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Denis D, Bottary R, Cunningham TJ, Drummond SPA, Straus LD. Beta spectral power during sleep is associated with impaired recall of extinguished fear. Sleep 2023; 46:zsad209. [PMID: 37542729 PMCID: PMC10566240 DOI: 10.1093/sleep/zsad209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 07/13/2023] [Indexed: 08/07/2023] Open
Abstract
The failure to retain memory for extinguished fear plays a major role in the maintenance of posttraumatic stress disorder (PTSD), with successful extinction recall necessary for symptom reduction. Disturbed sleep, a hallmark symptom of PTSD, impairs fear extinction recall. However, our understanding of the electrophysiological mechanisms underpinning sleep's role in extinction retention remains underdetermined. We examined the relationship between the microarchitecture of sleep and extinction recall in healthy humans (n = 71, both male and females included) and a pilot study in individuals with PTSD (n = 12). Participants underwent a fear conditioning and extinction protocol over 2 days, with sleep recording occurring between conditioning and extinction. Twenty-four hours after extinction learning, participants underwent extinction recall. Power spectral density (PSD) was computed for pre- and post-extinction learning sleep. Increased beta-band PSD (~17-26 Hz) during pre-extinction learning sleep was associated with worse extinction recall in healthy participants (r = 0.41, p = .004). Beta PSD was highly stable across three nights of sleep (intraclass correlation coefficients > 0.92). Results suggest beta-band PSD is specifically implicated in difficulties recalling extinguished fear.
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Affiliation(s)
- Dan Denis
- Department of Psychology, University of York, York, UK
| | - Ryan Bottary
- Institute for Graduate Clinical Psychology, Widener University, Chester, PA, USA
| | - Tony J Cunningham
- Center for Sleep and Cognition, Psychiatry Department, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Sean P A Drummond
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Laura D Straus
- Mental Health Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Department of Psychiatry, University of California, San Francisco, CA, USA
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Straus LD, Neylan TC, McLean SA. Potential Limitations for Assessing Adverse Posttraumatic Neuropsychiatric Sequelae With Wrist-Wearable Device and Self-report Survey-Reply. JAMA Psychiatry 2023:2804642. [PMID: 37163282 DOI: 10.1001/jamapsychiatry.2023.1147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Affiliation(s)
- Laura D Straus
- San Francisco Veterans Affairs Medical Center, San Francisco, California
- Department of Psychiatry, University of California, San Francisco
| | - Thomas C Neylan
- San Francisco Veterans Affairs Medical Center, San Francisco, California
- Department of Psychiatry, University of California, San Francisco
| | - Samuel A McLean
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill
- Institute for Trauma Recovery, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill
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Straus LD, An X, Ji Y, McLean SA, Neylan TC. Utility of Wrist-Wearable Data for Assessing Pain, Sleep, and Anxiety Outcomes After Traumatic Stress Exposure. JAMA Psychiatry 2023; 80:220-229. [PMID: 36630119 PMCID: PMC9857758 DOI: 10.1001/jamapsychiatry.2022.4533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/09/2022] [Indexed: 01/12/2023]
Abstract
Importance Adverse posttraumatic neuropsychiatric sequelae after traumatic stress exposure are common and have higher incidence among socioeconomically disadvantaged populations. Pain, depression, avoidance of trauma reminders, reexperiencing trauma, anxiety, hyperarousal, sleep disruption, and nightmares have been reported. Wrist-wearable devices with accelerometers capable of assessing 24-hour rest-activity characteristics are prevalent and may have utility in measuring these outcomes. Objective To evaluate whether wrist-wearable devices can provide useful biomarkers for recovery after traumatic stress exposure. Design, Setting, and Participants Data were analyzed from a diverse cohort of individuals seen in the emergency department after experiencing a traumatic stress exposure, as part of the Advancing Understanding of Recovery After Trauma (AURORA) study. Participants recruited from 27 emergency departments wore wrist-wearable devices for 8 weeks, beginning in the emergency department, and completed serial assessments of neuropsychiatric symptoms. A total of 19 019 patients were screened. Of these, 3040 patients met study criteria, provided informed consent, and completed baseline assessments. A total of 2021 provided data from wrist-wearable devices, completed the 8-week assessment, and were included in this analysis. The data were randomly divided into 2 equal parts (n = 1010) for biomarker identification and validation. Data were collected from September 2017 to January 2020, and data were analyzed from May 2020 to November 2022. Exposures Participants were recruited for the study after experiencing a traumatic stress exposure (most commonly motor vehicle collision). Main Outcomes and Measures Rest-activity characteristics were derived and validated from wrist-wearable devices associated with specific self-reported symptom domains at a point in time and changes in symptom severity over time. Results Of 2021 included patients, 1257 (62.2%) were female, and the mean (SD) age was 35.8 (13.0) years. Eight wrist-wearable device biomarkers for symptoms of adverse posttraumatic neuropsychiatric sequelae exceeded significance thresholds in the derivation cohort. One of these, reduced 24-hour activity variance, was associated with greater pain severity (r = -0.14; 95% CI, -0.20 to -0.07). Changes in 6 rest-activity measures were associated with changes in pain over time, and changes in the number of transitions between sleep and wake over time were associated with changes in pain, sleep, and anxiety. Simple cutoffs for these biomarkers identified individuals with good recovery for pain (positive predictive value [PPV], 0.85; 95% CI, 0.82-0.88), sleep (PPV, 0.63; 95% CI, 0.59-0.67, and anxiety (PPV, 0.76; 95% CI, 0.72-0.80) with high predictive value. Conclusions and Relevance These findings suggest that wrist-wearable device biomarkers may have utility as screening tools for pain, sleep, and anxiety symptom outcomes after trauma exposure in high-risk populations.
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Affiliation(s)
- Laura D. Straus
- San Francisco VA Medical Center, San Francisco, California
- Department of Psychiatry, University of California, San Francisco
| | - Xinming An
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill
| | - Yinyao Ji
- Institute for Trauma Recovery, Department of Psychiatry, University of North Carolina at Chapel Hill
| | - Samuel A. McLean
- Institute for Trauma Recovery, Department of Psychiatry, University of North Carolina at Chapel Hill
- Department of Emergency Medicine, University of North Carolina at Chapel Hill
| | - Thomas C. Neylan
- Department of Psychiatry, University of California, San Francisco
- Department of Neurology, University of California, San Francisco
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Abstract
Sleep plays a crucial role in the consolidation of memories, including those for fear acquisition and extinction training. This chapter reviews findings from studies testing this relationship in laboratory, naturalistic, and clinical settings. While evidence is mixed, several studies in humans have linked fear and extinction recall/retention to both rapid eye-movement and slow wave sleep. Sleep appears to further aid in the processing of both simulated and actual trauma and improves psychotherapeutic treatment outcomes in those with anxiety and trauma- and stressor-related disorders. This chapter concludes with a discussion of the current challenges facing sleep and emotional memory research in addition to suggestions for improving future research.
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Affiliation(s)
- Ryan Bottary
- Department of Psychology and Neuroscience, Boston College, Chestnut Hill, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Laura D Straus
- Department of Research, San Francisco VA Health Care System, San Francisco, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Edward F Pace-Schott
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA.
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA.
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5
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Straus LD, Dolsen EA, Nishimi K, Neylan TC, O'Donovan A. Worse sleep, worsening post-traumatic stress disorder (PTSD): Poor sleep quality associated with increases in PTSD symptoms amongst those experiencing high threat of the COVID-19 pandemic. J Sleep Res 2022; 31:e13568. [PMID: 35199399 PMCID: PMC9115198 DOI: 10.1111/jsr.13568] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 01/14/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic is a global health crisis with the potential to elicit and worsen psychiatric symptoms, particularly post-traumatic stress disorder (PTSD) symptoms. Identifying modifiable protective factors is critical for preventing and treating PTSD symptoms both during and following the COVID-19 pandemic. The present study examined associations of self-reported sleep quality and anticipatory threat appraisals of the pandemic with PTSD symptoms 6 months later in a sample enriched for pre-pandemic trauma exposure and PTSD. The sample included 590 adults (mean age 38.2 years) who completed a baseline survey in August/September 2020 and follow-up survey in March/April 2021. The sample was recruited from a pool of participants interested in a prior study about traumatic stress. Participants self-reported sleep quality and pandemic-related anticipatory threat appraisals at baseline. PTSD symptoms were assessed at baseline and follow-up. Baseline sleep quality was associated with PTSD symptoms at follow-up controlling for baseline PTSD symptoms (B = -2.49, p = 0.001). Perceived anticipatory threat of the pandemic moderated this association such that worse sleep quality was related to more severe PTSD symptoms at follow-up for participants with higher (B = -4.07, p < 0.001) but not lower (B = -0.43, p = 0.679) anticipatory threat about the COVID-19 pandemic. These findings suggest that poor sleep quality may enhance vulnerability to later PTSD symptoms during the pandemic, particularly among those individuals who perceived the pandemic as threatening for their future. Treatments that address sleep problems may be beneficial for reducing trauma-related symptoms during and following the global health crisis.
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Affiliation(s)
- Laura D Straus
- Mental Health Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
- Department of Psychiatry, University of California, San Francisco, California, USA
| | - Emily A Dolsen
- Mental Health Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
- Department of Psychiatry, University of California, San Francisco, California, USA
- Mental Illness Research Education and Clinical Centers, San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - Kristen Nishimi
- Mental Health Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
- Department of Psychiatry, University of California, San Francisco, California, USA
| | - Thomas C Neylan
- Mental Health Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
- Department of Psychiatry, University of California, San Francisco, California, USA
| | - Aoife O'Donovan
- Mental Health Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
- Department of Psychiatry, University of California, San Francisco, California, USA
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Colvonen PJ, Rivera G, Straus LD, Park J, Haller M, Norman SB, Ancoli-Israel S. Diagnosing obstructive sleep apnea in a residential treatment program for veterans with substance use disorder and PTSD. Psychol Trauma 2022; 14:178-185. [PMID: 34472946 PMCID: PMC8795467 DOI: 10.1037/tra0001066] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is often comorbid with both substance use disorders (SUD) and posttraumatic stress disorder (PTSD), yet frequently goes undiagnosed and untreated. We present data on the feasibility and acceptability of objective OSA diagnosis procedures, findings on OSA prevalence, and the relationship between OSA and baseline SUD/PTSD symptoms among veterans in residential treatment for comorbid PTSD/SUD. METHODS Participants were 47 veterans admitted to residential PTSD/SUD treatment. Participants completed questionnaires assessing PTSD and sleep symptoms, and filled out a sleep diary for seven days. Apnea-hypopnea index (AHI) was recorded using the overnight Home Sleep Apnea test (HSAT; OSA was diagnosed with AHI ≥ 5). RESULTS Objective OSA diagnostic testing was successfully completed in 95.7% of participants. Of the 45 veterans who went through HSAT, 46.7% had no OSA, 35.6% received a new OSA diagnosis, and 8.9% were previously diagnosed with OSA and were using positive airway pressure treatment (PAP); an additional 8.9% were previously diagnosed with OSA, reconfirmed with the HSAT, but were not using PAP. One hundred percent of respondents during follow-up deemed the testing protocol's usefulness as "Good" or "Excellent." CONCLUSION OSA diagnostic testing on the residential unit was feasible and acceptable by participants and was effective in diagnosing OSA. OSA testing should be considered for everyone entering a SUD and PTSD residential unit. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Peter J. Colvonen
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, United States;,University of California, San Diego, Department of Psychiatry, 9500 Gilman Drive, San Diego, CA 92093, United States;,VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Drive, MC 116A San Diego, CA 92161, United States;,National Center for PTSD, 215 North Main Street, White River Junction, VT, 05009, United States
| | - Guadalupe Rivera
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, United States
| | - Laura D. Straus
- Department of Psychiatry, University of California, San Francisco;,San Francisco VA Healthcare System
| | - Jae Park
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, United States;,University of California, San Diego, Department of Psychiatry, 9500 Gilman Drive, San Diego, CA 92093, United States
| | - Moira Haller
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, United States;,University of California, San Diego, Department of Psychiatry, 9500 Gilman Drive, San Diego, CA 92093, United States
| | - Sonya B. Norman
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, United States;,University of California, San Diego, Department of Psychiatry, 9500 Gilman Drive, San Diego, CA 92093, United States;,VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Drive, MC 116A San Diego, CA 92161, United States;,National Center for PTSD, 215 North Main Street, White River Junction, VT, 05009, United States
| | - Sonia Ancoli-Israel
- University of California, San Diego, Department of Psychiatry, 9500 Gilman Drive, San Diego, CA 92093, United States
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Holder N, Kanady JC, Straus LD, Khan AJ, Purcell N, Huggins J, Gloria R, Neylan TC, Lujan C, Maguen S. Reducing Barriers to Behavioral Treatments for Insomnia: A Qualitative Examination of Veterans' Perspectives of BBTI. Behav Sleep Med 2022; 20:37-49. [PMID: 33502265 DOI: 10.1080/15402002.2021.1878173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: Although behavioral treatments are recommended for treating insomnia disorder, these treatments are not the most commonly provided treatments due to numerous barriers (e.g., treatment length, time limitations). Brief Behavioral Treatment for Insomnia (BBTI) was developed, in part, to help overcome these barriers. The purpose of the current study was to qualitatively examine the treatment experiences of veterans with insomnia disorder participating in BBTI.Methods: All veterans (n=46) who were randomized to receive BBTI as part of a randomized clinical trial participated in 10-20 minute semi-structured interviews one week after completing treatment. Rapid analysis procedures were used for qualitative analysis.Results: Thirteen qualitative themes were identified: BBTI provided veterans with the skills they believed they needed to continue improving independently post-treatment; beginning BBTI with in-person sessions was valued; phone sessions helped participation; veterans did not perceive that they could cover the same content during phone and in-person sessionsl; materials could be more portable; BBTI created accountability; BBTI required discipline and willingness; BBTI facilitated buy-in; BBTI was aligned with military culture; loved ones could provide important support; BBTI could be improved with more personalization; BBTI challenged expectations of mental health; and BBTI improved awareness of health behaviors beyond sleep.Conclusions: BBTI was successful in overcoming barriers to behavioral insomnia treatment and interviews identified critical treatment aspects that should be maintained to preserve acceptability (e.g., in-person session first). Areas in which BBTI did not fully meet the needs of veterans and targets for improvement (e.g., ameliorating understanding and expectations of phone sessions) were also identified.
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Affiliation(s)
- Nicholas Holder
- San Francisco Veterans Affairs Health Care System, Mental Health, San Francisco, CA, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center; Mental Health, San Francisco, CA, USA.,Department of Psychiatry, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Jennifer C Kanady
- San Francisco Veterans Affairs Health Care System, Mental Health, San Francisco, CA, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center; Mental Health, San Francisco, CA, USA.,Department of Psychiatry, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Laura D Straus
- San Francisco Veterans Affairs Health Care System, Mental Health, San Francisco, CA, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center; Mental Health, San Francisco, CA, USA.,Department of Psychiatry, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Amanda J Khan
- San Francisco Veterans Affairs Health Care System, Mental Health, San Francisco, CA, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center; Mental Health, San Francisco, CA, USA.,Department of Psychiatry, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Natalie Purcell
- San Francisco Veterans Affairs Health Care System, Mental Health, San Francisco, CA, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center; Mental Health, San Francisco, CA, USA
| | - Joy Huggins
- San Francisco Veterans Affairs Health Care System, Mental Health, San Francisco, CA, USA
| | - Rebecca Gloria
- San Francisco Veterans Affairs Health Care System, Mental Health, San Francisco, CA, USA
| | - Thomas C Neylan
- San Francisco Veterans Affairs Health Care System, Mental Health, San Francisco, CA, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center; Mental Health, San Francisco, CA, USA.,Department of Psychiatry, University of California San Francisco School of Medicine, San Francisco, CA, USA.,Department of Neurology, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Callan Lujan
- San Francisco Veterans Affairs Health Care System, Mental Health, San Francisco, CA, USA.,Department of Psychology, Washington State University, Pullman, WA, USA
| | - Shira Maguen
- San Francisco Veterans Affairs Health Care System, Mental Health, San Francisco, CA, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center; Mental Health, San Francisco, CA, USA.,Department of Psychiatry, University of California San Francisco School of Medicine, San Francisco, CA, USA
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Richards A, Inslicht SS, Yack LM, Metzler TJ, Huie JR, Straus LD, Dukes C, Hubachek SQ, Felmingham KL, Mathalon DH, Woodward SH, Neylan TC. The Relationship of Fear-Potentiated Startle and Polysomnography-Measured Sleep in Trauma-Exposed Men and Women with and without PTSD: Testing REM Sleep Effects and Exploring the Roles of an Integrative Measure of Sleep, PTSD Symptoms, and Biological Sex. Sleep 2021; 45:6430783. [PMID: 34792165 DOI: 10.1093/sleep/zsab271] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 10/06/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES Published research indicates that sleep is involved in emotional information processing. Using a fear-potentiated startle (FPS) and nap sleep protocol, we examined the relationship of emotional learning with REM sleep (REMS) in trauma-exposed participants. We also explored the roles of PTSD symptoms, biological sex, and an integrative measure of polysomnography-measured (PSG) sleep in the learning-sleep relationship. METHODS After an adaptation nap, participants (N=46) completed 2 more visits (counterbalanced): a stress-condition visit, which included FPS conditioning procedures prior to a nap and assessment of learning retention and fear extinction training after the nap, and a control visit, which included a nap opportunity without stressful procedures. FPS conditioning included a "fear" visual stimulus paired with an air blast to the neck and a "safety" visual stimulus never paired with an air blast. Retention and extinction involved presentation of the visual stimuli without the air blast. Primary analyses examined the relationship between FPS responses pre- and post- sleep with stress-condition REMS duration, controlling for control-nap REMS duration. RESULTS Higher safety learning predicted increased REMS and increased REMS predicted more rapid extinction learning. Similar relationships were observed with an integrative PSG sleep measure. They also showed unexpected effects of PTSD symptoms on learning and showed biological sex effects on learning-sleep relationships. CONCLUSIONS Findings support evidence of a relationship between adaptive emotional learning and REMS. They underscore the importance of examining sex effects in sleep-learning relationships. They introduce an integrative PSG sleep measure with potential relevance to studies of sleep and subjective and biological outcomes.
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Affiliation(s)
- Anne Richards
- University of California, San Francisco, and San Francisco VA Medical Center (SFVAMC), San Francisco, CA, 94121, USA
| | - Sabra S Inslicht
- University of California, San Francisco, and San Francisco VA Medical Center (SFVAMC), San Francisco, CA, 94121, USA
| | - Leslie M Yack
- San Francisco VA Medical Center, San Francisco, CA, 94121, USA
| | | | - J Russell Huie
- University of California, San Francisco, and San Francisco VA Medical Center (SFVAMC), San Francisco, CA, 94121, USA
| | - Laura D Straus
- San Francisco VA Medical Center, San Francisco, CA, 94121, USA
| | - Cassandra Dukes
- San Francisco VA Medical Center, San Francisco, CA, 94121, USA
| | | | | | - Daniel H Mathalon
- University of California, San Francisco, and San Francisco VA Medical Center (SFVAMC), San Francisco, CA, 94121, USA
| | - Steven H Woodward
- National Center for PTSD and VA Palo Alto Health Care System, Palo Alto, CA 94304, USA
| | - Thomas C Neylan
- University of California, San Francisco, and San Francisco VA Medical Center (SFVAMC), San Francisco, CA, 94121, USA
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Kanady JC, Ruoff L, Straus LD, Varbel J, Metzler T, Richards A, Inslicht SS, O'Donovan A, Hlavin J, Neylan TC. Validation of sleep measurement in a multisensor consumer grade wearable device in healthy young adults. J Clin Sleep Med 2021; 16:917-924. [PMID: 32048595 DOI: 10.5664/jcsm.8362] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Our objective was to examine the ability of a consumer-grade wearable device (Basis B1) with accelerometer and heart rate technology to assess sleep patterns compared with polysomnography (PSG) and research-grade actigraphy in healthy adults. METHODS Eighteen adults underwent consecutive nights of sleep monitoring using Basis B1, actigraphy, and PSG; 40 nights were used in analyses. Discrepancies in gross sleep parameters and epoch-by-epoch agreements in sleep/wake classification were assessed. RESULTS Basis B1 accuracy was 54.20 ± 8.20%, sensitivity was 98.90 ± 2.70%, and specificity was 8.10 ± 15.00%. Accuracy, sensitivity, and specificity for distinguishing between the different sleep stages were 60-72%, 48-62%, and 57-86%, respectively. Pearson correlations demonstrated strong associations between Basis B1 and PSG estimates of sleep onset latency and total sleep time; moderate associations for sleep efficiency, duration of light sleep, and duration of rapid eye movement sleep; and a weak association for duration of deep sleep. Basis B1 significantly overestimates total sleep time, sleep efficiency, and duration of light sleep and significantly underestimates wake after sleep onset and duration of deep sleep. CONCLUSIONS Basis B1 demonstrated utility for estimates of gross sleep parameters and performed similarly to actigraphy for estimates of total sleep time. Basis B1 specificity was poor, and Basis B1 is not useful for the assessment of wake. Basis B1 accuracy for sleep stages was better than chance but is not a suitable replacement for PSG assessment. Despite low cost, ease of use, and attractiveness for patients, consumer devices are not yet accurate or reliable enough to guide treatment decision making in clinical settings.
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Affiliation(s)
- Jennifer C Kanady
- San Francisco Veterans Affairs Health Care System, San Francisco, California.,Department of Psychiatry, University of California, San Francisco, California
| | - Leslie Ruoff
- San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Laura D Straus
- San Francisco Veterans Affairs Health Care System, San Francisco, California.,Department of Psychiatry, University of California, San Francisco, California
| | - Jonathan Varbel
- San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Thomas Metzler
- San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Anne Richards
- San Francisco Veterans Affairs Health Care System, San Francisco, California.,Department of Psychiatry, University of California, San Francisco, California
| | - Sabra S Inslicht
- San Francisco Veterans Affairs Health Care System, San Francisco, California.,Department of Psychiatry, University of California, San Francisco, California
| | - Aoife O'Donovan
- San Francisco Veterans Affairs Health Care System, San Francisco, California.,Department of Psychiatry, University of California, San Francisco, California
| | - Jennifer Hlavin
- San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Thomas C Neylan
- San Francisco Veterans Affairs Health Care System, San Francisco, California.,Department of Psychiatry, University of California, San Francisco, California.,Department of Neurology, University of California, San Francisco, California
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10
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Maguen S, Gloria R, Huggins J, Goldstein LA, Kanady JC, Straus LD, Metzler TJ, Lujan C, Neylan TC. Brief behavioral treatment for insomnia improves psychosocial functioning in veterans: results from a randomized controlled trial. Sleep 2021; 44:5918478. [PMID: 33022048 DOI: 10.1093/sleep/zsaa205] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/28/2020] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES Our goal was to compare brief behavioral treatment for insomnia (BBTI) to a progressive muscle relaxation training (PMRT) control condition among veterans with insomnia, examining psychosocial functioning as a primary outcome and sleep-related outcomes, mood, cognition, and pain as secondary outcomes. METHODS Veterans were randomly assigned to either BBTI or PMRT (N = 91; 24-74 years; M = 49 years). BBTI consisted of two in-person (60-min and 30-min sessions) and two telephone sessions (20-min each), and the PMRT control condition was matched to BBTI for session duration and type. Veterans were assessed through clinical interview at baseline and self-report measures at pre-, mid-, and posttreatment, as well as 6-month follow-up for the BBTI condition to assess sustained response. Measures also included continuous sleep monitoring with sleep diary. RESULTS Intent-to-treat analyses demonstrated that individuals who completed BBTI versus PMRT reported greater improvements in work, home, social and cognitive functioning, insomnia symptom severity, mood, and energy. Improvements in psychosocial functioning, insomnia symptoms, and mood were maintained 6-months following BBTI treatment completion. CONCLUSIONS Veterans who received BBTI improved and maintained gains in psychosocial functioning, insomnia, and mood. BBTI is a treatment that can be implemented in primary care, mental health, or integrated care settings and provide symptom relief and improved functioning among those with insomnia, one of the most commonly reported mental health problems among veterans. CLINICAL TRIAL REGISTRATION NCT02571452.
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Affiliation(s)
- Shira Maguen
- San Francisco Veterans Affairs Health Care System, San Francisco, CA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA.,Sierra Pacific Mental Illness Research Education, and Clinical Center, San Francisco, CA
| | - Rebecca Gloria
- San Francisco Veterans Affairs Health Care System, San Francisco, CA
| | - Joy Huggins
- San Francisco Veterans Affairs Health Care System, San Francisco, CA
| | - Lizabeth A Goldstein
- San Francisco Veterans Affairs Health Care System, San Francisco, CA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA.,Sierra Pacific Mental Illness Research Education, and Clinical Center, San Francisco, CA
| | - Jennifer C Kanady
- San Francisco Veterans Affairs Health Care System, San Francisco, CA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA.,Sierra Pacific Mental Illness Research Education, and Clinical Center, San Francisco, CA
| | - Laura D Straus
- San Francisco Veterans Affairs Health Care System, San Francisco, CA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA.,Sierra Pacific Mental Illness Research Education, and Clinical Center, San Francisco, CA
| | - Thomas J Metzler
- San Francisco Veterans Affairs Health Care System, San Francisco, CA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA.,Sierra Pacific Mental Illness Research Education, and Clinical Center, San Francisco, CA
| | - Callan Lujan
- San Francisco Veterans Affairs Health Care System, San Francisco, CA.,Department of Psychology, Washington State University, Pullman, WA
| | - Thomas C Neylan
- San Francisco Veterans Affairs Health Care System, San Francisco, CA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA.,Sierra Pacific Mental Illness Research Education, and Clinical Center, San Francisco, CA
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11
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Khan AJ, Maguen S, Straus LD, Nelyan TC, Gross JJ, Cohen BE. Expressive suppression and cognitive reappraisal in veterans with PTSD: Results from the mind your heart study. J Affect Disord 2021; 283:278-284. [PMID: 33578339 DOI: 10.1016/j.jad.2021.02.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 01/14/2021] [Accepted: 02/01/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study examined whether expressive suppression (ES), a maladaptive regulation strategy, was more strongly associated with PTSD diagnosis and symptom clusters in veterans than cognitive reappraisal (CR), an adaptive regulation strategy. METHOD In a cohort study, 746 participants recruited from VHA facilities completed Clinician Administered PTSD Scale-IV, Emotion Regulation Questionnaire, and Patient Health Questionnaire. Participants were categorized into groups: Current, Remitted/Lifetime, and Never PTSD. RESULTS One-way ANOVA revealed significant differences between Current PTSD and both Remitted and Never PTSD for ES, but not CR. The Remitted and Never PTSD groups did not vary significantly from each other and were collapsed into one group for regressions. Adjusting for sex, race, employment, and comorbid depression, binary logistic regression showed ES, but not CR, was associated with increased likelihood of Current PTSD (p < .001, OR: 1.43). ES was also significantly associated with increased odds of meeting criteria for all symptom clusters (ps < 0.001). CR was not significantly associated with meeting criteria for Current PTSD or any symptom cluster. LIMITATIONS Cross-sectional design and use of self-report limit causality inferences that can be drawn. CONCLUSIONS ES is associated with increased odds of Current PTSD diagnosis and symptom clusters. Veterans in the Remitted and Never PTSD groups did not differ significantly. Greater suppression of emotional expression is more strongly linked with PTSD criteria in veterans than decreased cognitive reappraisal.
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Affiliation(s)
- A J Khan
- San Francisco VA Health Care System, San Francisco, CA; Department of Psychiatry, University of California, San Francisco, CA.
| | - S Maguen
- San Francisco VA Health Care System, San Francisco, CA; Department of Psychiatry, University of California, San Francisco, CA.
| | - L D Straus
- San Francisco VA Health Care System, San Francisco, CA; Department of Psychiatry, University of California, San Francisco, CA.
| | - T C Nelyan
- San Francisco VA Health Care System, San Francisco, CA; Department of Psychiatry, University of California, San Francisco, CA.
| | - J J Gross
- Department of Psychology, Stanford University, Stanford, CA.
| | - B E Cohen
- San Francisco VA Health Care System, San Francisco, CA; Department of Medicine, University of California, San Francisco, CA.
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12
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Chao LL, Kanady JC, Crocker N, Straus LD, Hlavin J, Metzler TJ, Maguen S, Neylan TC. Cognitive behavioral therapy for insomnia in veterans with gulf war illness: Results from a randomized controlled trial. Life Sci 2021; 279:119147. [PMID: 33549595 PMCID: PMC8217272 DOI: 10.1016/j.lfs.2021.119147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/15/2021] [Accepted: 01/24/2021] [Indexed: 01/08/2023]
Abstract
Aims: To examine whether cognitive behavioral therapy for insomnia (CBT-I), delivered by telephone, improves sleep and non-sleep symptoms of Gulf War Illness (GWI). Main methods: Eighty-five Gulf War veterans (21 women, mean age: 54 years, range 46–72 years) who met the Kansas GWI case definition, the Centers for Disease Control and Prevention (CDC) case definition for Chronic Multisymptom Illness (CMI), and research diagnostic criteria for insomnia disorder were randomly assigned to CBT-I or monitor-only wait list control. Eight weekly sessions of individual CBT-I were administered via telephone by Ph.D. level psychologists to study participants. Outcome measures included pre-, mid-, and post-treatment assessments of GWI and insomnia symptoms, subjective sleep quality, and continuous sleep monitoring with diary. Outcomes were re-assessed 6-months post-treatment in participants randomized to CBT-I. Key findings: Compared to wait list, CBT-I produced significant improvements in overall GWI symptom severity, individual measures of fatigue, cognitive dysfunction, depression and anxiety, insomnia severity, subjective sleep quality, and sleep diary outcome measures. The beneficial effects of CBT-I on overall GWI symptom severity and most individual GWI symptom measures were maintained 6-months after treatment. Significance: GWI symptoms have historically been difficult to treat. Because CBT-I, which is associated with low stigma and is increasingly readily available to veterans, improved both sleep and non-sleep symptoms of GWI, these results suggest that a comprehensive approach to the treatment of GWI should include behavioral sleep interventions.
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Affiliation(s)
- Linda L Chao
- San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA; University of California, San Francisco, CA 94143, USA.
| | | | - Nicole Crocker
- San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA
| | - Laura D Straus
- San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA; University of California, San Francisco, CA 94143, USA; Sierra Pacific Mental Illness Research, Education, and Clinical Center, San Francisco, CA 94121, USA
| | - Jennifer Hlavin
- San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA
| | - Thomas J Metzler
- San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA; University of California, San Francisco, CA 94143, USA; Sierra Pacific Mental Illness Research, Education, and Clinical Center, San Francisco, CA 94121, USA
| | - Shira Maguen
- San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA; University of California, San Francisco, CA 94143, USA; Sierra Pacific Mental Illness Research, Education, and Clinical Center, San Francisco, CA 94121, USA
| | - Thomas C Neylan
- San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA; University of California, San Francisco, CA 94143, USA; Sierra Pacific Mental Illness Research, Education, and Clinical Center, San Francisco, CA 94121, USA
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13
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Mascaro L, Phillips AJK, Clark JW, Straus LD, Drummond SPA. Diurnal Rhythm Robustness in Individuals With PTSD and Insomnia and The Association With Sleep. J Biol Rhythms 2021; 36:185-195. [PMID: 33472513 DOI: 10.1177/0748730420984563] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Posttraumatic stress disorder (PTSD) and insomnia are characterized by sleep disturbances and daytime functional impairments. Actigraphy metrics can quantify diurnal rhythms via interdaily stability, intradaily variability, relative amplitude, and sleep regularity. Here, we (a) compared diurnal rhythms in PTSD, insomnia, and healthy control samples using linear mixed modeling; (b) compared inter-individual variability of diurnal rhythms between groups using variance ratio tests; and (c) examined correlations between diurnal rhythms and sleep measures within the clinical samples. Participants (N = 98) wore wrist-activity monitors for one week and completed the Insomnia Severity Index and Pittsburgh Sleep Quality Index. Both clinical samples displayed significantly lower interdaily stability, relative amplitude, and sleep regularity compared with controls. Individuals with PTSD and insomnia did not differ on mean diurnal rhythm metrics. Both clinical samples showed more inter-individual variability in relative amplitude compared with controls, and the individuals with PTSD were distinguished from those with insomnia by greater inter-individual variability in interdaily stability and relative amplitude. Relative amplitude in the clinical samples was positively correlated with objective sleep efficiency and total sleep time. This is the first study to compare individuals with PTSD and insomnia on measures of diurnal rhythms, revealing those with PTSD and insomnia to have less robust and more variable diurnal rhythms compared with controls. Individuals with PTSD differed from those with insomnia in inter-individual variability of diurnal rest-activity stability and amplitude, highlighting this population as particularly heterogenous. Diurnal rhythm robustness might be considered an intervention target in insomnia and PTSD populations.
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Affiliation(s)
- Luis Mascaro
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Andrew J K Phillips
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Jacob W Clark
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Laura D Straus
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA.,San Francisco VA Medical Center, San Francisco, CA, USA
| | - Sean P A Drummond
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
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14
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Straus LD, Richards A, Inslicht SS, Dolsen MR, Neylan TC. Examining the Effect of Sleep Disruption on the Neural Correlates of Fear Extinction. Biol Psychiatry Cogn Neurosci Neuroimaging 2020; 6:251-252. [PMID: 33685648 DOI: 10.1016/j.bpsc.2020.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 12/17/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Laura D Straus
- San Francisco VA Health Care System, University of California San Francisco, San Francisco, California; Department of Psychiatry, University of California San Francisco, San Francisco, California.
| | - Anne Richards
- San Francisco VA Health Care System, University of California San Francisco, San Francisco, California; Department of Psychiatry, University of California San Francisco, San Francisco, California
| | - Sabra S Inslicht
- San Francisco VA Health Care System, University of California San Francisco, San Francisco, California; Department of Psychiatry, University of California San Francisco, San Francisco, California
| | - Michael R Dolsen
- Mental Illness Research Education and Clinical Centers, University of California San Francisco, San Francisco, California; San Francisco VA Health Care System, University of California San Francisco, San Francisco, California; Department of Psychiatry, University of California San Francisco, San Francisco, California
| | - Thomas C Neylan
- San Francisco VA Health Care System, University of California San Francisco, San Francisco, California; Department of Psychiatry, University of California San Francisco, San Francisco, California
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15
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Kanady JC, Straus LD, Gloria R, Neylan TC, Maguen S. 0503 Reductions in Sleep and Daily Rhythm Variability Following Brief Behavioral Treatment for Insomnia. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Brief behavioral treatment for insomnia (BBTI) is efficacious for insomnia symptoms. Here we examine whether BBTI reduces sleep and daily rhythm variability and whether reductions in variability result in improved functioning and quality of life.
Methods
Ninety-one Veterans with insomnia (49.3±18.7yrs; 18.7% female) were randomized to one of two treatment conditions: BBTI or progressive muscle relaxation training (PMRT; control condition). Variability was assessed using sleep diaries and actigraphy. The sleep diary outcome variables included bedtime variability, wake time variability, and total sleep time variability; actigraphy variables included interdaily stability, intradaily variability, and total sleep time variability. Functioning was assessed using the Work and Social Adjustment Scale. Quality of life was assessed using the Hotel Dieu-16 Scale.
Results
Compared to PMRT, BBTI resulted in a greater reduction in subjective total sleep time variability (F1,90=6.61, p<0.01, partial η 2=0.13) and a greater increase in interdaily stability (F1,78=12.41, p<0.01, partial η 2=0.25). There was a greater decrease in intradaily variability following PMRT (F1,78=27.96, p<0.01, partial η 2=0.42). Across the entire sample, reductions in subjective wake time variability were associated with improved functioning (F1,88=4.43, p=0.04, η 2=0.05) and reductions in subjective total sleep time variability were associated with improved quality of life (F1,89=4.91, p=0.03, partial η 2=0.05).
Conclusion
There was significant improvement in the stability of sleep-wake rhythms following BBTI, suggesting that BBTI not only treats insomnia, but also may stabilize circadian rhythms. Interestingly, PMRT resulted in greater intradaily variability reductions than BBTI. One explanation is that due to BBTI stimulus control guidelines, individuals were getting out of bed in the middle of the night more frequently and thus, these awakenings were better captured by actigraphy. Reductions in wake time and total sleep time variability were associated with improved functioning and quality of life, further demonstrating the importance of stable sleep-wake rhythms.
Support
VA Rehabilitation Research and Development Grant # RX001539-01A2
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Affiliation(s)
- J C Kanady
- San Francisco VA Medical Center, San Francisco, CA
| | - L D Straus
- San Francisco VA Medical Center, San Francisco, CA
| | - R Gloria
- San Francisco VA Medical Center, San Francisco, CA
| | - T C Neylan
- San Francisco VA Medical Center, San Francisco, CA
| | - S Maguen
- San Francisco VA Medical Center, San Francisco, CA
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16
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Straus LD, Colvonen PJ, Bertenthal D, Neylan TC, O’Donovan A. 1112 Mental Health And Sleep Disorders Are Associated With Elevated C-reactive Protein In Returning Veterans. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Mental health disorders and sleep disorders are associated with systemic inflammation, which may be a key element linking these highly co-occurring conditions to negative health outcomes. This study used national VA medical records to examine C-reactive protein (CRP) levels in Iraq/Afghanistan veterans based on presence of mental health and/or sleep disorder diagnoses.
Methods
We examined medical records for 16,576 Iraq/Afghanistan veterans under age 55 who had high-sensitivity CRP results reported. ICD diagnostic codes were used to compare CRP values for: a) veterans without sleep disorders or mental health diagnoses, b) veterans with mental health disorders only, c) veterans with sleep disorders only, and d) veterans with both conditions. In generalized linear models controlling for demographics, we examined the impact of diagnostic category on continuous CRP value as well as the risk of elevated CRP (>3mg/L).
Results
Veterans with mental health disorders (coeff=.14, p<.001) and comorbid sleep and mental health disorders (coeff=.21, p<.001) had higher continuous CRP values compared to veterans without either condition. Veterans with comorbid sleep and mental health disorders had higher continuous CRP values than veterans with sleep disorders alone (coeff=.22, p<.041); however, there were few patients in the current sample who were diagnosed with sleep disorders alone (n=401, 2.4%). Additionally, veterans with mental health disorders (ARR=1.12, p=.004) and comorbid sleep and mental health disorders (ARR=1.15, p=.001) were more likely to have CRP values >3mg/L compared to veterans without either condition.
Conclusion
Sleep disorders were highly likely to co-occur with mental health disorders in this sample of Iraq/Afghanistan veterans. Mental health disorders and comorbid mental health/sleep disorders were associated with elevated C-reactive protein, indicating these patients are at highest risk for negative health outcomes. Future studies should investigate directionality of relationships among sleep disruption, mental health symptoms, and inflammation.
Support
VA Advanced Fellowship Program in Mental Illness Research and Treatment
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Affiliation(s)
- L D Straus
- San Francisco VA Medical Center, San Francisco, CA
| | | | - D Bertenthal
- San Francisco VA Medical Center, San Francisco, CA
| | - T C Neylan
- San Francisco VA Medical Center, San Francisco, CA
| | - A O’Donovan
- San Francisco VA Medical Center, San Francisco, CA
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17
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Colvonen PJ, Straus LD, Drummond SPA, Angkaw AC, Norman SB. Examining sleep over time in a randomized control trial comparing two integrated PTSD and alcohol use disorder treatments. Drug Alcohol Depend 2020; 209:107905. [PMID: 32065939 PMCID: PMC8515903 DOI: 10.1016/j.drugalcdep.2020.107905] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 02/06/2020] [Accepted: 02/09/2020] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVES Insomnia is highly co-occurring with both posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD). This is concerning since insomnia contributes to worse substance abuse and PTSD, and a host of negative health consequences. No study has tracked how sleep indices and insomnia change related to integrated PTSD and AUD treatment using evidence-based exposure therapy. This study examined how insomnia changes over time in a randomized control trial of two integrated PTSD and AUD treatments. METHODS Participants were 119 adult veterans (90 % male) seeking treatment for AUD and PTSD at a large urban VA. Participants were randomized to either COPE (integrated treatment using prolonged exposure) or Seeking Safety (integrated therapy using cognitive behavioral, interpersonal techniques and case management). Assessments were done at pre- and post-treatment and include: Clinician Administered PTSD Scale, Timeline Follow-back calendar-assisted interview for AU, insomnia severity index (ISI), sleep diary and actigraphy for 7 days. RESULTS ISI showed significant decreases, but a majority remained above the clinical cutoff at post-treatment. Wake after sleep onset decreased, but only by 8 min, remaining above clinical thresholds. Decreases in PTSD, but not in heavy drinking, predicted change in ISI. No significant changes were observed in other sleep variables measured. CONCLUSIONS Findings suggested some statistical improvements in sleep quality, but sleep indices remained above clinical cut-offs. This study provides evidence that insomnia is an independent disorder and not responsive to PTSD or AUD treatments alone. Sleep symptoms should be assessed and treated in patients with comorbid mental health conditions.
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Affiliation(s)
- Peter J Colvonen
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, United States; University of California, Department of Psychiatry, 9500 Gilman Drive, San Diego, CA 92093, United States; VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Drive, MC 116A, San Diego, CA 92161, United States; National Center for PTSD, 215 North Main Street, White River Junction, VT 05009, United States.
| | - Laura D Straus
- Department of Psychiatry, University of California, San Francisco, United States; Sierra Pacific Mental Illness Research Education and Clinical Centers, San Francisco VA Healthcare System, United States
| | - Sean P A Drummond
- Turner Institute for Brain and Mental Health, School of Psychological Science, Monash University, Australia
| | - Abigail C Angkaw
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, United States; University of California, Department of Psychiatry, 9500 Gilman Drive, San Diego, CA 92093, United States; National Center for PTSD, 215 North Main Street, White River Junction, VT 05009, United States
| | - Sonya B Norman
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, United States; University of California, Department of Psychiatry, 9500 Gilman Drive, San Diego, CA 92093, United States; VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Drive, MC 116A, San Diego, CA 92161, United States; National Center for PTSD, 215 North Main Street, White River Junction, VT 05009, United States
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18
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Richards A, Kanady JC, Huie JR, Straus LD, Inslicht SS, Levihn-Coon A, Metzler TJ, Neylan TC. Work by day and sleep by night, do not sleep too little or too much: Effects of sleep duration, time of day and circadian synchrony on flanker-task performance in internet brain-game users from teens to advanced age. J Sleep Res 2019; 29:e12919. [PMID: 31631467 DOI: 10.1111/jsr.12919] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 07/20/2019] [Accepted: 08/18/2019] [Indexed: 11/28/2022]
Abstract
Research elucidating the effects of sleep and circadian rhythm on cognitive performance is advancing, yet many important questions remain. Using flanker-task performance scores from a large internet sample (N = 48,881) with repeated measures of cognitive performance and linked prior-night self-reported sleep duration, we analysed the relationship between sleep duration, time of day of task performance, and chronotype synchrony with performance in participants aged 15-80 years. Results indicate a performance peak at 7 hr habitual sleep duration, and point to a variable effect of deviation from habitual sleep duration depending on users' habitual sleep duration and age. Time-of-day effects were notable for a steady decline in performance up until 01:00 hours-02:00 hours for the group as a whole, which was accounted for by nighttime deterioration on trials requiring inhibitory executive functioning, particularly in older subjects. Analyses did not demonstrate an advantage for playing in synchrony with self-identified chronotype. Results strengthen findings indicating an inverted U-shaped relationship between sleep duration and cognitive performance across a broad spectrum of age groups. These findings underscore the importance of daytime task performance for tasks requiring inhibitory function, especially in elderly people. Findings highlight the utility of large-scale internet data in contributing to sleep and circadian science.
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Affiliation(s)
- Anne Richards
- University of California, San Francisco, San Francisco, CA, USA.,San Francisco VA Medical Center, San Francisco, CA, USA
| | - Jennifer C Kanady
- University of California, San Francisco, San Francisco, CA, USA.,San Francisco VA Medical Center, San Francisco, CA, USA
| | - John Russell Huie
- University of California, San Francisco, San Francisco, CA, USA.,San Francisco VA Medical Center, San Francisco, CA, USA
| | - Laura D Straus
- University of California, San Francisco, San Francisco, CA, USA.,San Francisco VA Medical Center, San Francisco, CA, USA
| | - Sabra S Inslicht
- University of California, San Francisco, San Francisco, CA, USA.,San Francisco VA Medical Center, San Francisco, CA, USA
| | | | | | - Thomas C Neylan
- University of California, San Francisco, San Francisco, CA, USA.,San Francisco VA Medical Center, San Francisco, CA, USA
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19
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Straus LD, Drummond SPA, Risbrough VB, Norman SB. Sleep Disruption, Safety Learning, and Fear Extinction in Humans: Implications for Posttraumatic Stress Disorder. Curr Top Behav Neurosci 2019; 38:193-205. [PMID: 28942597 DOI: 10.1007/7854_2017_31] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Fear learning is critical in the development and maintenance of posttraumatic stress disorder (PTSD) symptoms, and safety learning and extinction are necessary for recovery. Studies in animal models suggest that sleep disruption, and REM sleep fragmentation in particular, interfere with safety learning and extinction processes, and recently, studies are extending these findings to humans. A discussion of the human literature is presented here, which largely consists of experimental studies in healthy human control subjects. A theoretical model for the relationship between fear learning, sleep disruption, and impaired safety learning and extinction is proposed, which provides an explanatory framework for sleep disruption and its relationship to PTSD. Overall, findings suggest that sleep disruption plays a role in the development and maintenance of PTSD symptoms, and thus presents an important modifiable target in PTSD treatment.
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Affiliation(s)
- Laura D Straus
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA.
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA.
| | - Sean P A Drummond
- Monash Institute of Cognitive and Clinical Neuroscience, Monash School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Victoria B Risbrough
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Sonya B Norman
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- National Center for PTSD, White River Junction, VT, USA
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20
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Küffer A, Straus LD, Prather AA, Inslicht SS, Richards A, Shigenaga JK, Madden E, Metzler TJ, Neylan TC, O'Donovan A. Altered overnight levels of pro-inflammatory cytokines in men and women with posttraumatic stress disorder. Psychoneuroendocrinology 2019; 102:114-120. [PMID: 30544002 PMCID: PMC6420348 DOI: 10.1016/j.psyneuen.2018.12.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 11/26/2018] [Accepted: 12/04/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is associated with disturbed sleep and elevated levels of pro-inflammatory cytokines, including interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α). Studies in animals and healthy humans have also shown that disrupted sleep elevates pro-inflammatory cytokines, including IL-6 and TNF-α. A better understanding of overnight cytokine levels and sleep might shed light on possible mechanisms for elevated inflammation in PTSD. Thus, we investigated overnight levels of IL-6 and TNF-α in individuals with and without PTSD while recording sleep polysomnography (PSG). METHOD Serum samples were collected from otherwise healthy, medication-free participants with chronic PTSD (n = 44; 50% female; M age = 30.34 ± 8.11) and matched controls (n = 49; 53% female; M age = 30.53 ± 6.57) during laboratory PSG. Levels of IL-6 and TNF-α were measured at hours 0, 2, 4, 6, and 8 after typical sleep onset time using serial serum samples. Plasma IL-6 and TNF-α levels were quantified using enzyme-linked immunosorbent assays. RESULTS Growth model analysis indicated a significantgroup by time interaction for IL-6 (t[247] = -2.92, p = .005) and a significant group by sex by time interaction for TNF-α (t[275] = 2.02, p = .04). PTSD positive men and women initially had higher IL-6 and TNF-α at sleep onset, but not at the end of their sleep cycle. Men with PTSD showed a peak of TNF-α at the end of the sleep cycle, whereas male control subjects demonstrated an inverted U-shaped profile. There were no significant differences in TNF-α levels overnight between women with and without PTSD. CONCLUSION To our knowledge, this is the largest study to examine IL-6 overnight in a PTSD sample and the first study to examine overnight TNF-α in PTSD. Overnight IL-6 and TNF-α levels may be altered in individuals with PTSD compared to those without PTSD, and TNF-α trajectories also differed by sex. The current findings highlight the need to consider sex, sleep, time of day, and circadian variation when examining inflammation in PTSD. Additional research in broader study samples will be necessary to clarify associations between disrupted sleep, cytokines, and increased risk for disease in PTSD.
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Affiliation(s)
- Andreas Küffer
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA; Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Laura D Straus
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA; Department of Psychiatry, University of California, San Francisco, CA, USA; Mental Illness Research Education and Clinical Centers, San Francisco VA Healthcare System, San Francisco, CA, USA.
| | - Aric A Prather
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Sabra S Inslicht
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA; Department of Psychiatry, University of California, San Francisco, CA, USA; Northern California Institute for Research and Education, San Francisco, CA, USA
| | - Anne Richards
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA; Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Judy K Shigenaga
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA; Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Erin Madden
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Thomas J Metzler
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Thomas C Neylan
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA; Department of Psychiatry, University of California, San Francisco, CA, USA; Northern California Institute for Research and Education, San Francisco, CA, USA
| | - Aoife O'Donovan
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA; Department of Psychiatry, University of California, San Francisco, CA, USA; Northern California Institute for Research and Education, San Francisco, CA, USA
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21
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Abstract
PURPOSE OF REVIEW The emotional memory and learning model of PTSD posits maladaptive fear conditioning, extinction learning, extinction recall, and safety learning as central mechanisms to PTSD. There is increasingly convincing support that sleep disturbance plays a mechanistic role in these processes. The current review consolidates the evidence on the relationships between emotional memory and learning, disturbed sleep, and PTSD acquisition, maintenance, and treatment. RECENT FINDINGS While disrupted sleep prior to trauma predicts PTSD onset, maladaptive fear acquisition does not seem to be the mechanism through which PTSD is acquired. Rather, poor extinction learning/recall and safety learning seem to better account for who maintains acute stress responses from trauma versus who naturally recovers; there is convincing evidence that this process is, at least in part, mediated by REM fragmentation. Individuals with PTSD had higher "fear load" during extinction, worse extinction learning, poorer extinction recall, and worse safety learning. Evidence suggests that these processes are also mediated by fragmented REM. Finally, PTSD treatments that require extinction and safety learning may also be affected by REM fragmentation. Addressing fragmented sleep or sleep architecture could be used to increase emotional memory and learning processes and thus ameliorate responses to trauma exposure, reduce PTSD severity, and improve treatment. Future studies should examine relationships between emotional memory and learning and disturbed sleep in clinical PTSD patients.
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Affiliation(s)
- Peter J Colvonen
- VA San Diego Healthcare System, San Diego, CA, 92161, USA.
- Center of Excellence for Stress and Mental Health, San Diego, CA, 92161, USA.
- Department of Psychiatry, University of California San Diego, San Diego, CA, 92161, USA.
| | - Laura D Straus
- Mental Illness Research Education and Clinical Centers, San Francisco VA Healthcare System, San Francisco, CA, USA
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Dean Acheson
- VA San Diego Healthcare System, San Diego, CA, 92161, USA
- Center of Excellence for Stress and Mental Health, San Diego, CA, 92161, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, 92161, USA
| | - Philip Gehrman
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
- Philadelphia VA Medical Center, Philadelphia, PA, USA
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Straus LD, Norman SB, Risbrough VB, Acheson DT, Drummond SPA. REM sleep and safety signal learning in posttraumatic stress disorder: A preliminary study in military veterans. Neurobiol Stress 2018; 9:22-28. [PMID: 30116769 PMCID: PMC6084022 DOI: 10.1016/j.ynstr.2018.07.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 07/17/2018] [Accepted: 07/19/2018] [Indexed: 01/06/2023] Open
Abstract
Background Posttraumatic Stress Disorder (PTSD) is associated with a number of negative physical and mental health consequences. Fear conditioning plays an important mechanistic role in PTSD, and PTSD patients also show deficits in safety signal learning. Sleep, particularly REM sleep, is linked to improved safety learning and extinction processes in animal models and healthy humans. No studies have examined the link between REM sleep and safety signal learning or extinction memory in clinical populations. Methods This study examined the relationship between REM sleep, safety signal learning, and extinction processes in veterans with PTSD (n = 13). Patients' overnight sleep was characterized in the laboratory via polysomnography (PSG). The next day, participants underwent a fear conditioning paradigm during which they acquired fear toward a visual cue. This testing session also included a visual cue that became a safety signal (CS-). Following conditioning, the veterans' sleep was monitored overnight again, after which they underwent extinction training. Following a third night of sleep, extinction recall and safety recall were tested. Bivariate correlations examined the relationship between the slope of safety signal learning and subsequent REM sleep, as well as the relationship between REM sleep and subsequent extinction recall and safety recall on the last day of testing. Results Veterans learned to differentiate the CS+ and the CS- on the first day of testing. Veterans who underwent safety learning more quickly on the first day of testing showed more efficient REM sleep that night (r = .607, p = .028). On the second day of testing, the patients successfully underwent extinction learning. Patients with a higher percentage of REM sleep on the last night of the study showed more safety recall early on the last day of testing (r = .688, p = .009). Conclusion To our knowledge, this was the first study to examine the relationship between objective sleep and fear-potentiated startle performance in veterans with PTSD. Study methods were well tolerated by participants, supporting feasibility of the experimental design. Results indicated REM sleep was associated with both initial safety learning and subsequent safety recall. Taken together with previous studies in healthy controls, these preliminary results provide additional evidence suggesting REM sleep could play a mechanistic role in the maintenance of PTSD and thus identify a modifiable biological process to target in treatment of PTSD. These findings should be replicated in larger samples.
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Affiliation(s)
- Laura D Straus
- Mental Illness Research Education and Clinical Centers, San Francisco VA Healthcare System, San Francisco, CA, USA.,Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Sonya B Norman
- National Center for PTSD, White River Junction, VT, USA.,VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA.,University of California, San Diego, School of Medicine, San Diego, CA, USA
| | - Victoria B Risbrough
- VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA.,University of California, San Diego, School of Medicine, San Diego, CA, USA
| | - Dean T Acheson
- VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA.,University of California, San Diego, School of Medicine, San Diego, CA, USA
| | - Sean P A Drummond
- Monash Institute for Cognitive and Clinical Neuroscience, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
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23
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Kanady JC, Talbot LS, Maguen S, Straus LD, Richards A, Ruoff L, Metzler TJ, Neylan TC. Cognitive Behavioral Therapy for Insomnia Reduces Fear of Sleep in Individuals With Posttraumatic Stress Disorder. J Clin Sleep Med 2018; 14:1193-1203. [PMID: 29991428 DOI: 10.5664/jcsm.7224] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 04/12/2018] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Our study aims were to examine (1) the association between fear of sleep and posttraumatic stress disorder (PTSD) symptoms, (2) the association between fear of sleep and subjective and objective insomnia symptoms and disruptive behaviors during sleep, and (3) whether fear of sleep decreases following cognitive behavioral therapy for insomnia (CBT-I). METHODS Forty-five adults with PTSD and insomnia participated in the study. Fear of sleep was assessed using the Fear of Sleep Inventory; PTSD symptoms were assessed using the Clinician Administered PTSD Scale; and sleep disturbance symptoms were assessed using the Insomnia Severity Index, polysomnography, sleep diaries, and the Pittsburgh Sleep Quality Index Addendum for PTSD. Participants were randomly assigned to 8 weeks of CBT-I (n = 29) or a waitlist control condition (n = 16). RESULTS Greater fear of sleep was associated with greater PTSD symptom severity, greater nightmare frequency, and greater hypervigilance intensity. Greater fear of sleep was associated with decreased wake after sleep onset (WASO), reduced total sleep time, and greater disruptive nocturnal behaviors. Following CBT-I, there was a significant reduction in fear of sleep compared to the waitlist condition. These improvements persisted 6 months later. CONCLUSIONS Fear of sleep was related to sleep disturbances specific to trauma rather than "classic" insomnia symptoms. Unexpectedly, greater fear of sleep was associated with reduced WASO. These results may be related to having a truncated sleep period and thus more consolidated sleep. Fear of sleep deceased following CBT-I despite not being a permissible target for this research protocol and not being related to insomnia symptoms. CLINICAL TRIAL REGISTRATION Registry: CinicalTrials.gov; Name: Treating People with Post-traumatic Stress Disorder with Cognitive Behavioral Therapy for Insomnia; Identifier: NCT00881647; URL: https://clinicaltrials.gov/ct2/show/NCT00881647.
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Affiliation(s)
- Jennifer C Kanady
- San Francisco VA Health Care System, San Francisco, California.,Department of Psychiatry, University of California, San Francisco, California.,Mental Illness, Research, Education, and Clinical Center, San Francisco, California
| | - Lisa S Talbot
- San Francisco VA Health Care System, San Francisco, California.,Department of Psychiatry, University of California, San Francisco, California
| | - Shira Maguen
- San Francisco VA Health Care System, San Francisco, California.,Department of Psychiatry, University of California, San Francisco, California
| | - Laura D Straus
- San Francisco VA Health Care System, San Francisco, California.,Department of Psychiatry, University of California, San Francisco, California.,Mental Illness, Research, Education, and Clinical Center, San Francisco, California
| | - Anne Richards
- San Francisco VA Health Care System, San Francisco, California.,Department of Psychiatry, University of California, San Francisco, California
| | - Leslie Ruoff
- San Francisco VA Health Care System, San Francisco, California
| | | | - Thomas C Neylan
- San Francisco VA Health Care System, San Francisco, California.,Department of Psychiatry, University of California, San Francisco, California
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24
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Abstract
PURPOSE OF REVIEW Comorbidity of posttraumatic stress disorder (PTSD) and insomnia, nightmares, and obstructive sleep apnea (OSA) is high. We review recent research on psychotherapeutic and pharmacological interventions for sleep disorders in PTSD. RECENT FINDINGS PTSD treatments decrease PTSD severity and nightmare frequency, but do not resolve OSA or insomnia. Research on whether insomnia hinders PTSD treatment shows mixed results; untreated OSA does interfere with PTSD treatment. Cognitive behavioral therapy for insomnia is the recommended treatment for insomnia; however, optimal ordering with PTSD treatment is unclear. PTSD treatment may be most useful for PTSD-related nightmares. CPAP therapy is recommended for OSA but adherence can be low. Targeted treatment of sleep disorders in the context of PTSD offers a unique and underutilized opportunity to advance clinical care and research. Research is needed to create screening protocols, determine optimal order of treatment, and elucidate mechanisms between sleep and PTSD treatments.
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Affiliation(s)
- Peter J. Colvonen
- VA San Diego Healthcare System, University of California San Diego, 3350 La Jolla Village Dr. (116B), San Diego, CA 92161, USA,Center of Excellence for Stress and Mental Health, University of California San Diego, San Diego, CA, USA,Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Laura D. Straus
- Sierra Pacific Mental Illness Research Education and Clinical Centers, San Francisco VA Healthcare System, San Francisco, CA, USA,Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Carl Stepnowsky
- VA San Diego Healthcare System, University of California San Diego, 3350 La Jolla Village Dr. (116B), San Diego, CA 92161, USA,Department of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Michael J. McCarthy
- VA San Diego Healthcare System, University of California San Diego, 3350 La Jolla Village Dr. (116B), San Diego, CA 92161, USA,Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Lizabeth A. Goldstein
- Sierra Pacific Mental Illness Research Education and Clinical Centers, San Francisco VA Healthcare System, San Francisco, CA, USA,Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Sonya B. Norman
- VA San Diego Healthcare System, University of California San Diego, 3350 La Jolla Village Dr. (116B), San Diego, CA 92161, USA,Center of Excellence for Stress and Mental Health, University of California San Diego, San Diego, CA, USA,Department of Psychiatry, University of California San Diego, San Diego, CA, USA,National Center for PTSD, Boston, MA, USA
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25
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Straus LD, Kanady JC, Richards A, Ruoff L, Metzler T, Neylan TC. 0939 Cognitive Behavioral Therapy for Insomnia and REM Sleep Continuity in Posttraumatic Stress Disorder. Sleep 2018. [DOI: 10.1093/sleep/zsy061.938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- L D Straus
- San Francisco VA Medical Center, San Francisco, CA
- Sierra Pacific Mental Illness Research Education and Clinical Centers, San Francisco, CA
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA
| | - J C Kanady
- San Francisco VA Medical Center, San Francisco, CA
- Sierra Pacific Mental Illness Research Education and Clinical Centers, San Francisco, CA
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA
| | - A Richards
- San Francisco VA Medical Center, San Francisco, CA
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA
| | - L Ruoff
- San Francisco VA Medical Center, San Francisco, CA
| | - T Metzler
- San Francisco VA Medical Center, San Francisco, CA
| | - T C Neylan
- San Francisco VA Medical Center, San Francisco, CA
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA
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26
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Straus LD, Acheson D, Risbrough VB, Drummond SP, Norman SB. 1073 SLEEP, FEAR CONDITIONING, AND SAFETY SIGNAL LEARNING IN VETERANS WITH PTSD. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.1072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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27
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Straus LD, Acheson DT, Risbrough VB, Drummond SPA. Sleep Deprivation Disrupts Recall of Conditioned Fear Extinction. Biol Psychiatry Cogn Neurosci Neuroimaging 2017; 2:123-129. [PMID: 28758152 DOI: 10.1016/j.bpsc.2016.05.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Learned fear is crucial in the development and maintenance of posttraumatic stress disorder (PTSD) and other anxiety disorders, and extinction of learned fear is necessary for response to exposure-based treatments. In humans, research suggests disrupted sleep impairs consolidation of extinction, though no studies have examined this experimentally using total sleep deprivation. METHODS Seventy-one healthy controls underwent a paradigm to acquire conditioned fear to a visual cue. Twenty-four hours after fear conditioning, participants underwent extinction learning. Twenty-four hours after extinction learning, participants underwent extinction recall. Participants were randomized to three groups: 1) well-rested throughout testing ("normal sleep"; n = 21); 2) 36 hours total sleep deprivation before extinction learning ("pre-extinction deprivation"; n = 25); or 3) 36 hours total sleep deprivation after extinction learning and before extinction recall ("post-extinction deprivation"; n = 25). The groups were compared on blink EMG reactivity to the condition stimulus during extinction learning and recall. RESULTS There were no differences among the three groups during extinction learning. During extinction recall, the pre-extinction deprivation group demonstrated significantly less extinction recall than the normal sleep group. There was no significant difference between the normal sleep and post-extinction deprivation group during extinction recall. Results indicated sleep deprivation prior to extinction training significantly disrupts extinction recall. CONCLUSIONS These findings suggest that (1) sleep deprivation in the immediate aftermath of trauma could be a potential contributor to PTSD development and maintenance via interference with natural extinction processes and (2) management of sleep symptoms should be considered during extinction-based therapy.
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Affiliation(s)
- Laura D Straus
- San Diego State University / University of California San Diego Joint Doctoral Program in Clinical Psychology. 6363 Alvarado Court, Suite 103, San Diego, CA 92120, USA.,Research Service, San Diego Veterans Affairs Healthcare System (SDVAHS). 3350 La Jolla Village Dr, San Diego, CA 92161, USA
| | - Dean T Acheson
- Center of Excellence for Stress and Mental Health, San Diego Veterans Affairs. 3350 La Jolla Village Dr, San Diego, CA 92161, USA.,Department of Psychiatry, University of California San Diego. 9500 Gilman Drive, MC 0603, La Jolla, CA 92093, USA
| | - Victoria B Risbrough
- Center of Excellence for Stress and Mental Health, San Diego Veterans Affairs. 3350 La Jolla Village Dr, San Diego, CA 92161, USA.,Department of Psychiatry, University of California San Diego. 9500 Gilman Drive, MC 0603, La Jolla, CA 92093, USA
| | - Sean P A Drummond
- Monash Institute of Cognitive and Clinical Neurosciences. Clayton, VIC 3800, Australia.,School of Psychological Sciences, Monash University. Clayton, VIC 3800, Australia.,Department of Psychiatry, University of California San Diego. 9500 Gilman Drive, MC 0603, La Jolla, CA 92093, USA
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28
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Straus LD, Drummond SPA, Nappi CM, Jenkins MM, Norman SB. Sleep variability in military-related PTSD: a comparison to primary insomnia and healthy controls. J Trauma Stress 2015; 28:8-16. [PMID: 25630526 PMCID: PMC6037304 DOI: 10.1002/jts.21982] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Sleep disturbances are prevalent in posttraumatic stress disorder (PTSD) and are associated with a number of adverse health consequences. Few studies have used comprehensive assessment methods to characterize sleep in Operation Iraqi Freedom/Operation Enduring Freedom/Operation New Dawn (OEF/OIF/OND) veterans with PTSD. OEF/OIF/OND veterans with PTSD and sleep disturbance (n = 45) were compared to patients with primary insomnia (n = 25) and healthy control subjects (n = 27). Participants were assessed using questionnaire-based measures as well as daily subjective and objective measures of sleep. The 3 groups were compared with regard to (a) group means, (b) intraindividual (i.e., night-to-night) variability of sleep, and (c) interindividual (i.e., within-group) variability of sleep. In terms of group means, only objective sleep efficiency was significantly worse with PTSD than with primary insomnia (d = 0.54). Those with PTSD differed from those with primary insomnia on measures of intraindividual as well as interindividual variability (d = 0.48-0.73). These results suggested sleep symptoms in OEF/OIF/OND veterans with PTSD are more variable across nights and less consistent across patients relative to sleep symptoms in insomnia patients without PTSD. These findings have implications for research, as well as for personalizing treatment for individuals with PTSD.
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Affiliation(s)
- Laura D. Straus
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA,Veterans Affairs San Diego Healthcare System, Research Service, San Diego, California, USA
| | - Sean P. A. Drummond
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA,Veterans Affairs San Diego Healthcare System, Psychology Service, San Diego, California, USA,Veterans Affairs San Diego Center of Excellence for Stress and Mental Health, San Diego, California, USA,University of California-San Diego, Department of Psychiatry, La Jolla, California, USA,Monash University, School of Psychological Sciences, Victoria, Australia
| | - Carla M. Nappi
- Veterans Affairs San Diego Healthcare System, Psychology Service, San Diego, California, USA,University of California-San Diego, Department of Psychiatry, La Jolla, California, USA
| | - Melissa M. Jenkins
- Veterans Affairs San Diego Healthcare System, Research Service, San Diego, California, USA,University of California-San Diego, Department of Psychiatry, La Jolla, California, USA
| | - Sonya B. Norman
- Veterans Affairs San Diego Center of Excellence for Stress and Mental Health, San Diego, California, USA,University of California-San Diego, Department of Psychiatry, La Jolla, California, USA,National Center for PTSD, White River Junction, Vermont, USA
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Abstract
STUDY OBJECTIVES To examine neural correlates of working memory performance in patients with primary insomnia (PIs) compared with well-matched good sleepers (GSs). DESIGN Twenty-five PIs and 25 GSs underwent functional MRI while performing an N-back working memory task. SETTING VA hospital sleep laboratory and University-based functional imaging center. PATIENTS OR PARTICIPANTS 25 PIs, 25 GSs. INTERVENTIONS N/A. MEASUREMENTS AND RESULTS Although PIs did not differ from GSs in cognitive performance, PIs showed the expected differences from GSs in both self-reported and objective sleep measures. PIs, relative to GSs, showed reduced activation of task-related working memory regions. This manifested both as an overall reduction in activation of task-related regions and specifically as reduced modulation of right dorsolateral prefrontal cortex with increasing task difficulty. Similarly, PIs showed reduced modulation (i.e., reduced deactivation) of default mode regions with increasing task difficulty, relative to GSs. However, PIs showed intact performance. CONCLUSIONS These data establish a profile of abnormal neural function in primary insomnia, reflected both in reduced engagement of task-appropriate brain regions and an inability to modulate task-irrelevant (i.e., default mode) brain areas during working memory performance. These data have implications for better understanding the neuropathophysiology of the well established, yet little understood, discrepancy between ubiquitous subjective cognitive complaints in primary insomnia and the rarely found objective deficits during testing.
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Affiliation(s)
- Sean P A Drummond
- Psychology Service, VA San Diego Healthcare System, San Diego, CA 92161, USA.
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30
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Drummond SPA, Anderson DE, Straus LD, Vogel EK, Perez VB. The effects of two types of sleep deprivation on visual working memory capacity and filtering efficiency. PLoS One 2012; 7:e35653. [PMID: 22530064 PMCID: PMC3329471 DOI: 10.1371/journal.pone.0035653] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 03/22/2012] [Indexed: 12/03/2022] Open
Abstract
Sleep deprivation has adverse consequences for a variety of cognitive functions. The exact effects of sleep deprivation, though, are dependent upon the cognitive process examined. Within working memory, for example, some component processes are more vulnerable to sleep deprivation than others. Additionally, the differential impacts on cognition of different types of sleep deprivation have not been well studied. The aim of this study was to examine the effects of one night of total sleep deprivation and 4 nights of partial sleep deprivation (4 hours in bed/night) on two components of visual working memory: capacity and filtering efficiency. Forty-four healthy young adults were randomly assigned to one of the two sleep deprivation conditions. All participants were studied: 1) in a well-rested condition (following 6 nights of 9 hours in bed/night); and 2) following sleep deprivation, in a counter-balanced order. Visual working memory testing consisted of two related tasks. The first measured visual working memory capacity and the second measured the ability to ignore distractor stimuli in a visual scene (filtering efficiency). Results showed neither type of sleep deprivation reduced visual working memory capacity. Partial sleep deprivation also generally did not change filtering efficiency. Total sleep deprivation, on the other hand, did impair performance in the filtering task. These results suggest components of visual working memory are differentially vulnerable to the effects of sleep deprivation, and different types of sleep deprivation impact visual working memory to different degrees. Such findings have implications for operational settings where individuals may need to perform with inadequate sleep and whose jobs involve receiving an array of visual information and discriminating the relevant from the irrelevant prior to making decisions or taking actions (e.g., baggage screeners, air traffic controllers, military personnel, health care providers).
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Affiliation(s)
- Sean P A Drummond
- Psychology Service, VA San Diego Healthcare System, San Diego, California, United States of America.
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31
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Drummond SPA, Anderson DE, Straus LD, Vogel EK, Perez VB. The effects of two types of sleep deprivation on visual working memory capacity and filtering efficiency. PLoS One 2012; 7:e35653. [PMID: 22530064 DOI: 10.1371/journal.pone.003565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 03/22/2012] [Indexed: 05/21/2023] Open
Abstract
Sleep deprivation has adverse consequences for a variety of cognitive functions. The exact effects of sleep deprivation, though, are dependent upon the cognitive process examined. Within working memory, for example, some component processes are more vulnerable to sleep deprivation than others. Additionally, the differential impacts on cognition of different types of sleep deprivation have not been well studied. The aim of this study was to examine the effects of one night of total sleep deprivation and 4 nights of partial sleep deprivation (4 hours in bed/night) on two components of visual working memory: capacity and filtering efficiency. Forty-four healthy young adults were randomly assigned to one of the two sleep deprivation conditions. All participants were studied: 1) in a well-rested condition (following 6 nights of 9 hours in bed/night); and 2) following sleep deprivation, in a counter-balanced order. Visual working memory testing consisted of two related tasks. The first measured visual working memory capacity and the second measured the ability to ignore distractor stimuli in a visual scene (filtering efficiency). Results showed neither type of sleep deprivation reduced visual working memory capacity. Partial sleep deprivation also generally did not change filtering efficiency. Total sleep deprivation, on the other hand, did impair performance in the filtering task. These results suggest components of visual working memory are differentially vulnerable to the effects of sleep deprivation, and different types of sleep deprivation impact visual working memory to different degrees. Such findings have implications for operational settings where individuals may need to perform with inadequate sleep and whose jobs involve receiving an array of visual information and discriminating the relevant from the irrelevant prior to making decisions or taking actions (e.g., baggage screeners, air traffic controllers, military personnel, health care providers).
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Affiliation(s)
- Sean P A Drummond
- Psychology Service, VA San Diego Healthcare System, San Diego, California, United States of America.
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32
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Paukert JL, Straus LD, Rabinowitz JC. Formyl-methyl-methylenetetrahydrofolate synthetase-(combined). An ovine protein with multiple catalytic activities. J Biol Chem 1976; 251:5104-11. [PMID: 956178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Formyltetrahydrofolate synthetase, methenyltetrahydrofolate cyclohydrolase, and methylenetetrahydrofolate dehydrogenase in sheep liver co-purify 200-fold to yield a homogeneous preparation containing a single protein species observed on discontinuous polyacrylamide gel electrophoresis in the presence of dodecyl sulfate. The synthetase and dehydrogenase activities migrate with the single protein band observed on polyacrylamide gel electrophoresis in two discontinuous buffer systems near pH 8. The protein sediments with a single symmetrical boundary with sedimentation coefficient (S20,w) = 8.30 S and elutes from molecular exclusion chromatography columns at a position corresponding to a diffusion coefficient (D20,w) = 3.99 X 10(-7) cm2 sec-1. Dodecyl sulfate-polyacrylamide gel electrophoresis of the protein intramolecularly cross-linked with dimethylsuberimidate shows one protein species of Mr = 218,000 in addition to the species of Mr = 108,500 characteristic of the unmodified protein. NH2-terminal analysis of the protein using 5-dimethylaminonaphthalene-1-sulfonyl (dansyl) chloride in the presence of dodecyl sulfate results in the recovery of a single dansyl amino acid, alanine. The three activities are thus shown to reside in a protein composed of two apparently identical subunits, and the trivial name formyl-methenyl-methylenetetrahydrofolate synthetase(combined) is proposed for this enzyme to suggest the multiple catalytic activities associated with the single protein species.
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Abstract
Cell wall-membrane preparations of Escherichia coli, prepared by the ethylenediaminetetraacetic acid-lysozyme method, contain enzymes which catalyze the oxidation of d-alanine and, to a lesser extent, l-alanine into pyruvate and ammonia without the formation of hydrogen peroxide. The kinetic parameters were (i) pH optima of 8.3 to 8.4 for l- and d-alanine and (ii) a K(m) value of 6.6 +/- 0.2 mM for d-alanine. Several coenzymes were without effect when added to the reaction mixture. The participation of d-alanine oxidase in the oxidation of l-alanine was demonstrated. The evidence is based on (i) results of cellular fractionation; (ii) labeling experiments; (iii) inhibition studies with aminooxyacetate and cycloserine; (iv) denaturation experiments; and (v) demonstration of the presence of an active racemase.
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34
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Mackenzie RE, Straus LD, Rabinowitz JC. Photooxidation of formyltetrahydrofolate synthetase in the presence of methylene blue. Arch Biochem Biophys 1972; 150:421-7. [PMID: 5044034 DOI: 10.1016/0003-9861(72)90058-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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