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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.
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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
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Brooker EJ, Landry SA, Mann D, Prguda E, McLeay SC, Drummond SPA, Edwards BA. The obstructive sleep apnoea endotypes are similar in elderly trauma-exposed veterans with and without diagnosed PTSD. Sleep Med 2024; 115:48-54. [PMID: 38330695 DOI: 10.1016/j.sleep.2024.02.006] [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: 12/04/2023] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Approximately 60% of veterans living with posttraumatic stress disorder (PTSD) experience obstructive sleep apnoea (OSA). Why OSA is so prevalent in individuals with PTSD remains unknown, though PTSD may influence the underlying endotypes known to cause OSA. We examined whether these endotypes (upper airway collapsibility, muscle compensation, loop gain, and the arousal threshold) differ between those with comorbid OSA and PTSD relative to their counterparts with OSA-only. METHODS Using the ventilatory flow pattern from diagnostic polysomnography, the OSA endotypes were measured in a retrospective cohort of 21 OSA patients with PTSD and 27 OSA-only patients. All participants were trauma exposed elderly male Australian Vietnam War veterans with mild-to-severe OSA (median Apnoea-Hypopnea index: 20.2 vs. 23.6 events/h). Age and BMI were similar between groups (70.7 vs. 71.7 years, and 28.4 vs. 28.4 kg/m2). RESULTS There were no significant differences in the OSA endotype traits between PTSD + OSA and OSA-only patients for upper airway collapsibility (76.68 [71.53-83.56] vs. 78.35 [72.81-83.82] %Veupnea, median [IQR]), muscle compensation (4.27 [0.34-9.18] vs. 5.41 [1.83-7.21] %Veupnea), loop gain (0.56(0.17) vs. 0.60(0.14)), and arousal threshold (135.76 [126.59-147.54] vs. 146.95 [128.64-151.28] %Veupnea). CONCLUSION The OSA endotypes in veterans with PTSD were similar to their trauma exposed OSA-only counterparts. PTSD appears to exert little influence on the OSA endotypes beyond the effect that age and trauma exposure may have. The aetiology of increased prevalence of OSA in PTSD remains unclear. Further work examining OSA endotypes using larger and more diverse samples is needed before robust conclusions can be made.
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Affiliation(s)
- Elliot J Brooker
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, 3800, Australia
| | - Shane A Landry
- Biomedicine Discovery Institute, Department of Physiology, Monash University, Clayton, Victoria, 3800, Australia
| | - Dwayne Mann
- School of Electrical Engineering and Computer Science, The University of Queensland, Brisbane, Queensland, 4072, Australia
| | - Emina Prguda
- Gallipoli Medical Research Foundation, Brisbane, Queensland, 4120, Australia; The University of Queensland, Brisbane, Queensland, 4006, Australia
| | - Sarah C McLeay
- Gallipoli Medical Research Foundation, Brisbane, Queensland, 4120, Australia
| | - Sean P A Drummond
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, 3800, Australia
| | - Bradley A Edwards
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, 3800, Australia; Biomedicine Discovery Institute, Department of Physiology, Monash University, Clayton, Victoria, 3800, Australia.
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Wang S, Sit HF, Garabiles MR, Blum D, Hannam K, Chérie Armour, Hall BJ. A network analysis investigation of the comorbidity between sleep dysfunction and PTSD symptomatology among Filipino domestic workers in Macao (SAR) China. J Psychiatr Res 2021; 140:337-345. [PMID: 34134057 DOI: 10.1016/j.jpsychires.2021.05.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/01/2021] [Accepted: 05/18/2021] [Indexed: 12/28/2022]
Abstract
Posttraumatic stress disorder (PTSD) is highly comorbid with sleep dysfunction. This association was previously explained based on cognitive and emotional dysfunction. The current study extends this literature by investigating the symptom level comorbidity of sleep dysfunction and DSM-5 PTSD utilizing a network approach. Participants were trauma-exposed female Filipino domestic workers (N = 1241). Network analysis was applied to 23 items: 18 items from PCL-5 measuring PTSD (Community 1) and 5 items from PSQI assessing sleep dysfunction (Community 2). The results showed that the symptoms within each community had the strongest correlations. Bridge connections were identified between the sleep dysfunction and PTSD symptom communities. Symptoms with the highest bridge strength were concentration difficulties, recklessness, irritability, and sleep disturbance. This is among the first studies investigating the comorbidity between PTSD and sleep dysfunction from the network approach. Future interventions may be developed that emphasize the bridge symptoms to address comorbidity among trauma exposed migrants.
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Affiliation(s)
- Siyuan Wang
- New York University (Shanghai), People's Republic of China
| | - Hao Fong Sit
- New York University (Shanghai), People's Republic of China
| | | | - Daniel Blum
- New York University (Shanghai), People's Republic of China
| | - Kevin Hannam
- University of St. Joseph, Macao (SAR), People's Republic of China
| | - Chérie Armour
- Research Centre for Stress Trauma and Related Conditions (STARC), School of Psychology, Queen's University Belfast, Belfast, Northern Ireland, UK; New York University (Shanghai), Shanghai, China
| | - Brian J Hall
- New York University (Shanghai), People's Republic of China; School of Global Public Health, New York University, New York, NY, USA.
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Byrne SP, McCarthy E, DeViva JC, Southwick SM, Pietrzak RH. Prevalence, risk correlates, and health comorbidities of insomnia in US military veterans: results from the 2019-2020 National Health and Resilience in Veterans Study. J Clin Sleep Med 2021; 17:1267-1277. [PMID: 33656983 PMCID: PMC8314657 DOI: 10.5664/jcsm.9182] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 12/11/2022]
Abstract
STUDY OBJECTIVES Veterans experience high levels of trauma, psychiatric, and medical conditions that may increase their risk for insomnia. To date, however, no known study has examined the prevalence, risk correlates, and comorbidities of insomnia in a nationally representative sample of veterans. METHODS A nationally representative sample of 4,069 US military veterans completed a survey assessing insomnia severity; military, trauma, medical, and psychiatric histories; and health and psychosocial functioning. Multivariable analyses examined the association between insomnia severity, psychiatric and medical comorbidities, suicidality, and functioning. RESULTS A total of 11.4% of veterans screened positive for clinical insomnia and 26.0% for subthreshold insomnia. Greater age and retirement were associated with a lower likelihood of insomnia. Adverse childhood experiences, traumatic life events, lower education and income were associated with greater risk for insomnia. A "dose-response" association was observed for health comorbidities, with increasing levels of insomnia associated with elevated odds of psychiatric and medical conditions (clinical vs no insomnia odds ratio = 1.8-13.4) and greater reductions in health and psychosocial functioning (clinical vs no insomnia Cohen's d = 0.2-0.4). The prevalence of current suicidal ideation was 3-5 times higher in veterans with clinical and subthreshold insomnia relative to those without insomnia (23.9% and 13.6% vs 4.5%, respectively). CONCLUSIONS Nearly 2 in 5 US veterans experience clinical or subthreshold insomnia, which is associated with substantial health burden and independent risk for suicidal ideation. Results underscore the importance of assessment, monitoring, and treatment of insomnia in veterans as they transition from the military.
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Affiliation(s)
- Simon P. Byrne
- Department of Psychiatry, Westmead Hospital, Sydney, Australia
| | - Elissa McCarthy
- US Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, White River Junction, Vermont
| | - Jason C. DeViva
- US Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | | | - Robert H. Pietrzak
- US Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut
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Huang Y, Xu J, Zheng S, Xu S, Wang Y, Du J, Xiao L, Zhang R, Wang H, Tang Y, Su T. The risk factors for insomnia and sleep-disordered breathing in military communities: A meta-analysis. PLoS One 2021; 16:e0250779. [PMID: 33956821 PMCID: PMC8101965 DOI: 10.1371/journal.pone.0250779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 04/13/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Many reviews and meta-analyses had been conducted to investigate risk factors for sleep disorders in the general population. However, no similar research has been performed in the military population though insomnia and sleep-disordered breathing are quite prevalent in that population. OBJECTIVES To investigate risk factors for insomnia and sleep-disordered breathing in military personnel. METHODS A systematic literature search was performed from inception to March 2021 and 6496 records were produced. Two authors independently screened records for eligibility. Results were presented as odds ratios, and a random-effect model was used to pool results. Data analysis was performed respectively according to military personnel type (i.e., veteran, active-duty personnel). Risk factors were sorted into three categories: sociodemographic, army-specific, and comorbidity. This meta-analysis was registered in PROSPERO before data analysis (registration No: CRD42020221696). RESULTS Twenty-seven articles were finally included in the quantitative analysis. For sleep-disordered breathing in active-duty personnel, four sociodemographic (i.e., overweight/obesity, higher body mass index, male gender, >35 years old) and one comorbidity (i.e., depression) risk factors were identified. For insomnia in active-duty personnel, four sociodemographic (i.e., aging, alcohol dependence, white race, and female gender), two army-specific (i.e., deployment experience, combat experience), and four comorbidity (i.e., depression, post-traumatic stress disorder, traumatic brain injury, and anxiety) risk factors were identified. For insomnia in veterans, one army-specific (i.e., combat experience) and one comorbidity (i.e., post-traumatic stress disorder) risk factor was identified. CONCLUSIONS Several risk factors were identified for insomnia and sleep-disordered breathing in the current meta-analysis. Risk factors for veterans and active-duty personnel were partially different. Research on sleep breathing disorders remains limited, and more convincing evidence would be obtained with more relevant studies in the future.
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Affiliation(s)
- Yujia Huang
- Department of Medical Psychology, Faculty of Psychology, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Jingzhou Xu
- Department of Medical Psychology, Faculty of Psychology, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Siqi Zheng
- Department of Psychology, TongJi University, Shanghai, China
| | - Shuyu Xu
- Department of Medical Psychology, Faculty of Psychology, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Yajing Wang
- Department of Medical Psychology, Faculty of Psychology, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Jing Du
- Department of Medical Psychology, Faculty of Psychology, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Lei Xiao
- Department of Medical Psychology, Faculty of Psychology, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Ruike Zhang
- Department of Medical Psychology, Faculty of Psychology, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Hao Wang
- Department of Medical Psychology, Faculty of Psychology, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Yunxiang Tang
- Department of Medical Psychology, Faculty of Psychology, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Tong Su
- Department of Medical Psychology, Faculty of Psychology, Naval Medical University (Second Military Medical University), Shanghai, China
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Lewis C, Lewis K, Kitchiner N, Isaac S, Jones I, Bisson JI. Sleep disturbance in post-traumatic stress disorder (PTSD): a systematic review and meta-analysis of actigraphy studies. Eur J Psychotraumatol 2020; 11:1767349. [PMID: 33029311 PMCID: PMC7473131 DOI: 10.1080/20008198.2020.1767349] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Sleep disturbance has been described as a 'hallmark' symptom of posttraumatic stress disorder (PTSD). Although there are robust findings of self-reported sleep disturbance in PTSD, evidence of sleep disturbance measured using actigraphy is less certain. OBJECTIVE To conduct a systematic review and meta-analysis to determine whether there are any significant differences between individuals with and without PTSD in actigraph-derived sleep measures. METHOD Case-control studies comparing participants with current PTSD to those without PTSD were eligible for inclusion. Sleep parameters of interest were: (1) total sleep time; (2) sleep onset latency; (3) wake after sleep onset (WASO); and (4) sleep efficiency. Data were meta-analysed as standardised mean differences (SMDs) and potential sources of heterogeneity were explored through meta-regression. Six actigraphy studies with 405 participants were included. RESULTS There was no evidence of a statistically significant difference between those with and without PTSD in total sleep time (SMD 0.09, 95%CI -0.23 to 0.42); WASO (SMD 0.18, 95%CI -0.06 to 0.43); sleep latency (SMD 0.32, 95%CI -0.04 to 0.69); or sleep efficiency (SMD -0.28, 95%CI -0.78 to 0.21). CONCLUSIONS Further high-quality research is required to determine whether there is a true difference in sleep between those with and without PTSD.
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Affiliation(s)
- Catrin Lewis
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
| | - Katie Lewis
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
| | - Neil Kitchiner
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
| | - Samantha Isaac
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
| | - Ian Jones
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
| | - Jonathan I Bisson
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
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Silkis IG. The Possible Mechanism of the Appearance of Nightmares in Post-Traumatic Stress Disorder and Approaches to Their Prevention. NEUROCHEM J+ 2019. [DOI: 10.1134/s1819712419030127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Brock MS, Powell TA, Creamer JL, Moore BA, Mysliwiec V. Trauma Associated Sleep Disorder: Clinical Developments 5 Years After Discovery. Curr Psychiatry Rep 2019; 21:80. [PMID: 31410580 DOI: 10.1007/s11920-019-1066-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW We review recent and growing evidence that provides support for a novel parasomnia, trauma associated sleep disorder (TASD). Based on these findings, we further develop the clinical and polysomnographic (PSG) characteristics of TASD. We also address factors that precipitate TASD, develop a differential diagnosis, discuss therapy, and propose future directions for research. RECENT FINDINGS Nightmares, classically a REM phenomenon, are prevalent and underreported, even in individuals with trauma exposure. When specifically queried, trauma-related nightmares (TRN) are frequently associated with disruptive nocturnal behaviors (DNB), consistent with TASD. Capture of DNB in the lab is rare but ambulatory monitoring reveals dynamic autonomic concomitants associated with disturbed dreaming. TRN may be reported in NREM as well as REM sleep, though associated respiratory events may confound this finding. Further, dream content is more distressing in REM. Therapy for this complex disorder likely requires addressing not only the specific TASD components of TRN and DNB but comorbid sleep disorders. TASD is a unique parasomnia developing after trauma. Trauma-exposed individuals should be specifically asked about their sleep and if they have nightmares with or without DNB. Patients who report TRN warrant in-lab PSG as part of their evaluation.
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Affiliation(s)
- Matthew S Brock
- Department of Sleep Medicine, San Antonio Uniformed Services Health Education Consortium, San Antonio, TX, USA.
| | - Tyler A Powell
- Department of Sleep Medicine, San Antonio Uniformed Services Health Education Consortium, San Antonio, TX, USA
| | - Jennifer L Creamer
- Sleep Medicine Center, Martin Army Community Hospital, Fort Benning, GA, USA
| | - Brian A Moore
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,University of Texas at San Antonio, San Antonio, TX, USA
| | - Vincent Mysliwiec
- Department of Sleep Medicine, San Antonio Uniformed Services Health Education Consortium, San Antonio, TX, USA
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Theal R, McLeay S, Gleeson S, Lowrie F, O'Sullivan R. Comparison of Sleep Patterns in Vietnam Veterans With and Without Posttraumatic Stress Disorder Using Wrist Actigraphy. J Clin Sleep Med 2019; 15:725-732. [PMID: 31053212 DOI: 10.5664/jcsm.7762] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 01/16/2019] [Indexed: 01/26/2023]
Abstract
STUDY OBJECTIVES Disturbed sleep is a hallmark feature of posttraumatic stress disorder (PTSD). However, few studies have examined sleep objectively in individuals with PTSD compared to trauma-exposed controls. This study used wrist actigraphy to measure and compare sleep patterns in trauma-exposed Australian Vietnam veterans (VV) with and without PTSD. METHODS Trauma-exposed Australian VV with and without PTSD were recruited from the PTSD Initiative. VV wore wrist accelerometers over 14 days and completed daily sleep diaries. Sleep parameters were compared between groups including sleep latency (SL), time in bed (TIB), total sleep time (TST), wake after sleep onset (WASO), and movement index (MI). Night-to-night and overall within-individual variability were assessed by root mean squared successive differences and comparison of individual standard deviations. Correlations between sleep diary (self-reported) and wrist actigraphy (objective) variables were also assessed. RESULTS A total of 40 male VV (20 with PTSD) participated in the study. We found no difference in sleep patterns determined by wrist actigraphy between groups with the exception of reduced SL in VV with PTSD (3.9 ± 0.9 versus 4.9 ± 1.4 minutes, P < .05). Overall within-individual variability was significantly greater in VV with PTSD for TIB, TST, WASO, and MI. Self-reported and objective TST and WASO were more strongly correlated in VV without PTSD than those with PTSD. CONCLUSIONS Although there were no significant differences in sleep parameters, VV with PTSD had increased within-individual overall sleep variability and reduced correlation between self-reported and objective sleep parameters compared to trauma-exposed controls. Further evaluation of extended sleep patterns by actigraphy in VV with PTSD is warranted.
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Affiliation(s)
- Rebecca Theal
- Gallipoli Medical Research Institute, Brisbane, Queensland, Australia.,The University of Queensland, Brisbane, Queensland, Australia
| | - Sarah McLeay
- Gallipoli Medical Research Institute, Brisbane, Queensland, Australia.,The University of Queensland, Brisbane, Queensland, Australia
| | - Sarah Gleeson
- Sleep Care, Greenslopes Private Hospital, Brisbane, Queensland, Australia.,Greenslopes Private Hospital, Brisbane, Queensland, Australia
| | - Fraser Lowrie
- Sleep Care, Greenslopes Private Hospital, Brisbane, Queensland, Australia
| | - Robyn O'Sullivan
- Sleep Care, Greenslopes Private Hospital, Brisbane, Queensland, Australia.,Greenslopes Private Hospital, Brisbane, Queensland, Australia
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El-Solh AA, O'Brien N, Akinnusi M, Patel S, Vanguru L, Wijewardena C. Predictors of cognitive behavioral therapy outcomes for insomnia in veterans with post-traumatic stress disorder. Sleep Breath 2019; 23:635-643. [PMID: 31025272 DOI: 10.1007/s11325-019-01840-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/23/2019] [Accepted: 04/03/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Insomnia is a well-recognized co-morbid condition in veterans with post-traumatic stress disorder (PTSD) with negative personal and social consequences. Cognitive behavioral therapy (CBT) is considered an efficacious treatment, yet little attention has been devoted to treatment response in this population. The aim of this study was to identify factors that may predict clinical response to CBT for insomnia (CBT-I) in veterans with PTSD. METHODS A retrospective chart review of 136 veterans with PTSD-related insomnia was conducted. Epworth Sleepiness Score (ESS), PTSD Checklist (PCL), and Insomnia Severity Index (ISI) were assessed at baseline. We converted prescribed antidepressant and hypnotic dosages before and after CBT-I to dose equivalent of fluoxetine diazepam, respectively. A 6-point reduction or greater in ISI scores at 6-month follow-up visit was defined as CBT-I responsiveness. RESULTS CBT-I responsiveness was observed in 47% of veterans with PTSD. Seventy-seven percent completed treatment. Lack of perceived benefit was the most given reason for failure to return for follow-up. In contrast to hypnotics, antidepressants usage decreased in those who had experienced benefit from CBT-I (p = 0.001). Younger age, non-white race, and use of hypnotics prior to behavioral therapy were independently associated with lack of response to CBT-I. CONCLUSIONS While CBT-I ameliorates insomnia in veterans with PTSD, the use of hypnotics prior to instituting behavioral therapy may negatively affect the response rate to CBT-I. Future studies should examine whether racial and cultural influences on the generation of insomnia in veterans with PTSD affects the response to CBT-I.
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Affiliation(s)
- Ali A El-Solh
- VA Western New York Healthcare System, 3495 Bailey Avenue, Buffalo, NY, 14215, USA.
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Jacob School of Medicine, Buffalo, NY, USA.
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA.
| | - Nathan O'Brien
- Drexel University College of Medicine, Philadelphia, PA, USA
| | | | - Sumit Patel
- VA Western New York Healthcare System, 3495 Bailey Avenue, Buffalo, NY, 14215, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Jacob School of Medicine, Buffalo, NY, USA
| | - Leela Vanguru
- VA Western New York Healthcare System, 3495 Bailey Avenue, Buffalo, NY, 14215, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Jacob School of Medicine, Buffalo, NY, USA
| | - Chathura Wijewardena
- VA Western New York Healthcare System, 3495 Bailey Avenue, Buffalo, NY, 14215, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Jacob School of Medicine, Buffalo, NY, USA
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Sheth C, Prescot AP, Legarreta M, Renshaw PF, McGlade E, Yurgelun-Todd D. Reduced gamma-amino butyric acid (GABA) and glutamine in the anterior cingulate cortex (ACC) of veterans exposed to trauma. J Affect Disord 2019; 248:166-174. [PMID: 30735853 DOI: 10.1016/j.jad.2019.01.037] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 01/01/2019] [Accepted: 01/22/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Trauma-related diagnoses such as posttraumatic stress disorder (PTSD) are prevalent in veterans. The identification of mechanisms related to stress vulnerability and development of PTSD specifically in a veteran population may aid in the prevention of PTSD and identification of novel treatment targets. METHODS Veterans with PTSD (n = 27), trauma-exposed veterans with no PTSD (TEC, n = 18) and non-trauma-exposed controls (NTEC, n = 28) underwent single-voxel proton (1H) magnetic resonance spectroscopy (MRS) at 3 Tesla in the dorsal anterior cingulate cortex (dACC) using a two-dimensional (2D) J-resolved point spectroscopy sequence in addition to completing a clinical battery. RESULTS The PTSD and TEC groups demonstrated lower gamma-amino butyric acid (GABA)/H2O (p = 0.02) and glutamine (Gln)/H2O (p = 0.02) in the dACC as compared to the NTEC group. The PTSD group showed a trend towards higher Glu/GABA (p = 0.053) than the NTEC group. Further, GABA/H2O in the dACC correlated negatively with sleep symptoms in the PTSD group (p = 0.03) but not in the TEC and NTEC groups. LIMITATIONS Cross-sectional study design, concomitant medications, single voxel measurement as opposed to global changes, absence of measure of childhood or severity of trauma and objective sleep measures, female participants not matched for menstrual cycle phase. CONCLUSIONS Exposure to trauma in veterans may be associated with lower GABA/H2O and Gln/H2O in the dACC, suggesting disruption in the GABA-Gln-glutamate cycle. Further, altered Glu/GABA in the dACC in the PTSD group may indicate an excitatory-inhibitory imbalance. Further, lower GABA/H2O in the ACC was associated with poor sleep in the PTSD group. Treatments that restore GABAergic balance may be particularly effective in reducing sleep symptoms in PTSD.
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Affiliation(s)
- Chandni Sheth
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA; Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT, USA.
| | - Andrew P Prescot
- Department of Radiology, University of Utah School of Medicine, Salt Lake City, UT, USA.
| | - Margaret Legarreta
- Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT, USA; George E. Wahlen Department of Veterans Affairs Medical Center, VA VISN 19 Mental Illness Research, Education and Clinical Center (MIRECC), Salt Lake City, UT, USA.
| | - Perry F Renshaw
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA; Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT, USA; George E. Wahlen Department of Veterans Affairs Medical Center, VA VISN 19 Mental Illness Research, Education and Clinical Center (MIRECC), Salt Lake City, UT, USA.
| | - Erin McGlade
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA; Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT, USA; George E. Wahlen Department of Veterans Affairs Medical Center, VA VISN 19 Mental Illness Research, Education and Clinical Center (MIRECC), Salt Lake City, UT, USA.
| | - Deborah Yurgelun-Todd
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA; Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT, USA; George E. Wahlen Department of Veterans Affairs Medical Center, VA VISN 19 Mental Illness Research, Education and Clinical Center (MIRECC), Salt Lake City, UT, USA.
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