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Nobari H, Azarian S, Saedmocheshi S, Valdés-Badilla P, García Calvo T. Narrative review: The role of circadian rhythm on sports performance, hormonal regulation, immune system function, and injury prevention in athletes. Heliyon 2023; 9:e19636. [PMID: 37809566 PMCID: PMC10558889 DOI: 10.1016/j.heliyon.2023.e19636] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 08/21/2023] [Accepted: 08/29/2023] [Indexed: 10/10/2023] Open
Abstract
Objectives This study was a narrative review of the importance of circadian rhythm (CR), describes the underlying mechanisms of CR in sports performance, emphasizes the reciprocal link between CR, endocrine homeostasis and sex differences, and the unique role of the circadian clock in immune system function and coordination. Method As a narrative review study, a comprehensive search was conducted in PubMed, Scopus, and Web of Science (core collection) databases using the keywords "circadian rhythm", "sports performance", "hormonal regulation", "immune system", and "injury prevention". Inclusion criteria were studies published in English and peer-reviewed journals until July 2023. Studies that examined the role of CR in sports performance, hormonal status, immune system function, and injury prevention in athletes were selected for review. Results CR is followed by almost all physiological and biochemical activities in the human body. In humans, the superchiasmatic nucleus controls many daily biorhythms under solar time, including the sleep-wake cycle. A body of literature indicates that the peak performance of essential indicators of sports performance is primarily in the afternoon hours, and the evening of actions occurs roughly at the peak of core body temperature. Recent studies have demonstrated that the time of day that exercise is performed affects the achievement of good physical performance. This review also shows various biomarkers of cellular damage in weariness and the underlying mechanisms of diurnal fluctuations. According to the clock, CR can be synchronized with photonic and non-photonic stimuli (i.e., temperature, physical activity, and food intake), and feeding patterns and diet changes can affect CR and redox markers. It also emphasizes the reciprocal links between CR and endocrine homeostasis, the specific role of the circadian clock in coordinating immune system function, and the relationship between circadian clocks and sex differences. Conclusion The interaction between insufficient sleep and time of day on performance has been established in this study because it is crucial to balance training, recovery, and sleep duration to attain optimal sports performance.
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Affiliation(s)
- Hadi Nobari
- Faculty of Sport Sciences, University of Extremadura, 10003, Cáceres, Spain
- Department of Exercise Physiology, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, 56199-11367, Iran
| | - Somayeh Azarian
- Department of Exercise Physiology, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, 56199-11367, Iran
| | - Saber Saedmocheshi
- Department of Physical Education and Sport Sciences, Faculty of Humanities and Social Sciences, University of Kurdistan, Sanandaj, 66177-15175, Iran
| | - Pablo Valdés-Badilla
- Department of Physical Activity Sciences, Faculty of Education Sciences, Universidad Católica del Maule, Talca, 3530000, Chile
- Sports Coach Career, School of Education, Universidad Viña del Mar, Viña del Mar, 2520000, Chile
| | - Tomás García Calvo
- Faculty of Sport Sciences, University of Extremadura, 10003, Cáceres, Spain
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Raise-Abdullahi P, Meamar M, Vafaei AA, Alizadeh M, Dadkhah M, Shafia S, Ghalandari-Shamami M, Naderian R, Afshin Samaei S, Rashidy-Pour A. Hypothalamus and Post-Traumatic Stress Disorder: A Review. Brain Sci 2023; 13:1010. [PMID: 37508942 PMCID: PMC10377115 DOI: 10.3390/brainsci13071010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/25/2023] [Accepted: 06/28/2023] [Indexed: 07/30/2023] Open
Abstract
Humans have lived in a dynamic environment fraught with potential dangers for thousands of years. While fear and stress were crucial for the survival of our ancestors, today, they are mostly considered harmful factors, threatening both our physical and mental health. Trauma is a highly stressful, often life-threatening event or a series of events, such as sexual assault, war, natural disasters, burns, and car accidents. Trauma can cause pathological metaplasticity, leading to long-lasting behavioral changes and impairing an individual's ability to cope with future challenges. If an individual is vulnerable, a tremendously traumatic event may result in post-traumatic stress disorder (PTSD). The hypothalamus is critical in initiating hormonal responses to stressful stimuli via the hypothalamic-pituitary-adrenal (HPA) axis. Linked to the prefrontal cortex and limbic structures, especially the amygdala and hippocampus, the hypothalamus acts as a central hub, integrating physiological aspects of the stress response. Consequently, the hypothalamic functions have been attributed to the pathophysiology of PTSD. However, apart from the well-known role of the HPA axis, the hypothalamus may also play different roles in the development of PTSD through other pathways, including the hypothalamic-pituitary-thyroid (HPT) and hypothalamic-pituitary-gonadal (HPG) axes, as well as by secreting growth hormone, prolactin, dopamine, and oxytocin. This review aims to summarize the current evidence regarding the neuroendocrine functions of the hypothalamus, which are correlated with the development of PTSD. A better understanding of the role of the hypothalamus in PTSD could help develop better treatments for this debilitating condition.
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Affiliation(s)
| | - Morvarid Meamar
- Research Center of Physiology, Semnan University of Medical Sciences, Semnan, Iran
| | - Abbas Ali Vafaei
- Research Center of Physiology, Semnan University of Medical Sciences, Semnan, Iran
- Department of Physiology, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Maryam Alizadeh
- Department of Basic Medical Sciences, Faculty of Medicine, Qom Medical Sciences, Islamic Azad University, Qom, Iran
| | - Masoomeh Dadkhah
- Pharmaceutical Sciences Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Sakineh Shafia
- Immunogenetics Research Center, Department of Physiology, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Ramtin Naderian
- Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran
| | - Seyed Afshin Samaei
- Department of Neurology, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Ali Rashidy-Pour
- Research Center of Physiology, Semnan University of Medical Sciences, Semnan, Iran
- Department of Physiology, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran
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3
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Swift KM, Thomas CL, Balkin TJ, Lowery-Gionta EG, Matson LM. Acute sleep interventions as an avenue for treatment of trauma-associated disorders. J Clin Sleep Med 2022; 18:2291-2312. [PMID: 35678060 PMCID: PMC9435330 DOI: 10.5664/jcsm.10074] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 11/13/2022]
Abstract
Scientific evidence that acute, posttrauma sleep disturbances (eg, nightmares and insomnia) can contribute significantly to the pathogenesis of trauma-induced disorders is compelling. Sleep disturbances precipitating from trauma are uniquely predictive of daytime posttrauma symptom occurrence and severity, as well as subsequent onset of mental health disorders, including post-traumatic stress disorder. Conversely, adequate sleep during the acute posttrauma period is associated with reduced likelihood of adverse mental health outcomes. These findings, which are broadly consistent with what is known about the role of sleep in the regulation of emotion, suggest that the acute posttrauma period constitutes a "window of opportunity" during which treatment of sleep disturbances may be especially effective for preventing or mitigating progression of aberrant psychophysiological processes. At this point, the weight of the scientific evidence supporting this possibility warrants initiation of clinical trials to confirm the benefits of targeted prophylactic sleep enhancement, and to establish treatment guidelines as appropriate. CITATION Swift KM, Thomas CL, Balkin TJ, Lowery-Gionta EG, Matson LM. Acute sleep interventions as an avenue for treatment of trauma-associated disorders. J Clin Sleep Med. 2022;18(9):2291-2312.
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Affiliation(s)
- Kevin M. Swift
- Medical Readiness Systems Biology, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Connie L. Thomas
- Department of Sleep Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland
- Department of Psychiatry, Uniformed Services University of Health Sciences, Bethesda, Maryland
| | - Thomas J. Balkin
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Emily G. Lowery-Gionta
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Liana M. Matson
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland
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4
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Abstract
This article reviews the literature on the relationship between sleep deficiency and unipolar and bipolar depression, anxiety disorders, and posttraumatic stress disorder. We consider the evidence for sleep as a contributory causal factor in the development of psychiatric disorders, as well as sleep as an influential factor related to the outcome and recurrence of psychopathology. A case for sleep deficiency being an important treatment target when sleep and psychiatric disorders are comorbid is also made. Our recommendation is that sleep deficiency is recognized as a means to positively impact the development and course of psychopathology and, as such, is routinely assessed and treated in clinical practice.
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5
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Petzold M, Bunzeck N. Impaired episodic memory in PTSD patients - A meta-analysis of 47 studies. Front Psychiatry 2022; 13:909442. [PMID: 36245884 PMCID: PMC9553990 DOI: 10.3389/fpsyt.2022.909442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022] Open
Abstract
Episodic memory impairments beyond the traumatic event might be a characteristic hallmark of post-traumatic stress disorder (PTSD). Although several studies support such a claim, empirical findings are inconsistent. Therefore, we performed a random-effects meta-analysis including data from a total of 47 studies and 3,062 subjects. As main finding, we can show that PTSD patients show episodic memory deficits compared to all controls. This effect was significantly stronger for PTSD vs. non-traumatized healthy controls as compared to PTSD vs. traumatized controls without PTSD. Finally, episodic memory impairments in PTSD were most pronounced in verbal memory tests as compared to non-verbal memory tests. Our results provide new evidence that PTSD is characterized by impaired episodic long-term memory beyond the traumatic event, and these deficits are particularly pronounced in verbal memory. We will discuss our findings in the context of physiological, psychological and trauma related memory models. From a broader perspective, our findings may have implications for the treatment of PTSD by suggesting that the assessment and, if necessary, training of memory deficits could be included as part of diagnostics and psychotherapeutic treatment.
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Affiliation(s)
- Maria Petzold
- Department of Psychology, University of Lübeck, Lübeck, Germany
| | - Nico Bunzeck
- Department of Psychology, University of Lübeck, Lübeck, Germany.,Center of Brain, Behavior, and Metabolism, University of Lübeck, Lübeck, Germany
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Thomas KG, Bradley H, Chen A, Lipinska G. Trauma survivors with disrupted sleep generate less specific and less emotional autobiographical memories. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Saguin E, Gomez-Merino D, Sauvet F, Leger D, Chennaoui M. Sleep and PTSD in the Military Forces: A Reciprocal Relationship and a Psychiatric Approach. Brain Sci 2021; 11:brainsci11101310. [PMID: 34679375 PMCID: PMC8533994 DOI: 10.3390/brainsci11101310] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 09/21/2021] [Accepted: 09/28/2021] [Indexed: 11/29/2022] Open
Abstract
Sleep disturbances are well-recognised symptoms of Post-Traumatic Stress Disorder (PTSD). This review updates knowledge regarding the relationship between sleep during deployment, combat-related trauma, and PTSD in military personnel, from which the importance of restorative sleep results. The description of the characteristics of sleep in military forces with the considerable roles of the operational and training contexts highlights the important consequences of degraded sleep. Indeed, a lot of data suggest a dynamic link between sleep and the onset and chronicity of PTSD. We propose a reciprocal relationship model with strategies strongly recommended or already adopted by the military to promote restorative sleep before and after combat exposure. Among the alterations in a variety of sleep architecture and sleep patterns described in PTSD, the physiological hypothesis of REM sleep fragmentation in the development of PTSD symptoms may be important because REM sleep is generally associated with emotional memory. Finally, we address clinical and research perspectives that could be used to detect or restore sleep continuity before and during military deployment to possibly alleviate nightmares and insomnia related to combat exposure and PTSD occurrence and improve our understanding of sleep in PTSD.
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Affiliation(s)
- Emeric Saguin
- Psychiatric Department, Begin Military Teaching Hospital, 94160 Saint-Mandé, France
- VIFASOM (Vigilance Fatigue Sommeil et Santé Publique) EA 7330, Université de Paris, 75005 Paris, France
- Correspondence: ; Tel.: +33-0143985440
| | - Danielle Gomez-Merino
- VIFASOM (Vigilance Fatigue Sommeil et Santé Publique) EA 7330, Université de Paris, 75005 Paris, France
- French Armed Forces Biomedical Research Institute, 91220 Brétigny-sur-Orge, France; (D.G.-M.); (F.S.); (M.C.)
| | - Fabien Sauvet
- VIFASOM (Vigilance Fatigue Sommeil et Santé Publique) EA 7330, Université de Paris, 75005 Paris, France
- French Armed Forces Biomedical Research Institute, 91220 Brétigny-sur-Orge, France; (D.G.-M.); (F.S.); (M.C.)
| | - Damien Leger
- VIFASOM (Vigilance Fatigue Sommeil et Santé Publique) EA 7330, Université de Paris, 75005 Paris, France
- Centre du Sommeil et de la Vigilance, Hôtel-Dieu, APHP, 75004 Paris, France;
| | - Mounir Chennaoui
- VIFASOM (Vigilance Fatigue Sommeil et Santé Publique) EA 7330, Université de Paris, 75005 Paris, France
- French Armed Forces Biomedical Research Institute, 91220 Brétigny-sur-Orge, France; (D.G.-M.); (F.S.); (M.C.)
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Ponte L, Jerome L, Hamilton S, Mithoefer MC, Yazar‐Klosinski BB, Vermetten E, Feduccia AA. Sleep Quality Improvements After MDMA-Assisted Psychotherapy for the Treatment of Posttraumatic Stress Disorder. J Trauma Stress 2021; 34:851-863. [PMID: 34114250 PMCID: PMC8453707 DOI: 10.1002/jts.22696] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/19/2021] [Accepted: 03/22/2021] [Indexed: 02/01/2023]
Abstract
Sleep disturbances (SDs) are among the most distressing and commonly reported symptoms in posttraumatic stress disorder (PTSD). Despite increased attention on sleep in clinical PTSD research, SDs remain difficult to treat. In Phase 2 trials, 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy has been shown to greatly improve PTSD symptoms. We hypothesized that MDMA-assisted psychotherapy would improve self-reported sleep quality (SQ) in individuals with PTSD and be associated with declining PTSD symptoms. Participants in four studies (n = 63) were randomized to receive 2-3 sessions of active MDMA (75-125 mg; n = 47) or placebo/control MDMA (0-40 mg, n = 16) during all-day psychotherapy sessions. The PSQI was used to assess change in SQ from baseline to the primary endpoint, 1-2 months after the blinded sessions. Additionally, PSQI scores were measured at treatment exit (TE) and 12-month follow-up. Symptoms of PTSD were measured using the CAPS-IV. At the primary endpoint, CAPS-IV total severity scores dropped more after active MDMA than after placebo/control (-34.0 vs. -12.4), p = .003. Participants in the active dose group showed more improvement in SQ compared to those in the control group (PSQI total score ΔM = -3.5 vs. 0.6), p = .003. Compared to baseline, SQ had improved at TE, p < .001, with further significant gains reported at 12-month follow-up (TE to 12-months ΔM = -1.0), p = .030. Data from these randomized controlled double-blind studies provide evidence for the beneficial effects of MDMA-assisted psychotherapy in treating SDs in individuals with PTSD.
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Affiliation(s)
- Linnae Ponte
- Department of PsychiatryYale School of MedicineNew HavenConnecticutUSA
| | - Lisa Jerome
- MAPS Public Benefit CorporationSan JoseCaliforniaUSA
| | - Scott Hamilton
- Department of Neurology and Neurological SciencesStanford School of MedicineStanfordCaliforniaUSA
| | - Michael C. Mithoefer
- Department of Psychiatry and Behavioral SciencesMedical University of South CarolinaCharlestonSouth CarolinaUSA
| | | | - Eric Vermetten
- Department of PsychiatryLeiden University Medical CenterLeidenThe Netherlands
- ARQ National Psychotrauma CenterDiemenThe Netherlands
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9
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Heaton AL, Kelly C, Rood J, Tam CS, Greenway FL. Mechanism for the Increase in Human Growth Hormone with Administration of a Novel Test Supplement and Results Indicating Improved Physical Fitness and Sleep Efficiency. J Med Food 2020; 24:653-659. [PMID: 33030391 DOI: 10.1089/jmf.2020.0109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
An oral test supplement increases serum human growth hormone (hGH) levels after acute administration in healthy adults. We investigated the mechanism for the increase in hGH and the effect of continued daily administration of the test supplement on measures of physical fitness and sleep efficiency. In Study 1, serum triiodothyronine (T3) was measured in samples from a prior placebo-controlled, double-blind study in which 16 healthy participants received both placebo and the test supplement in a crossover design; treatment order was randomized, and treatments were separated by a 1-week washout. In Study 2, physical fitness (VO2 max) was measured at baseline and after 2 weeks of daily administration of the test supplement (N = 12 healthy participants). Study 3 assessed daily sleep onset latency and time awake during 3 weeks of daily administration of the test supplement (N = 15 healthy participants). A fall from baseline in T3 was observed with placebo (-6.1 ± 8.5 ng/dL, P = .01). Of note, the change in T3 was smaller with the test supplement (-3.3 ± 10.7 ng/dL, P = not significant) but was not statistically different from placebo. Mean VO2 max increased by 6% from baseline after 2 weeks (P = .02). Sleep-onset latency and time awake during the night were reduced from baseline to week 3 by 22% and 65%, respectively (P = .01 and P = .02). The conservation of T3 levels suggests that the mechanism for increased hGH secretion by the test supplement is through somatostatin inhibition. Furthermore, pilot studies indicated that daily administration of the supplement improved physical fitness and sleep efficiency from baseline, effects consistent with increased endogenous hGH release. Clinical Trial Registration No. NCT02987868.
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Affiliation(s)
- Amy L Heaton
- Pennington Biomedical Research Center, LSU System, Baton Rouge, Louisiana, USA.,Sierra Research Group, LLC, Salt Lake City, Utah, USA
| | - Colleen Kelly
- Kelly Statistical Consulting, Carlsbad, California, USA
| | - Jennifer Rood
- Pennington Biomedical Research Center, LSU System, Baton Rouge, Louisiana, USA
| | - Charmaine S Tam
- Pennington Biomedical Research Center, LSU System, Baton Rouge, Louisiana, USA
| | - Frank L Greenway
- Pennington Biomedical Research Center, LSU System, Baton Rouge, Louisiana, USA
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10
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Swift KM. Sleep and PTSD: delving deeper to understand a complicated relationship. Sleep 2020. [DOI: 10.1093/sleep/zsaa074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kevin M Swift
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD
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11
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Cox RC, Olatunji BO. Sleep in the anxiety-related disorders: A meta-analysis of subjective and objective research. Sleep Med Rev 2020; 51:101282. [PMID: 32109832 DOI: 10.1016/j.smrv.2020.101282] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/07/2020] [Accepted: 01/09/2020] [Indexed: 02/04/2023]
Abstract
Although sleep disturbance is implicated in psychopathology, its role in anxiety-related disorders remains unclear. The present meta-analysis characterizes sleep disturbance in anxiety-related disorders collectively and individually. Subjective measures of total sleep time and sleep continuity were included with objective measures. Results indicate a large effect for increased subjective sleep disturbance (g = 2.16), medium effects for decreased total sleep time (g = -.40) and sleep continuity (g = -.49), and a small effect for decreased sleep depth (g = -.20) in anxiety-related disorders compared to healthy controls. Each anxiety-related disorder exhibited a distinct sleep disturbance pattern, suggesting that sleep may facilitate identification of unique biopsychological underpinnings. Effects were not moderated by comorbid depression and were similar in magnitude to those found for depression. Sleep disturbances, particularly decreased sleep continuity, may be a key pathology in the anxiety-related disorders that could highlight novel etiological mechanisms and intervention targets.
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Affiliation(s)
- Rebecca C Cox
- Department of Psychology, Vanderbilt University, 301 Wilson Hall, 111 21st Avenue South, Nashville, TN 37240, USA.
| | - Bunmi O Olatunji
- Department of Psychology, Vanderbilt University, 301 Wilson Hall, 111 21st Avenue South, Nashville, TN 37240, USA
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12
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Abstract
The relationship between objective and subjective sleep quality is still debated. Here, we investigate differences in objective sleep parameters in habitual subjective good sleepers and bad sleepers with the aim of evaluating sleep continuity, stability and organization as possible determinants of subjective sleep quality. In total, 38 subjects (good sleepers, N = 18; bad sleepers, N = 20) underwent two nights of sleep recording. Traditional sleep parameters displayed no between-groups differences. Conversely, bad sleepers showed lower sleep continuity (awakenings frequency), stability (e.g. arousals and state transitions frequency) and organization (e.g. number of sleep cycles and time spent in cycles). Our findings point to the involvement of these measures in determining habitual sleep quality perception and suggest the possibility to include them in standard sleep assessments.
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13
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Soal LJ, Bester CM, Shaw BS, Yelverton C. Changes in chronic neck pain following the introduction of a visco-elastic polyurethane foam pillow and/or chiropractic treatment. Health SA 2020; 24:1099. [PMID: 31934412 PMCID: PMC6917418 DOI: 10.4102/hsag.v24i0.1099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 06/24/2019] [Indexed: 11/01/2022] Open
Abstract
Background Sleep ergonomics are increasingly prescribed as an adjunct treatment to chronic neck pain. Postulated benefits to maintaining the ideal sleeping posture are improved tissue repair in and around the facet joints, decrease in tension of associated musculature and better quality sleep. Aim The purpose of this study was to determine if the inclusion of a visco-elastic polyurethane (VEP) pillow could benefit the chiropractic treatment of chronic neck pain. Setting The study took place at a chiropractic training clinic in Johannesburg. Method Participants were randomly assigned to either a chiropractic treatment only group (CHI) (n = 15) or a chiropractic treatment with a VEP pillow group (CHI+P) (n = 15). Both groups underwent six chiropractic treatments spaced at 3-4-day intervals and the CHI+P were provided with a VEP pillow. Baseline and post-test measurements consisted of the initial Numerical Pain Rating Scale (NRS) and the Vernon-Mior Neck Pain and Disability Index (NDI). Results Both the CHI and CHI+P groups significantly (p ≤ 0.05) improved their NRS (p = 0.001 for both groups) and NDI (p = 0.001 and p = 0.000, respectively) scores. Furthermore, post hoc analysis indicated a significant difference at post-test between the two groups for NRS (p = 0.015), but not for NDI (p = 0.195). The CHI+P demonstrated an improved minimum clinically important difference (MCID) (43% vs. 73% for NRS and 59% vs. 71% for the NDI). Conclusion Findings of this study suggest that a VEP pillow could be included as an adjunct management tool to chiropractic treatment of chronic neck pain.
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Affiliation(s)
- Laura J Soal
- Department of Chiropractic, University of Johannesburg, Johannesburg, South Africa
| | - Charmaine M Bester
- Department of Chiropractic, University of Johannesburg, Johannesburg, South Africa
| | - Brandon S Shaw
- Department of Human Movement Science, University of Zululand, KwaZulu-Natal, KwaDlangezwa, South Africa
| | - Chris Yelverton
- Department of Chiropractic, University of Johannesburg, Johannesburg, South Africa
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Arzilli C, Cerasuolo M, Conte F, Bittoni V, Gatteschi C, Albinni B, Giganti F, Ficca G. The Effect of Cognitive Activity on Sleep Maintenance in a Subsequent Daytime Nap. Behav Sleep Med 2019; 17:552-560. [PMID: 29368954 DOI: 10.1080/15402002.2018.1425870] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background/Objective: The aim of this study is to assess the effects of a learning task on the characteristics of a subsequent daytime nap. Participants and Methods: Thirty-eight subjects were administered a control nap (C) and one preceded by a cognitive training session (TR). Results: Relative to C, TR naps showed significantly increased sleep duration with decreased sleep latency, as well as significantly increased sleep efficiency due to reduced awakening frequency. Meaningful trends were also found toward an increase of Stage 2 sleep proportion and a reduction of Stage 1 sleep, percentage of wake after sleep onset (WASO), and frequency of state transitions. Conclusions: Our results indicate that presleep learning favors sleep propensity and maintenance, offering the possibility to explore planned cognitive training as a low-cost treatment for sleep impairments.
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Affiliation(s)
- Cinzia Arzilli
- a Department of Neuroscience, Psychology, Drug Research and Child Health, University of Firenze , Firenze , Italy
| | - Mariangela Cerasuolo
- b Department of Psychology, University of Campania "Luigi Vanvitelli," , Caserta , Italy
| | - Francesca Conte
- b Department of Psychology, University of Campania "Luigi Vanvitelli," , Caserta , Italy
| | - Valentina Bittoni
- a Department of Neuroscience, Psychology, Drug Research and Child Health, University of Firenze , Firenze , Italy
| | - Claudia Gatteschi
- a Department of Neuroscience, Psychology, Drug Research and Child Health, University of Firenze , Firenze , Italy
| | - Benedetta Albinni
- b Department of Psychology, University of Campania "Luigi Vanvitelli," , Caserta , Italy
| | - Fiorenza Giganti
- a Department of Neuroscience, Psychology, Drug Research and Child Health, University of Firenze , Firenze , Italy
| | - Gianluca Ficca
- b Department of Psychology, University of Campania "Luigi Vanvitelli," , Caserta , Italy
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15
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Lipinska G, Thomas KGF. Rapid eye movement fragmentation, not slow-wave sleep, predicts neutral declarative memory consolidation in posttraumatic stress disorder. J Sleep Res 2019; 28:e12846. [PMID: 30932254 DOI: 10.1111/jsr.12846] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 02/04/2019] [Accepted: 02/19/2019] [Indexed: 11/30/2022]
Abstract
Individuals diagnosed with posttraumatic stress disorder (PTSD) experience disruption at both slow-wave sleep (SWS) and rapid-eye movement (REM) sleep stages and demonstrate marked memory impairment. A small group of studies suggests that, within the disorder, there is a mechanistic relation between these sleep and memory impairments. This study sought to extend that literature by examining whether, in PTSD-diagnosed individuals, memory-retention deficits are present after a sleep-filled (but not after a wake-filled) delay (i.e., whether memory deficits can be traced to interruptions of sleep-dependent memory consolidation). Moreover, we investigated whether SWS- or REM-based disturbances, or both, contribute to retention deficits. We recruited participants into three groups: PTSD (n = 21), trauma-exposed non-PTSD (TE; n = 19) and healthy control (HC; n = 20). Using a crossover design, we assessed memory recall before and after an 8-hr period of polysomnography-monitored sleep and an 8-hr period of regular waking activity. PTSD-diagnosed participants retained less information than controls over the sleep-filled (but not wake-filled) delay. Furthermore, increased REM fragmentation predicted postsleep memory retention in PTSD-diagnosed individuals only. No SWS parameter was associated with or predictive of the amount of information retained postsleep. We conclude that specific REM-related changes in PTSD-diagnosed individuals affected sleep-dependent neutral declarative memory consolidation. Generally, these findings extend the literature suggesting that the co-occurrence of sleep and memory difficulties in PTSD is not accidental, but that these two symptom clusters are meaningfully related. Specifically, the study illustrates that subtle REM-related disruptions contribute most strongly to memory impairment in PTSD.
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Affiliation(s)
- Gosia Lipinska
- UCT Sleep Sciences and ACSENT Laboratory, Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Kevin G F Thomas
- UCT Sleep Sciences and ACSENT Laboratory, Department of Psychology, University of Cape Town, Cape Town, South Africa
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Breen MS, Thomas KGF, Baldwin DS, Lipinska G. Modelling PTSD diagnosis using sleep, memory, and adrenergic metabolites: An exploratory machine-learning study. Hum Psychopharmacol 2019; 34:e2691. [PMID: 30793802 DOI: 10.1002/hup.2691] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 12/10/2018] [Accepted: 12/20/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Features of posttraumatic stress disorder (PTSD) typically include sleep disturbances, impaired declarative memory, and hyperarousal. This study evaluated whether these combined features may accurately delineate pathophysiological changes associated with PTSD. METHOD We recruited a cohort of PTSD-diagnosed individuals (N = 20), trauma survivors without PTSD (TE; N = 20), and healthy controls (HC; N = 20). Analyses of between-group differences and support vector machine (SVM)-learning were applied to participant features. RESULTS Analyses of between-group differences replicated previous findings, indicating that PTSD-diagnosed individuals self-reported poorer sleep quality, objectively demonstrated less sleep depth, and evidenced declarative memory deficits in comparison to HC. Integrative SVM-learning distinguished HC from trauma participants with 80% accuracy using a combination of five features, including subjective and objective sleep, neutral declarative memory, and metabolite variables. PTSD and TE participants could be distinguished with 70% accuracy using a combination of subjective and objective sleep variables but not by metabolite or declarative memory variables. CONCLUSION From among a broad range of sleep, cognitive, and biochemical variables, sleep characteristics were the primary features that could differentiate those with PTSD from those without. Our exploratory SVM-learning analysis establishes a framework for future sleep- and memory-based PTSD investigations that could drive improvements in diagnostic accuracy and treatment.
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Affiliation(s)
- Michael S Breen
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kevin G F Thomas
- Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - David S Baldwin
- Clinical and Experimental Sciences, University of Southampton, Southampton, UK.,Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Gosia Lipinska
- Department of Psychology, University of Cape Town, Cape Town, South Africa
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17
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Howell S, Griesbach GS. The interplay between neuroendocrine and sleep alterations following traumatic brain injury. NeuroRehabilitation 2019; 43:327-345. [PMID: 30347624 DOI: 10.3233/nre-182483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Sleep and endocrine disruptions are prevalent after traumatic brain injury (TBI) and are likely to contribute to morbidity. OBJECTIVE To describe the interaction between sleep and hormonal regulation following TBI and elucidate the impact that alterations of these systems have on cognitive responses during the posttraumatic chronic period. METHODS Review of preclinical and clinical literature describing long-lasting endocrine dysregulation and sleep alterations following TBI. The bidirectional relationship between sleep and hormones is described. Literature describing co-occurrence between sleep-wake disturbances and hormonal dysregulation will be presented. Review of literature describing cognitive effects of seep and hormones. The cognitive and functional impact of sleep disturbances and hormonal dysregulation is discussed within the context of TBI. RESULTS/CONCLUSIONS Sleep and hormonal alterations impact cognitive and functional outcome after TBI. Diagnosis and treatment of these disturbances will impact recovery following TBI and should be considered in the post-acute rehabilitative setting.
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Affiliation(s)
| | - Grace S Griesbach
- Centre for Neuro Skills, Encino, CA, USA.,Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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18
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Abstract
PURPOSE OF REVIEW Traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) can result from similar injuries and can result in similar symptoms, such as problems with sleep, concentration, memory, and mood. Although PTSD and persistent sequelae due to a TBI (PST) have generally been viewed as pragmatically confounded but conceptually separable entities, we examine emerging evidence emphasizing the breadth of overlap in both clinical presentation and underlying pathophysiology between PST and PTSD. RECENT FINDINGS New evidence underscores the poor specificity of symptoms to etiology and emphasizes the potential, after both physical brain injury and traumatic stress, for changes in each of the three interacting systems that coordinate the body's response to the experience or expectation of major injury-the immune, endocrine, and neuromodulatory neurotransmitter systems. A view of PTSD and PST sharing common pathophysiologic elements related to the CNS response to acute injury or threat carries important implications for research and clinical care.
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Poor Sleep Quality Is Associated with Higher Hemoglobin A1c in Pregnant Women: A Pilot Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15102287. [PMID: 30340366 PMCID: PMC6210387 DOI: 10.3390/ijerph15102287] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/12/2018] [Accepted: 10/14/2018] [Indexed: 02/07/2023]
Abstract
We hypothesized that poor sleep quality exacerbates glucose intolerance manifested as elevated glycosylated hemoglobin (HbA1c), which increases the risk for gestational diabetes. To test this, 38 pregnant and 22 non-pregnant (age, 18–35 years; body-mass index, 20–35 kg/m2) otherwise healthy women were enrolled in the study. Sleep quality was assessed during gestational week 24 (pregnant), or outside of the menstrual period (non-pregnant), using qualitative (Pittsburgh Sleep Quality Index) and objective (actigraphic wrist-watch) measures. Blood glucose, total cortisol, and depression status were evaluated. Eight pregnant and one non-pregnant women were lost to follow-up, or withdrew from the study. There was a higher incidence of poor sleep quality in pregnant (73%) relative to non-pregnant women (43%). Although actigraphic data revealed no differences in actual sleep hours between pregnant and non-pregnant women, the number of wake episodes and sleep fragmentation were higher in pregnant women. Poor sleep quality was positively correlated with higher HbA1c in both pregnant (r = 0.46, n = 26, p = 0.0151) and non-pregnant women (r = 0.50, n = 19, p = 0.0217), reflecting higher average blood glucose concentrations. In contrast, poor sleep was negatively correlated with cortisol responses in pregnant women (r = −0.46, n = 25, p = 0.0167). Three pregnant women had elevated one-hour oral glucose tolerance test results (>153 mg/dL glucose). These same pregnant women exhibited poor sleep quality. These results support the suggestion that poor sleep quality is an important risk factor that is associated with glucose intolerance and attendant health complications in pregnancy.
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20
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REM deprivation but not sleep fragmentation produces a sex-specific impairment in extinction. Physiol Behav 2018; 196:84-94. [PMID: 30144468 DOI: 10.1016/j.physbeh.2018.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 08/21/2018] [Accepted: 08/22/2018] [Indexed: 01/31/2023]
Abstract
REM sleep is essential for learning and memory processes, particularly emotional learning. Manipulations of REM sleep impair learning and memory and sleep architecture is often altered following a learning experience; for example, short term REM deprivation immediately after fear conditioning results in impaired extinction. In light of research demonstrating sex-dependent differences in fear conditioning as well as differences in sleep architecture, the present study investigated the effects of short term REM deprivation on the extinction of conditioned fear in male and female rats. In addition, given evidence that sleep fragmentation, which is a consequence of REM deprivation, can negatively impact learning and memory, this manipulation was compared to REM deprivation and a control condition. Male and female rats were exposed to fear conditioning followed by 6 h of REM deprivation, sleep fragmentation, or a control condition. Two extinction sessions were conducted at 48 h intervals after conditioning. REM deprivation, but not sleep fragmentation or the control condition, impaired extinction of conditioned fear. However, this effect was seen only in male rats. This study is the first to explore the effects of sleep manipulations on memory in female rats and suggests that female rats are more resilient to the deleterious effects of REM deprivation. In addition, it demonstrates that REM deprivation but not fragmentation of sleep is responsible for impairment in extinction of conditioned fear.
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21
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Medial temporal lobe atrophy relates more strongly to sleep-wake rhythm fragmentation than to age or any other known risk. Neurobiol Learn Mem 2018; 160:132-138. [PMID: 29864525 DOI: 10.1016/j.nlm.2018.05.017] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 05/19/2018] [Accepted: 05/24/2018] [Indexed: 11/21/2022]
Abstract
Atrophy of the medial temporal lobe of the brain is key to memory function and memory complaints in old age. While age and some morbidities are major risk factors for medial temporal lobe atrophy, individual differences remain, and mechanisms are insufficiently known. The largest combined neuroimaging and whole genome study to date indicates that medial temporal lobe volume is most associated with common polymorphisms in the GRIN2B gene that encodes for the 2B subunit (NR2B) of the NMDA receptor. Because sleep disruption induces a selective loss of NR2B from hippocampal synaptic membranes in rodents, and because of several other reports on medial temporal lobe sensitivity to sleep disruption, we hypothesized a contribution of the typical age-related increase in sleep-wake rhythm fragmentation to medial temporal lobe atrophy. Magnetic resonance imaging and actigraphy in 138 aged individuals showed that individual differences in sleep-wake rhythm fragmentation accounted for more (19%) of the variance in medial temporal lobe atrophy than age did (15%), or any of a list of health and brain structural indicators. The findings suggest a role of sleep-wake rhythm fragmentation in age-related medial temporal lobe atrophy, that might in part be prevented or reversible.
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Cox RC, Tuck BM, Olatunji BO. Sleep Disturbance in Posttraumatic Stress Disorder: Epiphenomenon or Causal Factor? Curr Psychiatry Rep 2017; 19:22. [PMID: 28321643 DOI: 10.1007/s11920-017-0773-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE OF REVIEW The goal of this review is to integrate recent findings on sleep disturbance and PTSD, examine sleep disturbance as a causal factor in the development of PTSD, and identify future directions for research, treatment, and prevention. RECENT FINDINGS Recent research highlights a relationship between both objective and subjective sleep disturbance and PTSD across diverse samples. Sleep disturbance also predicts PTSD over time. Finally, treatments targeting sleep disturbance lead to decreased PTSD symptoms, while standard PTSD treatments conclude with residual sleep disturbance. Sleep disturbance may be more than a mere epiphenomenon of PTSD. Future research examining the causal role of sleep disturbance in the development of PTSD, as well as the utility of targeting sleep disturbance in prevention and treatment, is necessary to fully understand the likely bidirectional relationship between sleep disturbance and PTSD.
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Affiliation(s)
- Rebecca C Cox
- Department of Psychology, Vanderbilt University, 301 Wilson Hall, 111 21st Avenue South, Nashville, TN, 37240, USA
| | - Breanna M Tuck
- Department of Psychology, Vanderbilt University, 301 Wilson Hall, 111 21st Avenue South, Nashville, TN, 37240, USA
| | - Bunmi O Olatunji
- Department of Psychology, Vanderbilt University, 301 Wilson Hall, 111 21st Avenue South, Nashville, TN, 37240, USA.
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Steyn FJ, Tolle V, Chen C, Epelbaum J. Neuroendocrine Regulation of Growth Hormone Secretion. Compr Physiol 2016; 6:687-735. [PMID: 27065166 DOI: 10.1002/cphy.c150002] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This article reviews the main findings that emerged in the intervening years since the previous volume on hormonal control of growth in the section on the endocrine system of the Handbook of Physiology concerning the intra- and extrahypothalamic neuronal networks connecting growth hormone releasing hormone (GHRH) and somatostatin hypophysiotropic neurons and the integration between regulators of food intake/metabolism and GH release. Among these findings, the discovery of ghrelin still raises many unanswered questions. One important event was the application of deconvolution analysis to the pulsatile patterns of GH secretion in different mammalian species, including Man, according to gender, hormonal environment and ageing. Concerning this last phenomenon, a great body of evidence now supports the role of an attenuation of the GHRH/GH/Insulin-like growth factor-1 (IGF-1) axis in the control of mammalian aging.
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Affiliation(s)
- Frederik J Steyn
- University of Queensland Centre for Clinical Research and the School of Biomedical Sciences, University of Queensland, St. Lucia, Brisbane, Queensland, Australia
| | - Virginie Tolle
- Unité Mixte de Recherche en Santé 894 INSERM, Centre de Psychiatrie et Neurosciences, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Chen Chen
- School of Biomedical Sciences, University of Queensland, St. Lucia, Brisbane, Queensland, Australia
| | - Jacques Epelbaum
- University of Queensland Centre for Clinical Research and the School of Biomedical Sciences, University of Queensland, St. Lucia, Brisbane, Queensland, Australia
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Bone Age and Serum Osteocalcin Levels in Children With Obstructive Sleep Apnea Hypopnea Syndrome Before and After Adenotonsillectomy. Am J Ther 2016; 24:e189-e195. [PMID: 26938749 DOI: 10.1097/mjt.0000000000000303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Our aim was to study the changes in bone age and serum osteocalcin levels before and after adenotonsillectomy (AT) in children with obstructive sleep apnea hypopnea syndrome (OSAHS). A total of 58 OSAHS children (37 males and 21 females) with the mean age of 6.68 ± 1.11 years were enrolled and assessed by x-ray-based bone age estimation and enzyme-linked immunosorbent assay-based measurement of serum osteocalcin levels, before surgery and 6 months after AT. SPSS 19.0 software was used for statistical analysis. Our results revealed that bone age and serum osteocalcin levels in OSAHS patients were significantly lower than normal controls before AT (P < 0.05). Within 6 months after surgery, the bone age and the serum osteocalcin levels were significantly elevated in OSAHS patients (P < 0.05), compared with those before surgery. Serum osteocalcin levels and bone age are negatively correlated with apnea-hypopnea index, oxygen desaturation index, the percentage of the total recorded time spent below 90% oxygen saturation, and Epworth sleepiness scale scores (all P < 0.05). Our findings suggested that bone age and serum osteocalcin levels may be correlated with the development of OSAHS in children. AT may improve bone age and serum osteocalcin levels in OSAHS children.
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25
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Guardado P, Olivera A, Rusch HL, Roy M, Martin C, Lejbman N, Lee H, Gill JM. Altered gene expression of the innate immune, neuroendocrine, and nuclear factor-kappa B (NF-κB) systems is associated with posttraumatic stress disorder in military personnel. J Anxiety Disord 2016; 38:9-20. [PMID: 26751122 DOI: 10.1016/j.janxdis.2015.12.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 10/08/2015] [Accepted: 12/08/2015] [Indexed: 12/21/2022]
Abstract
Whole transcriptome analysis provides an unbiased examination of biological activity, and likely, unique insight into the mechanisms underlying posttraumatic stress disorder (PTSD) and comorbid depression and traumatic brain injury. This study compared gene-expression profiles in military personnel with PTSD (n=28) and matched controls without PTSD (n=27) using HG-U133 Plus 2.0 microarrays (Affymetrix), which contain 54,675 probe sets representing more than 38,500 genes. Analysis of expression profiles revealed 203 differentially expressed genes in PTSD, of which 72% were upregulated. Using Partek Genomics Suite 6.6, differentially expressed transcription clusters were filtered based on a selection criterion of ≥1.5 relative fold change at a false discovery rate of ≤5%. Ingenuity Pathway Analysis (Qiagen) of the differentially expressed genes indicated a dysregulation of genes associated with the innate immune, neuroendocrine, and NF-κB systems. These findings provide novel insights that may lead to new pharmaceutical agents for PTSD treatments and help mitigate mental and physical comorbidity risk.
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Affiliation(s)
- Pedro Guardado
- National Institute of Nursing Research, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA
| | - Anlys Olivera
- National Institute of Nursing Research, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA
| | - Heather L Rusch
- National Institute of Nursing Research, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA; Henry M Jackson Foundation for The Advancement of Military Medicine, 6720A Rockledge Drive #100, Bethesda, MD 20817, USA
| | - Michael Roy
- Uniformed Service University of the Health Science, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Christiana Martin
- National Institute of Nursing Research, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA
| | - Natasha Lejbman
- National Institute of Nursing Research, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA
| | - Hwyunhwa Lee
- University of Nevada, Las Vegas, School of Nursing, 4505 South Maryland Parkway, Las Vegas, NV 89154, USA
| | - Jessica M Gill
- National Institute of Nursing Research, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA.
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26
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Cox RC, Olatunji BO. A systematic review of sleep disturbance in anxiety and related disorders. J Anxiety Disord 2016; 37:104-29. [PMID: 26745517 DOI: 10.1016/j.janxdis.2015.12.001] [Citation(s) in RCA: 213] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 11/20/2015] [Accepted: 12/01/2015] [Indexed: 10/22/2022]
Abstract
Recent research suggests that sleep disturbance may be a transdiagnostic process, and there is increasing interest in examining how sleep disturbance may contribute to anxiety and related disorders. The current review summarizes and synthesizes the extant research assessing sleep in anxiety and related disorders. The findings suggest that sleep disturbance exacerbates symptom severity in the majority of anxiety and related disorders. However, the nature of sleep disturbance often varies as a function of objective versus subjective assessment. Although sleep disturbance is a correlate of most anxiety and related disorders, a causal role for sleep disturbance is less clear. A model of potential mechanisms by which sleep disturbance may confer risk for the development of anxiety and related disorders is discussed. Future research integrating findings from basic sleep research with current knowledge of anxiety and related disorders may facilitate the development of novel treatments for comorbid sleep disturbance and clinical anxiety.
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27
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Goerke M, Müller NG, Cohrs S. Sleep-dependent memory consolidation and its implications for psychiatry. J Neural Transm (Vienna) 2015; 124:163-178. [PMID: 26518213 DOI: 10.1007/s00702-015-1476-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 10/20/2015] [Indexed: 02/06/2023]
Abstract
Both sleep disturbance and memory impairment are very common in psychiatric disorders. Since sleep has been shown to play a role in the process of transferring newly acquired information into long-term memory, i.e., consolidation, it is important to highlight this link in the context of psychiatric disorders. Along these lines, after providing a brief overview of healthy human sleep, current neurobiological models on sleep-dependent memory consolidation and resultant opportunities to manipulate the memory consolidation process, recent findings on sleep disturbances and sleep-dependent memory consolidation in patients with insomnia, major depression, schizophrenia, and post-traumatic stress disorder are systematically reviewed. Furthermore, possible underlying neuropathologies and their implications on therapeutic strategies are discussed. This review aims at sensitizing the reader for recognizing sleep disturbances as a potential contributor to cognitive deficits in several disorders, a fact which is often overlooked up to date.
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Affiliation(s)
- Monique Goerke
- German Center for Neurodegenerative Diseases (DZNE) Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany. .,Department of Psychiatry and Psychotherapy, University of Rostock, Gehlsheimer Str. 20, 18147, Rostock, Germany.
| | - Notger G Müller
- German Center for Neurodegenerative Diseases (DZNE) Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Stefan Cohrs
- Department of Psychiatry and Psychotherapy, University of Rostock, Gehlsheimer Str. 20, 18147, Rostock, Germany
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Ioachimescu AG, Hampstead BM, Moore A, Burgess E, Phillips LS. Growth hormone deficiency after mild combat-related traumatic brain injury. Pituitary 2015; 18:535-41. [PMID: 25266761 DOI: 10.1007/s11102-014-0606-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Traumatic brain injury (TBI) has been recognized as a cause of growth hormone deficiency (GHD) in civilians. However, comparable data are sparse in veterans who incurred TBI during combat. Our objective was to determine the prevalence of GHD in veterans with a history of combat-related TBI, and its association with cognitive and psychosocial dysfunction. DESIGN Single center prospective study. PATIENTS Twenty male veterans with mild TBI incurred during combat 8-72 months prior to enrollment. MEASUREMENTS GHD was defined by a GH peak <3 μg/L during glucagon stimulation test. Differences in neuropsychological, emotional, and quality of life of the GHD Veterans were described using Cohen's d. Large effect sizes were considered meaningful. RESULTS Mean age was 33.7 years (SD 7.8) and all subjects had normal thyroid hormone and cortisol levels. Five (25%) exhibited a subnormal response to glucagon. Sixteen participants (80%) provided sufficient effort for valid neuropsychological assessment (12 GH-sufficient, 4 GHD). There were large effect size differences in self-monitoring during memory testing (d = 1.46) and inhibitory control (d = 0.92), with worse performances in the GHD group. While fatigue and post-traumatic stress disorder were comparable, the GHD group reported more depression (d = 0.80) and lower quality of life (d = 0.64). CONCLUSIONS Our study found a 25% prevalence of GHD in veterans with mild TBI as shown by glucagon stimulation. The neuropsychological findings raise the possibility that GHD has adverse effects on executive abilities and mood. Further studies are needed to determine whether GH replacement is an effective treatment in these patients.
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Affiliation(s)
- Adriana G Ioachimescu
- Atlanta Veteran Affairs Medical Center, The Emory Clinic, Emory University, 1365 B Clifton Rd, Atlanta, GA, 30322, USA,
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Gilbert KS, Kark SM, Gehrman P, Bogdanova Y. Sleep disturbances, TBI and PTSD: Implications for treatment and recovery. Clin Psychol Rev 2015; 40:195-212. [PMID: 26164549 DOI: 10.1016/j.cpr.2015.05.008] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 04/27/2015] [Accepted: 05/13/2015] [Indexed: 12/26/2022]
Abstract
Post-Traumatic Stress Disorder (PTSD), traumatic brain injury (TBI), and sleep problems significantly affect recovery and functional status in military personnel and Veterans returning from combat. Despite recent attention, sleep is understudied in the Veteran population. Few treatments and rehabilitation protocols target sleep, although poor sleep remains at clinical levels and continues to adversely impact functioning even after the resolution of PTSD or mild TBI symptoms. Recent developments in non-pharmacologic sleep treatments have proven efficacious as stand-alone interventions and have potential to improve treatment outcomes by augmenting traditional behavioral and cognitive therapies. This review discusses the extensive scope of work in the area of sleep as it relates to TBI and PTSD, including pathophysiology and neurobiology of sleep; existing and emerging treatment options; as well as methodological issues in sleep measurements for TBI and PTSD. Understanding sleep problems and their role in the development and maintenance of PTSD and TBI symptoms may lead to improvement in overall treatment outcomes while offering a non-stigmatizing entry in mental health services and make current treatments more comprehensive by helping to address a broader spectrum of difficulties.
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Affiliation(s)
- Karina Stavitsky Gilbert
- Psychology Research, VA Boston Healthcare System, Boston, MA, United States; Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States
| | - Sarah M Kark
- Psychology Research, VA Boston Healthcare System, Boston, MA, United States
| | - Philip Gehrman
- Department of Psychiatry, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, United States; Philadelphia VA Medical Center, Philadelphia, PA, United States
| | - Yelena Bogdanova
- Psychology Research, VA Boston Healthcare System, Boston, MA, United States; Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States.
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30
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The role of rapid eye movement sleep for amygdala-related memory processing. Neurobiol Learn Mem 2015; 122:110-21. [PMID: 25638277 DOI: 10.1016/j.nlm.2015.01.008] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 12/19/2014] [Accepted: 01/19/2015] [Indexed: 01/01/2023]
Abstract
Over the years, rapid eye movement (REM) sleep has been associated with general memory consolidation, specific consolidation of perceptual, procedural, emotional and fear memories, brain maturation and preparation of waking consciousness. More recently, some of these associations (e.g., general and procedural memory consolidation) have been shown to be unlikely, while others (e.g., brain maturation and consciousness) remain inconclusive. In this review, we argue that both behavioral and neurophysiological evidence supports a role of REM sleep for amygdala-related memory processing: the amygdala-hippocampus-medial prefrontal cortex network involved in emotional processing, fear memory and valence consolidation shows strongest activity during REM sleep, in contrast to the hippocampus-medial prefrontal cortex only network which is more active during non-REM sleep. However, more research is needed to fully understand the mechanisms.
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31
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Kim TW, Jeong JH, Hong SC. The impact of sleep and circadian disturbance on hormones and metabolism. Int J Endocrinol 2015; 2015:591729. [PMID: 25861266 PMCID: PMC4377487 DOI: 10.1155/2015/591729] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 02/24/2015] [Accepted: 02/24/2015] [Indexed: 01/05/2023] Open
Abstract
The levels of several hormones fluctuate according to the light and dark cycle and are also affected by sleep, feeding, and general behavior. The regulation and metabolism of several hormones are influenced by interactions between the effects of sleep and the intrinsic circadian system; growth hormone, melatonin, cortisol, leptin, and ghrelin levels are highly correlated with sleep and circadian rhythmicity. There are also endogenous circadian mechanisms that serve to regulate glucose metabolism and similar rhythms pertaining to lipid metabolism, regulated through the actions of various clock genes. Sleep disturbance, which negatively impacts hormonal rhythms and metabolism, is also associated with obesity, insulin insensitivity, diabetes, hormonal imbalance, and appetite dysregulation. Circadian disruption, typically induced by shift work, may negatively impact health due to impaired glucose and lipid homeostasis, reversed melatonin and cortisol rhythms, and loss of clock gene rhythmicity.
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Affiliation(s)
- Tae Won Kim
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Suwon, Seoul 442723, Republic of Korea
| | - Jong-Hyun Jeong
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Suwon, Seoul 442723, Republic of Korea
- *Jong-Hyun Jeong:
| | - Seung-Chul Hong
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Suwon, Seoul 442723, Republic of Korea
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Berndt C, Diekelmann S, Alexander N, Pustal A, Kirschbaum C. Sleep fragmentation and false memories during pregnancy and motherhood. Behav Brain Res 2014; 266:52-7. [PMID: 24589545 DOI: 10.1016/j.bbr.2014.02.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 02/17/2014] [Accepted: 02/19/2014] [Indexed: 12/13/2022]
Abstract
Pregnant women, both before and after childbirth, frequently experience memory deficits and disrupted sleep. In the present study we assessed the relationship between false memory generation and fragmented sleep during pregnancy and motherhood. We tested 178 pregnant women and 58 female non-pregnant childless controls, during pregnancy (15-35th week of gestation) and again after childbirth (8-13th month). False memories were defined as memories of gist words that were semantically related to studied word lists but were not presented during learning of these lists in the Deese-Roediger-McDermott (DRM) paradigm. Sleep was monitored by actigraphy in the home environment for seven consecutive nights. Compared to the controls, the group of pregnant women produced more false memories and displayed more fragmented sleep both during pregnancy and after childbirth. However, false memory generation was not correlated to measures of sleep fragmentation. These results show that pregnant women suffer from sleep fragmentation and a higher susceptibility to false memories, but leave open the question as to whether both phenomena are related.
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Affiliation(s)
- Christiane Berndt
- Department of Psychology, Technische Universität Dresden, D-01062 Dresden, Germany.
| | - Susanne Diekelmann
- Institute of Medical Psychology and Behavioral Neurobiology, Universität Tübingen, D-72074 Tübingen, Germany.
| | - Nina Alexander
- Department of Psychology, Technische Universität Dresden, D-01062 Dresden, Germany.
| | - Anne Pustal
- Department of Psychology, Technische Universität Dresden, D-01062 Dresden, Germany.
| | - Clemens Kirschbaum
- Department of Psychology, Technische Universität Dresden, D-01062 Dresden, Germany.
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Lipinska M, Timol R, Kaminer D, Thomas KGF. Disrupted rapid eye movement sleep predicts poor declarative memory performance in post-traumatic stress disorder. J Sleep Res 2014; 23:309-17. [PMID: 24467663 DOI: 10.1111/jsr.12122] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 11/20/2013] [Indexed: 02/06/2023]
Abstract
Successful memory consolidation during sleep depends on healthy slow-wave and rapid eye movement sleep, and on successful transition across sleep stages. In post-traumatic stress disorder, sleep is disrupted and memory is impaired, but relations between these two variables in the psychiatric condition remain unexplored. We examined whether disrupted sleep, and consequent disrupted memory consolidation, is a mechanism underlying declarative memory deficits in post-traumatic stress disorder. We recruited three matched groups of participants: post-traumatic stress disorder (n = 16); trauma-exposed non-post-traumatic stress disorder (n = 15); and healthy control (n = 14). They completed memory tasks before and after 8 h of sleep. We measured sleep variables using sleep-adapted electroencephalography. Post-traumatic stress disorder-diagnosed participants experienced significantly less sleep efficiency and rapid eye movement sleep percentage, and experienced more awakenings and wake percentage in the second half of the night than did participants in the other two groups. After sleep, post-traumatic stress disorder-diagnosed participants retained significantly less information on a declarative memory task than controls. Rapid eye movement percentage, wake percentage and sleep efficiency correlated with retention of information over the night. Furthermore, lower rapid eye movement percentage predicted poorer retention in post-traumatic stress disorder-diagnosed individuals. Our results suggest that declarative memory consolidation is disrupted during sleep in post-traumatic stress disorder. These data are consistent with theories suggesting that sleep benefits memory consolidation via predictable neurobiological mechanisms, and that rapid eye movement disruption is more than a symptom of post-traumatic stress disorder.
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Baxter D, Sharp DJ, Feeney C, Papadopoulou D, Ham TE, Jilka S, Hellyer PJ, Patel MC, Bennett AN, Mistlin A, McGilloway E, Midwinter M, Goldstone AP. Pituitary dysfunction after blast traumatic brain injury: The UK BIOSAP study. Ann Neurol 2013; 74:527-36. [PMID: 23794460 PMCID: PMC4223931 DOI: 10.1002/ana.23958] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 05/08/2013] [Accepted: 05/24/2013] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Pituitary dysfunction is a recognized consequence of traumatic brain injury (TBI) that causes cognitive, psychological, and metabolic impairment. Hormone replacement offers a therapeutic opportunity. Blast TBI (bTBI) from improvised explosive devices is commonly seen in soldiers returning from recent conflicts. We investigated: (1) the prevalence and consequences of pituitary dysfunction following moderate to severe bTBI and (2) whether it is associated with particular patterns of brain injury. METHODS Nineteen male soldiers with moderate to severe bTBI (median age = 28.3 years) and 39 male controls with moderate to severe nonblast TBI (nbTBI; median age = 32.3 years) underwent full dynamic endocrine assessment between 2 and 48 months after injury. In addition, soldiers had structural brain magnetic resonance imaging, including diffusion tensor imaging (DTI), and cognitive assessment. RESULTS Six of 19 (32.0%) soldiers with bTBI, but only 1 of 39 (2.6%) nbTBI controls, had anterior pituitary dysfunction (p = 0.004). Two soldiers had hyperprolactinemia, 2 had growth hormone (GH) deficiency, 1 had adrenocorticotropic hormone (ACTH) deficiency, and 1 had combined GH/ACTH/gonadotrophin deficiency. DTI measures of white matter structure showed greater traumatic axonal injury in the cerebellum and corpus callosum in those soldiers with pituitary dysfunction than in those without. Soldiers with pituitary dysfunction after bTBI also had a higher prevalence of skull/facial fractures and worse cognitive function. Four soldiers (21.1%) commenced hormone replacement(s) for hypopituitarism. INTERPRETATION We reveal a high prevalence of anterior pituitary dysfunction in soldiers suffering moderate to severe bTBI, which was more frequent than in a matched group of civilian moderate to severe nbTBI subjects. We recommend that all patients with moderate to severe bTBI should routinely have comprehensive assessment of endocrine function.
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Affiliation(s)
- David Baxter
- Computational Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences Imperial College London, Hammersmith Hospital, London; Royal Centre for Defence Medicine, Academic Department of Military Surgery and Trauma, Birmingham
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Goswami S, Rodríguez-Sierra O, Cascardi M, Paré D. Animal models of post-traumatic stress disorder: face validity. Front Neurosci 2013; 7:89. [PMID: 23754973 PMCID: PMC3668155 DOI: 10.3389/fnins.2013.00089] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 05/13/2013] [Indexed: 01/20/2023] Open
Abstract
Post-traumatic stress disorder (PTSD) is a debilitating condition that develops in a proportion of individuals following a traumatic event. Despite recent advances, ethical limitations associated with human research impede progress in understanding PTSD. Fortunately, much effort has focused on developing animal models to help study the pathophysiology of PTSD. Here, we provide an overview of animal PTSD models where a variety of stressors (physical, psychosocial, or psychogenic) are used to examine the long-term effects of severe trauma. We emphasize models involving predator threat because they reproduce human individual differences in susceptibility to, and in the long-term consequences of, psychological trauma.
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Affiliation(s)
- Sonal Goswami
- Center for Molecular and Behavioral Neuroscience, Rutgers State University Newark, NJ, USA
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Caveats on psychological models of sleep and memory: A compass in an overgrown scenario. Sleep Med Rev 2013; 17:105-21. [DOI: 10.1016/j.smrv.2012.04.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Revised: 04/02/2012] [Accepted: 04/02/2012] [Indexed: 12/20/2022]
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Sympathetic activity and hypothalamo-pituitary-adrenal axis activity during sleep in post-traumatic stress disorder: a study assessing polysomnography with simultaneous blood sampling. Psychoneuroendocrinology 2013; 38:155-65. [PMID: 22776420 DOI: 10.1016/j.psyneuen.2012.05.015] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Revised: 05/21/2012] [Accepted: 05/22/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND Nightmares and insomnia in PTSD are hallmark symptoms, yet poorly understood in comparison to the advances toward a biological framework for the disorder. According to polysomnography (PSG), only minor changes in sleep architecture were described. This warrants alternative methods for assessing sleep regulation in PTSD. METHODS After screening for obstructive sleep apnea and period limb movement disorder, veterans with PTSD (n=13), trauma controls (TCs, n=17) and healthy controls (HCs, n=15) slept in our sleep laboratory on two consecutive nights with an IV catheter out of which blood was sampled every 20min from 22:00h to 08:00h. Nocturnal levels of plasma adrenocorticotropic hormone (ACTH), cortisol, melatonin were assessed in conjunction with PSG registration, as well as subjective sleep parameters. RESULTS PTSD patients showed a significant increase in awakenings during sleep in comparison to both control groups. These awakenings were correlated with ACTH levels during the night, and with the subjective perception of sleep depth. Also, heart rate (HR) was significantly increased in PTSD patients as compared with both control groups. The diurnal regulation of ACTH, cortisol and melatonin appeared undisturbed. PTSD patients exhibited lower cortisol levels at borderline significance (p=0.056) during the first half of the night. ACTH levels and cortisol levels during the first half of the night were inversely related to slow wave sleep (SWS). CONCLUSION This study suggests that hypothalamo-pituitary-adrenal (HPA) axis activity is related to sleep fragmentation in PTSD. Also, activity of the sympathetic nervous system (SNS) is increased during sleep in PTSD. Further research is necessary to explore the potential causal relationship between sleep problems and the activity of the HPA-axis and SNS in PTSD.
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Conte F, Carobbi G, Errico BM, Ficca G. The effects of pre-sleep learning on sleep continuity, stability, and organization in elderly individuals. Front Neurol 2012; 3:109. [PMID: 22798956 PMCID: PMC3394199 DOI: 10.3389/fneur.2012.00109] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Accepted: 06/16/2012] [Indexed: 12/14/2022] Open
Abstract
Several studies have consistently shown that pre-sleep learning is associated to changes of sleep structure. Whereas previous research has mainly focused on sleep states, namely REM and NREM amount, very little attention has been paid to the hypothesis that pre-sleep learning might improve sleep continuity, stability, and cyclic organization, which are often impaired in aging. Thus, aim of this research was to assess, in a sample of 18 healthy elderly subjects, whether a memory task administered at bedtime would determine changes in any sleep parameter, with special regard to sleep continuity, stability, and organization. To this purpose, a baseline sleep (BL), i.e., a normal sleep with 9-h time in bed (TIB), was compared to a post-training sleep (TR), with the same TIB but preceded by an intensive training session. For the latter, a verbal declarative task was used, consisting in learning paired-word lists, rehearsed, and recalled for three times in a row. To control for individual learning abilities, subjects were administered several sets of lists with increasing difficulty, until they reached an error rate ≥20% at third recall. Relative to BL, TR shows a significant reduction in the frequency of brief awakenings, arousals, state transitions, "functional uncertainty" (FU) periods, and in the percentage of time in FU over total sleep time (TST). A significant increase in the number of complete cycles, total cycle time (TCT), and TCT/TST proportion was also found. All these changes are evenly distributed over the sleep episode. No sleep stage measure display significant changes, apart from a slight reduction in the percentage of Stage 1. Scores at retest are negatively correlated with both the frequency of arousals and of state transitions. Our data suggest that pre-sleep learning can yield a beneficial re-organizing effect on elderlies' sleep quality. The inverse correlation between recall scores and the measures of sleep continuity and stability provides further support to the role of these features in memory processes.
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Affiliation(s)
- F. Conte
- Department of Psychology, University of Naples IICaserta, Italy
| | - G. Carobbi
- Department of Psychology, University of Naples IICaserta, Italy
| | - B. M. Errico
- Department of Psychology, University of Naples IICaserta, Italy
| | - G. Ficca
- Department of Psychology, University of Naples IICaserta, Italy
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van Liempt S, Westenberg HG, Arends J, Vermetten E. Obstructive sleep apnea in combat-related posttraumatic stress disorder: a controlled polysomnography study. Eur J Psychotraumatol 2011; 2:EJPT-2-8451. [PMID: 22893807 PMCID: PMC3402109 DOI: 10.3402/ejpt.v2i0.8451] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2011] [Revised: 11/13/2011] [Accepted: 11/21/2011] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) may be highly prevalent in posttraumatic stress disorder (PTSD) and may exacerbate PTSD complaints. OBJECTIVE Our objective was to determine whether the prevalence of OSA was high in a sample of Dutch veterans with PTSD as compared to age- and trauma-matched controls, and whether OSA was associated with more severe PTSD complaints. METHODS We determined the apnea hypopnea indices (AHI) with polysomnographic registrations in 20 veterans with PTSD, 24 veterans without PTSD, and 17 healthy controls. PTSD severity and nightmare complaints were assessed with the Clinician-Administered PTSD Scale (CAPS). RESULTS The prevalence of an AHI>10 was 29% in PTSD, 21% in trauma controls, and 29% in healthy controls (χ(2)= 0.60, df=2, p=n.s.). The mean CAPS score in patients with OSA (n=6) was significantly higher than in patients without OSA (p<0.05), while nightmare severity was similar in PTSD patients with OSA as compared to PTSD patients without OSA (p=n.s.). Furthermore, there was a significant correlation between AHI and CAPS score in PTSD patients (r=0.46, p<0.05, df=14). CONCLUSIONS Our results indicate that PTSD is not necessarily associated with a higher prevalence of OSA. However, PTSD severity was related to OSA, which may possibly mean that comorbid OSA leads to an increase in PTSD complaints. However, future research should indicate whether OSA exerts a negative influence on PTSD, and treatment of OSA alleviates PTSD symptoms.
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Affiliation(s)
- Saskia van Liempt
- Research Centre—Military Mental Healthcare, Utrecht, the Netherlands
- Department of Psychiatry, Rudolf Magnus Institute of Neuroscience, Utrecht, the Netherlands
| | - Herman G.M. Westenberg
- Department of Psychiatry, Rudolf Magnus Institute of Neuroscience, Utrecht, the Netherlands
| | - Johan Arends
- Department of Clinical Neurophysiology, Kempenhaeghe, Heeze, the Netherlands
| | - Eric Vermetten
- Research Centre—Military Mental Healthcare, Utrecht, the Netherlands
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