1
|
Thompson LM, Slavish DC, Messman BA, Dietch JR, Kelly K, Ruggero C, Taylor DJ, Ramarushton B, Blumenthal H. Alcohol Use Predicts Longer But More Fragmented Sleep: A Daily Diary Study of Alcohol, Sleep, and PTSD in Nurses. Int J Behav Med 2024:10.1007/s12529-024-10308-z. [PMID: 38977540 DOI: 10.1007/s12529-024-10308-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND Due to the demanding nature of their profession, nurses are at risk of experiencing irregular sleep patterns, substance use, and fatigue. Evidence supports a reciprocal relationship between alcohol use and sleep disturbances; however, no research has examined such a link in a sample of nurses. One factor that may further impact the dynamic between alcohol and sleep patterns is posttraumatic stress disorder (PTSD) symptoms. We investigated the daily bidirectional associations between alcohol use and several sleep domains (i.e., self-report and actigraphy-determined sleep), and moderation by baseline PTSD symptom severity. METHOD Over a 14-day period, 392 nurses (92% female; 78% White) completed sleep diaries and actigraphy to assess alcohol use and sleep patterns. Within-person bidirectional associations between alcohol and sleep were examined using multilevel models, with symptoms of PTSD as a cross-level moderator. RESULTS Daily alcohol use (i.e., ≥ 1 alcoholic beverage; 25.76%) was associated with shorter self-reported sleep onset latency (b = -4.21, p = .003) but longer self-reported wake after sleep onset (b = 2.36, p = .009). Additionally, days with any alcohol use were associated with longer self-reported sleep duration (b = 15.60, p = .006) and actigraphy-determined sleep duration (b = 10.06, p = .037). No sleep variables were associated with next-day alcohol use. Bidirectional associations between alcohol consumption and sleep were similar regardless of baseline PTSD symptoms. CONCLUSION Our results suggested that on days when nurses drank alcohol, they experienced longer but also more fragmented sleep.
Collapse
Affiliation(s)
- Linda M Thompson
- Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX, 76203, USA.
| | - Danica C Slavish
- Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX, 76203, USA.
| | - Brett A Messman
- Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX, 76203, USA
| | - Jessica R Dietch
- School of Psychological Science, Oregon State University, 2950 SW Jefferson Way, Corvallis, OR, 97331, USA
| | - Kimberly Kelly
- Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX, 76203, USA
| | - Camilo Ruggero
- School of Behavioral and Brain Sciences, University of Texas at Dallas, 800 West Campbell Road, Richardson, TX, 75080, USA
| | - Daniel J Taylor
- Department of Psychology, University of Arizona, 1503 E University Blvd, Tucson, AZ, 85721, USA
| | - Banan Ramarushton
- Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX, 76203, USA
| | - Heidemarie Blumenthal
- Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX, 76203, USA
| |
Collapse
|
2
|
Yuan P, Hu X, Qi G, Dai X, Chu X, Chen W, Shi X. [Poor sleep quality contributes to occurrence of posttraumatic stress disorder in trauma patients]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2024; 44:1166-1172. [PMID: 38977347 PMCID: PMC11237292 DOI: 10.12122/j.issn.1673-4254.2024.06.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
OBJECTIVE To evaluate the impact of poor sleep quality on occurrence of post-traumatic stress disorder (PTSD) in trauma patients. METHODS We prospectively recruited 256 trauma patients hospitalized in 4 general hospitals in Zunyi during the period from October, 2021 to November, 2022, and 226 of the participants completed the PTSD survey and assessment. The patients' sleep quality within a month before trauma was estimated using Pittsburgh Sleep Quality Index (PSQI), and their sleep quality within 7 days after admission was monitored by smart bracelet sleep monitoring; the PTSD Checklist-Civilian Version (PCL-C) was used to detect the occurrence of PTSD during the follow-up. RESULTS The detection rate of PTSD in the patients was 19.47% at 1 month and 17.61% at 3 months after trauma. The patients who developed PTSD had poorer sleep quality before the trauma, as shown by significantly higher PSQI scale scores (P < 0.001), than those without PTSD, and they showed a sleep abnormality rate as high as 72.73% prior to PTSD onset. Within 7 days after admission, the patients developing PTSD had lower sleep quality scores with more frequent night awakenings (P < 0.05). A 1 month and 3 months after trauma, the patients with PTSD had significantly higher PSQI scores than those without PTSD (P < 0.05). CONCLUSION PTSD is more likely to occur in trauma patients with poor sleep quality before trauma.
Collapse
Affiliation(s)
- P Yuan
- Department of Epidemiology and Health Statistics, School of Public Health, Zunyi Medical University, Zunyi 563006, China
| | - X Hu
- Department of Public Health, Xishui County People's Hospital, Zunyi 564600, China
| | - G Qi
- Department of Epidemiology and Health Statistics, School of Public Health, Zunyi Medical University, Zunyi 563006, China
| | - X Dai
- Department of Epidemiology and Health Statistics, School of Public Health, Zunyi Medical University, Zunyi 563006, China
| | - X Chu
- Department of Epidemiology and Health Statistics, School of Public Health, Zunyi Medical University, Zunyi 563006, China
| | - W Chen
- Department of Epidemiology and Health Statistics, School of Public Health, Zunyi Medical University, Zunyi 563006, China
| | - X Shi
- Department of Epidemiology and Health Statistics, School of Public Health, Zunyi Medical University, Zunyi 563006, China
| |
Collapse
|
3
|
Maurer JJ, Lin A, Jin X, Hong J, Sathi N, Cardis R, Osorio-Forero A, Lüthi A, Weber F, Chung S. Homeostatic regulation of rapid eye movement sleep by the preoptic area of the hypothalamus. eLife 2024; 12:RP92095. [PMID: 38884573 PMCID: PMC11182646 DOI: 10.7554/elife.92095] [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] [Indexed: 06/18/2024] Open
Abstract
Rapid eye movement sleep (REMs) is characterized by activated electroencephalogram (EEG) and muscle atonia, accompanied by vivid dreams. REMs is homeostatically regulated, ensuring that any loss of REMs is compensated by a subsequent increase in its amount. However, the neural mechanisms underlying the homeostatic control of REMs are largely unknown. Here, we show that GABAergic neurons in the preoptic area of the hypothalamus projecting to the tuberomammillary nucleus (POAGAD2→TMN neurons) are crucial for the homeostatic regulation of REMs in mice. POAGAD2→TMN neurons are most active during REMs, and inhibiting them specifically decreases REMs. REMs restriction leads to an increased number and amplitude of calcium transients in POAGAD2→TMN neurons, reflecting the accumulation of REMs pressure. Inhibiting POAGAD2→TMN neurons during REMs restriction blocked the subsequent rebound of REMs. Our findings reveal a hypothalamic circuit whose activity mirrors the buildup of homeostatic REMs pressure during restriction and that is required for the ensuing rebound in REMs.
Collapse
Affiliation(s)
- John J Maurer
- Department of Neuroscience, Chronobiology and Sleep Institute, Perelman School of Medicine, University of PennsylvaniaPhiladelphiaUnited States
| | - Alexandra Lin
- Department of Neuroscience, Chronobiology and Sleep Institute, Perelman School of Medicine, University of PennsylvaniaPhiladelphiaUnited States
| | - Xi Jin
- Department of Neuroscience, Chronobiology and Sleep Institute, Perelman School of Medicine, University of PennsylvaniaPhiladelphiaUnited States
| | - Jiso Hong
- Department of Neuroscience, Chronobiology and Sleep Institute, Perelman School of Medicine, University of PennsylvaniaPhiladelphiaUnited States
| | - Nicholas Sathi
- Department of Neuroscience, Chronobiology and Sleep Institute, Perelman School of Medicine, University of PennsylvaniaPhiladelphiaUnited States
| | - Romain Cardis
- Department of Fundamental Neurosciences, University of LausanneLausanneSwitzerland
| | | | - Anita Lüthi
- Department of Fundamental Neurosciences, University of LausanneLausanneSwitzerland
| | - Franz Weber
- Department of Neuroscience, Chronobiology and Sleep Institute, Perelman School of Medicine, University of PennsylvaniaPhiladelphiaUnited States
| | - Shinjae Chung
- Department of Neuroscience, Chronobiology and Sleep Institute, Perelman School of Medicine, University of PennsylvaniaPhiladelphiaUnited States
| |
Collapse
|
4
|
Shah AJ, Vaccarino V, Goldberg J, Huang M, Ko YA, Ma X, Levantsevych OM, Smith NL, Alagar N, Mousselli I, Johnson DA, Clifford GD, Bremner JD, Bliwise DL. Posttraumatic Stress Disorder and Obstructive Sleep Apnea in Twins. JAMA Netw Open 2024; 7:e2416352. [PMID: 38913378 PMCID: PMC11197451 DOI: 10.1001/jamanetworkopen.2024.16352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 03/13/2024] [Indexed: 06/25/2024] Open
Abstract
Importance Obstructive sleep apnea (OSA) is a common condition in older adult (aged >65 years) populations, but more mechanistic research is needed to individualize treatments. Previous evidence has suggested an association between OSA and posttraumatic stress disorder (PTSD) but is limited by possible selection bias. High-quality research on this association with a careful evaluation of possible confounders may yield important mechanistic insight into both conditions and improve treatment efforts. Objective To investigate the association of current PTSD symptoms and PTSD diagnosis with OSA. Design, Setting, and Participants This cross-sectional study of twin pairs discordant for PTSD, which allows for adjustment for familial factors, was conducted using in-laboratory polysomnography from March 20, 2017, to June 3, 2019. The study sample comprised male veteran twins recruited from the Vietnam Era Twin Registry. The data analysis was performed between June 11, 2022, and January 30, 2023. Exposure Symptoms of PTSD in twins who served in the Vietnam War. Diagnosis of PTSD was a secondary exposure. Main Outcomes and Measures Obstructive sleep apnea was assessed using the apnea-hypopnea index (AHI) (≥4% oxygen saturation criterion as measured by events per hour) with overnight polysomnography. Symptoms of PTSD were assessed using the PTSD Checklist (PCL) and structured clinical interview for PTSD diagnosis. Results A total of 181 male twins (mean [SD] age, 68.4 [2.0] years) including 66 pairs discordant for PTSD symptoms and 15 pairs discordant for a current PTSD diagnosis were evaluated. In models examining the PCL and OSA within pairs and adjusted for body mass index (BMI) and other sociodemographic, cardiovascular, and psychiatric risk factors (including depression), each 15-point increase in PCL was associated with a 4.6 (95% CI, 0.1-9.1) events-per-hour higher AHI. Current PTSD diagnosis was associated with an adjusted 10.5 (95% CI, 5.7-15.3) events-per-hour higher AHI per sleep-hour. Comparable standardized estimates of the association of PTSD symptoms and BMI with AHI per SD increase (1.9 events per hour; 95% CI, 0.5-3.3 events per hour) were found. Conclusions and Relevance This cross-sectional study found an association between PTSD and sleep-disordered breathing. The findings have important public health implications and may also enhance understanding of the many factors that potentially affect OSA pathophysiology.
Collapse
Affiliation(s)
- Amit J. Shah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Atlanta Veterans Affairs Healthcare System, Decatur, Georgia
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Jack Goldberg
- Seattle Epidemiologic Research and Information Center, Office of Research and Development, Department of Veterans Affairs, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle
| | - Minxuan Huang
- Department of Pediatrics, Stanford University, California
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Xin Ma
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | - Oleksiy M. Levantsevych
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Nicholas L. Smith
- Seattle Epidemiologic Research and Information Center, Office of Research and Development, Department of Veterans Affairs, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle
| | - Nikila Alagar
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Iman Mousselli
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Dayna A. Johnson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Gari D. Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, Georgia
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia
| | - J. Douglas Bremner
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Donald L. Bliwise
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
| |
Collapse
|
5
|
Semenza DC, Silver IA, Stansfield R, Bamwine P. Local gun violence, mental health, and sleep: A neighborhood analysis in one hundred US Cities. Soc Sci Med 2024; 351:116929. [PMID: 38733888 DOI: 10.1016/j.socscimed.2024.116929] [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] [Received: 06/05/2023] [Revised: 11/29/2023] [Accepted: 04/29/2024] [Indexed: 05/13/2024]
Abstract
RATIONALE Community gun violence significantly shapes public health and collective well-being. Understanding how gun violence is associated with community health outcomes like mental health and sleep is crucial for developing interventions to mitigate disparities exacerbated by violence exposure. OBJECTIVE This study examines the associations between community gun violence , insufficient sleep, and poor mental health across neighborhoods in the United States. METHODS We utilized a novel database covering nearly 16,000 neighborhoods in 100 US cities from 2014 through 2019. Correlated trait fixed-effects models were employed to conduct all analyses while considering various neighborhood covariates such as concentrated disadvantage, demographic composition, population density, and proximity to trauma centers. RESULTS Our analysis revealed that greater gun violence is associated with both insufficient sleep and poor mental health in subsequent years. There is a reciprocal relationship between poor mental health and insufficient sleep, with each partially mediating the other's association with community gun violence. Notably, gun violence exhibits the strongest direct association with poor sleep rather than with poor mental health. We found a consistent reciprocal relationship between sleep and mental health at the community level. CONCLUSIONS The findings highlight a complex interplay between community violence, sleep, and mental health, underlining the importance of reducing community violence through numerous long-term interventions to address health disparities across the US.
Collapse
Affiliation(s)
- Daniel C Semenza
- Department of Sociology, Anthropology, and Criminal Justice, Rutgers University - Camden, NJ, USA; Department of Urban-Global Public Health, Rutgers University, New Brunswick, NJ, USA; New Jersey Gun Violence Research Center, Rutgers University, NJ, USA.
| | - Ian A Silver
- Research Triangle Institute, Research Triangle Park, NC, USA
| | - Richard Stansfield
- Department of Sociology, Anthropology, and Criminal Justice, Rutgers University - Camden, NJ, USA
| | - Patricia Bamwine
- College of Social Work, University of Tennessee, Knoxville, TN, USA
| |
Collapse
|
6
|
Hong J, Choi K, Fuccillo MV, Chung S, Weber F. Infralimbic activity during REM sleep facilitates fear extinction memory. Curr Biol 2024; 34:2247-2255.e5. [PMID: 38714199 PMCID: PMC11111341 DOI: 10.1016/j.cub.2024.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/03/2024] [Accepted: 04/08/2024] [Indexed: 05/09/2024]
Abstract
Rapid eye movement (REM) sleep is known to facilitate fear extinction and play a protective role against fearful memories.1,2 Consequently, disruption of REM sleep after a traumatic event may increase the risk for developing PTSD.3,4 However, the underlying mechanisms by which REM sleep promotes extinction of aversive memories remain largely unknown. The infralimbic cortex (IL) is a key brain structure for the consolidation of extinction memory.5 Using calcium imaging, we found in mice that most IL pyramidal neurons are intensively activated during REM sleep. Optogenetically suppressing the IL specifically during REM sleep within a 4-h window after auditory-cued fear conditioning impaired extinction memory consolidation. In contrast, REM-specific IL inhibition after extinction learning did not affect the extinction memory. Whole-cell patch-clamp recordings demonstrated that inactivating IL neurons during REM sleep depresses their excitability. Together, our findings suggest that REM sleep after fear conditioning facilitates fear extinction by enhancing IL excitability and highlight the importance of REM sleep in the aftermath of traumatic events for protecting against traumatic memories.
Collapse
Affiliation(s)
- Jiso Hong
- Department of Neuroscience, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Chronobiology and Sleep Institute, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Kyuhyun Choi
- Department of Neuroscience, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Marc V Fuccillo
- Department of Neuroscience, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Shinjae Chung
- Department of Neuroscience, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Chronobiology and Sleep Institute, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Franz Weber
- Department of Neuroscience, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Chronobiology and Sleep Institute, University of Pennsylvania, Philadelphia, PA 19104, USA.
| |
Collapse
|
7
|
Cornelius T, Edmondson D, Abdalla M, Scott A, Sedano BF, Hiti D, Sullivan AM, Schwartz JE, Kronish IM, Shechter A. Prospective Bidirectional Relationship Between Sleep Duration and Posttraumatic Stress Disorder Symptoms After Suspected Acute Coronary Syndrome. Psychosom Med 2024; 86:283-288. [PMID: 38724037 PMCID: PMC11090408 DOI: 10.1097/psy.0000000000001279] [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] [Indexed: 05/15/2024]
Abstract
OBJECTIVE Sleep disturbance is a "hallmark" symptom of posttraumatic stress disorder (PTSD). Poor sleep (including short sleep) after combat-related trauma can also predict subsequent PTSD. Less is known about the association between sleep duration and PTSD symptoms when PTSD is induced by acute coronary syndrome (ACS). We examined the bidirectional relationship between sleep duration and PTSD symptoms over the year after hospital evaluation for ACS. METHODS Participants were enrolled in this observational study after emergency department evaluation for ACS. Sleep duration ("During the past month, how many hours of actual sleep did you get at night?") and cardiac event or hospitalization-induced PTSD symptoms (PTSD Checklist) were assessed at 1, 6, and 12 months after hospital discharge. Cross-lagged path analysis was used to model the effects of sleep duration and PTSD symptoms on each other. Covariates included age, sex, race/ethnicity, cardiac severity, baseline depression symptoms, and early acute stress disorder symptoms. RESULTS The sample included 1145 participants; 16% screened positive for probable PTSD (PTSD Checklist score ≥33). Mean sleep duration across time points was 6.1 hours. Higher PTSD symptoms predicted shorter sleep duration at the next time point (i.e., 1-6 and 6-12 months; B = -0.14 hours/10-point difference, SE = 0.03, p < .001). Shorter sleep duration was associated with higher PTSD symptoms at the next time point (B = -0.25 points/hour, SE = 0.12, p = .04). CONCLUSIONS Short sleep duration and PTSD symptoms are mutually reinforcing across the first year after ACS evaluation. Findings suggest that sleep, PTSD symptoms, and their relationship should be considered in the post-ACS period.
Collapse
Affiliation(s)
- Talea Cornelius
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Donald Edmondson
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Marwah Abdalla
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Allie Scott
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Brandon Fernandez Sedano
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - David Hiti
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Alexandra M. Sullivan
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Joseph E. Schwartz
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine, Stony Brook, NY
| | - Ian M. Kronish
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Ari Shechter
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
- Center of Excellence for Sleep & Circadian Research, Columbia University Irving Medical Center, New York, NY
| |
Collapse
|
8
|
Barone DA. Secondary RBD: Not just neurodegeneration. Sleep Med Rev 2024; 76:101938. [PMID: 38657360 DOI: 10.1016/j.smrv.2024.101938] [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: 01/16/2024] [Revised: 03/20/2024] [Accepted: 04/11/2024] [Indexed: 04/26/2024]
Abstract
Rapid eye movement sleep behavior disorder is a parasomnia characterized by excessive muscle activity during rapid eye movement sleep (rapid eye movement sleep without atonia), along with dream enactment behavior. Isolated rapid eye movement sleep behavior disorder tends to occur in older males and is of concern due to the known link to Parkinson's disease and other synucleinopathies. When rapid eye movement sleep behavior disorder occurs in association with other neurological or general medical conditions, or resulting from the use of various substances, it is called secondary rapid eye movement sleep behavior disorder; the most common cause is neurodegenerative illness, specifically the synucleinopathies. Here, the focus will be on the subset of secondary rapid eye movement sleep behavior disorder in which there is no neurodegenerative disease.
Collapse
Affiliation(s)
- Daniel A Barone
- Weill Cornell Center for Sleep Medicine, 425 East 61st Street, New York, NY, 10065, USA.
| |
Collapse
|
9
|
Parmenter ME, Lederman S, Weathers FW, Davis LL, Vaughn B, Engels J, Sullivan GM. A phase 3, randomized, placebo-controlled, trial to evaluate the efficacy and safety of bedtime sublingual cyclobenzaprine (TNX-102 SL) in military-related posttraumatic stress disorder. Psychiatry Res 2024; 334:115764. [PMID: 38350291 DOI: 10.1016/j.psychres.2024.115764] [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] [Received: 09/27/2023] [Revised: 01/20/2024] [Accepted: 01/26/2024] [Indexed: 02/15/2024]
Abstract
Sleep disturbances in posttraumatic stress disorder (PTSD) are a potential target for improving PTSD severity with pharmacotherapy. TNX-102 SL is a bedtime sublingual formulation of cyclobenzaprine with potent binding and antagonist activity at 5-HT2A, α1-adrenergic, H1 histaminergic, and M1 muscarinic receptors, which play roles in the pharmacological management of sleep disturbances. This Phase 3 trial evaluated the efficacy and safety of TNX-102 SL in patients with military-related PTSD. Early and sustained improvements in sleep were associated with TNX-102 SL treatment by PROMIS Sleep Disturbance scale and Clinician Administered PTSD Scale (CAPS-5) "sleep disturbance" item, establishing a sleep quality benefit. Primary analysis comparing change from baseline in CAPS-5 total severity between TNX-102 SL and placebo at week 12 was not significant; however, week 4 was associated with an improvement. Secondary analyses showed TNX-102 SL treatment was associated with benefits on the Clinician Global Impression of Improvement at week 4 and the Patient Global Impression of Change at week 12. Time since trauma exposure was a discriminator of CAPS-5 treatment response in the subgroup ≤ 9 years since the index event. This study provides preliminary evidence that TNX-102 SL is well-tolerated and may promote recovery from PTSD by addressing sleep-related symptoms.
Collapse
Affiliation(s)
- Megan E Parmenter
- Massachusetts General Hospital, Home Base Program, Charlestown, MA, United States
| | - Seth Lederman
- Tonix Pharmaceuticals, Inc., Chatham, NJ, United States
| | - Frank W Weathers
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, and Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States
| | - Lori L Davis
- Research Service, Tuscaloosa Veterans Affairs Medical Center, Tuscaloosa, AL, United States; Department of Psychiatry, University of Alabama Heersink School of Medicine, Birmingham, AL, United States; Department of Psychiatry, University of Alabama College of Community Health Sciences, Tuscaloosa, AL
| | | | - Jean Engels
- Tonix Pharmaceuticals, Inc., Chatham, NJ, United States
| | | |
Collapse
|
10
|
Cabrera Y, Koymans KJ, Poe GR, Kessels HW, Van Someren EJW, Wassing R. Overnight neuronal plasticity and adaptation to emotional distress. Nat Rev Neurosci 2024; 25:253-271. [PMID: 38443627 DOI: 10.1038/s41583-024-00799-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2024] [Indexed: 03/07/2024]
Abstract
Expressions such as 'sleep on it' refer to the resolution of distressing experiences across a night of sound sleep. Sleep is an active state during which the brain reorganizes the synaptic connections that form memories. This Perspective proposes a model of how sleep modifies emotional memory traces. Sleep-dependent reorganization occurs through neurophysiological events in neurochemical contexts that determine the fates of synapses to grow, to survive or to be pruned. We discuss how low levels of acetylcholine during non-rapid eye movement sleep and low levels of noradrenaline during rapid eye movement sleep provide a unique window of opportunity for plasticity in neuronal representations of emotional memories that resolves the associated distress. We integrate sleep-facilitated adaptation over three levels: experience and behaviour, neuronal circuits, and synaptic events. The model generates testable hypotheses for how failed sleep-dependent adaptation to emotional distress is key to mental disorders, notably disorders of anxiety, depression and post-traumatic stress with the common aetiology of insomnia.
Collapse
Affiliation(s)
- Yesenia Cabrera
- Department of Integrative Biology and Physiology, Brain Research Institute, University of California Los Angeles, Los Angeles, CA, USA
| | - Karin J Koymans
- Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Gina R Poe
- Department of Integrative Biology and Physiology, Brain Research Institute, University of California Los Angeles, Los Angeles, CA, USA
| | - Helmut W Kessels
- Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, Netherlands
- Department of Synaptic Plasticity and Behaviour, Netherlands Institute for Neuroscience, An Institute of the Royal Netherlands Society for Arts and Sciences, Amsterdam, Netherlands
| | - Eus J W Van Someren
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, An Institute of the Royal Netherlands Society for Arts and Sciences, Amsterdam, Netherlands
- Department of Integrative Neurophysiology and Psychiatry, VU University, Amsterdam UMC, Amsterdam, Netherlands
- Center for Neurogenomics and Cognitive Research, VU University, Amsterdam UMC, Amsterdam, Netherlands
| | - Rick Wassing
- Sleep and Circadian Research, Woolcock Institute of Medical Research, Macquarie University, Sydney, New South Wales, Australia.
- School of Psychological Sciences, Faculty of Medicine Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia.
- Sydney Local Health District, Sydney, New South Wales, Australia.
| |
Collapse
|
11
|
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).
Collapse
|
12
|
Mijnster T, Boersma GJ, van Veen MM, Liemburg E, Cath D, Pijnenborg GHM, De Jong PJ, Lancel M. Sleep disorders in a naturalistic cohort of Dutch psychiatric outpatients: prevalence rates and associations with psychopathology symptom severity and well-being. J Sleep Res 2024; 33:e14009. [PMID: 37533279 DOI: 10.1111/jsr.14009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/30/2023] [Accepted: 07/07/2023] [Indexed: 08/04/2023]
Abstract
Sleep problems are very common in individuals with a mental disorder. Given the abundant evidence indicating the negative impact of disturbed sleep on mental health outcome, insight into the prevalence of all types of sleep disorders in specific mental disorders and neurodevelopmental conditions is of practical importance. Therefore, we estimated the prevalence of six types of sleep disorders with the Holland Sleep Disorders Questionnaire in an overall mental health sample (n = 1082) and separately for different mental and neurodevelopmental conditions. Furthermore, associations between specific sleep disorders, psychopathology and well-being were studied. The impact of the total number of sleep disorders on these associations was examined. Overall, 46.2% of all participants scored above the cut-off for having a sleep disorder. Specifically, 26.8% scored on insomnia, 12.1% on sleep breathing disorders, 9.7% on hypersomnia, 13.7% on circadian rhythm sleep-wake disorders, 11.2% on parasomnia, and 17.9% on sleep-related movement disorders. Most sleep disorders were associated with greater severity of psychopathology and lower well-being. These associations got stronger with an increasing number of sleep disorders. Our study revealed higher suspected prevalence of most sleep disorders in a mental disorder sample compared to the general population. Moreover, the presence of sleep disorder(s) was strongly associated with symptom severity and reduced well-being. These findings extend the notion that early detection and treatment of sleep disorders in mental health populations is essential for psychiatric outcome.
Collapse
Affiliation(s)
- Teus Mijnster
- Centre of Expertise on Sleep and Psychiatry, GGZ Drenthe Mental Health Institute, Assen, The Netherlands
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Gretha J Boersma
- Forensic Psychiatric Hospital, GGZ Drenthe Mental Health Institute, Assen, The Netherlands
| | - Maaike M van Veen
- Centre of Expertise on Sleep and Psychiatry, GGZ Drenthe Mental Health Institute, Assen, The Netherlands
| | - Edith Liemburg
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Daniëlle Cath
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Specialist Trainings, GGZ Drenthe Mental Health Institute, Assen, The Netherlands
| | - Gerdina H M Pijnenborg
- Department of Psychotic Disorders, GGZ Drenthe Mental Health Institute, Assen, The Netherlands
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | - Peter J De Jong
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Marike Lancel
- Centre of Expertise on Sleep and Psychiatry, GGZ Drenthe Mental Health Institute, Assen, The Netherlands
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
- Forensic Psychiatric Hospital, GGZ Drenthe Mental Health Institute, Assen, The Netherlands
| |
Collapse
|
13
|
Iglesias N, Campbell MS, Dabaghi E, Prasai A, Ben-Aissa A, Ozhathil D, Jay J, Song J, Golovko G, Wolf S, El Ayadi A. Post-traumatic stress disorder in burn patients - A large database analysis. Burns 2024; 50:561-568. [PMID: 38233276 DOI: 10.1016/j.burns.2023.12.016] [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] [Received: 10/03/2022] [Revised: 12/21/2023] [Accepted: 12/30/2023] [Indexed: 01/19/2024]
Abstract
INTRODUCTION Post-traumatic stress disorder (PTSD) afflicts a significant portion of burn patients. This study aims to analyze the morbidity, prevalence, and treatment of PTSD in the burn population. METHODS Using the TriNetX database, we identified burned patients > 18 years of age without (A) or with (B) a PTSD diagnosis. Patients were then stratified by percent of total body surface area (TBSA) burned. Morbidity and mortality was analyzed in each cohort. Prevalence and pharmacologic treatments for PTSD were analyzed from 2002 to 2022. RESULTS PTSD incidence increased from 2.4% (n = 2281) in patients with < 10% to 3.1% (n = 542) in 10-30%, 7.4% (n = 285) in 30-59%, and 5.3% (n = 90) in > 60% TBSA burned. In patients with < 60% TBSA burned, PTSD diagnosis increased the risk of depression (p = <0.0003) and anxiety (p = <0.0001). In those with < 30% TBSA burned, PTSD diagnosis also increased risk of insomnia (p = <0.0001) and pruritus (p = 0.0211 for TBSA <10% and 0.0059 for TBSA 10-29%). PTSD diagnosis was associated with a decreased risk of mortality in patients with > 30% TBSA burned (p = 0.0179 for TBSA 30-59% and p = 0.0089 for TBSA >60%). From 2002 to 2022, the prevalence of PTSD in all burn patients was relatively stable between 2.2% and 3.2%. We found an increase in the use of serotonergic agents and prazosin for the treatment of PTSD during this timeframe. CONCLUSION PTSD is not uncommon in the burn population, and those with burns and concomitant PTSD have an increased risk of morbidity. Screening and preventative measures to reduce morbidity and early implementation of care in burned patients with PTSD are indicated.
Collapse
Affiliation(s)
- Nicholas Iglesias
- Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA
| | - Matthew Steven Campbell
- Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA
| | - Elissa Dabaghi
- Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA
| | - Anesh Prasai
- Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA
| | - Ameerah Ben-Aissa
- Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA
| | - Deepak Ozhathil
- Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA
| | - Jayson Jay
- Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA
| | - Juquan Song
- Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA
| | - George Golovko
- Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA
| | - Steven Wolf
- Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA
| | - Amina El Ayadi
- Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA.
| |
Collapse
|
14
|
Barone DA. Trauma-Associated Sleep Disorder. Sleep Med Clin 2024; 19:93-99. [PMID: 38368073 DOI: 10.1016/j.jsmc.2023.10.005] [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: 02/19/2024]
Abstract
Trauma-associated sleep disorder (TASD) is a recently described parasomnia that develops following a traumatic event. It consists of trauma-related nightmares, disruptive nocturnal behaviors, and autonomic disturbances, and shares similarities with post-traumatic stress disorder and rapid eye movement behavior disorder. The underlying pathophysiology of TASD and how it relates to other parasomnias are still not entirely understood; proposed treatment is similarly nebulous, with prazosin at the forefront along with management of comorbid sleep disorders. The purpose of this article is to characterize and highlight the clinical features of this condition.
Collapse
Affiliation(s)
- Daniel A Barone
- Weill Cornell Center for Sleep Medicine, Weill Cornell Medicine, New York-Presbyterian, 425 East 61st Street, 5th Floor, New York, NY 10065, USA.
| |
Collapse
|
15
|
Maurer J, Lin A, Jin X, Hong J, Sathi N, Cardis R, Osorio-Forero A, Lüthi A, Weber F, Chung S. Homeostatic regulation of REM sleep by the preoptic area of the hypothalamus. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2023.08.22.554341. [PMID: 37662417 PMCID: PMC10473649 DOI: 10.1101/2023.08.22.554341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Rapid-eye-movement sleep (REMs) is characterized by activated electroencephalogram (EEG) and muscle atonia, accompanied by vivid dreams. REMs is homeostatically regulated, ensuring that any loss of REMs is compensated by a subsequent increase in its amount. However, the neural mechanisms underlying the homeostatic control of REMs are largely unknown. Here, we show that GABAergic neurons in the preoptic area of the hypothalamus projecting to the tuberomammillary nucleus (POAGAD2→TMN neurons) are crucial for the homeostatic regulation of REMs. POAGAD2→TMN neurons are most active during REMs, and inhibiting them specifically decreases REMs. REMs restriction leads to an increased number and amplitude of calcium transients in POAGAD2→TMN neurons, reflecting the accumulation of REMs pressure. Inhibiting POAGAD2→TMN neurons during REMs restriction blocked the subsequent rebound of REMs. Our findings reveal a hypothalamic circuit whose activity mirrors the buildup of homeostatic REMs pressure during restriction and that is required for the ensuing rebound in REMs.
Collapse
Affiliation(s)
- John Maurer
- Department of Neuroscience, Chronobiology and Sleep Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Alex Lin
- Department of Neuroscience, Chronobiology and Sleep Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Xi Jin
- Department of Neuroscience, Chronobiology and Sleep Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jiso Hong
- Department of Neuroscience, Chronobiology and Sleep Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Nicholas Sathi
- Department of Neuroscience, Chronobiology and Sleep Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Romain Cardis
- Department of Fundamental Neurosciences, University of Lausanne, Rue du Bugnon 9, CH-1005 Lausanne, Switzerland
| | - Alejandro Osorio-Forero
- Department of Fundamental Neurosciences, University of Lausanne, Rue du Bugnon 9, CH-1005 Lausanne, Switzerland
| | - Anita Lüthi
- Department of Fundamental Neurosciences, University of Lausanne, Rue du Bugnon 9, CH-1005 Lausanne, Switzerland
| | - Franz Weber
- Department of Neuroscience, Chronobiology and Sleep Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Shinjae Chung
- Department of Neuroscience, Chronobiology and Sleep Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| |
Collapse
|
16
|
Hulot J, Roseau JB, Gomez-Merino D, Chennaoui M, Saguin E. Clinical description of sleep and trauma-related nightmares in a population of French active-duty members and veterans with Post-Traumatic Stress Disorder. L'ENCEPHALE 2024; 50:11-19. [PMID: 36424208 DOI: 10.1016/j.encep.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/02/2022] [Accepted: 10/08/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Post-traumatic stress disorder (PTSD) is a major public health problem. The most frequent complaints in this pathology are sleep disorders and trauma-related nightmares in particular. Trauma-related nightmares are characteristic of PTSD and impact its severity insofar as they are associated with more severe, longer-lasting symptoms and resistance to first-line treatments. There are specific characteristics associated with military personnel, including overrepresentation of replicative trauma-related nightmares. The aim of this study was to provide an accurate description of sleep patterns and the characteristics of trauma-related nightmares in a population of active-duty members or veterans diagnosed with PTSD. METHODS We recruited active-duty service members and veterans receiving treatment for PTSD in the psychiatric departments of five Military Teaching Hospitals (Hôpitaux d'Instruction des Armées, HIA) and described their sleep characteristics using a questionnaire, the Trauma-Related Nightmare Survey French version (TRNS-FR). RESULTS Out of 77 patients, 72 (93.5%) who experienced traumatic nightmares were included. This population had very severe clinical manifestations of PTSD, with a mean PCL-S score of 62.6 and an estimated total sleep time of 5.3h (317min). Among these patients, 31% had replicative nightmares and 57.7% had partially replicative nightmares. Nightmares were frequent (4.7 nightmares on average over the previous week), highly realistic, and highly immersive with exacerbated symptoms during the nightmare and also upon awakening. DISCUSSION Sleep quality was seriously altered among active-duty service members and veterans treated in Military Hospitals for PTSD with trauma-related nightmares. Certain criteria were identified to help characterize trauma-related nightmares: their level of replication, recurrence and the impact of these symptoms on patients' lives. CONCLUSION Long-term traumatic nightmares are a prominent feature in the symptomatology of active service members and veterans suffering from PTSD. This symptom is of particular interest as it may be a sign of changes in the patient's condition and a potential therapeutic target.
Collapse
Affiliation(s)
- J Hulot
- HIA Percy, 92140 Clamart, France.
| | - J-B Roseau
- Service de pneumologie et de médecine du sommeil, HIA Clermont-Tonnerre, 29240 Brest, France
| | - D Gomez-Merino
- VIFASOM (Vigilance Fatigue Sommeil et Santé Publique) EA 7330, Université de Paris, 75005 Paris, France; Institut de Recherche Biomédicale des Armées, 91220 Brétigny-sur-Orge, France
| | - M Chennaoui
- VIFASOM (Vigilance Fatigue Sommeil et Santé Publique) EA 7330, Université de Paris, 75005 Paris, France; Institut de Recherche Biomédicale des Armées, 91220 Brétigny-sur-Orge, France
| | - E Saguin
- VIFASOM (Vigilance Fatigue Sommeil et Santé Publique) EA 7330, Université de Paris, 75005 Paris, France; Service de Psychiatrie, HIA Bégin, 94160 Saint-Mandé, France
| |
Collapse
|
17
|
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: 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: 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.
Collapse
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
| |
Collapse
|
18
|
Smith J, Honig-Frand A, Antila H, Choi A, Kim H, Beier KT, Weber F, Chung S. Regulation of stress-induced sleep fragmentation by preoptic glutamatergic neurons. Curr Biol 2024; 34:12-23.e5. [PMID: 38096820 PMCID: PMC10872481 DOI: 10.1016/j.cub.2023.11.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 09/28/2023] [Accepted: 11/15/2023] [Indexed: 01/11/2024]
Abstract
Sleep disturbances are detrimental to our behavioral and emotional well-being. Stressful events disrupt sleep, in particular by inducing brief awakenings (microarousals, MAs), resulting in sleep fragmentation. The preoptic area of the hypothalamus (POA) is crucial for sleep control. However, how POA neurons contribute to the regulation of MAs and thereby impact sleep quality is unknown. Using fiber photometry in mice, we examine the activity of genetically defined POA subpopulations during sleep. We find that POA glutamatergic neurons are rhythmically activated in synchrony with an infraslow rhythm in the spindle band of the electroencephalogram during non-rapid eye movement sleep (NREMs) and are transiently activated during MAs. Optogenetic stimulation of these neurons promotes MAs and wakefulness. Exposure to acute social defeat stress fragments NREMs and significantly increases the number of transients in the calcium activity of POA glutamatergic neurons during NREMs. By reducing MAs, optogenetic inhibition during spontaneous sleep and after stress consolidates NREMs. Monosynaptically restricted rabies tracing reveals that POA glutamatergic neurons are innervated by brain regions regulating stress and sleep. In particular, presynaptic glutamatergic neurons in the lateral hypothalamus become activated after stress, and stimulating their projections to the POA promotes MAs and wakefulness. Our findings uncover a novel circuit mechanism by which POA excitatory neurons regulate sleep quality after stress.
Collapse
Affiliation(s)
- Jennifer Smith
- Department of Neuroscience, Chronobiology and Sleep Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Adam Honig-Frand
- Department of Neuroscience, Chronobiology and Sleep Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Hanna Antila
- Department of Neuroscience, Chronobiology and Sleep Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Ashley Choi
- Department of Neuroscience, Chronobiology and Sleep Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Hannah Kim
- Department of Neuroscience, Chronobiology and Sleep Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Kevin T Beier
- Department of Physiology and Biophysics, School of Medicine, University of California, Irvine, Irvine, CA 92617, USA
| | - Franz Weber
- Department of Neuroscience, Chronobiology and Sleep Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Shinjae Chung
- Department of Neuroscience, Chronobiology and Sleep Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
| |
Collapse
|
19
|
Chu X, Dai X, Yuan P, Qi G, Shi X. Epidemical trends and risk factors of PTSD in parents of critically ill children: Evidence from both meta-analysis and subgroup analysis. J Affect Disord 2024; 344:242-251. [PMID: 37832741 DOI: 10.1016/j.jad.2023.10.032] [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] [Received: 05/13/2023] [Revised: 09/07/2023] [Accepted: 10/08/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Post-Traumatic Stress Disorder (PTSD) in parents traumatized by a child's critical illness, while differences in prevalence and risk factors for parental PTSD in previous studies. This study aimed to assess trends in the prevalence and risk factors for PTSD in parents of critically ill children. METHODS Nine main databases were searched to extract the prevalence, sample size and risk factors from the published literature. Random effects model analysis, I2 statistic, quality assessment, subgroup analysis and sensitivity analysis were performed. RESULTS Twenty-five studies met the inclusion criteria, with pooled prevalence rates of 13.8 % (95 % CI: [confidence interval, CI] 10.0 %-17.7 %) in fathers and 20.2 % (95 % CI:16.1 %-24.3 %) in mothers. Mothers had a significantly higher prevalence of PTSD compared to fathers. The prevalence of PTSD generally increased after discharge, with the highest prevalence at 6 months, but then decreased (fathers: 18.0 %, CI: 6.1 %-29.9 %; mothers: 20.2 %, CI: 12.8 %-27.6 %), respectively. The results showed five risks, positive acute stress disorder (ASD) screening (OR [odds ratio, OR] =2.45), disease severity (OR = 3.78), perceived stress (OR = 1.44), unemployed status (OR = 2.52) and length of hospital stay (OR = 1.01). LIMITATIONS Due to the limitations of the original study, we could not explore trends in the prevalence of PTSD in this particular population over a more extended period after hospital discharge. CONCLUSION The prevalence of PTSD among parents of critically ill children is high and significantly different. Therefore, it is crucial to focus on this vulnerable group, providing them with essential psychological counseling and comprehensive social support to reduce the occurrence of PTSD.
Collapse
Affiliation(s)
- Xiangyuan Chu
- Department of Epidemiology and Health Statistics, School of Public Health, Zunyi Medical University, Zunyi, Guizhou, China
| | - Xiu Dai
- Department of Epidemiology and Health Statistics, School of Public Health, Zunyi Medical University, Zunyi, Guizhou, China
| | - Ping Yuan
- Department of Epidemiology and Health Statistics, School of Public Health, Zunyi Medical University, Zunyi, Guizhou, China
| | - Guojia Qi
- Department of Epidemiology and Health Statistics, School of Public Health, Zunyi Medical University, Zunyi, Guizhou, China
| | - Xiuquan Shi
- Department of Epidemiology and Health Statistics, School of Public Health, Zunyi Medical University, Zunyi, Guizhou, China.
| |
Collapse
|
20
|
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.
Collapse
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
| |
Collapse
|
21
|
Latent profile analysis of post-traumatic stress and post-traumatic growth among firefighters. Eur J Psychotraumatol 2023; 14:2159048. [PMID: 37052101 PMCID: PMC9848271 DOI: 10.1080/20008066.2022.2159048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background: Due to the job characteristics, firefighters are repeatedly exposed to trauma incidents. However, not all firefighters exhibit the same level of post-traumatic stress disorder (PTSD) or post-traumatic growth (PTG). Despite this, few studies have looked into firefighters' PTSD and PTG.Objective: This study identified subgroups of firefighters based on their PTSD and PTG levels, and investigated the influence of demographic factors and PTSD/PTG-related factors on latent class classification.Method: Latent profile analysis was used to examine the patterns of PTSD and PTG among 483 firefighters in South Korea. Using a cross-sectional design, demographic factors and job factors were examined as group covariates through a three-step approach. PTSD-related factors such as depression and suicide ideation, as well as PTG-related factors such as emotion-based response were analysed as differentiating factors.Results: Four classes were identified and named 'Low PTSD-low PTG (65.2%),' 'Mid PTSD-mid PTG (15.5%),' 'Low PTSD-high PTG (15.3%),' and 'High PTSD-mid PTG (3.9%).' The likelihood of belonging to the group with high trauma-related risks increased with more rotating shift work and years of service. The differentiating factors revealed differences based on the levels of PTSD and PTG in each group.Conclusions: 34.8% of firefighters experienced changes due to traumatic events while on the job, and some required serious attention. Modifiable job characteristics, such as the shift pattern, indirectly affected PTSD and PTG levels. Individual and job factors should be considered together when developing trauma interventions for firefighters.
Collapse
|
22
|
Khalifian CE, Titone M, Wooldridge JS, Knopp K, Seibert G, Monson C, Morland L. The role of veterans' PTSD symptoms in veteran couples' insomnia. FAMILY PROCESS 2023; 62:1725-1739. [PMID: 36347178 DOI: 10.1111/famp.12835] [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: 09/08/2021] [Revised: 09/14/2022] [Accepted: 09/25/2022] [Indexed: 06/16/2023]
Abstract
Insomnia contributes to individual mental and physical health and relationship well-being. Veterans' PTSD symptoms are associated with their own insomnia. However, research has not explored whether and how veterans' PTSD symptoms are associated with their partners' insomnia. The present study examined the association between veterans' PTSD symptom severity and veterans' and partners' insomnia. Veterans (n = 192) and their partners (n = 192; total N = 384) completed baseline assessments in a PTSD treatment study for veterans with PTSD and their partners. Path analysis was used to examine the relation between veterans' PTSD symptom severity, as measured by the PTSD symptom checklist-5 (PCL-5) and veterans' and partners' insomnia, as measured by the Insomnia Severity Index (ISI). Veterans' full-scale PCL-5 was positively related to veterans' and partners' insomnia. For veterans, intrusion and arousal symptoms were positively related to their own insomnia severity, while veterans' negative alterations in cognition and mood were associated with partners' insomnia severity. In exploratory analyses, partners' depressive symptoms fully mediated the relation between veterans' negative cognitions and mood and partners' insomnia. PTSD symptoms impact both veterans' and partners' insomnia. However, different PTSD symptom clusters were related to insomnia for each partner, and the link for partners was explained by their own depression symptoms. PTSD, insomnia, and integrated treatments should consider strategies for including partners in treatment to address these interconnected problems.
Collapse
Affiliation(s)
- Chandra E Khalifian
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Madison Titone
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Jennalee S Wooldridge
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Kayla Knopp
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Gregory Seibert
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | | | - Leslie Morland
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
- National Center for PTSD -Pacific Islands division, Honolulu, Hawaii, USA
| |
Collapse
|
23
|
Hamilton NA, Russell JA, Youngren WA, Gallegos AM, Crean HF, Cerulli C, Bishop TM, Hamadah K, Schulte M, Pigeon WR, Heffner KL. Cognitive behavioral therapy for insomnia treatment attrition in patients with weekly nightmares. J Clin Sleep Med 2023; 19:1913-1921. [PMID: 37421316 PMCID: PMC10620662 DOI: 10.5664/jcsm.10710] [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] [Received: 01/03/2023] [Revised: 07/03/2023] [Accepted: 07/06/2023] [Indexed: 07/10/2023]
Abstract
STUDY OBJECTIVES This study's objective was to evaluate the effect of nightmares (NMs) on attrition and symptom change following cognitive behavioral therapy for insomnia (CBT-I) treatment using data from a successful CBT-I randomized controlled trial delivered to participants with recent interpersonal violence exposure. METHODS The study randomized 110 participants (107 women; mean age: 35.5 years) to CBT-I or to an attention-control group. Participants were assessed at 3 time periods: baseline, post-CBT-I (or attention control), and at time 3 (T3) post-cognitive processing therapy received by all participants. NM reports were extracted from the Fear of Sleep Inventory. Participants with weekly NMs were compared with those with fewer than weekly NMs on outcomes including attrition, insomnia, posttraumatic stress disorder, and depression. Change in NM frequency was examined. RESULTS Participants with weekly NMs (55%) were significantly more likely to be lost to follow-up post-CBT-I (37%) compared with participants with infrequent NMs (15.6%) and were less likely to complete T3 (43%) than patients with less frequent NMs (62.5%). NMs were unrelated to differential treatment response in insomnia, depression, or posttraumatic stress disorder. Treatment with CBT-I was not associated with reduced NM frequency; however, change in sleep-onset latency from post-CBT-I to T3 predicted fewer NMs at T3. CONCLUSIONS Weekly NMs were associated with attrition but not a reduced change in insomnia symptoms following CBT-I. NM symptoms did not change as a function of CBT-I, but change in sleep-onset latency predicted lower NM frequency. CBT-I trials should screen for NMs and consider augmenting CBT-I to specifically address NMs. CITATION Hamilton NA, Russell JA, Youngren WA, et al. Cognitive behavioral therapy for insomnia treatment attrition in patients with weekly nightmares. J Clin Sleep Med. 2023;19(11):1913-1921.
Collapse
Affiliation(s)
| | | | - Westley A. Youngren
- U.S. Department of Veterans Affairs Center of Excellence for Suicide Prevention, Finger Lakes Health Care System, Canandaigua, New York
| | - Autumn M. Gallegos
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
| | - Hugh F. Crean
- U.S. Department of Veterans Affairs Center of Excellence for Suicide Prevention, Finger Lakes Health Care System, Canandaigua, New York
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
- Elaine Hubbard Center for Nursing Research on Aging, School of Nursing, University of Rochester Medical Center, Rochester, New York
| | - Catherine Cerulli
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
- Susan B. Anthony Center and Laboratory of Interpersonal Violence and Victimization, University of Rochester Medical Center, Rochester, New York
| | - Todd M. Bishop
- U.S. Department of Veterans Affairs Center of Excellence for Suicide Prevention, Finger Lakes Health Care System, Canandaigua, New York
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
| | | | | | - Wilfred R. Pigeon
- U.S. Department of Veterans Affairs Center of Excellence for Suicide Prevention, Finger Lakes Health Care System, Canandaigua, New York
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
| | - Kathi L. Heffner
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
- Elaine Hubbard Center for Nursing Research on Aging, School of Nursing, University of Rochester Medical Center, Rochester, New York
- Division of Geriatrics & Aging, Department of Medicine, University of Rochester Medical Center, Rochester, New York
| |
Collapse
|
24
|
Wickwire EM, Albrecht JS, Capaldi VF, Jain S, Gardner RC, Smith MT, Williams SG, Collen J, Schnyer DM, Giacino JT, Nelson LD, Mukherjee P, Sun X, Werner JK, Mosti CB, Markowitz AJ, Manley GT, Krystal AD. Association Between Insomnia and Mental Health and Neurocognitive Outcomes Following Traumatic Brain Injury. J Neurotrauma 2023. [PMID: 37463057 DOI: 10.1089/neu.2023.0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
We previously described five trajectories of insomnia (each defined by a distinct pattern of insomnia severity over 12 months following traumatic brain injury [TBI]). Our objective in the present study was to estimate the association between insomnia trajectory status and trajectories of mental health and neurocognitive outcomes during the 12 months after TBI. In this study, participants included N = 2022 adults from the Federal Inter-agency Traumatic Brain Injury Repository database and Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) study. The following outcome measures were assessed serially at 2 weeks, and 3, 6, and 12 months post-injury: Insomnia Severity Index, Patient Health Questionnaire, Post-Traumatic Stress Disorder (PTSD) Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), Patient Reported Outcomes Measurement Information System-Pain, and Quality of Life After Brain Injury-Overall Scale. Neurocognitive performance was assessed at 2 weeks, and 6 and 12 months using the Wechsler Adult Intelligence Scales Processing Speed Index and the Trails Making Test Parts A and B. Results indicated that greater insomnia severity was associated with greater abnormality in mental health, quality of life, and neuropsychological testing outcomes. The pattern of insomnia over time tracked the temporal pattern of all these outcomes for all but a very small number of participants. Notably, severe insomnia at 3 or 6 months post-TBI was a risk factor for poor recovery at 12 months post-injury. In conclusion, in this well-characterized sample of individuals with TBI, insomnia severity generally tracked severity of depression, pain, PTSD, quality of life, and neurocognitive outcomes over 12 months post-injury. More intensive sleep assessment is needed to elucidate the nature of these relationships and to help inform best strategies for intervention.
Collapse
Affiliation(s)
- Emerson M Wickwire
- Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jennifer S Albrecht
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Vincent F Capaldi
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Sonia Jain
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, California, USA
| | - Raquel C Gardner
- Department of Neurology, University of California, San Francisco, San Francisco, California, USA
| | - Michael T Smith
- Department of Psychiatry, Division of Behavioral Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Scott G Williams
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Department of Medicine, Fort Belvoir Community Hospital, Fort Belvoir, Virginia, USA
- Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Jacob Collen
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Sleep Disorders Center, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - David M Schnyer
- Department of Psychology, University of Texas Austin, Austin, Texas, USA
| | - Joseph T Giacino
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
| | - Lindsay D Nelson
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Pratik Mukherjee
- Department of Radiology, University of California, San Francisco, San Francisco, California, USA
| | - Xiaoying Sun
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, California, USA
| | - J Kent Werner
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Department of Neurology, Division of Behavioral Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Caterina B Mosti
- Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA
| | - Amy J Markowitz
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Geoffrey T Manley
- Brain and Spinal Injury Center, University of California, San Francisco, San Francisco, California, USA
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California, USA
| | - Andrew D Krystal
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| |
Collapse
|
25
|
Denis D, Bottary R, Cunningham TJ, Drummond SPA, Straus LD. Beta spectral power during sleep is associated with impaired recall of extinguished fear. Sleep 2023; 46:zsad209. [PMID: 37542729 PMCID: PMC10566240 DOI: 10.1093/sleep/zsad209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 07/13/2023] [Indexed: 08/07/2023] Open
Abstract
The failure to retain memory for extinguished fear plays a major role in the maintenance of posttraumatic stress disorder (PTSD), with successful extinction recall necessary for symptom reduction. Disturbed sleep, a hallmark symptom of PTSD, impairs fear extinction recall. However, our understanding of the electrophysiological mechanisms underpinning sleep's role in extinction retention remains underdetermined. We examined the relationship between the microarchitecture of sleep and extinction recall in healthy humans (n = 71, both male and females included) and a pilot study in individuals with PTSD (n = 12). Participants underwent a fear conditioning and extinction protocol over 2 days, with sleep recording occurring between conditioning and extinction. Twenty-four hours after extinction learning, participants underwent extinction recall. Power spectral density (PSD) was computed for pre- and post-extinction learning sleep. Increased beta-band PSD (~17-26 Hz) during pre-extinction learning sleep was associated with worse extinction recall in healthy participants (r = 0.41, p = .004). Beta PSD was highly stable across three nights of sleep (intraclass correlation coefficients > 0.92). Results suggest beta-band PSD is specifically implicated in difficulties recalling extinguished fear.
Collapse
Affiliation(s)
- Dan Denis
- Department of Psychology, University of York, York, UK
| | - Ryan Bottary
- Institute for Graduate Clinical Psychology, Widener University, Chester, PA, USA
| | - Tony J Cunningham
- Center for Sleep and Cognition, Psychiatry Department, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Sean P A Drummond
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Laura D Straus
- Mental Health Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Department of Psychiatry, University of California, San Francisco, CA, USA
| |
Collapse
|
26
|
van de Kamp MM, Scheffers M, Emck C, Fokker TJ, Hatzmann J, Cuijpers P, Beek PJ. Body-and movement-oriented interventions for posttraumatic stress disorder: An updated systematic review and meta-analysis. J Trauma Stress 2023; 36:835-848. [PMID: 37702005 DOI: 10.1002/jts.22968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/29/2023] [Accepted: 06/29/2023] [Indexed: 09/14/2023]
Abstract
This study is an update of the meta-analysis we published in 2019 on the effectiveness of body- and movement-oriented interventions (BMOIs) for adults with posttraumatic stress disorder (PTSD) in decreasing PTSD symptoms and secondary outcomes of depressive symptoms, sleep disturbance, and interoceptive awareness. Search terms for BMOIs and PTSD were combined to identify eligible studies in four bibliographical databases. Articles were selected if they included adult participants with a primary diagnosis of PTSD, included BMOI as one of the investigated therapies, were designed as a comparative outcome trial with any control condition, and involved a standardized outcome measure for PTSD symptom severity. This resulted in the addition of 14 new studies compared to the 2019 study. The meta-analysis, which included 29 studies in total, resulted in a mean Hedges' g effect size of 0.50, 95% CI [0.22, 0.79], in decreasing PTSD symptoms, with very high heterogeneity, I2 = 89%. Meta-analyses of secondary outcomes resulted in Hedges' g effect sizes of 0.37, 95% CI [0.08, 0.66] for depressive symptoms; 0.62, 95% CI [0.42, 0.81] for sleep quality; and -0.10, 95% CI [-0.23, 0.43] for interoceptive awareness. The risk of bias analysis resulted in some concerns or high risk of bias in almost all included studies; only one study had a low risk of bias. We conclude that BMOIs may be valuable for patients with PTSD. There is, however, still a lack of high-quality studies with proper control conditions and long-term follow-up periods from which to draw conclusions.
Collapse
Affiliation(s)
- Minke M van de Kamp
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands
| | - Mia Scheffers
- School of Health, Movement & Education, Windesheim University of Applied Sciences, Zwolle, the Netherlands
| | - Claudia Emck
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands
| | - Ties J Fokker
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands
| | - Janneke Hatzmann
- School of Health, Movement & Education, Windesheim University of Applied Sciences, Zwolle, the Netherlands
| | - Pim Cuijpers
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands
| | - Peter J Beek
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands
| |
Collapse
|
27
|
Messman BA, Fentem A, Compton SE, Griffith EL, Blumenthal H, Contractor AA, Slavish DC. The role of affect in associations between sleep disturbances and posttraumatic stress disorder symptoms: A systematic review. Sleep Med 2023; 110:287-296. [PMID: 37689045 DOI: 10.1016/j.sleep.2023.08.025] [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] [Received: 07/19/2023] [Revised: 08/14/2023] [Accepted: 08/28/2023] [Indexed: 09/11/2023]
Abstract
Strong evidence supports a bidirectional association between sleep disturbances and posttraumatic stress disorder (PTSD). Affect - temporary internal states experienced as feeling good or bad, energized or enervated - may play a central role in explaining this link. The current systematic review summarizes the literature on associations between sleep, PTSD, and affect among trauma-exposed adults. We systematically searched five electronic databases (PubMed, PsycInfo, PTSDpubs, Web of Science, CINAHL) using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Of 2656 screened articles, 6 studies met inclusion criteria. Four findings emerged: (1) greater insomnia symptom severity predicted greater PTSD symptom severity above the influence of negative affect, (2) negative affect mediated the effect of sleep quality on next-day PTSD symptom severity, (3) positive affect mediated the effect of PTSD symptom severity on insomnia symptom severity and sleep disturbances, and (4) greater negative affect (specifically, greater anger) was associated with greater severity of PTSD and sleep disturbances. Findings highlight areas for future research, such as the need to investigate more dimensions, timescales, and methods of studies simultaneously assessing affect, sleep, and PTSD, as well as the need for more longitudinal and experimental work to determine causality across these constructs.
Collapse
Affiliation(s)
- Brett A Messman
- Department of Psychology, University of North Texas, 1155 Union Circle, Denton, TX 76203, USA.
| | - Andrea Fentem
- Department of Psychology, University of North Texas, 1155 Union Circle, Denton, TX 76203, USA
| | - Sidonia E Compton
- Department of Psychology, University of North Texas, 1155 Union Circle, Denton, TX 76203, USA
| | - Elizabeth L Griffith
- Department of Psychology, University of North Texas, 1155 Union Circle, Denton, TX 76203, USA
| | - Heidemarie Blumenthal
- Department of Psychology, University of North Texas, 1155 Union Circle, Denton, TX 76203, USA
| | - Ateka A Contractor
- Department of Psychology, University of North Texas, 1155 Union Circle, Denton, TX 76203, USA
| | - Danica C Slavish
- Department of Psychology, University of North Texas, 1155 Union Circle, Denton, TX 76203, USA
| |
Collapse
|
28
|
Monari S, Guillot de Suduiraut I, Grosse J, Zanoletti O, Walker SE, Mesquita M, Wood TC, Cash D, Astori S, Sandi C. Blunted Glucocorticoid Responsiveness to Stress Causes Behavioral and Biological Alterations That Lead to Posttraumatic Stress Disorder Vulnerability. Biol Psychiatry 2023:S0006-3223(23)01590-1. [PMID: 37743003 DOI: 10.1016/j.biopsych.2023.09.015] [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: 06/15/2023] [Revised: 08/24/2023] [Accepted: 09/15/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Understanding why only a subset of trauma-exposed individuals develop posttraumatic stress disorder is critical for advancing clinical strategies. A few behavioral (deficits in fear extinction) and biological (blunted glucocorticoid levels, small hippocampal size, and rapid-eye-movement sleep [REMS] disturbances) traits have been identified as potential vulnerability factors. However, whether and to what extent these traits are interrelated and whether one of them could causally engender the others are not known. METHODS In a genetically selected rat model of reduced corticosterone responsiveness to stress, we explored posttraumatic stress disorder-related biobehavioral traits using ex vivo magnetic resonance imaging, cued fear conditioning, and polysomnographic recordings combined with in vivo photometric measurements. RESULTS We showed that genetic selection for blunted glucocorticoid responsiveness led to a correlated multitrait response, including impaired fear extinction (observed in males but not in females), small hippocampal volume, and REMS disturbances, supporting their interrelatedness. Fear extinction deficits and concomitant disruptions in REMS could be normalized through postextinction corticosterone administration, causally implicating glucocorticoid deficiency in two core posttraumatic stress disorder-related risk factors and manifestations. Furthermore, reduced REMS was accompanied by higher norepinephrine levels in the hippocampal dentate gyrus that were also reversed by postextinction corticosterone treatment. CONCLUSIONS Our results indicate a predominant role for glucocorticoid deficiency over the contribution of reduced hippocampal volume in engendering both REMS alterations and associated deficits in fear extinction consolidation, and they causally implicate blunted glucocorticoids in sustaining neurophysiological disturbances that lead to fear extinction deficits.
Collapse
Affiliation(s)
- Silvia Monari
- Laboratory of Behavioral Genetics, Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Isabelle Guillot de Suduiraut
- Laboratory of Behavioral Genetics, Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland; Synapsy Center for Neuroscience and Mental Health Research, School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Jocelyn Grosse
- Laboratory of Behavioral Genetics, Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland; Synapsy Center for Neuroscience and Mental Health Research, School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Olivia Zanoletti
- Laboratory of Behavioral Genetics, Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland; Synapsy Center for Neuroscience and Mental Health Research, School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Sophie E Walker
- Laboratory of Behavioral Genetics, Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Michel Mesquita
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Tobias C Wood
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Diana Cash
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Simone Astori
- Laboratory of Behavioral Genetics, Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland; Synapsy Center for Neuroscience and Mental Health Research, School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.
| | - Carmen Sandi
- Laboratory of Behavioral Genetics, Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland; Synapsy Center for Neuroscience and Mental Health Research, School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.
| |
Collapse
|
29
|
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.
Collapse
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.
| |
Collapse
|
30
|
Poli A, Cappellini F, Sala J, Miccoli M. The integrative process promoted by EMDR in dissociative disorders: neurobiological mechanisms, psychometric tools, and intervention efficacy on the psychological impact of the COVID-19 pandemic. Front Psychol 2023; 14:1164527. [PMID: 37727746 PMCID: PMC10505816 DOI: 10.3389/fpsyg.2023.1164527] [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: 02/12/2023] [Accepted: 08/07/2023] [Indexed: 09/21/2023] Open
Abstract
Dissociative disorders (DDs) are characterized by a discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, bodily representation, motor control, and action. The life-threatening coronavirus disease 2019 (COVID-19) pandemic has been identified as a potentially traumatic event and may produce a wide range of mental health problems, such as depression, anxiety disorders, sleep disorders, and DD, stemming from pandemic-related events, such as sickness, isolation, losing loved ones, and fear for one's life. In our conceptual analysis, we introduce the contribution of the structural dissociation of personality (SDP) theory and polyvagal theory to the conceptualization of the COVID-19 pandemic-triggered DD and the importance of assessing perceived safety in DD through neurophysiologically informed psychometric tools. In addition, we analyzed the contribution of eye movement desensitization and reprocessing (EMDR) to the treatment of the COVID-19 pandemic-triggered DD and suggest possible neurobiological mechanisms of action of the EMDR. In particular, we propose that, through slow eye movements, the EMDR may promote an initial non-rapid-eye-movement sleep stage 1-like activity, a subsequent access to a slow-wave sleep activity, and an oxytocinergic neurotransmission that, in turn, may foster the functional coupling between paraventricular nucleus and both sympathetic and parasympathetic cardioinhibitory nuclei. Neurophysiologically informed psychometric tools for safety evaluation in DDs are discussed. Furthermore, clinical and public health implications are considered, combining the EMDR, SDP theory, and polyvagal conceptualizations in light of the potential dissociative symptomatology triggered by the COVID-19 pandemic.
Collapse
|
31
|
Cox RC, Garcia AN, Jessup SC, Woronko SE, Rast CE, Olatunji BO. Subjective Sleep Disturbances in Sexual Assault Survivors: Associations With Trauma and Posttraumatic Stress Disorder Symptom Severity. Behav Ther 2023; 54:863-875. [PMID: 37597963 PMCID: PMC10440416 DOI: 10.1016/j.beth.2023.03.005] [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: 08/22/2022] [Revised: 02/28/2023] [Accepted: 03/03/2023] [Indexed: 08/21/2023]
Abstract
Prior work implicates sleep disturbance in the development and maintenance of posttraumatic stress disorder (PTSD). However, the majority of this literature has focused on combat veteran men, and limited work has examined links between sleep disturbance and PTSD symptoms in sexual assault survivors. This is a notable gap in the literature, as sexual trauma is disproportionately likely to result in PTSD and is more common in women. We sought to examine the relations between subjective sleep disturbance, sexual assault severity, and PTSD symptoms in a sample of sexual assault survivors with PTSD (PTSD+), without PTSD (PTSD-), and healthy controls. The sample (N = 60) completed the Insomnia Severity Index and prospectively monitored their sleep for 1 week using the Consensus Sleep Diary. The sexual assault survivors also completed the Sexual Experiences Survey and PTSD Checklist-5. Results of group comparisons found that the PTSD+ group reported significantly higher insomnia symptoms, longer sleep onset latency, more nocturnal awakenings, and lower sleep quality compared to the healthy control group and higher insomnia symptoms compared to the PTSD- group. Results of regression analyses in the sexual assault survivors found that insomnia symptoms and number of nocturnal awakenings were significantly associated with higher PTSD symptoms, and sexual assault severity was significantly associated with higher insomnia symptoms, longer sleep onset latency, and lower sleep quality. These findings highlight specific features of sleep disturbance that are linked to trauma and PTSD symptom severity among sexual assault survivors.
Collapse
Affiliation(s)
- Rebecca C Cox
- University of Colorado-Boulder; Vanderbilt University.
| | | | | | | | | | | |
Collapse
|
32
|
Natraj N, Neylan TC, Yack LM, Metzler TJ, Woodward SH, Hubachek SQ, Dukes C, Udupa NS, Mathalon DH, Richards A. Sleep Spindles Favor Emotion Regulation Over Memory Consolidation of Stressors in Posttraumatic Stress Disorder. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2023; 8:899-908. [PMID: 36889539 DOI: 10.1016/j.bpsc.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is a trauma-induced condition, characterized by intrusive memories and trauma-associated anxiety. Non-rapid eye movement (NREM) sleep spindles might play a crucial role in learning and consolidating declarative stressor information. However, sleep and possibly sleep spindles are also known to regulate anxiety, suggestive of a dual role for sleep spindles in the processing of stressors. Specifically, in individuals with high PTSD symptom burden, spindles might fail to regulate anxiety levels after exposure and instead might maladaptively consolidate stressor information. METHODS To disentangle the role of spindles in declarative memory versus anxiety regulation after stressor exposure and to examine the role of PTSD in these processes, we measured nap sleep after a cohort of 45 trauma-exposed participants were exposed to laboratory stress. Participants (high vs. low PTSD symptoms) completed 2 visits: a stress visit involving exposure to negatively valent images before nap and a control visit. In both visits, sleep was monitored via electroencephalography. A stressor recall session occurred after the nap in the stress visit. RESULTS Stage 2 NREM (NREM2) spindle rates were higher in stress versus control sleep, indicative of stress-induced changes in spindles. In participants with high PTSD symptoms, NREM2 spindle rates in stress sleep predicted poorer recall accuracy of stressor images relative to participants with low PTSD symptoms, while correlating with greater reduction in stressor-induced anxiety levels after sleep. CONCLUSIONS Contrary to our expectations, although spindles are known to play a role in declarative memory processes, our findings highlight an important role for spindles in sleep-dependent anxiety regulation in PTSD.
Collapse
Affiliation(s)
- Nikhilesh Natraj
- Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California; Department of Veterans Affairs San Francisco Health Care System, San Francisco, California
| | - Thomas C Neylan
- Department of Veterans Affairs San Francisco Health Care System, San Francisco, California; Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California
| | - Leslie M Yack
- Department of Veterans Affairs San Francisco Health Care System, San Francisco, California; Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California
| | - Thomas J Metzler
- Department of Veterans Affairs San Francisco Health Care System, San Francisco, California
| | - Steven H Woodward
- Veterans Administration National Center for PTSD, Department of Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Samantha Q Hubachek
- Department of Veterans Affairs San Francisco Health Care System, San Francisco, California; Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California
| | - Cassandra Dukes
- Department of Veterans Affairs San Francisco Health Care System, San Francisco, California; Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California
| | - Nikhila S Udupa
- Department of Veterans Affairs San Francisco Health Care System, San Francisco, California; Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California
| | - Daniel H Mathalon
- Department of Veterans Affairs San Francisco Health Care System, San Francisco, California; Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California
| | - Anne Richards
- Department of Veterans Affairs San Francisco Health Care System, San Francisco, California; Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California.
| |
Collapse
|
33
|
Mishler J, Ramanathan D. Sleep, Spindles, and Emotional Processing in Posttraumatic Stress Disorder. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2023; 8:882-883. [PMID: 37678967 DOI: 10.1016/j.bpsc.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 07/21/2023] [Indexed: 09/09/2023]
Affiliation(s)
- Jonathan Mishler
- Neural Engineering and Translation Labs, Department of Psychiatry, University of California, San Diego, La Jolla, California; Department of Mental Health, Veterans Affairs San Diego Healthcare System, San Diego, California
| | - Dhakshin Ramanathan
- Neural Engineering and Translation Labs, Department of Psychiatry, University of California, San Diego, La Jolla, California; Department of Mental Health, Veterans Affairs San Diego Healthcare System, San Diego, California; Center of Excellence for Stress and Mental Health, Veterans Affairs San Diego Healthcare System, San Diego, California.
| |
Collapse
|
34
|
Saguin E, Hulot LJ, Roseau JB, Metlaine A, Paul F, Nicolas F, Sipahimalani LG, Leger D, Gomez-Merino D, Chennaoui M. Translation, Cross-Cultural Adaptation and Preliminary Validation of a French Version of the Trauma-Related Nightmare Survey (TRNS-FR) in a PTSD Veteran Population. Mil Med 2023; 188:3182-3190. [PMID: 35472134 PMCID: PMC10464873 DOI: 10.1093/milmed/usac107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/29/2022] [Accepted: 04/14/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION In the military population, trauma-related nightmares (TRNs) are highly associated with deployments and combat-related events. Trauma-related nightmares are also correlated with severity, treatment resistance, and chronicity of Post-Traumatic Stress Disorder (PTSD). However, to date, no specific measure of TRNs has been validated for use in the French language. This study aimed to translate and culturally adapt the English version of the Trauma-Related Nightmare Survey into French and to evaluate the psychometric properties of the translation on veterans. MATERIALS AND METHODS After the translation and cultural adaptation process, we evaluated the reliability and validity of the French version of the questionnaire (TRNS-FR) in a population of veterans suffering from PTSD with nightmare complaints (n = 56 patients for test-retest and n = 60 for internal consistency), recruited from five French military hospitals. RESULTS Analyses demonstrated that TRNS-FR has good test-retest reliability (r = 0.59) and good internal consistency with PTSD symptoms, insomnia symptoms, and subjective sleep parameters assessed at home. This questionnaire provides a rapid and comprehensive assessment of sleep disturbance and a specific description of TRNs in the population of veterans with severe PTSD. Our results allowed us to propose a valid and reliable French adaptation of the questionnaire. CONCLUSION Because sleep disturbances and TRNs require specific therapeutic management, the psychometric qualities of TRNS-FR make it a tool of choice for assessing TRNs in future clinical research settings.
Collapse
Affiliation(s)
- Emeric Saguin
- Psychiatric Department, Begin Military Teaching Hospital, Saint-Mandé 94160, France
- VIFASOM (Vigilance Fatigue Sommeil et Santé Publique) EA 7330, Université de Paris, Paris 75005, France
| | | | - Jean-Baptiste Roseau
- Pneumology and Sleep Medicine Department, Clermont-Tonnerre Military Teaching Hospital, Brest 29240, France
| | - Arnaud Metlaine
- Centre du Sommeil et de la Vigilance, Hôtel-Dieu, APHP, Paris 75004, France
| | - Frédéric Paul
- Psychiatric Department, Laveran Military Teaching Hospital, Marseille 13384, France
| | - Florian Nicolas
- Psychiatric Department, Sainte-Anne Military Teaching Hospital, Toulon 83800, France
| | | | - Damien Leger
- VIFASOM (Vigilance Fatigue Sommeil et Santé Publique) EA 7330, Université de Paris, Paris 75005, France
- Centre du Sommeil et de la Vigilance, Hôtel-Dieu, APHP, Paris 75004, France
| | - Danielle Gomez-Merino
- VIFASOM (Vigilance Fatigue Sommeil et Santé Publique) EA 7330, Université de Paris, Paris 75005, France
- French Armed Forces Biomedical Research Institute, Brétigny-sur-Orge 91220, France
| | - Mounir Chennaoui
- VIFASOM (Vigilance Fatigue Sommeil et Santé Publique) EA 7330, Université de Paris, Paris 75005, France
- French Armed Forces Biomedical Research Institute, Brétigny-sur-Orge 91220, France
| |
Collapse
|
35
|
Pruiksma KE, Taylor DJ, Wachen JS, Straud CL, Hale WJ, Mintz J, Young-McCaughan S, Peterson AL, Yarvis JS, Borah EV, Dondanville KA, Litz BT, Resick PA. Self-reported sleep problems in active-duty US Army personnel receiving posttraumatic stress disorder treatment in group or individual formats: secondary analysis of a randomized clinical trial. J Clin Sleep Med 2023; 19:1389-1398. [PMID: 36988304 PMCID: PMC10394372 DOI: 10.5664/jcsm.10584] [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] [Received: 04/26/2022] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 03/30/2023]
Abstract
STUDY OBJECTIVES Sleep disturbances are common in military personnel with posttraumatic stress disorder (PTSD) and may persist following treatment. This study examined service members seeking treatment for PTSD, reporting insomnia symptoms, nightmares, excessive daytime sleepiness, and potential obstructive sleep apnea at baseline and the impact of sleep disturbances on a course of PTSD treatment. METHODS In this secondary analysis, sleep was evaluated in 223 service members who participated in a randomized clinical trial comparing Cognitive Processing Therapy for PTSD delivered in individual or group formats. Sleep assessments included the Insomnia Severity Index, the Trauma-Related Nightmare Survey, and Epworth Sleepiness Scale administered at baseline and 2 weeks posttreatment. RESULTS Following PTSD treatment, there were significant improvements for insomnia symptoms (MΔ = -1.49; d = -0.27), nightmares (MΔ = -0.35; d = -0.27), and excessive daytime sleepiness (MΔ = -0.91; d = -0.16). However, mean scores remained in clinical ranges at posttreatment. Participants with baseline insomnia symptoms had worse PTSD severity throughout treatment. Participants with baseline excessive daytime sleepiness or probable obstructive sleep apnea had greater PTSD severity reductions when treated with Cognitive Processing Therapy individually vs. in a group. Those with insomnia symptoms, nightmare disorder, and sleep apnea had greater depressive symptoms throughout treatment. CONCLUSIONS Insomnia symptoms, nightmares, and excessive daytime sleepiness were high at baseline in service members seeking treatment for PTSD. While sleep symptoms improved with PTSD treatment, these sleep disorders were related to worse treatment outcomes with regards to symptoms of PTSD and depression. Individual Cognitive Processing Therapy is recommended over group Cognitive Processing Therapy for patients with either excessive daytime sleepiness or probable obstructive sleep apnea. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Group vs. Individual Cognitive Processing Therapy for Combat-related PTSD; URL: https://clinicaltrials.gov/ct2/show/NCT02173561; Identifier: NCT02173561. CITATION Puriksma KE, Taylor DJ, Wachen JS, et al. Self-reported sleep problems in active-duty US Army personnel receiving posttraumatic stress disorder treatment in group or individual formats: secondary analysis of a randomized clinical trial. J Clin Sleep Med. 2023;19(8):1389-1398.
Collapse
Affiliation(s)
- Kristi E. Pruiksma
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas
| | - Daniel J. Taylor
- Department of Psychology, University of Arizona, Tucson, Arizona
- Department of Psychology, University of North Texas, Denton, Texas
| | - Jennifer Schuster Wachen
- Women’s Health Sciences Division, National Center for PTSD at VA Boston Healthcare System, Boston, Massachusetts
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Casey L. Straud
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas
- Department of Psychology, University of Texas at San Antonio, San Antonio, Texas
| | - Willie J. Hale
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Department of Psychology, University of Texas at San Antonio, San Antonio, Texas
| | - Jim Mintz
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas
- Department of Population Health Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Stacey Young-McCaughan
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas
| | - Alan L. Peterson
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas
- Department of Psychology, University of Texas at San Antonio, San Antonio, Texas
| | - Jeffrey S. Yarvis
- Department of Behavioral Health, Carl R. Darnall Army Medical Center, Fort Hood, Texas
- School of Social Work, Tulane University, New Orleans, Louisiana
| | - Elisa V. Borah
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- School of Social Work, University of Texas at Austin, Austin, Texas
| | - Katherine A. Dondanville
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Brett T. Litz
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, Massachusetts
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
| | - Patricia A. Resick
- Department of Psychiatry and Behavioral Sciences, Duke Health, Durham, North Carolina
| | - on behalf of the STRONG STAR Consortium
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas
- Department of Psychology, University of Arizona, Tucson, Arizona
- Department of Psychology, University of North Texas, Denton, Texas
- Women’s Health Sciences Division, National Center for PTSD at VA Boston Healthcare System, Boston, Massachusetts
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
- Department of Psychology, University of Texas at San Antonio, San Antonio, Texas
- Department of Population Health Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Department of Behavioral Health, Carl R. Darnall Army Medical Center, Fort Hood, Texas
- School of Social Work, Tulane University, New Orleans, Louisiana
- School of Social Work, University of Texas at Austin, Austin, Texas
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, Massachusetts
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
- Department of Psychiatry and Behavioral Sciences, Duke Health, Durham, North Carolina
| |
Collapse
|
36
|
Messman BA, Slavish DC, Briggs M, Ruggero CJ, Luft BJ, Kotov R. Daily Sleep-Stress Reactivity and Functional Impairment in World Trade Center Responders. Ann Behav Med 2023; 57:582-592. [PMID: 37078921 DOI: 10.1093/abm/kaad005] [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: 04/21/2023] Open
Abstract
BACKGROUND How sleep is impacted by stress ("sleep reactivity to stress") and how stress is impacted by sleep ("stress reactivity to sleep") are trait-like characteristics of individuals that predict depression, anxiety, and insomnia. However, pathways between reactivity and functional impairment (e.g., impairment in social relationships and interpersonal functioning) have not been explored, which may be a critical pathway in understanding the link between reactivity and the development of psychological disorders. PURPOSE We examined associations between reactivity and changes in functional impairment among a cohort of 9/11 World Trade Center responders. METHODS Data from 452 responders (Mage = 55.22 years; 89.4% male) were collected between 2014 and 2016. Four baseline sleep and stress reactivity indices (i.e., sleep duration and efficiency reactivity to stress; stress reactivity to sleep duration and efficiency) were calculated from 14 days of sleep and stress data using random slopes from multilevel models. Functional impairment was assessed approximately 1 year and 2 years after baseline via semi-structured interviews. Latent change score analyses examined associations between baseline reactivity indices and changes in functional impairment. RESULTS Greater baseline sleep efficiency reactivity to stress was associated with decreases in functioning (β = -0.05, p = .039). In addition, greater stress reactivity to sleep duration (β = -0.08, p = .017) and sleep efficiency (β = -0.22, p < .001) was associated with lower functioning at timepoint one. CONCLUSION People who are more reactive to daily fluctuations in stress and sleep have poorer interpersonal relationships and social functioning. Identifying individuals with high reactivity who could benefit from preventative treatment may foster better social integration.
Collapse
Affiliation(s)
- Brett A Messman
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Danica C Slavish
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Madasen Briggs
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Camilo J Ruggero
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Benjamin J Luft
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Roman Kotov
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| |
Collapse
|
37
|
Xiao W, Liu X, Wang H, Huang Y, Dai Z, Si M, Fu J, Chen X, Jia M, Leng Z, Cui D, Mak WWS, Su X. Prevalence and risk for symptoms of PTSD among survivors of a COVID-19 infection. Psychiatry Res 2023; 326:115304. [PMID: 37352746 PMCID: PMC10275658 DOI: 10.1016/j.psychres.2023.115304] [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: 02/22/2023] [Revised: 06/09/2023] [Accepted: 06/10/2023] [Indexed: 06/25/2023]
Abstract
COVID-19 pandemic has profound psychological effects worldwide and the psychological sequelae will persist for a long time among COVID-19 survivors. This cross-sectional study aimed to explore the prevalence of PTSD and its associated risk factors in COVID-19 survivors of the first wave pandemic. Demographics questionnaire, the Impact of Events Scale-Revised, the Pittsburgh Sleep Quality Index, the Fatigue Scale-14, the Resilience Style Questionnaire, the Short Version of COVID-19 Stigma Scale, the Peace of Mind Scale, and the Perceived Social Support Questionnaire were used to collect relevant information of the participants. The propensity score-matching (PSM) method was employed to adjust covariate or confounding variables in order to derive more accurate conclusions. After PSM, adjusted odds ratios and 95% confidence intervals were determined by binary conditional logistic regression. A total of 1541 COVID-19 survivors were included firstly and 15.2% reported PTSD symptoms, 1108 participants left after PSM. Four risk factors were identified: higher severity of COVID-19 infection, fatigue, COVID-19 related stigma and poor sleep quality. When designing psychological interventions to alleviate PTSD symptoms of COVID-19 survivors, reducing stigma and fatigue, and improve their sleep quality are suggested.
Collapse
Affiliation(s)
- Weijun Xiao
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
| | - Xiaoyang Liu
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
| | - Hao Wang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yiman Huang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhenwei Dai
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Mingyu Si
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jiaqi Fu
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xu Chen
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Mengmeng Jia
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhiwei Leng
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Dan Cui
- Department of Pulmonary and Critical Care Medicine, National Center for Respiratory Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China; Department of Pulmonary and Critical Care Medicine, The 2nd Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Winnie W S Mak
- Diversity and Well-Being Laboratory, Department of Psychology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Xiaoyou Su
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| |
Collapse
|
38
|
Rajkumar RP. Biomarkers of Neurodegeneration in Post-Traumatic Stress Disorder: An Integrative Review. Biomedicines 2023; 11:biomedicines11051465. [PMID: 37239136 DOI: 10.3390/biomedicines11051465] [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: 04/10/2023] [Revised: 05/11/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023] Open
Abstract
Post-Traumatic Stress Disorder (PTSD) is a chronic psychiatric disorder that occurs following exposure to traumatic events. Recent evidence suggests that PTSD may be a risk factor for the development of subsequent neurodegenerative disorders, including Alzheimer's dementia and Parkinson's disease. Identification of biomarkers known to be associated with neurodegeneration in patients with PTSD would shed light on the pathophysiological mechanisms linking these disorders and would also help in the development of preventive strategies for neurodegenerative disorders in PTSD. With this background, the PubMed and Scopus databases were searched for studies designed to identify biomarkers that could be associated with an increased risk of neurodegenerative disorders in patients with PTSD. Out of a total of 342 citations retrieved, 29 studies were identified for inclusion in the review. The results of these studies suggest that biomarkers such as cerebral cortical thinning, disrupted white matter integrity, specific genetic polymorphisms, immune-inflammatory alterations, vitamin D deficiency, metabolic syndrome, and objectively documented parasomnias are significantly associated with PTSD and may predict an increased risk of subsequent neurodegenerative disorders. The biological mechanisms underlying these changes, and the interactions between them, are also explored. Though requiring replication, these findings highlight a number of biological pathways that plausibly link PTSD with neurodegenerative disorders and suggest potentially valuable avenues for prevention and early intervention.
Collapse
Affiliation(s)
- Ravi Philip Rajkumar
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry 605006, India
| |
Collapse
|
39
|
Dawson SC, Krakow B, Haynes PL, Rojo-Wissar DM, McIver ND, Ulibarri VA. Use of Sleep Aids in Insomnia: The Role of Time Monitoring Behavior. Prim Care Companion CNS Disord 2023; 25:22m03344. [PMID: 37227396 PMCID: PMC11166003 DOI: 10.4088/pcc.22m03344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
Objective: Over-the-counter (OTC) and prescription sleep medications are frequently used as treatments for chronic insomnia, despite risks and limited long-term efficacy. Investigating mechanisms underlying this predilection for pharmacotherapy may uncover strategies to decrease reliance on sleep aids. The objective of this study was to determine how time monitoring behavior (TMB; clock-watching) and associated frustration may interact with insomnia symptoms to drive the use of sleep aids. Methods: Patients (N = 4,886) presenting for care at a community-based, private sleep medical center between May 2003 and October 2013 completed the Insomnia Severity Index (ISI) and Time Monitoring Behavior-10 (TMB-10) and reported their frequency of sleep medication use (OTC and prescription, separately). Mediation analyses examined how clock-watching and related frustration could be associated with insomnia symptoms and medication use. Results: The relationship between TMB and sleep medication use was significantly explained by ISI (P < .05), in that TMB (especially related frustration) appears to aggravate insomnia, which in turn leads to sleep aid use. Similarly, but to a lesser extent, the relationship between ISI and sleep medication use was explained by TMB, in that ISI may lead to increased TMB, which may in turn lead to sleep aid use. Conclusions: TMB and the associated frustration it engenders may perpetuate a negative cycle of insomnia and sleep aid use. Future longitudinal and interventional research is necessary to examine the developmental course of these clinical symptoms and behaviors and to test whether decreasing frustration by limiting TMB reduces the proclivity for pharmacotherapy.
Collapse
Affiliation(s)
- Spencer C Dawson
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana
| | - Barry Krakow
- Sleep and Human Health Institute, Savannah, Georgia
- Sleep Arts & Sciences, Savannah, Georgia
- Department of Psychiatry and Behavioral Health, Mercer University School of Medicine, Savannah, Georgia
- Corresponding author: Barry Krakow, MD, 211 Early St, Savannah, GA 31405
| | | | - Darlynn M Rojo-Wissar
- The Initiative on Stress, Trauma, and Resilience (STAR), Department of Psychiatry and Human Behavior, Center for Behavioral and Preventive Medicine, The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Natalia D McIver
- Sleep and Human Health Institute, Savannah, Georgia
- Department of Orthopaedics and Rehabilitation, The University of New Mexico, Albuquerque, New Mexico
| | | |
Collapse
|
40
|
Rexrode L, Tennin M, Babu J, Young C, Bollavarapu R, Lawson LA, Valeri J, Pantazopoulos H, Gisabella B. Regulation of dendritic spines in the amygdala following sleep deprivation. FRONTIERS IN SLEEP 2023; 2:1145203. [PMID: 37928499 PMCID: PMC10624159 DOI: 10.3389/frsle.2023.1145203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
The amygdala is a hub of emotional circuits involved in the regulation of cognitive and emotional behaviors and its critically involved in emotional reactivity, stress regulation, and fear memory. Growing evidence suggests that the amygdala plays a key role in the consolidation of emotional memories during sleep. Neuroimaging studies demonstrated that the amygdala is selectively and highly activated during rapid eye movement sleep (REM) and sleep deprivation induces emotional instability and dysregulation of the emotional learning process. Regulation of dendritic spines during sleep represents a morphological correlate of memory consolidation. Several studies indicate that dendritic spines are remodeled during sleep, with evidence for broad synaptic downscaling and selective synaptic upscaling in several cortical areas and the hippocampus. Currently, there is a lack of information regarding the regulation of dendritic spines in the amygdala during sleep. In the present work, we investigated the effect of 5 h of sleep deprivation on dendritic spines in the mouse amygdala. Our data demonstrate that sleep deprivation results in differential dendritic spine changes depending on both the amygdala subregions and the morphological subtypes of dendritic spines. We observed decreased density of mushroom spines in the basolateral amygdala of sleep deprived mice, together with increased neck length and decreased surface area and volume. In contrast, we observed greater densities of stubby spines in sleep deprived mice in the central amygdala, indicating that downscaling selectively occurs in this spine type. Greater neck diameters for thin spines in the lateral and basolateral nuclei of sleep deprived mice, and decreases in surface area and volume for mushroom spines in the basolateral amygdala compared to increases in the cental amygdala provide further support for spine type-selective synaptic downscaling in these areas during sleep. Our findings suggest that sleep promotes synaptic upscaling of mushroom spines in the basolateral amygdala, and downscaling of selective spine types in the lateral and central amygdala. In addition, we observed decreased density of phosphorylated cofilin immunoreactive and growth hormone immunoreactive cells in the amygdala of sleep deprived mice, providing further support for upscaling of dendritic spines during sleep. Overall, our findings point to region-and spine type-specific changes in dendritic spines during sleep in the amygdala, which may contribute to consolidation of emotional memories during sleep.
Collapse
Affiliation(s)
- Lindsay Rexrode
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, United States
| | - Matthew Tennin
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, United States
| | - Jobin Babu
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, United States
- Program in Neuroscience, University of Mississippi Medical Center, Jackson, MS, United States
| | - Caleb Young
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, United States
| | - Ratna Bollavarapu
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, United States
| | - Lamiorkor Ameley Lawson
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, United States
| | - Jake Valeri
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, United States
- Program in Neuroscience, University of Mississippi Medical Center, Jackson, MS, United States
| | - Harry Pantazopoulos
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, United States
- Program in Neuroscience, University of Mississippi Medical Center, Jackson, MS, United States
| | - Barbara Gisabella
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, United States
- Program in Neuroscience, University of Mississippi Medical Center, Jackson, MS, United States
| |
Collapse
|
41
|
Meule A, Riemann D, Voderholzer U. Sleep quality in persons with mental disorders: Changes during inpatient treatment across 10 diagnostic groups. J Sleep Res 2023; 32:e13624. [PMID: 35487501 DOI: 10.1111/jsr.13624] [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: 12/30/2021] [Revised: 02/07/2022] [Accepted: 04/13/2022] [Indexed: 11/26/2022]
Abstract
Sleep disturbances have been documented across a range of mental disorders, particularly depression. However, studies that have examined sleep quality in large samples of different diagnostic groups and that report how sleep quality changes during inpatient treatment have been scarce. This retrospective, observational study examined changes in sleep quality during inpatient treatment at a psychosomatic hospital in Germany from admission to discharge as a function of 10 diagnostic groups. Data of 11,226 inpatients were analysed who completed the Pittsburgh Sleep Quality Index as part of the routine diagnostic assessment at admission and discharge. All diagnostic groups showed impaired sleep quality (Pittsburgh Sleep Quality Index score > 5). Patients with trauma-related disorders had the lowest sleep quality and patients with obsessive-compulsive disorder had the highest sleep quality. While sleep quality significantly improved in each diagnostic group, changes differed in size, with patients with trauma-related disorders showing the smallest improvement and patients with eating disorders showing the largest improvement. The current study documents impaired sleep quality in inpatients with mental disorders and shows that sleep problems are a transdiagnostic feature in this population. Results also resonate with earlier suggestions that sleep disturbances represent a key feature of trauma-related disorders in particular and the need for trauma-specific sleep interventions. Although sleep quality significantly improved during disorder-specific inpatient treatment in all diagnostic groups, average scores were still clinically elevated at discharge. Thus, a future avenue would be to examine whether adding sleep-specific treatment elements fosters both short- and long-term success in the treatment of mental disorders.
Collapse
Affiliation(s)
- Adrian Meule
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.,Schoen Clinic Roseneck, Prien am Chiemsee, Germany
| | - Dieter Riemann
- Medical Center, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ulrich Voderholzer
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.,Schoen Clinic Roseneck, Prien am Chiemsee, Germany.,Medical Center, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| |
Collapse
|
42
|
Baskaran A, Marogi E, Bitar R, Attarian H, Saadi A. Improving Sleep Health Among Refugees: A Systematic Review. Neurol Clin Pract 2023; 13:e200139. [PMID: 36936393 PMCID: PMC10022726 DOI: 10.1212/cpj.0000000000200139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/05/2022] [Indexed: 03/15/2023]
Abstract
Purpose of Review Sleep disorders among refugees are common yet understudied. Interventions are difficult in resource-limited settings where most of these populations live. A systematic review of sleep disorders in refugee populations is warranted to identify prevalence, comorbidities, and the limitations of the current state of sleep health among refugees. Recent Findings Sleep disturbances, particularly insomnia and nightmares, occur with a higher prevalence among refugees. Diseases associated with insomnia in this population included fibromyalgia, posttraumatic stress disorder, depression, and anxiety. Risk factors include trauma, migration, lower socioeconomic status, lower educational level, and settlement in areas with a high influx of new residents or proximity to conflict. Only a few partially successful therapies were identified. Summary This review identifies the high prevalence of the disturbed sleep in this population and its risk factors. It proposes ways of increasing awareness of it in this vulnerable population as a first step toward remediation.
Collapse
Affiliation(s)
- Archit Baskaran
- Department of Neurology (AB), University of Chicago, IL; Department of Internal Medicine (EM), University of California San Francisco, CA; American University of Beirut (RB), Lebanon; Department of Neurology (HA), Northwestern University, Chicago, IL; Department of Neurology (AS), MGH Asylum Clinic, Harvard Medical School, Boston, MA
| | - Emily Marogi
- Department of Neurology (AB), University of Chicago, IL; Department of Internal Medicine (EM), University of California San Francisco, CA; American University of Beirut (RB), Lebanon; Department of Neurology (HA), Northwestern University, Chicago, IL; Department of Neurology (AS), MGH Asylum Clinic, Harvard Medical School, Boston, MA
| | - Ricardo Bitar
- Department of Neurology (AB), University of Chicago, IL; Department of Internal Medicine (EM), University of California San Francisco, CA; American University of Beirut (RB), Lebanon; Department of Neurology (HA), Northwestern University, Chicago, IL; Department of Neurology (AS), MGH Asylum Clinic, Harvard Medical School, Boston, MA
| | - Hrayr Attarian
- Department of Neurology (AB), University of Chicago, IL; Department of Internal Medicine (EM), University of California San Francisco, CA; American University of Beirut (RB), Lebanon; Department of Neurology (HA), Northwestern University, Chicago, IL; Department of Neurology (AS), MGH Asylum Clinic, Harvard Medical School, Boston, MA
| | - Altaf Saadi
- Department of Neurology (AB), University of Chicago, IL; Department of Internal Medicine (EM), University of California San Francisco, CA; American University of Beirut (RB), Lebanon; Department of Neurology (HA), Northwestern University, Chicago, IL; Department of Neurology (AS), MGH Asylum Clinic, Harvard Medical School, Boston, MA
| |
Collapse
|
43
|
Rojczyk P, Seitz-Holland J, Kaufmann E, Sydnor VJ, Kim CL, Umminger LF, Wiegand TLT, Guenette JP, Zhang F, Rathi Y, Bouix S, Pasternak O, Fortier CB, Salat D, Hinds SR, Heinen F, O’Donnell LJ, Milberg WP, McGlinchey RE, Shenton ME, Koerte IK. Sleep Quality Disturbances Are Associated with White Matter Alterations in Veterans with Post-Traumatic Stress Disorder and Mild Traumatic Brain Injury. J Clin Med 2023; 12:2079. [PMID: 36902865 PMCID: PMC10004675 DOI: 10.3390/jcm12052079] [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: 02/17/2023] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 03/09/2023] Open
Abstract
Sleep disturbances are strongly associated with mild traumatic brain injury (mTBI) and post-traumatic stress disorder (PTSD). PTSD and mTBI have been linked to alterations in white matter (WM) microstructure, but whether poor sleep quality has a compounding effect on WM remains largely unknown. We evaluated sleep and diffusion magnetic resonance imaging (dMRI) data from 180 male post-9/11 veterans diagnosed with (1) PTSD (n = 38), (2) mTBI (n = 25), (3) comorbid PTSD+mTBI (n = 94), and (4) a control group with neither PTSD nor mTBI (n = 23). We compared sleep quality (Pittsburgh Sleep Quality Index, PSQI) between groups using ANCOVAs and calculated regression and mediation models to assess associations between PTSD, mTBI, sleep quality, and WM. Veterans with PTSD and comorbid PTSD+mTBI reported poorer sleep quality than those with mTBI or no history of PTSD or mTBI (p = 0.012 to <0.001). Poor sleep quality was associated with abnormal WM microstructure in veterans with comorbid PTSD+mTBI (p < 0.001). Most importantly, poor sleep quality fully mediated the association between greater PTSD symptom severity and impaired WM microstructure (p < 0.001). Our findings highlight the significant impact of sleep disturbances on brain health in veterans with PTSD+mTBI, calling for sleep-targeted interventions.
Collapse
Affiliation(s)
- Philine Rojczyk
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02145, USA
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-University, 80336 Munich, Germany
| | - Johanna Seitz-Holland
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02145, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Elisabeth Kaufmann
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02145, USA
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-University, 80336 Munich, Germany
- Department of Neurology, Ludwig-Maximilians-University, 81377 Munich, Germany
| | - Valerie J. Sydnor
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02145, USA
| | - Cara L. Kim
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02145, USA
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-University, 80336 Munich, Germany
| | - Lisa F. Umminger
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02145, USA
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-University, 80336 Munich, Germany
| | - Tim L. T. Wiegand
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02145, USA
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-University, 80336 Munich, Germany
| | - Jeffrey P. Guenette
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02145, USA
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Fan Zhang
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Yogesh Rathi
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02145, USA
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Sylvain Bouix
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02145, USA
- Department of Software Engineering and IT, École de Technologie Supérieure, Montreal, QC H3C 1K3, Canada
| | - Ofer Pasternak
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02145, USA
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Catherine B. Fortier
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA 02130, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02215, USA
| | - David Salat
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA 02130, USA
- Neuroimaging Research for Veterans (NeRVe) Center, VA Boston Healthcare System, Boston, 02115 MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Department of Radiology, Boston, MA 02129, USA
| | - Sidney R. Hinds
- Department of Neurology, Uniformed Services University, Bethesda, MD 20814, USA
| | - Florian Heinen
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians-University, 80337 Munich, Germany
| | - Lauren J. O’Donnell
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - William P. Milberg
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA 02130, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02215, USA
- Neuroimaging Research for Veterans (NeRVe) Center, VA Boston Healthcare System, Boston, 02115 MA, USA
| | - Regina E. McGlinchey
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA 02130, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02215, USA
- Neuroimaging Research for Veterans (NeRVe) Center, VA Boston Healthcare System, Boston, 02115 MA, USA
| | - Martha E. Shenton
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02145, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Inga K. Koerte
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02145, USA
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-University, 80336 Munich, Germany
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Graduate School of Systemic Neurosciences, Ludwig-Maximilians-University, 82152 Munich, Germany
| |
Collapse
|
44
|
Sujan MSH, Tasnim R, Haghighathoseini A, Hasan MM, Islam MS. Investigating posttraumatic stress disorder among COVID-19 recovered patients: A cross-sectional study. Heliyon 2023; 9:e14499. [PMID: 36942241 PMCID: PMC10015743 DOI: 10.1016/j.heliyon.2023.e14499] [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: 01/23/2022] [Revised: 03/02/2023] [Accepted: 03/08/2023] [Indexed: 03/17/2023] Open
Abstract
Background During the 21st century, pandemics have emerged frequently and become more challenging. Coronavirus disease (COVID-19) is among the most prominent examples. A considerable public health issue following the pandemic is posttraumatic stress disorder (PTSD). COVID-19-recovered patients are highly susceptible to developing PTSD. Earlier epidemic studies showed a high prevalence of trauma-exposed people as a result of infectious diseases. This research aimed to quantify the estimated prevalence of PTSD and its contributing variables among COVID-19-recovered patients in Bangladesh. Methods This was a cross-sectional research carried out through an e-survey comprising 326 individuals (69.0% male; mean age = 37.97 ± 13.02 years; age range = 18-76 years) and conducted between September 2020 to January 2021. The online survey included a section for gathering participant's informed permission as well as sections on key demographics and way of life, and social supports during the suffering period from acute COVID-19, as well as a PTSD Checklist for DSM-5 (PCL-5) to examine PSTD. Descriptive statistics and multiple regression analyses were performed. Results: The prevalence estimates of PTSD ranged between 36 and 41% based on three predefined cut-offs. As per multiple linear regression analysis, PTSD was much more common among those who took part and reported being middle-aged/older adults (≥40 years), having lower S.E.S., and who slept more (>9 h/day). In addition, PTSD was negatively associated (p <0.05) with the social support of family members/friends/relatives, and colleagues in working settings; while positively correlated with health care providers. Conclusion: The current investigation revealed a considerably higher level of PTSD among COVID-19-recovered patients. The findings suggest extending the mental health services, other covariates, and immediate intervention among national and international COVID-19 recovered patients.
Collapse
Affiliation(s)
- Md. Safaet Hossain Sujan
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
- Centre for Advanced Research Excellence in Public Health, Dhaka, Bangladesh
- Corresponding author. Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka-1342, Bangladesh
| | - Rafia Tasnim
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
- Centre for Advanced Research Excellence in Public Health, Dhaka, Bangladesh
| | | | | | - Md. Saiful Islam
- Centre for Advanced Research Excellence in Public Health, Dhaka, Bangladesh
| |
Collapse
|
45
|
Zalta AK, Vanderboll K, Dent AL, Contreras IM, Malek N, Lascano XN, Zellner KL, Grandhi J, Araujo PJ, Straka K, Liang CZ, Czarny JE, Martinez J, Burgess HJ. Sleep timing, chronotype, and posttraumatic stress disorder: An individual participant data meta-analysis. Psychiatry Res 2023; 321:115061. [PMID: 36706561 DOI: 10.1016/j.psychres.2023.115061] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/12/2023] [Accepted: 01/14/2023] [Indexed: 01/19/2023]
Abstract
Sleep disturbance is a major component of posttraumatic stress disorder (PTSD). The role of circadian disruption is largely overlooked, though many PTSD studies collect proxy markers of circadian timing. This individual participant data (IPD) meta-analysis examined the correlation between sleep timing / chronotype and PTSD severity among individuals diagnosed with PTSD, the standardized mean difference in sleep timing / chronotype for individuals with and without PTSD, and moderators of these relationships. A systematic search was conducted; authors provided IPD for 27 studies and aggregate data for 16 studies (3,011 participants with PTSD; 2,703 participants without PTSD). Two-step meta-analyses were conducted using a random-effects multivariate approach with robust variance estimation. Bedtime and wake time were not significantly associated with PTSD symptoms or diagnosis. Less total sleep time / time in bed was weakly associated with greater PTSD symptoms. Moderator analyses revealed that effect sizes were stronger in certain populations and when using wrist actigraphy to measure sleep timing; however, gap maps revealed few studies in moderator categories with the strongest effects. Only two studies measured chronotype, prohibiting strong conclusions. Our findings indicate that the relationship between sleep timing and PTSD is weak; however, key gaps in the literature warrant further study.
Collapse
Affiliation(s)
- Alyson K Zalta
- Department of Psychological Sciences, University of California, Irvine, United States.
| | | | - Amy L Dent
- Department of Psychological Sciences, University of California, Irvine, United States
| | - Isaias M Contreras
- Department of Psychological Sciences, University of California, Irvine, United States
| | - Nadia Malek
- Department of Psychological Sciences, University of California, Irvine, United States; Dissemination and Training Division, National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, CA, United States
| | - Xrystyan N Lascano
- Department of Psychological Sciences, University of California, Irvine, United States
| | - Kelly L Zellner
- Department of Psychological Sciences, University of California, Irvine, United States
| | - Jyotsna Grandhi
- Department of Psychological Sciences, University of California, Irvine, United States; Department of Counseling and Psychological Services, Georgia State University, United States
| | - Precious J Araujo
- Department of Psychological Sciences, University of California, Irvine, United States
| | - Kelci Straka
- Department of Psychological Sciences, University of California, Irvine, United States; School of Social Work, Virginia Commonwealth University, United States
| | - Cathy Z Liang
- Department of Psychological Sciences, University of California, Irvine, United States
| | - Jordyn E Czarny
- Kresge Hearing Research Institute and Department of Otolaryngology, University of Michigan, Ann Arbor, United States; Department of Psychiatry, University of Michigan, United States
| | - Jazmin Martinez
- Department of Psychological Sciences, University of California, Irvine, United States
| | - Helen J Burgess
- Department of Psychiatry, University of Michigan, United States
| |
Collapse
|
46
|
Saguin E, Feingold D, Roseau JB, Quiquempoix M, Boussaud M, Izabelle C, Metlaine A, Guillard M, Van Beers P, Gheorghiev C, Lahutte B, Leger D, Gomez-Merino D, Chennaoui M. An ecological approach to clinically assess nightmares in military service members with severe PTSD. Sleep Med 2023; 103:78-88. [PMID: 36764045 DOI: 10.1016/j.sleep.2023.01.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 01/30/2023]
Abstract
BACKGROUND Trauma-related nightmares (TRNs) are distressing events which contribute to insomnia severity, chronicity and treatment resistance of PTSD. Therefore, recording TRNs is a crucial technical challenge in order to understand their physiopathological patterns and their impact on sleep. However, TRNs are difficult to record during a single night in a sleep laboratory, which, moreover, is likely to be considered by patients as a protective sleep environment that is therefore not representative of home sleep conditions. METHOD In the present study, we investigate if objective sleep measures acquired at-home using two ambulatory devices is of clinical value by correlating with PTSD patients' complaints about sleep and nightmares. A secondary objective is to relate awakenings associated with TRNs to sleep stages and to provide new insights into the use of electrodermal activity (EDA) as a potential physiological marker of TRNs. Sixty veterans and active-duty service members were assessed by questionnaires and recorded for 5 consecutive nights in their homes. RESULTS Our approach firstly identified positive correlations between subjective and objective sleep parameters (total sleep time, sleep-onset latency and TRNs frequency). We also developed a method of synchronization between the two ambulatory devices that allowed us to match 200 TRNs (reported by event marker push button) with sleep stages corresponding to 91 nights and 37 patients. Most awakenings associated with TRNs occurred during NREM sleep (65.5% versus 34.5% during REM sleep). Our results also reveal significant differences in the frequency of EDA peaks 10 min before the reported events, with a lower frequency in REM (13.7 peaks) than in NREM (24.8 peaks) awakenings associated with TRNs. This EDA peaks frequency in REM sleep is not statistically different from that in REM sleep preceding awakenings that are not associated with TRNs. CONCLUSION The development of wearable devices to collect physiological parameters is of interest in clinical practice to improve our knowledge of sleep and trauma-related nightmares in patients with PTSD.
Collapse
Affiliation(s)
- Emeric Saguin
- Psychiatric Department, Begin Military Teaching Hospital, Saint-Mandé, 94160, France; VIFASOM (Vigilance Fatigue Sommeil et Santé Publique) URP 7330, Université Paris Cité, Paris, 75005, France.
| | - Dorone Feingold
- VIFASOM (Vigilance Fatigue Sommeil et Santé Publique) URP 7330, Université Paris Cité, Paris, 75005, France; French Armed Forces Biomedical Research Institute, Bretigny-sur-Orge, 91220, France; ECE Paris Graduate School of Engineering, 75015 Paris, France
| | - Jean-Baptiste Roseau
- Pneumology and Sleep Medicine Department, Clermont-Tonnerre Military Teaching Hospital, Brest, 29240, France
| | - Michael Quiquempoix
- VIFASOM (Vigilance Fatigue Sommeil et Santé Publique) URP 7330, Université Paris Cité, Paris, 75005, France; French Armed Forces Biomedical Research Institute, Bretigny-sur-Orge, 91220, France
| | - Marie Boussaud
- Psychiatric Department, Percy Military Teaching Hospital, Clamart, 92140, France
| | - Clotilde Izabelle
- Psychiatric Department, Laveran Military Teaching Hospital, Marseille, 13384, France
| | - Arnaud Metlaine
- APHP, Hôtel Dieu, Centre du Sommeil et de la Vigilance, Paris, 75004, France
| | - Mathias Guillard
- VIFASOM (Vigilance Fatigue Sommeil et Santé Publique) URP 7330, Université Paris Cité, Paris, 75005, France; French Armed Forces Biomedical Research Institute, Bretigny-sur-Orge, 91220, France
| | - Pascal Van Beers
- VIFASOM (Vigilance Fatigue Sommeil et Santé Publique) URP 7330, Université Paris Cité, Paris, 75005, France; French Armed Forces Biomedical Research Institute, Bretigny-sur-Orge, 91220, France
| | - Charles Gheorghiev
- Psychiatric Department, Sainte-Anne Military Teaching Hospital, Toulon, 83800, France; Ecole du Val-de-Grâce, Paris, 75005, France
| | - Bertrand Lahutte
- Psychiatric Department, Begin Military Teaching Hospital, Saint-Mandé, 94160, France; Ecole du Val-de-Grâce, Paris, 75005, France
| | - Damien Leger
- VIFASOM (Vigilance Fatigue Sommeil et Santé Publique) URP 7330, Université Paris Cité, Paris, 75005, France; APHP, Hôtel Dieu, Centre du Sommeil et de la Vigilance, Paris, 75004, France
| | - Danielle Gomez-Merino
- VIFASOM (Vigilance Fatigue Sommeil et Santé Publique) URP 7330, Université Paris Cité, Paris, 75005, France; French Armed Forces Biomedical Research Institute, Bretigny-sur-Orge, 91220, France
| | - Mounir Chennaoui
- VIFASOM (Vigilance Fatigue Sommeil et Santé Publique) URP 7330, Université Paris Cité, Paris, 75005, France; French Armed Forces Biomedical Research Institute, Bretigny-sur-Orge, 91220, France
| |
Collapse
|
47
|
Sheaves B, Rek S, Freeman D. Nightmares and psychiatric symptoms: A systematic review of longitudinal, experimental, and clinical trial studies. Clin Psychol Rev 2023; 100:102241. [PMID: 36566699 PMCID: PMC10933816 DOI: 10.1016/j.cpr.2022.102241] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 11/24/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
Nightmares occur across a wide range of psychiatric disorders, but outside of PTSD presentations are infrequently considered a treatment priority. We aimed to assess evidence for a contributory causal role of nightmares to the occurrence of psychiatric disorders, and vice versa. A systematic review was conducted of longitudinal, experimental, and clinical trial studies. Twenty-four longitudinal, sixteen trials, and no experimental studies were identified. Methodological shortcomings were common, especially the use of single-item nightmare assessment. Thirty-five studies assessed the path from nightmares to psychiatric symptoms. Depression (n = 10 studies), PTSD (n = 10) and anxiety (n = 5) were the most commonly assessed outcomes in trials. Most were not designed to assess the effect of nightmare treatment on psychiatric symptoms. Treating nightmares led to moderate reductions in PTSD and depression, small to moderate reductions in anxiety, and potentially moderate reductions in paranoia. Nightmares increased the risk of later suicide outcomes (n = 10), but two small pilot trials indicated that treating nightmares might potentially prevent recovery of suicidal ideation. PTSD treatment led to large reductions in trauma-related nightmares (n = 3). The limited literature suggests that treating nightmares may be one route to lessening threat-based disorders in particular, suggestive of a causal relationship. Overall, however, nightmares in most disorders are greatly understudied.
Collapse
Affiliation(s)
- Bryony Sheaves
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, United Kingdom; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, OX3 7JX, United Kingdom.
| | - Stephanie Rek
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, United Kingdom; Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany; International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, United Kingdom; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, OX3 7JX, United Kingdom
| |
Collapse
|
48
|
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.
Collapse
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
| | | |
Collapse
|
49
|
Quasi-causal associations between chronotype and post-traumatic stress disorder symptoms: A twin study. Sleep Health 2023; 9:218-227. [PMID: 36775751 DOI: 10.1016/j.sleh.2023.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 02/12/2023]
Abstract
OBJECTIVE The evening ("night owl") chronotype is associated with greater severity and lifetime prevalence of post-traumatic stress disorder (PTSD) symptoms compared to morning or intermediate chronotypes. This twin study investigated the gene-environment relationships between chronotype, recent PTSD symptoms, and lifetime intrusive symptoms. METHODS We used the reduced Horne-Östberg Morningness-Eveningness Questionnaire (rMEQ) to assess chronotype in a sample of 3777 same-sex adult twin pairs raised together (70.4% monozygotic, 29.6% dizygotic) in the community-based Washington State Twin Registry. PTSD symptoms were reported on the Impact of Events Scale (IES) and a single item for lifetime experience of intrusive symptoms after a stressful or traumatic event. RESULTS Genetic influences accounted for 50% of chronotype variance, 30% of IES score variance, and 14% of lifetime intrusive symptom variance. Bivariate twin models showed a phenotypic association (bp) between evening chronotype and more severe PTSD symptoms (bp = -0.16, SE = 0.02, p < .001) that remained significant even after adjusting for shared genetic and environmental influences (bp = -0.10, SE = 0.04, p = .009), as well as age, sex, and self-reported sleep duration (bp = -0.11, SE = 0.04, p = .004). An association was found between evening chronotype and lifetime intrusive symptoms (bp = -0.11, SE = 0.03, p < .001) that was no longer significant after adjusting for shared genetic and environmental influences (bp = 0.04, SE = 0.06, p = .558). CONCLUSIONS Our results suggest a "quasi-causal" relationship between evening chronotype and PTSD symptoms that is not purely attributable to genetic or shared environmental factors. Evening chronotype may increase vulnerability to pathologic stress responses in the setting of circadian misalignment, providing potential avenues of prevention and treatment using chronobiological strategies.
Collapse
|
50
|
Overnight Corticosterone and Gene Expression in Mouse Hippocampus: Time Course during Resting Period. Int J Mol Sci 2023; 24:ijms24032828. [PMID: 36769150 PMCID: PMC9917930 DOI: 10.3390/ijms24032828] [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: 12/22/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 02/05/2023] Open
Abstract
The aim of the experiment was to test the effect of an elevated level of glucocorticoids on the mouse hippocampal transcriptome after 12 h of treatment with corticosterone that was administered during an active phase of the circadian cycle. Additionally, we also tested the circadian changes in gene expression and the decay time of transcriptomic response to corticosterone. Gene expression was analyzed using microarrays. Obtained results show that transcriptomic responses to glucocorticoids are heterogeneous in terms of the decay time with some genes displaying persistent changes in expression during 9 h of rest. We have also found a considerable overlap between genes regulated by corticosterone and genes implicated previously in stress response. The examples of such genes are Acer2, Agt, Apod, Aqp4, Etnppl, Fabp7, Fam107a, Fjx1, Fmo2, Galnt15, Gjc2, Heph, Hes5, Htra1, Jdp2, Kif5a, Lfng, Lrg1, Mgp, Mt1, Pglyrp1, Pla2g3, Plin4, Pllp, Ptgds, Ptn, Slc2a1, Slco1c1, Sult1a1, Thbd and Txnip. This indicates that the applied model is a useful tool for the investigation of mechanisms underlying the stress response.
Collapse
|