Through Physical Activity, Lifestyle and Sport Research Centre & Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Laura C Roden
- Health Through Physical Activity, Lifestyle and Sport Research Centre & Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, South Africa; Research Centre for Sport, Exercise and Life Sciences, Faculty of Health and Life Sciences, Coventry University, United Kingdom
| | - Dale E Rae
- Health Through Physical Activity, Lifestyle and Sport Research Centre & Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, South Africa
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22
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Actigraphic sleep monitoring in patients with post-traumatic stress disorder (PTSD): A meta-analysis. J Affect Disord 2023; 320:450-460. [PMID: 36174789 DOI: 10.1016/j.jad.2022.09.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 08/05/2022] [Accepted: 09/20/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Sleep disruption is a common complaint among patients with post-traumatic stress disorder (PTSD). Modern technology of activity monitoring (actigraphy) enables extended, objective, unobtrusive recording and measuring of daytime and nighttime activity. We conducted a meta-analysis to investigate the actigraphic sleep patterns in PTSD compared with healthy controls. METHODS We searched through seven electronic databases from inception to July 2022. Only case-control studies comparing rest-activity variables measured by actigraphy devices between clinically diagnosed PTSD patients and healthy individuals were included. RESULTS We identified 12 eligible studies comparing 323 PTSD patients and 416 healthy controls. Using a random-effects model, we showed that PTSD patients have significantly lower sleep efficiency (SMD: -0.26, 95 % CI = -0.51 to -0.004, p < .05, I2 = 29.31 %), more fragmented sleep (SMD: 0.52, 95 % CI = 0.17 to 0.87, p < .01, I2 = 0 %), and longer time in bed (SMD: 0.41, 95 % CI = 0.07 to 0.74, p < .05, I2 = 0 %) compared to healthy controls. LIMITATIONS This study included a limited number of studies. Publication bias was not examined on all variables, which could lead to an overestimation of effect size. Four studies involved veterans, which likely differ from civilians regarding traumatic exposure. CONCLUSION This meta-analytic review highlighted a pattern of sleep disturbances in PTSD patients compared with non-PTSD individuals. High-quality, large-scale studies are necessary to draw a definitive conclusion regarding the distinctive sleep profile in PTSD. Future research can pay attention to sleep-specific mechanisms underlying PTSD and explore the momentary interactions between sleep-wake variables.
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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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24
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Schenker MT, Ince S, Ney LJ, Hsu CMK, Zuj DV, Jordan AS, Nicholas CL, Felmingham KL. Sex differences in the effect of subjective sleep on fear conditioning, extinction learning, and extinction recall in individuals with a range of PTSD symptom severity. Behav Res Ther 2022; 159:104222. [PMID: 36327524 DOI: 10.1016/j.brat.2022.104222] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 10/17/2022] [Accepted: 10/21/2022] [Indexed: 12/14/2022]
Abstract
Sleep has been found to play a key role in fear conditioning, extinction learning and extinction recall, and sleep disturbances are linked to many mental disorders including post-traumatic stress disorder (PTSD). Previous studies examining associations between sleep and fear or extinction processes primarily focused on objectively measured sleep architecture. Little research has so far focused on subjective sleep measures and particularly in clinical populations, which often experience subjectively poor sleep, including PTSD. Here we investigated whether subjective sleep disturbance, sleep onset latency, wake after sleep onset or sleep efficiency were related to fear conditioning, extinction learning or extinction recall in a large sample of individuals with a range of PTSD symptom severity (n = 248). Overall, we did not find that subjective sleep was associated with fear conditioning or extinction processes. However, exploratory analyses examining the moderating effect of sex found that shorter sleep onset latency and greater sleep efficiency were associated with improved extinction recall in women with higher PTSD symptom severity. This suggests that less time falling asleep and longer time asleep while in bed may be protective in highly symptomatic women against the commonly observed impaired extinction recall in PTSD. More studies are needed to explore sex-specific effects further.
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Affiliation(s)
- Maya T Schenker
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia.
| | - Sevil Ince
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia.
| | - Luke J Ney
- School of Psychological Sciences, University of Tasmania, Hobart, TAS, Australia; School of Psychology and Counselling, Queensland University of Technology, Brisbane, QLD, Australia.
| | - Chia-Ming K Hsu
- School of Psychological Sciences, University of Tasmania, Hobart, TAS, Australia.
| | - Daniel V Zuj
- School of Psychological Sciences, University of Tasmania, Hobart, TAS, Australia.
| | - Amy S Jordan
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia.
| | - Christian L Nicholas
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia.
| | - Kim L Felmingham
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia; School of Psychological Sciences, University of Tasmania, Hobart, TAS, Australia.
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25
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Pace-Schott EF, Seo J, Bottary R. The influence of sleep on fear extinction in trauma-related disorders. Neurobiol Stress 2022; 22:100500. [PMID: 36545012 PMCID: PMC9761387 DOI: 10.1016/j.ynstr.2022.100500] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/21/2022] [Accepted: 10/31/2022] [Indexed: 11/09/2022] Open
Abstract
In Posttraumatic Stress Disorder (PTSD), fear and anxiety become dysregulated following psychologically traumatic events. Regulation of fear and anxiety involves both high-level cognitive processes such as cognitive reattribution and low-level, partially automatic memory processes such as fear extinction, safety learning and habituation. These latter processes are believed to be deficient in PTSD. While insomnia and nightmares are characteristic symptoms of existing PTSD, abundant recent evidence suggests that sleep disruption prior to and acute sleep disturbance following traumatic events both can predispose an individual to develop PTSD. Sleep promotes consolidation in multiple memory systems and is believed to also do so for low-level emotion-regulatory memory processes. Consequently sleep disruption may contribute to the etiology of PTSD by interfering with consolidation in low-level emotion-regulatory memory systems. During the first weeks following a traumatic event, when in the course of everyday life resilient individuals begin to acquire and consolidate these low-level emotion-regulatory memories, those who will develop PTSD symptoms may fail to do so. This deficit may, in part, result from alterations of sleep that interfere with their consolidation, such as REM fragmentation, that have also been found to presage later PTSD symptoms. Here, sleep disruption in PTSD as well as fear extinction, safety learning and habituation and their known alterations in PTSD are first briefly reviewed. Then neural processes that occur during the early post-trauma period that might impede low-level emotion regulatory processes through alterations of sleep quality and physiology will be considered. Lastly, recent neuroimaging evidence from a fear conditioning and extinction paradigm in patient groups and their controls will be considered along with one possible neural process that may contribute to a vulnerability to PTSD following trauma.
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Affiliation(s)
- Edward F. Pace-Schott
- Massachusetts General Hospital, Department of Psychiatry, Charlestown, MA, USA
- Harvard Medical School, Department of Psychiatry, Charlestown, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
- Corresponding author. Harvard Medical School, Massachusetts General Hospital - East, CNY 149 13th Street, Charlestown, MA, 02129, USA.
| | - Jeehye Seo
- Massachusetts General Hospital, Department of Psychiatry, Charlestown, MA, USA
- Harvard Medical School, Department of Psychiatry, Charlestown, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
- Korea University, Department of Brain & Cognitive Engineering, Seongbuk-gu, Seoul, South Korea
| | - Ryan Bottary
- Massachusetts General Hospital, Department of Psychiatry, Charlestown, MA, USA
- Harvard Medical School, Department of Psychiatry, Charlestown, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
- Department of Psychology and Neuroscience, Boston College, Chestnut Hill, MA, USA
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26
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Bajor LA, Balsara C, Osser DN. An evidence-based approach to psychopharmacology for posttraumatic stress disorder (PTSD) - 2022 update. Psychiatry Res 2022; 317:114840. [PMID: 36162349 DOI: 10.1016/j.psychres.2022.114840] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 09/05/2022] [Accepted: 09/07/2022] [Indexed: 01/04/2023]
Abstract
Algorithms for posttraumatic stress disorder were published by this team in 1999 and 2011. Developments since then warrant revision. New studies and review articles from January 2011 to November 2021 were identified via PubMed and analyzed for evidence supporting changes. Following consideration of variations required by special patient populations, treatment of sleep impairments remains as the first recommended step. Nightmares and non-nightmare disturbed awakenings are best addressed with the anti-adrenergic agent prazosin, with doxazosin and clonidine as alternatives. First choices for difficulty initiating sleep include hydroxyzine and trazodone. If significant non-sleep PTSD symptoms remain, an SSRI should be tried, followed by a second SSRI or venlafaxine as a third step. Second generation antipsychotics can be considered, particularly for SSRI augmentation when PTSD-associated psychotic symptoms are present, with the caveat that positive evidence is limited and side effects are considerable. Anti-adrenergic agents can also be considered for general PTSD symptoms if not already tried, though evidence for daytime use lags that available for sleep. Regarding other pharmacological and procedural options, e.g., transcranial magnetic stimulation, cannabinoids, ketamine, psychedelics, and stellate ganglion block, evidence does not yet support firm inclusion in the algorithm. An interactive version of this work can be found at www.psychopharm.mobi.
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Affiliation(s)
- Laura A Bajor
- James A. Haley VA Hospital, Tampa, FL, United States; University of South Florida Morsani School of Medicine, Tampa, FL, United States; VA Boston Healthcare System and Harvard South Shore Psychiatry Residency Training Program, Brockton, MA, United States.
| | - Charmi Balsara
- HCA Healthcare East Florida Division GME/HCA FL Aventura Hospital, United States
| | - David N Osser
- VA Boston Healthcare System and Harvard South Shore Psychiatry Residency Training Program, Brockton, MA, United States
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27
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Woodward SH. Autonomic regulation during sleep in PTSD. Neurobiol Stress 2022; 21:100483. [DOI: 10.1016/j.ynstr.2022.100483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 08/01/2022] [Accepted: 08/25/2022] [Indexed: 10/31/2022] Open
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Li W, Chen J, Li M, Smith AP, Fan J. The effect of exercise on academic fatigue and sleep quality among university students. Front Psychol 2022; 13:1025280. [PMID: 36337542 PMCID: PMC9634171 DOI: 10.3389/fpsyg.2022.1025280] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 09/20/2022] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Routine academic events may cause fatigue and impair sleep quality. This research aimed to examine the prevalence and risk factors for academic fatigue among college students and its adverse effects on well-being and sleep. A brief exercise intervention was also evaluated. METHODS A total of 864 college students (33.5% female) filled out self-reported questionnaires with few open-ended questions. Fatigue and sleep quality were assessed using the translated version of the Smith Well-being Questionnaire and the Chinese version of the Pittsburgh Sleep Quality Index (PSQI). Spearman correlations, logistic regression analysis, and t-tests were used to test the hypotheses. In a second study, 29 female participants took part in an exercise intervention aimed at reducing fatigue and improving sleep. RESULTS Among the effective respondents, nearly 40% reported higher academic-related fatigue, and a few reported high-quality sleep. Negative coping styles, workload, stress, and disturbed surroundings had a significant positive predictive effect on academic fatigue. In addition, adverse consequences of fatigue were found for physical health and academic-life balance, and a significant, positive relationship was observed between the degree of fatigue and PSQI score (p < 0.01). The exercise study showed some beneficial effects of the intervention for both sleep and fatigue outcomes. CONCLUSION Fatigue is common and widely reported among Chinese college students, and it may have a major negative impact on their health. Increased awareness of daily academic fatigue and its impact on college students is important for individuals, schools, and society. Exercise may be a simple way to improve sleep and reduce fatigue.
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Affiliation(s)
- Wenjing Li
- School of Psychology, Shenzhen University, Shenzhen, China
- Center for Mental Health, Shenzhen University, Shenzhen, China
| | - Jianing Chen
- School of Psychology, Shenzhen University, Shenzhen, China
| | - Mingping Li
- School of Psychology, Shenzhen University, Shenzhen, China
| | - Andrew P. Smith
- School of Psychology, Cardiff University, Cardiff, United Kingdom
| | - Jialin Fan
- School of Psychology, Shenzhen University, Shenzhen, China
- Center for Mental Health, Shenzhen University, Shenzhen, China
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29
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Vanuk JR, Pace-Schott EF, Bullock A, Esbit S, Dailey NS, Killgore WDS. Morning blue light treatment improves sleep complaints, symptom severity, and retention of fear extinction memory in post-traumatic stress disorder. Front Behav Neurosci 2022; 16:886816. [PMID: 36172467 PMCID: PMC9510714 DOI: 10.3389/fnbeh.2022.886816] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 08/17/2022] [Indexed: 11/13/2022] Open
Abstract
Disrupted sleep is a major feature in numerous clinical disorders and is related to decrements in affective memory processing. The prevalence of sleep disruption in post-traumatic stress disorder (PTSD) is suggested to be a key feature that exacerbates the impaired ability to recall extinction memories during experimental fear conditioning. We hypothesized that an intervention employing blue-wavelength light therapy (BLT) to regulate sleep and stabilize circadian rhythms in patients with PTSD (i.e., via regulated morning exposure) would be associated with PTSD symptom improvement, decreased sleep-related complaints, as well as improved consolidation and retention of extinction memories relative to a fear conditioning/extinction paradigm. Eighty-two individuals with PTSD underwent a well-validated fear conditioning/extinction protocol with subsequent assignment to receive morning BLUE (BLT) or placebo AMBER (ALT) light therapy daily for 30-min over 6-weeks. Participants returned after the intervention for post-treatment extinction recall, comprised of exposure to the previously conditioned stimuli, with the difference in skin conductance response between the "extinguished" and the "never-extinguished" stimuli at follow-up. Participants also viewed previously conditioned stimuli in a novel context during a functional magnetic resonance imaging (fMRI) scan. BLUE light therapy was associated with improvements relative to correlated decreases between PTSD symptoms and sleep-related complaints. Participants receiving BLT also sustained retention of the extinction memory, while those in the placebo amber light treatment group showed impairment, characterized by the restoration of the extinguished fear response after 6-weeks. Participants in the ALT also demonstrated greater reactivity in the left insula when viewing the previously extinguished fear-conditioned stimuli in a novel context. Daily BLUE-wavelength morning light exposure was associated with greater retention of extinction learning in patients with PTSD when compared to ALT, as supported by both autonomic and neurobiological reactivity. We speculate that improved sleep facilitated by a stabilized circadian rhythm, after fear-learning, led to greater consolidation of the fear extinction memory, decreased PTSD symptom presentation, and associated decreases in sleep-related complaints. Prominent exposure treatments for PTSD incorporate principles of fear extinction, and our findings suggest that blue light treatment may facilitate treatment gains by promoting the consolidation of extinction memories via improved sleep.
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Affiliation(s)
- John R. Vanuk
- Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Edward F. Pace-Schott
- Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, United States
| | - Ayla Bullock
- Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Simon Esbit
- Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Natalie S. Dailey
- Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - William D. S. Killgore
- Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
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30
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Griffith EL, Jin L, Contractor AA, Slavish DC, Vujanovic AA. Heterogeneity in patterns of posttraumatic stress disorder symptoms and sleep disturbances among firefighters: Latent profile analyses. J Psychiatr Res 2022; 153:64-72. [PMID: 35802952 DOI: 10.1016/j.jpsychires.2022.06.052] [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] [Received: 11/23/2021] [Revised: 05/12/2022] [Accepted: 06/24/2022] [Indexed: 11/29/2022]
Abstract
Firefighters are at increased risk for posttraumatic stress disorder (PTSD) symptoms and sleep disturbances due to occupational trauma exposure as well as the nature of their job (e.g., shift work, workplace stress). PTSD symptoms co-occur with sleep disturbances, including poor sleep quality, short sleep duration, and low sleep efficiency. No published studies have examined subgroups of firefighters based on PTSD symptoms and sleep disturbances. Thus, we used latent profile analysis to identify the best-fitting class solution to categorize firefighters based on endorsed PTSD symptoms and sleep disturbances and examined relations between the optimal class solution and health covariates (i.e., anger reactions, depression symptoms, emotion regulation difficulties, number of traumatic event types). The sample included 815 trauma-exposed firefighters (Mage = 38.63; 93.20% male). Results indicated three latent subgroups: High PTSD-Sleep Disturbances, Moderate PTSD-Sleep Disturbances, and Low PTSD-Sleep Disturbances. Multinomial logistic regression indicated that endorsing greater anger reactions, depression symptoms, and emotion regulation difficulties increased the chances of being in the more severe classes. Endorsing greater number of traumatic event types increased the chances of being in the Moderate vs. Low PTSD-Sleep Disturbances Classes. Findings improve our understanding of subgroups of firefighters based on PTSD and sleep disturbances and underscore the importance of addressing depression symptoms, anger management, and emotion regulation skills for firefighters reporting more severe PTSD symptoms and sleep disturbances.
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Affiliation(s)
- Elizabeth L Griffith
- Department of Psychology, University of North Texas, 1155 Union Circle, #311280, Denton, TX, 73203, USA.
| | - Ling Jin
- Werklund School of Education, The University of Calgary, 2750, University Way NW, Calgary AB, T2N, Canada.
| | - Ateka A Contractor
- Department of Psychology, University of North Texas, 1155 Union Circle, #311280, Denton, TX, 73203, USA.
| | - Danica C Slavish
- Department of Psychology, University of North Texas, 1155 Union Circle, #311280, Denton, TX, 73203, USA.
| | - Anka A Vujanovic
- Department of Psychology, University of Houston, 3695 Cullen Boulevard, 126 Heyne Building, Houston, TX, 77204, USA.
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31
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Oh CH, Wallace ML, Germain A. Childhood trauma and gender: Synergistic and additive effects on sleep in healthy young adults. Sleep Health 2022; 8:498-504. [PMID: 35965190 DOI: 10.1016/j.sleh.2022.06.008] [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: 01/24/2021] [Revised: 05/13/2022] [Accepted: 06/15/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVES To examine whether gender moderates the effects of childhood trauma on subjective and objective sleep measures. DESIGN Secondary data analysis, exploratory SETTINGS: Sleep research lab PARTICIPANTS: A total of 213 men and 278 women aged 18-30 completed subjective measures. A subsample of 172 participants without any psychiatric, medical, or sleep disorders completed objective polysomnography for 1 night at baseline, before sleep manipulation. MEASUREMENTS Subjective measures: Childhood Trauma Questionnaire (CTQ), Pittsburgh Sleep Quality Index, Insomnia Severity Index, and Epworth Sleepiness Scale. Objective measures: Standard polysomnography measures. Multiple regressions determined whether gender moderated CTQ score on any objective or subjective sleep measures. If gender was not a moderator, we examined additive effects of gender and CTQ score. Models were adjusted for race and age. RESULTS Gender and CTQ score interactions were non-significant for both subjective (p > .675) and objective (p > .110) sleep. Women demonstrated better subjective sleep quality (Pittsburgh Sleep Quality Index, B = -0.264, p = .041) and more delta sleep than men (B = 3.032, p =.005). Greater CTQ score was associated with increased sleepiness (Epworth Sleepiness Scale, B = 0.029, p = .042), increased insomnia severity (Insomnia Severity Index, B = 0.027, p = .005), and lower REM density (B = -0.132, p = .045). CONCLUSION Our finding of greater delta sleep and better subjective overall sleep quality in women suggests that, among people without comorbidities, women may experience better sleep. Childhood trauma is associated with objective and subjective sleep measures, but this association is non-specific to gender. Clear links between childhood trauma and sleep are detectable in a sample of healthy sleepers with no comorbidities.
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Affiliation(s)
- Cristine H Oh
- Department of Psychiatry, University of Pittsburgh School of Medicine, Stanford University, Palo Alto, CA, United States
| | - Meredith L Wallace
- Departments of Psychiatry, Statistics and Biostatistics, University of Pittsburgh, Pittsburgh PA, United States
| | - Anne Germain
- Department of Psychiatry, University of Pittsburgh, Pittsburgh PA, United States.
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Brownlow JA, Miller KE, Ross RJ, Barilla H, Kling MA, Bhatnagar S, Mellman TA, Gehrman PR. The association of polysomnographic sleep on posttraumatic stress disorder symptom clusters in trauma-exposed civilians and veterans. SLEEP ADVANCES : A JOURNAL OF THE SLEEP RESEARCH SOCIETY 2022; 3:zpac024. [PMID: 36171859 PMCID: PMC9510784 DOI: 10.1093/sleepadvances/zpac024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/15/2022] [Indexed: 01/29/2023]
Abstract
Study Objectives Self-reported sleep disturbance has been established as a risk factor and predictor for posttraumatic stress disorder (PTSD); however, less is known about the relationship between objective sleep and PTSD symptom clusters, and the specific role of hyperarousal. The present study examined the relationships between sleep continuity and architecture on PTSD symptom clusters. Methods Participants underwent two in-laboratory sleep studies to assess sleep continuity and architecture. They also completed the Clinician-Administered PTSD-IV scale and the Structured Clinical Interview for the DSM-IV to assess for PTSD diagnosis and other psychiatric disorders. Results Sleep continuity (i.e. total sleep time, sleep efficiency percent, wake after sleep onset, sleep latency) was significantly related to PTSD Cluster B (reexperiencing) symptom severity (R 2 = .27, p < .001). Sleep architecture, specifically Stage N1 sleep, was significantly associated with PTSD Cluster B (t = 2.98, p = .004), C (Avoidance; t = 3.11, p = .003), and D (Hyperarosual; t = 3.79, p < .001) symptom severity independently of Stages N2, N3, and REM sleep. REM sleep variables (i.e. REM latency, number of REM periods) significantly predicted Cluster D symptoms (R 2 = .17, p = .002). Conclusions These data provide evidence for a relationship between objective sleep and PTSD clusters, showing that processes active during Stage N1 sleep may contribute to PTSD symptomatology in civilians and veterans. Further, these data suggest that arousal mechanisms active during REM sleep may also contribute to PTSD hyperarousal symptoms.This paper is part of the War, Trauma, and Sleep Across the Lifespan Collection. This collection is sponsored by the Sleep Research Society.
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Affiliation(s)
- Janeese A Brownlow
- Corresponding author. Janeese A. Brownlow, Department of Psychology, Delaware State University, 1200 N DuPont Highway, Dover, DE 19901, USA.
| | - Katherine E Miller
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Richard J Ross
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Holly Barilla
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Mitchel A Kling
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Seema Bhatnagar
- Children’s Hospital of Philadelphia, Philadelphia, PA, USA,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Philip R Gehrman
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA,Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
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van der Heijden AC, van den Heuvel OA, van der Werf YD, Talamini LM, van Marle HJF. Sleep as a window to target traumatic memories. Neurosci Biobehav Rev 2022; 140:104765. [PMID: 35803396 DOI: 10.1016/j.neubiorev.2022.104765] [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: 02/17/2022] [Revised: 06/20/2022] [Accepted: 07/01/2022] [Indexed: 10/17/2022]
Abstract
Post-traumatic stress disorder (PTSD) is a severe psychiatric disorder in which traumatic memories result in flashbacks and nightmares. With one-third of patients not responding to standard exposure-based psychotherapy, new treatment strategies are needed. Sleep offers a unique time window to enhance therapeutic efficacy. Traumatic memories that are neutralized in therapy need to be stored back into memory (consolidated) during sleep to solidify the treatment effect. New basic research shows that memory consolidation can be enhanced by presenting sounds or scents that were linked to the memory at encoding, again during sleep. This procedure, termed targeted memory reactivation (TMR), has, despite its clinical potential, not been tested in (PTSD) patients. In this narrative review, we explore the potential of TMR as a new sleep-based treatment for PTSD. First we provide the necessary background on the memory and sleep principles underlying PTSD as well as the present applications and conditional factors of TMR. Then, we will discuss the outstanding questions and most promising experimental avenues when testing TMR to treat traumatic memories.
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Affiliation(s)
- A C van der Heijden
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Psychiatry, Department Anatomy & Neuroscience, Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Neuroscience, Mood Anxiety Psychosis Stress Sleep, Amsterdam, the Netherlands.
| | - O A van den Heuvel
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Psychiatry, Department Anatomy & Neuroscience, Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Neuroscience, Compulsivity Impulsivity and Attention, Amsterdam, the Netherlands
| | - Y D van der Werf
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Psychiatry, Department Anatomy & Neuroscience, Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Neuroscience, Compulsivity Impulsivity and Attention, Amsterdam, the Netherlands
| | - L M Talamini
- University of Amsterdam, Dept. of Psychology, Brain & Cognition, Nieuwe Achtergracht 129B, 1018 WS Amsterdam, the Netherlands
| | - H J F van Marle
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Psychiatry, Department Anatomy & Neuroscience, Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Neuroscience, Mood Anxiety Psychosis Stress Sleep, Amsterdam, the Netherlands; GGZ inGeest Mental Health Care, Amstelveenseweg 589, 1081 JC Amsterdam, the Netherlands
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34
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Movement behaviors and posttraumatic stress disorder during the COVID-19 pandemic: A retrospective study of Chinese university students. J Exerc Sci Fit 2022; 20:263-268. [PMID: 35646129 PMCID: PMC9131174 DOI: 10.1016/j.jesf.2022.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 04/20/2022] [Accepted: 05/22/2022] [Indexed: 12/12/2022] Open
Abstract
Background/objective This study aimed to examine the associations between physical activity (PA), sedentary behavior, sleep and posttraumatic stress disorder (PTSD) among undergraduate students during the coronavirus disease 2019 (COVID-19) pandemic in China. Methods A total of 3178 university students responded to an online questionnaire between December 2020 and January 2021. Participants self-reported the time they spent on PA, screen time and sleep after (over the past seven days) and during the outbreak peak (from January to March 2020). Their sleep quality was measured using the Chinese version of the Pittsburgh Sleep Quality Index. The Chinese version of the Posttraumatic Stress Disorder Checklist - Civilian Version was used to measure PTSD. Logistic regressions and generalized linear mixed models were conducted. Results The final analysis included data from 2070 university students (20.2 ± 1.3 years old, 37.0% males). The prevalence of PTSD was 7.1%. Better sleep quality both during and after the outbreak peak, and longer sleep duration after the outbreak peak were associated with a lower odds ratio of having PTSD and lower re-experiencing, avoidance and hyperarousal scores. Higher total PA levels during the outbreak peak were associated with a higher odds ratio of having PTSD and higher levels of re-experiencing and avoidance. Conclusion Sleep quality and duration were negatively associated with PTSD among university students during the COVID-19 pandemic. The associations between PA, screen time and PTSD require further examination. Future interventions to enhance mental health could consider targeting university students’ sleep hygiene.
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Pk Bernstein J, Milberg WP, McGlinchey RE, Fortier CB. Associations between Post-Traumatic stress disorder symptoms and automobile driving behaviors: A review of the literature. ACCIDENT; ANALYSIS AND PREVENTION 2022; 170:106648. [PMID: 35367898 PMCID: PMC9022601 DOI: 10.1016/j.aap.2022.106648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/28/2022] [Accepted: 03/25/2022] [Indexed: 06/03/2023]
Abstract
Human factors are responsible for most motor vehicle accidents that occur on the road. Recent work suggests that symptoms of posttraumatic stress disorder (PTSD) are linked to reduced driving safety, yet none have provided a comprehensive review of this small, emerging literature. The present review identified twenty-two studies reporting associations between PTSD and driving behaviors. Among these, longitudinal designs (k = 3) and studies using objective driving performance measures (e.g., simulators) (k = 2) were rare. Most studies (k = 18) relied on brief screener measures of PTSD status/symptoms or a prior chart diagnosis, while few used a standardized structured interview measure to determine PTSD status (k = 4), and only a small number of studies assessed PTSD symptom clusters (k = 7). PTSD was most frequently associated with increased rates of hostile driving behaviors (e.g., cutting off others), unintentional driving errors (e.g., lapses in attention) and negative thoughts and emotions experienced behind the wheel. Findings regarding risk of motor vehicle accident and driving-related legal issues were variable, however relatively few studies (k = 5) explored these constructs. Future directions are discussed, including the need for work focused on concurrent PTSD symptom/driving-related changes, more comprehensive PTSD and driving assessment, and consideration of the contributions of comorbid traumatic brain injury history and other neurological and psychiatric conditions on driving outcomes.
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Affiliation(s)
- John Pk Bernstein
- Translational Research Center for TBI and Stress Disorders (TRACTS) & Geriatric Research, Educational and Clinical Center (GRECC), VA Boston Healthcare System, Boston MA.
| | - William P Milberg
- Translational Research Center for TBI and Stress Disorders (TRACTS) & Geriatric Research, Educational and Clinical Center (GRECC), VA Boston Healthcare System, Boston MA; Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Regina E McGlinchey
- Translational Research Center for TBI and Stress Disorders (TRACTS) & Geriatric Research, Educational and Clinical Center (GRECC), VA Boston Healthcare System, Boston MA; Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Catherine B Fortier
- Translational Research Center for TBI and Stress Disorders (TRACTS) & Geriatric Research, Educational and Clinical Center (GRECC), VA Boston Healthcare System, Boston MA; Department of Psychiatry, Harvard Medical School, Boston, MA
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36
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Simon KC, Whitehurst LN, Zhang J, Mednick SC. Zolpidem Maintains Memories for Negative Emotions Across a Night of Sleep. AFFECTIVE SCIENCE 2022; 3:389-399. [PMID: 35791418 PMCID: PMC9249708 DOI: 10.1007/s42761-021-00079-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 09/01/2021] [Indexed: 11/27/2022]
Abstract
Zolpidem, a common medication for sleep complaints, also shows secondary, unexpected memory benefits. We previously found that zolpidem prior to a nap enhanced negative, highly arousing picture memory. As zolpidem is typically administered at night, how it affects overnight emotional memory processing is relevant. We used a double-blind, placebo-controlled, within-subject, cross-over design to investigate if zolpidem boosted negative compared to neutral picture memory. Subjects learned both pictures sets in the morning. That evening, subjects were administered zolpidem or placebo and slept in the lab. Recognition was tested that evening and the following morning. We found that zolpidem maintained negative picture memory compared to forgetting in the placebo condition. Furthermore, zolpidem increased slow-wave sleep time, decreased rapid eye movement sleep time, and increased the fast spindle range in NREM. Our results suggest that zolpidem may enhance negative memory longevity and salience. These findings raise concerns for zolpidem administration to certain clinical populations.
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Affiliation(s)
- Katharine C. Simon
- Department of Cognitive Science, University of California, Irvine, 2201 Social & Behavioral Sciences Gateway, Irvine, CA 92697 USA
| | | | - Jing Zhang
- Department of Cognitive Science, University of California, Irvine, 2201 Social & Behavioral Sciences Gateway, Irvine, CA 92697 USA
| | - Sara C. Mednick
- Department of Cognitive Science, University of California, Irvine, 2201 Social & Behavioral Sciences Gateway, Irvine, CA 92697 USA
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Kaplan GB, Lakis GA, Zhoba H. Sleep-Wake and Arousal Dysfunctions in Post-Traumatic Stress Disorder:Role of Orexin Systems. Brain Res Bull 2022; 186:106-122. [PMID: 35618150 DOI: 10.1016/j.brainresbull.2022.05.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 04/20/2022] [Accepted: 05/10/2022] [Indexed: 12/15/2022]
Abstract
Post-traumatic stress disorder (PTSD) is a trauma-related condition that produces distressing fear memory intrusions, avoidance behaviors, hyperarousal/startle, stress responses and insomnia. This review focuses on the importance of the orexin neural system as a novel mechanism related to the pathophysiology of PTSD. Orexinergic neurons originate in the lateral hypothalamus and project widely to key neurotransmitter system neurons, autonomic neurons, the hypothalamic-pituitaryadrenal (HPA) axis, and fear-related neural circuits. After trauma or stress, the basolateral amygdala (BLA) transmits sensory information to the central nucleus of the amygdala (CeA) and in turn to the hypothalamus and other subcortical and brainstem regions to promote fear and threat. Orexin receptors have a prominent role in this circuit as fear conditioned orexin receptor knockout mice show decreased fear expression while dual orexin receptor antagonists (DORAs) inhibit fear acquisition and expression. Orexin activation of an infralimbic-amygdala circuit impedes fear extinction while DORA treatments enhance it. Increased orexin signaling to the amygdalocortical- hippocampal circuit promotes avoidance behaviors. Orexin has an important role in activating sympathetic nervous system (SNS) activity and the HPA axis stress responses. Blockade of orexin receptors reduces fear-conditioned startle responses. In PTSD models, individuals demonstrate sleep disturbances such as increased sleep latency and more transitions to wakefulness. Increased orexin activity impairs sleep by promoting wakefulness and reducing total sleep time while DORA treatments enhance sleep onset and maintenance. The orexinergic neural system provides important mechanisms for understanding multiple PTSD behaviors and provides new medication targets to treat this often persistent and debilitating illness.
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Affiliation(s)
- Gary B Kaplan
- Mental Health Service, VA Boston Healthcare System, West Roxbury, MA, 02132 USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, 02118 USA; Department of Pharmacology and Experimental Therapeutics, Boston University School of Medicine, Boston, MA, 02118 USA.
| | - Gabrielle A Lakis
- Research Service, VA Boston Healthcare System, West Roxbury, MA, 02132 USA; Undergraduate Program in Neuroscience, Boston University, Boston, MA, 02215 USA
| | - Hryhoriy Zhoba
- Research Service, VA Boston Healthcare System, West Roxbury, MA, 02132 USA
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38
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Manassero E, Giordano A, Raimondo E, Cicolin A, Sacchetti B. Sleep Deprivation During Memory Consolidation, but Not Before Memory Retrieval, Widens Threat Generalization to New Stimuli. Front Neurosci 2022; 16:902925. [PMID: 35663560 PMCID: PMC9160568 DOI: 10.3389/fnins.2022.902925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/06/2022] [Indexed: 11/13/2022] Open
Abstract
Past aversive experiences shape our ability to deal with future dangers, through the encoding of implicit and explicit memory traces and through the ability to generalize defensive reactions to new stimuli resembling learned threats. Numerous evidence demonstrate that sleep is important for the consolidation of memories related to threatening events. However, there is a lack of studies examining the effects of sleep deprivation on the retrieval of consolidated threat memories, and previous studies on the role of sleep in threat generalization have produced mixed results. To address these issues, here we adopted a differential threat conditioning and a delayed (second half of the night) sleep deprivation during the first or the seventh night after learning. We found no effects of sleep deprivation on either implicit or explicit threat memories, regardless of its occurrence timing. Conversely, implicit but not explicit responses to novel cues similar to a learned threat displayed a widened generalization pattern, but only if sleep deprivation took place during the first night after conditioning and not if it occurred during the seventh night after conditioning. Therefore, we propose that sleeping after exposure to danger may support optimal implicit discrimination processes to evaluate new signals in the future and that even a brief period of sleeplessness may widen threat generalization to new stimuli, which is a hallmark of several threat-related disorders.
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Affiliation(s)
- Eugenio Manassero
- Department of Neurosciences “Rita Levi Montalcini”, University of Turin, Turin, Italy
| | - Alessandra Giordano
- Sleep Disorder Center, Department of Neurosciences “Rita Levi Montalcini”, University of Turin, Turin, Italy
| | - Erika Raimondo
- Sleep Disorder Center, Department of Neurosciences “Rita Levi Montalcini”, University of Turin, Turin, Italy
| | - Alessandro Cicolin
- Sleep Disorder Center, Department of Neurosciences “Rita Levi Montalcini”, University of Turin, Turin, Italy
| | - Benedetto Sacchetti
- Department of Neurosciences “Rita Levi Montalcini”, University of Turin, Turin, Italy
- *Correspondence: Benedetto Sacchetti,
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Osorio-Forero A, Cherrad N, Banterle L, Fernandez LMJ, Lüthi A. When the Locus Coeruleus Speaks Up in Sleep: Recent Insights, Emerging Perspectives. Int J Mol Sci 2022; 23:ijms23095028. [PMID: 35563419 PMCID: PMC9099715 DOI: 10.3390/ijms23095028] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/14/2022] [Accepted: 04/19/2022] [Indexed: 12/03/2022] Open
Abstract
For decades, numerous seminal studies have built our understanding of the locus coeruleus (LC), the vertebrate brain’s principal noradrenergic system. Containing a numerically small but broadly efferent cell population, the LC provides brain-wide noradrenergic modulation that optimizes network function in the context of attentive and flexible interaction with the sensory environment. This review turns attention to the LC’s roles during sleep. We show that these roles go beyond down-scaled versions of the ones in wakefulness. Novel dynamic assessments of noradrenaline signaling and LC activity uncover a rich diversity of activity patterns that establish the LC as an integral portion of sleep regulation and function. The LC could be involved in beneficial functions for the sleeping brain, and even minute alterations in its functionality may prove quintessential in sleep disorders.
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40
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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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41
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Bidirectional Associations between Daily PTSD Symptoms and Sleep Disturbances: A Systematic Review. Sleep Med Rev 2022; 63:101623. [DOI: 10.1016/j.smrv.2022.101623] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/14/2022] [Accepted: 03/03/2022] [Indexed: 11/24/2022]
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Pan X, Xiao Y, Ren D, Xu ZM, Zhang Q, Yang LY, Liu F, Hao YS, Zhao F, Bai YH. Prevalence of mental health problems and associated risk factors among military healthcare workers in specialized COVID-19 hospitals in Wuhan, China: A cross-sectional survey. Asia Pac Psychiatry 2022; 14:e12427. [PMID: 33089622 PMCID: PMC7645907 DOI: 10.1111/appy.12427] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/11/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION China has been severely affected by coronavirus disease 2019 (COVID-19) since December 2019. Military healthcare workers in China have experienced many pressures when combating COVID-19. This study aimed to investigate the current psychological status and associated risk factors among military healthcare workers. METHODS We collected data from 194 military healthcare workers from three inpatient wards in two specialized COVID-19 hospitals using a web-based cross-sectional survey. The survey covered demographic information, the patient health questionnaire-9, the Generalized Anxiety Disorder-7, and the patient health questionnaire-15. Hierarchical regression analysis was used to explore potential risk factors for mental health problems. RESULTS The overall prevalence rates of depressive, generalized anxiety, and somatic symptoms were 37.6%, 32.5%, and 50%, respectively. Rates of severe depression, generalized anxiety, and somatic symptoms were 5.2%, 3.6%, and 15.5%, respectively. In 22.7% of cases, comorbidities existed between depression, generalized anxiety, and somatization. A junior-grade professional title was associated with depression, older age was associated with generalized anxiety and somatization, and short sleep duration and poor sleep quality were associated with all three symptoms. DISCUSSION The prevalence of depression, generalized anxiety, and somatic symptoms among military healthcare workers in specialized COVID-19 hospitals is high during the current COVID-19 outbreak. A junior-grade professional title, older age, short sleep duration, and poor sleep quality significantly affect military healthcare workers' mental health. Continuous surveillance and monitoring of the psychological consequences of the COVID-19 outbreak should be routine to promote mental health among military healthcare workers.
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Affiliation(s)
- Xiao Pan
- Department of Medical Psychology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Ying Xiao
- Hongkou District of Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Ding Ren
- Department of Medical Psychology, PLA Navy No.905 Hospital, Second Military Medical University, Shanghai, China
| | - Zheng-Mei Xu
- Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Qian Zhang
- Department of Hyperbaric, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Li-Ying Yang
- Department of Radiotherapy, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Fen Liu
- Department of Critical Medicine, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yu-Shi Hao
- Department of Medical Psychology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Feng Zhao
- Hongkou District of Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yong-Hai Bai
- Department of Medical Psychology, Changzheng Hospital, Second Military Medical University, Shanghai, China
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Miles SR, Pruiksma KE, Slavish D, Dietch JR, Wardle-Pinkston S, Litz BT, Rodgers M, Nicholson KL, Young-McCaughan S, Dondanville KA, Nakase-Richardson R, Mintz J, Keane TM, Peterson AL, Resick PA, Taylor DJ. Sleep disorder symptoms are associated with greater posttraumatic stress and anger symptoms in U.S. army service members seeking treatment for PTSD. J Clin Sleep Med 2022; 18:1617-1627. [PMID: 35197191 DOI: 10.5664/jcsm.9926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Characterize associations between sleep impairments and posttraumatic stress disorder (PTSD) symptoms, including anger, in service members seeking treatment for PTSD. METHODS Ninety-three US Army personnel recruited into a PTSD treatment study completed the baseline assessment. State of the science sleep measurements included (1) retrospective, self-reported insomnia, (2) prospective sleep diaries assessing sleep patterns and nightmares, and (3) polysomnography (PSG) measured sleep architecture and obstructive sleep apnea-hypopnea (OSAH) severity. Dependent variables included self-report measures of PTSD severity and anger severity. Pearson correlations and multiple linear regression analyses examined if sleep symptoms, not generally measured in PTSD populations, were associated with PTSD and anger severity. RESULTS All participants met PTSD, insomnia, and nightmare diagnostic criteria. Mean sleep efficiency = 70%, total sleep time = 5.5 hours, obstructive sleep apnea/hypopnea (OSAH index ≥ 5) = 53%, and clinically significant anger = 85%. PTSD severity was associated with insomnia severity (β =.58), nightmare severity (β = .24), nightmare frequency (β = .31), and time spent in Stage 1 sleep (β = .27, all p < .05). Anger severity was associated with insomnia severity (β =37), nightmare severity (β = .28), and OSAH during rapid eye movement (β = .31, all p < .05). CONCLUSIONS Insomnia and nightmares were related to PTSD and anger severity, and OSAH was related to anger. Better assessment and evidence-based treatment of these comorbid sleep impairments in service members with PTSD and significant anger, should result in better PTSD, anger, and quality of life outcomes. CLINICAL TRIALS REGISTRATION Registry: ClinicalTrials.gov; Name: Treatment of Comorbid Sleep Disorders and Post Traumatic Stress Disorder; Identifier: NCT02773693; URL: https://clinicaltrials.gov/ct2/show/NCT02773693.
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Affiliation(s)
- Shannon R Miles
- James A. Haley Veterans' Hospital, Tampa, FL.,Division of Psychiatry & Behavioral Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Kristi E Pruiksma
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX
| | - Danica Slavish
- Department of Psychology, University of North Texas, Denton, TX
| | - Jessica R Dietch
- School of Psychological Science, Oregon State University, Corvallis, OR
| | | | - Brett T Litz
- Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System, Boston, MA.,Department of Psychiatry, Boston University School of Medicine, Boston, MA.,Department of Psychological and Brain Sciences, Boston University, Boston, MA
| | | | | | - Stacey Young-McCaughan
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX
| | - Katherine A Dondanville
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Risa Nakase-Richardson
- James A. Haley Veterans' Hospital, Tampa, FL.,Division of Pulmonary and Sleep Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Jim Mintz
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX
| | - Terence M Keane
- Department of Psychiatry, Boston University School of Medicine, Boston, MA.,Behavioral Science Division, National Center for PTSD at VA Boston Healthcare System, Boston, MA
| | - Alan L Peterson
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX.,Department of Psychology, University of Texas at San Antonio, San Antonio, TX
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Hall OT, Coccaro EF. Assessment of subjective sleep quality and issues in aggression: Intermittent Explosive Disorder compared with psychiatric and healthy controls. Compr Psychiatry 2022; 112:152270. [PMID: 34702562 DOI: 10.1016/j.comppsych.2021.152270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 08/10/2021] [Accepted: 08/19/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND While prior research has linked clinical sleep issues and aggression, little is known about how clinical sleep issues among individuals with Intermittent Explosive Disorder (IED), which is characterized by a pervasive pattern of impulsive aggression and associated with consequences across multiple life-domains. The present study aims to examine clinical sleep issues among individuals with IED in contrast to individuals with other psychopathology and healthy controls. METHODS 257 adults, including 100 healthy controls, 85 psychiatric controls and 72 individuals with IED, took part in this study. Participants completed the Structured Clinical Interview for DSM-V Diagnoses, Assessment of clinical sleep issues included the Pittsburgh Sleep Quality Inventory (PSQI), obstructive sleep apnea (OSA) screening, and the Epworth Sleepiness Scale (ESS) as well as assessments of aggression and impulsivity. RESULTS IED study participants reported significantly worse sleep quality, increased sleep latency, greater daytime sleepiness and symptoms of OSA. Daytime sleepiness and sleep quality was correlated with impulsivity and aggression. CONCLUSIONS This study suggests that individuals with IED have clinically relevant sleep anomalies, and that these are directly associated with measures of impulsivity and aggression. Clinicians treating aggressive individuals are advised to assess and treat such individuals for sleep issues.
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Affiliation(s)
- O Trent Hall
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Emil F Coccaro
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, USA.
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45
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Feemster JC, Steele TA, Palermo KP, Ralston CL, Tao Y, Bauer DA, Edgar L, Rivera S, Walters-Smith M, Gossard TR, Teigen LN, Timm PC, Richardson JW, Robert Auger R, Kolla B, McCarter SJ, Boeve BF, Silber MH, St. Louis EK. Abnormal rapid eye movement sleep atonia control in chronic post-traumatic stress disorder. Sleep 2021; 45:6484914. [PMID: 34958372 PMCID: PMC8919203 DOI: 10.1093/sleep/zsab259] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 10/12/2021] [Indexed: 12/30/2022] Open
Abstract
STUDY OBJECTIVES Post-traumatic stress disorder (PTSD) and rapid eye movement (REM) sleep behavior disorder (RBD) share some common features including prominent nightmares and sleep disturbances. We aimed to comparatively analyze REM sleep without atonia (RSWA) between patients with chronic PTSD with and without dream enactment behavior (DEB), isolated RBD (iRBD), and controls. METHODS In this retrospective study, we comparatively analyzed 18 PTSD with DEB (PTSD+DEB), 18 PTSD without DEB, 15 iRBD, and 51 controls matched for age and sex. We reviewed medical records to determine PTSD clinical features and quantitatively analyzed RSWA. We used nonparametric analyses to compare clinical and polysomnographic features. RESULTS PTSD patients, both with and without DEB, had significantly higher RSWA than controls (all p < .025, excepting submentalis phasic duration in PTSD+DEB). Most RSWA measures were also higher in PTSD+DEB than in PTSD without DEB patients (all p < .025). CONCLUSIONS PTSD patients have higher RSWA than controls, whether DEB is present or not, indicating that REM sleep atonia control is abnormal in chronic PTSD. Further prospective studies are needed to determine whether neurodegenerative risk and disease markers similar to RBD might occur in PTSD patients.
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Affiliation(s)
- John C Feemster
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Division of Pulmonary and Critical Care Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Tyler A Steele
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Division of Pulmonary and Critical Care Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Kyle P Palermo
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,St. Olaf College, Northfield, MN, USA
| | - Christy L Ralston
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Cornell College, Mount Vernon, IA, USA
| | - Yumeng Tao
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Cornell College, Mount Vernon, IA, USA
| | - David A Bauer
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,St. Olaf College, Northfield, MN, USA
| | - Liam Edgar
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,St. Olaf College, Northfield, MN, USA
| | - Sonia Rivera
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Maxwell Walters-Smith
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Thomas R Gossard
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Division of Pulmonary and Critical Care Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Medicine, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Luke N Teigen
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Division of Pulmonary and Critical Care Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Medicine, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Paul C Timm
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Division of Pulmonary and Critical Care Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Medicine, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Jarrett W Richardson
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Division of Pulmonary and Critical Care Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Psychiatry, Mayo Clinic and Foundation, Rochester, MN, USA
| | - R Robert Auger
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Division of Pulmonary and Critical Care Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Psychiatry, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Bhanuprakash Kolla
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Division of Pulmonary and Critical Care Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Psychiatry, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Stuart J McCarter
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Division of Pulmonary and Critical Care Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Bradley F Boeve
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Division of Pulmonary and Critical Care Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Michael H Silber
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Division of Pulmonary and Critical Care Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Erik K St. Louis
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Division of Pulmonary and Critical Care Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA,Mayo Clinic Health System Southwest Wisconsin, La Crosse, WI, USA,Corresponding author. Erik K. St. Louis, Mayo Center for Sleep Medicine, Departments of Medicine and Neurology, Mayo Clinic College of Medicine, 200 First Street Southwest, Rochester, MN 55905, USA.
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Friedmann F, Hill H, Santangelo P, Ebner-Priemer U, Neubauer AB, Rausch S, Steil R, Müller-Engelmann M, Lis S, Fydrich T, Priebe K. Women with abuse-related PTSD sleep more fitfully but just as long as healthy controls: an actigraphic study. Sleep 2021; 45:6473455. [PMID: 34932818 DOI: 10.1093/sleep/zsab296] [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: 06/28/2021] [Revised: 10/06/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES Subjective reports of sleep impairments are common in individuals with posttraumatic stress disorder (PTSD), but objective assessments of sleep have yielded mixed results. METHODS We investigated sleep via actigraphy and e-diary on 6 consecutive nights in a group of 117 women with PTSD after childhood abuse (CA; PTSD group), a group of 31 mentally healthy women with a history of CA (healthy trauma controls, HTC group) and a group of 36 non-traumatized mentally healthy women (healthy controls, HC group). RESULTS The PTSD group reported lower sleep quality, more nights with nightmares, and shorter sleep duration than both HTC and HC. Actigraphic measures showed more and longer sleep interruptions in the PTSD group compared to HTC and HC, but no difference in sleep duration. While the PTSD group underestimated their sleep duration, both HTC and HC overestimated their sleep duration. HTC did not differ from HC regarding sleep impairments. CONCLUSIONS Sleep in women with PTSD after CA seems to be more fragmented but not shorter compared to sleep patterns of mentally healthy control subjects. The results suggest a stronger effect of PTSD psychopathology on sleep compared to the effect of trauma per se.
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Affiliation(s)
- Franziska Friedmann
- Department of Psychology, Humboldt-Universität zu Berlin, Unter den Linden 6, 10099 Berlin, Germany
| | - Holger Hill
- Mental mHealth Lab, Institute of Sport and Sport Sciences, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany
| | - Philip Santangelo
- Mental mHealth Lab, Institute of Sport and Sport Sciences, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany
| | - Ulrich Ebner-Priemer
- Mental mHealth Lab, Institute of Sport and Sport Sciences, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany.,Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim/Medical Faculty Mannheim, Heidelberg University, J5, 68159 Mannheim, Germany
| | - Andreas B Neubauer
- Department of Education and Human Development, DIPF
- Leibniz Institute for Research and Information in Education, P.O. Box 900270, 60442 Frankfurt am Main, Germany
| | - Sophie Rausch
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim/Medical Faculty Mannheim, Heidelberg University, J5, 68159 Mannheim, Germany
| | - Regina Steil
- Department of Clinical Psychology and Psychotherapy, Goethe University Frankfurt, 60323 Frankfurt am Main, Germany
| | - Meike Müller-Engelmann
- Department of Clinical Psychology and Psychotherapy, Goethe University Frankfurt, 60323 Frankfurt am Main, Germany
| | - Stefanie Lis
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim/Medical Faculty Mannheim, Heidelberg University, J5, 68159 Mannheim, Germany
| | - Thomas Fydrich
- Department of Psychology, Humboldt-Universität zu Berlin, Unter den Linden 6, 10099 Berlin, Germany
| | - Kathlen Priebe
- Department of Psychology, Humboldt-Universität zu Berlin, Unter den Linden 6, 10099 Berlin, Germany.,Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
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Oroian BA, Ciobica A, Timofte D, Stefanescu C, Serban IL. New Metabolic, Digestive, and Oxidative Stress-Related Manifestations Associated with Posttraumatic Stress Disorder. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:5599265. [PMID: 34966477 PMCID: PMC8712172 DOI: 10.1155/2021/5599265] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 09/29/2021] [Accepted: 12/04/2021] [Indexed: 12/14/2022]
Abstract
Posttraumatic stress disorder (PTSD) represents a pressing and generally invalidating syndrome that is triggered by a terrifying or stressful experience, relying on recurrently reliving the traumatic event feelings associated to it, which is subsequently linked to ongoing activations of stress-related neurobiological pathways and is often associated with neurodegeneration. In this paper, we examine what lies beneath this disorder, reviewing evidence that connects PTSD with a wide array of mechanisms and its intertwined pathways that can lead to the decompensation of different pathologies, such as cardiovascular disease, gastrointestinal ailments, autoimmune disorders, and endocrine diseases. Also, the significance of the oxidative stress in this frame of reference is debated. Thus, knowing and identifying the main features of the distressing experience, the circumstances around it, as well as the neuropsychological and emotional characteristics of people prone to develop PTSD after going through disturbing incidents can offer an opportunity to anticipate the development of potential destructive consequences in several psychological dimensions: cognitive, affective, relational, behavioral, and somatic. We can also observe more closely the intricate connections of the disorder to other pathologies and their underlying mechanisms such as inflammation, oxidative stress, bacterial overgrowth syndrome, irritable bowel syndrome, metabolic disorders, oxytocin, and cortisol in order to understand it better and to optimize the course of treatment and its management. The complex foundation PTSD possesses is supported by the existing clinical, preclinical, and experimental data encompassed in the current review. Different biological systems and processes such as the hypothalamic-pituitary-adrenal axis, sympathetic nervous system, oxidative stress, inflammation, and microbiome suffer modifications and changes when it comes to PTSD; that is why targeted therapies exert tremendous alleviations of symptoms in patients diagnosed with this disorder. Therefore, this implies that PTSD is not restricted to the psychiatric domain and should be viewed as a systemic condition.
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Affiliation(s)
| | - Alin Ciobica
- Department of Biology, Faculty of Biology, Alexandru Ioan Cuza University, B dul Carol I No. 11 Iasi, Romania
| | - Daniel Timofte
- “Grigore T. Popa” University of Medicine and Pharmacy, 16, Universitatii Street, 700115 Iasi, Romania
| | - Cristinel Stefanescu
- “Grigore T. Popa” University of Medicine and Pharmacy, 16, Universitatii Street, 700115 Iasi, Romania
| | - Ionela Lăcrămioara Serban
- “Grigore T. Popa” University of Medicine and Pharmacy, 16, Universitatii Street, 700115 Iasi, Romania
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48
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Kobayashi I, Mellman TA, Cannon A, Brown I, Boadi L, Howell MK, Lavela P, Sandhu I. Blocking the orexin system following therapeutic exposure promoted between session habituation, but not PTSD symptom reduction. J Psychiatr Res 2021; 145:222-229. [PMID: 34933185 PMCID: PMC9192822 DOI: 10.1016/j.jpsychires.2021.12.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/06/2021] [Accepted: 12/11/2021] [Indexed: 11/24/2022]
Abstract
There is a need to identify strategies to increase the effectiveness of treatments for posttraumatic stress disorder (PTSD). Sleep is often disturbed in PTSD and has been implicated in learning processes that underlie recovery from PTSD, including extinction of conditioned fear. Our prior study suggested that diminished arousal during sleep may enhance benefits of therapeutic exposure for PTSD. The orexin system regulates arousal, and blocking the system diminishes arousal and promotes sleep. We, therefore, examined whether a dual orexin receptor antagonist, suvorexant, administered following evening exposure sessions, would enhance their therapeutic effectiveness for PTSD. In this randomized double-blind placebo-controlled trial, adults with PTSD completed four written narrative exposure (WNE) sessions, two of which took place in the evening, and two the next morning. Participants received either suvorexant or placebo after each evening WNE. We found that suvorexant increased N3 sleep and decreased N2 sleep and rapid-eye-movement latency measured by polysomnography. Between session habituation indexed by subjective distress ratings was greater with suvorexant, but there was no group difference in the reduction of PTSD severity from baseline to 1-week follow-up. No safety concerns emerged. The present findings provide preliminary support for enhancement of an effect of therapeutic exposure for PTSD by suvorexant. Further studies with larger samples are needed to translate the present findings into clinical applications, including studies to develop optimal suvorexant administration and exposure session schedules to achieve persistent benefits to sleep and possibly greater treatment augmentation.
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Affiliation(s)
- Ihori Kobayashi
- Department of Psychiatry and Behavioral Sciences, Howard University, Washington, DC, USA.
| | - Thomas A Mellman
- Department of Psychiatry and Behavioral Sciences, Howard University, Washington, DC, USA
| | - Ashley Cannon
- Department of Psychiatry and Behavioral Sciences, Howard University, Washington, DC, USA
| | - Imani Brown
- Department of Psychiatry and Behavioral Sciences, Howard University, Washington, DC, USA
| | - Linda Boadi
- Department of Psychiatry and Behavioral Sciences, Howard University, Washington, DC, USA
| | | | - Pewu Lavela
- Department of Psychiatry and Behavioral Sciences, Howard University, Washington, DC, USA
| | - Ishaan Sandhu
- Department of Psychiatry and Behavioral Sciences, Howard University, Washington, DC, USA
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49
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Chellappa SL, Aeschbach D. Sleep and anxiety: From mechanisms to interventions. Sleep Med Rev 2021; 61:101583. [PMID: 34979437 DOI: 10.1016/j.smrv.2021.101583] [Citation(s) in RCA: 104] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 12/31/2022]
Abstract
Anxiety is the most common mental health problem worldwide. Epidemiological studies show that sleep disturbances, particularly insomnia, affect ∼50% of individuals with anxiety, and that insufficient sleep can instigate or further exacerbate it. This review outlines brain mechanisms underlying sleep and anxiety, by addressing recent human functional/structural imaging studies on brain networks underlying the anxiogenic impact of sleep loss, and the beneficial effect of sleep on these brain networks. We discuss recent developments from human molecular imaging studies that highlight the role of specific brain neurotransmitter mechanisms, such as the adenosinergic receptor system, on anxiety, arousal, and sleep. This review further discusses frontline sleep interventions aimed at enhancing sleep in individuals experiencing anxiety, such as nonbenzodiazepines/antidepressants, lifestyle and sleep interventions and cognitive behavioral therapy for insomnia. Notwithstanding therapeutic success, up to ∼30% of individuals with anxiety can be nonresponsive to frontline treatments. Thus, we address novel non-invasive brain stimulation techniques that can enhance electroencephalographic slow waves, and might help alleviate sleep and anxiety symptoms. Collectively, these findings contribute to an emerging biological framework that elucidates the interrelationship between sleep and anxiety, and highlight the prospect of slow wave sleep as a potential therapeutic target for reducing anxiety.
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Affiliation(s)
- Sarah L Chellappa
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany.
| | - Daniel Aeschbach
- Department of Sleep and Human Factors Research, Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany; Institute of Experimental Epileptology and Cognition Research, University of Bonn Medical Center, Bonn, Germany; Division of Sleep Medicine, Harvard Medical School, Boston, United States
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50
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Williamson JB, Jaffee MS, Jorge RE. Posttraumatic Stress Disorder and Anxiety-Related Conditions. Continuum (Minneap Minn) 2021; 27:1738-1763. [PMID: 34881734 DOI: 10.1212/con.0000000000001054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW This article provides a synopsis of current assessment and treatment considerations for posttraumatic stress disorder (PTSD) and related anxiety disorder characteristics. Epidemiologic and neurobiological data are reviewed as well as common associated symptoms, including sleep disruption, and treatment approaches to these conditions. RECENT FINDINGS PTSD is no longer considered an anxiety-related disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition classification and instead is associated with trauma/stressor-related disorders. PTSD symptoms are clustered into four domains including intrusive experiences, avoidance, mood, and arousal symptoms. Despite this reclassification, similarities exist in consideration of diagnosis, treatment, and comorbidities with anxiety disorders. PTSD and anxiety-related disorders are heterogeneous, which is reflected by the neural circuits involved in the genesis of symptoms that may vary across symptom domains. Treatment is likely to benefit from consideration of this heterogeneity.Research in animal models of fear and anxiety, as well as in humans, suggests that patients with PTSD and generalized anxiety disorder have difficulty accurately determining safety from danger and struggle to suppress fear in the presence of safety cues.Empirically supported psychotherapies commonly involved exposure (fear extinction learning) and are recommended for PTSD. Cognitive-behavioral therapy has been shown to be effective in other anxiety-related disorders. Selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) are commonly used in the treatment of PTSD and anxiety disorders in which pharmacologic intervention is supported. Treating sleep disruption including sleep apnea (continuous positive airway pressure [CPAP]), nightmares, and insomnia (preferably via psychotherapy) may improve symptoms of PTSD, as well as improve mood in anxiety disorders. SUMMARY PTSD has a lifetime prevalence that is close to 10% and shares neurobiological features with anxiety disorders. Anxiety disorders are the most common class of mental conditions and are highly comorbid with other disorders; treatment considerations typically include cognitive-behavioral therapy and pharmacologic intervention. Developing technologies show some promise as treatment alternatives in the future.
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