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Pebole MM, Whitworth JW, Iverson KM, Currao A, Fortier CB. Traumatic Brain Injury and Posttraumatic Stress Disorder Are Associated with Physical Health Burden among Post-9/11 Women Veterans. J Womens Health (Larchmt) 2024. [PMID: 38873776 DOI: 10.1089/jwh.2024.0147] [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: 06/15/2024] Open
Abstract
Background: Little research focuses on physical health outcomes of traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD) among post-9/11 women veterans (WVs). This study examined lifetime TBI, current PTSD, and their associations with biomarkers of cardiometabolic health, sleep, pain, and functional disability among post-9/11 WVs. Methods: WVs (n = 90) from the Translational Research Center for TBI and Stress Disorders longitudinal cohort study were included in this study. Gold standard clinician administered interviews assessed lifetime TBI (Boston Assessment of TBI-Lifetime) and current PTSD symptoms (Clinician-Administered PTSD Scale-IV). Objective measures of health included waist-hip ratio (WHR) and fasted blood biomarker (high density lipoprotein [HDL], low density lipoprotein [LDL], blood glucose, triglycerides) levels. Self-reported surveys assessed sleep, pain, and functional disability. Results: Just under two-thirds (58.9%) of WVs experienced a lifetime TBI, and just over half (53.3%) of this sample had a current PTSD diagnosis at the time of testing. Lifetime TBI was significantly associated with higher WHR, triglycerides levels, and worse pain and sleep (ps = <0.01 to 0.02; ds = 0.01 to 1.12). Current PTSD was significantly associated with higher WHR, lower HDL, and worse pain and sleep (ps = <0.01 to 0.02; ds = 0.009 to 1.19). PTSD was significantly associated with lower total functioning and each of its subdomains (βs = -0.58 to 0.63; ps = <0.001 to 0.02). Lifetime TBI was significantly associated with total functioning, mobility, and life/work (βs = -0.20 to 0.30; ps = <0.01 to 0.02). Conclusions: These findings highlight the importance of screening for lifetime TBI and cardiovascular disease for WVs and support transdiagnostic treatment approaches targeting physical health outcomes.
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Affiliation(s)
- Michelle M Pebole
- The Translational Research Center for TBI and Stress Disorders (TRACTS), Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - James W Whitworth
- National Center for PTSD Behavioral Health Sciences Division at VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston Massachusetts, USA
| | - Katherine M Iverson
- The Translational Research Center for TBI and Stress Disorders (TRACTS), Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston Massachusetts, USA
- National Center for PTSD Women's Health Sciences Division, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Alyssa Currao
- The Translational Research Center for TBI and Stress Disorders (TRACTS), Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
| | - Catherine B Fortier
- The Translational Research Center for TBI and Stress Disorders (TRACTS), Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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Wilson M, Skeiky L, Muck RA, Miller MA, Hansen DA, Williams RM, Jensen MP, Van Dongen HPA. Sleep and Pain in Veterans with Chronic Pain: Effects of Psychological Pain Treatment and Temporal Associations. Nat Sci Sleep 2023; 15:1061-1077. [PMID: 38144708 PMCID: PMC10748706 DOI: 10.2147/nss.s418532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/26/2023] [Indexed: 12/26/2023] Open
Abstract
Introduction Chronic pain is highly prevalent in US military Veterans. Non-opioid and non-pharmacologic treatments are recommended when clinically appropriate, but research on the mechanisms underlying benefits of these treatments is lacking. Here, we examined the role of sleep in the effects of three non-pharmacologic pain treatments in Veterans. Specifically, we investigated whether treatment effects on sleep predicted treatment effects on pain occurring later, or vice versa. Methods Veterans enrolled in a randomized controlled trial were invited to participate in this supplementary sleep study. A total of 174 Veterans were randomized to one of three 8-session, in-person, group-based pain treatments: hypnosis, mindfulness meditation, or education control. Measurements included self-reported sleep disturbance, pain intensity, and pain catastrophizing; sleep duration was assessed with actigraphy. Sleep and pain measurements were obtained at baseline, posttreatment, and 3-month posttreatment follow-up. Results At baseline, average pain intensity was moderate (mean ± SD: 5.7 ± 1.7 on the 0-10 Numeric Rating Scale), pain catastrophizing was just below the clinically relevant threshold (mean ± SD: 28.6 ± 12.2 on the Pain Catastrophizing Scale), and subjective sleep disturbance exceeded the US population average (mean ± SD: 58.5 ± 8.1 on the Patient Reported Outcomes Measurement Information System Sleep Disturbance - Short Form). By contrast, objective sleep duration was consistent with the recommended daily sleep amount of 7-8 h for adults (mean ± SD: 8.3 ± 1.4 h). Across treatment conditions, pain intensity, pain catastrophizing, and subjective sleep disturbance were significantly less at posttreatment and 3-month follow-up than at baseline (p < 0.001). Actigraphic sleep duration did not differ significantly as a function of time. There was a high degree of covariation among the measures of pain intensity, pain catastrophizing, and sleep disturbance (p < 0.05). However, self-reported sleep disturbance was not significantly correlated with actigraphic sleep duration (|r| <= 0.13, p > 0.05). Sleep and pain variables observed at prior assessments predicted these same variables at subsequent assessments. There was no significant evidence that changes in pain preceded changes in sleep or that changes in sleep preceded changes in pain (all p > 0.05). Discussion For this study's Veterans, treatment-related changes in sleep and pain appeared to occur in parallel. The concomitant changes in sleep and pain suggest that therapies improving pain in Veterans may yield attendant benefits for the treatment of sleep, and possibly vice versa.
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Affiliation(s)
- Marian Wilson
- College of Nursing, Washington State University, Spokane, WA, USA
- Sleep and Performance Research Center, Washington State University, Spokane, WA, USA
| | - Lillian Skeiky
- Sleep and Performance Research Center, Washington State University, Spokane, WA, USA
- Department of Translational Medicine and Physiology, Washington State University, Spokane, WA, USA
| | - Rachael A Muck
- Sleep and Performance Research Center, Washington State University, Spokane, WA, USA
- Department of Translational Medicine and Physiology, Washington State University, Spokane, WA, USA
| | - Megan A Miller
- Rehabilitation Care Service, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Devon A Hansen
- Sleep and Performance Research Center, Washington State University, Spokane, WA, USA
- Department of Translational Medicine and Physiology, Washington State University, Spokane, WA, USA
| | - Rhonda M Williams
- Rehabilitation Care Service, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Hans P A Van Dongen
- Sleep and Performance Research Center, Washington State University, Spokane, WA, USA
- Department of Translational Medicine and Physiology, Washington State University, Spokane, WA, USA
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Malkani R. REM Sleep Behavior Disorder and Other REM Parasomnias. Continuum (Minneap Minn) 2023; 29:1092-1116. [PMID: 37590824 DOI: 10.1212/con.0000000000001293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
OBJECTIVE This article reviews rapid eye movement (REM) sleep behavior disorder (RBD) and other REM sleep parasomnias, particularly recurrent isolated sleep paralysis and nightmare disorder. LATEST DEVELOPMENTS People with RBD have dream enactment behaviors that can be distressing and cause injuries to themselves or a bed partner. Diagnosis of RBD still requires video polysomnography but new evaluative techniques are emerging. Automatic scoring of REM sleep without atonia, the polysomnographic RBD feature, has led to clearer diagnostic cutoff values. Isolated RBD is strongly linked with neurodegenerative disorders, particularly α-synucleinopathies, with a median latency to neurodegenerative disease diagnosis of 8 years. Mounting imaging, electrophysiologic, and pathologic evidence supports neurodegenerative changes in patients with isolated RBD. Safety precautions should be reviewed with patients to reduce the risk of injury. Clonazepam and melatonin are first-line agents for RBD symptoms, and rivastigmine appears to be beneficial for RBD in people with mild cognitive impairment. For nightmare disorder, image rehearsal therapy is effective and can be delivered through online platforms. ESSENTIAL POINTS While RBD symptoms can often be managed, patients with isolated RBD should be monitored for signs and symptoms of impending neurodegenerative disease. Individuals who wish to know about the associated risk should be counseled accordingly to allow planning and involvement in research if they choose. Exercise may have some neuroprotective effects, although no treatment has been shown to modify the neurodegenerative risk.
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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.
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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
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Fear of Sleep Inventory- Short Form (FoSI-SF): A validation study for Turkish speaking populations. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-02991-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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6
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Wilson M, Skeiky L, Muck RA, Honn KA, Williams RM, Jensen MP, Van Dongen HPA. Pain Catastrophizing Mediates the Relationship Between Pain Intensity and Sleep Disturbances in U.S. Veterans With Chronic Pain. Mil Med 2022; 188:usac065. [PMID: 35306565 PMCID: PMC10363005 DOI: 10.1093/milmed/usac065] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/29/2022] [Accepted: 02/24/2022] [Indexed: 07/25/2023] Open
Abstract
INTRODUCTION Veterans with chronic pain frequently report comorbid disruptions in sleep and psychological dysfunction. The purpose of this study was to investigate whether psychological function variables mediate the sleep-pain relationship. Knowledge regarding such contributing factors can inform the development and optimization of treatments for sleep disturbances and pain. MATERIALS AND METHODS In an IRB-approved, registered clinical trial, we collected objective sleep data from U.S. military Veterans with chronic pain (N = 184, ages 23-81) using wrist actigraphy for 7 days and self-reported survey data assessing sleep quality, pain intensity, and psychological function (depression, anxiety, post-traumatic stress disorder, and pain catastrophizing). We investigated the associations between objectively measured and self-reported sleep quality and self-reported pain intensity. In addition, using parallel mediation analyses, we examined whether psychological function variables mediated these associations. RESULTS Actigraphy showed suboptimal sleep duration (less than 7 hours) and sleep fragmentation for most participants. Self-reported poor sleep quality and pain intensity were significantly correlated. Pain catastrophizing was found to mediate the association between self-reported sleep quality and pain intensity. CONCLUSIONS Sleep disturbances in this sample of Veterans with chronic pain included insufficient sleep, fragmented sleep, and perceived poor sleep quality. Analyses suggest that poor perceived sleep quality and pain intensity are mediated via pain catastrophizing. The finding highlights the potential importance of pain catastrophizing in Veterans with chronic pain. Future longitudinal research is needed to determine the extent to which treatments that reduce pain catastrophizing might also improve both sleep and pain outcomes.
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Affiliation(s)
- Marian Wilson
- College of Nursing, Washington State University, Spokane, WA 99202, USA
- Sleep and Performance Research Center, Washington State University, Spokane, WA 99202, USA
| | - Lillian Skeiky
- Sleep and Performance Research Center, Washington State University, Spokane, WA 99202, USA
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA 99202, USA
| | - Rachael A Muck
- Sleep and Performance Research Center, Washington State University, Spokane, WA 99202, USA
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA 99202, USA
| | - Kimberly A Honn
- Sleep and Performance Research Center, Washington State University, Spokane, WA 99202, USA
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA 99202, USA
| | - Rhonda M Williams
- VA Puget Sound Health Care System, Seattle, WA 98108, USA
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA 98104, USA
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA 98104, USA
| | - Hans P A Van Dongen
- Sleep and Performance Research Center, Washington State University, Spokane, WA 99202, USA
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA 99202, USA
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Onton J, Le LD. Amount of < 1Hz deep sleep correlates with melatonin dose in military veterans with PTSD. Neurobiol Sleep Circadian Rhythms 2021; 11:100072. [PMID: 34368501 PMCID: PMC8326800 DOI: 10.1016/j.nbscr.2021.100072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/18/2021] [Accepted: 07/14/2021] [Indexed: 11/28/2022] Open
Abstract
Military veterans with posttraumatic stress disorder often complain of non-restful sleep, which further exacerbates their symptoms. Our previous study showed a deficit in Lo Deep sleep, or slow oscillations, in the PTSD population compared to healthy control sleepers. Because Lo Deep sleep is likely a stage when the brain eliminates protein debris, it is critical to find the cause and effective therapeutics to reverse Lo Deep deficiency. The current study aims to replicate and extend this finding by examining several physiological and medication factors that may be responsible for the Lo Deep deficiency. We recorded overnight sleep electroencephalogram (EEG) via a 2-channel headband device on 69 veterans in a residential treatment facility. Dried urine samples were collected at 4 time points during one day to measure melatonin, cortisol, norepinephrine and other factors. EEG data were transformed into frequency power and submitted to an automated sleep scoring algorithm. The scoring corresponds to clear spectral patterns in the overnight spectrogram but does not align exactly with traditional visual scoring stages. As expected, veterans showed decreased Lo Deep (activity < 1 Hz) and more Hi Deep sleep (1-3 Hz activity) than healthy controls, replicating our previous study. Multiple linear regressions showed that melatonin dose and morning urine melatonin correlated with more Lo Deep sleep. Buspirone dose also correlated with more Lo Deep, but only 6 subjects were taking buspirone. Also replicating the findings from our last study were independent reductions of REM sleep with prazosin and sertraline. Other findings included decreased Lo and increased Hi Deep sleep with higher caffeine dose, and less Hi Deep percentage with higher testosterone. Finally, evening cortisol levels correlated with a higher percentage of Wake after sleep onset. These results confirm Lo Deep deficiency in this PTSD population and suggests melatonin as a possible therapeutic to reverse Lo Deep deficiency. This is a critical first step to establishing a systematic sleep assessment and treatment program in this and potentially other populations to prevent future brain pathology.
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Affiliation(s)
- Julie Onton
- Institute for Neural Computation, University of California San Diego, 9500 Gilman Drive, #0523, La Jolla, CA, 92093, USA
| | - Lu D. Le
- Veterans Affairs San Diego Healthcare System, ASPIRE Center, 2121 San Diego Avenue, San Diego, CA, 92110, USA
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Saguin E, Gomez-Merino D, Sauvet F, Leger D, Chennaoui M. Sleep and PTSD in the Military Forces: A Reciprocal Relationship and a Psychiatric Approach. Brain Sci 2021; 11:brainsci11101310. [PMID: 34679375 PMCID: PMC8533994 DOI: 10.3390/brainsci11101310] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 09/21/2021] [Accepted: 09/28/2021] [Indexed: 11/29/2022] Open
Abstract
Sleep disturbances are well-recognised symptoms of Post-Traumatic Stress Disorder (PTSD). This review updates knowledge regarding the relationship between sleep during deployment, combat-related trauma, and PTSD in military personnel, from which the importance of restorative sleep results. The description of the characteristics of sleep in military forces with the considerable roles of the operational and training contexts highlights the important consequences of degraded sleep. Indeed, a lot of data suggest a dynamic link between sleep and the onset and chronicity of PTSD. We propose a reciprocal relationship model with strategies strongly recommended or already adopted by the military to promote restorative sleep before and after combat exposure. Among the alterations in a variety of sleep architecture and sleep patterns described in PTSD, the physiological hypothesis of REM sleep fragmentation in the development of PTSD symptoms may be important because REM sleep is generally associated with emotional memory. Finally, we address clinical and research perspectives that could be used to detect or restore sleep continuity before and during military deployment to possibly alleviate nightmares and insomnia related to combat exposure and PTSD occurrence and improve our understanding of sleep in PTSD.
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Affiliation(s)
- Emeric Saguin
- Psychiatric Department, Begin Military Teaching Hospital, 94160 Saint-Mandé, France
- VIFASOM (Vigilance Fatigue Sommeil et Santé Publique) EA 7330, Université de Paris, 75005 Paris, France
- Correspondence: ; Tel.: +33-0143985440
| | - Danielle Gomez-Merino
- VIFASOM (Vigilance Fatigue Sommeil et Santé Publique) EA 7330, Université de Paris, 75005 Paris, France
- French Armed Forces Biomedical Research Institute, 91220 Brétigny-sur-Orge, France; (D.G.-M.); (F.S.); (M.C.)
| | - Fabien Sauvet
- VIFASOM (Vigilance Fatigue Sommeil et Santé Publique) EA 7330, Université de Paris, 75005 Paris, France
- French Armed Forces Biomedical Research Institute, 91220 Brétigny-sur-Orge, France; (D.G.-M.); (F.S.); (M.C.)
| | - Damien Leger
- VIFASOM (Vigilance Fatigue Sommeil et Santé Publique) EA 7330, Université de Paris, 75005 Paris, France
- Centre du Sommeil et de la Vigilance, Hôtel-Dieu, APHP, 75004 Paris, France;
| | - Mounir Chennaoui
- VIFASOM (Vigilance Fatigue Sommeil et Santé Publique) EA 7330, Université de Paris, 75005 Paris, France
- French Armed Forces Biomedical Research Institute, 91220 Brétigny-sur-Orge, France; (D.G.-M.); (F.S.); (M.C.)
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9
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Pattinson CL, Guedes VA, Edwards K, Mithani S, Yun S, Taylor P, Dunbar K, Kim HS, Lai C, Roy MJ, Gill JM. Excessive daytime sleepiness is associated with altered gene expression in military personnel and veterans with posttraumatic stress disorder: an RNA sequencing study. Sleep 2021; 43:5802516. [PMID: 32191323 DOI: 10.1093/sleep/zsaa036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 02/11/2020] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES Posttraumatic stress disorder (PTSD) is a common condition for military personnel and veterans. PTSD has been shown to impact gene expression, however, to date no study has examined comorbid conditions which may also impact gene expression, for example, excessive daytime sleepiness (EDS). As such, this study sought to examine gene expression using RNA sequencing across three group comparisons of military personnel and veterans: (1) PTSD with EDS (PTSDwEDS) versus PTSD without EDS (PTSDw/outEDS), (2) Controls (no PTSD or EDS) versus PTSDwEDS, and (3) Controls versus PTSDw/outEDS. METHODS We performed experimental RNA-seq using Illumina's HiSeq 2500 Sequencing System. We also used Ingenuity Pathway Analysis (IPA), a bioinformatics application, to identify gene pathways and networks which may be disrupted. RESULTS There were only two genes that were significantly dysregulated between the Controls and PTSDw/outEDS, therefore IPA analysis was not conducted. However, comparisons revealed that there was significant gene dysregulation between Controls and the PTSDwEDS (251 genes), and the PTSDwEDS versus the PTSDw/outEDS (1,873 genes) groups. Four candidate networks were identified via the IPA software for analysis. Significantly dysregulated genes across the four candidate networks were associated with sleep and circadian function, metabolism, mitochondrial production and function, ubiquitination, and the glutamate system. CONCLUSIONS These results suggest that PTSD with concurrent EDS is associated with gene dysregulation. This dysregulation may present additional biological and health consequences for these military personnel and veterans. Further research, to track these gene changes over time and to determine the cause of the EDS reported, is vital.
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Affiliation(s)
- Cassandra L Pattinson
- National Institutes of Nursing Research, National Institutes of Health, Bethesda, MD.,Institute for Social Science Research, University of Queensland, Indooroopilly, Queensland, Australia
| | - Vivian A Guedes
- National Institutes of Nursing Research, National Institutes of Health, Bethesda, MD
| | - Katie Edwards
- National Institutes of Nursing Research, National Institutes of Health, Bethesda, MD.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Sara Mithani
- National Institutes of Nursing Research, National Institutes of Health, Bethesda, MD
| | - Sijung Yun
- National Institutes of Nursing Research, National Institutes of Health, Bethesda, MD.,Yotta Biomed, LLC, Bethesda, MD
| | - Patricia Taylor
- Institute for Social Science Research, University of Queensland, Indooroopilly, Queensland, Australia.,Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Kerri Dunbar
- Institute for Social Science Research, University of Queensland, Indooroopilly, Queensland, Australia.,Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Hyung-Suk Kim
- National Institutes of Nursing Research, National Institutes of Health, Bethesda, MD
| | - Chen Lai
- National Institutes of Nursing Research, National Institutes of Health, Bethesda, MD
| | - Michael J Roy
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD.,Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Jessica M Gill
- National Institutes of Nursing Research, National Institutes of Health, Bethesda, MD
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10
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An Y, Sun Y, Liu Z, Chen Y. Investigation of the mental health status of frontier-line and non-frontier-line medical staff during a stress period. J Affect Disord 2021; 282:836-839. [PMID: 33601725 PMCID: PMC7773008 DOI: 10.1016/j.jad.2020.12.060] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 12/14/2020] [Accepted: 12/17/2020] [Indexed: 11/18/2022]
Abstract
The Coronavirus Disease 2019 (COVID-19) epidemic has become a global public health event. Medical staff around the world are nervously responding to the crisis, and their mental health problems deserve attention. To better know the differences in the mental health status between frontier-line and non-frontier-line medical staff. This study used the Child PTSD Symptom Scale, the Self-Rating Depression Scale, the Self-Rating Anxiety Scale and the Connor-Davidson Resilience Scale to examine the PTSD, depression, anxiety and resilience among 162 frontier-line medical workers and 163 non-frontier-line medical workers in China. The results showed that all negative factor scores of non-frontier-line medical staff seemed to be worse than those of frontier-line medical staff, and the positive factor scores were the opposite through descriptive analysis, independent sample t-test and Chi-square test. Some psychological effects and theories were used to explain this phenomenon. Intervention suggestions for medical staff and future research directions were discussed.
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Affiliation(s)
- Yuanyuan An
- School of Psychology, Nanjing Normal University, Nanjing, China
| | - Yijing Sun
- School of Psychology, Nanjing Normal University, Nanjing, China
| | - Zhengkui Liu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
| | - Yaru Chen
- School of Psychology, Nanjing Normal University, Nanjing, China
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11
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Lancel M, van Marle HJF, Van Veen MM, van Schagen AM. Disturbed Sleep in PTSD: Thinking Beyond Nightmares. Front Psychiatry 2021; 12:767760. [PMID: 34899428 PMCID: PMC8654347 DOI: 10.3389/fpsyt.2021.767760] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/02/2021] [Indexed: 11/13/2022] Open
Abstract
Sleep disturbances frequently co-occur with posttraumatic stress disorder (PTSD). Insomnia and nightmares are viewed as core symptoms of PTSD. Yet, relations between disturbed sleep and PTSD are far more complex: PTSD is linked to a broad range of sleep disorders and disturbed sleep markedly affects PTSD-outcome. This article provides a concise overview of the literature on prevalent comorbid sleep disorders, their reciprocal relation with PTSD and possible underlying neurophysiological mechanisms. Furthermore, diagnostic procedures, standard interventions-particularly first choice non-pharmacological therapies-and practical problems that often arise in the assessment and treatment of sleep disturbances in PTSD are described. Finally, we will present some perspectives on future multidisciplinary clinical and experimental research to develop new, more effective sleep therapies to improve both sleep and PTSD.
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Affiliation(s)
- Marike Lancel
- Centre of Expertise on Sleep and Psychiatry, GGZ Drenthe Mental Health Institute, Assen, Netherlands.,Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands
| | - Hein J F van Marle
- Department of Psychiatry, Amsterdam Neuroscience, Vrije Universiteit, Amsterdam UMC, Amsterdam, Netherlands.,GGZ InGeest Specialized Mental Health Care, Amsterdam, Netherlands
| | - Maaike M Van Veen
- Centre of Expertise on Sleep and Psychiatry, GGZ Drenthe Mental Health Institute, Assen, Netherlands
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12
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From the perspective of Traditional Chinese Medicine: Treatment of mental disorders in COVID-19 survivors. Biomed Pharmacother 2020; 132:110810. [PMID: 33053508 PMCID: PMC7524684 DOI: 10.1016/j.biopha.2020.110810] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/19/2020] [Accepted: 09/25/2020] [Indexed: 12/24/2022] Open
Abstract
PURPOSE The aim of this study is to explore the possible benefits of traditional Chinese medicine on the pathogenesis of psychological and mental health of COVID-19 survivors. METHODS A literature search was conducted to confirm the effects of COVID-19 on psychological and mental health of survivors. In addition to this, on the basis of signs and symptoms, TCM were used on treat mental disorder as per suggested clinical and animal experimental data plus relevant records in classical Chinese medicine books written by Zhang Zhongiing during Han Dynasty. A series of treatment plans were prescribed for COVID-19 survivors with psychological and mental disorders. RESULTS According to previous extensive studies focusing on effects on mental health of survivors, high incidence was observed in severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) survivors. During investigations of mental health of COVID-19 patients and survivors, it is observed that they also had symptoms of mental disorders and immune dysfunction. Furthermore, it was also proposed that depression, anxiety and post-traumatic stress disorder (PTSD) were most common mental disorders requiring special attention after the recovery from COVID-19. The symptoms of COVID-19 were analyzed, and the TCM syndrome of the depression, anxiety and PTSD after recovered from COVID19 was interpreted as internal heat and Yin deficiency. These three mental disorders pertains the category of "Lily disease", "hysteria" and "deficient dysphoria" in TCM. CONCLUSION Lily Bulb, Rhizoma Anemarrhena Decoction and Ganmai Dazao Decoction were used to treat depression. Suanzaoren Decoction, Huanglian Ejiao Decoction and Zhizi Chi Decoction were suggested for anxiety. Moreover, Lily Bulb, Rehmannia Decoction and Guilu Erxian Decoction were the formula for PTSD.
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13
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Reitz SL, Wasilczuk AZ, Beh GH, Proekt A, Kelz MB. Activation of Preoptic Tachykinin 1 Neurons Promotes Wakefulness over Sleep and Volatile Anesthetic-Induced Unconsciousness. Curr Biol 2020; 31:394-405.e4. [PMID: 33188746 DOI: 10.1016/j.cub.2020.10.050] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 09/28/2020] [Accepted: 10/16/2020] [Indexed: 12/22/2022]
Abstract
Endogenous sleep and general anesthesia are distinct states that share similar traits. Of particular interest to neuroscience is the loss of consciousness that accompanies both states. Multiple lines of evidence demonstrate that general anesthetics can co-opt the neural circuits regulating arousal to produce unconsciousness. However, controversy remains as to whether the neural circuits and, more specifically, the same neurons shaping sleep and wakefulness actually do influence the anesthetic state in vivo. Hypothalamic preoptic area (POA) neurons are intimately involved in modulating spontaneous and anesthetic-induced changes in arousal. Nevertheless, recent work suggests that POA GABAergic or glutamatergic neurons capable of regulating endogenous sleep fail to influence the onset or dissipation of anesthesia. We hypothesized that the POA's broad neuronal diversity could mask convergent roles of a subset of neurons in regulating both arousal and anesthesia. Contrary to a previously published report, we show that chemogenetic activation of POA Tac1 neurons obliterates both non-rapid eye movement (NREM) and rapid eye movement (REM) sleep, strongly consolidating the waking state for hours, even during a period of elevated sleep drive. Moreover, chemogenetic activation of Tac1 POA neurons stabilizes the wake state against both isoflurane- and sevoflurane-induced unconsciousness. Tac1-activated mice display a partial resistance to entering isoflurane anesthesia and a more pronounced ability to exit both isoflurane- and sevoflurane-induced unconscious states. We conclude that POA Tac1 neurons can potently reinforce arousal both against endogenous and drug-induced unconscious states. POA Tac1 neurons thus add causal support for the involvement of arousal-regulating systems in the state of general anesthesia.
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Affiliation(s)
- Sarah L Reitz
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Perelman School of Medicine, 3620 Hamilton Walk, 334 John Morgan Building, Philadelphia, PA 19104, USA; Mahoney Institute for Neurosciences, University of Pennsylvania, Philadelphia, PA 19104, USA; Circadian and Sleep Institute, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Andrzej Z Wasilczuk
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Perelman School of Medicine, 3620 Hamilton Walk, 334 John Morgan Building, Philadelphia, PA 19104, USA; Circadian and Sleep Institute, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Gretel H Beh
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Perelman School of Medicine, 3620 Hamilton Walk, 334 John Morgan Building, Philadelphia, PA 19104, USA
| | - Alex Proekt
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Perelman School of Medicine, 3620 Hamilton Walk, 334 John Morgan Building, Philadelphia, PA 19104, USA; Mahoney Institute for Neurosciences, University of Pennsylvania, Philadelphia, PA 19104, USA; Circadian and Sleep Institute, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Max B Kelz
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Perelman School of Medicine, 3620 Hamilton Walk, 334 John Morgan Building, Philadelphia, PA 19104, USA; Mahoney Institute for Neurosciences, University of Pennsylvania, Philadelphia, PA 19104, USA; Circadian and Sleep Institute, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Lou T, Ma J, Wang Z, Terakoshi Y, Lee CY, Asher G, Cao L, Chen Z, Sakurai K, Liu Q. Hyper-Activation of mPFC Underlies Specific Traumatic Stress-Induced Sleep-Wake EEG Disturbances. Front Neurosci 2020; 14:883. [PMID: 32973436 PMCID: PMC7461881 DOI: 10.3389/fnins.2020.00883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 07/28/2020] [Indexed: 11/28/2022] Open
Abstract
Sleep disturbances have been recognized as a core symptom of post-traumatic stress disorders (PTSD). However, the neural basis of PTSD-related sleep disturbances remains unclear. It has been challenging to establish the causality link between a specific brain region and traumatic stress-induced sleep abnormalities. Here, we found that single prolonged stress (SPS) could induce acute changes in sleep/wake duration as well as short- and long-term electroencephalogram (EEG) alterations in the isogenic mouse model. Moreover, the medial prefrontal cortex (mPFC) showed persistent high number of c-fos expressing neurons, of which more than 95% are excitatory neurons, during and immediately after SPS. Chemogenetic inhibition of the prelimbic region of mPFC during SPS could specifically reverse the SPS-induced acute suppression of delta power (1–4 Hz EEG) of non-rapid-eye-movement sleep (NREMS) as well as most of long-term EEG abnormalities. These findings suggest a causality link between hyper-activation of mPFC neurons and traumatic stress-induced specific sleep–wake EEG disturbances.
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Affiliation(s)
- Tingting Lou
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Japan
| | - Jing Ma
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Japan.,HIT Center for Life Sciences (HCLS), School of Life Sciences and Technology, Harbin Institute of Technology, Harbin, China
| | - Zhiqiang Wang
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Japan.,HIT Center for Life Sciences (HCLS), School of Life Sciences and Technology, Harbin Institute of Technology, Harbin, China
| | - Yuka Terakoshi
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Japan
| | - Chia-Ying Lee
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Japan
| | - Greg Asher
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Japan
| | - Liqin Cao
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Japan
| | - Zhiyu Chen
- National Institute of Biological Sciences (NIBS), Beijing, China.,Tsinghua Institute of Multidisciplinary Biomedical Research (TIMBR), Tsinghua University, Beijing, China
| | - Katsuyasu Sakurai
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Japan
| | - Qinghua Liu
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Japan.,National Institute of Biological Sciences (NIBS), Beijing, China.,Tsinghua Institute of Multidisciplinary Biomedical Research (TIMBR), Tsinghua University, Beijing, China
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15
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Martindale SL, Konst MJ, Bateman JR, Arena A, Rowland JA. The role of PTSD and TBI in post-deployment sleep outcomes. MILITARY PSYCHOLOGY 2020; 32:212-221. [PMID: 38536314 PMCID: PMC10013407 DOI: 10.1080/08995605.2020.1724595] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 01/29/2020] [Indexed: 12/18/2022]
Abstract
The purpose of this study was to evaluate the main and interaction effects of PTSD and TBI on sleep outcomes in veterans. Post-deployment combat veterans (N = 293, 87.37% male) completed clinical interviews to determine diagnosis and severity of PTSD and deployment TBI history, as well as subjective measures of sleep quality, sleep duration, and restedness. Sleep-related medical diagnoses were extracted from electronic medical records for all participants. PTSD and TBI were each associated with poorer ratings of sleep quality, restedness, shorter sleep duration, and greater incidence of clinically diagnosed sleep disorders. Analyses indicated main effects of PTSD on sleep quality (p < .001), but no main effects of TBI. PTSD severity was significantly associated with poorer sleep quality (p < .001), restedness (p = .018), and shorter sleep duration (p = .015). TBI severity was significantly associated with restedness beyond PTSD severity (p = .036). There were no interaction effects between diagnostic or severity variables. PTSD severity is a driving factor for subjective ratings of sleep disturbance beyond PTSD diagnosis as well as TBI diagnosis and severity. Despite this, poor sleep was apparent throughout the sample, which suggests post-deployment service members may globally benefit from routine screening of sleep problems and increased emphasis on sleep hygiene.
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Affiliation(s)
- Sarah L. Martindale
- Salisbury VA Medical Center, Salisbury, North Carolina
- Mid-Atlantic MIRECC, Durham, North Carolina
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | - James R. Bateman
- Salisbury VA Medical Center, Salisbury, North Carolina
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Alyssa Arena
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Jared A. Rowland
- Salisbury VA Medical Center, Salisbury, North Carolina
- Mid-Atlantic MIRECC, Durham, North Carolina
- Wake Forest School of Medicine, Winston-Salem, North Carolina
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16
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Bavafa A, Khazaie H, Khaledi-Paveh B, Rezaie L. The relationship of severity of symptoms of depression, anxiety, and stress with sleep quality in earthquake survivors in Kermanshah. J Inj Violence Res 2019; 11:225-232. [PMID: 31263090 PMCID: PMC6646827 DOI: 10.5249/jivr.v11i2.1203] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 06/26/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Earthquake is one of the most common natural disasters. A 7.3" Richter earthquake happened at 5km from the town of Ezgeleh in Kermanshah province in 2017, which caused several physical and mental injuries. The present study was conducted to investigate the sleep quality and mental health difficulties of those affected by earthquake and predict sleep quality according to severity of symptoms of depression, anxiety, and stress in the township of Sarpol-e Zahab, which suffered the most damage. METHODS A total of 999 earthquake survivors living in temporary tents and camps were assessed in terms of sleep quality and pattern using Pittsburgh Sleep Quality Index, and severity of psychological symptoms using Depression, Anxiety, and Stress scale 10 days after the disaster. RESULTS According to the results, poor sleep quality was experienced by 20.61% of survivors, severe stress by 60.5%, and severe depression by 41.5%, and moderate anxiety by 74%. The subjective quality, efficiency, daily dysfunction, use of hypnotics, and total sleep quality had a positive and significant relation with severity of experienced depression, anxiety, and stress. Sleep latency had a positive and significant relation only with stress, and sleep disturbance with depression and stress. CONCLUSIONS Severity of depression, anxiety, and stress can predict changes in total sleep quality of those affected by earthquake. Stress can be considered as the sole predictor of total sleep quality and the only factor that can explain components of sleep quality. The implications of the present study are debatable.
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Affiliation(s)
| | | | - Behnam Khaledi-Paveh
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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17
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Khumtong C, Taneepanichskul N. Posttraumatic stress disorder and sleep quality among urban firefighters in Thailand. Nat Sci Sleep 2019; 11:123-130. [PMID: 31616194 PMCID: PMC6698610 DOI: 10.2147/nss.s207764] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 07/05/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Urban firefighters are at risk of posttraumatic stress disorder (PTSD) because of their occupational exposure to trauma events. Little is known, however, about the effects of exposure to trauma events on sleep quality among firefighters in Thailand. PURPOSE The objective of this study was to find an assocaition between PTSD and sleep quality among firefighters. METHODS A cross-sectional study was conducted among active male firefighters in Bangkok. Participants completed the Posttraumatic Stress Disorder Checklist - Civilian Version (PCL-C-THAI) and the Pittsburgh Sleep Quality Index (PSQI-THAI) questionnaires. Multivariable logistic regression models were performed to estimate adjusted odds ratio (AOR) and 95% confidence intervals (95% CI). RESULTS A total of 1215 firefighters participated, of which 78 (6.4%) met the suggested PCL cut-point criteria for civilians (PCL-C scores >44). In addition, 596 (49.1%) had poor sleep quality (PSQI >5). PTSD firefighters had increased 6.49 fold odds of poorer sleep quality (AOR =6.49, 95% CI 3.13-13.44). CONCLUSION Firefighters with PTSD had a significantly higher probability of experiencing poor sleep quality than those without. In response, a psychological health intervention may be needed to enhance the firefighters' health.
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Affiliation(s)
- Chinchuta Khumtong
- College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand.,Faculty of Science and Technology, Valaya Alongkorn Rajabhat University, Phathum Thani, Thailand
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18
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Paul MA, Love RJ, Jetly R, Richardson JD, Lanius RA, Miller JC, MacDonald M, Rhind SG. Blunted Nocturnal Salivary Melatonin Secretion Profiles in Military-Related Posttraumatic Stress Disorder. Front Psychiatry 2019; 10:882. [PMID: 31866882 PMCID: PMC6910089 DOI: 10.3389/fpsyt.2019.00882] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 11/08/2019] [Indexed: 12/16/2022] Open
Abstract
Background: Sleep disturbances are a hallmark of posttraumatic stress disorder (PTSD), yet few studies have evaluated the role of dysregulated endogenous melatonin secretion in this condition. Methods: This study compared the sleep quality and nocturnal salivary melatonin profiles of Canadian Armed Forces (CAF) personnel diagnosed with PTSD, using the Clinician Administered PTSD Scale (CAPS score ≥50), with two healthy CAF control groups; comprising, a "light control" (LC) group with standardized evening light exposure and "normal control" (NC) group without light restriction. Participants were monitored for 1-week using wrist actigraphy to assess sleep quality, and 24-h salivary melatonin levels were measured (every 2h) by immunoassay on the penultimate day in a dim-light (< 5 lux) laboratory environment. Results: A repeated measures design showed that mean nocturnal melatonin concentrations for LC were higher than both NC (p = .03) and PTSD (p = .003) with no difference between PTSD and NC. Relative to PTSD, NC had significantly higher melatonin levels over a 4-h period (01 to 05 h), whereas the LC group had higher melatonin levels over an 8-h period (23 to 07 h). Actigraphic sleep quality parameters were not different between healthy controls and PTSD patients, likely due to the use of prescription sleep medications in the PTSD group. Conclusions: These results indicate that PTSD is associated with blunted nocturnal melatonin secretion, which is consistent with previous findings showing lower melatonin after exposure to trauma and suggestive of severe chronodisruption. Future studies targeting the melatonergic system for therapeutic intervention may be beneficial for treatment-resistant PTSD.
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Affiliation(s)
- Michel A Paul
- Defence Research & Development Canada, Toronto Research Centre, Operational Health and Performance Section, Toronto, ON, Canada
| | - Ryan J Love
- Defence Research & Development Canada, Toronto Research Centre, Operational Health and Performance Section, Toronto, ON, Canada
| | - Rakesh Jetly
- Directorate of Mental Health, Canadian Forces Health Services, Ottawa, ON, Canada
| | - J Donald Richardson
- Department of Psychiatry, Western University, London, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.,Operational Stress Injury Clinic, Parkwood Institute, London, ON, Canada.,MacDonald Franklin Operational Stress Injury Research Centre, Lawson Research Institute, London, ON, Canada
| | - Ruth A Lanius
- Department of Psychiatry, Western University, London, ON, Canada.,Department of Neuroscience, Western University, London, ON, Canada
| | - James C Miller
- Department of Life Sciences, Texas A&M University Corpus Christi, Corpus Christi, TX, United States
| | - Michael MacDonald
- Directorate of Mental Health, Canadian Forces Health Services, Ottawa, ON, Canada
| | - Shawn G Rhind
- Defence Research & Development Canada, Toronto Research Centre, Operational Health and Performance Section, Toronto, ON, Canada
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19
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Balba NM, Elliott JE, Weymann KB, Opel RA, Duke JW, Oken BS, Morasco BJ, Heinricher MM, Lim MM. Increased Sleep Disturbances and Pain in Veterans With Comorbid Traumatic Brain Injury and Posttraumatic Stress Disorder. J Clin Sleep Med 2018; 14:1865-1878. [PMID: 30373686 DOI: 10.5664/jcsm.7482] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 07/23/2018] [Indexed: 12/11/2022]
Abstract
STUDY OBJECTIVES Veterans are at an increased risk for traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD), both of which are associated with sleep disturbances and increased pain. Furthermore, sleep disturbances and pain are reciprocally related such that each can exacerbate the other. Although both TBI and PTSD are independently linked to sleep disturbances and pain, it remains unclear whether Veterans with comorbid TBI+PTSD show worse sleep disturbances and pain compared to those with only TBI or PTSD. We hypothesized that sleep and pain would be worse in Veterans with comorbid TBI+PTSD compared to Veterans with only TBI or PTSD. METHODS Veterans (n = 639) from the VA Portland Health Care System completed overnight polysomnography and self-report questionnaires. Primary outcome variables were self-reported sleep disturbances and current pain intensity. Participants were categorized into four trauma-exposure groups: (1) neither: without TBI or PTSD (n = 383); (2) TBI: only TBI (n = 67); (3) PTSD: only PTSD (n = 126); and (4) TBI+PTSD: TBI and PTSD (n = 63). RESULTS The PTSD and TBI+PTSD groups reported worse sleep compared to the TBI and neither groups. The TBI+PTSD group reported the greatest pain intensity compared to the other groups. CONCLUSIONS These data suggest sleep and pain are worst in Veterans with TBI and PTSD, and that sleep is similarly impaired in Veterans with PTSD despite not having as much pain. Thus, although this is a complex relationship, these data suggest PTSD may be driving sleep disturbances, and the added effect of TBI in the comorbid group may be driving pain in this population.
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Affiliation(s)
- Nadir M Balba
- VA Portland Health Care System, Portland, Oregon.,Department of Behavioral Neuroscience, Oregon Health and Science University, Portland, Oregon
| | - Jonathan E Elliott
- VA Portland Health Care System, Portland, Oregon.,Department of Neurology, Oregon Health and Science University, Portland, Oregon
| | - Kris B Weymann
- VA Portland Health Care System, Portland, Oregon.,School of Nursing, Oregon Health and Science University, Portland, Oregon
| | - Ryan A Opel
- VA Portland Health Care System, Portland, Oregon
| | - Joseph W Duke
- Department of Biological Sciences, Northern Arizona University, Flagstaff, Arizona
| | - Barry S Oken
- Department of Behavioral Neuroscience, Oregon Health and Science University, Portland, Oregon.,Department of Neurology, Oregon Health and Science University, Portland, Oregon
| | - Benjamin J Morasco
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon.,Department of Psychiatry, Oregon Health and Sciences University, Portland, Oregon
| | - Mary M Heinricher
- VA Portland Health Care System, Portland, Oregon.,Department of Behavioral Neuroscience, Oregon Health and Science University, Portland, Oregon.,Department of Neurological Surgery; Oregon Health and Science University, Portland, Oregon
| | - Miranda M Lim
- VA Portland Health Care System, Portland, Oregon.,Department of Behavioral Neuroscience, Oregon Health and Science University, Portland, Oregon.,Department of Neurology, Oregon Health and Science University, Portland, Oregon.,Department of Medicine, Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, Oregon.,Oregon Institute of Occupational Health Sciences, Oregon Health and Science University, Portland, Oregon
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Baird T, Theal R, Gleeson S, McLeay S, O'Sullivan R, McLeay S, Harvey W, Romaniuk M, Crawford D, Colquhoun D, McD Young R, Dwyer M, Gibson J, O'Sullivan R, Cooksley G, Strakosch C, Thomson R, Voisey J, Lawford B. Detailed Polysomnography in Australian Vietnam Veterans With and Without Posttraumatic Stress Disorder. J Clin Sleep Med 2018; 14:1577-1586. [PMID: 30176975 DOI: 10.5664/jcsm.7340] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 06/05/2018] [Indexed: 01/26/2023]
Abstract
STUDY OBJECTIVES Recent results from the PTSD Initiative, a cross-sectional cohort study in Australian Vietnam veterans (VV) with and without posttraumatic stress disorder (PTSD), demonstrated an increased prevalence of self-reported sleep disturbances in those with PTSD. This study aimed to objectively assess the prevalence of sleep disorders in the same cohort using detailed polysomnography (PSG). METHODS Participants from the PTSD Initiative were recruited to undergo PSG. PTSD status was determined with the Clinician Administered PTSD Scale for DSM-5 (CAPS-5). Subjective sleep information was attained via structured questionnaires. Data from single night PSG were compared between trauma-exposed VV with and without PTSD. RESULTS A total of 74 trauma-exposed male VV (40 with PTSD) underwent PSG (prospective n = 59, retrospective n = 15). All PSG parameters were similar between groups. No difference was seen in PSG-diagnosed obstructive sleep apnea (OSA) or periodic limb movements of sleep (PLMS). VV with PTSD showed a trend toward increased duration of sleep with oxygen saturations < 90% (10% versus 1.8%; P = .07). VV with PTSD reported increased sleep onset latency (42.4 versus 13.3 minutes; P < .01); were less likely to report sleeping well (32.5% versus 67.5%; P < .01); had higher OSA risk using Berlin Questionnaire (BQ) (70% versus 38.2%; P < .01); and had higher rates of partner-reported limb movements (56.4% versus 17.6%; P < .01). No association between PSG-diagnosed OSA and PTSD severity was evident. CONCLUSIONS In Australian VV with and without PTSD, no difference was seen across all PSG parameters including the diagnosis and severity of OSA and PLMS. However, VV with PTSD demonstrated an increased perception of sleep disturbances.
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Affiliation(s)
- Timothy Baird
- Sleep Care, Greenslopes Private Hospital, Brisbane, Queensland, Australia.,Greenslopes Private Hospital, Brisbane, Queensland, Australia
| | - Rebecca Theal
- Gallipoli Medical Research Institute, Brisbane, Queensland, Australia
| | - Sarah Gleeson
- Sleep Care, Greenslopes Private Hospital, Brisbane, Queensland, Australia.,Greenslopes Private Hospital, Brisbane, Queensland, Australia
| | - Sarah McLeay
- Gallipoli Medical Research Institute, Brisbane, Queensland, Australia.,The University of Queensland, Brisbane, Queensland, Australia
| | - Robyn O'Sullivan
- Sleep Care, Greenslopes Private Hospital, Brisbane, Queensland, Australia.,Greenslopes Private Hospital, Brisbane, Queensland, Australia
| | | | - Sarah McLeay
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Newdegate St, Greenslopes
| | - Wendy Harvey
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Newdegate St, Greenslopes
| | - Madeline Romaniuk
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Newdegate St, Greenslopes.,School of Biomedical Sciences, Faculty of Health and Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD
| | - Darrell Crawford
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Newdegate St, Greenslopes.,School of Medicine, The University of Queensland, Herston, Queensland.,Greenslopes Private Hospital, Newdegate St, Greenslopes, Queensland
| | - David Colquhoun
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Newdegate St, Greenslopes.,School of Medicine, The University of Queensland, Herston, Queensland.,Greenslopes Private Hospital, Newdegate St, Greenslopes, Queensland
| | - Ross McD Young
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Newdegate St, Greenslopes.,Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD
| | - Miriam Dwyer
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Newdegate St, Greenslopes
| | - John Gibson
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Newdegate St, Greenslopes.,Greenslopes Private Hospital, Newdegate St, Greenslopes, Queensland
| | - Robyn O'Sullivan
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Newdegate St, Greenslopes.,School of Medicine, The University of Queensland, Herston, Queensland.,Greenslopes Private Hospital, Newdegate St, Greenslopes, Queensland
| | - Graham Cooksley
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Newdegate St, Greenslopes.,School of Medicine, The University of Queensland, Herston, Queensland
| | - Christopher Strakosch
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Newdegate St, Greenslopes.,School of Medicine, The University of Queensland, Herston, Queensland.,Greenslopes Private Hospital, Newdegate St, Greenslopes, Queensland
| | - Rachel Thomson
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Newdegate St, Greenslopes.,School of Medicine, The University of Queensland, Herston, Queensland.,Greenslopes Private Hospital, Newdegate St, Greenslopes, Queensland
| | - Joanne Voisey
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Newdegate St, Greenslopes.,School of Biomedical Sciences, Faculty of Health and Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD
| | - Bruce Lawford
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Newdegate St, Greenslopes.,School of Biomedical Sciences, Faculty of Health and Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD.,School of Medicine, The University of Queensland, Herston, Queensland.,Greenslopes Private Hospital, Newdegate St, Greenslopes, Queensland
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21
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Ghadami MR, Khazaie H, Masoudi M. Obstructive sleep apnea in veterans with post-traumatic stress disorder: looking beyond their complaint. Sleep Breath 2018; 23:293-294. [PMID: 30145677 DOI: 10.1007/s11325-018-1706-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 04/20/2018] [Accepted: 08/05/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Mohammad Rasoul Ghadami
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Habibolah Khazaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Maryam Masoudi
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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22
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Jasbi M, Sadeghi Bahmani D, Karami G, Omidbeygi M, Peyravi M, Panahi A, Mirzaee J, Holsboer-Trachsler E, Brand S. Influence of adjuvant mindfulness-based cognitive therapy (MBCT) on symptoms of post-traumatic stress disorder (PTSD) in veterans - results from a randomized control study. Cogn Behav Ther 2018; 47:431-446. [PMID: 29893182 DOI: 10.1080/16506073.2018.1445773] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Even 30 or more years after the end of a war, veterans can suffer from post-traumatic stress disorder (PTSD). In the present study, we explored the influence on symptoms of PTSD among Iranian veterans of the Iran-Iraq war of mindfulness-based cognitive therapy (MBCT) as add-on to a standard treatment with citalopram. Forty-eight male veterans with PTSD (mean age: 52.97 years) took part in this eight-week intervention study. Standard treatment for all patients consisted of citalopram (30-50 mg/day at therapeutic dosages). Patients were randomly assigned either to the treatment or to the control condition. Treatment involved MBCT delivered in group sessions once a week. Patients in the control condition met at the hospital with the same frequency and duration for socio-therapeutic events. At baseline and at study completion, patients completed questionnaires covering symptoms of PTSD, depression, anxiety, and stress. At study completion after eight weeks, scores for PTSD (re-experiencing events, avoidance, negative mood and cognition, hyperarousal), depression, anxiety, and stress were lower, but more so in the intervention than the control group. Data suggest that, as adjuvant to standard SSRI medication, MBCT is an effective intervention to significantly reduce symptoms of PTSD, depression, anxiety, and stress among veterans.
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Affiliation(s)
| | - Dena Sadeghi Bahmani
- b Psychiatric Clinics (UPK), Center for Affective, Stress and Sleep Disorders (ZASS) , University of Basel , Basel , Switzerland.,c Department of Psychiatry, Sleep Disorders Research Center , Kermanshah University of Medical Sciences (KUMS) , Kermanshah , Iran
| | | | | | - Maryam Peyravi
- f Researching Science Unit of Tehran , Tehran University of Medical Sciences , Tehran , Iran
| | | | - Jafar Mirzaee
- h Janbazan Medical and Engineering Research Center (JMERC) , Tehran University of Medical Sciences , Tehran , Iran
| | - Edith Holsboer-Trachsler
- b Psychiatric Clinics (UPK), Center for Affective, Stress and Sleep Disorders (ZASS) , University of Basel , Basel , Switzerland
| | - Serge Brand
- b Psychiatric Clinics (UPK), Center for Affective, Stress and Sleep Disorders (ZASS) , University of Basel , Basel , Switzerland.,c Department of Psychiatry, Sleep Disorders Research Center , Kermanshah University of Medical Sciences (KUMS) , Kermanshah , Iran.,i Department of Sport, Exercise and Health, Division of Sport Science and Psychosocial Health , University of Basel , Basel , Switzerland
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Baird T, McLeay S, Harvey W, Theal R, Law D, O'Sullivan R. Sleep Disturbances in Australian Vietnam Veterans With and Without Posttraumatic Stress Disorder. J Clin Sleep Med 2018; 14:745-752. [PMID: 29734981 PMCID: PMC5940424 DOI: 10.5664/jcsm.7096] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 01/11/2018] [Accepted: 01/18/2018] [Indexed: 01/03/2023]
Abstract
STUDY OBJECTIVES Posttraumatic stress disorder (PTSD) is a condition that may develop after a traumatic event, particularly combat-related trauma. Although sleep disturbance is a hallmark of PTSD, the prevalence of sleep disturbances in Australian veterans with PTSD remains uncertain. This study aimed to subjectively compare the prevalence of sleep disturbances in Australian Vietnam veterans with and without PTSD. METHODS A cross-sectional cohort study compared trauma-exposed Australian Vietnam veterans with and without PTSD. PTSD diagnosis was confirmed using the Clinician Administered PTSD Scale for DSM-5. Sleep information was evaluated using supervised structured questionnaires, including Epworth Sleepiness Scale (ESS) and Berlin and Mayo Questionnaires. RESULTS Two hundred fourteen male Vietnam veterans (108 with PTSD) were included. Participants with PTSD had higher body mass index (30.3 versus 29 kg/m2; P < .05), higher ESS score (9.2 versus 7.6; P < .05), and increased alcohol or medication use to assist with sleep (19% versus 6%; P < .01; and 44% versus 14%; P < .01). Those with PTSD were less likely to sleep well (32% versus 72%; P < .01) and reported higher rates of restless legs (45% versus 25%; P < .01), nightmares (91% versus 29%; P < .01), nocturnal screaming (73% versus 18%; P < .01), sleep terrors (61% versus 13%; P < .01) and dream enactment (78% versus 11.8%; P < .01). The PTSD group had higher rates of diagnosed OSA (42% versus 21%; P < .01) and an increased risk of OSA on the Berlin Questionnaire (69% versus 43%; P < .01). CONCLUSIONS Compared to trauma-exposed controls, Australian Vietnam veterans with PTSD demonstrated an increased prevalence of a wide range of sleep disturbances, including OSA. In veterans with PTSD, detailed sleep assessment, including consideration of polysomnography, is paramount.
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Affiliation(s)
| | - Sarah McLeay
- Gallipoli Medical Research Institute, Brisbane, Australia
| | - Wendy Harvey
- Greenslopes Private Hospital, Brisbane, Australia
- Gallipoli Medical Research Institute, Brisbane, Australia
| | - Rebecca Theal
- Gallipoli Medical Research Institute, Brisbane, Australia
| | - Dayna Law
- Greenslopes Private Hospital, Brisbane, Australia
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Higher Risk for Obstructive Sleep Apnea in Chronic Treatment-Resistant Depression. IRANIAN JOURNAL OF PSYCHIATRY AND BEHAVIORAL SCIENCES 2018. [DOI: 10.5812/ijpbs.10718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Weymann KB, Lim MM. Sleep Disturbances in TBI and PTSD and Potential Risk of Neurodegeneration. CURRENT SLEEP MEDICINE REPORTS 2017. [DOI: 10.1007/s40675-017-0077-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Excitation of GABAergic Neurons in the Bed Nucleus of the Stria Terminalis Triggers Immediate Transition from Non-Rapid Eye Movement Sleep to Wakefulness in Mice. J Neurosci 2017. [PMID: 28642284 DOI: 10.1523/jneurosci.0245-17.2017] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Emotionally salient situations usually trigger arousal along with autonomic and neuroendocrine reactions. To determine whether the extended amygdala plays a role in sleep-wakefulness regulation, we examined the effects of optogenetic and pharmacogenetic excitation of GABAergic neurons in the bed nucleus of the stria terminalis (GABABNST neurons). Acute optogenetic excitation of these cells during nonrapid eye movement (NREM) sleep resulted in an immediate state transition to wakefulness, whereas stimulation during REM sleep showed no effect on sleep-wakefulness states in male mice. An anterograde tracing study suggested GABABNST neurons send axonal projections to several brain regions implicated in arousal, including the preoptic area, lateral hypothalamus, periaqueductal gray, deep mesencephalic nucleus, and parabrachial nucleus. A dual orexin receptor antagonist, DORA-22, did not affect the optogenetic transition from NREM sleep to wakefulness. Chemogenetic excitation of GABABNST neurons evoked a sustained wakefulness state, but this arousal effect was markedly attenuated by DORA-22. These observations suggest that GABABNST neurons play an important role in transition from NREM sleep to wakefulness without the function of orexin neurons, but prolonged excitation of these cells mobilizes the orexin system to sustain wakefulness.SIGNIFICANCE STATEMENT We examined the role of the bed nucleus of the stria terminalis (BNST) in the regulation of wakefulness. Optogenetic excitation of GABAergic neurons in the BNST (GABABNST neurons) during nonrapid eye movement (NREM) sleep in mice resulted in immediate transition to a wakefulness state without function of orexins. Prolonged excitation of GABABNST neurons by a chemogenetic method evoked a longer-lasting, sustained wakefulness state, which was abolished by preadministration of a dual orexin receptor antagonist, DORA-22. This study revealed a role of the BNST GABAergic system in sleep-wakefulness control, especially in shifting animals' behavioral states from NREM sleep to wakefulness, and provides an important insight into the pathophysiology of insomnia and the role of orexin in arousal regulation.
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